How to keep elderly from sliding out of wheelchair: A comprehensive guide

Over 9.5 million seniors in the U.S. live, for some period, in long-term care or post-acute care facilities, where mobility issues are common. A common challenge for many is knowing how to keep elderly from sliding out of wheelchair, a problem that can cause falls, injury, and a loss of dignity. Preventing this requires a multi-faceted approach, combining proper equipment with attentive care techniques.

Quick Summary

Preventing an elderly individual from sliding out of their wheelchair requires a careful combination of proper seating assessments, utilizing effective positioning aids like specialized cushions and belts, and employing correct transfer and repositioning techniques to ensure safety, comfort, and stability.

Key Points

• Check Wheelchair Fit: Ensure the wheelchair's seat depth and width are appropriate for the user to provide adequate support and prevent slouching.

• Use Specialized Cushions: Invest in an anti-thrust or pommel cushion with a non-slip base to promote proper pelvic alignment and prevent forward sliding.

• Perfect Positioning: Always help the person sit with their hips fully against the backrest, feet properly supported on footrests, and shoulders relaxed.

• Employ Safe Transfers: Use correct body mechanics and a gait belt during transfers, and always remember to lock the wheelchair brakes.

• Encourage Gentle Exercise: Implement physical or occupational therapy exercises to strengthen core muscles and improve posture, reducing the tendency to slide.

• Monitor for Discomfort: Listen to the user's feedback, as sliding can be a sign of discomfort. Regularly check for signs of skin irritation or pressure sores.

Understanding the Root Causes of Sliding

To effectively address the issue of sliding, it's essential to understand the underlying reasons. It's often a combination of physical and environmental factors.

Physical and Physiological Factors

• Muscle Weakness and Fatigue: As we age, a natural decline in muscle strength, particularly in the core, legs, and back, makes it difficult to maintain an upright, stable posture for extended periods. Individuals may slump forward to compensate, initiating a slide.
• Poor Posture and Pelvic Tilt: A posterior pelvic tilt, where the hips roll backward, causes the user to slump and slide forward in the chair. This can be caused by muscle imbalances, comfort-seeking behaviors, or discomfort.
• Hamstring Tightness: Tight hamstrings can pull the pelvis into a posterior tilt, forcing the user to slide forward in an attempt to straighten their legs and find a more comfortable position.
• Sensation Changes: Reduced sensation due to conditions like neuropathy can limit a person's awareness of their positioning, making it harder to correct a slide instinctively.

Equipment-Related Factors

• Improper Wheelchair Fit: A wheelchair that is too wide offers inadequate lateral support, causing a person to lean and shift. If the seat is too deep, it can put pressure behind the knees and cause sliding. Conversely, a seat that is too short may cause the user to lean forward for support.
• Incorrect Footrest Height: If the footrests are set too high, pressure is placed on the bony parts of the hips. If they are too low, pressure falls on the back of the thighs. Both scenarios can trigger a cascade of poor positioning and sliding.
• Inadequate Cushioning: A standard, flat cushion offers little to no support for maintaining proper pelvic alignment. It can also increase pressure, prompting the user to shift and fidget.

Practical Solutions and Essential Equipment

Fortunately, a range of solutions and specialized equipment can significantly reduce the risk of sliding.

Positioning Aids and Cushions

• Anti-Thrust Cushions: These cushions have a raised front and a lower back, which helps to tilt the pelvis back into a neutral, stable position, preventing forward sliding.
• Pommel Cushions: Featuring a built-up area between the legs, a pommel cushion provides excellent slide control and helps keep the legs properly aligned.
• Non-Slip Seat Pads: These pads, with special high-friction material on the underside, prevent the cushion itself from shifting. Some even have a one-way slide feature that allows movement backward but not forward.
• Wheelchair Belts and Harnesses: Used properly, a pelvic belt can stabilize the user’s hips and prevent the pelvis from tilting forward. It is crucial to position the belt correctly across the pelvic bone, not the abdomen, to avoid injury. For more comprehensive support, a torso support vest can prevent leaning or tilting.

Comparison of Positioning Aids

Aid Type	Primary Benefit	Best For...	Considerations
Anti-Thrust Cushion	Corrects posterior pelvic tilt	General sliding prevention	May not be enough for severe cases.
Pommel Cushion	Provides slide control and leg alignment	Individuals who slide forward significantly	Requires proper sizing to ensure comfort.
Non-Slip Seat Pad	Secures the cushion to the chair	Preventing the cushion itself from shifting	Does not provide postural support on its own.
Pelvic Belt	Stabilizes the pelvis and hips	Preventing sliding due to poor posture	Must be fitted correctly across the hip bones.
Torso Support Vest	Offers comprehensive upper body stability	Preventing tilting or leaning for those with significant weakness	Requires careful fitting to avoid injury and must never be used as a restraint.

Perfecting Positioning and Transfers

Even with the right equipment, proper technique is vital to ensure long-term safety and comfort.

Safe and Correct Seating

1. Scoot to the Back: Ensure the individual is sitting all the way back in the wheelchair with their buttocks completely touching the backrest.
2. Level the Pelvis: Check that the hips are level and the spine is straight. For those who need assistance, gently help shift their weight side to side to push them back into position.
3. Adjust Footrests: Position the footrests so the feet are supported and the thighs are parallel to the floor.
4. Support Upper Body: Make sure the armrests are at a height that allows the elbows to be slightly bent and the shoulders relaxed, providing stable upper body support.

Safe Transfer Techniques

• Lock the Brakes: Always lock the wheelchair's brakes before initiating any transfer. This is a non-negotiable safety step.
• Minimize Distance: Position the wheelchair as close as possible to the destination surface (e.g., bed, toilet, chair) to reduce the distance of the transfer.
• Use Proper Body Mechanics: Caregivers should bend at the knees and hips, not the waist, to protect their back. Maintain a wide base of support and keep the individual close to your body.
• Employ a Gait Belt: A gait belt provides a secure handhold around the person's waist, allowing for a safer and more controlled transfer. It's positioned around the waist, below the ribcage.

For more in-depth information on proper transfer techniques, visit the Physiopedia guide on Wheelchair Skills Training.

The Importance of Exercise and Therapy

While equipment and technique are crucial, maintaining a degree of physical strength is also vital for preventing sliding. Occupational and physical therapy can play a significant role.

How Therapy Helps

• Strengthening and Conditioning: Therapists can provide specific seated exercises to strengthen the core and upper body, improving the ability to maintain an upright position.
• Posture Correction: Occupational therapists help patients practice proper seating alignment and develop the skills to adjust their own posture.
• Range of Motion: Regular exercises help to combat joint stiffness and muscle tightness, including tight hamstrings that contribute to sliding.

Promoting Independence

By helping seniors improve their physical capabilities, therapy empowers them to be more active participants in their care, boosting their confidence and independence.

Creating a Safe Environment and Maintaining Vigilance

Beyond individual techniques, the overall environment and a mindful approach are key.

• Regular Skin Checks: Poor posture and sliding increase the risk of pressure sores. Regular skin inspections are crucial for early detection and prevention.
• Awareness and Education: Caregivers should be educated on the risks and prevention strategies associated with wheelchair sliding. This includes recognizing early signs and knowing how to respond.
• Listen to the Senior: Often, sliding is a sign of discomfort. Listen to the individual's concerns about pain or positioning, as they are the best source of feedback.

Conclusion

Sliding out of a wheelchair is a serious concern, but it is largely preventable with the right combination of tools, techniques, and care. By addressing the root causes, implementing effective positioning aids, teaching safe transfer methods, and encouraging physical activity, caregivers can ensure the safety, comfort, and dignity of their elderly loved ones. A proactive approach is the best way to prevent falls and create a stable, supportive environment for those who rely on a wheelchair for mobility.

Frequently Asked Questions

What is the primary cause of an elderly person sliding out of a wheelchair?

The primary cause is often a combination of muscle weakness, fatigue, and poor posture, particularly a posterior pelvic tilt where the hips roll backward. An ill-fitting wheelchair or inadequate cushioning can also exacerbate the problem.

Are wheelchair belts considered a form of restraint?

When used for proper positioning and support, a pelvic belt is not a restraint. It helps stabilize the hips. However, using any device to restrict a person's movement without medical necessity or informed consent is considered a restraint and should be avoided.

How can I check if the wheelchair fits properly?

Ensure the user's hips are completely at the back of the seat. For width, there should be a small space on either side of the hips. Check that the seat depth doesn't put pressure behind the knees, and that footrests allow thighs to be parallel to the floor.

What are the risks of ignoring a sliding problem?

Ignoring a sliding problem can lead to serious risks, including falls, injury, skin breakdown, and pressure sores due to increased shear forces. Poor posture can also restrict breathing and digestion.

What kind of cushion is best for preventing sliding?

Anti-thrust cushions with a raised front or pommel cushions with a built-up area between the legs are highly effective. For added security, a non-slip pad can be placed beneath the cushion.

Should I use a towel or a pillow to help with positioning?

No. While it might seem helpful, pillows and towels can create concentrated pressure points that increase the risk of skin breakdown and pressure sores. Specialized cushions and positioning aids are designed to distribute pressure evenly and safely.

How often should I reposition someone in a wheelchair?

To prevent sliding and pressure sores, a caregiver should assist with repositioning every 15 to 30 minutes, especially for individuals who cannot shift their own weight. This helps redistribute pressure and maintain good blood flow.