They know I am going to say something. And, yes, I have been known to say something to complete strangers.
I see it all the time.
From photos on social media to the waiting room at the doctor’s office to grandma’s outing at the mall, I cringe every time I see it. Even my kids now recognize the look in my eye. They try to distract me but I can’t NOT see it. They know I am going to say something.
“Who fit that person for their wheelchair?”
These poor souls are leaning over the side, leaning forward, or look like they are going to slide right out of the seat at any moment. Don’t these people understand that sitting in a poorly sized wheelchair is bad for posture, causes back and leg pain, and can even lead to injuries?
Ok, rant over.
In the past, proper wheelchair fitting was not really a priority. The most important goal was just to get the person some level of mobility. It didn’t really matter how. Thank goodness, though, times have changed.
Properly sizing a wheelchair and positioning its rider properly are now an important part of the process. We now know that when a person is sitting up properly, they swallow easier, breathe better, and have less pain. There are also psychological and social benefits to being seated properly. Because the user is sitting straight, they are more comfortable and feel better about themselves.
The ideal sitting position for most people in a wheelchair is what we call 90-90-90. This refers to a 90 degree bend in the hips, a 90 degree bend in the knees, and a 90 degree bend in the ankle. Their bottom should be all the way back in the chair making contact with wheelchair back upholstery. The upper legs should be parallel to the ground – the knees should not be elevated or dip below the hips.
To make sure a wheelchair will fit, there are a few key measurements you should know before buying any wheelchair. These measurements are:
- Hip Width – this is the measurement from the edge of one hip to the edge of the other. This will determine the seat width of the wheelchair.
- Upper Leg Length – this is the measurement from the back of user’s bottom, along the upper leg, to the back of the knee. This will determine the seat depth of the wheelchair.
For accuracy, always take these measurements with the person sitting on a firm chair. If they are sunk into a nice soft recliner, the measurements will probably be wrong.
To determine the best seat width for the wheelchair, look at the hip width measurement from above. I recommend a seat width that is 1” – 2” more than the hip width measurement. The closer the seat width is to the actual hip width, the more support the user will have. In colder climates or if the person wears a lot of baggy clothes, 2” may be more appropriate.
I recommend a seat depth that is about 1” less than the upper leg measurement. Having a seat depth that is too short does not support the legs or pelvis adequately and can cause back pain. A seat depth that is too long causes a person to slide out of the chair because they are unable to get themselves back in the chair all the way.
To improve positioning of a user in a wheelchair, there are a few other features that I recommend. Having these options on the new wheelchair will allow a more custom type of fit.
- Adjustable height arms are an absolutely mandatory feature. This style of wheelchair arms has a button or lever that allows the arms to be raised or lowered. When a wheelchair user has to lean over to make contact with the arm rests, this leads to a “hunched over” position which causes back pain. Best practice is raising the arm rests up to meet the user’s arms. This supports a more upright posture. An added benefit is that the arms lower when it’s necessary to get under a dining table or desk.
- Swing away leg rests can help prevent injuries and reduce chances of falling while getting in and out of a wheelchair. This style of leg rest swings away to the side of the wheelchair and even removes completely from the wheelchair frame. This keeps the leg rests from getting tangled with the feet and legs while the user is getting in and out of the wheelchair.
- Leg rests that are adjustable in length help with proper wheelchair positioning too. Having the upper legs parallel to the ground often relieves back pain and discomfort. Raising or lowering the footrest based on the length of the patient’s lower leg length is the only way to achieve this optimal position.
- Wheelchair cushions help improve the comfort of any wheelchair. Wheelchair seat upholstery is stretched tight which makes it pretty firm. Adding a cushion will soften this up a bit. If the user has a history of pressure sores though, consult a professional about the best cushion for their needs.
All of these options are available on standard manual wheelchairs if you know to look for them. My advice is to ask your medical professional, do your research before buying a wheelchair, then decide which wheelchair features you need the most. If you really want to geek out about getting the perfect wheelchair, check out my wheelchair buying guide. Then call the folks at AvaCare Medical or shop their website for the best fitting wheelchair.
OH! And, please, don’t let me catch you or your loved leaning over in a poorly sized wheelchair. My neck muscles are tense enough. And my kids can’t take it anymore!
Scott Grant, ATP, CRTS® is a self-admitted wheelchair geek and writer of GrayingWithGrace.com a blog dedicated to helping elderly and seniors choose the right products to maintain their independence. He also works as an Assistive Technology Professional for Active Medical, LLC in West Virginia where he provides custom manual and power wheelchairs for people with severe disabilities. He is the father of four daughters and the grandfather of three.