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Thread: yo, SCI_OTR, seating challenge:

  1. #11
    To any one following this thread,

    Do not be deceived by the fancy graphics into believing that the following is anything other than speculation about the etiology of Scott's postural issues. Anyone having any theories or comments please feel free to jump in.


    The pic of you sitting in the TDX4 verified how I thought you would look in traditional rehab seating and your comment about feeling that your posture is better when sitting in a regular automotive seat got me thinking.

    Of course they do not correspond exactly, but this is your xray superimposed over your TDX4 pic. It needed to be resized and rotated clockwise ~20 degrees, but the aspect ratio is unchanged.

    Green arrows represent what I think are the primary areas of support provided by your seating.

    Red arrows indicate where additional support could counter forces contributing to an excessive curvature of the lumbar spine and probably anterior pelvic tilt (hard to tell for certain).

    What is it about sitting in an automotive seat that is significantly different from sitting in a wheelchair?

    1) The backs on most driver's seats are reclined at least 10 degrees if not more (100-120 degrees).

    2) Most driver's seats have a higher back than those on manual wheelchairs or standard powerchairs without power seating.

    Have you tried sitting in the TDX4 with the back angle reclined to 100-105 degrees and the Infinity Back mounted higher on the back posts? Sitting with the back more reclined could divert some of the load being transferred down your spinal column to the back rest. While too much recline is normally bad because it encourages excessive posterior pelvic tilt, I am guessing yours has an anterior tilt. (Sheering could still be an issue). Having the back higher could shift support onto the thoracic area instead of having nearly all support concentrated in the lumbar region. A higher back could be of greater benefit than simply remounting the UniFlex back higher because it would provide more area on which to distribute support.

    While there is a certain amount of logic to what I just stated, I have no clue whether it would actually work. In fact, I believe it more-likely than not will not.

    If you did realize a noticeable improvement and you had a 16 or 18 wide seat width, I would suggest looking into replacing the Infinity back with Invacare's Contoura back pan & cushion--which would be closer to an automotive seat. If pressure over the spinous processes was still a problem, pressure could be diverted away from these areas by removing some of the foam from the padding where the dashed line is.

    Well that's the best I have to offer for now. Let's do any further discussion through pm.

    BTW, is anyone tracking the progression of your lordosis over time?


    Take care

  2. #12
    Thanks - I'll PM you Monday or Tues, as I've been out of town all day today and will be out all of tomorrow as well.

    I wanted to post back here though to get others thinking. To anyone: feel free to jump into the dialogue.

    I sit better in my Crossfire (manual chair) w/ more dump (4-5") and an almost 90-degree back angle, with a *low* Jetstream back. Reclining a back on any chair with minimal dump won't be terribly beneficial, in my opinion, as I need to sit up [as] straight [as possible]. Reclining the back would simply contribute to slumping over and putting my spine in a worse position, wouldn't it?

    I'm not discounting your logic, just questioning it w/o thinking through the mechanics completely, as it doesn't click at the moment. Let me chew on this later.

    Will get a profile pic sitting in the Crossfire tomorrow (or soon).

    More later.


  3. #13
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    Well Scott...

    Didnt want you to feel alone...LOL But this conversation is way over my head... I hope you find a solution soon!!
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  4. #14
    hehe... thanks Daisy. I wanted to post this b/c I can't be the only one dealing with this, or at least something similar. It will hopefully get a few gears turning in some minds. As stated earlier, this is nothing new for me & I remain active despite a few bumps in the road. Local doctors &/or therapists have been no help b/c sonething like this, for example, isn't a simple textbook case. I've learned more researching and discussing things on my own.

    Long story short, I personally think most wheelchair seating sucks.

  5. #15
    All I know is that I have never encountered a problem which required this much time & effort to illustrate & explain, then put it out there for anyone in the world to see, a suggestion which I have my own doubts about whether it would work!

    But it may be a possible solution for a complex problem. The only downside to trying it would be the time required to change the back angle and backrest location back to their original locations.

    If the backrest is reclined, the support required to sit upright would come from the backrest instead of the ligaments and facet joints of your lumbar spine. Your pelvis may also rotate back slightly which could also reduce stress on the lumbar curve. My line of reasoning assumes that the flexibility of your lumbar spine is normal or too flexible. If you have limited flexibility, then this may not work as well.

    As far as the set up of your Crossfire, I would leave it the way you have it.

  6. #16
    Quote Originally Posted by Scott Pruett
    I sit better in my Crossfire (manual chair) w/ more dump (4-5") and an almost 90-degree back angle, with a *low* Jetstream back. Reclining a back on any chair with minimal dump won't be terribly beneficial, in my opinion, as I need to sit up [as] straight [as possible]. Reclining the back would simply contribute to slumping over and putting my spine in a worse position, wouldn't it?

    I'm not discounting your logic, just questioning it w/o thinking through the mechanics completely, as it doesn't click at the moment. Let me chew on this later.
    I always sat with better/more comfortable posture/balance/pressure in manual - w/Jay active back and extreme cushion ( ~5 dump, 75-80 degrees back angle w/added inserts).

    Power chair, w/higher Jay back - cause great discomfort and pain, limited movement of shoulders (scapula restricted).
    * old power chair (Q p100) had Jay tall (as described above) w/no dump and cushions from reg. Jay, Jay2, to Jay contour (worst). Only thing providing comfort and pressure relief was regular standard Jay, with double layer of gel overlay (which was as good as current roho- highp).
    * current power (Q p222): Varilte back (~15 in high) w/added padding on to to give more support/angle (so maybe overall angle ~80); high profile Roho. Had back positioned higher, which was uncomfortable and restrictive, so lowered it just under scapula.

    I have lots of pain if I don't sit very straight, even slightly forward with arch in back. There has to be mid level support - upper lumbar/low thorasic, thus my padding mostly the upper edge of backrest pad.

    Looking at your pics, the back curve may be a bit deceiving, as you both point out, with your shirt and the Jay lumbar support. The Jay support pad is rather thin in center, with the padding curving out along side edges, thus from side view making it appear greater in thickness than it really is. So following/tracing along the Jay support can be misleading. Also, your support and consequent back curve, seems focused on the lower lumbar. This would give support and also better position of hips, but it may also leave your mid/upper back w/o support, thus greater curve out/leaning back. When I don't have support below/between my scapula, I have increasing pain that extends from back up to neck. If you support your back higher, your lower will follow naturally.

  7. #17
    Suspended Andy's Avatar
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    Nothing really useful as a suggestion here, but one tool you guys could use is an X-ray machine when comparing different backs (and can find a willing Dr. office to do this, along with irradiating yourself). Back in the day the surgeon that did my back had an x-ray machine that could take a picture seated in a wheelchair, so it is possible to directly see how each system works.

  8. #18
    BTW Andy,

    I was going to install a Roho JetStream back on that TiLite ZR I posted pics of a couple of weeks ago. The vet that I spec'd it out for had one on his previous chair, so I ordered one for the ZR. After installing it, I tried out the chair, and took it off. I definitely want him to try the adjustable tension upholstery first and I'll bet he will like it. TiLite's adjustable upholstery is awesome.

  9. #19
    SCI_OTR...im sure everyone here respects your professional wheelchair and seating "opinion" on things. its not everyday we get someone with your credentials/stature on here to give as much input and constructive ideas as you do. i for 1 wont hate ya if i try something and it don't work.

    scott...i too have back pain like a MF. i think having a jay2 back and a chair with 2 in. dump for 4 yrs is what screwed me. them fools at rehab saw i couldn't sit upright and did little to help me out plus still sent me home with an uncomfortable chair.

    i wish you could turn that foot rest around just to try it. dunno if the tubular type will sit right the other way though. ive got a colours eclipse, 90 degree front, 4 in. dump and jetstream pro back. when i had my feet tucked under me, my butt was wayyy back in the seat. i always had to scooch forward a lil bit to keep from being pushed forward and get my back in a more straight position. since ive turned the plate around so my legs are more in a 90 degree angle instead of feet tucked under me i dont have to slide my butt forward anymore to sit straight comfortably and my legs and back feel better.

    my back may be screwed differently than yours but this just what has given me some relief.

    ive got that same invacare back on my power chair. power chair=uncomfortable, lol. ive also noticed that car seats are really comfortable. ive wondered if i shoulda just got the captains seat on my torque sp, haha.

    oh yea...im glad yall kept this discussion out in the open. im sure a bunch of ppl will benefit from these ideas.
    Last edited by rollin64; 01-29-2007 at 05:52 PM.

  10. #20
    Suspended Andy's Avatar
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    Quote Originally Posted by SCI_OTR
    . TiLite's adjustable upholstery is awesome.


    After 2 or so years I found no need to readjust it either, it stays the way you put it. Folds down a whole lot nicer too, eh?

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