Lecture on Wheelchair Posture and Support

Introduction

• Importance of correct posture in a wheelchair
• Basic guidelines for sitting positions
• Ensuring support and pressure distribution

Sitting Position

• Person should sit as far back in the seat as possible
• Consider need for backrest
• Check pressure distribution (e.g., on buttocks and trunk)
• Aim for a 90-90-90 position (hips, knees, and ankles)

Cushioning

• Cushion mapping and stress distribution
• Even pressure distribution is ideal
• Uneven distribution can lead to pressure sores
• Importance of choosing the right cushion
• Types of cushions depending on patient needs and financial status

Pelvic Symmetry

• Key to wheelchair posture
• Check if pelvis is symmetrical using ASIS (Anterior Superior Iliac Spine)
• Effects of pelvic tilt:
  • Posterior tilt: affects swallowing, breathing, leads to kyphotic posture
  • Anterior tilt: muscle fatigue, bladder control issues
• Asymmetry can cause instability and limited range of motion

Foot Position

• Achieve a 90-90-90 position
• Allow maximum hamstring length; tight hamstrings lead to posterior pelvic tilt
• Adjust the height and depth of calf support

Thigh Position

• Thighs should be straight to avoid pressure on medial side of legs
• Asymmetric thigh position can lead to scoliosis tendency
• Use wedges for symmetry
• Check size of wheelchair and seat depth

Seat Angle and Cushion

• Ensure a large contact area between seat and backrest
• Cushion should support ischial tuberosities without side pressure
• Eyes and ears should be level (parallel to the floor)

Back Support

• Eyes and ears parallel to the floor
• Backrest should support the trunk/spine
• Typical height: 1-2 inches below scapula
• Sports wheelchairs may have lower back supports

Back Shape and Trunk Support

• Should be supported, add wedges if necessary
• Avoid using lateral/trunk supports unless needed (e.g., high thoracic spinal injury)

Armrest

• Height should allow relaxation of shoulders and elbows
• Should permit user to push themselves up for pressure relief

Head Support

• Needed if backrest angle > 105 degrees
• Supports head to avoid hyperextension
• Position based on use (transportation vs. normal use)