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Information & Advice

Seating & Positioning

Proper seating and positioning is critical for people using mobility devices. Learn more about seating and positioning issues from Ottobock — the expert in mobility solutions for you and your loved ones.

Sitting all day is hard work—something you surely know if you’re a wheelchair user. If you’re an able-bodied caregiver, however, you may not have given it much thought—until an endless car trip leaves you feeling stiff, aching and exhausted. Read on to find out more about seating and positioning issues.

Seating & Positioning Issues

Seating & Positioning Issues

Seating & Positioning Issues

1. Posture

The natural, healthy alignment of the human body is all about function and comfort. Good posture promotes normal functioning of organs and greater efficiency of muscles, which minimizes fatigue.

Good posture is especially important to anyone who uses a wheelchair. In a sitting position, the natural curves of the back and neck should be supported. The shoulders, pelvis and knees should ideally be level. In that symmetrical position, muscles are in balance, ready to flex when needed and relax in between.

2. Skin integrity—and protecting it

Skin Integrity

2. Skin integrity—and protecting it

Skin that bears weight in a wheelchair lives in hostile territory. Pressure, shear, moisture and heat combine to create ideal conditions for the development of decubitus ulcers. In fact, a landmark study found that at least 20 percent of wheelchair users have a skin breakdown in any one year, which means that virtually every user is likely to encounter a skin problem within four to five years.

Ottobock specializes in seating and positioning products for users at high risk for skin-integrity issues. You are considered at high risk of skin-integrity issues if any of three statements is true as relates to sitting in your chair.

You have a history of redness and/or the presence of open wounds on your seated surface.
You cannot do an effective, independent weight shift on a consistent basis.
You have impaired sensation and don't check your skin daily and don't practice consistent weight shifts.
The good news is that most pressure ulcers—localized injuries to the skin and/or underlying tissue, usually over a bony prominence—are preventable. For that reason, anyone who spends their days in a wheelchair needs three types of skin protection as it relates to their wheelchair seating system.

3. Function

To maximize your full potential, you have to be able to reach the world. Seating systems, positioning aids and accessories can help make it possible for wheelchair users to achieve a correct, comfortable and safe seating position in most everyday environments.

Products & Materials

Products & Materials

Seating and positioning products come in a broad variety of types and styles, from simple off-the-shelf wheelchair cushions to custom seating. They’re also made out of a variety of materials.

Products by Level of Need

Three general categories of seating and positioning products meet increasing levels of need.

Products by Level of Need

Standard.

For those who have symmetrical posture and low to moderate risk of developing sores, standard cushions and backs may provide adequate comfort.

SHAPE Custom Contoured Seating

Our digital ‘SHAPE’ Seating Systems have been trusted for over 20 years, aiming to prevent further postural deterioration ideally as part of a ’24 hour postural management programme.

SHAPE Seating Systems are the only solution for patients with complex needs as the design and accessories can be fully customised to suit the needs of the user.

Materials make the difference

Cushions and backs are made with a variety of materials to provide support, distribute weight and protect skin. Ottobock cushions and backs feature several unique materials.

Materials

Floam

An ultralight patented material, is a “low-memory” foam that automatically flows around bony prominences, reducing pressure by allowing weight to be supported by broader body surfaces. Floam adjusts to the shape of the user and holds practically any shape.

Why tilt?

The tilt-in-space feature on some wheelchairs plays an important role in seating and positioning for some users. With tilt-in-space, the user rotates back, maintaining the same seat-to-back and seat-to-leg angles.

Positioning.

Tilting back 5 to 15 degrees can use gravity to help position the user for better posture.

Pressure redistribution.

Researchers have determined that 45 degrees of tilt (midway between horizontal and vertical) is needed for effective pressure management. That angle reduces pressure by one-third by distributing weight over a larger area. Tilting at various degrees throughout the day also provides relief.

Other Supporting Elements

Other Supporting Elements

Other factors besides posture, skin health, and function

If two or more options seem equal on The Big 3 of posture, skin health, and function, look at a few other factors:

  • Comfort. How does it feel to the user?

  • Fit. Cushions and backs come in multiple sizes because the wrong size will cause strain over time.

  • Adjustability. “Low-memory” foam automatically flows around bony prominences. Some products allow you to position pouches filled with “low-memory” foam for more support and weight distribution where you need it.

  • Integration. Some cushions and backs are designed to work together.

  • Safety. Is the user stable?

  • Ease of use. Will the user or caregiver have any trouble with it?

  • Maneuverability. Any problems with movement for the user or the wheelchair?

  • Durability. Whatever you buy probably will be used for years, so it better hold up.

Get the right solution

Get the right solution

You have individual needs that require an individual solution. To get the right seating and positioning for you, start by getting an assessment from a physiatrist (a physician who specializes in physical medicine and rehabilitation) or a Physical or Occupational Therapist who specializes in seating who will work alongside a Rehabilitation Technology Specialist (RTS) in helping you obtain the best solution.

To make sure you’re fit in the right system, you should have a thorough hands-on evaluation to determine:

  • Range of motion and flexibility in the spine, pelvis and leg joints

  • Postures that are flexible and those that are fixed

  • Cause(s) of seating and positioning challenges

  • The level of risk for issues with skin integrity

  • Functional needs and limitations

The specialist may take photographs to document your condition as well as measurements to ensure your wheelchair is the right size and is adjusted properly for you.

Be your own best advocate and make sure you get:

  1. A solution that accommodates changing needs. What can you anticipate in the future—a child’s growth or loss of muscle mass with a degenerative condition?

  2. A trial of the proposed solution before the physiatrist writes the final prescription.

  3. Instruction on how to use the equipment.

Focus on causes, not symptoms

Wheelchairs are notorious for frustrating caregivers. The caregiver positions the user in the wheelchair, but soon the user is sliding or slouching or leaning. The caregiver readjusts the user, who repeatedly gets into the same unnatural position. The caregiver may use pads and supports to discourage sliding or to keep a leg from sliding off a footplate, but nothing seems to work.

Efforts to help by restricting movement tend to be misguided. People often spend time trying to control the device user when they should be adjusting the wheelchair. More often than not, there’s something wrong with the wheelchair, and discomfort compels the user to escape from an uncomfortable position.

Instead of trying to conquer a recurring misalignment, think of it as a symptom. Then try to figure out what causes it.

Common symptoms and possible causes

  • Sliding out of seat - Limited hip flexion, increased extensor tone, posterior pelvic tilt with kyphotic posture, tight hamstrings

  • Slouching (posterior pelvic tilt) - Weak trunk muscles, limited hip flexion, decreased lordosis, increased thoracic kyphosis, tight hamstrings

  • Falling forward (anterior pelvic tilt) - Tight hip flexors, tight quadriceps, tightened spinal extensor, weak abdominals, increased lumbar lordosis, forward sloping seat, backrest too vertical, excessive lumbar contour

  • Leaning (pelvic obliquity) - Pain in opposite hip, asymmetrical muscle strength or tone, scoliosis, inadequate support in seat, overly wide wheelchair, arm support(s) too high or too low

  • Windswept legs (pelvic rotation) - Unsupported trunk, inadequate posterior pelvic support, seat too high for foot propulsion, footrest height not adjusted for asymmetrical hip flexion, asymmetrical muscle tone in trunk and/or legs, asymmetrical hip abduction, adduction or flexion, difference in leg length, posterior dislocated hip

How can we help?

Get in touch with Ottobock UK by completing the enquiry form below. If your request is urgent you can call us on 01784 744900. Monday to Thursday 08:30 to 17:00 & Friday 08:30 to 16:00.