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  • In need of advice and help (Wheelchair)

    Will Medicare pay for a wheelchair earlier than the 5 year limit?

    I have had posture and sliding issues with my current TiLite ZR with a 16" Jay Back for and couple years. I have been told by a couple of guys that Medicare will but also been told by the supplier
    Tech that they won't. It took a couple years but I tried a lower 9" Jay Back that was recommended from another supplier Tech that I had seen at a seating eval last year. The 9" back didn't solve nothing. Maybe made it a little worse actually.

    I don't want to go through the fun process of having to get a chair early but if I have to I will. All I want is the problem solved as I am not sitting very comfortable for some time now. And don't feel very safe when going down a slight step or curb. Can not do a wheelie very well in this chair.

    I just don't feel like I am getting much help with this problem right now.

    I tried to make it shorter but my explainations and questions never are.

  • #2
    Sounds llke your chair just needs a good adjustment to fit you. For one, I've never heard of a T/10 using a 16" tall back unless you're like 6'6"tall.That's really tall. It'll make it really tough because the rhomboids are trapped by the tall back making it much harder to push. Start out with the height just below your scapulas and adjust down until you find it more comfortable.

    If you have difficulty doing a wheelie, your COG is too far back or the back angle is too far forward. A good rule for COG is fingertips should be close to the middle of the axle button with arms hanging down and relaxed. What's the angle of your back? If you feel you are falling forward going down, either adjust your COG forward so you can do a wheelie going down or adjust the angle of your back back a bit. I suggest trying to adjust the back angle first to see if that makes a difference. It's amazing what two degrees angle difference makes for comfort or having the cog 1/2" too far back.

    Being a T/10, your chair should be fast and agile.

    Comment


    • #3
      Thanks for posting Patrick. Yes I agree that the 16" back is too tall. I was recommended a 7" back but I guess because of the width of my chair (20" wide) that all my supplier could get was 9" back. I have the 16" back far back and as low as I can get it. I have tried a bunch of different adjustments with non of them helped much.

      I also agree that I should be able to move faster and have better control and maneuverability.

      I am 6'.

      With the 9" back I was able to get further back and as low as I could get it. I have a cross bar that prevents me from getting it lower. Later I will take some pictures and post them.

      And yeah I was also told my back wheels were an inch too far back. Looks like I have an adjustment there so I can solve that but I don't want do anything yet until I solve my posture issue.

      The way this guy is sitting is the way I sit a lot of times. I lean forward a lot because it's a little more comfortable. My lower back is achy and the top of my stomach is also achy and uncomfortable.

      Comment


      • #4
        Just a couple of comments. The picture of the quad rugby player shows a chair that has a lot of "dump" (rear height from floor to seat is lower than front height from floor to seat) - which I believe rugby players like as it's a stable position for ball handling. Some folks have some dump in their everyday chairs, so just wondering if you do, and if it needs adjustment.
        Does your footrest need adjustment? Too low or too high may effect your posture.
        Also, consider a custom cushion if you haven't already.
        There's lots of folks here who, like Patrick, can make suggestions to help, so hope you can get more comfortable.

        Comment


        • #5
          Can you post a picture of yourself in your chair? That might help us help you.
          Rollin' since '89. Complete C8

          Comment


          • #6
            Pics would definitely help. Off the cuff, it sounds like you could benefit from a much lower back rest height and some more dump and squeeze (lower the rear seat height and close the back rest angle a bit. Making sure your feet are well planted helps too, and that you've got good cushion contact along your entire femur.
            "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

            "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

            "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

            Comment


            • #7
              Originally posted by triumph View Post
              Just a couple of comments. The picture of the quad rugby player shows a chair that has a lot of "dump" (rear height from floor to seat is lower than front height from floor to seat) - which I believe rugby players like as it's a stable position for ball handling. Some folks have some dump in their everyday chairs, so just wondering if you do, and if it needs adjustment.
              Does your footrest need adjustment? Too low or too high may effect your posture.
              Also, consider a custom cushion if you haven't already.
              There's lots of folks here who, like Patrick, can make suggestions to help, so hope you can get more comfortable.
              I was just using the he sits as a reference as to how I am sitting.

              My footrest is fine. I have long legs and if I were to adjust it any higher I think it would make my position more uncomfortable. My first cushion that I had really liked and had 3 of was the Jay Active. I burst the gel from my last one trying to solve this issue in the beginning. They don't make that cushion no more. I would like to think that my problem isn't so much the Stimulite cushion I am currently using but more of the adjustments that I need to do.

              Comment


              • #8
                Here is the picture of me and how my posture is. I can tell you this..... It is not very comfortable after a and hour or a few hours of being in the chair. And even sometimes sitting in it after waking up.

                The files for the other pictures I took are too large. How can I make them smaller so I can upload them on here? Is there another way besides using a image hosting site?

                The back of my legs from the front of my cushion can be anywhere from 2 inches to 4 inches forward. I think in this picture they would be 4 inches forward.
                Attached Files

                Comment


                • #9
                  Sometimes the after market backrests push you too far forward as they are usually mounted in front of the back canes. There is a chance you would be more comfortable with standard back upholstery with velcro adjustable straps that comes with the chair.

                  Comment


                  • #10
                    Thanks for the picture. Wondering if you want to consider a longer frame on a chair. Yes, you appear to be sitting pretty far forward; if you put your left arm straight down it looks like your hand would be well in front of the rear wheel axle instead of just kind of touching the axle.
                    On my chair, I picture my rear wheel axle as being in line with my hip joint.
                    It would be great if you could go somewhere that wheelers are congregated, such as a road race with a wheelchair division, to look at the various adjustments they have on their everyday chairs. It's really sick that we can't try out various chairs when ordering.

                    Comment


                    • #11
                      Definitely looks like you're sitting too far forward and/or the chair is a couple/few inches too short for you. A couple fingers cushion clearance behind your calves is all you need, generally speaking.

                      If that black bit behind your left shoulder is the top of the backrest, I'd say that's WAY too high. T injuries can often feel pushed forward and uncomfortable not having their lats and traps free of the backrest. IMO the backrest shouldn't be higher than your injury level for a thoracic injury.

                      Can't tell if it's because you're too far forward but axle position looks too far back. The rule of thumb is you should be able to touch the hubs with your finger tips with your arms hanging relaxed.

                      Can't make out dump in this angle, but it looks shallow. I'd recommend 2.5-3" as a good place to start for a T10.

                      Is your newer Stimulite cushion contoured like the old Jay? It might should be, if not. Contoured cushion can help keep you in place, although if you're constantly sliding forward shearing injuries are a big concern to me, so addressing the other chair geometry issues comes first IMO.

                      There are a couple rehab places in my region I can visit to try chairs out. Maybe something like that near you too?

                      Either way, my priorities would be, were this me, in this order:

                      - MUCH lower back (~12" high from seat pan)
                      - Longer chair/move backrest farther rearward
                      - Experiment with more dump
                      - Experiment with axle position
                      - Contoured cushion

                      Tough part is, all these changes will impact each other (wheelchair is a closed system), so taking them one at a time is important IMO. I think this order of operations is a good approach to managing this, but once you get to start tweaking axle position and dump, you'll most likely have to go back and make perfectory modifications to your back angle and height.
                      "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

                      "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

                      "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

                      Comment


                      • #12
                        Dude, whoever guided you on your wheelchair setup needs to get another job. To echo Oddity, lowering the back to about your SCI level and moving your rear axles ahead so your fingertips can touch them with arms at rest on your sides will get you about 80% of where you want to be. (Those two changes are not difficult to accomplish with this chair.) After that, it's all fine tuning one thing at a time. I've been in a chair for 29 years and my body continues to change (not in a good way lol). I'm still making minor corrections. That's why I think it's wise to continue getting chairs that allow for plenty of adjustment--even at the expense of being a bit heavier.


                        Originally posted by Oddity View Post
                        Definitely looks like you're sitting too far forward and/or the chair is a couple/few inches too short for you. A couple fingers cushion clearance behind your calves is all you need, generally speaking.

                        If that black bit behind your left shoulder is the top of the backrest, I'd say that's WAY too high. T injuries can often feel pushed forward and uncomfortable not having their lats and traps free of the backrest. IMO the backrest shouldn't be higher than your injury level for a thoracic injury.

                        Can't tell if it's because you're too far forward but axle position looks too far back. The rule of thumb is you should be able to touch the hubs with your finger tips with your arms hanging relaxed.

                        Can't make out dump in this angle, but it looks shallow. I'd recommend 2.5-3" as a good place to start for a T10.

                        Is your newer Stimulite cushion contoured like the old Jay? It might should be, if not. Contoured cushion can help keep you in place, although if you're constantly sliding forward shearing injuries are a big concern to me, so addressing the other chair geometry issues comes first IMO.

                        There are a couple rehab places in my region I can visit to try chairs out. Maybe something like that near you too?

                        Either way, my priorities would be, were this me, in this order:

                        - MUCH lower back (~12" high from seat pan)
                        - Longer chair/move backrest farther rearward
                        - Experiment with more dump
                        - Experiment with axle position
                        - Contoured cushion

                        Tough part is, all these changes will impact each other (wheelchair is a closed system), so taking them one at a time is important IMO. I think this order of operations is a good approach to managing this, but once you get to start tweaking axle position and dump, you'll most likely have to go back and make perfectory modifications to your back angle and height.

                        Comment


                        • #13
                          *Update*

                          In the last 3 weeks there have been 2 changes so far. I went back to using the lower Jay Back that is 11" and not 9" like I orginally said. And I moved the axle forward about 1".

                          My posture issue is still the same if not slightly worse. My lower back was already aching and still is now. It has to be aching pretty bad if I can feel it at my Lumbar being a T10 complete. I would like to try a sling back to see if it would set me back to where I would need to be. But can't find a demo back for my width. Hopefully I can.

                          The back wheels do feel slightly better with them forward 1" but only slightly because of my current position.

                          My bucket is at 2.5" to 3" so I would like to keep it there and maybe even less if possible with my next chair. I feel more comfortable sitting closer to 90? then how I feel where I am wedged in like I do now when I sit in a "good position". With the 11" Jay Back it feels tight. My old Jay Active cushion helped with that. But they don't make that cushion no more.

                          @triumph, I think I do need a longer frame. I have long legs. The next chair with definitely be longer.

                          @Oddity, I know the rehab clinics have chairs that were donated to them so maybe I will go to a couple that will hopefully have a chair close to my size. There is no contour with the Stimulite cushion. It is a egg crate design flat square. There was a little contour to the Jay Active on the front but nothing in the back. The gel sat on top of the foam.

                          I don't want to push for a new chair because I would like to lose weight before I do get a new chair but I am given not much choice here. Looks like I will have to try and push for a new chair early.

                          I would like hear from and see other T10 level wheelchair users in their chairs to see how their back rests and postures are and what kind of cushion they are using if some would like to share a picture.

                          Also if anyone or everyone could post links to all types of cushions that are out there. Maybe some out there I haven't found yet.


                          Thanks everyone for any and all help.

                          Comment


                          • #14
                            *UPDATE*

                            So I got my new TiLite Aero Z and the Jay X2 cushion for it. The chair is fully adjustable and I have been messing around with the adjustments in every which way possible but I am still having the same damn posture issues. My last TiLite was 17 inches from front to back and this one is 20 or 21 inches front to back. I was hoping the extra 3 - 4 inches would have helped but it hasn't. My butt and hips want to slide forward every time which then drops my back and shoulders and pushed my chest more to my stomach. I moved the back wheels forward 3/4" forward from where they were when I got it in hoping that would help with center of gravity a little but that don't matter because of how my butt and hips slide forward that takes any of that way if there is any. I can barely do a simple little front wheel hop to avoid a little crack on the sidewalk.

                            I do not know how much of this is just my luck with the chairs or how much of all this is me. I don't do my stretches as much as I need to but trying to do them more and don't know if that could also be a cause to this problem.

                            Any other advice would help.

                            Thanks.

                            Comment


                            • #15
                              ***I do not know a thing about manual chair!*****
                              Extra 3-4" is alot if talking seat depth if you were talking powerchairs.
                              I'd ask how much seat dump do you have since sliding forward, too. I forgot to ask on one of my chairs and ended up having keep in slight tilt to have enough dump to keep from sliding.
                              I didn't go back to read but did a seating clinic do your measurements?

                              Comment

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