When it comes to wheelchair seating, cushions are in the forefront of our minds.  After all, few mobility aspects are more crucial than maintaining comfort and ensuring against pressure-related issues.  However, in the seating realm, cushions are only part of the positioning paradigm, with backrests playing an integral role in positioning, comfort, and function, as well. No matter if you use a power or manual wheelchair, there's a good chance that you could benefit from an after-market backrest.  An after-market backrest by definition is a backrest designed to replace the existing sling or solid back upholstery that's found on wheelchairs with traditional back canes (captain's-style seats excluded).  While sling and solid backs are economical and practical as standard upholstery, they lack positioning features like lumbar and lateral support, angle adjustment, and contoured, layered padding needed for ergonomic, long-term seating.  In contrast, after-market backrests feature contoured, ergonomic shells, with multiple layers of foam, and the ability to dial in angle, depth, and height to your needs.  Further, most after-market backrests accept lateral and lumbar components, allowing enhanced positioning.

More often, clinicians, providers, and users alike recognize that after-market backrests are all but a necessity on most high-end powerchairs, offering positioning, comfort, and pressure management from stationary seating to tilt and reclines.  However, after-market backrests can also dramatically improve the seating and performance of manual wheelchairs, providing far greater support than a sling back, and a rigid backrest shell can better translate propulsion energy to the wheelchair. While after-market backrests are off-the-shelf - readily available through rehab providers and online discounters - there are variables to consider when ordering a backrest.  Toward width, not all wheelchairs are an exact width, as an 18" seat may actually measure 17.5" or 18.25" (the standard point of measurement is to the outsides of the back canes).  To accommodate the variations of seat width, most backrests build in a tolerance of 1.5" to 2.5" of width adjustment - that is, an 18" after-market back may adjust from 17.5" to 19" or 20" wide.  In this way, it's important to accurately measure the width of your back canes - again, outside-to-outside - and fully understand the width adjustability built into the after-market backrest that you're considering. Much like offering ranges in width, after-market backrests also allow ranges of angle, depth, and height adjustment.  Many backrests offer from 15- to 55-degrees of angle adjustment, 2" to 4" of depth adjustment, and infinite height placement (based on how high or low you mount the back on the canes).  On wheelchairs with fixed back canes, these adjustments dramatically expend the ability to tailor the wheelchair's fit to your needs. If you use a manual wheelchair, especially if it's a folding frame, it's important to note the means of backrest removal when shopping for an after-market backrest.  After-market backrests vary greatly in how they're removed for transport, from four-point release, to two clips, to one-hand release.  Since such a back may need removal everytime you transport your chair, it's wise to determine prior to purchase if a backrest's removal method suits your abilities and lifestyle. With MSRPs from $300 to $700, and discounters charging $200 to $500 based on model, after-market backrests can prove pricey.  Yet, the benefits the offered - improved support, enhanced shock absorption, optimized pressure management - make after-market backrests one of the healthiest investments that you can make toward your mobility. The next time you're feeling an ache or pain from sitting, and are quick to curse the cushion that's underneath you, remember that it's only part of the seating equation - there may be a symptom working its way from the top down, testifying toward the needs of an after-market backrest.