If you work in an office, you know how important it is to have a supportive desk chair. Cheap ones leave your back aching at the end of the day.
It’s the same with wheelchairs. Most wheelchairs come with soft, fabric backs rather than firm, ergonomic ones that support good posture. Thanks to physical therapist Cindy Smith, PT, DPT, ATP, a 30-year team member at Craig Hospital, that’s hopefully changing.
In 2017, Cindy attended a legislative session in Washington DC where she contributed to testimony on getting insurance coverage for wheelchair accessories, including supportive backs.
“Even though we shared clinical evidence that people with spinal cord injuries (SCI) sit better, have less pain and push their chairs more easily, lawmakers kept asking for research data. There really isn’t any out there, so a colleague and I decided to do a study ourselves,” says Cindy.
Cindy approached Craig’s Research Department with a study proposal, along with the Craig Foundation for funding support. The pilot study was approved and Craig and Shirley Ryan AbilityLab in Chicago both enrolled 25 wheelchair users for a total of 50. The study was published in The Journal of Spinal Cord Medicine, under the title Wheelchair Backs that Support the Spinal Curves: Assessing Postural and Functional Changes. Results clinically demonstrated that a supportive wheelchair back had benefits—including increasing vertical reach, aiding a stronger push, improving posture and providing more comfort.
“At first, people in the study thought the soft backs that came with their chairs would be more comfortable and more functional, but they quickly realized that wasn’t true,” Cindy says.
She describes the spine as a set of building blocks. When you set one block on top of another in a straight row, they stand up. If one is off-kilter, the stack falls down.
“If you sit crooked, your body has to curve to keep its center of gravity. In a wheelchair, you can’t easily change positions so you stay in that crooked position,” she says. “The long term effects are scoliosis, hunching forward, neck pain, back pain, and a decrease in function. That’s why keeping the back in a good position is so important.”
With a supportive chair back, people in wheelchairs can more easily sit up all day and perform their jobs. Without one, pain often forces them to abandon sitting after a few hours, affecting their productivity.
“Sometimes, a minor adjustment can make a major change in someone’s ability to function. It’s really satisfying to give people with SCI simple solutions to help them maintain their independence and productive lives,” Cindy adds.
Cindy’s research and advocacy efforts are far from minor. She’s currently seeking funding for a follow-up study with 150 people to reach statistical significance and hopefully change the law. If her evidence is strong, the Centers for Medicare and Medicaid Services will likely change how they reimburse for wheelchair backs and other insurers will follow suit. If all goes well, her efforts could improve the lives of millions of people in wheelchairs across the nation.
“It was intimidating to speak in front of Congress, but it’s really important to advocate on the national level and make life better for everyone in wheelchairs,” she concludes.