Never underestimate the importance of proper wheelchair positioning, especially with a neuromuscular disease.
The correct alignment of pelvis, hips, lower extremities, trunk, head and neck helps you function throughout the day.
|Permobil's new RS Seating System offers an adjustable head support that cradles the head by providing suboccipital (below the back of the neck) support and allowing rotation for a functional visual field.|
Headrests are a crucial part of wheelchair positioning, particularly for those with weak neck muscles. Whether your chair should have a headrest, and what kind would work best for you, are questions to be discussed with your physical or occupational therapist (PT or OT).
Signs and symptoms
If you're starting to feel fatigued and having trouble holding yourself upright, or noticing breathing or swallowing problems, a headrest may be helpful, said Jeff Steinburger, a PT at Prairie Rehabilitation Services, an outpatient facility in Sioux Falls, S.D.
Talk with your PT or OT, he advised. "You need to be communicating your needs. You need to be good consumers and good advocates for your health."
During the assessment, the therapist will make sure a headrest, not some other positioning device, is what's needed to correct your symptoms. Before your head and neck can be in a correct position, your pelvis, trunk and lower extremities must be positioned correctly.
Some PTs and OTs recommend waiting as long as possible to get a headrest so that you're using your neck muscles while you still have them. They argue that if you don't use those muscles, you'll lose them.
For some people, that's true, said Steinburger. It depends on the effects of your neuromuscular disease and how quickly it's progressing. That's why it's important to see a PT or OT regularly.
Why a headrest?
A headrest can promote correct posture, prevent deformities, help your breathing and help you maintain a correct visual field while driving your wheelchair.
|Stealth Products manufactures the Comfort Plus, which can be used as a stand-alone head support or as part of a larger system that includes various switch sites and facial pads. Optional swing-away hardware can be used to mount pads or egg switches.|
Besides supporting weak neck muscles, a headrest also can be used for positioning throughout the day if your neck becomes fatigued, said Dave Hass, an assistive technology supplier (ATS) at Binson's Home Health Care Center in Detroit.
Headrests are most commonly used when tilting or reclining a wheelchair.
"When you tilt the chair, you need to be able to rest your head against [the headrest] in a comfortable, well-supported position so [your neck muscles] can relax, and you can get the full benefit of tilting the chair," said Steinburger.
Some people use their headrests only while tilting or reclining, not when they're in an upright position, while others use theirs for full-time support, or to help them perform other functions.
For people who can't use a standard joystick, headrests are an alternative means of driving a wheelchair. With a head array device, head movement activates switches and sensors inside the headrest's padding, signaling the chair to go forward, back, left or right. Switches in the headrest also control seat functions such as tilt and recline.
Wheelchair headrests are sometimes used to make transportation safer.
Hass said he's unaware of any law requiring your wheelchair to have a headrest if you stay in it while driving or riding in a vehicle. However, the National Institute for Rehabilitation Engineering (NIRE) recommends a headrest to protect your head and neck from whiplash in the event of a rear-end collision.
For this reason, some school districts require headrests on children's wheelchairs in order for them to ride on the school bus. Contact your city, county or state for local rules for public transportation.
Keep in mind that there's a major difference in the way headrests for wheelchairs and those on vehicle seats are designed and mounted.
"A wheelchair headrest is primarily designed to support the head and promote a correct posture," Hass said. "A headrest in a car is designed to help prevent injury." A wheelchair headrest may provide some limited protection in a car crash, but that isn't its primary purpose.
Invacare and Permobil make their own headrests for their wheelchairs. Companies such as Otto Bock Healthcare, Stealth Products, Adaptive Engineering Lab, Freedom Designs, Whitmyer Biomechanix and RehabiliTech manufacture specialty headrests to fit a variety of chairs and individual needs.
"There's more adjustability in headrests than there used to be, and there are more options," said Steinburger, who's worked with people served by MDA for some 20 years. "It used to be that if what you needed was unusual, we had to custom fabricate it. Now, it's a matter of finding what company makes one like that."
Steinburger looks for headrests that are durable, functional and adjustable. Headrests come in different shapes and sizes, and a perfect fit ensures maximum comfort, support and control. It's important that the headrest is positioned so it doesn't cause discomfort, obstruct your view, or inhibit breathing or swallowing.
Different shapes of headrests offer different amounts of support in different places on the body, Hass said. Where you need the support depends on which muscles are weak. Most people look for a headrest that supports the posterior (back), lateral (side) or anterior (front) of the head.
You can get a variety of attachments such as facial pads for added support. Most headrests are removable.
Headrests range in price from $200 to $700. They're covered by Medicaid, Medicare or private insurance with a letter of medical necessity from your doctor.
Getting the right fit
|Therafin's tri-form headrest has three adjustable panels and a removable cover for adding switches.|
If your wheelchair doesn't already have a headrest and your rehab team (ATS and PT or OT) decides you need one, Steinburger recommends getting a headrest from the wheelchair vendor and having your ATS install it to make sure it's properly attached. It can be risky to buy it from the manufacturer and install it yourself if you don't know what you're doing.
When selecting a headrest, your rehab team considers your diagnosis and how you're going to use the headrest, Hass said. For example, a boy with Duchenne muscular dystrophy who only needs support while tilting and reclining would use a much simpler headrest than a woman with amyotrophic lateral sclerosis who requires full support at all times. In the second case, a headrest with more padding and support would be best.
Ultimately, the decision to acquire a headrest may depend on how you want to use your energy: to function well at school, work or social activities, or to hold up your head?
Adaptive Engineering Lab
Adaptive Switch Laboratories
Mulholland Positioning Systems
National Institute for Rehabilitation Engineering (NIRE)
Otto Bock Healthcare
Precision Rehab Manufacturing