Seating & Positioning

Our students' seating and mobility is key to figuring out access to activities and communication.

Our students need active seating with pelvic weight bearing which assists with visual attention and task engagement.

Task performance position (Rotelli and Kangas)

• • Many times, students in wheelchairs are in passive positions that are intended for getting them safely from one destination to another (home to school, on the school bus, etc)

  • We need to get our students out of their chairs and try getting them in different positions to understand how their bodies work and how we can provide that "working position" as well as the "resting position" they need during the day

  • For isolation, adequate use of an extremity in a graded, controlled movement within a task, pelvic weight bearing must occur and be controlled by the student.

  • This pelvic weight bearing is a position of active holding rather than being passively restricted.

  • Pelvic girdle stability is required for shoulder girdle mobility. (one has to hold for the other to move) This then allows a foundation from which the student's head and hands and eyes can be controlled.

  • Generally a seated position for task performance is best described as the posture a person uses to get up out of a chair. Although this position may be different for every student.

    • shoulders and head are aligned in front of pelvis rather than in line or behind pelvis if possible

    • Feet on the floor, weight bearing and may or may not be symmetrical

    • One knee may be lower than the hip and other in line with hip

    • Knees may be less than 90 degrees flexion, placed below or under body

The power of video & mindful observation

We find it most helpful to use a team approach to view the student videos. Take 3 videos of your student:

• • • student at rest (doing nothing in a typical position)

    • student engaged in a preferred activity without a switch

    • student engaged in a preferred activity with a switch

Key things to observe:

• • • the position of the student’s head, arms, legs, and pelvis

    • is the student in pelvic weight bearing?

Signs the student is potentially not pelvic weight bearing

• • • • • If their feet are kicking

        • Arms hooked around back canes

        • Arms extended and internally rotated

        • They are wearing their hair off the back of the head rest

        • Arms flying up in the air

        • When they are fully collapsed and rounded and hanging on their chest harness

        • Constant pushing and standing on footrests

        • Seats that cause posterior pelvic tilt