The 4 elements of seating solutions

In order to create the optimum seating position for wheelchair users, we believe that you should always have these 4 elements in mind as these are prerequisites.

  • Positioning
  • Stability
  • Variation
  • Skin protection

You cannot look at one of the elements without keeping the influence on the other 3 elements in mind. The 4 elements are closely linked, but which element you chose to focus on at first depends on the individual user adaptation. The overall goal of the user adaptation is to ensure that the user has optimized ADL (activities of daily living), can be active, participate in social life and remain healthy. In order to help with this, we as professionals must ensure that the user receives a wheelchair in which he or she will be able to sit well over time. The user will only be able to sit well over time, if the 4 elements are well balanced.

Our Product Adviser Mike Dongelmans (Physiotherapist and Osteopath DO) has written a whitepaper about healthy seating in regards to the 4 elements.


Having the right position in a wheelchair is one of the main factors to age well with a disability.

In a wheelchair we can help the user to be correctly positioned by choosing the required seat and back cushion to secure the trunk and pelvic to be stabilized. A correctly adjusted wheelchair with e.g. the right seat depth, seat height, adjusted leg support length is also of great importance for the user in order to keep the position, prevent sliding and shearing and minimize the need for repositioning.

General wheelchair adjustment possibilities and pressure distributing accessories like seat plates and special seat cushions should be looked at, when focusing on correct positioning.

Primary and secondary positioning tools


Stability is needed to keep the right position. Loss of position increases the negative load on the body –  the skin, muscles, nerves, blood vessels and other structures, and reduces the quality of life.

In a wheelchair we have various possibilities for creating stability. The user must be positioned and supported in the best possible way to prevent him or her for falling to one side and thereby reducing the need for repositioning. If the user has involuntary movements, dynamic elements can be of help to allow for movements and guide the user back to a stable position.

ADL eating and drinking
Better eating and drinking prerequisites
ADL Mobility
Increased mobility
ADL skin protection
Skin protection


Changing position is important to vary the load on the skin, muscles, nerves, blood vessels and other structures and helps to increase circulation, so health can be optimized.

To support variation in a wheelchair, the possibility of changing tilt and recline is vitally important. Variation is needed since the wheelchair user often sits many hours in the chair, and a change of pressure distribution is needed to prevent skin damage.

In cases where the users can change position themselves, electric functions can be recommended or even a stand-up chair to support the frequent repositioning.

Skin protection

The skin must be protected to be able to tolerate long term seating. Temperature, moist, gravity pressure, friction, shear forces and other factors in the wheelchair need to be optimized to protect the skin.

As a wheelchair manufacturer we look at the external factors which we can change or improve. As professionals, we all know the importance of skin protection and the danger of pressure sores. For a wheelchair user, 50% of the body weight is supported by only 8% of the body surface - this puts a lot of pressure on the seat bones. In a wheelchair fitting we must do our best to:

  • Prevent high pressure at bone protrusion
  • Reduce shear and friction
  • Optimize microclimate (reduce temperature and humidity)
  • Enable mobility

Our Product Adviser Mike Dongelmans (Physiotherapist and Osteopath DO) has written a whitepaper about healthy seating in regards to the 4 elements.

Download whitepaper
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