Wheelchair for children

What should you consider when choosing a wheelchair for a child? There are many different types of wheelchairs for children, which can make it difficult to determine which type is best for your child in terms of optimal seating position. In this article, we provide advice on what to consider when choosing a wheelchair for a child.

Written by: Kine Huseby Michelsen, Physiotherapist

What should you consider when choosing a wheelchair for a child?

Children who use a wheelchair often spend extended periods sitting throughout the day. If a child remains in an unfavorable position for a long time, it can be tiring for the child and place undue strain on both joints and muscles. An unfavorable position may involve sitting asymmetrically, which is especially important to consider if the child has limited mobility. An asymmetrical position can lead to muscle contractures and deformities in the legs and joints for children with reduced or no mobility. Therefore, it is very important from the beginning to prevent the child from developing poor postures.

What is PPAS?

PPAS (Posture and Postural Ability Scale) is a valid and reliable assessment tool used by healthcare professionals to evaluate asymmetries in sitting, standing, supine, and prone positions. This tool highlights that some positions are better for the child than others, and assessments are made based on six points from both the front and the side. The goal is for the child to sit as symmetrically as possible. PPAS is used for all different diagnoses and levels of function, as well as for both adults and children. Based on the PPAS manual (with some adjustments), we have outlined the points to consider when, among other things, choosing a wheelchair for a child.

Assessment of wheelchair for children

1. The head is in a neutral position

Is the head within the body’s midline, or does it lean to one side? The position of the head starts with the pelvis and lower back. A straight lower back and a neutral pelvis balance the entire spine, neck, and head.

2. The trunk must be symmetrical

The trunk refers to the upper body without the arms. Here, you should look for whether the trunk is symmetrical, or if there is asymmetry, such as the upper body leaning to one side or being rotated/twisted. If you are unsure, you can compare the distance from the shoulder to the pelvis.

3. The pelvis is neutral

Is the pelvis neutral, rotated, or tilted/lifted more on one side? (A neutral pelvis means that all the surrounding muscles are in balance.)

4. Legs apart and straight in relation to the pelvis

The legs should be apart and straight in relation to the pelvis. They should not be close together, rotated, or crossed (scissor position).

5. Arms resting along the sides

The arms should rest relaxed along the sides, without tension, reflexes, or involuntary movements.

6. Even weight distribution on both feet

The feet serve as active support points. It is therefore important that the weight is evenly distributed on both feet, that the soles are placed on the footrest (or floor), and under the body.

Assessment of wheelchair from the side:

7. Head in a Neutral Position

Is the head bent forward or backward, or does it maintain a straight line with the body?

8. Upper Body in a Neutral Position

Does the trunk maintain a neutral position as shown in the left image, or does the upper body lean forward as in the two images on the right? The back can also have excessive extension, which means there is too much arch in the lower back

9. Pelvis Neutral

Is the pelvis neutral, or does it tilt forward or backward? The best way to keep the pelvis neutral over time is to have an open hip angle of around 120–130 degrees (measured from the trunk to the thigh). If the back is reclined (see image), you achieve an open hip angle, but the neck muscles will be strained, as the head must work against gravity to stay upright. The image on the right shows a better sitting position, where there is a midline through the spine and the center of gravity is over the sitting bones.

10. Hips Bent

Is the child sitting with a 90-degree angle at the hips? Or does the child have an open hip angle of about 120–130 degrees? Again, the goal is to achieve the open hip angle.

11. Knees Bent (90°)

Are the knees bent at a 90-degree angle?

12. Feet in a Neutral Position

Are the feet well positioned with the entire sole on the footrest? Is the ankle at 90 degrees when the child has an open hip angle?

Referencing sources

• Elisabet Rodby-Bousquet1, Måns Persson-Bunke and Tomasz Czuba. Psychometric evaluation of the Posture and Postural Ability Scale for children with cerebral palsy. Clinical Rehabilitation 2016, Vol. 30(7) 697–704
• Elisabet Rodby-Bousquet, Atli Ágústsson, Guðný Jónsdóttir, Tomasz Czuba, Ann-Christin Johansson and Gunnar Hägglund. Interrater reliability and construct validity of the Posture and Postural Ability Scale in adults with cerebral palsy in supine, prone, sitting and standing positions. Clin Rehabil 2014 28: 82 originally published online 28 November
• Gale, M. An opionion on the theory of ergonomic task seating vs. the facts (2011).