How to Choose the Right Back Height for Your Client

Thanks to always-evolving technology — not to mention the evolution of funding policies — today’s wheelchair backs are more versatile, functional and customizable than ever.

One important aspect of the backs used on manual wheelchairs, and especially on ultralightweight chairs that are self propelled, is height. Manufacturers often produce the same back in different heights — for instance, low, medium and high — to further enable providers and clinicians to create a seating system that closely matches a particular client’s needs.

The Relationship Between Height & Function

Manufacturers offer different back heights to correspond to different needs among different clients. For instance, taller backs, while providing more support, can also interfere with or limit trunk and upper-extremity function, including the ability to self propel as efficiently as possible.

Generally speaking, clinicians say, the height of a wheelchair back is directly correlated to how much support the client needs, and therefore refl ects the level or severity of the client’s involvement.

Backs used, for example, by active clients with low-thoracic spinal cord injuries (SCI) may not rise much higher than the client’s lumbar spine. These back heights are preferable for this patient population because clients have good trunk balance and need less support. Lower backs enable a good range of upper-extremity motion and allow some rotation of the trunk as well.

High (or “tall”) backs provide much more intensive support and can be the better choice for patients who need that assistance — for instance, SCI patients with quadriplegia. High backs are also the clinicians’ choice for clients using tilt and/or recline, so clients are properly supported while using their positioning systems. High backs may measure up to the tip of the client’s shoulder. Higher backs can also accommodate the addition of lateral trunk supports or headrests for clients who need them.

The mid-range back provides additional postural support for clients who need it, but the mid-range back’s reduced height compared to high backs means less interference with upperextremity motion and function. Mid-height backs often measure up to the bottom of the client’s scapula, and some mid-height models can also accommodate lateral trunk supports to give the client more stability without impeding upper extremities any more than necessary.

Other Low/Mid/High Considerations

In addition to the various clinical and functional considerations that impact back height choices, providers should also be aware of several other factors to consider during the decision-making
process:

  • Transportation issues: If the client will be using the wheelchair as seating while in an automotive vehicle, a higher backrest may be needed to accommodate a chest harness or similar passenger restraint system. As part of the seating & mobility assessment process, providers should ask about transportation expectations, including public or school transportation, and determine whether a higher back will be needed to satisfy those safety policies.
  • Weight: Self-propelling wheelchair users often consider it crucial to keep their chairs as svelte as possible, which means every component of their chairs is scrutinized for unnecessary weight. Differences in materials used, actual size, etc., cause back weight to vary from model to model, so even once the client and rehab team choose a back height, you’ll still have product choices within that height category.
  • Lifestyle: As with any other major component in the seating system, if a client doesn’t like the wheelchair back that’s been chosen — because it interferes with daily activities, it’s uncomfortable, etc. — he/she could be less functional and may spend less time in the system, period. Although clinical needs are crucial to choosing a back height, a thorough evaluation of how the back will fit into the seating & mobility system and into the client’s entire environment and lifestyle could help prevent a lot of dissatisfaction later.

Explain the back’s pros and cons, and why the evaluation team is recommending this particular back height, model, material, cover, etc. Encourage the client to ask questions and voice concerns about difficulties he might have, particularly if he worries that the back is going to make it difficult to easily carry out activities that are important to him. In some cases, the rehab team, client, caregivers, etc., may be able to brainstorm a work-around to the problem that will enable the client to still function efficiently while simultaneously using the seating & mobility system that provides the very best clinical fit.

The best news for clients and rehab professionals alike is that backs of all heights offer more customizing options than ever, whether it’s in contouring or in materials used or in cover choices — thereby enabling rehab teams to “create” a new, clinically advantageous and unique system every time.

Back to Basics

  • Read “Proper Fit of a Wheelchair” by Chris Maurer, MPT, ATP, by going to http://atwiki.assistivetech.net/index.php/Proper_fit_of_a_wheelchair. The story includes instructions for properly measuring back height, seat width/depth/height, armrest height/length and more.

  • Go to mobilitymgmt.com, and use the Comparos section on the home page to download a pdf of Mobility Management’s latest Wheelchair Backs Comparo. This side-by-side comparison provides specifications and sizing for an array of wheelchair backs, including low, mid and tall heights. And look for an updated 2010 Wheelchair Backs Comparo later this year!

This article originally appeared in the July 2010 issue of Mobility Management.

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