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Wheelchair Seating Tipsheet

Our interactive guide features tips for PT professionals to ensure patient safety

This exclusive ADVANCE interactive guide offers physical therapy professionals information about different aspects of wheelchair seating to ensure patient safety, comfort and mobility.

Roll over each area "hot spot" to learn more!

Information for this interactive guide was provided by Lauren Rosen, PT, MPT, MSMS, ATP/SMS, program coordinator of the
Motion Analysis Center at St. Joseph's Children's Hospital in Tampa, Fla.

Download a printable version of this handout!


If you read the whole comment by Ms. Rosen, it states "as far forward as possible -without compromising stability-". Individuals have different COG; their level of comfort in their chair is different. "Newbies" often prefer greater stability, thus their rear wheels are usually positioned further back. After they are more comfortable in their w/c, moving the axle forward does increase their mobility and push efficiency putting less stress on their shoulders. It is up to the seating specialist to educate the pros and cons of axle position, it is up to the client to have the axle positioned where it is required for their wheelchair and their mobility needs.

April Bretz,  P.T.,  Touro Rehabilitation CenterNovember 22, 2013
New Orleans, LA

I work with the elderly population who tend toward excessive spinal flexion and sacral sliding in wheelchairs. This posture results in falls and pressure ulcers. I prefer dropping the seat down slightly in the front to promote spinal extension and decrease sacral sitting. A seat dropped slightly in the front with a contoured gel cushion and thigh strap (if they can unstrap themselves) has proven very effective to stop sacral sliding with the elderly. I have found tilting the seat down in the back promotes more spinal flexion for this population resulting in decreased room for lung expansion and digestion.

Jacqueline McCalister,  Physical TherapistNovember 22, 2013

While I agree that this is only a guide, and that the patient's posture is important, to say "as far forward as possible" is putting a risk for the patient to not have adequate pushing. I have been working with OT and PT's who are ATP for years and they have also been guest lectures here and never heard any of them state "as far forward as possible". Having also measured w/c myself for many years, this has never been a practice.
I will agree though that this is a GUIDE only and people should look at the whole person when fitting a w/c.

Jill  HeitzmanNovember 18, 2013

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