Phone: 866-782-6258

Wheelchair Positioning for the Bariatric Patient

Kirsten Davin, OTD, OTR/L, ATP, SMS

August 2, 2012



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?


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.  

kirsten davin

Kirsten Davin, OTD, OTR/L, ATP, SMS

DR. KIRSTEN DAVIN, OTD, OTR/L, ATP, SMS is best known for her long running seminar, Let’s Roll!  The Art of Performing Seating and Mobility Evaluations.  She is a licensed Occupational Therapist, certified Assistive Technology Professional (ATP) and Seating and Mobility Specialist (SMS), with extensive experience in a variety of practice areas including inpatient, acute care and intensive care units, as well as the Central Illinois Regional Burn Center.  She is the owner of a successful home health-based private practice, Escape Mobility Solutions, LLC, which is dedicated to evaluating individuals for custom forms of assistive technology, such as power and manual wheelchairs, seating and positioning systems, and augmentative and alternative communication.  She regularly conducts workshops on a national basis, regarding seating/positioning and assistive technology, and prides herself in offering entertaining and engaging seminars, and make learning fun.  Dr.Davin completed her undergrad studies in occupational therapy, and graduated Summa Cum Laude from the University of Illinois at Chicago in 2001.  She received her Doctorate in Occupational Therapy in 2007, from Rocky Mountain University of Health Professions in Provo, Utah, where she now holds a faculty position. 


Related Courses

Contemporary Guidelines for Exercise and Diabetes: Application to Physical Therapy Cases
Presented by Gina Pariser, PT, LDE, PhD
Recorded Webinar


Gina Pariser, PT, LDE, PhD
Course: #3387Level: Introductory2 Hours
  'Overall the course was very well put together and organized and went along with my learning style'   Read Reviews
Physical activity is established as an important therapy in the prevention and management of diabetes and diabetes-related health comorbidities. This course reviews new guidelines related to physical activity for improving glucose control and cardiovascular health in people with Type 1 and Type 2 diabetes and highlights ways to apply these guidelines in different physical therapy cases. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Diabetes in Adults: Current Guidelines and Evidence
Presented by Sally Stillings, MA, PT, MPT, CHT
Recorded Webinar


Sally Stillings, MA, PT, MPT, CHT
Course: #3958Level: Intermediate2 Hours
  'The course provided useful information for treatment of my patients that have a form of diabetes'   Read Reviews
This course gives us an overview of diabetes in adults, discusses current perspectives and guidelines, and addresses its significance in PT practice. It also looks at some of the current literature that addresses the evidence for risk factors and interventions and to see how they may apply to our practices. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

A Physical Therapist Guide to Exercise Prescription for the Diabetic and Pre-diabetic Population
Presented by Rina Pandya, PT, DPT, PGCert LTHE, AFHEA
Recorded Webinar


Rina Pandya, PT, DPT, PGCert LTHE, AFHEA
Course: #4483Level: Advanced3 Hours
  'Really excellent presenter who keeps you engaged through the long course time'   Read Reviews
This course equips the physical therapist to identify pre-diabetes and type 1 diabetes in their patients based on history and clinical signs and symptoms. Exercise Prescription, the interaction of other medications, and modulation of a current exercise program for patients with diabetes as a co-morbidity are also included. This course also includes the management of diabetes from a Covid-19 perspective.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 3 hours of Direct Access CE credit.

Trauma Informed Care Principles for Rehabilitation Professionals
Presented by Jennifer Stone, PT, DPT, OCS, PHC
Recorded Webinar


Jennifer Stone, PT, DPT, OCS, PHC
Course: #3975Level: Intermediate2 Hours
  'well explained topic'   Read Reviews
Acute and chronic trauma is very prevalent in the United States, and have been tied strongly to adverse health behaviors and outcomes. This course provides the rehabilitation professional with an overview of the physiology of trauma, as well as practical tools to work with patients who are experiencing trauma. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Overcoming Compassion Fatigue in Our Work Environment
Presented by Neely Sullivan, MPT, CLT-LANA, CDP
Recorded Webinar


Neely Sullivan, MPT, CLT-LANA, CDP
Course: #4314Level: Introductory2 Hours
  'This is a good reminder for therapists to take care of thrmselves, both physically and mentally'   Read Reviews
This seminar will describe the stages, causes, symptoms, and consequences of compassion fatigue. It will also introduce strategies for assessing levels of stress and implementing strategies to prevent/minimize the development of compassion fatigue in your healthcare setting. This course is directly related to the practice of physical therapy and athletic training and is therefore appropriate for the PT/PTA and AT.

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.