Hands-On Postural Assessment for Seating

Interview · Assessment in sitting · Assessment in supine · Summary of findings

Posture & Mobility
Jennifer McKee, DPT
www.postureandmobility.com

Document all findings from the hands-on assessment in sitting and supine, completed by a trained clinician. Measures use the standardised definitions in Waugh & Crane's Clinical Application Guide to Standardized Wheelchair Seating Measures (see References). Further documentation may be needed for wheelchair and seating provision.

Person being assessed Date of birth / age Assessment date Clinician(s) Setting / location Others present

Consent obtained for assessment (including hands-on assessment in supine)

1Interview & history

Start with the person, then their health, function and equipment. This follows the person-centred, individualised assessment the WHO Wheelchair provision guidelines (2023) recommend.

About the person

Who is this person? What do they enjoy, and what matters most to them?

Interests & activities

Lives with / who supports them School / work / day service

Communication

How do they show pain or discomfort?

Reason for referral / main concern Goals: the person, family and carers

Diagnoses, medical & surgical history

Primary diagnosis Other diagnoses

Relevant conditions

GMFCS level (if applicable)

Seizures

Medical history

Surgical history

Surgical details and dates

Hip migration % R Hip migration % L Scoliosis Cobb angle Date of last imaging

Relevant medications (e.g. antispasmodics, botulinum toxin, analgesia, anticoagulants) Vision, hearing, cognition, behaviour

Weight Height / length Recent weight change

Hospital admissions, last 12 months (number)

Reasons for admission

Tone & movement

Where

Patterns and triggers (e.g. extensor thrust, ATNR, startle, posture that changes with emotion or effort)

Tone management

Pain

Location, score & tool, what makes it worse or better

Body systems

Respiration

SpO₂ / notesPositions that help or worsen breathing

Digestion & feeding

Route

Food texture (IDDSI level) Fluids (IDDSI level / thickened)

Position needed during and after feeds (e.g. upright, how many degrees, for how long)

Circulation

Details

Continence

Sleep

Sleep position(s)

Sleep issues

Repositioning overnight (how often, by whom)Notes

Skin integrity & pressure injury risk

The risk domains below follow the International Pressure Injury/Ulcer Guideline, 4th edition (NPIAP / EPUAP / PPPIA, 2025). The guideline says to use a structured approach, include a full skin assessment and use clinical judgement. Don't rely on a tool's total score alone: use its subscales to target prevention.

Current pressure injury?

History of pressure injury?

Skin check today (redness, non-blanchable erythema, marks from equipment)

Activity & mobility

Skin & tissue status

Perfusion, circulation & oxygenation

Nutrition

Moisture

Sensory perception

Other

Weight shifting

Independent, consistent & effective?

How often

Time in seating per day Longest continuous sit Pressure mapping

Braden subscales	Sensory	Moisture	Activity	Mobility	Nutrition	Friction / shear	Total
Score

Waterlow score Other tool and score (e.g. SCIPUS for SCI)

Current equipment & technology

Tick what's in use. Record make/model, size, age, fit and condition.

Item	Type	Details, fit & condition	Hrs / day

Mobility & independence

Manual wheelchair

Propulsion method

Distance / terrain / notes

Powered wheelchair

Access / control method (R/L joystick, head array, switches…) Power seat functions used

Transfers

Walking

Aids, distance, assistance

Activities of daily living	Independent	Set-up	Assisted	Dependent	Notes

24 h: sitting (hrs) Lying (hrs) Standing (hrs) Other (hrs)

Outcome measures

FMA WhOM PPAS Other

Gross observations in the current seating system (type of chair, posture, propulsion pattern, controls, how long since last review) Anything else relevant

2Assessment in sitting

A snapshot of this moment. Complete this section with the person in their current seating system, as they are. Don't reposition them or change anything: leave lateral supports, arm supports, pelvic positioning belt etc. as found.

ALife Box · relationship between the ribs and the pelvis

Landmarks: R and L ASIS, and the inferior angle of the ribs (lowest point of the rib cage) on each side. Picture the box joining these four points.

Tick all that apply (e.g. closed and a parallelogram).

If parallelogram: ribs shifted towards RL relative to the ASISs

Draw the shape you see (inferior angle of ribs above, ASISs below; viewed from the front)

Open: space between the ASISs and the ribs
Closed: little space between the ASISs and the ribs
Symmetrical: same distance between ASIS and ribs on both sides

Notes

BPelvic position

Frontal plane

If measured Frontal pelvic angle ° R side lowL side low Frontal sternal angle ° towards RL

Transverse plane

If measured Transverse pelvic angle °

Sagittal plane

If measured Sagittal pelvic angle ° (+ posterior / − anterior tilt)

CSitting footprint

A rough check of loading areas for symmetry, gaps and peak pressure. Score each area 0–3, then use Notes for finer grading (e.g. 2+, 2−, 3+++) and to say exactly where (e.g. lateral aspect of foot only, mid-femur only, inferior angle of scapula).

0 = no contact1 = contact, no load2 = optimal load3 = excessive load

Inferior support (seat & feet)

Area	R	L	Notes (grading +/−, exact area)

Posterior support (back)

Area	R	L	Notes (grading +/−, exact area)

Midline	Score	Notes (grading +/−, exact area)

Upper limb loading (arm supports / tray)

Other contact points (lateral supports, belt, head support)

Loading map

Fills in automatically as you score each area above. Each area is coloured by its loading score, so you can see asymmetries, gaps and peak pressure at a glance. On paper: write the score in each area (or shade it) to build the same picture. An asterisk (*) means there's a note for that area.

✓Sitting summary

Comments

3Assessment in supine

On a firm plinth or mat. Split into Pelvis-up (finding the optimal Life Box) and Pelvis-down (what the hips, knees and ankles allow while that Life Box is kept).

APelvis-up · mobility & position

Goal: find this person's optimal Life Box. In each plane, assess mobility first, then record the optimal / resting position. Each finding is recorded pelvis first, then trunk.
Measuring in supine: take the long axis of the plinth as the vertical reference (Y) and a line across the plinth as horizontal (Z).

Frontal plane

Optimal / resting position Frontal pelvic angle ° R side lowL side low Frontal sternal angle ° towards RL

Frontal pelvic angle: angle of the line joining R and L ASIS to the horizontal. Frontal sternal angle: angle of the line from upper to lower sternal notch to the vertical (Waugh & Crane, Figs 2.25 & 2.27).

Transverse plane

⚠ Make sure the legs can move freely, so the hips aren't driving the pelvic rotation.

Optimal / resting position Transverse pelvic angle °

Transverse pelvic angle: rotation of the line joining R and L ASIS, viewed from above.

Sagittal plane

Optimal / resting position Sagittal pelvic angle (pelvic tilt) °

Sagittal pelvic angle: orientation of the pelvis, using the line perpendicular to the ASIS–PSIS line, viewed from the side. Posterior tilt is recorded as + and anterior tilt as −. In supine this is measured relative to the trunk lying on the plinth.

Optimal Life Box

Landmarks: R and L ASIS, and the inferior angle of the ribs on each side.

Tick all that apply.

If parallelogram: ribs shifted towards RL relative to the ASISs

Draw the optimal shape

This person's optimal Life Box, taking the above into account

The pelvis-up findings show the position the pelvis will need to be in when sitting.

BPelvis-down

Keep the optimal Life Box (from pelvis-up) for the rest of the pelvis-down assessment. Stop each movement at the moment the pelvis starts to move out of that position.

1Pelvic tilt held during pelvis-down

Sagittal pelvic angle held ° Leave blank to use the pelvis-up value.

2Hip flexion

With the knee relaxed in flexion, flex the hip slowly. Stop just before any of these happen, and measure there:

the pelvis tilts posteriorly
a pelvic obliquity appears (the pelvis hitches up on the side being tested)
the Life Box changes or shifts

Angle measured with the goniometer

Angle (anterior side)	R	L
Thigh-to-trunk angle stationary arm along the trunk line, moving arm along the thigh	°	°
Thigh-to-pelvis angle stationary arm along the perpendicular to the ASIS–PSIS line	°	°

Functional hip flexion = 180° − thigh-to-trunk angle
True hip flexion = 180° − thigh-to-pelvis angle
Thigh-to-pelvis = thigh-to-trunk + pelvic tilt
(pelvic tilt: posterior +, anterior −)
⇒ True hip flexion = functional hip flexion − pelvic tilt

3Knee extension / flexion

Keep the hip flexed to the angle found above. Extend the knee and stop just before the pelvis moves (posterior tilt, obliquity or a change in the Life Box), or at end range.

Angle	R	L
Thigh-to-lower-leg angle (posterior side)	°	°
Lower-leg-to-foot angle (anterior side, optional)	°	°

Knee flexion = 180° − thigh-to-lower-leg angle
Ankle: lower-leg-to-foot < 90° = dorsiflexion, > 90° = plantarflexion

4Hip abduction / adduction

Keep the leg at the hip and knee flexion angles found above.

5Hip internal / external rotation

Pelvis-down comments (end-feel, pain, tone response, reducible vs non-reducible)

CLinear body measures · optional (Waugh & Crane, Fig. 4.2)

Measure	R / single (cm)	L (cm)	Measure	R / single (cm)	L (cm)

4Summary of findings

The shaded sections fill in automatically from your entries above. Add your clinical reasoning in the boxes underneath.

Key measures (from supine, to apply in sitting)

Translating to the seating system · side view

Frontal & transverse planes

Clinical reasoning

Summary of relevant clinical findings

Key features of the seating system needed for skin protection, postural support and stability for function, with likely positive and negative effects

Component	Key features & rationale

Was a seating solution simulated?

Simulation details Person / family / carer concerns Recommendations & follow-up plan

Clinician signature Name & registration (e.g. CORU) Date

References

Waugh K, Crane B. A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces (rev. ed.). Denver, CO: University of Colorado Denver; 2013. Definitions and landmarks used here are from Figs 2.3, 2.5, 2.8, 2.10, 2.25, 2.27 & 4.2. The diagrams on this form are simplified drawings, not reproductions. Free download: ucdenver.edu (Center for Inclusive Design and Engineering).
ISO 16840-1:2006. Wheelchair seating, Part 1: Vocabulary, reference axis convention and measures for body segments, posture and postural support surfaces.
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline, 4th ed. Haesler E (Ed.). 2025. internationalguideline.com (chapter: Pressure Injury Risk).
World Health Organization. Wheelchair provision guidelines. Geneva: WHO; 2023. ISBN 978-92-4-007452-1.