Wheelchair Positioning for the Bariatric Patient

Question

What is the optimal wheelchair positioning for obese individuals with a majority of their weight around their hips?  Are there specific positioning techniques to utilize so that they can assist with pushing the wheelchair?

Answer

In terms of obesity, keep in mind that a lot of times you will have clients with a notable gluteal shelf.  By that, I am referring to the fact that when you look at the client laterally, you would see the client's back and then, as their back continues down towards the buttocks, there is excess tissue on the actual buttocks area.  A lot of times, if you were to look at an individual, you may actually have four, five or six inches of tissue behind the actual back of the person that you have to accommodate for.  There’s one thing you can do.  If we go back to our sacrum to popliteal fossa measurement (our upper leg length measurement) you can actually take two measurements instead.  First, you take one measurement from the back of the knee all the way to the farthest point, so as to include that rear end in the actual measurement.  Then, you’re going to take a measurement from where the client’s back is before the rear end starts, so roughly right above that iliac crest, and measure out to where the back of the knee would be.  Now, don’t angle down to the back of the knee, but measure out parallel to the first measurement to where that back of the knee would fall.  So, you essentially have two different measurements, one of which is from where the back of the knee would be to the patient's actual back, and the other one is from the back of the knee to the back of the rear end.  You’ll take those two measurements, and that will tell you how much extra tissue you must accommodate for. 

Now, there is an option that you can get for a wheelchair called a gluteal table.  It will actually mount onto the back of the wheelchair frame. What that will do is allow that client to have that tissue rest on that gluteal table if you incorporate a wheelchair back, that leaves the lumbar portion of the back open and supports them in the upper lumbar to thoracic region of the actual back. This will allow that individual to recess into the chair a little bit more, which will give them better positioning in terms of where their upper extremities are in conjunction with the drive wheels.  This will also give them a better center of gravity.