Last week I posted my list of questions to ask relating to a seat cushion (Selecting a Seat Cushion: A Simple List to Get Started!). I think a lot of us can agree that seat cushions get most of the attention in discussions around seating.
Sure, back supports, head supports, and lateral supports get an honorary mention, but really, when it comes down to it, how often do we receive a referral to evaluate just the back support on a person’s wheelchair because they have a new pressure injury? Or because they’re sliding out of their chair? Or because they have a pelvic obliquity? Not very often. But we know, and I can say this with the upmost confidence, that even the best, most perfectly fitted and appropriately prescribed cushion can lack the desired outcomes without a well-fitting back support. If you disagree, I would love to hear your thoughts on why. If you agree, I would love to hear your thoughts on why. Maybe I’ll do a post solely dedicated to those responses, because I truly believe it, and I honestly think the value of a well fitted posterior support is often overlooked.
Rant over. Let’s talk back supports.
So long are the days of measuring from the seated surface to the inferior angle of scapula or to the shoulder, then throwing on some lateral supports for added stability.
As clinicians in today’s world, we have a critically important role in ensuring that the seating system we recommend and/or prescribe is optimal for the individual we are working with and aligns with our clinical findings.
Similar to selecting a seat cushion, our decision on which back support to prescribe will depend on various factors influenced by the human and others influenced by the technology. This is a list I created with the same purpose as the list for Selecting a Seat Cushion with a focus on the key parameters of a back support.
The intended use for this list was for an exhibition or in a suppliers showroom where many back supports are on display and to get clinicians thinking about the differentials in off the shelf back support solutions. It is a subjective list that I hope may be helpful. We can then match the answers to these questions with the answers we obtained from our postural assessment with a particular client, and bam! we are on a direct path to an optimal match!
So, let us ask ourselves:
Can we answer these questions about the back supports we use or prescribe?
How much posterior support does it offer (i.e. what is the level of support offered)?
How do I get what I need- what are the clinical measurements needed?
Does the manufacturer/supplier make the difference between “Length” and “Height” clear as per best practices?
How much angle adjustment is provided?
How much seat depth is lost with angle adjustment?
Can I match the shape of the individual from top to bottom and side to side?
Can I change the shape if needed?
Can the client/care givers change the shape easily?
How much lateral support does it offer? What is the depth of integrated contour and/or addition of lateral supports?
How much width is there between the laterals? Consider the impact on the width of the person at the point where the lateral support is needed versus the width of the chair the back support is designed to fit on.
How much depth adjustment does it have?
Is it crash tested?
How compatible is it with head supports, positioning straps and harnesses?
What materials or technologies are available to manage microclimate/heat & moisture buildup?
Is it compatible with dynamic components?
What are the considerations around push handles?
Is it possible to clean thoroughly? Does it comply with Covid-19 disinfecting best practices?
How easy is it to fit with the person in the chair?
How much dexterity is required for releasing the back support from the chair?
What is the weight of the fully assembled back support?
This list is not static. It has changed, evolved and expanded based on discussions with others in clinical practice and advances in the field.
Every time this list is presented in a seminar, I invite clinicians to suggest additional questions that I have not included that may be meaningful for their clinical practice. So, I’d like to do the same with you.
What kinds of questions would you add to this list?
What questions do you have about what’s already on this list?
If you were limited by time, resources, etc. and were only able to ask 5 of the questions listed, which would they be? Why is that?
Every day is an opportunity for us to learn from each other. I hope that by sharing my experience with you, you can learn from me. I hope just as much that you are willing to share your experiences and/or insights and thoughts with me, so I can learn from you.