Master Wheelchair Fitting with Picmonic for Occupational Therapy

Seat width is the measurement across the widest point of the hips and thighs of the client. Adding half an inch to one inch on each side ensures that the client has enough space to sit comfortably in the wheelchair.

When measuring for wheelchair seating, it is important to keep a 2-inch gap between the front edge of the seat and the popliteal space to prevent pressure. To measure, begin at the user's posterior buttock and follow the lateral thigh to the popliteal fold, while keeping your hand horizontal to the seat. It is recommended that there should be enough space for three to four fingers between the front edge of the seat and the back of the user's knee.

Determine based on the user’s height and if the wheelchair is self-propelled. For those who use their feet to propel, the seat height should allow them to reach the floor with their heel. Those using footrests have higher seat heights. Measure from the user’s heel to the popliteal fold, with the bottom of the footrest 2 inches from the floor.

Measure the distance between the seat of the chair and the olecranon and add one inch to allow users to sit erect, with level shoulders when bearing weight on the forearms as they rest on the armrest.

To ensure an erect posture while seated, the inferior angles of the scapula should be approximately 1 finger-breadth above the back. This distance is determined by measuring the distance between the seat of the chair and the patient's axilla and subtracting four inches. The height of the backrest should be determined based on the user's needs. Those who self-propel their chair require a backrest that allows their shoulders to move freely. Users who struggle with sitting upright may need a higher backrest that provides greater spinal support.

This measurement impacts the support provided to both the feet and thighs as well as the distance between the footplates and the ground. To ensure proper ground clearance, the footplate should be elevated approximately 1 to 2 inches above the ground.

16” x 18” x 20” (DxWxH) is considered the standard adult wheelchair size. The 16-inch width is measured from the inside of one side of the wheelchair frame to the inside of the other side at the widest point of the seat. The 18-inch depth is measured from the back of the seat to the front, where the legs will rest on the footrests. The 20-inch height is the height of the chair's backrest from the seat to the top. This size is considered the standard because it fits the majority of adult users and allows for easy maneuverability in tight spaces. However, it is important to note that not all individuals will fit into this standard size, and wheelchair measurements should always be taken on an individual basis to ensure proper fit and comfort.

A recline wheelchair is a type of wheelchair that allows the user to tilt the seat backrest to a reclined position, usually ranging from 90 to 180 degrees. This feature can provide pressure relief, increased comfort, and improved positioning for individuals who spend long periods of time in a wheelchair. The degree of recline can be adjusted to meet the specific needs of the user, such as reducing pressure on certain areas of the body or facilitating activities such as feeding and communication. Recline wheelchairs are often prescribed for individuals with spinal cord injuries, cerebral palsy, multiple sclerosis, or other conditions that affect mobility and positioning.

A tilt-in-space wheelchair is a type of wheelchair that allows the user to maintain the same seated position while the entire seat frame tilts backward. A tilt-in-space feature rotates the seat around a fixed axis, does not change the client’s position, and provides pressure relief for the buttocks. The tilt angle can be adjusted to meet the user's needs, which can include improved posture, pressure relief, or better access to daily activities. This type of wheelchair is often used for individuals who require extended periods of sitting or who have difficulty with repositioning themselves. Tilt-in-space wheelchairs are commonly prescribed by occupational therapists and physical therapists as part of a comprehensive seating and mobility evaluation.

ADA Wheelchair Regulations are a set of guidelines that provide specifications and requirements for wheelchair design and use, including considerations for accessibility and safety. These regulations are important in the context of wheelchair fitting, as they help ensure that the wheelchair is appropriately designed and adjusted to meet the individual needs of the user. OT and PT programs teach students about ADA regulations related to wheelchair fitting to help them understand the importance of proper fitting and to provide them with the knowledge and skills necessary to conduct thorough assessments and make appropriate recommendations for wheelchair use.

Skin integrity protection in relation to wheelchair fitting refers to the measures taken to prevent pressure sores, skin breakdown, and other skin injuries in wheelchair users. Proper fitting of the wheelchair, including seat width, depth, and height, as well as appropriate cushioning and support, can help distribute pressure and reduce the risk of skin damage. In addition, regular repositioning and movement, proper hygiene and skin care, and adequate nutrition and hydration are important factors in protecting skin integrity for individuals who use wheelchairs. Proper skin integrity protection is crucial for the overall health and well-being of wheelchair users and is an important consideration in the process of wheelchair fitting.

Contracture prevention refers to the strategies and interventions implemented to prevent or reduce the development of joint contractures in individuals who use wheelchairs. Joint contractures occur when muscles and connective tissues surrounding a joint become stiff and inflexible, limiting the range of motion and causing pain. Contracture prevention strategies during wheelchair fitting may include selecting a chair with appropriate seating and positioning options, providing regular range of motion exercises, and ensuring that the user is repositioned frequently to prevent prolonged periods of pressure on any one area of the body. By preventing contractures, individuals who use wheelchairs can maintain their mobility, reduce pain and discomfort, and improve overall quality of life.

Proper posture refers to the correct alignment of the body in the wheelchair to prevent musculoskeletal complications and improve functional abilities. The proper alignment includes maintaining a neutral spine, level pelvis, and proper positioning of the extremities. Maintaining proper posture can improve breathing, digestion, circulation, and overall comfort of the individual. Inadequate or incorrect posture can lead to various complications, including contractures, pressure injuries, and respiratory or digestive problems. Proper posture is essential to achieve the maximum potential of the individual's functional abilities and overall quality of life.

Functional tasks, mobility, and transitions refer to the ability of a person to perform everyday activities and move around in their environment using a wheelchair. Proper wheelchair fitting can greatly improve a person's ability to perform these tasks by ensuring that the wheelchair provides adequate support and stability, allows for proper posture, and is tailored to the individual's specific needs and abilities. Additionally, the wheelchair must be able to safely and comfortably transition between different surfaces and environments, such as going from indoors to outdoors or from flat surfaces to uneven terrain. A well-fitted wheelchair can greatly enhance a person's independence and quality of life by enabling them to perform functional tasks and participate in their community.