1. Wheelchair Seating for Elders
Betsy Willy MA, PT, FCCWS
Pathway Health Services
And
Pat Fritz RN, BC, NHA
Mountain Pacific Quality Health-WY

2. Wheelchair Seating for Elders
Betsy Willy MA, PT, FCCWS
Pathway Health Services
And
Pat Fritz RN, BC, NHA
Mountain Pacific Quality Health-WY

3. Why Wheelchair Seating?
Prevention of Falls
Prevention of injury from Falls
Reduction of response time to rescue

4. Enhancing Resident Safety
Stable staffing
Units
Neighborhoods
Relationships
Predict behaviors
Ownership of resident’s safety
Caring for your own
All staff involved
Identify high risk
Execute intervention
Vigilance
Visual supervision
Mobile work stations
Handoff Communications
Shift changes
Admission
Transfer unit to unit
Transfer to ED
Discharge to home

5. Enhancing Resident Safety
Maintaining
Strength
Balance
Endurance
Flexibility
Hydration

6. Provide Alternative Seating Options throughout the day

7. Causes of Falls Related to Seating
Unlocked Brakes
Over reaching
Sliding
Tipping chair
Unassisted transfers

8. Wheelchair Seat Belt Entrapment Risks
Inappropriate Use
Too loose
Poor placement
Improper attachment to chair

9. Why DO folks attempt to get out of their chairs?
Uncomfortable
Pain
Fatigue
Boredom
Lack of engagement with others
Left for long periods in front of TV or in their rooms
Confusion
Agitation/anxiety

10. Fit The Chair to Resident and Keep it Well Maintained

11. Basic Principles for Wheelchair Seating
Knees should be level with hips – thighs horizontal to floor
Feet flat on floor if self propelling
Wheelchair Back comes up to mid scapula
Elbows rest on armrests without leaning
Two finger rule
Width: There should be two fingers of space between hip and side arm
Seat depth: Two fingers of space behind back of calf and edge of seat

12. Start with Ideal Position

13. Too Wide, Just Right, Too Narrow

14. Seat or Cushion Depth Cushion too short causes coccyx pressure
Cushion too long causes sacral sitting

15. Arm Rest Height Armrest too high – folks tuck arms inside chair arms
Armrest too low – folks will lean sideways seeking support

16. Too Low – lack of support for back
Back of chair
Mid scapula - correct
Too Low – lack of support for back

17. Footrest If too Low the elder will Slide into sacral sitting
Arch Low Back causing pain
If too Short
Pressure on Coccyx
Elevating footrests
Pulls individual into sacral sitting
Special Order footrests are available to accommodate
“Foot drop” contractures
Supination or Pronation foot contractures
Knee Flexion Contractures

18. No Footrests Advantage: Disadvantage
If correct wheelchair seat height the elder can propel self
Disadvantage
When pushed, risk of trauma to feet
Seat height too high with no foot rests
Slides into sacral sitting causing fall risk
Arches low back causing pain and discomfort

19. Tall lean folks require deeper higher seat with a taller back to avoid falling forward from chair
Chair too small
Correct

20. Morbidly Obese Folks Provide extra depth wheelchair seat
Support low back above the buttocks
Provide extra width seat
Use heavy duty chair frame
Consider large wheels in front of chair with casters in back for easier propelling

21. Gravity Assisted Seating to prevent sliding from chair
Seat the pelvis down and back into the chair
Tip chair using dual axel option
Increase seat depth

22. Over Reaching will Tip Wheelchair
Avoid by:
Increasing seat depth
Tipping chair using dual axel components

23. Kyphotic (Curved) Back
Causes:
Sliding from chair
High pressure points on spinal processes and coccyx
Poor eye contact due to facial orientation
Back pain due lack of low back support

24. Seating for Kyphotic Back
Tip front of seat up using dual axel component to allow eye contact and reduce sliding
Replace back upholstery with molded or surround back option to reduce pressure and pain
Increase seat depth to support low back

25. Modifications of Chair Back for Kyphotic Backs
Surround Back
Molded Back

26. Avoid Unplanned Wheelchair Movement
Ensure brakes are well maintained
Use Anti – Rollback brake device for individuals who forget to lock brakes
Ensure anti-rollback device is correctly adjusted to avoid excessive pressure

27. Exhaustion causes falls and judgment errors
Cardio-pulmonary compromised elders
Use lightweight Wheelchair
Use Lightweight oxygen tank
Avoid Rugs which create resistance
Keep wheelchair wheels gliding easily

28. Falls related to Wheelchair seating can often be solved through simple wheelchair adaptations. This material was developed by Betty Willy, PT, Pathway Health Services and reproduced, with permission, by Mountain-Pacific Quality Health, the Medicare quality improvement organization for Montana, Wyoming, Hawaii and Alaska, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Contents presented do not necessarily reflect CMS policy. 9SOW-AS-MQPHF-PS-10-61