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yo, SCI_OTR, seating challenge:

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    #16
    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.

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      #17
      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.

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        #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.

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          #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; 29 Jan 2007, 5:52 PM.

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            #20
            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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              #21
              sorry, been out a good bit this weekend.

              Anyway, Mr. OTR, I *do* think there's merit behind your suggestion of a more reclined back angle. I don't think it's practical for myself, but conceptually it makes sense. Over the past week, I've been paying close attention to every surface I sit on. The lightbulb-going-off-in-my-head moment was when I got out of the shower & transferred onto my roho. My pelvis sits in a more natural position in the shower (mind you, 90 degree back angle, zero dump) due to what I'm pretty sure is the seating surface. I don't sink in it. It's just a solid seat. When I'm on a cushion, the roho especially, I sink in and there's a tendency for the pelvis to rotate forward. So... if the pelvis is rotated fwd, and I want the rest of my spine to follow in a more natural position, more back tilt is necessary. Unfortunately, I can't deal with everything I do during the day in a semi-reclined position.

              When I do a depression pressure relief (i.e. lifting my butt in the air), my spine realigns due to gravity pulling it down. Dropping back onto a cushion, it shifts things differently. I've tried all three different cushions I have (roho, jay2, stimulite) over the past couple days, and they all have their issues, although the stimulite is the better out of the three in this regard. I think the automotive seats are more comfortable partially b/c they simply offer better support b/c they're not as "soft." Granted, this isn't taking the pressure-relieving characteristics of w/c cushions into mind...

              I dunno. Right now I don't see a win-win solution.

              Chick, Andy, Rollin, thanks for your thoughts. I'll reply again later..

              Comment


                #22
                Originally posted by Scott Pruett
                Anyway, Mr. OTR,
                Please, call me SCI.

                I think we reached the same conclusion about the win-win. In my illustration, the two biggest red arrows are in a spot where seating could not provide effective support. The reason I inquired about monitoring the progression of the curve is that it may be helpful to determine if a surgical option may be indicated in the future. It sounds like your discomfort is nowhere near that point, however, and I am by no means advocating it.

                As for myself, I see no need for you to post pics of you in the shower!

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                  #23
                  Originally posted by SCI_OTR
                  As for myself, I see no need for you to post pics of you in the shower!
                  The women of CareCure would disagree....this IS Scotty the Hottie we're talking about afterall.....
                  'Chelle
                  L-1 inc 11/24/03

                  "My Give-a-Damn's Busted"......

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                    #24
                    I am not too satisfied with the Varilite or Jay2 backs - very similar. Shorter however is much better than their tall backs. Don't like their brackets either, the Varilite being very weak (tho understand they have a new, stronger design now). I might return to the tried and true Jay Active for my power chair, after I see what the new replacement bracket for my Varilite is like.
                    * Unlike the others, Jay Active has a curved top lip, which doesn't press painfully into back. It also allows me to easily/comfortably lean back/stretch. Less bracket/hardware than others too.

                    The Roho is another issue - used last 2 years now. It does inhibit a more secure and fixed position of hips, as well as prevent at times, my hips from being situated far back into seat (necessary for my straight sitting/posture). There are pros/cons, incl. weighing the benefits of great pressure relief, low maintenance, etc.. with the possible contribution to adverse effects on my hips (esp. dislocated L. side) re leg/hip position/structure, pain, etc (all deteriorating and pain increasingly heightened over last couple years).

                    Position of hips greatly effects (my) overall posture and thus, the resulting pain in back, neck, and at times extending down left arm.

                    So, all that to say, yep... given what I've read from you, and my own experience, it (probably) isn't just a back issue alone.

                    ETA: Plan on getting a smaller Roho - 7 x 8 cells, so less "immersed" in it - current is 8wx9d cells. Hoping this helps with some of the seating issues. Also, look into solid base, flat or contour insert.

                    Below is rough estimate of my back/backrest (front angle view):
                    Last edited by chick; 30 Jan 2007, 5:35 AM.

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                      #25
                      Originally posted by chick
                      There are pros/cons, incl. weighing the benefits of great pressure relief, low maintenance, etc.. with the possible contribution to adverse effects on my hips (esp. dislocated L. side) re leg/hip position/structure, pain, etc (all deteriorating and pain increasingly heightened over last couple years).
                      I have been wondering if there is a correlation between anterior pelvic tilt/excessive lordosis and subluxation of the femoral head. A number of guys I know that have an excessive curve also have a dislocated hip.

                      Looking at your belt, it dawned on me that an abdominal binder would be another non-surgical way to lessen the lumbar curve in an extreme case.

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                        #26
                        Originally posted by SCI_OTR
                        I have been wondering if there is a correlation between anterior pelvic tilt/excessive lordosis and subluxation of the femoral head. A number of guys I know that have an excessive curve also have a dislocated hip.

                        Looking at your belt, it dawned on me that an abdominal binder would be another non-surgical way to lessen the lumbar curve in an extreme case.
                        Please keep all these discussions public, I have the same problems but no solutions so had nothing of value to add.

                        I'm fairly sure I have a dislocated hip [haven't bothered to confirm since there is no remedy] and my spine is in similar condition to Scott's. I also have a definite curve to the right.
                        _____oOo_____
                        Phil C6
                        "If you can't explain it to me in less than 10 seconds, it's probably not worth knowing anyway..." - Calvin

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                          #27
                          Originally posted by SCI_OTR
                          I have been wondering if there is a correlation between anterior pelvic tilt/excessive lordosis and subluxation of the femoral head. A number of guys I know that have an excessive curve also have a dislocated hip.

                          Looking at your belt, it dawned on me that an abdominal binder would be another non-surgical way to lessen the lumbar curve in an extreme case.
                          I've been wondering what kind of correlation the type of posture, and where stress (arch) is most placed, has on spine. I've not only been sitting as I do, due to minimizing pain, but also to prevent/delay onset of other adverse spine effects - scoliosis and other curvatures. I've minimized, but not completely eliminated (obviously can't). I'm going on 19 yrs post, and given all things considered, have managed to keep a relatively good posture/spine (albeit, increased pain due to other/related factors). It's a compromise - in balance, pushing manual chair and other functional needs, etc.; but at the same time, these in turn become more improved as well, esp. balance.

                          RE: hip/femur.
                          I think there may be some correlation, and this would be something interesting to examine. For ME, there are other contributing factors, which are related to my injury - broken left femur and rod replacement in most of left femur. Other contributing factors could be my leaning over mostly onto left side/thigh, which could be adding greater stress onto the bones/tendons/ligaments, etc.. weakening left hip/femoral head position. Mine is actually more than a dislocation, but a gradual deterioration of the hip socket area, where the femoral head no longer has anything to keep it in position. There are also heterotopic ossification and other issues at play.

                          I think many of us share many of these concomitant factors. Wish there were simple answers, eh. Good to have your input

                          ETA: I've worn a binder daily, since injury (fyi. Injury dx: c1-4 complete lesion; function: c5/6 Asia A). I'm a big advocate of binders - to help posture, balance, breathing/strength/energy, low bp, to the everyone's favorite quad gut .
                          Last edited by chick; 30 Jan 2007, 2:44 PM.

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                            #28
                            Originally posted by AO
                            I'm fairly sure I have a dislocated hip [haven't bothered to confirm since there is no remedy] and my spine is in similar condition to Scott's. I also have a definite curve to the right.
                            Hey AO. There may be no perm "fix", but getting Dx to find out what the specific issues/problems are may be beneficial in finding some solution - even if to relieve pain and prevent further problems (or at the very least, minimizes/slow progression of whatever problem/pain exists).

                            Just thinking - regarding your seating as it relates to back curve:
                            If hip is not level/symetrical, then some "lift" to opposing side might help balance you out - if hip is more level, the back may be less required to compensate.
                            If using roho, the roho quatro select, can be adjusted to give more support as needed, per quadrant. I didn't find this too helpful for me (but maybe didn't play with it long enough to really be sure).
                            As I mentioned earlier, a solid base may help also (if not have already). I've always had solid fixed base on chairs (both manual and power), and notice difference in the current power chair where it is only sling -- even greater "caving" since using roho.

                            Anyway, these are just temp/short term ideas. How I think of it, short-term "solutions" can be helpful in delaying/exascerbation of long-term problems.
                            Last edited by chick; 30 Jan 2007, 2:31 PM.

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                              #29
                              I get the tilting hips like all of you. I am an EXCLUSIVE roho user. I do own a varilite contour but usually only use it on my handcycle. My hips tilt really bad on the hc with a roho, such that I am reseating myself every few minutes. That is why I have got the vari. It holds my hips w/o adjusting very often. I WOULD use it in my chair but it was made for a wider person and won't fit. Got it used on ebay. I have been tempted to trim it down but am waiting until I try to get a new manual sometime in the future. ]
                              I am notoriously lazy about adjusting my roho, but one day recently, I upped the pressure in the right side where my hip always drops and it felt like I was riding in a new chair!
                              I need to adjust it again as it seems to have deflated a bit, but it made a world of difference.
                              Scott, I am NEVER comfortable in the shower from lack of balance. Even though my hips are level. But where my butt is practically nonexistant, I sit on pointy bones and if I lean either way, I start falling. I have debated getting a rolling shower chair quite a few times, but I just feel like I can't get clean in one of them.
                              My first two years with sci was a pressure sore mess so I have stuck with the rohos and haven't had a CUSHION related problem since. I hate trying to experiment with things like this. I was pressure mapped in 99 when I got my first powerchair and they gave me tilt because the ONLY time my butt wasn't red on the device was when I was tilted back all the way.
                              When I broke both my hips in 2004 and got the bad pessure sore shortly thereafter, my problems began. My left hip rotated about 35 degrees and healed that way. When I lean left in my chair, the foot goes flying across the footplate and lays across my right foot. That is now it's 'natural' position. This is a real pain for transfers and such. My hips also tilt back as I sit and leave two indentations on my seatback, I'm always feeling as if I am sliding forward.
                              The rt ischial was shaved during the first flap surgery. Now they want to shave it again but are convinced the flap will not take once again, due to lack of muscle and deep tissue. That is another story though, to be detailed later here WHEN they decide what is going to happen.
                              I also had got a jay2 back on a p300 that I got given to me. I too found the hardware of poor design and constantly poking me so I took the FOAM part and just stick it behind my back on bad pain days.
                              I would give anything to go somewhere they had a variety of seating/back solutions and just try them out. I have to get off here before I write a book.

                              Hey Chick, as far as the shower goes, I'll wash your back if you wash mine
                              Hope each of you find a workable solution soon. This pain in the butt never seems to end!

                              https://www.facebook.com/john.baxter.1213986

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                                #30
                                Originally posted by chick
                                If using roho, the roho quatro select, can be adjusted to give more support as needed, per quadrant. I didn't find this too helpful for me (but maybe didn't play with it long enough to really be sure).
                                I do not find that the multi-chamber Roho's help a great deal because the whole premise upon which a Roho is based is maximum immersion of bony prominences and distribution pressure over a large surface area. Instead, I will put foam wedges under the Roho. In the cases where a person finds it is difficult to transfer off the front of the cushion because they sink down, I will put a 1/4" foam layer on top of the front half.

                                The only exception of accomplishing both pressure relief and positioning using exclusively air was this double decker arrangement I did for a paraplegic with a left hip disarticulation. The top layer is a "Design a Roho"

                                Last edited by SCI_OTR; 31 Jan 2007, 1:00 AM.

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