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Q: How can I explain to new carers how to help me sit up properly in my wheelchair when I become slumped or slip forward on the seat? Is there an instruction manual? I've been getting carers to place their hands under my backside to easily slide me back while I lean forward, but some carers from agencies say they're not allowed to lift without using a hoist.  

A: There is a section of the Spinal Cord Injury Manual, published by the Regional Spinal Cord Injury Center of Delaware Valley, that coves this. It explains that proper position is essential to prevent skin breakdown over bony areas. It describes and shows methods using one or two assistants.

The Spinal Cord Injury Manual is available free from www.spinalcordcenter.org/manual. There are sections on skin care, bowel and bladder management, diet and much more. The seating/positioning information is in the section about Mobility.

However, even though people have been using this and a number of other manual seating and repositioning methods for a long time, concern about occupational safety has led care agencies to introduce "no lift" policies that require staff to always use hoists when transferring their clients. Even though, strictly speaking, this repositioning technique does not involve lifting, there is still a concern that a carer could injure themselves.

If you are sliding and slumping a lot, you might need a reassessment of your seating needs to prevent it in the first place. The assessment and prescription of wheelchairs and  seating systems are specialised fields. You will need an Occupational Therapist or attend a seating clinic. Contact your Spinal Clinic or Community Health Centre for an appointment. Also, some disability equipment supply companies have their own seating assessment services.