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

Abstract

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.

Keywords: Functional outcomes manual wheelchair; Manual wheelchair; Wheelchair back supports.

Figure 1

Upholstered and Solid Back – The upholstered back was placed on the participant’s wheelchair in standard configuration which allowed a slight posterior pelvic tilt. The solid back was configured to support the spinal curves in a neutral sitting position. (Photo courtesy Cynthia Smith – used with permission.)

Figure 2

Pelvic Angle – Femur to pelvis angle was measured by placing the goniometer over the hip and the arms aligned with pelvis and femur. This denotes pelvic tilt. (Photo courtesy Jessica Presperin Pedersen-used with permission.)

Figure 3

Spinal Angle of Kyphosis – Femur to acromion was measured by placing the goniometer over the hip and the arms aligned with acromion and femur. This denotes the orientation of the upper back and reflects spinal flexion or extension. (Photo courtesy Cindy Smith. Used with permission)

Figure 4

Linear Measurement of Spine (Floor to Acromion) – The distance of the floor to acromion was measured. This denotes whether there were differences in participant height with alternate back supports. (Photo courtesy Cindy Smith. Used with permission)

Figure 5

Vertical Forward Reach – The highest point reached parallel to the floor was measured. This evaluates participant stability and is a measure of functional mobility. (Photo courtesy Jessica Presperin Pedersen-used with permission.)

Figure 6

One Stroke Push – The forward distance propelled when pushing once with maximal effort on carpet was measured. This evaluates single stroke propulsion efficiency and is a functional mobility measure.

Figure 7

Vertical Forward Reach density plot.

Figure 8

One Stroke Push density plot.

Figure 9

Ramp Ascent density plot.

Figure 10

Upholstery Back, slouch. (Photo courtesy Cindy Smith. Used with permission.)

Figure 11

Solid Back, upright. (Photo courtesy Cindy Smith. Used with permission.)