"CONTOURED POSITIONING" -- IS IT FOR YOU?
                   by John R. Woodward, M.S.W.

     A new technology has revolutionized the way people with
mobility impairments think about and use their wheelchairs.  It's
called "contoured positioning," and it may be the biggest thing
since the invention of the joystick.
     "Think of your wheelchair as the environment in which you
spend your day," says Jody Whitmyer, the owner of Whitmyer
Biomechanix and an inventor and rehabilitation engineer who
helped pioneer contoured positioning.  "Your wheelchair should be
designed to help you manage the symptoms of your disability.  If
it's not helping you stay healthy, it's part of the problem."
     A contoured wheelchair uses gravity to help you hold your
body in the seated posture that is best for your health.  The old
philosophy of "planar seating" treated gravity as the enemy and
held your body in place against the force of gravity, usually
with uncomfortable straps that limited your mobility.  Contoured
wheelchairs that distribute your weight properly are more
comfortable; and they can help you with pressure sores, pain,
spasticity, range of motion, bowel management, dysreflexia,
stamina, muscle tone, calcium loss, edema and other problems.
     The difference between the philosophies of planar seating
and contoured positioning can be as simple -- and as crucial --as
the design of a proper headrest. Planar designs frequently
ignored the need a wheelchair user's need for a headrest, or
placed the headrest so far back that a person leaning against it
was unable to read, operate a computer or do anything requiring
them to focus on close-by objects. By contrast, contoured designs
usually have an adjustable headrest that positions the wheelchair
user so that he or she can easily and efficiently work without
pain or fatigue. Contoured wheelchairs are designed for the
user's lifestyle and environment, as well as their bodily needs.
     "Your position in the wheelchair is more important than most
people realize," says Whitmyer.  "If your weight's not
distributed, you'll have skin breakdown.  If your inner organs
are cramped together, they won't work right.  If your limbs
aren't supported, they'll spasm.  If you have to hold yourself in
position all day, you'll get tired out just sitting there.  But
all these problems are in the chair, not you."
     Since the needs of each wheelchair user are unique,
contoured wheelchairs are custom-made for each consumer. The
design process usually begins with a device called a "seating
simulator."  The simulator is a large, chair-shaped object that
consists of a thin plastic skin over thousands of tiny beads. 
The wheelchair vendor, a physical therapist, an occupational
therapist and the wheelchair customer adjust her body in the
simulator until it embraces and supports her in the ideal posture
for her symptom-management needs.  When she is lifted out of the
simulator, it retains the imprint of her body and the vendor
makes a plaster cast of it.
     Next, the vendor produces a group of vinyl and foam rubber
moldings from the cast.  These moldings are attached to the
wheelchair frame; sometimes the frame itself will be modified to
support the user at a particular angle.  Contoured wheelchairs
can be designed from scratch, or an existing wheelchair can be
rebuilt.
     Contoured wheelchairs require painstaking craftwork.  A
contoured design is not complete until it has been used for a
while and the "real-world" problems that emerge have been fixed.
The vendor makes several visits after the moldings are installed
for those all-important small adjustments that make the
difference between a perfect job and a merely adequate one.
     Jody Whitmyer, a pioneer of contoured designs, works out of
a 26-foot trailer with a complete machine shop built in.
Whitmyer, who sells wheelchairs everywhere within a 100-mile
radius of Tallahassee, Florida, says it's the only way he can
follow one of his customers through a typical day and make
adjustments "on the scene" so he and his customers can test their
effectiveness in the real world and still get immediate feedback.
     For Ken Hauser, a C-5 quad, a contoured wheelchair meant the
end of long-term problems with pressure sores and spasticity.  "I
was constantly losing time from school," Ken says, "always
finding red spots on my thighs, buttocks and lower back.  My new
chair eliminated those problems, and stopped the spasms in my
legs, too."
     Ann MacKenzie, a polio survivor, appreciates the release
from pain and fatigue that her contoured wheelchair brought her.
"Every day, my back would begin to hurt a long time before five
o'clock, and as soon as I got home, I'd have to go to bed.  I
tried massage, heat, pills -- nothing really helped.  Now I
understand that I was carrying the weight of my spine on the
wrong muscles.  The pain's gone and I feel I have more energy at
the end of the day."
     If you would like to explore the possibility of getting a
contoured wheelchair, ask your physical therapist or orthopedist
about finding a vendor who is qualified and equipped to make one
for you.   


     John R. Woodward is a social worker at the Center for
Independent Living of North Florida, Inc.


Reprinted from ACCESS USA, September 1993
Used with Permission

This document may be distributed freely in electronic format.