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.