Wheelchair Positioning

Positioning is a word used

by Seating
therapists
to
Optimal
Position
describe the posture or position of the body that
Pelvis
best enables an individual
to achieve every day
activities. Just imagine the number of positions
90-100
and postures you use in your daily life. Imagine if
Trunk
you had to do everything throughout your entire
day sitting in one position. We
all need
to change
Support
natural
curves
our position during the day, depending
on the
activity we are doing, and
ourExtremities
comfort.
Lower
Repositioning is to alternate pressure on joints
Knees 90-105
that bear weight, to adjust posture, and to
Ankles 90
promote comfort.
Upper Extremities

POSITIONING

Standard
Optimal
Seat height & leg
Proper fit will
Bottom of foot

Shoulder flex 30
Elbow flex 60

Head

Neutral

Wheelchair Measurements for

Wheelchair Positioning
length
allow 2-3 fingers under thigh from the front seat edge
rest must be at least 2 inches from the floor

Seat depth
3-4 inches
popliteal fold

between the front edge of the seat and the individuals

Seat width
Placement of
the armrest

hand between the greater trochanter, hip, or thigh and

panels with your hand positioned vertically to the seat

Back height
Able to place
and the floor of
Inferior angle
back

four fingers between the top of the back upholstery

the individuals axilla
of scapulae should be one finger length above the
upholstery

Research Findings

Armrest height
The user should be able to sit with the trunk erect and the shoulders level when
bearing wt. on the armrests

Bed Positioning
Supine Position
The head should be positioned in
line with the spine. Patients head
should be about 2 to 3 inches
from the head of the bed. A
pillow should be placed under the
patients head. It should be
extended about two inches below
the patients pillow while
maintaining the head in line with
the spine. Hip flexion should be
minimized by positioning the
trunk well. A rolled towel 12-14
inches long can be placed along
the greater trochanter of affected
hip or along both hips to prevent
external rotation if the patient has
little control over the legs. Flex
the arms of the patient at the
elbow and let the hands rest
against the lateral side of the
abdomen. Legs are extended with
a small and firm support under
the popliteal area. The toes
should be pointed straight up and
supported by a foot board. If foot
board is not available for use,
placing a folded pillow to
support the patients feet will
produce the same effect. The

ankles should be at 90 degree

angle.
Prone Position
Laterally turn the head to either
side. Keep in mind that the
head should be in alignment
with the rest of the body. The
spines should be straight and
the legs extended. To reduce
pressure against female breasts
a rolled towed can be placed
under the shoulder or a small
pillow can be placed under the
abdomen. This method also
relieves pressure on the back. A
small flat support is placed
under the pelvis. The length of
this support should extend from
the level of the umbilicus to the
upper third of the thigh. Lower
extremities should be
maintained at a neutral position.

The concept of 90-90-90 (hip,

knee, ankle angle) has been
suggested as the optimal position
for sitting based on alignment,
pressure distribution, and muscle
potential (Dudgeon & Dietz,
2002).
Functional alignment is based on
the clients physical abilities; is
desirable for improved balance
comfort and stability (ShumwayCook & Woollacott, 2001); and
supports improved functional
performance of ADLs, IADLs,
sleep and rest, functional mobility
tasks, leisure, and social
participation.
Common seating and positioning
triggers
Unable to engage in
ADLs/IADLs
Frequently falls or slides
out of chair
Consistently leans to one
side and is unable to right
self
Restlessness or agitation
while seated in
wheelchair
Presence of contractures
Inadequate trunk/pelvic
support
Pressure ulcers

References
Capasso, N., & Kloczko, E. (2012). 3 tiers for seating and positioning.
OT Practice, 17(20), 8-12. Retrieved from
http://search.proquest.com/docview/1181256852?
accountid=40780
Chew, Felicia,M.S., O.T.R./L. (2014). Seating and positioning for
productive aging. OT Practice, 19(3), CE1-CE7. Retrieved from
http://search.proquest.com/docview/1504643826?
accountid=40780

Side-Lying Position
The head should be positioned
in line with the spine. Support
the patients head with a pillow.
Make sure that body alignment
is correct and spines are

straight, and not twisted. Flex

the shoulders and the elbow and
support the upper arm with a
pillow. The left arm is slightly
flexed and supported with a
pillow.