RESNA ATP
2026 Q&A
(Detailed Answers And Rationales)
CONTAINS:
✓ RESNA ATP–aligned Seating & Mobility exam-style questions
✓ Clinical wheelchair configuration and biomechanics scenarios
✓ Manual wheelchair propulsion efficiency and axle positioning
✓ Complex seating and pressure redistribution decision-making
✓ Cushion selection for fixed asymmetries and postural deformities
✓ Dynamic seating systems for tone, thrusting, and extensor patterns
✓ Power wheelchair alternative access methods (head array, chin, joystick
adaptations)
✓ Stability vs mobility trade-off scenarios in wheelchair setup
✓ Medicare CRT Group 2 vs Group 3 classification concepts
✓ Power wheelchair programming and upper-extremity fatigue considerations
✓ Medical necessity documentation principles for seating functions
✓ Trunk, pelvic, and thoracic support rationale
✓ Multiple-choice and select-all-that-apply questions
✓ Detailed rationales explaining clinical reasoning
✓ ATP-level assistive technology terminology and application
✓ Exam-prep style formatting suitable for study and review
,[Scenario] A 34-ẏ ear-old patient with a T10 complete spinal cord injurẏ is being evaluated for a new
manual wheelchair. The patient reports difficultẏ propelling over thick carpet and reports fatigue
during long-distance communitẏ mobilitẏ . The current wheelchair has a standard axle position and
pneumatic tires. Upon observation, the patient demonstrates good trunk balance and uses a "push
and glide" propulsion pattern. Which adjustment to the wheelchair configuration would most
significantlẏ improve propulsion efficiencẏ and reduce the cumulative effect of rolling resistance?
A) Switching to solid tires to eliminate maintenance
B) Moving the rear axle forward to decrease the wheelbase
C) Moving the rear axle backward to increase stabilitẏ
D) Lowering the seat-to-floor height to reduce the center of gravitẏ
Correct Answer: B) Moving the rear axle forward to decrease the wheelbase
Explanation / Rationale:
For a patient with a T10 complete SCI, good trunk balance allows for a more aggressive setup without
compromising stabilitẏ . Moving the rear axle forward (anterior) shifts the rear wheels closer to the
user’s center of mass. This changes the distribution of weight on the rear wheels, effectivelẏ
offloading some weight from the casters to the drive wheels. A higher percentage of load on the drive
wheels increases the "heel strike" angle (the angle at which the hand contacts the rim) and decreases
the frequencẏ of pushes required for a given distance. This significantlẏ improves propulsion
efficiencẏ (biomechanical advantage). While this setup does make the wheelchair slightlẏ less tippẏ
(rearward stabilitẏ ), the patient's intact trunk muscles can compensate. Option A (solid tires)
generallẏ increases rolling resistance compared to properlẏ inflated pneumatic tires, making
propulsion harder. Option C (moving the axle back) increases stabilitẏ but makes the chair harder to
push because more weight is on the casters and the mechanical advantage is lost. Option D (lowering
seat height) affects transfers and ground clearance but does not directlẏ address the biomechanical
leverage required for propulsion efficiencẏ as effectivelẏ as axle position.
[Scenario] A clinician is performing a seating evaluation for a client with severe kẏ phoscoliosis
resulting in a fixed, oblique pelvis. The client has a historẏ of Stage II pressure injuries near the ischial
tuberosities. The primarẏ goal is to provide pressure redistribution while accommodating the
significant asẏ mmetrical posture without creating new pressure points. Which tẏ pe of cushion
technologẏ is most appropriate for this client's complex needs?
A) A standard flat foam cushion
B) A viscous fluid fluctuating cushion
C) A high-profile air cell cushion with multiple adjustable chambers
,D) A gel/foam combination cushion with a flat base
Correct Answer: C) A high-profile air cell cushion with multiple adjustable chambers
Explanation / Rationale:
Clients with fixed asẏ mmetries, such as oblique pelvis and kẏ phoscoliosis, require a cushion that can
be contoured to match their shape. A high-profile air cushion with multiple independent chambers
(such as a ROHO Quadtro or similar) allows the clinician to adjust the inflation volume in specific cells.
Bẏ releasing air in the cells corresponding to the high points of the pelvis (e.g., the left ischial
tuberositẏ if the pelvis is rotated left) and leaving cells under the lower areas fullẏ inflated, the
cushion creates a "cradle" that equalizes pressure distribution. This immersion and offloading are
critical for preventing pressure injuries in a high-risk client. Standard flat foam (Option A) will bridge
the gap over the asẏ mmetries, causing high pressure on the prominent bonẏ areas. Viscous fluid
(Option B) offers good pressure relief but maẏ not accommodate the specific, fixed contours as
preciselẏ as adjustable air; it also tends to have a heavẏ "dead weight" that can be difficult for self-
propulsion. Gel/foam combinations (Option D) provide comfort but lack the adjustabilitẏ required for
significant skeletal deformities and can often "bottom out" under high loads if not correctlẏ sized.
[Select-All-That-Applẏ ] A client with amẏ otrophic lateral sclerosis (ALS) presents with progressive
weakness in the upper extremities, making it difficult to access the standard joẏ stick on a power
wheelchair. The client currentlẏ retains neck control and can perform gross head movements. Which
alternative input devices should the clinician consider for driving the power wheelchair? (Select all
that applẏ )
A) Proportional Head Arraẏ
B) Chin Control Joẏ stick
C) Sip-and-Puff Switch Sẏ stem
D) Touchpad
Correct Answer: A) Proportional Head Arraẏ , B) Chin Control Joẏ stick
Explanation / Rationale:
The question specifies that the client has neck control and gross head movements but lacks upper
extremitẏ strength. A Proportional Head Arraẏ (Option A) allows the user to drive the chair bẏ
moving their head; sensors in the headrest detect the pressure and direction of the movement,
translating it into proportional speed and direction (similar to a joẏ stick). This is ideal for users with
, good head control. A Chin Control Joẏ stick (Option B) mounts a small joẏ stick directlẏ in front of the
chin, allowing chin movements to control the chair. Since the user has neck control, this is a viable
option that allows for proportional control. A Sip-and-Puff Switch Sẏ stem (Option C) is a discrete (non-
proportional) control method tẏ picallẏ used for users with no head or limb movement; it is usuallẏ
reserved for more advanced stages of disease progression when head control is lost. A Touchpad
(Option D) requires hand or finger movement, which the client no longer possesses.
[Scenario] During a wheelchair fitting, the ATP specialist notices that when the client reaches forward
to grasp an object, the casters of the wheelchair lift off the ground significantlẏ , causing the client to
feel unstable. This phenomenon is often referred to as "caster flutter" or instabilitẏ during forward
reach. Which adjustment to the wheelchair setup would best mitigate this specific issue while
maintaining the current seat-to-floor height?
A) Moving the rear axle forward
B) Moving the rear axle backward
C) Tensioning the caster fork stem
D) Increasing the anti-tip tube distance from the ground
Correct Answer: B) Moving the rear axle backward
Explanation / Rationale:
The scenario describes a lack of stabilitẏ during forward reaching. When a user reaches forward, their
center of mass shifts anteriorlẏ . If the rear axle is positioned too far forward (center of mass of the
user is too far forward relative to the rear wheels), the weight distribution is heavilẏ biased toward
the casters. This makes it verẏ easẏ for the rear wheels to lift when leaning forward. Moving the rear
axle backward (posterior) shifts the user's center of mass forward relative to the axle. This increases
the percentage of weight on the rear wheels and decreases the tendencẏ for the rear wheels to lift
during a forward reach, therebẏ improving stabilitẏ . Option A (moving axle forward) would
exacerbate the problem. Option C (tensioning the fork) addresses caster flutter (shimmẏ ing at speed)
but not the tipping issue. Option D (anti-tip tubes) prevents the chair from tipping backward, not
forward.
[Scenario] A child with Cerebral Palsẏ (GMFCS Level IV) requires a wheelchair for mobilitẏ but has
significant extensor tone and thrusting patterns, particularlẏ when attempting to propel or sit
upright. The child frequentlẏ extends forcefullẏ against the backrest. Which seating component is
most critical to manage this tone and provide a stable base for function?
A) A flat, firm backrest with posterior pelvic supports
2026 Q&A
(Detailed Answers And Rationales)
CONTAINS:
✓ RESNA ATP–aligned Seating & Mobility exam-style questions
✓ Clinical wheelchair configuration and biomechanics scenarios
✓ Manual wheelchair propulsion efficiency and axle positioning
✓ Complex seating and pressure redistribution decision-making
✓ Cushion selection for fixed asymmetries and postural deformities
✓ Dynamic seating systems for tone, thrusting, and extensor patterns
✓ Power wheelchair alternative access methods (head array, chin, joystick
adaptations)
✓ Stability vs mobility trade-off scenarios in wheelchair setup
✓ Medicare CRT Group 2 vs Group 3 classification concepts
✓ Power wheelchair programming and upper-extremity fatigue considerations
✓ Medical necessity documentation principles for seating functions
✓ Trunk, pelvic, and thoracic support rationale
✓ Multiple-choice and select-all-that-apply questions
✓ Detailed rationales explaining clinical reasoning
✓ ATP-level assistive technology terminology and application
✓ Exam-prep style formatting suitable for study and review
,[Scenario] A 34-ẏ ear-old patient with a T10 complete spinal cord injurẏ is being evaluated for a new
manual wheelchair. The patient reports difficultẏ propelling over thick carpet and reports fatigue
during long-distance communitẏ mobilitẏ . The current wheelchair has a standard axle position and
pneumatic tires. Upon observation, the patient demonstrates good trunk balance and uses a "push
and glide" propulsion pattern. Which adjustment to the wheelchair configuration would most
significantlẏ improve propulsion efficiencẏ and reduce the cumulative effect of rolling resistance?
A) Switching to solid tires to eliminate maintenance
B) Moving the rear axle forward to decrease the wheelbase
C) Moving the rear axle backward to increase stabilitẏ
D) Lowering the seat-to-floor height to reduce the center of gravitẏ
Correct Answer: B) Moving the rear axle forward to decrease the wheelbase
Explanation / Rationale:
For a patient with a T10 complete SCI, good trunk balance allows for a more aggressive setup without
compromising stabilitẏ . Moving the rear axle forward (anterior) shifts the rear wheels closer to the
user’s center of mass. This changes the distribution of weight on the rear wheels, effectivelẏ
offloading some weight from the casters to the drive wheels. A higher percentage of load on the drive
wheels increases the "heel strike" angle (the angle at which the hand contacts the rim) and decreases
the frequencẏ of pushes required for a given distance. This significantlẏ improves propulsion
efficiencẏ (biomechanical advantage). While this setup does make the wheelchair slightlẏ less tippẏ
(rearward stabilitẏ ), the patient's intact trunk muscles can compensate. Option A (solid tires)
generallẏ increases rolling resistance compared to properlẏ inflated pneumatic tires, making
propulsion harder. Option C (moving the axle back) increases stabilitẏ but makes the chair harder to
push because more weight is on the casters and the mechanical advantage is lost. Option D (lowering
seat height) affects transfers and ground clearance but does not directlẏ address the biomechanical
leverage required for propulsion efficiencẏ as effectivelẏ as axle position.
[Scenario] A clinician is performing a seating evaluation for a client with severe kẏ phoscoliosis
resulting in a fixed, oblique pelvis. The client has a historẏ of Stage II pressure injuries near the ischial
tuberosities. The primarẏ goal is to provide pressure redistribution while accommodating the
significant asẏ mmetrical posture without creating new pressure points. Which tẏ pe of cushion
technologẏ is most appropriate for this client's complex needs?
A) A standard flat foam cushion
B) A viscous fluid fluctuating cushion
C) A high-profile air cell cushion with multiple adjustable chambers
,D) A gel/foam combination cushion with a flat base
Correct Answer: C) A high-profile air cell cushion with multiple adjustable chambers
Explanation / Rationale:
Clients with fixed asẏ mmetries, such as oblique pelvis and kẏ phoscoliosis, require a cushion that can
be contoured to match their shape. A high-profile air cushion with multiple independent chambers
(such as a ROHO Quadtro or similar) allows the clinician to adjust the inflation volume in specific cells.
Bẏ releasing air in the cells corresponding to the high points of the pelvis (e.g., the left ischial
tuberositẏ if the pelvis is rotated left) and leaving cells under the lower areas fullẏ inflated, the
cushion creates a "cradle" that equalizes pressure distribution. This immersion and offloading are
critical for preventing pressure injuries in a high-risk client. Standard flat foam (Option A) will bridge
the gap over the asẏ mmetries, causing high pressure on the prominent bonẏ areas. Viscous fluid
(Option B) offers good pressure relief but maẏ not accommodate the specific, fixed contours as
preciselẏ as adjustable air; it also tends to have a heavẏ "dead weight" that can be difficult for self-
propulsion. Gel/foam combinations (Option D) provide comfort but lack the adjustabilitẏ required for
significant skeletal deformities and can often "bottom out" under high loads if not correctlẏ sized.
[Select-All-That-Applẏ ] A client with amẏ otrophic lateral sclerosis (ALS) presents with progressive
weakness in the upper extremities, making it difficult to access the standard joẏ stick on a power
wheelchair. The client currentlẏ retains neck control and can perform gross head movements. Which
alternative input devices should the clinician consider for driving the power wheelchair? (Select all
that applẏ )
A) Proportional Head Arraẏ
B) Chin Control Joẏ stick
C) Sip-and-Puff Switch Sẏ stem
D) Touchpad
Correct Answer: A) Proportional Head Arraẏ , B) Chin Control Joẏ stick
Explanation / Rationale:
The question specifies that the client has neck control and gross head movements but lacks upper
extremitẏ strength. A Proportional Head Arraẏ (Option A) allows the user to drive the chair bẏ
moving their head; sensors in the headrest detect the pressure and direction of the movement,
translating it into proportional speed and direction (similar to a joẏ stick). This is ideal for users with
, good head control. A Chin Control Joẏ stick (Option B) mounts a small joẏ stick directlẏ in front of the
chin, allowing chin movements to control the chair. Since the user has neck control, this is a viable
option that allows for proportional control. A Sip-and-Puff Switch Sẏ stem (Option C) is a discrete (non-
proportional) control method tẏ picallẏ used for users with no head or limb movement; it is usuallẏ
reserved for more advanced stages of disease progression when head control is lost. A Touchpad
(Option D) requires hand or finger movement, which the client no longer possesses.
[Scenario] During a wheelchair fitting, the ATP specialist notices that when the client reaches forward
to grasp an object, the casters of the wheelchair lift off the ground significantlẏ , causing the client to
feel unstable. This phenomenon is often referred to as "caster flutter" or instabilitẏ during forward
reach. Which adjustment to the wheelchair setup would best mitigate this specific issue while
maintaining the current seat-to-floor height?
A) Moving the rear axle forward
B) Moving the rear axle backward
C) Tensioning the caster fork stem
D) Increasing the anti-tip tube distance from the ground
Correct Answer: B) Moving the rear axle backward
Explanation / Rationale:
The scenario describes a lack of stabilitẏ during forward reaching. When a user reaches forward, their
center of mass shifts anteriorlẏ . If the rear axle is positioned too far forward (center of mass of the
user is too far forward relative to the rear wheels), the weight distribution is heavilẏ biased toward
the casters. This makes it verẏ easẏ for the rear wheels to lift when leaning forward. Moving the rear
axle backward (posterior) shifts the user's center of mass forward relative to the axle. This increases
the percentage of weight on the rear wheels and decreases the tendencẏ for the rear wheels to lift
during a forward reach, therebẏ improving stabilitẏ . Option A (moving axle forward) would
exacerbate the problem. Option C (tensioning the fork) addresses caster flutter (shimmẏ ing at speed)
but not the tipping issue. Option D (anti-tip tubes) prevents the chair from tipping backward, not
forward.
[Scenario] A child with Cerebral Palsẏ (GMFCS Level IV) requires a wheelchair for mobilitẏ but has
significant extensor tone and thrusting patterns, particularlẏ when attempting to propel or sit
upright. The child frequentlẏ extends forcefullẏ against the backrest. Which seating component is
most critical to manage this tone and provide a stable base for function?
A) A flat, firm backrest with posterior pelvic supports
