Finding the right fit isn’t just about being close enough to perfect, it’s about ensuring we can be as comfortable as possible and can function properly without having to worry about building an exceptional pain tolerance.
*General disclaimer that I am not a spokesperson or representative for any company. These are just my personal thoughts and observations based on what I’ve found online.
Whenever I go in for wheelchair clinics, maintenance would usually take about an hour or two depending on the services required. Nowadays, it’s become two and a half to three or so hours.
Why you may ask?
Because I need a lot of trunk support, it means I require some type of lateral piece to hold me up. The problem with that is the base of my wheelchair has its own seating system designed just for it, but the one I use and need has a hard time fitting onto it. And while the repairmen can make it work, it requires a lot of elbow grease and patiently waiting. Seriously, bring a book, whatever electronics, some snacks, and pillows and try getting as comfortable as you can in the meantime because it’ll be a long day.
And if I need to make slight adjustments after they replace all the parts, it’s not a quick fix. They have to use tiny tools that can fit in between the specific areas then carefully adjust it, which I feel guilty that it requires extra effort on their part as it’s not an easy task.
In my case, I lean heavily to the left, so much so that for years I had to have two lateral pads installed because I put so much weight against them. While every wheelchair part needs replacing, the lateral pads would give out after some time because I put a lot of torque to the point the rather flexible metal would bend. Sometimes the pad would even pop open, and someone would have to push it back in place. Luckily the second lateral would catch the first, preventing me from slumping over, but after a certain point, the pads wouldn’t keep me straight. This caused pain in my lower back since I have scoliosis so as a temporary fix, we’d use pieces of foam boards for extra support. But even then, the foam would become indented and need to be replaced after a few weeks.
Currently, I have a different lateral support that seems to be much sturdier, but it doesn’t swing out, rather it must be pulled out completely. This new setup isn’t easy for transfers as my caregiver must both hold me up and fight with the lateral trying to pull it out. Needless to say, it’s been rather interesting lately. A wheelchair mechanic has suggested I look into custom seating molds due to my unique posture.
And that’s why I want to write about my research when comparing these two products as I’ve found no post discussing the overall pros and cons of contour seating systems.
Because who doesn’t love doing research for everything? Obviously, it’s important and necessary to do so when buying products, especially with those that may be expensive or critical to our needs. But I figured that since I have to research anyway, I might as well share my findings too.
All links will also be included at the bottom of this post.
Is custom contoured seating the right fit for you?
This is something that you should discuss with your healthcare provider as well as a physical therapist. For this particular section most of the information comes from a PowerPoint created by Kelly Waugh for the University of Colorado—Denver’s Department of Bioengineering. But essentially, the main objectives for custom contoured seating are:
- Accommodating moderate to severe distortion in the body
- Inhibiting/blocking abnormal movement patterns
- Preventing postural collapse
- Decreasing pain and/or preventing skin breakdown
Advantages of Custom Contoured Seating
- It can address clinical objectives better than planar or generic contoured seating
- Greater surface area contact creates increased stability, alignment, and skin protection leading to improved health, comfort and function
- Basic seating systems aren’t always the right fit, especially since everyone’s body grows and forms differently.
- Greater surface area contact creates increased stability, alignment, and skin protection leading to improved health, comfort and function
- Can be aesthetically more pleasing
- Less hardware and pads, cleaner smoother look
- Having less pieces to one’s wheelchair could make it easier for transfers, especially if assistance from a caregiver is needed.
- Less hardware and pads, cleaner smoother look
- Easier maintenance
- Less hardware to repair/adjust
- Enough said.
- Less hardware to repair/adjust
But with the pros there must also be the cons.
Disadvantages of Custom Contoured Seating
- Limited adjustment for growth, change or error (depending on the product)
- Experiencing a growth spurt or having internal/external factors causing a shift in one’s body can be an issue. Any sort of change may not be simply fixed as once the mold has been made it can’t be adjusted after the fact.
- Limits dynamic movement (depending on aggressiveness of shape) and may therefore interfere with movements needed for function
- The seat molds around one’s body so it can be impeding in some instances. For example, if you have a curved spine, the seating system molds around your back, instead of the typical rigid, vertical seat which doesn’t. So if you tilt back in your chair to stretch or relax, rather than your spine stretching out it will instead remain as is due to the contoured molding.
- Support surfaces don’t swing away or remove for transfers, unless custom adaptions are made
- Basically, this could make transfers more difficult or tedious.
- Generally incompatible with adjustable recline
- I’m not sure what recline means in this context as some people refer to the tilt feature as reclining or if it’s referring to the actual recline function. Either way, it is noted that product innovation is working to address some of these disadvantages so it may not be as much of an issue now.
- More costly and labor intensive
- While not directly pertaining to the overall function and comfort of a wheelchair user, this is still an ongoing issue as insurance is usually quite difficult to work with in general.
- Requires considerable skill to do shape capture process well
- A majority of wheelchair technicians that have assisted me are usually pretty skilled and experienced so I would hope that this is the case for others too.
- Risks (and costs) of error can be high (if non-adjustable)
- While the initial molding process allows for plenty of adjustments to be made during that time, once completed it leaves little room for even marginal alterations.
Red Flags (Things to Consider/Keep in Mind)
- Client uses independent movement of their trunk (leaning to side, for example) to function
- Client likes to ‘move’ in their wheelchair, shifting their weight or readjusting their body on their own
- Client independently transfers in/out of wheelchair
- Client’s body is likely to change significantly due to growth or other changes (growing child, upcoming surgery, weight)
Overall, if you have a strong trunk support and maintain independent functionality, then chances are a contoured seating system isn’t necessary. But of course, please consult with your medical team as I am not a trained specialist.
Product Features to Consider
- Primary Materials — what’s it made of?
- Foam, Plastic/Orthotic shell, other materials
- Options or no options; Adjustability?
- Surface Covering Options
- Stretchy vs. non stretchy; Water resistant/proof; Breathability
- Removable or not
- Construction Features and Options
- Lateral support features – depth of contour, min thickness; reinforcement; thinning; swing away, removable, wrap around
- Cut outs/recessed areas – soft spots; gel/fluid/air inserts
- Belt notches, strap slots
- It’s good that there are various options of trunk supports because it can be one of the more difficult areas to accommodate. Everyone’s built differently and even the slightest inch or degree makes a world of change.
- Mounting Options
All of these aspects are good questions to ask when considering a contoured seating system.
Custom Contour Systems Technologies and Methods (Direct vs. Indirect)
Direct:
- The medium that’s used to capture the body contours actually becomes the final seat and back support, so there’s no “reading” of the contour required, nor translation/fabrication
- Examples include:
- FIPS: Foam-in-place Seating
- Shapeable Matrices/Adjustable Micro-Modular Seating (Matrix Seating; Symmetric Designs)
- Examples include:
Indirect:
- The medium used to capture the body contours isn’t the final cushion
- A particular medium is used to “capture” the body contours, then the contours are “read” and this contour information is translated into a final cushion using a variety of methods, depending on the manufacturer
- Examples include:
- Indirect vacuum consolidation methods, either carved foam or modified orthotic shell: Otto Bock, Ride Designs, PinDot (specializes in ContourU), Prairie Seating, PRM
- Most common indirect method, which involves a bag filled with small beads which is used to capture the desired body contours in the sitting position. The client is seated in a special fitting chair that holds the manufacturer’s molding bags and air is then sucked out of bag using a pump, which progressively hardens the bag.
- Indirect vacuum consolidation methods, either carved foam or modified orthotic shell: Otto Bock, Ride Designs, PinDot (specializes in ContourU), Prairie Seating, PRM
- Examples include:
Ride Designs
Credit: RideNews
When researching Ride Design’s products, it was recently announced that starting November 2022, the custom backs would be manufactured utilizing 3-D printing technology. The following information is pulled from the Ride Designs website. While still using the bead (not bean, unfortunately) bag and vacuum system for capture, the company has the RideWorks app which can quickly and accurately scan a 3-D image of the shape, taking the place of the plastering step.
Other features for the Ride Custom Back include:
- Supports Individual Contours
- Supports the unique contours of the user’s body to provide accurate supportive contact.
- Offers Lightweight Strength
- A thin profile and lightweight design have little or no impact on wheelchair seat depth, width, or performance, making this appropriate even for active users.
- Liner Options
- AccuSoft open-cell polyurethane foam insert works as a more forgiving user interface, whereas the ultra-breathable 3D mesh liner provides better airflow.
- Aids in Protection and Comfort
- Supplementary padding and relief options improve protection and comfort at sensitive areas and also enhance the overall performance of the Ride seat cushion.
- Adjusts Easily
- The adjustable FlexLoc mounting system allows adjustment in every axis of movement ensuring optimal balance and postural control. Height, depth, angle, and rotation can all be adjusted independently. Mounting hardware is available in fixed or quick release styles.
- Grows Along with the User
- It can be modified for linear growth and weight change at a fraction of the cost of a new back.
- Cover Options
- Spacer fabric or wipeable, incontinence-proof covers are available.
ContourU
Credit: Invacare
As for the information I could find about PinDot and the ContourU custom molds, this is what I found on the Invacare website.
Features are as follows:
- Variety of mounting options are available to optimize fit to the mobility base
- For those with more complex orthopedic asymmetries or tone abnormalities, ContourU allows for an accurate, individual fit. ContourU seat and back cushions provide full-contact support, even weight distribution, and excellent stability, enhancing the user’s abilities the way no off-the-shelf seating system can. Simulation is used to measure the surface shapes and contact areas, while our precise VirtualU technology ensures exact duplication of the shape created
- Multiple finishing options, including naked foam with removable cover, vacuformed vinyl, lateral reinforcements, and strap slots make the product unique for each user
- Simulation creates individually shaped support surfaces for each user
- Support surfaces are built into the cushion, minimizing the need for additional accessories
Both Ride Designs and ContourU fall under the indirect method, meaning they utilize the bead bag system for molding. Below is a picture of what this bag looks like though there may be some variations depending on the company.
Credit: Rehab Management
Once situated in the seat, the client will then stay for some time to get an idea of what’s comfortable with minute adjustments being made as necessary. It’s a good way to see if a custom backing will work for someone before ordering the product and without having to take it home.
Of course, while I was researching these two products, I also found plenty of other brands each with their own custom contour mold seating systems. Even though the options seem endless, it depends on which ones are available in your area and what insurance is willing to cover. RideDesigns and ContourU were the options given to me, so I have limited my search to just these two.
That said, one thing that stood out to me is most of these products are fairly similar, just with a difference in specific wording and phrases.
Another difficult aspect of this kind of product comparison is that there’s not many posts discussing it for one. Perhaps because choices are limited due to a variety of factors such as costs, availability, location or simply because of how similar they all inherently function. Otherwise, I mostly just found the company websites and various manufacturers discussing product details and why customers should buy one today. At the very least, here’s one post that can hopefully provide insight into custom seating systems.
Who knows, a post about custom seating cushions might have to be added into the queue soon too. The one I currently have is fine, but I’ve been dealing with some aches and pains recently so an entirely new seat may help. We’re not 100% sure what’s causing the discomfort. Besides the fact that I’m old or I mostly just feel like it. ~So Says The Disabled Dryad~
Links:
ContourU Information:
PowerPoint:
http://seatingsymposium.com/images/pdf/PS/PS3_Waugh.pdf
Ride Designs Information:
https://www.ridedesigns.com/custom-back