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Orthotics & Seating
Wheelchair Seating Assessments
A surgeon's perspective on wheelchair seating assessments — what a proper seating assessment involves, why it matters for spinal health, and why it is carried out by specialist seating teams.
A wheelchair seating assessment is the careful, individualised process by which a specialist team works out how a person should be supported in their chair. For someone with a spinal condition or complex postural needs, this assessment is genuinely important — it shapes their posture, comfort, skin health and function for much of the day. As a spinal surgeon I value good seating and understand how it interacts with the spine, but the assessment itself is carried out by specialist seating teams — occupational therapists, physiotherapists and rehabilitation engineers — not by me. This page explains, from a surgeon's viewpoint, what a seating assessment involves and why it matters.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
What a seating assessment is
A seating assessment is a structured evaluation of how a person sits and how they should be supported. It typically looks at their posture and any fixed or flexible spinal shape, their movement and function, their skin and pressure risk, their comfort, and their goals and lifestyle. From this, the team works out the right seating, support and cushioning to hold them well, protect their skin and help them function. It is a considered, individualised process rather than simply choosing a chair, and it is often revisited as needs change over time.
Why it matters for the spine
Seating and the spine are closely linked. How a person is supported in their chair influences their spinal posture, and for people with conditions such as neuromuscular scoliosis or after spinal surgery, good seating can help support posture and comfort, while poor seating can contribute to pain, deformity and pressure problems. This is why I take an interest in my patients' seating — it is part of the wider picture of their spinal health. But recognising its importance is different from carrying it out; the detailed assessment belongs to the seating specialists.
Who carries out the assessment
Seating assessments are carried out by specialist seating and wheelchair services, staffed by occupational therapists, physiotherapists and rehabilitation engineers with specific expertise in posture and pressure management. They have the training, the measuring tools and the equipment to assess and provide seating properly, and to review it over time. My role, as a surgeon, is to understand how a person's spinal condition and any surgery relate to their seating needs, and to communicate with these teams so that care is joined up. I defer to their expertise for the assessment itself.
What the evidence shows
The evidence supports careful, standardised, individualised seating assessment. A Delphi consensus study has worked to define best practice in complex postural seating assessment, reflecting the specialist nature of the task, and reviews of seating and posture management emphasise structured assessment to support posture and prevent complications such as pressure injuries. Studies of seating interventions show that appropriate seating can influence posture and comfort. This evidence underlines why the assessment is done by dedicated specialists.
What to expect
If you need a seating assessment, it is carried out by a specialist seating or wheelchair service, who assess you individually and provide and review your seating over time. Where I am involved in your spinal care, I will share the relevant surgical information and liaise with the seating team so that your seating and your spinal treatment work together, but the assessment itself is theirs.
Disclaimer. The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Mr Madi is a spinal surgeon; wheelchair seating assessments are carried out by specialist seating services, occupational therapists, physiotherapists and rehabilitation engineers. Every patient is different, and seating needs depend upon an individual's diagnosis, posture, general health and personal circumstances. Decisions should always be made following consultation with your treating spinal surgeon, seating service, therapist or healthcare professional.
Evidence & further reading
- —Dupitier E, et al. Defining best practice in complex postural seating assessment: a Delphi study. 2023. (PMID 37682819)
- —Michael SM, et al. Seating and postural management. 2000. (PMID 10869132)
- —Ravnborg M, et al. Wheelchair seating and posture. 2020. (PMID 32406808)
- —Nowak A, et al. Seating interventions and postural management. 2021. (PMID 34347138)
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Every patient is different. The information on this page is a starting point — Mr Madi will tailor any plan to your specific imaging, symptoms and goals.