Wheelchair Fitting

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Introduction

Wheelchair fitting is the sixth step in the key steps to wheelchair service delivery.  Fitting entails trial of the wheelchair by the user and final adjustments to ensure the wheelchair is correctly assembled and set up. During the fitting, the wheelchair user and personnel together check that:

• the wheelchair is the correct size and all the necessary modifications and adjustments have been made to ensure an optimum fit;
• the wheelchair and cushion support the wheelchair user in sitting upright;
• if a pressure relief cushion has been prescribed, the cushion really relieves pressure.

A properly fitted wheelchair provides comfortable seating and good back support, improving posture and ultimately optimizing function. 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. A wheelchair that does not fit properly may lead to pressure ulcers, poor posture, reduced balance, difficulty propelling the wheelchair, and difficulty with transfers. The ideal sitting position for most people in a wheelchair follows the 90-90-90 rule;

• 90° bend in the hips
• 90° bend in the knees
• 90° bend in the ankle

Wherever possible, the same person who carried out the assessment should carry out the fitting. A wheelchair fitting for a wheelchair user who needs additional postural support takes longer because additional fittings may be needed. Always check the fit with the wheelchair stationary, and then while the wheelchair user self-propels or is pushed.

Process

Wheelchair fitting should always be carried out in the following order: check size and adjustments, check posture, check pressure, check fit while the wheelchair user is moving.

Check Size and Adjustments

• Seat Width; A correct fit should fit closely. Run your fingers between the outside of the user’s thighs and the sides of the wheelchair. Your fingers should fit comfortably without being pinched
• Seat Depth; A correct fit should have a two-finger gap (30 mm) between the back of the knee and the cushion. It gives the thigh good support which will reduce pressure under the seat bones and helps to stop pressure sores. Check that the wheelchair user is sitting upright and then slide hand between the cushion and the back of the knee, there should be a gap large enough to admit two fingers. There may be a bigger gap for wheelchair users with long legs, up to 60 mm is acceptable. Always check both sides.
• Footrest Height; For a correct fit, the thighs are fully supported on the cushion with no gaps and the feet are fully supported on the footrests with no gaps. Check by sliding hand between the thigh and the cushion. There should be even pressure along the thigh and no gaps. Look at each foot on the footrest. The foot should be supported at the front and the back with no gaps. If there are gaps under the thigh, the footrest may be too high. If there are gaps under the foot, the footrest may be too low.
• Backrest Height; The correct fit should give the wheelchair user the support needed and allow an active person the freedom to move the shoulders to push. Check by observing whether the trunk is balanced over the hips and ask the wheelchair user whether the backrest is comfortable. Also check that the wheelchair user able to push the wheelchair without the backrest interfering.
• Rear Wheel Position for Hand Propulsion; Is correctly fit if the user’s elbows should be at a right angle when hands are placed on the push rims, Ask the wheelchair user to grip the push rims at the top of the wheels. The elbow should be bent at 90 degrees. Also check with the user if the rear wheels are positioned correctly for balance (forward for active, back for safe).

Check Posture

Observe how the wheelchair user is sitting in the wheelchair from the side, and from the front. Is the user sitting in an upright posture?

Check Pressure

For every wheelchair user at risk of developing a pressure sore – check if the pressure under the seat bones is safe.

Check Fit while the Wheelchair User is Moving

The final part of fitting is to check how the wheelchair fits when the wheelchair user is moving. If a wheelchair user cannot push the wheelchair independently, ask a family member/caregiver to push the wheelchair. You should look out for:

• Backrest- should give enough support and allow the wheelchair user freedom to move the shoulders to push
• Rear wheel position- should allow positioned correctly to allow the user to push
• Seat height and depth- should be correct for the wheelchair user to push with their legs
• Posture supports- should allow for unrestricted and safe wheelchair mobility
• Footrest- user’s feet should stay on the footrests
• Movement of the wheelchair- movement or pushing should not cause the wheelchair user to change their posture or feel uncomfortable or unstable in any way

Wheelchair Fitting Checklist

• Is the wheelchair ready?
• Check size and adjustments
• Check posture
• Check pressure
• Check fit while the wheelchair is moving

Good Practice

Resources

Rosen L. Fit to Function: Four areas where function can be improved by selecting the proper fit of the manual wheelchair. Rehab Management: The Interdisciplinary Journal of Rehabilitation [serial online]. November 2010;23(10):14-15.

Sprigle S. Measure it: Proper wheelchair fit is key to ensuring function while protecting skin integrity. Adv Skin Wound Care. 2014;27(12):561-572.

References