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The 7 Key Measurements to Determine Proper Wheelchair Fit

The origins of the wheelchair are a bit hazy. A quick check of Wikipedia, reveals a depiction of Confucius in a wheelchair (which would date the mobility device back to somewhere in 6th century BC). A chair was made for Phillip II of Spain in 1595. In 1655, a paraplegic watchmaker built a self-propelling chair on a three wheel chassis.

In 1783, John Dawson designed a wheelchair that outsold all others through the early part of the 19th century. While the wheelchair clearly has a long history, it has also (thankfully) had an incredible period of innovation; today’s chairs are lighter, more maneuverable, and more comfortable than ever before, and for many people, they are the tool that allows them to reclaim some mobility and greatly improve quality of life.

It’s estimated that 80-90% of wheelchair users are in a chair that doesn’t fit their body. That’s like wearing the wrong size shoes every day! And yet it happens more often than it should. Why?

  • Because people don’t know the proper way to fit a wheelchair.
  • Because their bodies and needs change over time.
  • Because wheelchairs can be just one component in the overwhelming process of learning to deal with limited mobility.

But different types of wheelchairs offer different options for how they feel, how they fit, how they respond, and what they enable you to do. Choosing the right one can mean the difference between maximizing your mobility and experiencing chronic discomfort, or worse, additional medical problems. That’s why today we’re going to cover Wheelchair 101 – the nuts and bolts of these wheeled devices that can help get you from point A to point B, and from limited mobility to maximum comfort.

What are the benefits of a wheelchair?

Let’s start by making an even finer distinction here and ask, what are the benefits of a properly-fitted wheelchair?

  1. Improved mobility. Wheelchairs provide the freedom to move around as you wish (independently or with the aid of a caregiver/attendant). They give you a more comfortable and active lifestyle.
  2. Independence and increased socialization. Many people (particularly seniors) who feel unbalanced when they walk, gradually settle into a sedentary and isolated lifestyle to avoid feeling vulnerable or at risk for injury. A wheelchair can help restore their independence and allow them to return to many of their regular hobbies and activities.
  3. Injury prevention. In addition to increased independence and socialization, wheelchairs can help prevent injuries related to balance and instability. People at risk for serious falls can now move about with more ease. Proper fitting can also prevent medical problems such as pressure wounds and blood clots.
  4. Comfort. A properly fitted wheelchair provides comfortable seating and good back support, improving posture. In addition, it can help you breathe easier, swallow easier, and experience less pain.

What are the different types of wheelchairs?

“In some ways a wheelchair is like a bicycle: there are many designs and styles to choose from including imports, lightweights, racing models, etc.” ChristopherReeve.org

We love that quote because it makes wheelchairs sound exciting, and indeed they can be, because what they are is a specialized piece of equipment, designed to optimize performance. But just as a novice athlete might not know the right bike to tackle the Tour de France, selecting the right chair, especially for a first-time wheelchair user, can be confusing. Let’s start with the easy stuff.

Wheelchairs are either manual or electric.

Manual wheelchairs are lighter and require physical force to move them.

Electric wheelchairs are heavier and have motors, powered by large rechargeable batteries, to propel them.

A little over a generation ago, the standard chair was a chrome-plated behemoth that weighed about 50 pounds. Today, chairs come in a rainbow of colors and a dizzying array of styles. There are platform-model power chairs with a captain's seat. There are three- and four-wheel configuration scooters. There are folding models for travel and rugged, off-road ready models for adventures in the open air. There are reclining chairs and standing chairs, smart chairs, and chairs made for specific sports.

Wound Care carries a wide selection of chairs, infinitely customizable to meet the differing needs of patients. Check them out here.

How do I know which is the right one for me?

Whatever your situation, there is a wheelchair configuration that will work for you. Work with your doctor or medical professional to determine the best option. Start by answering these questions to narrow down the scope:

  • Where will I use my wheelchair most? What kind of surfaces or slopes are involved?
  • How much of the day will I spend in this chair? Will I be using it occasionally or constantly?
  • How will I get my wheelchair (and myself) from place to place?
  • How will I transfer from the wheelchair to other surfaces?
  • What kinds of activities would I like to be able to do?
  • If I need help with my wheelchair, what features are important to my attendant?

Then consider fit. (Remember we said in the beginning that 80-90%of wheelchair users are in a chair that doesn’t fit their body? Let’s make sure you’re in the 10-20%.)

How to properly fit a wheelchair.

The ideal sitting position for most people in a wheelchair follows the 90-90-90 rule.

The 90-90-90 Rule:

A 90° bend in the hips.

A 90° bend in the knees.

A 90° bend in the ankle.

The person’s bum should be all the way back in the seat, making contact with wheelchair back. Their thighs should be parallel to the ground and their knees should be in line with their hips (not above or below).

Proper fit can ensure optimal posture, swallowing, and breathing while preventing pressure wounds, hip and pelvic problems, and general discomfort so it’s worth spending some time getting it right.

The 7 Key Measurements to Determine Proper Wheelchair Fit

  1. The seat width should be wide enough to accommodate the hips, but not so wide that you have to stretch to reach the wheels if self-propelling. Ensure the chair sides are not touching the hips to avoid pressure wounds.
  2. The seat depth should be two inches away from the back of the knee to avoid blood vessel constriction in the legs.
  3. If a person needs to use their feet to move, the seat height should allow for them to reach the floor with their heel. Those using footrests will have a higher seat height.
  4. The height of the back of the chair should also be considered. Patients with a condition that requires additional back support may prefer a full length back rest with headrest.
  5. Footrest style and length should ensure that the legs don't dangle and that they aren’t pushed too high, leading to pelvic tilt. Calf supports can be included if a person is going to recline.
  6. Armrest height is determined by the needs of the user. You want enough support so your arms are not drooping. Positioning devices can help support the arms if needed.
  7. Weight. This might seem an obvious one but remember that different wheelchairs are built to accommodate different weight limits so keep that in mind when selecting a chair.

Do I need all the extra accessories?

Not every chair requires all the bells and whistles, but extra features and accessories that help customize a chair can improve comfort, increase mobility, and prevent injury.

  • Wheelchair seat and back cushions help distribute pressure evenly and reduce moisture build up, stopping pressure wounds before they begin.
  • Between 65,000 and 80,000 wheelchair-related injuries from tips and falls occur each year. Anti-tip devices can prevent potentially fatal skull fractures at an extremely low cost to both patients and providers.
  • Adjustable armrests can improve posture and increase comfort.
  • Locking brake handle extensions ensure your chair will stay in one place when you want it to.
  • Elevating leg rests promote healthy circulation and even out blood flow to different areas of the body.
  • Fully reclining backrests allows caregivers to assist in performing weight shifts, preserving skin integrity and preventing pressure wounds.

Wound Care Solutions has a full range of wheelchairs and accessories to suit every need, all

designed with prevention in mind, keeping patients at home, healthy, and out of the hospital. Visit us today to learn more.