DSPs Using and Supporting Technology Use
An Appropriately-Matched Wheelchair Can Make All the Difference
Becky Breaux, author
A wheelchair can be an important technology for people with intellectual and developmental disabilities who also have trouble walking. In the U.S., experts estimate that 3.6 million people use wheelchairs (Brault, 2012). Some people may use a wheelchair for a few hours each week or month, while others may use their wheelchair several hours each day. When people use a wheelchair as their main way to get from place to place, it can be critical to their well-being. Whether using a wheelchair a little or a lot, it is important for users to have a good “match” with their wheelchair. A good match occurs when the wheelchair is set up properly for their specific needs and abilities. As a direct support professional (DSP), you can play an important role in determining if the wheelchair matches the person’s support needs.
A good match occurs when the wheelchair is set up properly for their specific needs and abilities. As a direct support professional (DSP), you can play an important role in determining if the wheelchair matches the person’s support needs.
Many problems can occur when an individual's wheelchair is not properly set up. A poor match can harm a person’s health, safety, and quality of life (Chen et al., 2011; Ferretti et al., 2021; World Health Organization, 2023). For example, some people develop sores on their skin if their wheelchair cushions don’t match their needs (Park & Lee, 2017). Other people can injure themselves or others when they operate a chair that is not set up for their abilities (Chen et al., 2011). To achieve the best match and improve outcomes for individuals, several factors can be considered. These factors can include how well the wheelchair supports their posture, fits their body shape and size, and matches their abilities.
For example, not everyone can sit in a perfect, upright posture. This is especially difficult for people with limited flexibility in their spine, hips, and knees. People who have weakness in the muscles that help them sit up may also struggle. When a person’s spine is curved, their upper body may sit hunched or rounded. As a result, a wheelchair with a flat back will only push them forward into a more hunched position (Photo 1) . On the other hand, a curved back support can match their body shape better and help them sit up straighter (Photo 2) .
Photo 1. When a person’s back is curved and the back on the wheelchair is straight, the person will be pushed forward into a hunched position.
Photo 2. A contoured back support can match a person’s body better and help them sit up straighter.
Photo 3. The seat cushion is too short, leaving a large gap between the seat and the person’s legs. This causes people to slouch when sitting.
Making sure the chair is the proper size is equally important. For example, when a cushion is too long for a user’s body, they may need to slide forward on the seat so their knees can bend. As they slide forward, they often end up sitting with a large gap between their back and the wheelchair. Sometimes, their legs hang over the edge of the cushion by several inches (Photo 3). They also tend to sit in a slouched position with their backs rounded. This position creates pressure where their tailbone contacts the cushion and where the curved part of their spine contacts the back of the chair. When the pressure is high, it can lead to discomfort. Sometimes, they risk getting skin redness or sores on their buttocks or back.
Matching a chair to the user’s abilities is also important. For example, people with very weak muscles may need a chair that offers tilt (Photo 4). Tilt can help reduce their tendency to fall forward if they are too weak to sit up. People in power wheelchairs may need special handles for their joysticks that work best for their hand movements and coordination (Photo 5). The height of the wheelchair can also impact how well individuals can stand to transfer in and out of it.
Photo 4. This type of wheelchair can support someone who has weakened muscles. Tilting back helps them to not lean or fall forward.
Photo 5. Some people drive their wheelchair using a joystick. Here are some examples.
These are just a few examples that show why a good match is important. An evaluation with an occupational or physical therapist can help. The therapist will interview the person and their care team. They often test the person’s strength and flexibility. They also take measurements of their body and they typically have sample wheelchairs to try. (Wheelchair Seating & Positioning Guide, n.d.). Usually, an equipment supplier attends the session and knows a lot about different products. Suppliers can recommend the best wheelchair for each person. In some cases, the person’s wheelchair may simply need to be adjusted so that it works better for them.
As a DSP, there are several things you can do to see if the wheelchair is a good match for the person you support. Below are some questions to think about.
Does the wheelchair fit their body?
Do you see large gaps between the person’s body and the wheelchair, such as behind their back or buttocks, or between their torso and side supports? Do their legs hang over the edge of the cushion by several inches? (Photo 3) Are their knees high above the cushion and without support under their thighs? Are their feet dangling or poorly supported by the foot supports?
Does the seating system offer good support and keep the person stable?
Do they sit in a very slumped posture or lean to one side of the other? Is their head falling forward, backward, or to the side? If you help them reposition their body in the wheelchair, do they quickly slide or move out of position again?
Does the wheelchair match the person’s abilities?
Does the person have trouble using the manual or power wheelchair? Would they be more independent if the chair was set up differently?
Is the person safe?
Are you concerned for their safety, or the safety of others, while they are using the chair? Are they safe while transferring in and out of it?
Is the person comfortable?
Do they complain of discomfort in the chair? If they cannot express their feelings to you, do they show other signs of discomfort like fidgeting in their seat, sleeping a lot, or “tuning-out” when they are in the wheelchair?
Is the person having problems with their skin?
Do skin redness or open sores near bony areas of their body, like their buttocks, spine, shoulder blades, or ribs, worsen when they use the wheelchair? Does it take longer than 10-15 minutes for skin redness to go away after they get out of the chair? Do parts of the chair scrape or bruise their arms, legs, or other body areas?
Does the person have other health problems that the wheelchair might be making worse?
Do they drool or have trouble breathing or swallowing when in the chair compared to when positioned in other places, such as in their bed? Have you observed other health concerns that might be worse when they are in their chair?
If your response to these questions is concerning, an evaluation may help. People who want this type of assessment can ask their physician for a referral to a knowledgeable occupational or physical therapist. You can also search for providers online . When a wheelchair is not set up properly for someone, the consequences can be harmful. On the other hand, a well-fitting wheelchair can make all the difference. When a wheelchair matches the person’s needs, it can improve their health, function, and quality of life. A good match with a wheelchair is an important goal for everyone.
References
Brault, M. (2012). Americans with disabilities: 2010 (Household Economic Studies, pp. 70–131) [Current Population Reports]. U.S. Census Bureau.
Chen, W.-Y., Jang, Y., Wang, J.-D., Huang, W.-N., Chang, C.-C., Mao, H.-F., & Wang, Y.-H. (2011). Wheelchair-related accidents: Relationship with wheelchair-using behavior in active community wheelchair users. Archives of Physical Medicine and Rehabilitation, 92(6), 892–898. https://doi.org/10.1016/j.apmr.2011.01.008
Ferretti, E. C., Suzumura, E., Rozman, L. M., Cooper, R. A., & de Soárez, P. C. (2021). Economic evaluation of wheelchair interventions: A systematic review. Disability and Rehabilitation: Assistive Technology, 0(0), 1–12. https://doi.org/10.1080/17483107.2021.1993360
Park, J.-S., & Lee, S.-H. (2017). Comparing the interface pressure redistribution after applying three different types of cushions: Differences according to cushion type. Journal of Physical Therapy Science, 29(1), 128–132. https://doi.org/10.1589/jpts.29.128
Permobil. Wheelchair seating & positioning guide. (n.d.). Retrieved July 25, 2024, from https://hub.permobil.com/wheelchair-seating-positioning-guide
World Health Organization. (2023). WHO wheelchair provision guidelines. WHO