front view of an obese female client in a bariatric...

Front view of an obese female client in a bariatric wheelchair seated on a lift sling; wheel lock extensions are in place bilaterally. The left upper extremity is unsupported, and the left shoulder is lower than the right shoulder.

Photograph from the Genesis Rehab Services collection. Used with permission.

Side view of a female client in a power wheelchair with an adapted backrest and seat cushion in place. The client is close to the elevator and is using a long dowel to access the elevator buttons.


Front view of a rigid frame, aluminum wheelchair with full-length tubular armrests and fixed, nonremovable foot plates. This chair has 24-in. rear spoke wheels.

Quickie GT Wheelchair (http://www.sunrisemedical.com). Photograph from the Sunrise Medical collection. Used with permission.

Front view of a foldable wheelchair with 24-in. rear wheels and 8-in. front casters. The armrests are full length, fixed height, padded, and nonremovable. The chair has swing-away front rigging and heel loops on each foot plate.

Invacare Tracer EX2 (http://www.invacare.com). Photo from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Front view of a reclining wheelchair in an upright position. The wheelchair has a recliner back with a range of 90° to 180° and a head rest that extends 10 in. above the seat back. The wheelchair has padded desk arms.

Invacare Tracer SX5 (http://www.invacare.com). Photograph from the Sammons Preston c ollection (http://www.sammonspreston.com). Used with permission.

Side view of a specialty reclining wheelchair. This chair has small front and rear casters and cannot be self-propelled. The wheelchair is padded with lateral supports at the trunk and lower extremities; it also has a padded backrest, seat, armrests, and calf pad as well as a removable head rest.


Side view of a female client in a tilt-in-space wheelchair with a head rest. The wheelchair has a seating surface that moves along a rail system to provide tilt to the entire seating surface, not just the back. The front casters are smaller on this wheelchair than on standard wheelchairs, and self-propulsion is not possible. In this photo, the chair is in an upright position.


The same female client as in the previous image, seated in the same tilt-in-space wheelchair with 20° of posterior tilt.


Front view of an obese female client seated in a bariatric wheelchair. The positions shown are without any adaptations or modifications.


Rear view of a bariatric wheelchair in a doorway to demonstrate the width of the wheelchair compared with the width of the doorway.


Side view of a power wheelchair with adapted seating. This chair tilts and reclines and has a detachable head rest and adjustable-height full-length armrests. The front rigging is removable and nonelevating; the control mechanism is located on the right side of the chair in front of the armrest.


Side view of a power scooter with three wheels, a captain’s chair, handlebars, and a carrying basket.

Photograph from the Genesis Rehab Services collection.

Side view of an adjustable axle for a dual-axle wheelchair. The axle here is in the top position; for this photo only, a screw has been placed in the bottom axle position to demonstrate the lower position.


Side view of full-length adjustable-height armrests; the right armrest is flipped up to demonstrate removable features for transfers.


Side view of desk arms; these armrests are cut away to allow the wheelchair to maneuver closer to a desk or table.


Side view of elevating, swing-away, front rigging with foot plates that flip up to accommodate a client’s lower extremity position in extension.


Side view of nonelevating, fixed front rigging. Foot plates with heel loops are in place to support lower extremities.


Front view of a pull-to-lock brake mechanism on a wheelchair. This wheel lock is engaged with the lever closest to the tire and the metal brake engaged against the tire


Side view of a wheelchair showing the ball at the top of the brake extension; this ball permits easy grip and visual attention. This is a push-to-lock mechanism.

Bright Brakes. Photo from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Rear view of an automatic braking mechanism applied to a wheelchair. This mechanism has metal bars that clamp down over the rear of the wheels when a pressure differential is detected or the wheelchair begins to roll backward.


Side view of the same automatic breaking mechanism applied to the wheelchair.


Side view of standard aluminum hand rims that are smaller in diameter than the tire and positioned outside of the tire to provide a push surface.


Side view of black plastic-coated hand rims that are smaller in diameter than the tire and positioned outside of the tire to provide a push surface.


Side view of triangular front anti-tippers attached to a wheelchair in front of the casters.


Side view of rear anti-tippers attached to the frame of a wheelchair, protruding downward beyond the back wheels.


Front view of a deeply contoured backrest attached to the upright tubular frame of a wheelchair. This backrest replaces the wheelchair’s original backrest upholstery.


Side view of a female client seated in a wheelchair with modification. The backrest upholstery has been replaced by a foam backrest that attaches to the upright tubular frame of the wheelchair and is reclined at approximately 20°.


Front view of a standard wheelchair with a dense foam solid seat insert that covers the entire seat base.

Solid Seat Insert. Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Front view of a wheelchair with a plastic solid seat. The seat has areas cut out above the crossbars of the chair’s base. The seat is designed to have another cushion placed on it. This seat can be lowered a maximum of 3 in.

Adjustable Seat Insert. Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Front view of a standard wheelchair with a lap tray attached. The tray has a translucent acrylic surface with a molded rim that prevents objects from rolling off. On the tray is a glass in one of the two recessed cup holders; the tray also holds a bowl of popcorn. The tray has a pencil well and includes two hook-and-loop fastener straps and a D-ring back strap.

Clear Lap Tray. Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Side view of a standard wheelchair with a half tray attached. This tray is for clients who do not need the surface area that a full lap tray provides. This lap tray has a raised outside edge to keep the client’s arm positioned correctly. The interlocking bracket keeps the half tray securely fastened; a swivel base allows the tray to be rotated.

The Comfort Company DuraSoft Half Tray (http://www.comfortcompany.com). Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Front view of a male client seated in a standard wheelchair with a pair of wings screwed onto the seat back. The wings are washable vinyl and foam padded; they measure 7_ in. wide by 10_ in. long.

Wheelchair Wings. Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Front view of a standard wheelchair with foam lateral supports attached to the foam backrest. The foam supports are just above the wheelchair arms. This foam contours to the client’s trunk.

The Comfort Company Incredihugger Back Cushion (http://www.comfortcompany.com). Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Front view of a standard wheelchair with a padded support in the wheelchair on one side. The support is 173/4 in. long, approximately the same depth of the wheelchair seat. It is 7 in. wide at the top covering the armrest and approximately 3 in. wide from the armrest down to the seat. It is 12 in. high from the seat bottom over the armrest. The support is covered with a removable, washable, terrycloth material; the support attaches with three ties and a nylon webbing strap with hook-and-loop closure.

Lateral Body Pad. Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Female client seated in power wheelchair with triangular foam abductor wedge positioned between her knees and secured with hook-and-loop fastener to promote lower extremity abduction.


Male client seated on a saddle cushion that is carved out to create two troughs to position his femurs; a low-profile pommel sits in the center of the cushion for abduction.


Front view of a female client seated in a wheelchair with a black canvas belt across her pelvis; the belt has a push-release mechanism.


Front view of a wheelchair showing only the front wheels, the foot boxes, and the client’s feet and lower legs. The foot boxes on each foot plate are 10 in. long by 6 in. wide by 3 in. deep; they are vinyl covered and open at the top and front. The client’s feet are resting in the foot boxes.

Skil-Care Swing-Away Foot Support (http://www.skil-care.com). Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Front view of a wheelchair showing only the client’s feet and legs, the leg rest pad behind the legs, and the pad on the foot rest. The pads are vinyl covered and are each approximately 2 in. thick. The client’s shoes are on the pad on the foot rest.

Skil-Care Drop-Stop Leg Rest Pad (http://www.skil-care.com). Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Side view of a wheelchair with an arm trough on one of the chair’s arms. The trough has a 17-in. plastic tray that can slide off the chair’s armrest. A foam insert in the plastic tray sits low at the elbow end and is elevated at the wrist end.

Premier Wheelchair Arm Tray. Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Side view of a male client in a wheelchair with only the client’s trunk and arms showing. The client’s right arm is resting on an arm trough; the front of the trough is elevated approximately 4 in.; two straps hold the client’s arm on the trough.

The Comfort Company Comfort Armrest (http://www.comfortcompany.com). Photo from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Top view of a rectangular air cushion composed of rows of individual air-filled bladders. Each individual bladder has a star configuration on the top. The cover is removed to show all air bladders.

Skil-Care Cushion Air (http://www.skil-care.com). Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Top view of a rectangular air cushion composed of rows of individual air-filled bladders. Each individual bladder has an “X” configuration on the top. This cushion has more air bladders than the previous cushion. The cover is removed to show all air bladders.

Roho Quadtro Select (http://www.rohoinc.com). Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Front view of a honeycomb cushion with cover removed halfway to show the inside. The entire surface of the cushion consists of individual cells made into a honeycomb pattern.


Front view of a gel cushion with cover removed halfway to show gel pouches that are laid over a foam base. The gel is self-contained in two individual pouches.


Top view of a seat cushion. The cover, which has loops on each side for removal, is pulled back to show the gel inside the cushion. The 1/2-in.-thick gel insert has a checkerboard pattern with a rim of gel around the outside.

Gel Right Checkerboard Cushion. Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Front view of a wheelchair with the low sheer cover of the seat cushion turned back to show the inside of the cushion. The inside foam is carved into sections to allow for individual distribution of pressure.

Skil-Care Pressure-Check (http://www.skil-care.com). Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Side view of a wheelchair cushion. The cushion is rectangular to fit in a wheelchair seat; it has a saddle shape carved into it and a waterfall front to prevent pressure on and behind the knees and thighs.

The Comfort Company Saddle 7 Series (http://www.comfortcompany.com). Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Top view of a wheelchair with the vinyl cover of the seat cushion turned back to show the inside of the cushion. The cushion has a top layer of soft foam over a firm foam foundation to eliminate slinging of the chair seat. The cushion includes an inside layer of pressure-reducing gel.

Skil-Care Ultra Wedge (http://www.skil-care.com). Photograph from the Sammons Preston collection (http://www.sammonspreston.com). Used with permission.

Front view of a male client seated in a standard wheelchair with full-length, fixed-height armrests; a solid seat insert with gel cushion; and no front rigging. The client has in place a left arm sling and a left lower extremity multipodus boot or foot splint. He is sliding forward to the edge of the wheelchair. The positions shown are without any adaptations or modifications.


Side view of the same male client seated in a standard wheelchair with full-length, fixed-height armrests; a solid seat insert with gel cushion; and no front rigging. The client has in place a left arm sling and a left lower extremity multipodus boot or foot splint to keep the foot in anatomical alignment. The client is sliding forward to the edge of the wheelchair with posterior pelvic tilt. The backrest has a hammock effect contributing to the client’s semi-reclined position. The positions shown are without any adaptations or modifications.


Front view of a male client seen in an earlier photo. The client is now seated in a standard wheelchair with a solid seat and custom cushion; the client’s left arm is supported in an arm trough, and his left lower extremity, in a multipodus boot or foot splint, is supported by elevating front rigging.


Lateral view of the male client seen in the previous photo. The client is now seated in a standard wheelchair with a solid seat and custom cushion. The wheelchair is tilted back slightly by way of a lower axle position with a higher front caster position. The backrest continues to hammock and allow the client to recess into the seat.


Side view of a female client seated in a power wheelchair. The client is in a slouched position with pelvis tilted posteriorly toward the back of the wheelchair. The client is also wearing a right knee splint, and both feet are supported by a foot stool. The positions described are without any adaptations or modifications.


Side view of a male client seated in a transport wheelchair. The client is in a slouched position with pelvis tilted posteriorly toward the back of the wheelchair. The positions described are without any adaptations or modifications.


Top view of the same male client seated in a transport wheelchair. The client is in a slouched position with pelvis tilted posteriorly toward the back of the wheelchair. The position of the lower extremities shows that the right extremity appears longer than the left due to the pelvic position. The positions described are without any adaptations or modifications.


Side view of the male client seen in earlier photo. The client is now seated in a standard wheelchair with a solid seat and custom cushion. The cushion shown has a wedge-and-saddle effect. The client also has a pelvic belt in place, and his left arm is supported on a half lap tray with an edema glove in place.


Side view of the same male client seen in earlier photo. The client is now seated in a standard wheelchair with a solid seat and custom cushion. The cushion shown has a wedge-and-saddle effect. The client also has a pelvic belt in place, and his left arm is supported on a half lap tray with an edema glove in place.


Front view of a female client seated in a standard wheelchair. Right pelvic obliquity is shown with the right side of the pelvis higher than the left. The client appears to be bearing all her weight on the left side. The positions shown are without any adaptations or modifications.


Front view of a female client seated in a standard wheelchair with lower extremities in extension and supported on pillows. Left pelvic obliquity is shown with the left side of the pelvis higher than the right. The client appears to be bearing all her weight on the right side. The positions shown are without any adaptations or modifications.


Front view of the female client seen in earlier photo. The client is seated in a wheelchair with a solid seat insert and gel cushion with leveling of the pelvis shown.


Front view of a female client seated in a power wheelchair. The client’s upper extremities are supported by armrests. The client’s lower extremities are shown to be internally rotated with adduction. The positions shown are without any adaptations or modifications.


Front view of a male client seated in a standard wheelchair. The client’s upper extremities are supported by armrests, and the floor supports his lower extremities. The wheelchair has a hammock seat, resulting in internal rotation and adduction of the client’s lower extremities. The positions shown are without any adaptations or modifications.


Side view of the female client seen in earlier photo. The client has a small triangular abductor in place between her knees and secured by hook-and-loop fastener straps. Internal rotation and adduction of the lower extremities are resolved.


Front view of the male client seen in earlier photo. The client is seated on a solid seat insert with gel cushion with both feet on the floor. Internal rotation and adduction of the lower extremities are resolved.


Front view of a female client seated in a standard wheelchair with desk arms, elevating front rigging, a foam cushion, and additional padding on the armrests. The client’s lower extremities are positioned as if the wind had blown them to the left side of the wheelchair. The client’s pelvis is rotated forward on the right; the left lower extremity is externally rotated and flexed at the knee; and the right lower extremity is internally rotated and flexed at the knee. Both knees are touching on the medial surface. Both feet are resting near the foot plates but are not firmly supported. The positions shown are without any adaptations or modifications.


Front view of the same female client seated in a standard wheelchair with desk arms, elevating front rigging, a foam cushion, and additional padding on the armrests. The client’s lower extremities are positioned as if the wind had blown them to the left side of the wheelchair. The client’s pelvis is rotated forward on the right; the left lower extremity is externally rotated and flexed at the knee; and the right lower extremity is internally rotated, with increased hip and knee flexion. The client’s right lower leg is resting against the left knee, and her right foot is resting on top of the calf plate. Her left foot is resting on the foot plate. The positions shown are without any adaptations or modifications.


Front view of the same female client seen in earlier photo. The client is seated in a standard wheelchair with desk arms, elevating front rigging, a foam cushion, and additional padding on the armrests. The client’s lower extremities are now positioned using an abductor device shaped like a “T.” The “T” is positioned downward so that there is abduction at the knees with the foam separator and a bolster behind the knees for extension. A drop stop is also in place to provide a firm surface and full contact for both feet on the foot plates.


Side view of a female client seated in a power wheelchair. The chair armrest has been removed for this photo. Bilateral knee contractures are shown with a splint in place for the right knee and both feet resting on a foot stool.


Side view of a female client with knee extension contractures. Both lower extremities are positioned in a foot box.


Front view of a male client seated in a standard wheelchair. The client is shown with knee contractures of both lower extremities. His right knee is flexed and adducted. A calf pad is in place in the wheelchair to accommodate contractures and prevent injury to lower extremities.


Front view of the female client seen in earlier photo. Both lower extremities have knee splints in place and are supported on the foot plate. A small pillow is shown on the rear of the foot plate for comfort.


Front view of a female client with bilateral ankle contractures. The left ankle is inverted and the right ankle is inverted and laterally flexed. Neither lower extremity is resting on the foot plates of the wheelchair. The positions shown are without any adaptations or modifications.


Front view of the female client seen in the previous photo. The client’s ankle contractures are accommodated by placement of her ankles on the wheelchair foot plates. Heel loops have been added to the foot plates. Both feet have contact with the foot plates on the wheelchair.


Rear view of a female client in a bariatric wheelchair. The client is shown to be leaning significantly to the right, with her right upper extremity supported on an armrest and resting against the upright cane of the wheelchair. The positions shown are without any adaptations or modifications.


Front view of a female client seated in a standard wheelchair. The client is leaning to the right with her right upper extremity unsupported and hanging over the armrest. The armrest shown is resting against the client’s ribs and axilla. The positions shown are without any adaptations or modifications.


Front view of the female client seen in earlier photo. The client is shown in a wheelchair with an alternate backrest; no lean is shown. The client is holding a small dog on her lap.


Side view of the female client seen in earlier photo. The client is seated in a wheelchair with an alternate backrest with a deep contour and built-in side support.


Side view of a female client seated in a reclining wheelchair. The client is sitting upright and not using the recline feature of the wheelchair. Kyphosis, forward head position, and downward eye gaze are shown. The positions shown are without any adaptations or modifications.


Side view of a female client in a standard wheelchair with standard backrest. The client is shown with kyphosis, forward head position, and downward eye gaze. The positions shown are without any adaptations or modifications.


Side view of the female client seen in earlier photo. The client is seated in a reclining wheelchair, reclined against the backrest with head support in place.


Side view of the female client seen in earlier photo. The client is seated in a wheelchair with a deep backrest in place with slight recline.


Side view of a female client seated in a tilt-in-space wheelchair with her head in forward flexion and lateral flexion to the left. Her chin is resting on her chest. The positions shown are without any adaptations or modifications.


Side view of the female client seen in the previous photo. The client is seated in a tilt-in-space wheelchair that is tilted to 45° with a commercial head rest that supports her head in midline and neutral.


Front view of an obese female client seated in a standard wheelchair. The positions shown are without any adaptations or modifications.


Side view of an obese female client seated in a standard wheelchair. The positions shown are without any adaptations or modifications.


Front view of a female client seated in a super hemi-low wheelchair with desk armrests and without front rigging. The client is seated in front of a window in her room.


Side view of a female client seated in a standard wheelchair without front rigging. The client is positioned close to the edge of the wheelchair seat to allow both feet to contact the floor for self-propulsion. A gap between the client’s back and the backrest is shown but is difficult to see because of the lack of definition between the client’s black sweater and the black backrest. The positions shown are without any adaptations or modifications.


Side view of a male client seated in a standard wheelchair without front rigging; both feet are supported on the floor. The desk arms are reversed to provide adequate support for the upper extremity and a surface to push against for functional transfers. The client is seated with his back resting against the backrest. The client’s lower extremities are not fully supported by the wheelchair seat; the length of leg unsupported is substantial. The positions shown are without any adaptations or modifications.


Front view of a female client seated in a standard wheelchair without front rigging. The client is seated in the wheelchair without any space or gaps on either side of the seat. The client’s thighs are in contact with the armrests on both sides. The positions shown are without any adaptations or modifications.


Side view of a standard wheelchair with one desk arm reversed to show the potential for increased space in seat width. The right armrest is in the usual position; the left armrest is reversed with the desk feature toward the back of the wheelchair.


Front view of a female client seated in a standard wheelchair with desk arms and swing-away, elevating front rigging. The client is seated on a foam cushion in a hammocking wheelchair seat. There is approximately 3 in. of space on both sides of the chair between the client and the armrests. The client’s lower extremities are supported by the front rigging but are internally rotated and adducted proximally and abducted distally due to the width of the wheelchair and the front rigging placement. The positions shown are without any adaptations or modifications.


Side view of a male client seated in a standard wheelchair with both feet firmly planted on the floor. The client is shown with hip and knee flexion greater than 90° bilaterally. The positions shown are without any adaptations or modifications.


Front view of a female client seated in a standard wheelchair with desk arms. Front rigging is absent from the wheelchair, and the client’s lower extremities are not supported, as indicated by her feet not reaching the floor—both feet are dangling above a support surface. The positions shown are without any adaptations or modifications.


Side view of the same female client seen in earlier photo. The client is now seated in a standard wheelchair with bilateral elevating front rigging; both lower extremities are supported with contact on bilateral foot plates.


Front view of a male client seated in a wheelchair with hammock effect of the seat. The seat upholstery is bowed out by the weight of the client sitting on the seat.


Top view of a male client seated in a wheelchair with a hammock back; the upholstery is recessed between the upright tubular frames of the wheelchair and is bowed out by the weight of the client resting against the backrest.


Side view of a female client in a power wheelchair. The client is engaged in conversation with someone at the window of a pharmacy.


Front view of a female client seated in a power wheelchair; the wheelchair is situated close to the client’s desk and the client is using the telephone.


Male client seated in a hemi-height wheelchair. The client’s involved left arm is supported in an arm trough; front rigging supports his involved left lower extremity; a solid seat with a gel cushion is in place.


Side view of a male client seated in a standard wheelchair with elevating front rigging, desk arms, and a pelvic belt. A padded half lap tray is in place on the left armrest, and a left edema glove is shown. The client is outside in a courtyard conversing with a woman seated on a bench.


Front view of the same male client seated in a standard wheelchair with elevating front rigging, desk arms, and a pelvic belt. A padded half lap tray is in place on the left armrest, and a left edema glove is shown.


Front view head shot of a smiling male client.


Side view of a male client seated in a transport chair with four small wheels on the tubular frame. The client’s left upper extremity is not supported on the armrest; removable, nonelevating front rigging supports both lower extremities. The positions shown are without any adaptations or modifications.


Side and top views of a male client seated in a transport chair. The client’s left upper extremity is not fully supported on the armrest; his right upper extremity is supported by the armrest. The client shows posterior pelvic tilt. The positions shown are without any adaptations or modifications.


front view of an obese female client in a bariatric...

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