Weight Shifts

If the patient is in a manual folding, or rigid, wheelchair and requires assistance to weight shift:

1. Ensure that the lap belt and chest strap, if applicable, are securely fastened.
2. Position the patient’s wheelchair in front of you while you are seated in a sturdy, non-wheeled chair. When possible, you can position the chair against a wall or non-moving surface to increase stability during this weight shift.
3. Lock the wheelchair brakes.
4. Flip up or remove the anti-tip bars in the back of the wheelchair.
5. Grip your hands on a non-moving part of the wheelchair frame, such as a crossbar, the upright bars located behind the patient’s back cushion, or the push handles.
6. Keeping your back straight, push down on the handles to tip the wheelchair backwards until the chair is resting in your lap. If you are having difficulty, you can step on the bottom of the back of the wheelchair frame to help tilt backwards, but avoid putting any pressure on the anti-tip bars. If you are having trouble tilting the wheelchair back from a sitting position, you can start in a standing position and then sit down as the wheelchair tilts back.
7. Support the person’s head and neck as needed against your chest.
8. Ensure that you have tilted the wheelchair far enough back that the weight has been relieved from the patient’s bottom.
9. After one minute, slowly return the chair to upright.
10. Flip the anti-tip bars back down into place.

If the patient is in a power-tilt wheelchair, use the drive mechanism of the chair to fully tilt backwards. If the power chair’s power source has run out or is malfunctioning, you can perform one of the alternative weight-shifting options.

If the patient is in a manual wheelchair that can recline backwards:

1. Ensure that the small wheels, called casters, in the front of your chair are facing forward.
2. Lock all wheels on the chair.
3. Raise the leg rests of the chair to a horizontal position.
4. Stand behind the chair and locate the releases that recline the chair. Next, while keeping your back straight, knees bent and stomach muscles engaged, brace the back of the wheelchair with your body as you release the recline mechanism. Slowly lower the back of the wheelchair until it is in a fully reclined position.
5. After one minute, bring the chair back to the upright position by bracing your body against the chair, squeezing the chair’s release mechanism and pushing the back of the chair into an upright position.
6. Finally, lower the chair’s leg rests.

If the patient is in a manual wheelchair that tilts, instead of reclining, backward:

1. Ensure that the small wheels, or casters, in the front of your chair are facing forward.
2. Lock all wheels on the chair.
3. Stand behind the chair and locate the releases that recline the chair. Next, while keeping your back straight, knees bent and stomach muscles engaged, brace the back of the wheelchair with your body as you release the recline mechanism. Slowly lower the back of the wheelchair until it is in a fully reclined position.
4. After one minute, bring the chair back to the upright position by bracing your body against the chair, squeezing the chair’s release mechanism and pushing the back of the chair into an upright position.

1. Ensure that all of the wheelchair’s wheels are locked.
2. Unfasten the lap belt and chest strap, if applicable, and move any laterals out of the way.
3. Flip back or remove the armrest on the side to which the weight shift will be performed.
4. Kneel or sit at the patient’s side.
5. While keeping your back straight, cradle the head onto your shoulder and lean the person slightly forward.
6. Transition the person’s head to your outside shoulder, then lean your loved one over to one side until the bone that he/she sits on, known as the ischial tuberosity, clears the cushion on the opposite side.
7. If the ischium is not off of the cushion, take your free arm to pull the hip up and over to relieve pressure from the bone.
8. Hold this position for one minute. Keep your back straight and your knees bent throughout this weight shift.
9. To return to an upright position, support the head, and return the trunk to upright.
10. Repeat the procedure for the opposite side.
11. Once the weight shifting is finished, ensure that the lap belt, chest strap, laterals and armrests are all secured back in place, if applicable.
12. If seated in a chair, repeat the above procedure. The only exception is that the patient’s head should be placed on your outside forearm rather than your shoulder. All other steps remain the same.

1. Flip the casters of the wheelchair forward to extend the base of support for safety purposes.
2. Lock the brakes on both sides of the wheelchair.
3. Ensure that the lap belt is fastened, and remove the chest strap, if applicable.
4. Place the patient’s arms in his/her lap.
5. Keep your back straight and knees bent. Engage your abdominal muscles and stand as close as possible to your loved one.
6. Support the patient’s head on your shoulder or forearm.
7. Begin to lean the patient forward, going down on one knee when reaching the floor. Stop when his/her body is on the lap and the head is at the knees.
8. Continue to support the head throughout the process. Hold this position for one minute.
9. Placing your hands on the patient’s chest or shoulders, assist him/her to the upright position while continuing to support his/her head.
10. Once finished, return arms to the armrests and replace the chest strap, if applicable.