ACCOMMODATING FOR KYPHOSIS:
I can remember when I started being trained to do wheelchair fittings, many of the patients were people who had been sitting in their recliners or sling upholstery wheelchairs for years and hence had spinal deformities due to lack of proper positioning and support. Kyphosis was a common diagnosis on the list of seating issues I was addressing.
That was over 15 years ago and at that time we utilized foam-in-place backs or backs that had removable sections of foam in the center to accommodate the curvature. If the curvature was centered on the spine the removable foam backs worked. When the curvature was off-center and/ or in the high thoracic region foam-in-place was the better option for the patient. The downsides to foam-in-place were that it required moving the patient multiple times during the process, it decreased the seat depth, added weight to a chair and could be messy. If the wheelchair frame the patient already owned did not allow for depth adjustment then the patient was moved away from the axel reducing access to the wheel for mobility. Many of the patients did not find the foam-in-place that comfortable in those days either. Better and softer foam kits are now available but in those days they tended to be on the firm side. In order for the patient to get comfortable the caregiver had to get them exactly placed. Then if there were any changes to the patient the back had to be re-done.
Thankfully over the years new ways for treating old issues have developed. Many patients with kyphosis do not need an aggressive foam-in-place back as their solution. They need a back that provides the contact and support without being fixed and limiting their mobility. The newest revolutionary technology can be found in the Acta-Relief back from Comfort Company. By using the Boa® strap system to create the optimal contours needed to support and lower the pressure on the bony prominences of the spine the Acta-Relief properly positions the patient in the seating system without taking up seat depth and adding weight to the wheelchair. The Boa® system is adjustable throughout the entire back section with a minimal aluminum shell allowing it to accommodate high, mid, low and offset curvatures.
By not taking up depth or adding weight to the wheelchair the patient remains appropriately centered over the rear axle of the wheelchair to allow for arm propulsion by the patient in a chair without seat depth adjustability. The Acta-Relief also can be fitted with a headrest and because the patient is not “pushed” forward with excess foam it is easy to properly position the head when combined with a tilt-in-space wheelchair.
It is honestly a relief to see new ways to treat old issues that are off the shelf and so easy to utilize. Comfort and adjustability to meet our client’s kyphotic postures is what the Acta-Relief back provides.
JONATHAN BIGGERS, ATP
