How do I choose a backrest for my client

How do I choose a backrest for my client?
We have talked for a couple weeks now about backrests and the importance of choosing the right backrest for our client, but how do we make that final decision? There are so many backrest options out there and typically a client can benefit from more than just one option. Often, I am asked the question, “As a therapist should I know all the backrest options on the market?”  The answer is simple – NO. Your role as the therapist is to know what your client would benefit from for positioning, function, comfort, etc… Then, to communicate those needs to your supplier who can offer specific options. Remember that the client should have options, and your supplier will offer these.
This is not to say that every client should trial 5 different backrest options at the seating appointment, but instead to keep in mind that there are options.  We want to consider what the goals of the seating system are, and then determine when discussing or trialling a backrest option if that option is meeting those goals. Those goals being both your goals as the therapist and the goals of your client.
So now you have looked at a few backrest options and you think you found one that the client is happy with, what’s next?  We want to be able to show that our goals have been achieved. The best way we can do this is by completing outcome measures.  Outcome measures will give us objective feedback to truly show if the goals we were looking to accomplish have been met. Outcome measures are an important tool that we should be utilising during our wheelchair evaluation process, especially when it comes to funding.  Reviewers like to see outcome measures as these are not subjective to your opinion, but instead objectively give insight into the outcomes of the equipment you are trialling.
There are many options for outcome measures and we will have an upcoming blog dedicated to these, but for today let’s think about a few options. For example, we have a client and the goal for this client and his seating system was that he would have less pain in his back.  We could simply have the client complete the numeric pain rating scale in his current seating system and then with this new backrest option depending on how quickly the pain typically starts. This outcome seems simple but showing the difference in the numbers could be powerful or could give you the feedback that perhaps another backrest option is required.
Another example is the client that needs to be positioned well for stability but has to be able to reach within their environment in order to be independent.  Here we can think about a functional outcome measure like the modified functional reach test. This test will allow us to see how far our client can reach forward and can be compared to their previous seating system. It is important to remember that the set-up of the chair and cushion will largely impact this score, so be sure to have considered the whole seating system.  If you have not heard of the modified functional reach test, it is one of my favourites. I included the link to the exam below.
Remember that there are always numerous backrest options out there and likely more than one option will work for your client.
Modified Functional Reach Test:

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