I will say, in regard to my own practice I do make compromises on an “ideal” seating to various degrees. I have certain “red lines” that I won’t cross such as a seated position that applies excessive pressure to any body part or positioning a user with bare skin pressed against a hard surface, or “making brakes loose and easier to deploy” as one patient requested. Essentially, anything that could result in a pressure sore or dangerous operation of their wheelchair. But I HAVE given a 40-ish patient with severely contracted tendons in his leg an over-sized wheelchair with a thick cushion so that he could sit cross-legged in it. He has sat in this position for almost 3/4ths of his life and there was absolutely no way he was going to sit with his feet on the footplates, and should he get a properly fit chair he (and I WATCHED him continually try to do this) would bring his legs up and essentially squish his lower half into his chair, applying a LOT of force to the armrest with his legs. At best he would develop even worse distortion as his hips were now rotated and tilted and at worse he would develop pressure sores on his thigh, knee or ischial tuberosity.
Was this proper procedure? Most DEFINITELY not. Did this improve his posture? Overall, I would argue that it did not. My perspective tends to divide patients up into two categories – corrective and maintenance, with the majority of patients being “corrective”. My goal for this man’s fitting would be to maintain his capabilities and avoid degradation as opposed to a “corrective” patient wherein I would be trying to actively affect his posture or positioning. And that’s not to say that there aren’t corrective aspects to his fitting, but overall I would be trying to maintain and preserve as much independence as possible.
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