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Measuring & Fitting for Seating & Mobility Equipment

General Rules:

•Alwaystakeanatomicalmeasurementsinsittingonaflatsurface–notincurrentequipment,

especially if it has sling seat and/or back upholstery

• Position client in most optimal upright posture based on mat evaluation results. This is the

posture you plan to achieve with the seating system. You might need assistance to hold client

in position and measure at the same time

• Use a stiff measuring tape and keep it straight

• Measure both right and left sides as appropriate

•Ifthereisalongdelaybetweeninitialevaluationandfundingapproval,

re-measure,especiallywithpediatricclients

A. SEATWIDTH–determinesseatwidthandaffectsoverallchairwidth

Measure the widest body part in a frontal plane (usually hips or thighs)•Bring LEs into midline or slight abduction if possible•To increase accuracy use straight edges on either side of the body and measure between them•Considerfixeddeformities

- FixedLEabduction–widestpartisatthedistalfemurs - Orderchairtofitthiswidthvsthehipwidth - Fill in spaces on either side of pelvis/hips with lateral supports

- Windsweptdeformity–measurefromhiponadductedsidetokneeonabducted - Orderchairtofitthiswidthvsthehipwidth - Fill in at adducted side (knee) and abducted side (hip) with lateral supports

- Scoliosis–measurefromapexofspinalcurveonconvexsidetohiponotherside - Orderchairtofitthiswidthvsthehipwidth - Fill in space on side of pelvis with lateral pelvic support - Support trunk with lateral trunk supports on either side

What do you do with this measurement?•Keep chair as narrow as possible

- Do you order the seat width equal to the anatomical measurement + 2”? - An old rule not often applicable - Used in past to accommodate winter clothing and old armrest styles

- Do you order the seat width the same as the anatomical measurement ? - Narrower seat = more effective in supporting the pelvis - Narrower seat = better wheel access - Narrower seat = more accessible and maneuverable chair

• Add width to accommodate secondary supports as necessary - Lateral pelvic and/or thigh supports

• Add width to accommodate orthotics/prosthetics as necessary - Ifwornwhileinthechairforsignificantamountsoftimeduringeachday

•Consider body type - Client with more soft tissue might need added width - Verybonyclientwhoisnotgrowing–ordersameasanatomicalmeasurement

• Consider need to accommodate for potential weight changes - New injuries

- Muscles might atrophy causing potential decrease in width - Might have a decrease in activity level causing potential increase in width

- Feedingtube–willalwayscauseincreaseinclientsize(widthandpossiblydepth) - Debilitatingconditions–mightcauseapotentialdecreaseinwidth

•Consider potential growth spurts - Some disabilities have typical growth patterns - Too much growth in a pediatric system can compromise function!

• Compare measurement “A” to measurement “M” (trochanter to trochanter) if using seat with a contoured well (see “M” below) - Accommodateforanysignificantdifference

•Each client is different - consider all aspects

A. SEATWIDTH–determinesseat width and affects overall chair width

B. SEATDEPTH–determinesseatdepthandchairlength

Measure the longest body segment in a lateral view • Distance from popliteal fossa (back of knee) to back of buttocks• Must have client positioned in most optimal upright posture while measuring

What do you do with this measurement?• Actual seat depth ordered depends on user’s functional and postural needs

- Oneruleofthumb–neverorderseatexactlythesamelengthastheclient•1 - 2” shorter provides:

- Appropriatedepthforclientsrequiringmaximumpressuredistribution/LEsupport•> or = 2” shorter:

- Accommodatestightkneeangles-tighthamstringsorkneeflexioncontractures - AllowsLEpropulsion–allowsLE(s)topullthroughundertheseat - Provide shorter chair for increased maneuverability - Accommodates very tall client with long upper leg length

- ProvidesenoughLEsupport,butcanuseshorteroverallframe - Accommodate tight front hanger angles used for comfort or positioning

• Leg length discrepancies - accommodate as appropriate: - <or=2”–noneedtoaccommodate–orderseataccordingtotheshorterleg - >2”–useasymmetricseat

- Orderseatslingtoshorterside,measurecushionorsolidseattothelongerlegandcutdownfortheshorterside;ororder with an asymmetric cut-out

• Solidbacks–mustconsidereffectonseatdepth,i.e.: - A 16” deep seat with back upholstery provides 16” of usable seat depth - A 16” deep seat with a 2” solid back mounted in front of the backposts provides only 14” of usable seat depth.

C. SEATHEIGHT–determinesSTFHneededforfootpropellersand/ortransfers

Measure distance from back of knee to heel• Position client in optimal hip/knee position with foot well supported•Consider height of footwear typical for the user

What do you do with this measurement?• TodetermineactualwheelchairSTFHneeded(distancefromseatrailtofloor):

- If cushion sits on top of seat rails - subtract cushion thickness from client measurement - Ifcushionsitsondropseat-subtractlengthofdrophooksfromcushionthickness,thensubtractthisfromclient

measurement - ClientpropelswithoneLE–considergroundclearanceneededforotherfootrest

- Minimum 2” of clearance is recommended - Creatingfixedtiltonmanualchair-identifyspecificrearandfrontSTFHdesired

D. FOOTREST LENGTH– determines footrest length needed for proper support

Measure from back of knee to heel (same as for seat height above)• Position client in optimal hip/knee position with foot well supported•Consider height of footwear typical for the user•Fixedanklecontractures:

- Measure to bottom of heel and use angle adjustable footplates to accommodate height difference between front and back of foot

What do you do with this measurement?•To determine actual footrest length needed:

- If cushion sits on top of seat rails - subtract cushion thickness from client measurement - Ifcushionsitsondropseat-subtractlengthofdrophooksfromcushionthickness,thensubtractt

his from client measurement - Consider ground clearance needed

- Minimum 2” of clearance is recommended - Ifusercanperformwheelies,footrestclearancecansometimesbe<2”

Angle - measure ankle angle with hip and knee in optimal sitting posture • Forankledeformities–useangleadjustablefootplatestoavoid:

- Poor LE postures - Pressure points and increased pressure over ball or lateral aspect of foot

E&F. BACK HEIGHT AND ANGLE– determines appropriate back support

E - measure from seat surface to inferior angle of scapula F - measure from seat surface to top of shoulders

Whatdoyoudowiththesemeasurements?•• Add thickness of cushion or solid seat to get total height needed• Individual back height and back angle depend on:

- Height of client - Shape of client’s back - Need for postural support and balance - Need for scapular support vs UE freedom of movement

• Oneruleofthumb-backsupportshouldendeitheraboveorbelowinferiorangleofthescapula, but never right at inferior angle - Could cause shearing across the scapula as it rotates during UE movements

• Ifusingananteriortrunksupport,thebacksupportshouldcometothetopoftheshoulders (measurement F plus cushion thickness)

- Allows the straps to come straight over top of shoulders• Straightbackpostssittheclientinupright;8°bendallowssomeuppertrunkrecline

G. SHOULDERWIDTH–determinesplacementforanteriortrunksupportstraps

Measure distance between acromium processes (edges of shoulders)• Use to determine placement of attachment points for anterior trunk support straps

- Should be positioned over medial clavicle•Straps too lateral:

- Strapscomeovershouldersrightattheendscausingimpingementofstructures(tendons,burse,nerves)betweenhumeral head and acromium process

•Straps too medial: - Straps too close to neck area causing impingement of critical structures at neck

H&N.HEADHEIGHT–determinesplacementandhardwareforheadsupport

H–measurefromseatsurfacetotopofhead• Use H to determine the height to the top of a full headrest• Add height of cushion or solid seat to get the actual height needed from the seat rails of the chair to the top of the head• Subtract the cushion height and the height of the back support itself to determine length of hardware needed to achieve

appropriate headrest height• H + C + cushion height = overall height of client in wheelchair

- Use to determine clearance needed for van door opening

N–measurefromseatsurfacetooccipitalledgeofhead

• Use N to determine the height to the occipital ledge or occipital pads of headrest• Add height of cushion or solid seat to get the actual height needed from the seat rails of the chair to the occipital area• Subtract the cushion height and the height of the back support itself to determine the length of hardware needed to

achieve appropriate occipital support

I. ARMRESTHEIGHT–determinesappropriatearmsupportandtrunkposture

Measure from seat surface to bottom of elbow with UE in optimal position (arm at planned height and degree of bend)•Add cushion height to obtain height of the actual armrests (from seat rails)

J. BACKWIDTH–determineswidthneededbetweenlaterals

Measure trunk width in a frontal plane •Use to determine the type of hardware needed to bring lateral thoracic supports in close enough to trunk

- If J is smaller than A (seat width) - need offset hardware

K. CHESTDEPTH–determinesappropriatelengthoflateraltrunksupports

Measure from most posterior aspect of trunk to front of chest in lateral plane•Longer pads might be needed for:

- Excessiveposteriortissuethatpositionsclientfurtherinfrontofbackposts - “Barrel chest” or increased breast tissue

L. ARMRESTLENGTH–determinesappropriatearmsupport

•PlaceUEincomfortableposition–comfortableshoulderandelbowflexion - Overall length will depend on amount of support desired under arm and/or hand

•Measure from back posts to point on arm where support should end - For armrests without fore-aft adjustability:

•Measure from elbow to point on arm where support should end - For armrests with fore-aft adjustability:

M. FOOTREST/LEGRESTANGLE–determinesappropriateLEandpelvicposition

Measureuser’sROMatthekneewiththehipflexedtoitsoptimalposition•Hamstring tightness might require a tighter (more acute) footrest/legrest angle.

- ELR’s and ALR’s are generally not appropriate in these cases•The most acute angle that still allows minimum ground clearance keeps overall length of wheelchair to a minimum•Sizeofcasterandframedesignmightlimituseofsomeacutefootrestangles• WithunilateralLEpropulsion,hangeranglemightneedtobemoreopentoallowgroundclearanceforthesupportedLE (i.e.60°footrest)