The benefits of a solid back for everyday wheelchair users

Benefits of the right back support:

For a person who uses a wheelchair most of the time, the back support plays a key role in optimizing function and independence. A solid back support for an individual, especially one who utilizes a rigid manual wheelchair, may accomplish some or all the benefits below:

1. Provide trunk stability and balance by supporting the natural curves of the spine
   
   
2. Enhance the cushion in promoting pelvic stability and pressure redistribution to minimize peak pressures
   
   
3. Decrease the likelihood of/or progression of postural abnormalities
   
   
4. Decrease pain and increase sitting tolerance
   
   
5. Promote optimal function, safety, and independence by increasing the connection and responsiveness of the manual wheelchair

When considering a standard sling back or a solid back, a thorough physical and functional therapy evaluation needs to be done that will include assessments of range of motion, strength, tone, and balance. The therapist can then determine whether a solid back support would be better than a sling back by asking the following questions:

1. Is the client at risk of or already have a postural abnormality that affects pelvic and/or trunk stability and alignment?
   
   
2. Is the natural ‘give and take’ of upholstery affecting the client’s posture, function or independence?
   
   
3. Does the client complain of pain while using their wheelchair?

If the answer is yes to any of these, a solid back support should be considered. The therapist should then have the client sit on a mat table and determine the amount of support needed and at what level of the trunk it is needed to optimize stability and function. They can do this using their hands to simulate the amount and level of support.

How do I know which solid back to choose?

Back supports include various shape options. When looking specifically at back supports for people who propel independently and function well in an appropriate wheelchair, the shape differences relate more to the contouring. These backs typically are shorter to allow freedom of movement of the upper extremities. Depending on the level of injury, each person will be unique in how much lateral contouring they require and prefer to function well in daily tasks. When the therapist has determined the appropriate length of a back support, the amount of contouring can be determined. This can be done in the same way as determining length: on the mat, using their hands to simulate the amount of lateral support needed to maintain an optimal posture. This amount of support can then be provided by a back support that has the amount of lateral contouring required. If more customized support is required, lateral trunk supports can be considered.

The medium of the back support shell and hardware is very important, especially for an active user. They can be made from various materials, which can impact the weight of the back and, ultimately, the entire wheelchair system. The goal is to keep a system as lightweight as possible to make propulsion, and loading/unloading the chair in the vehicle as easy as possible. When assessing a back support, take the cover off and look at the shell. The most common material is aluminum as it is durable while remaining relatively light weight. Carbon fiber is also becoming a more affordable option and is often preferred due to the increased strength to weight ratio, allowing the backrest to be very lightweight. Hardware materials vary greatly, so be sure to include the weight of the hardware when assessing the weight of the back support.

The backrest insert medium can be foam, air, or a combination of foam and air. The medium can have a significant impact on function and should not be taken lightly. For example, if a person using a wheelchair relies on the back support stability when performing lower body dressing, the firmness of the foam can impact that stability. A back support with only air cells could possibly make the back seem less stable for someone who needs a firm surface for stability. Of course, every individual is unique, so a functional trial is always recommended to ensure the individual can complete daily tasks safely and efficiently.

This feature is one of the most important when looking at a back support. Angle and depth adjustability are achieved through the hardware. So, when assessing a back support, a good look at the hardware and how it works is important. The key adjustment for any back support is angle adjustability. Simply opening the seat-to-back angle can significantly improve stability, comfort, and function

As you can see, there are many factors to consider in selecting an appropriate back support for an active wheelchair user. Permobil now has a complete line of back supports to meet the needs of individuals with an active lifestyle. The Agility Active series is designed to stabilize the person’s pelvis and trunk, utilizing lightweight shell materials. The minimal backrest hardware offers 15 degrees of discrete angle adjustment forward and rearward while not weighing the seating system down. Check out the entire Agility Active series here!