Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Seating Assessment

Activities to maximize reduction in pressure, friction, and shear when seating.
  • If the client uses a wheelchair, ensure that the wheelchair and seat cushion have been prescribed for that client and it is the latest prescription. Clients may have been given a wheelchair that was prescribed for another relative, or purchased without a therapist’s involvement. In these situations, the fit of the chair may not be ideal. In other cases, the client may have a newer piece of equipment that they are not using. Encouraging the use of the most recently prescribed equipment may help to minimize friction and shearing forces.
  •  Check that there are no foreign objects in the wheelchair.
  • Encourage clients to engage in weight shifting behavior. Depending on the abilities of the client this may include shifting from side to side, leaning forward or using the tilt feature on their chair.
  • Assist clients to reposition themselves in the wheelchair at least every 2 hours.
  • Always use a specialty wheelchair cushion, which has been prescribed by an occupational or physical therapist. Ensure this cushion is correctly placed in the wheelchair. Many cushions have contours on the top of the cushion. The contour in the middle on one side of the cushion is called a pummel. The pummel should be positioned on the top at the front of the wheelchair, as it is designed to help align the legs. Provide education for the client and/or family on cushion use.
  • Check to ensure that the wheelchair is properly maintained and is not worn or bottoming out. As foam cushions near the end of their life span, they may not return to their original shape when the client’s weight is removed; alternatively they may collapse under the client and not distribute the pressure under the client. Some gel cushions may leak. Bottoming out or leaking are indicators that the client requires a new pressure management cushion. Air cushions should be checked to ensure they are properly inflated weekly. The only way to check the inflation of an air cushion is to put your hand between the client and cushion when the client is sitting normally on the chair (Note: wear gloves during this procedure. A low friction sleeve or sheet over the glove will make this process easier). There should be approximately one inch of air between the client’s lowest bony prominence, and the bottom of the cushion