Providence physical therapist Leslie Black talks with David Stuart of Ashland about how to improve his seating position in his wheelchair. Above: Computerized pressure mapping tools allow therapists to identify areas where a patient’s weight is concentrated on the wheelchair seat. Jim Craven 2/13/2008 Jim Craven 2/13/2008 - Jim Craven

Technology helps therapists, vendors find the perfect chair

Wheelchairs are like shoes — fit is everything.

You don't just sit down in the first chair that comes along and roll away. A chair has to be sized to match a person's physical dimensions, and customized to accommodate his or her particular limiting factors.

David Stuart knows all too well how much fit matters. He's been in a wheelchair since 1952, when he injured his spine in a surfing accident. He has some use of his arms, but he's basically paralyzed from the neck down.

"You spend a lot of money on a chair," Stuart said. "You want one that really works."

Stuart went to Providence Medford Medical Center for help when he began to develop pressure sores where his weight comes down on the chair seat and back rest. Leslie Black, a physical therapist, talked with him about ways to address his problems while Jody Marple, a wheelchair vendor, measured his legs, chest and shoulders.

Therapists and vendors usually work together to fit a chair because they have complementary skills. Therapists can assess a patient's physical needs; vendors know more about the kinds of chairs that are available and the features they offer. Vendors also know more about the regulations and requirements of the insurance companies and government agencies such as Medicare that pick up most or all of the tab, which can easily run to $20,000 for a power chair with accessories.

"It's all very individualized," Black said. "This is usually a piece of equipment somebody's sitting in 12 to 16 hours a day. You've got to be sure you get it right."

Proper fit improves patients' comfort level and allows them to sit in a chair longer, but there are other benefits, too. Black said a well-fitted chair can help a person breathe easier because the upper body is held upright, allowing the lungs to function efficiently. A properly fitted chair also helps a person look directly at others, making social interaction easier and more natural.

Recent technological innovations make fitting more precise. Pressure-mapping pads illustrate how a patient's weight is distributed across the area of the seat. Seats themselves can be molded to match the exact body contours of people with severe deformities that are associated with diseases such as cerebral palsy.

Tammy Radford of Eagle Point, who cares for two brothers who have cerebral palsy, says molded seats have dramatically improved the quality of life for the two men.

"They lack neck control and they need structure," she says. "Their custom-molded chairs have aligned them perfectly straight. They were kind of slumped over before, but now they're sitting up straight and their head is straight where before it was cockeyed.

"They can stand being in the chair for a longer time now, and the molding system helps their spine so it's not so painful for them," she says. "Before when we'd put them in a chair they'd be whining because they were hurting. They're a lot more comfortable now."

Psychological factors can play a role in the choice of a chair, too. Some people don't want to accept the level of impairment that a wheelchair implies, says Carolyn Wheeler, an occupational therapist who fits chairs at Rogue Valley Medical Center.

"Sometimes there's an image concern," Wheeler says. "The patient says 'I want to use a scooter,' but they really need a wheelchair.

"You have to pick apart every detail of how their day will work in that chair," Weaver says. "It doesn't just get them from point A to point B."

Reach reporter Bill Kettler at 776-4492 or e-mail

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