Wheelchair Seating for Elders

Betsy Willy MA, PT, FCCWSPathway Health Services

AndPat Fritz RN, BC, NHA

Mountain Pacific Quality Health-WY

Wheelchair Seating for Elders

Betsy Willy MA, PT, FCCWSPathway Health Services

AndPat Fritz RN, BC, NHA

Mountain Pacific Quality Health-WY

Why Wheelchair Seating?

Prevention of Falls

Prevention of injury from Falls

Reduction of response time to rescue

Enhancing Resident Safety

Stable staffing– Units– Neighborhoods

Relationships– Predict behaviors

Ownership of resident’s safety– Caring for your own

All staff involved– Identify high risk– Execute intervention

Vigilance– Visual supervision– Mobile work

stations Handoff

Communications– Shift changes– Admission– Transfer unit to unit– Transfer to ED– Discharge to home

Enhancing Resident Safety

Maintaining– Strength– Balance– Endurance– Flexibility– Hydration

Provide Alternative Seating Options

throughout the day

Causes of Falls Related to Seating

Unlocked Brakes Over reaching Sliding Tipping chair Unassisted

transfers

Wheelchair Seat Belt Entrapment Risks

Inappropriate Use– Too loose– Poor placement– Improper attachment to chair

Why DO folks attempt to get out of their chairs? Uncomfortable

– Pain– Fatigue

Boredom– Lack of

engagement with others

– Left for long periods in front of TV or in their rooms

Confusion– Agitation/anxiety

Fit The Chair to Residentand Keep it Well Maintained

Basic Principles for Wheelchair Seating

Knees should be level with hips – thighs horizontal to floor

Feet flat on floor if self propelling

Wheelchair Back comes up to mid scapula

Elbows rest on armrests without leaning

Two finger rule– Width: There

should be two fingers of space between hip and side arm

– Seat depth: Two fingers of space behind back of calf and edge of seat

Start with Ideal Position

Too Wide, Just Right, Too Narrow

Seat or Cushion DepthCushion too short causes coccyx pressure

Cushion too long causes sacral sitting

Arm Rest HeightArmrest too high – folks tuck arms inside chair arms

Armrest too low – folks will lean sideways seeking support

Back of chair

Mid scapula - correct Too Low – lack of support for back

Footrest

If too Low the elder will– Slide into

sacral sitting– Arch Low Back

causing pain If too Short

– Pressure on Coccyx

Elevating footrests– Pulls individual

into sacral sitting

Special Order footrests are available to accommodate “Foot drop”

contractures Supination or

Pronation foot contractures

Knee Flexion Contractures

No Footrests

Advantage:– If correct

wheelchair seat height the elder can propel self

Disadvantage– When pushed,

risk of trauma to feet

– Seat height too high with no foot rests

Slides into sacral sitting causing fall risk

Arches low back causing pain and discomfort

Tall lean folks require deeper higher seat with a taller

back to avoid falling forward from chair

Chair too small Correct

Morbidly Obese Folks

Provide extra depth wheelchair seat

Support low back above the buttocks

Provide extra width seat Use heavy duty chair

frame Consider large wheels in

front of chair with casters in back for easier propelling

Gravity Assisted Seating to prevent sliding from

chair Seat the pelvis

down and back into the chair

Tip chair using dual axel option

Increase seat depth

Over Reaching will Tip Wheelchair

Avoid by:– Increasing seat

depth– Tipping chair

using dual axel components

Kyphotic (Curved) Back

Causes:– Sliding from chair– High pressure

points on spinal processes and coccyx

– Poor eye contact due to facial orientation

– Back pain due lack of low back support

Seating for Kyphotic Back

Tip front of seat up using dual axel component to allow eye contact and reduce sliding

Replace back upholstery with molded or surround back option to reduce pressure and pain

Increase seat depth to support low back

Modifications of Chair Back for Kyphotic Backs

Surround Back Molded Back

Avoid Unplanned Wheelchair Movement

Ensure brakes are well maintained

Use Anti – Rollback brake device for individuals who forget to lock brakes

Ensure anti-rollback device is correctly adjusted to avoid excessive pressure

Exhaustion causes falls and judgment

errors Cardio-

pulmonary compromised elders– Use lightweight

Wheelchair– Use Lightweight

oxygen tank– Avoid Rugs which

create resistance– Keep wheelchair

wheels gliding easily

Falls related to Wheelchair seating can often be solved

through simple wheelchair

adaptations.

This material was developed by Betty Willy, PT, Pathway Health Services and reproduced, with permission, by Mountain-Pacific Quality Health, the Medicare quality

improvement organization for Montana, Wyoming, Hawaii and Alaska, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S.

Department of Health and Human Services. Contents presented do not necessarily reflect CMS policy. 9SOW-AS-MQPHF-PS-10-61