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The top two (2) straps would be left looser to allow the
upper body to lean back over the upholstery to fight grav-
ity. This configuration may enable the back canes to be
lowered for a quad. In another instance, you might loosen
all of the straps and allow the end-user to sink all the way
back into the wheelchair.
Every person will be different. Let the therapist experi-
ment with different positions and then decide. It is easy
to change.
THE BACK UPHOLSTERY COVER.
The back upholstery cover is designed for three (3)
reasons:
1. It is as a modesty cover to prevent one's posterior
from protruding out of the wheelchair.
2. It keeps the cushion from sliding out of the back of
the wheelchair.
3. It is a sacral support depending upon how far or tight
the flap is pulled under the seat cushion.
WHY USE ADJUSTABLE BACK UPHOLSTERY: A
CLINICAL DISCUSSION.
The flexible sling upholstery commonly used on wheel-
chairs allows the wheelchair to fold without removing rigid
components. Sling upholstery will stretch with use. Un-
fortunately, stretched upholstery does not support the
back well. Stretched upholstery often allows the pelvis to
drift into posterior tilt while the back assumes a kyphotic
posture.
With the adjustable tension backrest, the sag can be
taken out of the sling restoring the original tightness.
Adjustable tension upholstery can also provide signifi-
cant improvement to the seated posture and function of
the wheelchair. By changing the tension of the strap, the
backrest can be adjusted to accommodate back pos-
tures such as kyphosis, lordosis, stabilize the pelvis and
back, and provide lateral stability.
In addition to restoring the sling to original tension, the
adjustable tension backrest can be adjusted to help
maintain the pelvis and back position, which can improve
posture balance and function.
The wheelchair backrest should be able to follow the
natural anatomical contours of the back. When viewing
a person from the side, the thoracic portion of the back
will extend posteriorly to the pelvis and buttocks (FIG-
URE 4).
FIGURE 4
PROCEDURE 3 BACK
B
A
C
K
When using a nonadjustable flat backrest, the top
portion of the upholstery will usually push the trunk
forward of the center of gravity over the pelvis. To
maintain the trunk in the upright posture, the user must
have and use the back extesor musculature, or add
tilt or recline to backrest (FIGURE 5).
FIGURE 5
When using adjustable upholstery, it is possible to
tighten the lower portion of the backrest which assists
in maintaining a neutral pelvis. The upper portion can
then be adjusted to follow the natural curvature of the
spine bringing the back over the pelvis in a position of
balance relative to the center of gravity (FIGURE 6).
FIGURE 6
The best point of control for the pelvis is near the Pos-
terior Superior, Iliac Spine (P.S.I.S.). The upper trunk
should be relined until a balanced posture is achieved,
approximately 10 to 15 degrees (FIGURE 7).