How to Know If a Wheelchair Fits

A wheelchair fits if the child's

head and trunk are upright and in the midline with or without support
shoulders are over the hips and level
legs are slightly abducted or neutral
pelvis is level, in a neutral tilt, and all the way back in the seat
weight is on the thighs and buttocks
feet are on the footrest
knees are no more than 2-3 finger breaths in front of the seat edge in a growing child
skin is healthy and has good integrity – check the coccyx and ischial tuberosities (if the seat is too deep, the child will lean back to reach the support surface, the pelvis will be in a posterior tilt, and the child may have redness behind the knees)
vision is forward
chest harness is supportive and does not cut into the neck or present a choking hazard (the child should not be "hanging" on support)
wheelchair has a snugly fitting pelvic positioning belt (seat belt), with padding if needed
wheelchair is in good repair
and the child is comfortable for at least 2 hours at a time in the chair

Special or Problem Situations

If a child has severe deformity and/or contractures, a wheelchair may not fit as described above. With a fixed deformity, the seating/positioning should accommodate the deformity and comfort and skin integrity may become the primary goals.
If the wheelchair does not fit properly, a referral to a PT/OT should be made to resolve the problem or recommend a new chair or other alternatives.
If repairs are needed, the parent should contact the vendor. If needed, the physician should write a prescription/referral for the wheelchair repairs.

Resources

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Author:

Terry Holden PT, 1/2009