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Top 5 Reasons to use an Adjustable Back Support in a Wheelchair System

Posted by Ana Endsjo, MOTR/L, CLT

Too many of our geriatric residents present with some degree of abnormal curvature of the spine, which causes them to slide into undesirable postures in the wheelchair system. When we allow them to slide into abnormal postures, we place our residents at risk for pressure injuries and falls from the wheelchair.

The commonly seen abnormal curvatures of the spine are:

When we place a resident with one of the above curvatures in a standard wheelchair sling back, we decrease contact with the seat surface. It also increases peak pressures at the apex of the curvature and decreases stability of the trunk since less of the spine is supported by the back support.

This blog is intended to demonstrate the advantages of using an adjustable back support that allows us to envelop and immerse the resident.

Top 5 Reasons to Use an Adjustable Back Support:

  • 1. Open or close seat-to-back angle
  • 2. Increase stability due to increased contact with more of the trunk
  • 3. Decrease peak pressures at the apex of the curvature of the spine
  • 4. Increase visual field by adjusting seat angle
  • 5. Optimize midline alignment through the addition of necessary accessories such as lateral trunk supports and a head support

Use case:
When using a straight, non-adjustable sling back:
When using an adjustable back support:
Contact with Back Support
Only the apex of the curvature is making contact with the seat surface
The entire spine is making contact with the seat surface
Pressure Distribution
Peak pressures are placed directly at the apex
Even pressure distribution throughout the length of the spine decreases peak pressure and pain
Increased pressure on a smaller diameter causes pain and places the resident at risk of skin breakdown at the peak pressures
Residents feel stable and have less pain, making them less likely to shift into abnormal postures
Residents shift and slide out of midline to alleviate pain and pressure
Maximizes stability as the entire trunk is supported
Stability is lost due to poor contact with seat surface, increasing the risk of unwanted movement
Assists with pelvic stability when trunk stability is maximized
Line of Sight
Line of sight is lost with the eye gaze pointing at the ground, ceiling, or to the left or right due to the inability to open or close the seat-to-back angle
Allows you to adjust seat-to-back angle to change the line of sight back to midline


Hopefully you have gained the necessary information to consider not only a cushion to solve a seating issue, but to recognize the value an adjustable back gives to the seated posture when optimizing the quality of life.



Ana Endsjo
Clinical Education Manager LTC Division

Ana Endsjo is an occupational therapist with a Master of Occupational Therapy degree from Nova Southeastern University and a Bachelor of Nutrition and Dietetics degree from the University of Delaware. Despite the very Scandinavian last name, Ana is half American, half Spanish and has lived all over the East Coast of the USA and in Spain. She has practiced OT in multiple states and settings which has helped her to be a better-rounded, culturally aware therapist, able to connect on a deeper level with a multitude of patients and their families.

Ana has worked as an occupational therapist for over 14 years, mainly with the geriatric population in a variety of treatment settings including, acute care, sub-acute care, outpatient, acute rehab, long term care, and as a lymphedema certified therapist.

Over the last 8 years, she has been dedicated to the betterment of the treatment of the elderly in LTC centers. Her time was focused on seating and positioning and contracture management of the nursing home residents. Through this experience, her hope is to guide other therapists, rehab directors, nurses, and administrators, through blogs, Webinars, and courses to be able to do the same as she takes on her new role with Comfort Company as Clinical Education Manager for the long term care division.