Postural supports in wheelchairs are important to ensure proper positioning and function. Examples of postural supports include the seat, backrest, footrests, and armrests. A client-centered approach involving the client, caregivers, and therapist is important for selecting the appropriate wheelchair and seating system. Proper positioning can reduce complications like pressure sores and respiratory issues by supporting the trunk and allowing for full expansion of the lungs. Armrests in particular can assist with more efficient breathing by keeping the arms in a closed-chain position.

1. Postural Supports
and
Custom Wheelchair Seating

2. What are Postural Supports?
• The World Health Organization defines postural support as:
Any part of the body that comes in contact with a surface, such as a wheelchair.
• Examples: Wheelchair (postural Supports)
Seat
Backrest
Foot rests
Arm rests
Lateral support
Lumbar supports

3. Wheelchair seating Specialist
OT or PT?
• Often depends on the clinic setting and wheelchair seating specialists
available.

4. OT Domain of Practice
• Biomechanical Frame of Reference
• Rehabilitation Frame of Reference
• Model of Human Occupation Frame of Reference

5. Wheelchair seating: A Client Centered Process
• Client (preferences, understanding of day to day needs in a wheelchair and postural supports)
• Spouse/ partner
• Family
• Care givers
• Therapist (Knowledge base)

6. Canadian Journal of Occupational Therapy looked at the
Wheelchair Procurement Process through the perspectives of the
clients, their family members, care givers and the Prescribers.
This client centered study examined barriers to appropriate
seating systems for individuals with physical disabilities and
their families and caregivers. Clearly the involvement of the
consumer client and the practitioners’ knowledge must be
collaborative to provide a wheelchair that offers the postural
support to meet the needs of the client on a functional, social
and environmental level.

7. Factors in choosing a wheelchair
Functionality: What is the environment the client will be using the wheelchair in?
Seating, Wheelchair Support and postural:
Durability and safety:

8. What are Postural Supports?
The World Health Organization defines postural support as:
Any part of the body that comes in contact with a surface, such as a wheelchair.
Examples: Wheelchair (postural Supports)
Seat
Backrest
Foot rests
Arm rests
Lateral support
Lumbar supports

9. Appropriate wheelchair seating and postural supports can reduce many
future complications:
 Pressure sores
 Secondary disabling conditions
 In efficient respiration

10. Armstrong (2008) pp. 57
Prevention of Pressure sores through good postural support.
Evaluate and Monitor the following areas:
- Ischial tuberosity/ sacrum
- Back of the head
- Spine of the scapula
- Calcaneus
- Elbows, knees, wrists, back of knees and hips

11. Proper postural supports such as
armrests assist in allowing for more
efficient breathing. If a client rests their
arms on their arm rests (close chained
activity), the respiratory muscles will be
more effective while preforming reversal
of muscle action.

12. Inefficient Respiration
Poor posture while seated for a long period of time can inhibit the normal up and out motion of the
ribcage. This is particularly important for clients with poor trunk control, such as a person with cerebral
palsy (CP) or Muscular Dystrophy (MD).
If a person who is lacking trunk control is placed in a wheelchair that does not provide adequate trunk
support and other supports, the rib cage may not expand enough to allow the lungs to fully inflate,
resulting in inefficient respiration, and less oxygen getting to the body.

13. • A study conducted by Bakes and Devenport titled “Wheelchair Components and
Pulmonary Function in Children with Cerebral Palsy found the following:
• A person with Cerebral Palsy, who experiences no obstruction in airways, may
experience less efficiency during respiration, without correct postural supports.
• If this same individual experiences further compromise by the development of
secondary physical deformities, such as scoliosis, caused by poor postural seating, the
effects on respiration would be further compromised.
• In this study, it was found that lateral trunk stability through the use of an anterior
pelvic belt, upper extremity supports as well as posterior seat tilt of 30 degrees, may
align the trunk and lessen weight or compression on the abdomen, thus allowing the
diaphragm to move more freely, leading to more efficient respiration (Bakes,
Davenport, 2012 pp. 84-85).

14. References
Armstrong, W., Borg, J., Krizack, M., Lindsay, A. Mines, K., .. and Sheldon, S.,(2008) Guidelines on the provisions of
Manual Wheelchairs in less resourced settings. World Health Organization (WHO) pp. 57
Barks, L., Davenport,P.,(2012). Wheelchair Components and Pulmonary Function in Children with Cerebral Palsy:
Assistive Technology® 24.2.pp.78–86.
Clark, J., Michael, S., Morrow, M., (2004). Wheelchair postural support for young people with progressive
neuromuscular disorders: International Journal of Therapy and Rehabilitation, Volume 11, No. 8. , P. 358- 371.
Retrieved from: http://web.b.escohost.com.ezproxy.greenriver.edu/ehost/pdfviewer/pdfviewer?sid=453bf50-
b449-4512-8547-cbea9792cb0c%40sessionmgr110&vid=7&hid=107
Mortenson, W. B., & Miller, W. C. (2008). The Wheelchair Procurement Process: Perspectives of Clients and
Prescribers. Canadian Journal of Occupational Therapy. Revue Canadienne D’ergotherapie, 75(3), 167–175.
Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113492/
Parent, F., Dansereau, J., Lacoste, M., Aissaoui, R. (2000). Evaluation of the new flexible contour backrest for
wheelchairs: Journal of Rehabilitation Research and Development Vol. 37 No . 3, Pages 325—333.
Sladyk, K. & Ryan, S. (Eds.).(2015).(5th Ed). Ryan’s Occupational Therapy Assistant: Principles, Practice Issues, and
Techniques. Thorofare, NJ: SLACK Incorporated. ( 478, 31, 54, 76, 272-282, 476, 478, 480, 522-523,391 -391).