How to Build Exceptional
Seating Outcomes for
Complex Postures
Part 1 - Clinical Evaluation
Part 2 - Installation to Wheelchair
Part 3 - Adjustments for Positioning
Part 4 - Overview
Watch Part 1
Watch Part 2
Watch Part 3
Watch Part 4

The pelvis is the key to maintaining correct posture as it dictates the position of the head, trunk and extremities for users in wheelchairs.

Good posture is characterised by:

  • The symmetrical alignment of the pelvis
  • Physiological curvatures of the sagittal plane and straight spine in the coronal plane
  • Well-formed chest
  • Shoulders slightly backward in relation to the pelvis
  • Straight position of head

Modifications to posture and position are best done in small incremental changes as these allow the user to physiologically adapt to them and for the assessor to manage the progress sufficiently.

DISCLAIMER: EVERY OUTCOME HAS TO BE DETERMINED BY THE CLIENT AND BASED ON THE CLINICAL EVALUATION ASSESSMENT.

Clinical Issue

Common Suggestions for Intervention

Suitable Products
Posterior Pelvic Tilt
  • Decrease thigh-to-calf angle
  • Provide posterior pelvic support through the back support
  • Create biangular shaping in back support to accommodate asymmetries
  • Check the depth of the cushion – it may be too deep.
Anterior Pelvic Tilt/Lordosis
  • Encourage more weight bearing on ischial tuberosities
  • Position hip belt over ASIS
  • Create a rearward sloping seat and carefully set up the back angle to reduce the tendency to lumbar Lordosis
  • Provide contouring in the back support to support the user’s back
  • Using an adapted tray to form an anterior support for the trunk is often very effective and functional for the user
Tight Hamstrings
  • Drop the front of the cushion down/build up at the rear for a sloping seat surface
  • Decrease thigh-to-calf angle with footplate position
Limited Hip Flexion (one side or both)
  • Accommodate limitation in hip flexion by adjusting the rear side of the cushion to meet the presentation of the pelvis and adjust both frontal sections of the cushion to address each hip angle
  •  Set up footplates at different heights to accommodate hip flexion limitation
Extensor Thrust
  • Provide increased pre-ischial shelf build-up
  • Stabilise pelvis using an appropriately angled pelvic belt and posterior support
  • Increase hip and knee flexion
Leg Length Discrepancy
  • Leg discrepancy cut-out in cushion
Pelvic Rotation
  • Create build-up in pre-ischial support under the affected pelvis
  • Contour the back surface to support the pelvis if fixed
  • Maximise use of a hip belt to control forward side
  • Check the dimensions of the chair and components. A chair that is too wide, for example, can facilitate pelvic rotation
  • Contoured cushions with good leg troughs
  • Appropriate lower back support is preferable to a canvas back which may mould to the rotated pelvis
Windsweeping
  • Hip and thigh lateral supports
  • Provide more adductor/abductor support on the cushion with higher contouring/deeper leg troughs
Hip Adduction
  • Medial thigh support/pommel
  • Deeper leg troughs
  • Customised abduction shaping in cushion
Hip Abduction
  • Lateral thigh supports
  • Deeper leg troughs
  • Customised adduction shaping in cushion
Pelvic Obliquity
  • Ensure correct seat dimensions, arm support positioning etc.
  • Ensure a level base of support for the cushion
  • If obliquity is flexible, build up under the low side to correct
  • If the obliquity is fixed, compensate by building up the high side and/or lowering the low side to even out the contact area throughout the cushion
  • Ensure sufficient trunk support for the level of disability and prescribe proactively
Painful or Dislocated Hip
  • Use softer materials under and/or around the hip
  • Avoid lateral contact with hip
Pressure Risk on Cushion Most wheelchair users spend many hours in their wheelchairs. They may have full sensation but are often unable to change position independently or effectively.

With a user that has pelvic deformities, often the core reason behind their pressure concerns is coming from poor positioning and loading of the pelvis on the cushion. An adjustable cushion that provides the ability to load the pelvis properly will give them improved posture and function.

A suitable high-pressure redistribution cushion used with the tilt-in-space function can promote skin integrity and help users independently maintain comfort.
Scoliosis
  • Lateral support via thoracic pads will assist, but the condition should be managed by ongoing assessment etc.
  • Some users find harnesses give them more confidence and trunk stability when they are out and about, particularly in vehicles or when negotiating uneven ground, slopes and ramps.
  • Use 3-point contact with lateral supports, strategically placed on the sides of the trunk and lower down at the pelvis level
  • Check for pressure areas and add extra padding/gel or increase the surface area if necessary with larger pads
  • Swing-away laterals significantly help with transfers and some activities of daily living.
  • The contouring profile of the back support is also important and should encourage the maintenance of the natural curves of the spine.
Disclaimer: This information is provided for professional use only, and as a general resource for clinicians and suppliers. It is not intended to be used as, or as a substitute for, professional medical advice, diagnosis or treatment. Clinicians should rely on their own professional medical training when providing medical advice or treatment, and should consult a range of different information sources before making decisions about the diagnosis or treatment of any person. Your use or reliance on this information is at your own risk.