There are a few misconceptions that seem to persist in the world of wheelchair seating and positioning. Last week we looked at the wedge misconception, and we’re now taking a look why a patient could be sliding out of the wheelchair and some possible solutions.
What should I do when my patient keeps sliding out of the wheelchair?
First, we need to find out why they are sliding. The list below can help get you started:
- Check for tightened hamstrings as they can pull the pelvis forward in the seated posture
- Check for hip ROM and see if they are trying to increase the seat-to-back angle by sliding forward
- Check the seat depth and see if it is too deep and putting pressure on the back of their legs
- Check the seat-to-floor height, and see if they are sliding to try and reach the floor for propulsion
- Check trunk stability and strength; if weakness is present, the patient may slide forward seeking stability
When we know what might be causing the patient to slide, then we can look at possible solutions.
- Accommodate tightened hamstrings by adapting the seat depth and back angle to match the patient’s posture. Use an immersion style cushion to protect the sacrum and coccyx from pressure injury.
- Adjust the seat-to-back angle either through the back canes or the hardware of the back support. Find their optimal STBA based on your mat evaluation results.
- Measure upper leg length and get a wheelchair with the appropriate seat depth.
- Lower STFH at the wheel axle or use a drop seat.
- Try a cushion with tapered adductors that will stabilize the pelvis and provide increased support for the trunk.
To learn more about seating and positioning, check out the digital wheelchair seating and positioning. To see the rest of the Permobil education guides click here.
