WHEELCHAIR POSITIONING - Assuming and maintaining an upright sitting position, with the buttocks well back in the seat:

Physical and Skill Prerequisites

1. With Functioning Biceps and Deltoids - Techniques for independent positioning in a wheelchair appear under Stabilize the Trunk in a Wheelchair, Move the Trunk in a Wheelchair, and Move the Buttocks in a Wheelchair.

2. Without Functioning Biceps and Deltoids - To stabilize and move the trunk, the high-lesion patient requires:
   • At least 3/5 strength in the cervical paraspinals, sternocleidomastoid, and trapezius
   • At least 2-/5 strength for cervical lateral flexion and extension and for scapular elevation

   (Strength in the anterior, middle, and posterior deltoids and in the serratus anterior is not required, but is helpful).

   • Ability to sit in a wheelchair and move the trunk using head and scapula motions

Functional Skills - The high-lesion patient:

1. Holds the head upright and adducts the scapulae to maintain an upright sitting Position

2. Throws the head in one direction and elevates the scapula of the shoulder in opposite direction to adjust the position of the trunk and to tilt the trunk laterally and return it to an upright position