Page 19 - Mobility Management, August 2017

Q: DME vs. CRT Backrests
Mobility Management: What are the main functions of a backrest that’s on a complex rehab power or manual wheelchair? How
do those functions and expectations differ from the sling-style backrest on a general-use manual wheelchair or a captain’s-style back on a consumer power chair?
Jeff Rogers: If you look at sling upholstery, its primary job
is to keep you from falling out. That’s about as much as it can really do. In some cases, it can be a little more involved, when it’s tension adjustable. But overall, its primary focus is to make sure you don’t go out the back.
Scott Brown: The primary function of a “backrest” is simply to provide the client with a posterior resting spot. The outcome is directed more toward comfort than positioning. Many of these products (e.g., sling style, captain’s style) do not integrate additional functions that would allow us to reposition the client, or accommodate for postural deformities, effectively within the mobility environment.
Suzanne Eason: When looking at someone who requires a great deal of postural support throughout the trunk, neck and head, we want to look for a back that complements what they can do and compensates for what they cannot do.
For example, a person may have a well-seated pelvis and lumbar area, but may collapse through the trunk and neck region — a backrest may need to be taller with well-fitting lateral supports. Off-the-shelf backs are often meant for someone with little to no postural asymmetries and may be more harmful than supporting without custom modifications.
Cindi Petito: With the exception of adjustable-tension, soft sling backs, where you can do some minor positioning for patients with kyphosis or posterior pelvic tilt, standard sling backs and captain seat backs are not adjustable and provide no positioning or skin-protection qualities. They cannot be changed or modified to meet the needs of a complex rehab client.
I would choose a sling back if the end-user wants to fold the manual chair, keep it lightweight, or has a preference for a sling back.
The main function [of a CRT back] is contoured support, both posterior and lateral support, and whether or not the back can be modified to meet individual needs of the client.
The second feature I look for with back support is the type of foam and fabric to meet the needs of those who have bony spinal prominences or heat issues.
The third feature would be if the back can be modified for complex rehab patients or is able to accommodate complex spinal deformities.
Q: Top Qualities in a Backrest
MM: What are the most important considerations when designing a complex rehab backrest? How crucial are such factors as backrest adjustability and backrest weight?
• Scott Brown: Complex rehab “back supports” are designed with client accommodation in mind. These options provide us with a wide range of features, such as adjustable back height and seat/back angle, customization, removability, etc. This level of personalization results in a more function-driven outcome, addressing the postural needs that are unique to the individual.
• Cindi Petito: Weight is the primary feature needed for wheelchair backs that are used on manual wheelchairs. Backrest adjustability is very critical in meeting the positioning needs of patients with progressive neuromuscular diseases. It is also crit- ical for those where primary positioning needs are to accommo- date complex spinal deformities.
The third consideration when thinking about adjustability is if the medical team recommends surgical (invasive and non-in- vasive) [interventions] and the patient’s posture will change.
A modular backrest that can accommodate postural change is important in this scenario.
• Suzanne Eason: Tilt-in-space frame systems are often used for complex rehab, especially if someone is not able to relieve pressure from their backs and bottoms through active movement. Tilt-in-space frames are very heavy, and because of this, I typi- cally do not worry about the weight of the back.
A few things I would like in a custom complex back are adjust- ability, especially if the client is young or has a progressive condi- tion — that the back is able to contour to all parts of the client’s body so they do not take excessive pressure, that the back is cool (temperature), has some dynamic movement and has a low visual profile so you see the person and not the chair.
Jeff Rogers: Trying to develop a back that’s really focused in a complex rehab environment — a lot of it is about adjustability, being able to move the backrest, to adjust it, to really focus on unique needs of that individual. My saying with cushions is no two butts are the same. I think the same applies to the backrest.
I think we err on the side of over-engineering, making sure that we have plenty of adjustment range, whether it be back angle or back height. That’s the key of the adjustability: making sure it fits well, supports the individual, helps them extend their day by making them able to sit longer.
We err on the side of having a lot of adjustment range, but we also start to tailor to those individuals that may need a certain thing: less adjustment on one side, more adjustment on the other. We try to tailor that if we can, but if we can give the dealer or
the clinician more of an adjustment range, the better off they are, because they’re not going to have problems later when they can’t get it to fit the individual and have to either buy new parts or go with a different backrest.
I think it’s critical [that a clinician or ATP can adjust a backrest in real time, while the client is in the clinic]. A lot of times, when a person gets fit for their chair or their back, they’re venturing in from 10 or 100 miles away. They may not come back into clinic
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