At Physit, we believe that learning never stops! Recently, we hosted a collaborative continuing professional development (CPD) meeting with an experienced Occupational Therapist (OT), Sue Hughes, which focused on wheelchair assessments – a crucial aspect of ensuring independence, mobility and quality of life for many of our patients.

Why Wheelchair Assessments Matter

Wheelchairs are not just a mode of transport; they are an extension of a person’s daily life. The right chair can support posture, reduce pain, prevent secondary complications and enhance participation in everyday activities. Conversely, an unsuitable chair can limit independence and even compromise health. That’s why our CPD session with OT Sue Hughes was so important!

Wheelchair assessments are detailed and highly individual

They consider how the chair will be used, methods of propulsion and transfer, the patient’s posture, skin integrity, sitting balance, and even cognitive status. Practical considerations such as storage, maintenance, and NHS eligibility for powered chairs also play a role. Careful measurements, from hip width to back height, ensure the right fit for comfort, safety, and postural support.

During the CPD we explored the assessment process – from understanding physical needs to evaluating the home environment.

A thorough seating assessment is the foundation of effective wheelchair selection:

• Pelvis: Look for obliquity (unequal height of the pelvis), rotation, or tilt (anterior or posterior). Many people naturally sit in some degree of posterior tilt, but this must be carefully managed in wheelchairs, as it places significant pressure on the sacrum and increases the risk of sacral pressure sores.
• Trunk: Assess for spinal curves such as scoliosis or kyphosis. The key is to determine whether these are fixed contractures or flexible enough to be influenced by correcting pelvic alignment. Adjustments at the pelvis can often change trunk positioning.
• Head: Consider the person’s preferred or habitual head posture – whether lateral lean, rotation, or forward positioning is preferred. Head position has implications for communication, swallowing, and overall comfort.
• Feet: Check how the individual’s feet can be positioned on the footplates. Proper foot placement contributes to overall stability and weight distribution.

Measurements are also essential to ensure the chair fits the person, rather than the person adapting to the chair.

• Seat width: Based on hip width, with an allowance of about 1.5 inches on either side.
• Seat depth: Measured from the buttocks to the back of the knee, minus around 2 inches to prevent pressure into the back of the legs.
• Lower leg length: From the back of the knee to the heel – check the adjustability of footplates according to manufacturer specifications.
• Back height: Ideally up to just below the scapula, unless greater trunk or head support is needed, in which case, higher backs and headrests may be required.
• Height and weight: Both critical for ensuring safe prescription, particularly within NHS provision.
• Attendant factors: Adjustable handle heights may be necessary depending on who will push the chair.

Postural support and comfort – how seating systems and positioning prevent complications.

Postural support directly impacts function, skin integrity, and long-term health. A well fitted wheelchair not only provides comfort but also prevents secondary complications such as pressure injuries, contractures, or respiratory problems. Cushioning is central to this:

• Gel cushions: offer a stable base and are often preferred for postural management.
• Air cushions: adjustable for asymmetries – air can be shifted side to side or front to back to re-distribute pressure.
• Foam cushions: lightweight and suitable for shorter journeys where posture is less of a concern.

The goal is to achieve comfort, stability, and security in the chair, enabling the person to engage in daily activities without compromising their health.

Collaboration across professions – physios and OTs working together to recommend the best solutions.

Physiotherapists bring expertise in movement, posture, and muscle balance, while occupational therapists contribute insights into function, daily living, and environmental factors. Working together, they can:

• Identify and prioritise seating needs.
• Balance mobility with postural security.
• Recommend equipment that is clinically effective, practical, and acceptable for the person’s lifestyle.

This collaboration ensures recommendations are holistic, blending physical alignment and support with functional and social considerations.