A common saying among occupational therapy practitioners and others who work with wheelchair positioning is:
“Proximal stability produces distal mobility.”
This short quote actually says a lot. Proximal stability means that the individual’s trunk is supported and stable. Distal mobility means control of moving parts of the body that are furthest away from the trunk such as the wrists and fingers.
| Proximal | Closer to the midline or center of the body (e.g., trunk) |
| Distal | Far from the midline or center of the body (e.g., hands) |
Individuals using a wheelchair need proper posture and support at the trunk to enable function of the arms and hands. A person is able to do tasks more easily when he or she has better positioning
Try it: Sit slouched in a chair and try to raise your arms. Is this easy? How high can you reach?
Now sit up straight and try the same thing. Is this easier? Can you reach higher?
Your ability to reach has likely increased because your body is in an optimal position.
Some individuals may have trouble obtaining proximal support (support at the trunk). However, there are many wheelchair adaptations that can assist with this. Lateral supports and armrests are critical for making the individual stable and supported to promote better mobility of the arms.
When selecting a wheelchair for an individual the therapist should go through a wheelchair seating assessment. Multiple angle and length measurements will be calculated to truly understand the individual’s body and proper fit of the wheelchair. The therapists will record body measurements and then use clinical judgment to request for the appropriate wheelchair parts in the letter of medical necessity documented for the client.
wheelchair advance 