Michelle L. Lange, OTR/L, ATP/SMS

Our brains are wired to move, and we seek out movement.

It is so easy for me to take movement for granted. While I may spend too many hours in an office chair in front of my computer, I can stand and move about. I can also move my body within the office chair – rocking, rotating, tilting, reclining, and scooting around on the seat. Why do I change my position? The same reasons you do – to increase my alertness and focus, to relieve discomfort associated with remaining in one position too long, and to resume a more functional position for the task at hand.

In this longer-than-average blog, we will take a deep dive into why many people using wheelchair seating are unable to move within their seating system or can only do so at the expense of losing alignment. While more product innovation is indicated, solutions are available and must be explored and advocated to best meet client needs.

I believe that people using wheelchair seating fall into 3 categories of movement – or lack thereof:

1. People who can move within their wheelchair seating system and return to optimal alignment

Movement provides variety of position, which is important for functional tasks as well as moving joints and muscles.

Many people using wheelchair seating can move within their seating system and then return to an optimal position. This provides variety of position, which is important for functional tasks as well as moving joints and muscles. This movement also provides, well, movement. Our brains are wired to move and movement within a wheelchair seating system provides the same benefits as me moving within my office chair – increased alertness, relieving discomfort, and changing position for specific tasks. For someone in a wheelchair seating system, pressure is also relieved and redistributed.

An example is a person who intentionally slides into a posterior tilt for a short time to vary position, and then independently returns to upright sitting. An example of a technology that helped to increase changes in position for this population was the Elevation wheelchair through PDG Mobility. Unfortunately, this innovative product was discontinued in 2023.

2. People who can move within their wheelchair seating system, though lose postural alignment

Some people using wheelchair seating can move within their seating system yet are not able to independently return to an optimal position. This is typically because movement results in the person pushing off of a non-yielding surface, such as pushing against the backrest during hip extension, resulting in the pelvis pushing into posterior pelvic tilt. Another example is pushing off of the footplates, elevating the pelvis, which then returns to the seating surface in a posterior pelvic tilt. This person may lack the ability to return to an optimal position after movement.

In these situations, movement can be provided through Dynamic Seating without resultant loss of position.

In these situations, movement can be provided through Dynamic Seating without resultant loss of position. When a person, for example, pushes against the backrest during hip extension, a Dynamic Back moves in response, diffusing force and reducing leverage so that the user returns to a neutral position. If the person is pushing against the footplates, Dynamic Footrests move in response to this force, again, diffusing force and reducing leverage so the user can extend the legs without loss of pelvic position.

3. People who have little or no movement within their wheelchair seating system

Then there are people using wheelchair seating who are not able to move at all or very little within their seating system. This may be due to paralysis, profound muscle weakness, or a very aggressive seating system which limits movement while providing significant postural support.

In these situations, movement may be provided through manual or power seating options such as tilt, recline, elevating legrests, or seat elevation. While some movement is provided, there is no change of body angles (one part of the body in relation to another part of the body) when using tilt or elevate features. And this movement is only independent if the user can control a power seating function(s) which is typically available on power wheelchairs.

Our industry needs to provide further positional changes for this population which the user can independently control. Most driver seats in motor vehicles offer more positional changes than a power wheelchair with power seating!

For someone with little or no active movement, it is critical to provide external movement though power seating. Although limited primarily to changing the seat to back and knee angles, this movement provides the benefits already mentioned and more. Our industry needs to provide further positional changes for this population which the user can independently control. Most driver seats in motor vehicles offer more positional changes than a power wheelchair with power seating!

This young lady has almost no ability to move within her seating system, with the exception of her arms and neck.

For someone who requires a very aggressive seating system which limits active movement, tilt can provide movement, though not a true change in body position. As many people in this scenario have increased muscle tone, recline can actually increase muscle tone by opening the seat to back angle. Once the person chooses to return to upright seating, the pelvis typically returns to a position of posterior pelvic tilt secondary to shear forces and/or increased muscle tone. Similarly, elevating legrests can elicit further increases in lower extremity extension as the knee angle increases and make return to a more flexed position difficult. Use of power elevating legrests to extend the legs can actually lead to muscle tears and other injuries when pulling against tight muscles.

Dynamic Seating can provide some movement, even within a very aggressive seating system. A client may not be able to move their hips in relation their seating system secondary to restrictive seating, however a Dynamic Back can allow hip extension without loss of position. A client may not be able to move their feet off of the footplates secondary to seating interventions such as shoe holders with strapping, however the client can extend their knees and ankles using Dynamic Footrests.

I see many people who require aggressive seating interventions to achieve and maintain optimal positioning. Pairing these interventions with Dynamic Seating preserves alignment with the seating system while allowing movement.

I would love to hear your thoughts on this important topic. Please leave questions and comments below. Let’s get this discussion ‘moving’!