How a wheelchair is propelled and how a client is positioned in it are both critical to safety and health. Poor propelling technique injures caregivers; poor positioning injures clients.

Section 01

Caregiver Propelling Technique

  • Handle grip: Both hands on the push handles. Grip firmly but without tension — a relaxed grip reduces hand and forearm fatigue over long distances.
  • Body position: Upright, not leaning into the chair. Leaning forward loads the lower back — propel with leg drive, not spinal bend.
  • Turning: Slow turns — never spin the chair rapidly. On narrow turns, approach slowly and use small adjustments rather than one large sweep.
  • Speed: Walk at a comfortable pace — never run with a wheelchair. Running reduces control and increases the risk of tipping on transitions.
  • Inform the client: Tell the client when you are about to turn, go over a threshold, or change direction — they cannot see where you are going.
Section 02

Navigating Thresholds and Obstacles

🚪

Doorway thresholds

Approach at a slight angle for smooth crossing. Tip the chair slightly backward (pop a small wheelie) for significant thresholds to lift the front wheels over. Never ram into a threshold — the sudden stop risks forward ejection of the client.

⬆️

Going up a curb

Tip chair back, roll front wheels up onto the curb, then roll rear wheels up. Face forward (not backward) when going up a curb — you need to see the curb height.

⬇️

Going down a curb

Turn the wheelchair backward. Step off the curb first, then ease the rear wheels down, then lower the front wheels. Face up the curb (backward approach) to maintain control of the descent.

Section 03

Optimal Client Positioning in the Wheelchair

💡 The 90-90-90 position
Optimal wheelchair positioning is the 90-90-90 position:

  • Hips at 90 degrees (not slouching back)
  • Knees at 90 degrees (feet supported on footrests)
  • Ankles at 90 degrees (feet flat on footrests)
This position distributes weight evenly, reduces pressure on the sacrum, maintains alignment, and reduces the risk of the client sliding forward out of the chair. If the client has slid into a slouched position — reposition before propelling.
Section 04

Repositioning a Slumped Client

⚠ Repositioning in the wheelchair
Never lean over the client from behind to pull them back into the chair — this causes back injury. Safe approaches:

  • Have the client lean forward and push back with their arms if able
  • Use a draw sheet under the client to slide them back with a second person
  • Transfer the client briefly out of the chair, reposition the cushion, and transfer back
If a client is consistently sliding out of the wheelchair, report to the nurse — the wheelchair may need a different cushion or positioning device, and the reason for the sliding should be assessed.
Section 05

Lap Belts and Positioning Devices

✓ Positioning device use
Some clients have prescribed positioning devices — lap belts, lateral supports, headrests, anti-thrust seat inserts. Important principles:

  • Use all prescribed positioning devices every time the client is in the wheelchair
  • Lap belts are safety devices — not restraints. They should be applied at a 45-degree angle across the hips (not across the abdomen) to prevent sliding, not to restrain movement
  • Never improvise positioning restraints — only use prescribed devices
  • If a positioning device seems to be causing discomfort or skin issues — report to the nurse
Knowledge Check

Lesson 2 Quiz

5 questions · Passing score: 80%
Question 1
When propelling a wheelchair, the caregiver's body position should be:
Question 2
When descending a curb in a wheelchair, the correct approach is:
Question 3
The 90-90-90 positioning goal in a wheelchair refers to:
Question 4
A client has slid forward into a slouched position in the wheelchair. The safest repositioning method for the caregiver is:
Question 5
A wheelchair lap belt should be applied at what angle and position: