Wheelchair Assessment - Body Measurements

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Introduction

Accurate measurement of the client will enable clinicians to:

• Correctly size trial equipment for the client
• Reduce the number of client transfers and improve time management by pre-setting the seating and wheeled mobility equipment according to body measurement prior to an appointment
• Have an accurate reference for the final seating configuration and any future equipment trials, and
• Outline the clinical reasoning behind the specifications of wheeled mobility prescriptions in funding applications.

Preparations

A well-fitted seating and wheeled mobility system requires a ‘made-to-measure’ solution. Generally, the more seating surface that is in contact with the client, the more body measurements need to be obtained for a wheelchair prescription.

Measuring Tools

• Use a retractable metal tape measure
• clipboards/books can be used to help measure accurately (see How to take body measurements).
• Large callipers are an additional tool that can be very useful. These can be made locally from wood.
• Foot-blocks can be used to support the wheelchair user’s feet at the correct height.

Process

• Ask the wheelchair user to sit as upright as possible.
• The wheelchair user’s feet should be supported on the floor or on foot-blocks if they cannot reach the floor comfortably.
• For all measurements, make sure the tape measure is held straight and the wheelchair user is sitting upright. Holding a clipboard/book on either side of the wheelchair user can help in obtaining an accurate measurement.
• Bend down to ensure you are viewing the tape measure at the correct angle.

Basic Measurements

Five measurements from the wheelchair user are needed to choose the best available size of wheelchair for for a wheelchair user that does not require additional postural support and has good trunk control.

Intermediate Measurements

Pelvis and Hip Posture Screen

Sitting posture is influenced by what is happening around the pelvis and the hips. In this part of the assessment wheelchair service personnel need to determine if the wheelchair user’s pelvis is level when viewed from the front, and whether the hips are able to bend to a neutral sitting posture (trunk to thigh angle is more than 90 degrees), with or without support.

If the pelvis is not level or the hips cannot bend to neutral sitting posture, the wheelchair service personnel need to consider whether the wheelchair user can sit in neutral posture with support or if not, how close to the neutral posture they can sit? If the wheelchair user cannot sit in a neutral sitting posture, it is also important to know if this is limited by a restriction either above the pelvis in the lumbar spine or below the pelvis in the hip joint.

In order for the wheelchair service personnel to answer all the questions above it is necessary to carry out a ‘pelvis and hip posture screen’ part of the assessment. This is not a full Range of Motion assessment but aims to identify only to identify the factors noted above. You may choose to carry out a more extensive Range of Motion Assessment in order to gather more detailed information.

During the screen explain to the wheelchair user what you are going to do and why it is important; and ask the wheelchair user to lie down on their back on an assessment bed. Note: in these instructions, the person carrying out a pelvis and hip posture screen is called the ‘assessor’ and the person who assists the assessors is called ‘assistant’, who could be a co-worker, trained assistant, family member or caregiver.

In order to conduct the Pelvis and Hip Posture Screen the wheelchair service personnel will need to be able to:

• Locate bony landmarks of the pelvis
• Understand the structure of the wheelchair users skeleton and the influence of the various muscle groups on the articulation of the joints.
• Understand body planes and ranges of movement to identify fixed vs. flexible deformities.

Pelvis Posture Screen

Step 1

• assessor bends both the wheelchair user’s knees slightly and provides some support, which helps to relieve tension on the hips;
• assistant places their hands firmly on the wheelchair user’s trunk, around their lower ribs;
• assessor grips the pelvis gently with thumbs on the ASIS;
• assessor checks if thumbs/ASIS are level;
• if not level, assessor gently but firmly tries to align the pelvis so that both ASIS are level;
• assistant reports if he/she feels the trunk move, which means that there is some restriction to the movement;
• note how close to neutral/level it is possible to bring the pelvis;
• assessor records if the pelvis can be level on the intermediate wheelchair assessment form.

Hip Posture Screen

Step 2

• assistant gently but firmly holds the wheelchair user’s pelvis;
• assessor bends the leg that is not being tested slightly at the knee, resting the foot on the mat. This helps to reduce the tension in the hip being tested. This leg may need to be supported.

Step 3

• assessor gently moves the leg being tested into the neutral sitting posture;
• assistant reports if he/she feels the pelvis move, which means that there is some limit (restriction) to the movement;
• assessor feels how freely the hip joint can move;
• assessor repeats on the other side and compares;
• assessor records if right and left hip can bend to neutral sitting posture on the intermediate wheelchair assessment form.

Step 4

• assessor records how close to neutral posture each hip can reach with a goniometer with the help of an assistant;
• assessor places the pivot point of the goniometer on the hip joint. Assessor positions one arm of the goniometer along the thigh bone and one arm in line with the trunk;
• assessor holds the two arms together firmly;
• assessor records right and left hip angle degree measurements on the intermediate wheelchair assessment form. Assessor can also draw the angle of the goniometer on a separate piece of paper or on the back of the intermediate wheelchair assessment form.

Consider temporary supports for a fixed unlevel pelvis and for the hips that cannot bend to neutral sitting posture. If the pelvis cannot be level or the hip cannot bend to a neutral sitting posture, it will need to be supported in the non-neutral posture in the final wheelchair. To continue the assessment, a temporary support should be made for the wheelchair user to sit on.

During an assessment, the temporary support will: allow the wheelchair user to sit with more stability and balance; stop the wheelchair user from compensating for the unlevel pelvis or hips that cannot bend to neutral sitting posture and allow the wheelchair service personnel to carry on the assessment and concentrate on the rest of the wheelchair user’s posture including pelvis, trunk, head, neck and legs.

A temporary support can be made of firm foam. The table below shows the different postural problems, temporary supports and possible permanent support for these problems.

Hand Simulation

Hand simulation helps to identify what support the wheelchair user needs. During the hand simulation, the wheelchair service personnel use their hands to determine if the wheelchair user sit in neutral posture with support and if not, then determine how close to the neutral posture they can sit in order to assess what support is needed and where. During a hand simulation, the wheelchair service personnel work with the wheelchair user and an assistant or family member/caregiver to provide support with hands.

How to Carry Out Hand Simulation

Important aspects to remember when carrying out a hand simulation are: explanation to the wheelchair user about what you are going to do and why. Ask the wheelchair user to sit on a firm but padded, flat surface. An assessment box is idea so the wheelchair service personnel and assistant or family member/ caregiver can easily provide support to the wheelchair user from the front, back and sides. If the wheelchair user cannot safely sit without support ask an assistant or family member/caregiver to support them. Ensure the wheelchair user’s feet are supported at the correct height for them. If the pelvis is unlevel or if one of the hips cannot bend to neutral sitting posture (trunk to thigh angle is more than 90 degrees), provide a temporary support as described above.

It is often necessary to have more than one pair of hands when completing a Hand Simulation, so team work is key. Take help from the assistant, who could be a co-worker, trained assistant, family member or caregiver. Involving family members/caregiver will also help them to better understand the final Postural Support Device solution that is selected.

Communication is also vital, both with the wheelchair user and family member/caregiver. If the wheelchair user is non-verbal, ensure you find an appropriate method of communication with them so they can feedback to you in relation to how the changes feel. Remember to explain to the wheelchair user what you are doing at each step.

Think carefully about what your hands are doing as they are providing the support that will later be provided by the wheelchair and postural support devices. Ensure you pay careful attention to;

• where your hands are placed;
• the direction of force/support;
• how much force/support is being used;
• how much surface area your hands are covering (for example, are you using just one finger or a whole hand);

Always provide support at the pelvis first as the posture of the pelvis will affect the posture of the rest of the body. So if the wheelchair user’s pelvis is not in neutral, use your hands to encourage the pelvis towards neutral. When the pelvis has been supported, focus on other parts of the body in the following order:

• trunk/arms;
• head and neck;
• hips and thighs;
• lower legs.

Finally ensure you only make one change at a time and observe how the changes in one part of the body affect other parts, always getting feedback from the wheelchair user.

Resources

References