Hesperian Health Guides

Healthy, Comfortable, and Functional Positions

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HealthWiki > Disabled Village Children > Chapter 64: Decisions About Special Seats and Wheelchairs > Healthy, Comfortable, and Functional Positions


Whether or not a chair has wheels, the position in which it allows a child to sit is very important. (See Chapter 65.)

For most children, the chair should help them to sit more or less like this:

Side view of person sitting with arrows indicating ideal posture.
back straight
legs at a right angle to the back
hips in straight line with the back, against the back of the chair
looking ahead (not tilted back or down)
knees at a right angle
ankles at a right angle
feet firmly supported
Front view of person sitting with arrows indicating ideal posture.
head evenly centered (not tilting to one side)
knees somewhat separated
shoulders even
ankles and feet separated
body straight and centered above hips
hips centered
legs straight down
feet supported at right angles to the body (not tilted in or out)
CAUTION! The seat should be wide enough to allow some free movement and narrow enough to give needed support (see Measurements).


Common seating problems and possible solutions

Problem: Hips tilt back

Side view of boy sitting on stool with spine curving back.
hips tilt back
In children with spastic cerebral palsy the hips often stiffen backward. This triggers spasms that straighten the legs and cause other muscle tightness with loss of control.
Side view of boy sitting in wheelchair with curved back.
Also, children with weak hips or back, from spinal cord injury, spina bifida, or severe polio, often sit slumped with their hips tilted back and the back severely curved. This can lead to permanent deformity.
One of the most common causes of backward tilting hips is a chair like this one that is too big for the child.
Other causes of backward tilt and bad position are: A good position can often be gained through:
a chair back that tilts far back BAD a fairly stiff, upright back at a right angle to the seat. GOOD
and a cloth back that sags. Side view of girl sitting in wheelchair with curved back. a chair that fits the child so that his hips reach the chair back. Side view of boy sitting in wheelchair with a straight back
These let the child lean back and cause the hips to slip forward.
Also, footrests that are far forward so that knees do not bend enough can Increase spasticity that tilts hips back the knees at right angles, and feet firmly supported.
Most children, and especially a child who tends to fall forward in his seat, will sit better and more comfortably if the whole chair tilts back a little. But be sure to keep right angles at hips, knees, and ankles. BETTER
Side view of a boy sitting in slightly tilted backwards wheelchair with a straight back.


This page was updated:19 Jan 2018