Wheelchair Skills Training - Pressure Relief

Original Editor - Lee Kirby as part of the Wheelchair Service Provision Content Development Project

Top Contributors - Naomi O'Reilly and Amrita Patro  

Relieves Weight from Buttocks

Description and Rationale

The learner relieves weight from both buttocks, although not necessarily at the same time. Weightrelief is important for comfort and the prevention of pressure sores. 

General Training Tips

  • Partial unloading (30-90%) of each buttock for 15 seconds every 25 minutes and complete off-loading (90% or more) of both buttocks for at least 15 second every 2 hours is recommended. 
  • Trainers should recognize that susceptibility to pressure ulceration varies among wheelchair users (e.g. due to such factors as variations in co-morbidities, sensation, local anatomy, blood supply, nutrition, moisture, nature of clothing worn), many of which are not affected by skills training. However, if the trainer notices any such correctable factors, these should be pointed out to the learner and/or an appropriate health-care provider.
  • If using any of the leaning methods (practiced earlier for the “picks objects from ground” skill) to relieve weight from the buttocks, the extent of weight relief is proportional to the extent of the lean.
  • With the forward leaning method, the elbows can be rested on the thighsor a table. Further unloading can be achieved by resting the trunk on the thighs, grabbing the footrests and pulling on them. It may be socially inconvenient to use the full forward-leaning technique in some circumstances. A more moderate forward lean may be adequate. Getting back upright from the forward-bent position can be a challenge for some wheelchair users. The hands can be walked up the thighs until an armrest or the backrest can be reached to allow the person to pull him/herself the rest of the way.
  • Side leaning or shifting the weight onto one buttock can also be effective, for those who cannot lean forward and recover, or in situations when the wheelchair user might find it inconvenient to lean forward. The armrests or rear wheels can be used to push or pull on. As was the case for leaning forward, the wheelchair user can lean sideways on a table.
  • The leaning techniques can cause tips in the direction toward which the wheelchair user is leaning. 
  • If leaning forward fully, the casters should be in the forward-trailing position to increase forward stability.

Variations:

  • Bridging (lifting the weight off the buttocks by pushing down firmly on the feet) is effective but difficult to maintain for prolonged periods.
  • Tilt and recline are alternative methods that may be adequate for some wheelchair users. If tilt or recline are used, the greater the extent of tilt or recline the better, preferably at least 45°.
  • Reclining a wheelchair can cause shear forces between the backrest and trunk that can be compensated for by lifting the trunk away from the backrest after the reclining has taken place. Some wheelchairs provide built-in compensation for such shear forces, but the extent of such compensation may not exactly match the amount needed.
  • Standing up is effective, but if it is done using a stand-up wheelchair feature, there may be new pressure areas to consider related to how the wheelchair user is supported in the upright position. Standing on the footrests is generally not recommended, although it can be safe if the footrests are not too far forward and/or the casters are oriented in the forward-trailing position.After a weight-relief maneuver, the wheelchair user’s buttocks should be gently repositioned on the seat rather than dropped back into place.
  • Transferring out of the wheelchair (e.g. onto a bed), where the wheelchair user can lie on his/her side or front is also effective.
  • Push-ups are not recommended because of the high loads on the upper limbs (that may contribute to overuse symptoms) and because they cannot be sustained for long.
  • The tilt-rest position (with the wheel locks applied [or hands holding the hand-rims] and the wheelchair or wheelchair user leaning against a wall or curb) may permit sufficient rear tilt that can be sustained for many minutes. This position can be achieved in a variety of ways, for instance:
  • Pull-back technique: The wheelchair user positions the wheelchair close to the object (e.g. a sofa or wall) that he/she intends to lean against. Some trial and error may be needed to select the correct distance from the object; it is better to start too close to the object than too far from it. The wheel locks are applied and are checked to ensure that they are functioning. The wheelchair user then reaches back and pulls on the external object to tilt the wheelchair back just beyond the balance position, so that the wheelchair or wheelchair user rests against the object.
  • Push-back technique: As for the pull-back technique except that the wheelchair user pushes against an external object to create the tilt. This can include using the foot to push on the ground.
  • See wheelie variation later.
  • When returning from the tilt-rest to the upright position, the wheelchair user should leave the wheel locks on and tilt forward by leaning or by pushing against the object being leaned against.
  • Resting on the rear anti-tip devices may permit sufficient rear tilt but can result in a rear tip. With a spotter in place behind the wheelchair resting on the rear anti-tip devices, the wheelchair user can lean and rock backward to see if the wheelchair tips over; if so, this technique should not be used. 

References