Know How a Wheelchair Should Fit Your Body

Know How a Wheelchair Should Fit Your Body

Posted by AskNurseLinda on Apr 13, 2015 3:40 pm

Alternative forms of mobility are often used by individuals with paralysis, most often a wheelchair.  Knowing how a wheelchair should fit your body is helpful. As a consumer, it is good to have an idea about what is needed to be specific for your body.  It has been estimated that 80-90% of individuals are not properly fitted in their current wheelchair as their bodies and needs change over time. Adjustments of your current wheelchair can improve function. Improperly fitting wheelchairs can lead to medical problems such as skin breakdown from pressure and rubbing, blood clots from poorly fitting seats and posture issues from misalignments.

Most people think of a wheelchair as a device for getting around. This is true. But it is also the chair that is used to perform all of your daily activities and things you like to do. You want it to work well for all of your needs.

When sitting, the pelvic area will bear the load of your body. Making sure that the pelvis is in good alignment is the place to start. Therefore, correct positioning using the seat and back of the chair is necessary. You don't want to slide out of the chair or be off center. Hips and spine need to be in alignment, even with adaptations for your individual needs. Too much pressure on the coccyx or ischial bones can lead to pressure ulcers on the buttocks. The same is true for sitting with too much weight on one side of the buttock over the other. To reduce pressure, it has to be dispersed. Pressure dispersion cushions aid greatly but starting with even pressure across the bottom and back is the first step. Even with balancing pressure, releases will still have to be performed periodically.

You want to be able to see where you are going. Reclining is great for resting and pressure release but you don't want to be positioned so you are constantly looking at the ceiling. You want to be able to look at others and engage with them. A head rest may be necessary to assist you with looking outward. Reclining all of the time leaves you out interactions with others. You also don't want to strain your neck just to look around.

Wheelchair fitting focuses on six measurements.
 
  1. The seat width should be wide enough so there is not pressure on the hips but not so wide that you have to stretch to reach the wheels if self-propelling. You should not be constricted by the sides of the wheelchair against your hips to avoid pressure ulcers at that location.
  2. The seat depth and seat cushion should be two inches from the back of the knee to avoid blood vessel constriction in the legs. The bulk of the back of the thigh should rest on the seat cushion.
  3. Seat height is determined by the height of the individual and if they will be propelling the wheelchair with assistance from their feet or with one foot or if they will be using foot rests. Those using foot rests will have a higher seat height to clear the floor and any small inclines.
  4. The same is true for foot rest length. Natural fitting to the body is necessary as too lengthy foot rests will cause the leg to dangle, too short will push up the thighs which leads to too much tilt of the pelvis. Calf supports should be included if a person is going to recline. Legs will not stay on foot rests in recline without calf supports.
  5. Arm rest height is determined by the needs of the user. Many people who perform their own transfer will prefer no arm rest. Those that use arm rests can relax their forearms on them. Positioning devices can help support the arms if needed. You don't want tension in the shoulders but enough support so your arms are not drooping. Arm rests are also used to perform pressure releases. Most arm rest users will prefer quick releases for removal when transferring. Arm rests come in full length, equal to the seat depth or desk style which make it easier to pull up to a table or desk.
  6. The height of the back of the chair should also be considered according to need. Individuals will lower injury may prefer a lower back while those with higher injury require a full length back rest with head rest.
To assess yourself in your wheelchair, take a look in a full length mirror. Look to make sure your body is even, that you don't lean to one side or forward or backward. Make sure your legs, feet, and arms are in alignment or even on both sides. Your shoulders should not be pulled or scrunched. You can tell a lot about your wheelchair positioning by giving yourself a good review. Checking yourself can allow you to alert your healthcare professional that you might need a review of your seating system.

Wheelchair parts can be replaced as needed. Often times, wheels or tires will need replacement just because they wear out. Breaks often require adjusting because they are used so often. The upholstery can get stretched out of shape. Most adjustments to wheelchairs can be made by the therapist as a person's body changes. Sometimes people think they need an entirely new chair when only part needs to be replaced, thereby extending the life of the wheelchair.

Most payors will only issue a new wheelchair every ten years. Therefore, taking care of your wheelchair is important. The wheelchair should fit your needs as your body changes over time. Subtle changes can affect your skin and your health so you want to have the wheelchair periodically adjusted by a trained professional.

I'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

Leave a comment any time by clicking the reply button. Let's get the discussion going!

Nurse Linda

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Re: Know How a Wheelchair Should Fit Your Body

Posted by Mi on Apr 27, 2015 1:53 am

Dear Nurse Linda,
       How are you doing? I absolutely loved your wheelchair article. I am in that 80 to 90% category of wrongful fit. I been in an 8 year old stripped & unsafe broken manual folding chair. A few years back I was fitted for Tlite folding chair. It took a very long time between 45 minute sessions to pick out & try a few chairs , backs , cushions etc... The whole process lasted months into years. Because I had to keep scheduling appointments to return. Wheeling in a demo chair down a hallway each time switching from chair to mat & numerous cushions & backs take more then the time slot they give in these rehabliitation seating clinic appointments.  Finally I get that Tlite I mentioned earlier. Completely had to be returned. The cushion was heavy, the back was a puzzle piece ( falling out of my car to fit it in exactly) foot plate was so small when I turned my feet fell off. I was falling in between the wheels & my car transfers. Then I get put down as if it was my fault. ( "Telling me we tried every chair & I need togo elsewhere") No longer can they help me. 

       So here I go again going back to the company that made the 8 year old chair that was made wrong. Which I thought for years I was fine in, until my SCI Dr. pointed it out. The reason I went back with the company is I was recommended by the new rehab chair clinic that this particular person is the best of the best & will measure you right. So I took a chance . It's a very long story as you can see  , same situation with clinic. This time I was set to go for nonfolding rigid taper frame. Get rid of my car/chair topper & do what's best for my health. I was told to get light weight it will make pushing a lot easier. Strain off my shoulders and back. Again not enough time to try numerous chairs. So the rep offered to come to my home with demos of all. Now back when I was at the other place I fell in love with a chair. Took pictures although I  could not get it, cause I was not ready to give up my car. When she came to my house months later with the demos I was not thrilled. Two chairs??? I waited months. And only tried one at new clinic. However when I showed her the picture ... amazingly it was one of the two. She pointed out the name on the bottom. So we moved on with cushions, backs, colors , the whole 9 yards. Took forever over a year. I get the chair it's short tapered / rigid. Everything else I thought was comfortable. But I really , really liked the long look. I begged when the chair was being delivered to me to have that person who made it be the one to hand it over. Company wouldn't send her out. So the guy had no idea what I was talking about, even though I was showing him pictures of the frame from what she assured me I was recieving & the one in my house. So he called his boss and all they wanted to know is am I accepting this chair or not. All I wanted was to see why short verses long? Had nothing to do with my height. He took the chair back. I did not deny the chair. Just wanted my concern to be address to my liking. I waited another 4 weeks until the wheelchair clinic, the rep & her boss to meet me at the rehab. Again my fault because aluminum does not come in long frame only titanium. How was I supposed to know that? She told me I was getting the same exact chair as the picture I was ecstatic . She did some magic & lowered foot plate . Made it look a touch longer. Now I'm wheeling around my new chair & with just pushing around the rehab for a few minutes no
ramps just floor take a stroll. I'm flipping back & feel I'm leaning to one side. They we're ignorant & fed up. Making rude comments that maybe I need to learn how to wheel a chair. I been in a chair 17 years!!! The rep pushed a touched on my shoulders & I slightly fell to the left a bit . She said "' You been in that chair for 8 years! The reason you feel uneven is because it's new. I feel that it was a poor excuse. Especially after reading your article . The funny thing is... they said the same thing "if I don't accept the chair I will need to start all over again. Not with that company. We can't help you. I accept the chair because there was no way in the universe I can wait any longer for another process.  

  Take the chair home , winter time very, very bad winter this year in Pa. Can't go out unless someone took me out with that chair, because I am not capable of taking apart & it's not folding for my topper. Finally was taken out 4 times along with wheeling around the neighborhood. Curb cuts, threshold , ramps tipping back all over the place. Your article came out around the 12th or 13th of April. I already had a call in to company for them to come out to see if my wheels , tipsters could be moved in some way so I feel safe & move on to get a van. I was scheduled for the 20th . Called after Easter. Guess what? The tech came & did all he can do. Wheels, anti tipsters & so on. He feels it's unsafe. Took it back to the company his pictures & findings. I gave 4 days for somekind of response. Left messages & still no call back. 

  My level is C5, C6, C7. I was told by a friend who is a rep for wheelchairs in another state. Who I did totally forget about through this process ( more like an Aquitaine ) he is in a chair also similar to my level. That he would never sell or order a chair for anyone unless they try it out for a week? Meaning let's say I like this quickie chair at the clinic . The next step is the rep would call
quickie headquarters & say do you have either these measurements or close to these measurements in a demo chair? So this client can try out in the real world & make sure for a week or few days that this is the chair she/he will be 100% satisfied with before signing on dotted line & ordering? Now this person told me he does that with his customers. I asked that question all the time in the past. I used to beg please can I bring this chair home in the meantime? Or do you have a folding chair I can use till I get my new one. Since it's unsafe. So much pain. Getting worst off with medical issues from chair. Answer is always No. I never heard of Demos being lend out to try ? Has anyone else? Or did this friend just tell me what I wanted to hear? Because when I mentioned it to the tech on Monday. He never heard of it either. Please get back. I'm desperately in need for help. Seriously at my breaking point.

             Sincerely,
                Mi111

Re: Know How a Wheelchair Should Fit Your Body

Posted by AskNurseLinda on Apr 27, 2015 10:17 am

Dear Mi111, Finding the right chair is a challenge as you have pointed out how difficult this can be. A wheelchair is an extension of your being since it is the way people get around but also, you live in your chair so a great match to your needs is the minimum that should be acceptable to you. I don't think a lot of people realize the importance of wheelchair fit until they are using one.

Buying a chair is a huge task. Finding what is right as well as sorting through the options is laborious. It is no different than trying on a pair of shoes at the store, which feel great, until you get them home an wear them for an hour only to discover they are not quite right. When purchasing a chair, the vendor is critical as when you buy a car, if you go to a Ford dealer, you are going have only the options of Ford, if you go to a Chevrolet dealer, you will have only the options of a Chevrolet. Fortunately, most wheelchair vendors sell several brand but the best parts of each are not interchangeable.  Many vendors have extensive experience in fitting chairs and many are physical therapists but having your own physical therapist help you to cull through all of the options is a huge benefit.  I think that would be a good place to start. If you have a therapist who is not vested in which chair your purchase, they can help you cut through all of the options and focus on which will be the best for you. They can also help you with ongoing adjustments that you will need as you get used to the new chair. It does take time to get fully comfortable in your new ride. By time, I mean months, not an hour as you know.

So you are exactly right. You are not asking for too much when you need time to adjust to your chair as well as to adjust your chair to you. Needs for chairs change over time.Sometimes, we have to move into something more substantial. The ripple effect is astounding as you are experiencing. Changing a chair can change the way the chair is carried in the car, seating, footing, the list is extensive. Equipment is improving over time so options you have had years ago will not be available now.

Some physical therapists have vendors  who will loan equipment. This is typically based on the relationship between the physical therapist and the vendor. Vendors can loan chairs while repairs are being done so individuals have a means of mobility. They have several models that they carry but within the same brand. It is a huge purchase so you want to 'test drive' the chair to be sure it is right for you.

Your story is very sad and frustrating. I am glad to see that you are an individual that is not giving up. As the purchaser, you should be satisfied with what you choose. I hope you talk with a physical therapist. Most payors will allow a few visits for 'mobility training' which can be used to help you find a new chair. Hopefully, an expert intermediary will be able to help you sift through this maze to get mobility that will work in your favor. You are not alone in this process. Nurse Linda

Re: Know How a Wheelchair Should Fit Your Body

Posted by Mi on Apr 28, 2015 4:16 pm

Dear Nurse Linda, 
   I want to thank you from the bottom of my heart for your response. I'm not familiar with this site since I barely used in the past . I kept looking at my email for response. Had to pull up this article to see if you or the community left messages. Finally somewhat figured it out. (LoL) The new chair I have now in my home is the 2nd one that is made incorrectly. I went to SCI rehab with vendor & their wheelchair clinic therapist. That is when the vendor said " give me a few weeks I will get like 5 or 6 different kinds of chairs. Will make lunch out of it. Because I explained what happened years before with the other chair I had to return. Also I believe the vendor saw the attitude in the therapist that day. So months went   she came to my house. With only the  "2" chairs. That's where I explained to you nurse Linda , the whole picture deal in first message to you. Finally order the chair, the winter, the rigid taper long/ short , going back there with this recent new chair ,therapist & vendor, vendor's boss.! Moving Around in chair & find out I'm falling , tipping all over the place. Call company tech comes out does all he can possibly do for chair. He said it was unsafe . No more adjustments can be done. I now get a call today to go back to rehab with the therapist &
Vendor will meet me there to see what we can do? That was the message I get after a week? These two
people along with company are the ones that told me maybe I need to learn how to push a chair. Pushed me slightly  when saying I felt uneven. Blaming my 8 year old chair which I thought In your article you talked about alignment. If I wheeled around trial & error & it's absolutely clear this chair is a No, no!!! Why go through meeting with the same people ? Plus I call ? Make the appointment 
with the clinc therapist & then I call them back to see if that vendor can meet? All going throgh the vendors coordinator. I really need to talk to you by phone. Nurse Linda. I need help? My family is saying call insurance & return chair? It's confirmed unsafe. They are just stringing me along. And I can't take much more of that!!! I had it the past 2 years with a secondary injury. Pleae can you contact me by phone ? Please

Sincerely, 
Mi111

Re: Know How a Wheelchair Should Fit Your Body

Posted by AskNurseLinda on Apr 28, 2015 4:30 pm

Mi111, your family is right. If your insurance is paying for the chair, they will not pay for an unsafe piece of equipment. Do you have a nursing case manager assigned to you through your insurance company? If you don't know, call the number on the back of your card and request one. There appears to be some miscommunication with the vendors so a nursing case manager can intervene on your behalf. You really need someone acting in your favor. Taking this huge process on by yourself is not necessary when you have individuals who are trained in these processes at your disposal. This would be out of the scope for me but a nursing case manager would be just the right person. Nurse Linda

Re: Know How a Wheelchair Should Fit Your Body

Posted by Mi on Apr 28, 2015 7:17 pm

Thank you again. I'm just so stressed out , heartbroken , in so much pain. You have no idea on top of all this I had an secondary injury over 2 years ago. That caused so many complications & changed me completely. Injured in the hands of someone else. I had 4 ruptured ligaments in ankle . Gastrocnemius solous partial tear in calf. ATFL & CfL is still torn. Can't be fixed. I went to more Dr.s & hospitals, MRI , therapies then I did all 17 years in 2 years & more. I can't catch a break.  I'm in a Mafo the rest of my life.' & my last three toes curled from the injury within the first few weeks . So looks like I got foot drop. One step forward ten back. I DON'T think I can wait another 2 years for new wheelchair. My Back... So sad. It's going to take forever. 
  Thank you, 
   Mi111

Re: Know How a Wheelchair Should Fit Your Body

Posted by Mi on Apr 28, 2015 7:30 pm

Am I the only one that touched based on your article ? I missed your video chat on the wheelchair fittings? I been looking for it & the only recent is your skin issue one. 
 

Re: Know How a Wheelchair Should Fit Your Body

Posted by Mi on Apr 28, 2015 8:04 pm

I'm sure I have the nurse care on my insurance. You seem extremely knowledgable from the article. Even though they told me numerous times - No such thing as a loaner chair..I will need one. But this company won't deal with me anymore if I return chair. So who do I turn too? Do not have a physical therapist in wheelchair clinic that I'm close to , that will go the distance to get what I need. Just that vendor I told you about in first message. He is in different state . But I will be contacting him next. Thank you for your help Nurse Linda. Insurance is next also & expo.
Mi

do not have a wheelchair clinic therapist that I am close too. So reaching out for demo loaner chair

Re: Know How a Wheelchair Should Fit Your Body

Posted by AskNurseLinda on Apr 29, 2015 12:50 pm

Mi, yes, these issues do take a long time but not forever as it seems when you are living it. A case manager would definitely help you. The interaction of providers, vendors and insurance is a complicated situation at best. It is far better to have a trained case manager to negotiate the process on your behalf as they know the process and how to present issues to the vendors so they will understand. Taking this on by yourself is just too much for anyone.
Another resource is peer support through the Christopher & Dana Reeve Foundation. This is a person in your area who has been through similar issues in your area. They can help you connect with a therapist that will be able to assist you because they know the people in your community. 

Nurse Linda

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