The Importance of Fit in a Manual Wheelchair

In a study done in 2004, 70 people with spinal cord injuries were surveyed, including some with tetraplegia and paraplegia, regarding the perception of their wheelchair, their impairment, their environment, and their ability to participate in activities and return to life. The wheelchair was reported as the most commonly limiting factor, followed by their physical impairment, and their actual environment. 
 
Let’s break down this particular study’s results: 

• The wheelchair is the most important mobility device used by the respondents 

• The wheelchair is what the survey participants associated most with barriers in their daily lives 

These participants identified their equipment as more limiting than their actual paralysis. They associated this inadequate technology as a factor preventing them from doing more. 

While there are currently no devices that can eliminate all  barriers for people using wheelchairs, there are key considerations to assess on the front end of the process to improve outcomes. 

A Common Problem 

Many manual wheelchair users have experienced receiving a new wheelchair that was not optimally configured for the user’s unique dimensions or needs. In these cases individuals are surviving but not necessarily thriving or living their best lives. They are compensating all the time for the ill-fitting wheelchair, which can lead to discomfort, poor function, pain, limited participation, and even injury. They might not realize they're at a disadvantage because it could be their first experience with wheeled mobility, and they have never had a really great fitting manual wheelchair. 

Key Concept: 

Wheelchair configuration, when adjusted and fit to each individual, will have the greatest impact on the maneuverability, propulsion efficiency, and function of ULWCs. (Worobey, et al. 2023)  

What is Considered Best Practice? 

Every manual wheelchair user deserves a chair that is tailored to their individual needs.   

A proper fit improves postural support, propulsion, function and participation, while mitigating pain, risk of repetitive stress injury and other negative consequences of a poor fitting chair.   

A CRT (complex rehab technology) manual wheelchair is best practice for every full-time manual wheelchair user. 

The 2023 RESNA Position Paper on the Application of Ultralight Manual Wheelchairs https://www.resna.org/Resources/Position-Papers-and-Service-Provision-Guidelines, together with an abundance of evidence on the need for upper extremity protection for wheelchair users, including the PVA Clinical Practice Guidelines on the Preservation of Upper Limb Function following Spinal Cord Injury https://pva.org/research-resources/publication/, can help guide us as we seek to ensure that every manual wheelchair gets the best possible fit. The new Permobil MWC Guide Manual Wheelchair Guide also offers some helpful tips for measuring and understanding wheelchair fit and function considerations for clients needing a new wheelchair. 
 
Each individual is unique and should be considered individually. When we think of a wheelchair as an orthotic or prosthetic, it helps to illustrate the concept that fit enhances function. Fit is critical to match the exact dimensions of the individual in order to provide necessary postural support and function.  

The many individual variables for CRT wheelchair fit include, but are not limited to:  

• seat width 

• seat depth 

• frame depth 

• front seat-to-floor height  

• seat slope (front seat to floor height minus rear seat to floor height) 

• leg rest and footplate support length and angle 

• back support height and angle  

• horizontal and vertical position of the rear wheel axle (center of gravity and rear seat-to-floor height) 

• camber 

• overall footprint of the chair  

The wheelchair specifications selected need to work well in conjunction with the characteristics of the wheelchair cushion and back support identified to meet the individual’s needs as well.  

Both the size and the design of each chair must fit the needs of the specific person who will be using it. Manual wheelchair users also have choices of different frame materials from titanium to aluminum to carbon fiber and even steel; individual needs guide these choices, as well as choices for components of the chair. All individual needs must be considered, which often means balancing the many choices, to reach a functional solution for the person’s lifestyle. Of all these variables, starting with the right fit is most important!  

Sources: 

1. Chaves, E. S., Boninger, M. L., Cooper, R. Fitgerald, S.G. Gray, D.B. Cooper, R. A. Assessing the influence of wheelchair technology on perception of participation in spinal cord injury Arch Phys Med Rehabil 2004; 85: 1854-1858 

1. Paralyzed Veterans of America Consortium for Spinal Cord Medicine. (2005). Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals. The journal of spinal cord medicine, 28(5), 434. 

1. Lynn A. Worobey, Jennith Bernstein, Joseph Ott, Theresa Berner, Jaqueline Black, Mary Cabarle, Tina Roesler, Sage Scarborough & Kendra Betz (2023): RESNA position on the application of ultralight manual wheelchairs, Assistive Technology, DOI: 10.1080/10400435.2023.2221148     
2. Consortium for Spinal Cord Medicine. (2005). Preservation of Upper Limb Function Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals. https://pva.org/wp-content/uploads/2021/09/cpg_upperlimb.pdf