Ask a PT: Top 7 Wheelchair Positioning Tips for Speech Therapy

As a busy speech therapy professional, you have enough on your plate without having to worry about your patients’ wheelchair positioning!

That’s why we asked Tae, an acute care physical therapist at a regional hospital, for his top wheelchair positioning tips with adult patients. These tips will help your patients remain safe, engaged, and comfortable for a successful speech therapy session.

Tae also draws from his experience in home health and inpatient rehab to make the tips as global as possible, no matter the type of wheelchair or patient factors.

Keep scrolling for 7 Wheelchair Positioning Tips for Speech Therapy!

And for everything you need to assess, treat, and document, check out the Adult Speech Therapy Starter Pack!

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Wheelchair Positioning Tips For Speech Therapy

speech therapy wheelchair positioning

During speech therapy, you want to position your patient so that their session with you is as successful as possible. This means that they’re safe, engaged, comfortable, and not working overly hard just to stay upright.

These tips assume that the patient is already in a well-fitting wheelchair.

If you suspect that this isn’t the case, request a physical therapy and/or occupational therapy referral, as appropriate.

Below are your 7 wheelchair positioning tips for speech therapy!

1. Get The Patient in Their Wheelchair!

wheelchair positioning tips for slp

Being (properly!) positioned in their wheelchairs helps patients remain relaxed and with the support they need to participate safely and effectively in your session.

If possible, ensure that the patient is in their wheelchair and not in bed.

If they’re inpatient and in a hospital wheelchair, get them into their own wheelchair, if you can. This provides the best positioning.

If you’re not yet comfortable transferring patients, ask an OT, PT, or seasoned SLP how to safely do so. You’ll often be able to transfer patients on your own but always check for any precautions (two-person transfer, etc.) beforehand.

2. Make Sure The Wheelchair Isn’t Reclined or Tilted

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Some chairs have both a reclining and tilting feature. In Tae’s experience, this tilting feature is something that speech therapy professionals can miss.

If you incline a patient’s wheelchair yet they still appear to be working hard to remain upright, check whether it’s also tilted back.

3. Avoid Slips & Falls

how to avoid falls slp

To avoid slips and falls, make sure that the armrests and footrests are in place.

In addition to supporting their posture, armrests block patients from falling sideways out of the wheelchair while footrests block them from slipping down out of the chair.

4. Position Them In Midline

speech therapy wheelchair positioning

Scoot the patient’s backside all the way back into the seat of the wheelchair. To put it plainly, you want their butt up against the backrest so that they’re not putting undue pressure on their tailbone, a common hotspot for pressure sores.

If they have one, use the headrest to keep the head in midline.

Help patients avoid leaning on one elbow or one side of their bottom. Check with caregivers about what supports are in place for each patient (straps, custom cushions, etc.)

Make sure that their thighs are parallel to the floor when their feet are in the footrests. If not, readjust the height of the footrests (unless their footrests are intentionally set to a higher or lower position by their PT).

For step-by-step instructions on how to safely position a patient in a wheelchair, see the University of Alabama Department of Physical Medicine & Rehabilitation’s Tip Sheet.

5. Check For A Pressure Relief Program

wheelchair positioning for slp

Check whether your patient has a pressure relief program in place.

Let’s say that a patient should only be in their wheelchair for 2 hours. You find them in their wheelchair and your treatment takes one hour. In this case, you may want to ask a caregiver or nursing if they should be reclined or assisted to a different position after your session.

6. Leave Them Comfortable & Safe

wheelchair positioning speech therapy

Even if a patient doesn’t have a specific pressure relief program, Tae still recommends positioning them after your session for optimal comfort and safety.

  • Recline the chair with armrests, leg rests, and headrest in place
  • Make sure their bottoms are scooted back against the backrest
  • Make sure they’re not leaning to one side
  • Always lock the wheelchair

Always ask your patient about their comfort level and make adjustments, as needed.

7. Know When To Request a Custom Wheelchair

how to request a custom wheelchair

A physical therapist can recommend a custom wheelchair. In fact, in many parts of the U.S. you’ll need a PT referral for a custom wheelchair to be covered by insurance.

If is seems that your patient is not being supported enough in their current wheelchair, recommend a physical therapy screening.

Other signs that your patients may need a custom wheelchair:

  • They’re aspirating because they can’t get out of bed or because they don’t have proper neck support in their wheelchair
  • They’re falling out of their current wheelchair
  • They’re not walking anymore due to weakness

In these cases, they may also need a physiatry, PM&R (physical medicine and rehabilitation), or neurology assessment.

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wheelchair positioning tips for speech therapy


Ecsedy, A. (n.d.). Seating and Positioning for the Geriatric Client [MOOC]. Medbridge.

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