Wheelchair considerations: Spinal cord injury

A man using a wheelchair smiles for a photo, surrounded by his family and friends.

All wheelchair users need a wheelchair that is safe and durable, provides proper fit and postural support and suits their local environment [1] This online factsheet highlights some key considerations for people with a spinal cord injury (SCI).

Reduce pressure sore risk

SCI impairs sensation, increasing the risk of pressure sores. SCI can also reduce bowel and bladder control, and the moisture associated with incontinence can further increase pressure sore risk. For these reasons:

  • Assess the pressure risk carefully for each client
  • Provide a pressure relief cushion and manually check pressure under the user’s seat bones
  • Provide a spare cushion if incontinence is an issue
  • Check the overall wheelchair fit for other possible pressure areas

Wheelchair set up

Maximise the ability of a person with paraplegia or low level quadriplegia to self-propel. Set up should ensure that:

  • Rear wheel axle is directly under or in front of the user’s shoulder
  • When user’s hands are on the top of their wheels, their elbows are flexed to 60-80°

Postural support

People with an SCI need good postural support from their wheelchair to reduce fatigue and prevent secondary complications. Ensure:

  • The backrest, seat, cushion and footrests are correctly fitted
  • The height of backrest does not interfere with the user’s shoulder movement when propelling
  • The tension on canvas seats and backrests is maintained to avoid sagging


All wheelchair users benefit from learning how to use and look after their wheelchair. Information and skills of particular importance for people with a SCI include:

Managing pressure sore risk:

  • Relieve pressure every 20-30 minutes for at least 2 minutes using the most appropriate weight shift method
  • Check pressure risk areas daily to reduce the risk of pressure sores developing.

Mobility skills training:

Good mobility skills can enable people with an SCI to live active lives. Provide mobility skills training as part of rehabilitation, ideally with the assistance of a peer trainer, encouraging independence and considering:

  • Correct pushing technique (long circular push strokes)
  • Propelling over different terrain
  • Managing obstacles (steps, kerbs, rough ground)
  • Transferring in different situations

More information

Wheelchair considerations: Stroke
Wheelchair considerations: Amputees

Support services in the Pacific to continue to provide treatment for wheelchair users and those who have had an amputation by donating to Motivation Australia.


Motivation Australia


[1] WHO, 2012. WSTP Reference Manual for Participants – Basic level. WHO Press, Geneva.