Essential steps for safe manual wheelchair positioning
Safely and correctly positioning someone in a wheelchair is paramount for their health, comfort, and safety. The process should be a collaborative effort, involving clear communication and respecting the individual's abilities and needs. Before starting, always ensure the wheelchair's brakes are locked and any accessories like armrests or footrests are moved out of the way to create a clear and stable workspace.
The hip hitch method (for individuals who can assist)
The hip hitch is a manual repositioning technique suitable for those who can bear some weight and assist in the movement.
- Step 1: Preparation. Start with the individual sitting slightly forward in the chair. Ask them to cross their arms over their chest.
- Step 2: Lean to one side. With a caregiver kneeling or squatting in front, have the person lean to one side (e.g., to the right). The caregiver places one hand on the person's left hip and the other on their left knee.
- Step 3: Move the hip back. Guide the person's left hip backward, helping them scoot back in the chair. Use your legs, not your back, for the lift.
- Step 4: Repeat on the other side. Have the person lean to the other side (e.g., to the left) and repeat the process on the right hip.
- Step 5: Final adjustment. Continue alternating sides until the person is seated all the way back in the wheelchair, with their pelvis touching the backrest.
Two-person repositioning technique (for maximum safety)
For individuals with limited or no ability to assist, a two-person team provides maximum safety and support.
- Step 1: Positioning. Lock the wheelchair brakes. One caregiver kneels in front and the second stands behind the chair.
- Step 2: Secure the person. Have the person cross their arms over their chest. The caregiver in front places their arms under the person's thighs. The caregiver behind reaches under the person's arms and grasps their forearms or a transfer belt.
- Step 3: Lift and shift. The caregivers count to three and, using their legs to lift, slowly and carefully lift the person up and back into the chair.
Using assistive positioning aids
Assistive devices can significantly improve safety and reduce strain on both the caregiver and the user.
| Assistive Device | Description | Best For | Benefits |
|---|---|---|---|
| One-Way Slide Sheet | Fabric with a textured surface that allows movement in one direction (e.g., backward) but not the other. | Repositioning someone who slides forward in their chair frequently. | Reduces friction, minimizes physical strain on the caregiver, and prevents sliding back forward. |
| Transfer Belt | A belt with handles that is placed around a person's waist, providing caregivers a secure and comfortable grip. | Manual-assist transfers and repositioning maneuvers. | Allows the caregiver to maintain a firm hold and use proper body mechanics, reducing risk of back injury. |
| Anti-thrust Cushion | A specialized seat cushion with a higher front and lower rear to prevent the user from sliding forward. | Users who experience frequent forward sliding or "sacral sitting." | Promotes proper pelvic alignment, reducing pressure on the tailbone. |
| Mechanical Lift | A motorized device with a sling used for transfers between surfaces. | Individuals who cannot bear weight or require maximum assistance. | Safest option for transfers, virtually eliminates caregiver lifting and reduces risk of injury. |
Ensuring correct posture in a wheelchair
Proper posture is vital to prevent complications like pressure ulcers, pain, and respiratory issues. Once a person is seated all the way back in their wheelchair, follow the 90-90-90 rule to ensure optimal alignment.
- Hips: The hips should be positioned at a 90-degree angle.
- Knees: The knees should also be bent at a 90-degree angle, with the thighs parallel to the ground.
- Ankles: The ankles should be at a 90-degree angle, with feet flat and fully supported on the footrests.
Final adjustments
- Backrest: The backrest should support the natural curves of the spine. For those needing higher support, a full backrest with a headrest might be necessary.
- Head: The head should be centered and aligned with the spine, not tilted to one side.
- Armrests: The armrests should be adjusted so the elbows are comfortably bent at a 90-degree angle, with shoulders relaxed.
Prevention and care: Beyond the initial position
Maintaining good positioning is an ongoing process. Caregivers should implement a schedule of regular repositioning, typically every 15 to 30 minutes, to relieve pressure on weight-bearing areas. This practice is essential for preventing pressure ulcers, which are a major health risk for wheelchair users. Daily skin inspections are also critical for early detection of any redness, warmth, or irritation. Using specialized cushions can further aid in pressure redistribution.
Conclusion
Knowing how to position someone in a wheelchair correctly is a fundamental skill that directly impacts their health, comfort, and quality of life. By following safe manual repositioning techniques, utilizing appropriate assistive aids, and ensuring the correct postural alignment, caregivers can provide superior care while protecting their own bodies from strain. Regular repositioning and proactive measures against pressure injuries are continuous responsibilities that contribute to the long-term well-being of the person in the wheelchair. If there are any complex medical needs, always consult with a physical therapist or occupational therapist for a personalized seating assessment. For further reading on safe transfers and positioning, consult authoritative resources like the Model Systems Knowledge Translation Center (MSKTC).(https://msktc.org/sci/factsheets/safe-transfer-technique)
