Wheelchair Adjustments, Small Changes for Big Improvements Series: Part 5-Low Cost Backrest Options

Jason M., Occupational Therapist

Part 5 – Low Cost Backrest Options

This fifth and final installment in my wheelchair adjustments series will focus on the backrest of the wheelchair. For most patients, the standard backrest that comes attached to the wheelchair they are in is sufficient. For patients with abnormal postures or low back pain, though, the standard is usually not enough, and often becomes the cause for pain, skin integrity issues, and undue stress. Peruse through most medical supply websites and magazines and you will find many different custom, contoured, padded, adjustable, and engineered backrest to meet a variety of needs. Many of these works well, some do not, but they all tend to be rather expensive. The following are some low cost options that with a little trial and error may meet your patients wheelchair backrest support needs without the changing any part of the wheelchair itself:

Towel Roll – using a small pillow, a roll of towels, or a blanket, fashion a small log shaped rolled. Additional layers may need to be added or removed to achieve the appropriate size, firmness, and comfort level. I recommend using surgical tape to help the roll retain its’ shape. For cleaning purposes, either cover with a pillowcase, or simply change out for a new one. Once assembled, placing the towel roll between the patient and the backrest to provide additional posterior support that the backrest may not provide. This works especially well with low back/lumbar support, but I have also used the towel roll for lateral trunk support on one and both sides, and to provide padding between the patient and the bilateral bars of the backrest and handles.

Custom Cut Foam – Go to pretty much any fabric or seamstress shop or department and get dense foam. Similar to the density of foam found in upholstery and seat cushions. With a block of foam, simply measure and graph the patient’s back where they need additional support. Approach this with a “measure twice, cut once” mentally to not waste the foam and start with a larger, rough form that you can further shape. You do not need any special tools to cut the foam, a sharp knife is enough. Cut and shape the foam until you reach a custom cut piece that fills in the space between the patient and the backrest, or provides additional padding in the right area. For patients with kyphosis, scoliosis, and other spine and posture abnormalities, having a custom shaped padded backrest to lean against that contours to their back can make all the difference.

Inflatable Ring/Donut – Yes, I mean the inflatable ring, or donut, that is often used for comfort with patients suffering from hemorrhoids. The inflatable, shifting support and unique shape of the donut can provide ample support for a kyphotic spine. By aligning the hole of the inflatable ring with the approximate apex, or peak, of the patient’s spine with the backrest, as they lean back the donut cushions and supports around the highest point of their spine, reducing the pressure on that area.

* For all of these options remember to affix/attach the added supports to the backrest and wheelchair to ensure proper placement and compliance with use. Adhesive Velcro strapping is the best options.

I know I’m not breaking any ground with these low cost backrest options, but they have served me and my patients well many times in the past. With that, I figured they were at least valuable enough to share. That said, consider the following outcomes that may improve the quality of life for your patients:

Compliance – With a trialed and established backrest support option, patients and caregivers will be able to use and place the support in the same area every time.

Pressure Reduction – Patients with abnormal postures are often plagued by areas of high pressure on their back in wheelchairs. With custom formed supports, the pressure can be spread, diffuse, and reduced to a point of comfort.

Pain Reduction – Those with low back pain especially have increased pain with prolonged sitting and the straight back or sling shape of many wheelchair backrests. With a lumbar support, they can rest comfortably for the desired amount of time without marked increases in pain.

I hope that some of these low cost backrest support options serve you and your patients well. Look for my additional installments in this series for more options and tips.