Dial In Your Seating Position Without Changing Your Chair
by Seth McBride
The right seating position in a manual wheelchair can make the all the difference in your everyday functionality and your long-term health, affecting everything from balance to skin and shoulder health. The ideal seating position is different for everyone — an interplay between your body’s dimensions, your function and your day-to-day life. It’s a process to find what works best for you.
Fortunately, if you’re in a wheelchair that doesn’t feel right, there are a number of adjustments you can do and components you can swap that can make a big difference for your seating position.
Warning: Changing your seating position can significantly alter pressure distribution. Check your skin religiously whenever you make changes, and if you are at risk of skin breakdown, consulting a physical therapist with experience in pressure mapping may be a good idea.
Changing Front Seat Height
Dialing in the right seat dump can help compensate for a lack of core strength.
If you have room to spare between your knees and a typical table top, raising your front seat height is worth considering. A discouraging percentage of physical therapists have people sit in a minimum of dump. It’s usually out of the belief that a flat seat reduces pressure on the sit bones. But what this doesn’t take into account is that in real life, someone without strong core muscles who sits in a flat-seated chair will likely slouch to maintain balance. This puts extra pressure on the coccyx and can lead to pressure sores. Not having any core, I’ve found that the only way to maintain an upright seating position without falling over my lap every time I try to move is to sit with a lot of dump — as in a 4-to-5-inch difference between front and rear seat height.
One option is to raise front seat height and put bigger front casters on. My go-to casters are 4-by-1.5-inch soft roll casters, but in my previous chair I went to 5-inch casters to increase my dump by an inch. Make sure you have clearance for the larger casters to rotate without hitting your feet or footplate and that your fork has room to fit them as well. Websites like SpinLife and DMEHub have soft roll casters starting at about $45 each.
Additionally, you can put more spacers, which are found at most hardware stores, under your caster housing to raise your front end up. How much you can raise using spacers depends on the specific model of your chair. If you can’t raise it enough using spacers, looking online for a taller fork can do the trick. Note: Raising front seat height changes the caster fork angle and can cause caster flutter or sticky spots when turning. The more you raise your seat height, the more noticeable the difference. If your caster fork barrels are adjustable, check them with a pocket level or square to make sure they are at 90-degrees and adjust as needed to keep them in line.
If you have a chair with an adjustable rear seat height, play with it. Sure, it’s nice to be able to reach high cabinets, but in addition to balance and posture benefits, a lower rear seat height — sitting down in your wheels rather than on top of them — can give you better leverage to push your chair.
If you have a fixed rear seat height, unfortunately there aren’t many ways to alter it other than changing your rear wheel size, and going from a 25-inch rear to a 24-inch rear wheel only changes your seat height a half an inch. But, changing your rear wheel size can have another effect on your pushing that’s worth considering.
If you live in a flat area with little need to push hills on a daily basis, larger wheels like a 26-inch can give you more distance per push, making it quicker and easier to cover distance. If your day-to-day includes a lot of hills, going down to a 24-inch could make it a little easier to get up the steep stuff. Personally, I have good arm strength but live in a hilly area, so 25-inch wheels hit the sweet spot.
Ergo seating is a still-fairly-uncommon seating setup where the frame rails extend straight out for 4-to-6 inches before they angle up. This creates a bucket that holds your pelvis in place better than traditional dump. If you’re active and don’t have core strength, I can’t recommend it enough.
For a preview of what ergo feels like before you fork over thousands of dollars for a new frame, you can make a DIY version using a foam wedge under the front of your regular cushion. A few years ago, I made a wedge using strips of gym flooring mats duct taped together, which made it easy to play with dimensions until I found something I liked. If you’d prefer a premade (and less janky-looking) version, Stimulite sells a 2-inch-high wedge cushion for just under $100.
Another option is to get a Roho Quattro cushion, which has four air compartments and a valve that lets you seal off the air flow between them. Slightly overinflate the cushion and sit down with the valve open. Put your feet up on a couch, bed or other high surface — which will put more of your weight on the back of the cushion. Let the compartments adjust and then, while your feet are still up, lock the valve.
It may take a few tries to figure out the best amount of air in the cushion. In the end, you should wind up with the rear compartments deflated to your normal Roho pressure, while the front two compartments will be overinflated, pressing up into the back of your thighs, where you have enough meat to handle the extra pressure. This is similar to what a Ride cushion does. Quattros are available from your local DME supplier or a variety of online retailers.
If you change your dump, you’re probably going to need to change your backrest angle along with it. Many chairs come with angle-adjustable back rest bars, but there are options even if yours is fixed. Many backrest shells offer angle-adjustable hardware. My personal favorite is the Roho Agility Active, as it’s adjustable without clunky, heavy hardware and has an air insert in the middle of the backrest to better protect the skin over my bony spine. If you use an upholstery backrest, adjusting the individual tension straps — tighter at top, looser at the bottom, or vice-versa — can effectively change your backrest angle.
Simplifying Life With Power Chairs
by Jenny Smith
With the complicated electronics and seating systems on modern power chairs, maintaining my chair — my life — can feel overwhelming. I’d rather avoid problems than have to fix them. But issues still arise. Whether it’s a cushion, a small part, or a major fix, always expect a long wait with DME providers and insurance. I try to avoid the long delays by practicing these tips:
• One-stop shopping: When I ordered the new cushion, we requested new batteries, armrest pads, a lumbar support, and upholstery for the backrest. It was more convenient to do everything at one time since we needed to get an order from my doctor, a letter of medical necessity and go through the long wait of insurance approval.
• Get to know your tech: I’ll often call my tech first, and he can tell me what to do to avoid a service call. But for this relationship to work, direct your frustration over slow response times at the DME provider or insurance company — not the tech, who is just doing his job.
• Just ask: For example, as a quad, I couldn’t remove a broken lock on my armrest by myself. Learn to be willing to ask for help.
• Learn from others in the SCI/D community: I asked members in an SCI support group on Facebook how to disassemble the broken lock. With the instructions I received, I walked my helper through the steps of removing the part. I had a functioning, albeit non-locking, armrest until the new part arrived.
• Do your research before you order: Find the owner’s manual and order form for your chair online. Get familiar with the available options, such as the seat width and depth, turn radius, base width, tilt or recline features, or ground clearance.