by Kathy Wechsler
Most people don’t want to sag as they get older. Why should their manual wheelchairs be any different?
Manual wheelchairs with both folding and rigid frames come with sling seating unless rigid seating is specifically requested for positioning purposes. When the wheelchair’s frame folds, some people prefer sling seating for the convenience factor. All they have to do is pull up on the sling to fold the wheelchair.
Sling seating doesn’t offer any positioning components and will begin to sway after a year or two of use, causing the user’s hips to rotate internally because they’re following the swayed upholstery. The result typically is hip pain, says Teresa Tisdell, an occupational therapist (OTR/L) at the MDA clinic at Integris Southwest Medical Center in Oklamoma City.
Because of poor positioning, the person may develop scoliosis or pelvic obliquity, where one hip is higher than the other, Tisdell says.
The “hammocked out” effect of sling seating also forces the pelvis into a sacral sitting position, meaning users roll back on their pelvis, greatly increasing the risk of lower back pain and pressure wounds on the tailbone.
The only reason for sitting in a sling seat is if you’ve been in one for many years and your body already is formed to that position. In that case, changing may cause pain and inability to function, and staying with a sling seat may be the only option.
“It’s very hard to make changes for a lot of patients,” Tisdell says. “Although a rigid seat may be the best positioning and [the wheelchair user] looks great, if they’re miserable in that wheelchair, it’s not doing anything for them.”
Tisdell argues that positioning at the pelvis always is more important than the back.
“I had a patient come in this last week with a rigid [wheelchair] back and a sling seat, complaining of back pain,” she says. “The problems didn’t start with his back, the problems start at the pelvis typically, so it’s important to get the pelvis correct and then move to the back from there.”
It’s not necessary to sacrifice seating and positioning for the convenience and por-tability of a folding wheelchair.
One possibility is ordering adjustable upholstery, so that when the sling seat starts to become loose it can be pulled back tight.
“You have to specify you want adjustable upholstery,” says Tisdell, adding that she still prefers rigid over sling seating, “even with all of the new improvements they’ve come up with.”
Another option is to replace the sling seat with a removable rigid seat. Usually made of plastic or aluminum, this type of seat is attached to the wheelchair’s frame by dropping it in place or by latching levers, and is removed by lifting it up or unlatching the levers. These types of seats also are used to lower the seat-to-floor height. Almost any type of cushion can be used with a rigid seat, which runs around $300.
Yet another option is to put a rigidizer, or solid seat insert, under the cushion inside the seat cushion cover. Rigidizers can be flat or contoured at the bottom and are made of molded plastic or an appleboard, a thin piece of wood.
Flat wood rigidizers work best with new wheelchairs with no sway in the sling, because the appleboard eventually will develop a curve if the wheelchair’s sling already is hammocked out.
Contoured rigidizers work best on older sling chairs that are “kind of swung out a little bit and you can fill in that space,” Tisdell says. “If you put a rigidizer that’s got a little bit of roundness to it on a sling seat that’s not yet hammocked out, it’s not going to fit very nicely.”
Rigidizers can be used under most types of seat cushions, and will slide right inside the cushion cover. This makes them easier to handle than solid seat inserts that are heavier and must be latched and unlatched. When folding the wheelchair, just take off the cushion and
Rigidizer by Varilite
M a TRx-Vi Cushion by Motion Concepts
Jay Adjustable Solid Seat by Sunrise Medical
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