What are adjustments I can make to the set-up of my wheelchair?

Author: Sharon Jang | Reviewer: Emma M. Smith | Published: 3 March 2020 | Updated: ~

There are many necessary considerations for setting up a manual wheelchair properly for mobility and function. It is important to work with a knowledgeable health care professional and vendor to ensure the correct decisions are made.

These considerations may include:

Various factors can influence your ideal wheelchair set up. In this photo, some considerations include having a dog and wheeling on grass.¹³

• Activities of Daily Living: It is important to think about where you need to take your chair, how close you can get to or under surfaces, reach for things, and how easily you can remove components and put them back on.
• Mobility: You need to consider what surfaces you will wheel on (carpet, flooring, snow, rain). How the chair will move over inclines and transitions as well as in confined spaces. Is it a primary chair or just an indoor chair or a transport chair?
• Positioning: It is important to consider your posture, comfort and interacting with people and your environment.
• Psychosocial: You want to consider how you look and feel and how you will interact with people and your environment.
• Transfers: You need to look at the ability to get in and out of the wheelchair safely so the height, stability, ease of moving and weight are some of the things to consider.

The three most important adjustments to have in a manual wheelchair are back angle, axle position and seat to floor height. These adjustments are important as they can have an impact on pain, wounds, or postural issues. The wheelchair set-up is essential to allow for safety and balance of the chair.

The horizontal position of the rear wheel axle can affect how much energy is required to move the wheelchair. Studies have shown that placing the rear wheel axle closer to the front of the wheelchair can make it easier to propel. However, it can also affect the stability of the wheelchair, and make the wheelchair more likely to tip backwards. This is because there is more weight behind the axle. Decisions on where to place the axle will depend on the person’s wheelchair skills. The distance between the shoulder and the axle of the rear wheel can also affect efficiency. One study showed that greater distances may result in greater energy requirements. Adding adjustable axles to manual wheelchairs can help individuals customize their wheelchairs to improve propulsion. This can lead to reduced risks of upper body injuries specifically shoulder injuries.

The appropriate backrest height is largely a trade-off between posture, comfort and freedom of movement. A backrest is usually 406mm (16″) tall, and often does not come up any higher than your shoulder blades – any higher and it will impede your ability to push your wheelchair. Most manual wheelchairs have the ability to modify the height of the backrest (so it can be modified as function increases or decreases). A higher backrest is seen to be more comfortable, and is often used by individuals with limited trunk functioning as it provides more support. On the contrary, a shorter back rest allows for more movement of the trunk, which can be functionally useful (e.g., it will allow you to reach for objects sideways and behind you).

Using a wheelchair with backrest height that is not optimal may have negative consequences. If the backrest is too low, there will be a lack of support which may lead to postural instability. However, most often individuals are using backrests that are too high. This may result in a limited reach (and thus reduction in functional activity), pain, and a slouching posture as a result of compensating for sliding forward.

The lateral position of the rear wheel is the distance the wheel is from the wheelchair frame. This distance can affect the overall width of the wheelchair and how accessible the wheel is.

Camber relates to the rear wheels being set on an angle from their axle position, where the distance between the top of the wheels is less than at the bottom of the wheels. The angle can range from 0º up to an extreme 12º, although the average camber for day wheelchairs varies from 0º to 4º. Some wheelchair models offer adjustability in camber angles within the same chair. Stability, wheeling efficiency, and turning maneuverability can be enhanced with wheel camber, especially when moving over side slopes. In addition, the hands are better protected against trauma because the wheels touch the floor spanning a wider area than the hands have in contact with the hand rims. Too much camber can make the overall width of the wheelchair wider so assessment of the spaces and doorways needed to access is essential when deciding on camber.

A large camber is often seen on sport wheelchairs, measuring up to 15º. A greater camber is of beneficial use to wheelchair sports, as it provides more lateral support to prevent tipping over to the side when turning quickly and sharply. It also helps to create turns that are smoother and sharper when in motion.

Proper support of the feet and legs is important to the comfort and safety of the wheelchair user. If the foot and thigh is not properly supported it may result in the leg or foot moving excessively and may result in instability, pain, and spasticity. In addition, it can create areas of pressure on the leg or the foot, ultimately leading to pressure injuries. Support can be adjusted through altering the height and length of the footrest.

The foot rest should be 1-2 inches off the ground to allow for optimal clearance. If it is too low, it may catch on door threshold and other objects, and may cause difficulties when trying to go up or down hills or slopes. Should the footrest unexpectedly hit an obstacle, there is a high risk of the user falling out of their wheelchair.

Refer to our article on Wheelchair Seating for more information on footrest set-ups