- 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 breadths 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
- 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.
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|Author:||Terry Holden, PT - 1/2009|