Wheelchair Adjustments, Small Changes for Big Improvements Series: Part 4-Narrow Wheelchair Choice
Jason M., OT
Option 4: Narrow Wheelchair Choice
The fourth installment of this wheelchair adjustments series doesn’t require any real adjusting or altering. Instead, I want to encourage the consideration of a narrow wheelchair frame/seat to assist with positioning. When addressing postural positioning for a patient in a wheelchair, the issue that tends to cause the most trouble is leaning to the left or right of neutral center. Whatever the cause, whether trunk weakness, hemiplegic neurological deficits, or musculoskeletal changes/deformities, providing lateral support to the patient’s trunk is the main goal in fixing right/left leaning to encourage and achieve proper, upright postural positioning.
To aid you in providing this support there are many products currently in place in the market. A few examples to mention are lateral “wings” that affix to the wheelchair; positioning pillow, pads, and props of different forms and materials; and custom contoured backrest. I would like to note that I am not discouraging the use of these items. I have recommended, purchases, and trial several versions of these items in the past with positive results. In addition, I will also note that with the success there have been issues and concerns resulting from skin integrity and pressure risks, fitting and compatibility difficulties, and overall general effectiveness. So, I encourage you, before sending away for new equipment, to consider first the option of simply trialing a narrower wheelchair.
With positioned in a narrower wheelchair additional support is available at the hips and lower trunk. With the option of raised armrests or higher desk style armrests, this support can reach up to mid sternum. The narrower seating area also provides less room for the patient to shift their trunk or hips left or right, increasing the tilt of their trunk to the opposite side. Finally, no additional accessories or parts need applied or contested with, providing a less restrictive and complicated wheelchair setup. It is important, however, to consider the patient’s skin integrity with a narrower wheelchair. A patient can safely sit in a snug wheelchair, but if the frame is too narrow shearing and possibly pinching can occur at the sides of the hips. Also, when adjusting the armrests, consider additional padding needs to reduce pressure under the patient’s arms or sides of the ribs. As with all wheelchair positioning, adequate assessment and trials are necessary. If deemed appropriate, this easy change of wheelchairs can help in many of the following outcomes:
Pressure Reduction – Reducing lateral shifting and supporting upright, neutral positioning, with an adequate cushion, lateral hip pressure and general comfort can improve.
Restraint Reduction – Leaning left, right, or frequent repositioning of the hips can shift the patient‘s weight into unsafe situations and increase fall risk from a wheelchair. Establishing a narrow seat base will discourage repositioning and appropriate lateral support with elicit upright sitting.
Postural Support – As mentioned earlier, lateral hip and trunk support from a narrower wheelchair and armrests setup with provide a more bilateral, core based series of support to help the patient maintain a neutral, upright posture to increase performance with daily tasks from the wheelchair level.
I hope this adjustment technique helps you and a patient of yours. Look for my additional installments in this series for more options and tips.