Wheelchair users expect a lot from their wheelchairs’ backrests, from positioning to support to comfort. Since each wheelchair user has unique clinical, environmental and lifestyle needs, it’s natural that the factors they see as most important in a wheelchair back would vary. Still, listening to consumer chatter in cyberspace can give clinicians and complex rehab technology providers valuable insight into what consumers are thinking, complaining about and wishing for.

One Backrest, Many Demands

Finding the right wheelchair back can be a challenge even for higher-profile users, such as Paralympic athletes. Take, for example, Pippa Britton, a Paralympian in archery from Great Britain.

In a YouTube video, Britton – who was born with spina bifida and began developing scoliosis at age 12 – talked about challenges she faced in finding a backrest that would enable her to compete up to her full potential.

“We started off with my wheelchair, just stuffing towels down behind me to try to give me extra support,” she says. “And then we went to an orthotics company and they took a cast of my back and made a rigid back support that we fitted to my existing chair.”

Britton said that solution “worked quite well,” but the complete lack of flexibility of the system was a drawback.

“Your body never stays the same, does it?” she points out. “You put on weight, and you lose weight. Within that sort of confine of the support on my back, I needed something that would hug me on the one side and open out on the other side. It also needed to have a rotational element as well.”

Her coach, Tim Hazell, added they were seeking a backrest that was fully adjustable “literally down to 1-millimeter increments.”

“A couple of millimeters one way or the other would make the difference to whether my back would spasm or not. Having a curve in your back doesn’t mean a pain-free existence,” Britton says, “so that’s something I struggle with on a daily basis.”

What Consumers Are Discussing

Judging from consumer conversations on Rutgers University’s CareCure Community Forums, finding the “right” wheelchair back requires a very personalized search, and consumers are eager to tap into resources on the subject, including which backrests other wheelchairs users are successfully using.

Their comments and questions can help ATPs to learn what sorts of wheelchair backrest topics are on consumers’ minds (as well as what possible backrest-related misperceptions are out there).

In the SCI CareCure forum, consumers…

— Compared personal preferences for and experiences with different wheelchair back heights.

— Discussed the amount of support that different back heights can offer in relation to the amount of support needed by consumers with various spinal cord injuries.

— Asked how wheelchair back widths are measured: “My chair is 15 inches wide, and they only have 14-inch and 16-inch widths. What size would I need?”

— Questioned each other regarding whether hardware, such as clamps, get in the way when consumers in wheelchairs reach out or bend.

— Talked about whether certain back makes and models have been crash tested to WC20 standards.

— Mentioned difficulties that backrests with excessive play can cause.

Consumers also were interested in those all-important smaller details, such as how easily backrest covers could be removed and the aesthetics of different backrest covers.

Not surprisingly for ultralightweight wheelchair users, backrest weight was also discussed.

Positioning as a Day-Long Challenge

A companion thread in the SCI CareCure forum starts with a community member asking another forum participant – who is an OT — for suggestions on how to improve his posture, which he describes as “my lumbar curve out of whack” with “a lot of back pain” as a result. The community member includes an x-ray of his spine.

The OT replies that the x-ray suggests “your lumbar curve is excessive” and recommends the wheelchair user undergo a detailed assessment from a physiatrist or orthopedic specialist, as well as by “a seating therapist experienced in SCI.”

The consumer’s response detailed the challenges of creating not only a suitable seating & mobility system, including an appropriate backrest, but also of achieving and maintaining optimal positioning throughout the day.

“My new chair does help give me decent support, but it’s not the issue,” the forum member said. “Over the years I’ve experienced chronic back pain, and to offer some relief, a lumbar pad between my back and the wheelchair back is often used. Similarly, I have, more so in the past, slept on my back with a pillow under my lower back to give more support. Obviously, this can contribute to what is illustrated (in the x-ray).”

And while the solutions for each wheelchair user will be as unique as the user himself, other forum members said they appreciated being able to take part in the conversation.

“I’m glad y’all kept this discussion out in the open,” one member said. “I’m sure a bunch of people will benefit from these ideas.”