This patient was sitting slid forward in a posterior pelvic
tilt, with a significant rounded back posture (khyphosis). This is a typical
position for anyone post SCI who was not initially provided structured seating.
She was being held in the chair by her
seat belt. She had to hook her arms
around the back canes (push handles) to stabilize her posture.
On inspection, it was concluded her ROHO cushion was over
inflated, and her back support provided only support to her scapula with a huge
gap between her pelvis and lower back support. Patient complains about sitting
pain, and the therapist is deeply concerned that her posture will only progress
and that it is destructive and will lead to significant health complications. She also stated the company who provided the
chair had to provide more foam to the back support since it was provided.
I asked the woman, who has been using a powered wheelchair
for over thirty years, what her concerns were. She said discomfort, and in-stability.
When discussing the cushion, she said she had inflated the
cushion as when it was delivered the cushion was too unstable and she added air
to make it more stable. We discussed that the cushion for its therapeutic value
needed to be less inflated she said that was not a possibility. We discussed
that a different cushion may have been more appropriate, but she had always
used a ROHO, and nobody asked her those questions. her insurance only covers a
one cushion every five years. When we
discussed the back support, I offered that a back that was more contoured,
possibly even molded would improve her stability and posture. She said that if
she had a back that was more confining it would affect her ability to move and
she was not willing at this time to compromise.
After several minutes of listening and learning what her
needs were, and more importantly what she was unwilling to compromise over; it
was obvious that there was little we could do to improve the situation. She is an adult and can make her own informed
decisions. At this time her function outweighs any physical complications that
will result in the future from sitting in a destructive manor.
I offered her some information, and suggested she watch her
postural progression and remember that there are other options if and when she
is open to trying them. As a Seating and Mobility Specialist, I was
disappointed that I could not help; however understand that I am not in her
body, and understand that it is ultimately her decision.
Carey Britton, is the seating and mobility specialist forActive Mobility Center. He can be reached at 954-946-5793 or at
cbritton@wheelchairguys.com .
