Wheelchair backs that support the spinal curves: Assessing postural and functional changes.

Objective: To compare outcomes using a wheelchair back designed to support the natural seated spinal curves versus an upholstered back that promotes posterior pelvic tilt and thoracolumbar kyphosis.Design: Cross-over intervention.Setting: Two free-standing spinal cord injury (SCI) model system hospitals.Participants: Fifty adults with motor complete SCI C6-T4, between the ages of 18-60 years who use a manual wheelchair for mobility were recruited from a convenience sample.Intervention: Each participant's wheelchair back support was removed and replaced by an upholstered back and a solid back in randomized order. Postural and functional outcomes, pain, and satisfaction were evaluated using each back.Outcome measures: Seated postural measurements included pelvic angle, spinal angle of kyphosis and linear measurement of spine. Functional outcomes included vertical forward reach, one stroke push, timed forward wheeling, ramp ascent and descent. Numerical pain rating and a satisfaction survey provided input pertaining to both backs.Results: The solid back demonstrated significance in seated postural measurements. Participants using the solid back trended to higher scores in functional outcome measures including vertical forward reach, one stroke push and timed ramp ascent. Participants reported increased satisfaction with comfort and stability with the solid back.Conclusions: This pilot study demonstrated that a wheelchair back, which supports the seated spinal curves improves upright posture, functional reach, and wheelchair propulsion skills. Further research is necessary to demonstrate statistical findings as well as to assess back height and lateral support.

RESNA position on the application of dynamic seating.

Dynamic Seating is an intervention used as a part of a manual or power wheelchair to provide movement against resistance in response to client force. This technology can be used for various clinical applications including preventing client injury and equipment breakage; dissipating extensor forces; providing movement for sensory input, calming, and increased alertness; increasing muscle strength, trunk and head control; and other medical benefits. The purpose of this RESNA Position Paper is to provide a definition for this technology in relation to other seating and wheeled mobility technologies as well as present clinical indicators for this seating intervention including literature to substantiate these claims. Although more recent and stronger evidence is needed, existing research does support the application of dynamic seating in numerous clinical scenarios.