Bridget Churchill

Bridget Churchill

Clinical Educator and Occupational Therapist

Welcome to Part 2 of this series exploring the effect back supports can have on sitting posture. First, to recap:

The back support height and width selection is dependent on a number of factors. The base of the back support generally runs from the height of the posterior superior iliac spines (PSIS) to the chosen height against the user’s back depending on the support needed for stability and the freedom of movement required at the shoulders (e.g. if a wheelchair user is self-propelling).

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How does Spex offer off-the-shelf solutions for complex postures?

Basic wheelchair measurements include the shoulder width, chest width (from armpit to armpit) and hip width. These width measures must be considered and accommodated when prescribing the wheelchair chassis and corresponding modular seating options to optimise:

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The back support, cushion height and width selection is dependent on a number of factors. The base of the back support generally runs from the height of the posterior superior iliac spines (PSIS) to the chosen height against the user’s back depending on the support needed for stability and the freedom of movement required at the shoulders (e.g. if a wheelchair user is self-propelling).

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This article is a simple refresher to pelvic anatomy, what we mean by ‘stability’ and how we can optimise this in wheelchair sitting. Clinical evidence to support this blog is listed at the end. An introduction to pelvic anatomy and an anatomically neutral position in sitting.
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Wheelchair users often require postural support devices (PSD’s) such as chest straps/harnesses to reinforce support and optimise function within the wheelchair seating system. This allows support in both the sagittal and coronal planes for stability of the wheelchair user in the wheelchair.  

Anterior trunk support may include chest straps and chest harnesses.

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When providing a seating solution, the focus is generally on the seating cushion, back support and footrests. The primary contact surfaces are the starting point, always, as these provide the major contributions to alignment and stability at the weight-bearing surfaces at the pelvis and the trunk and feet in sitting. There are additional postural support devices and accessories that help to maintain posture in sitting so that sitting effort is reduced, and pressure is offloaded for comfort and skin integrity.

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Joel Harris

Cushion contouring can provide stability, comfort, and help to offload pressure from the main weight-bearing areas of the buttocks and back of the thighs onto the medial or lateral area. This is achieved by maximising surface contact between cushion and the wheelchair user, maintaining or improving pelvis alignment and body posture and preventing factors that contribute to abnormal tone and pain. 

Common cushion surface contouring includes:

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How we think about wheelchairs varies from person to person. When I was researching information about the ‘look’ of a wheelchair earlier this year, there wasn’t really the information out there that I needed. When I wrote ‘Part 1’ of this blog, I was motivated to explore this further. This research is an opportunity to find out from people who use wheelchairs, their family members, and their caregivers about what actually is important to them.
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In February 2020 I met Jesse and his family during a Spex backrest handover and set-up. What struck me most about Jesse was how his 24/7 posture care management routine was so carefully followed and monitored to maintain his engagement in activities he loved, whilst preserving and protecting body shape since his childhood, following a diagnosis of Cerebral Palsy.
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When it comes to wheelchairs that are essential for mobility and functional activities, these devices may become a form of self-expression and identity because they become an extension to the wheelchair user's body (Cifu, 2013, p.292). Children and teenagers may add decorative spoke guards or choose colours to promote self-expression. Therefore, prescription of assistive technology should meet functional needs, meet a clinical need and be nice to look at.

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