Abstract:
In the past, a posterior transfer was only an option using zipper back sling upholstery. The removable swing away solid wheelchair back offers multiple ways to transfer while preventing orthopedic, neuromotor, and respiratory complications from wheelchair positioning. By mounting the swing away removable solid wheelchair back at a slight angle, the rib cage, lungs, and diaphragm are opened making breathing easier when the respiratory system is compromised.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     (1) Field of the Invention  
         [0002]     The field of invention relates to devices and methods for facilitating posterior ingress and egress from a wheelchair for individuals with limited dexterity and to improve overall oxygenation of said individual.  
         [0003]     (2) Description of the Related Art  
         [0004]     Sling back and seats are the most common types of wheelchair upholstery provided in the seating and positioning industry. These sling back and seats are normally made of leather or a breathable nylon fabric. The sling back and seats allow for comfortable seating when a child or adult does not have irregular tone, muscle weakness, abnormal reflex patterns, shortening of a muscle group, or skeletal deformities. Irregular tone and abnormal reflex patterns can cause muscle spasms or extensor thrusts that actually cause a client to lurch out of a wheelchair uncontrollably. The weak muscle strength, shortening of muscles and skeletal deformities prevent a client from sitting erect in a wheelchair and maintaining that posture. There are some inherent problems that result from long term use of sling upholstery such as internal rotation of the hips from sitting on a sling seat. In addition, if a sling seat and back are used an elongated “C” posture occurs in the spine. (1)  
         [0005]     Solid backs and seats were developed to improve orthopedic, neuromotor, respiratory and circulatory factors. The orthopedic factors are range of motion, skeletal deformities, and skeletal alignment, as described by Cook and Hussy (1995). (2) The solid backs and seats by providing better support resulted in clients not developing skeletal deformities and skeletal alignment problems like scoliosis, kyphosis, or lordosis. The neuromotor factors are muscle tone, reflex patterns, postural control and voluntary movement, Cook and Hussy (1995). (2) Optimal seating systems could prevent triggering abnormal tone and reflex patterns thus allowing voluntary movement and better postural control while sitting. This would allow more participation in normal activities throughout the day. With use of solid seat components respiratory and circulatory factors like vital capacity, forced expiratory volume and expiratory time in children all improved according to Nwaobi and Smith (1986). (3) The benefit from using solid seat and backs became apparent as wheelchairs were used for longer periods of time. Orthopedic, neurmotor, circulatory and respiratory problems could be identified and addressed preventing further medical complications from wheelchair positioning.  
         [0006]     Solid backs and seating systems became removable systems to allow easy transport of the wheelchairs in automobiles. The solid seats and backs were not easy to fold and transport in a vehicle. The removable solid seat and back systems could be taken completely off of the frame of the wheelchair once a client had transferred to the car. An attendant could assist with the wheelchair, if the client did not have adequate strength to lift the chair components or frame into the back seat or trunk of the vehicle.  
         [0007]     The swing away removable solid back described herein was developed to allow four types of transfers from the wheelchair. The subject can transfer with a sliding board, or transfer laterally, to the right or left sides of the chair, using a front approach to transfer, or transfer through the rear upright frame or push handles on the chair for a posterior transfer.  
         [0008]     In the past, a posterior transfer was only an option using zipper back sling upholstery. The subject could unzip the back and complete a posterior transfer. The problems with skeletal deformities, skeletal alignment and compromised respiratory status from long term use of a sling zipper back on the wheelchair lead us to develop the swing away removable solid back.  
         [0009]     The swing away removable solid wheelchair back allows individuals with minimal strength to complete a sliding board or lateral transfer with modified assistance to a toilet, or bed. The swing away hardware allows the solid back to swing and slide around the toilet tank for transfer ease. The swing away removable solid wheelchair back is designed to allow individuals with poor muscle strength the ability to safely use the swing away removable solid wheelchair back. The swing away removable solid wheelchair back has an easy latching device that allows an individual with minimal hand function to set up for a transfer, and securely latch the seat back into place. By mounting the swing away removable solid wheelchair back at an eight (8) degree angle, the individual has opened the rib cage, lungs, and diaphragm making breathing easier when the respiratory system is compromised. The removable swing away solid wheelchair back offers multiple ways to transfer while preventing orthopedic, neuromotor, and respiratory complications from wheelchair positioning.  
         [0010]     The following references are cited throughout this disclosure using the associated numerical identifiers. Applicant makes no statement, inferred or direct, regarding the status of these references as prior art and reserves the right to challenge the accuracy of any statement made in these references. These references are incorporated herein by reference.  
       REFERENCE CITED DESCRIPTION OF THE RELATED ART  
       [0011]     (1) Bergen A., Presperin, J., and Tallman, T. (1990). Positioning for function: Wheelchairs and other assistive technologies. Valhalla, N.Y.: Valhalla Rehabilitation Publications.  
         [0012]     (2) Cook, A., and Hussey S. (1995). Seating and Positioning Systems as Extrinsic Enablers for Assistive Technologies In A. Cook and S. Hussey, (Eds.), Assistive Technologies: Principles and Practice. St. Louis: Mosby.  
         [0013]     (3) Nawobi, O., and Smith, P. (1986) Effects of adaptive seating on pulmonary function of children with cerebral palsy, Developmental Medicine Child Neurology 28: 351-354.  
       SUMMARY OF THE INVENTION  
     The Device  
       [0014]     The invention provides a simple device, which can be placed on existing solid wheelchair backs to facilitate posterior ingress and egress for individuals with poor muscle strength, while improving the overall oxygenation of said individual. The instant device can be readily removed by the individual with poor muscle strength thus facilitating said individual&#39;s posterior ingress and egress from the wheelchair.  
         [0015]     In the preferred aspect depicted in  FIGS. 1, 1A ,  1 B,  2 ,  2 A and  3 , the device comprises a swing away removable solid wheelchair seat back, an upper and a lower frame support attached to the back of the swing away removable solid wheelchair seat back, a frame attached to the swing away removable solid wheelchair seat back (via the upper and lower frame support attached to the back of the removable solid wheelchair seat back) which articulates via a connecting device(s) on the frame with a left wheelchair handle clamp, and a securing bracket attached to the swing away solid wheelchair seat back via a securing bracket mount which articulates with a right wheelchair handle clamp which contains an integral latch mechanism that locks the securing bracket in place when said latch mechanism is in the closed position. The connecting device(s) on the frame articulates with the left wheelchair handle clamp such that when the latch mechanism of the right wheelchair handle clamp is in the open position the securing bracket is unrestrained and is able to disengage from the right wheelchair handle clamp such that the swing away removable solid wheelchair seat back is able to rotate from the fixed position through an arc of greater than ninety (90) degrees. When the securing bracket is unrestrained, i.e. the latch mechanism is in the open position, and is disengage from the right wheelchair handle clamp the swing away removable solid wheelchair seat back can be rotated via the connecting device(s) on the frame which articulates with the left wheelchair handle clamp and removed from the wheelchair by lifting the swing away removable solid wheelchair seat back straight up and disengaging the connecting device(s) on the frame from the left wheelchair handle clamp. The right and left wheelchair handle clamps are designed such that when said right and left wheelchair handle clamps are attached to the wheelchair&#39;s handles and the swing away removable solid wheelchair back is attached to the wheelchair proper via the right and left wheelchair handle clamp the swing away removable solid wheelchair back is inclined at an angle of eight (8) degrees. By mounting the swing away removable solid wheelchair back at an eight (8) degree angle, individual&#39;s seated in the wheelchair experience a more opened rib cage, lungs, and diaphragm making breathing easier when the respiratory system is compromised. The removable swing away solid wheelchair back offers multiple ways to transfer while preventing orthopedic, neuromotor, and respiratory complications from wheelchair positioning.  
       The Method  
       [0016]     In another embodiment, the instant invention provides a method for posterior ingress and egress for individuals with poor muscle strength while improving overall oxygenation of said individual. To prepare for posterior egress from the wheelchair the individual with poor muscle strength will first manipulate the latch mechanism to the open position. When the latch mechanism is in the open position the securing bracket is unrestrained. With the latch mechanism in the open position the individual with poor muscle strength can push back on the swing away removable solid wheelchair seat back and disengage the securing bracket from the right wheelchair handle clamp. Once the individual with poor muscle strength has disengaged the securing bracket the swing away removable solid wheelchair seat back can be rotated via the connecting device(s) on the frame, which articulates with the left wheelchair handle clamp. The swing away removable solid wheelchair seat back can then either be rotated in excess of ninety (90) degrees out of the individual with poor muscle strength&#39;s way while remaining attached to the wheelchair and allowing the individual access and egress from the wheelchair or the swing away removable solid wheelchair seat back can be removed completely from the wheelchair to allow access and egress from the wheelchair. The swing away removable solid wheelchair seat back can be detached completely from the wheelchair by individuals with poor muscle strength when the securing bracket has been disengaged as previously described and the removable solid wheelchair seat back is lifted straight up disengaging the connecting device(s) on the frame from the left wheelchair handle clamp. With the swing away removable solid wheelchair seat back removed from the wheelchair individuals with poor muscle strength can egress from the wheelchair by transferring through the rear upright frame or push handles on the chair for a posterior transfer. Similarly, with the swing away removable solid wheelchair seat back removed from the wheelchair or rotated in excess of ninety (90) degrees individuals with poor muscle strength can transfer into the wheelchair by transferring through the rear upright frame or push handles on the chair for a posterior ingress.  
     
    
     BRIEF DESCRIPTIONS OF THE DRAWINGS  
       [0017]      FIG. 1  shows a rear view of the device comprising a swing away removable solid wheelchair seat back, an upper and a lower frame support attached to the back of the swing away removable solid wheelchair seat back, a frame attached to the swing away removable solid wheelchair seat back (via the upper and lower frame support) which articulates via a connecting device(s) on the frame with a left wheelchair handle clamp, and a securing bracket attached to the swing away solid wheelchair seat back which articulates with a right wheelchair handle clamp which locks the securing bracket in place via a latch mechanism.  
         [0018]      FIG. 1A  shows a top view of the device with said securing clamp in the engaged position.  
         [0019]      FIG. 1B  shows a top view of the device with said securing clamp in the disengaged position.  
         [0020]      FIG. 2  shows a side view of said right wheelchair handle clamp with said latch mechanism in the open position.  
         [0021]      FIG. 2A  shows a side view of said right wheelchair handle clamp with said latch mechanism in the closed position.  
         [0022]      FIG. 3  shows a side view of the left wheelchair handle clamp. 
     
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT  
       [0023]     It is understood that this invention is not limited to the particular embodiments and methodologies, as these may vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to limit the scope of the present invention, which will be limited only by the appended claims.  
         [0024]     Unless defined otherwise, all technical and scientific terms used herein have the same meanings as commonly understood by one of ordinary skill in the art to which this invention belongs. The preferred methods, devices, and materials are now described, although any methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention. Nothing herein is to be construed as an admission that the invention is not entitled to antedate such disclosure by virtue of prior invention. Each reference cited herein is incorporated by reference herein in its entirety.  
       Embodiments  
       [0025]     Disclosed is a simple device, which can be placed on existing solid wheelchair backs and mounted on existing wheelchair handles to facilitate posterior ingress and egress for individuals with poor muscle strength, while improving the overall oxygenation of said individual. A preferred embodiment of the present invention, which shows the latch mechanism in the open position, is presented in  FIGS. 1, 1A ,  2  and  3 . This device has a swing away removable solid wheelchair seat back  1 , an upper frame support  2  and a lower frame support  3  attached to the back of the swing away removable solid wheelchair seat back  1 , a frame  4  consisting of; a top wheelchair back frame support  4 A which is attached to the swing away removable solid wheelchair seat back  1  via the upper frame support  2 , a bottom wheelchair back frame support  4 B which is attached to the swing away removable solid wheelchair seat back  1  via the lower frame support  3 , a left wheelchair back frame support  4 C which is attached to the top wheelchair back frame support  4 A and the bottom wheelchair back frame support  4 B, and a right wheelchair back frame support  4 D which is attached to the top wheelchair back frame support  4 A and the bottom wheelchair back frame support  4 B, an upper connecting device  5  and a lower connecting device  5 A attached to the left wheelchair back frame support  4 C, a left wheelchair handle clamp  6  attached to the wheelchair&#39;s left handle, a right wheelchair handle clamp  7  consisting of: a right wheelchair posterior clamp  7 A, a latch  7 B, a latch spring tension screw assembly  7 C, an upper anterior clamp  7 D, and a lower anterior clamp  7 E attached to the wheelchair&#39;s right handle, and a securing bracket  8  attached to a securing bracket mount  9  which is further attached to the swing away removable solid wheelchair seat back  1 .  
         [0026]     The instant device, as described may be operated in either the locked or unlocked position. When in the locked position the latch  7 B of the right wheelchair handle clamp  7  is in the closed position. The latch  7 B is in the closed position when the latch  7 B is rotated clockwise ninety (90) degrees from the perpendicular to engage with the channel on the right wheelchair posterior clamp  7 A. When the latch  7 B of the right wheelchair handle clamp  7  is in the closed position the securing bracket  8  restrained and remains engaged to the right wheelchair posterior clamp  7 A such that the swing away removable solid wheelchair seat back  1  is secured in place. When in the unlocked position the latch  7 B of the right wheelchair clamp  7  is in the open position. The latch  7 B is in the open position when the latch  7 B is rotated counterclockwise ninety (90) degrees to disengage from the channel on the right wheelchair posterior clamp  7 A. When the latch  7 B is in the open position, and the securing bracket  8  is disengaged from the right wheelchair posterior clamp  7 A the swing away removable solid wheelchair seat back  1  can be disengaged from the wheelchair proper by rotating the swing away removable solid wheelchair seat back  1  via the upper connecting device  5  and the lower connecting device  5 A through an arc of zero (0) to one hundred and twenty (120) degrees and lifting the swing away removable solid wheelchair seat back  1  straight up which disengages the upper connecting device  5  and the lower connecting device  5 A from the left wheelchair handle clamp  6  and completely disengages the swing away removable solid wheelchair seat back  1  from the wheelchair proper.  
         [0027]     For the instant device, as described the upper connecting device  5  and the lower connecting device  5 A attaches to the left wheelchair back frame support  4 C and articulates with the left wheelchair handle clamp  6 . The left wheelchair handle clamp  6  and the right wheelchair handle clamp  7  are designed such that when the left wheelchair handle clamp  6  and the right wheelchair handle clamp  7  are attached to the corresponding wheelchair handle, by fasteners in the case of the left wheelchair handle clamp  6  and by an upper anterior clamp  7 D, and a lower anterior clamp  7 E for the right wheelchair handle clamp  7 , the swing away removable solid wheelchair seat back  1  is inclined at an eight (8) degree angle.  
         [0028]     In another embodiment, the instant invention provides a method for posterior ingress and egress for individuals with poor muscle strength while improving overall oxygenation of said individuals. To prepare for posterior egress from the wheelchair individuals with poor muscle strength will first manipulate the latch  7 B to the open opposition. When the latch  7 B is in the open position the securing bracket  8  is unrestrained. With the latch  7 B in the open position individuals with poor muscle strength can push back on the swing away removable solid wheelchair seat back  1  and disengage the securing bracket  8  from the right wheelchair handle clamp  7 . Once the individual with poor muscle strength has disengaged the securing bracket  8  the swing away removable solid wheelchair seat back  1  can be rotated via the upper connecting device  5  and the lower connecting device  5 A attached to the left wheelchair back frame support  4 C which articulates with the left wheelchair handle clamp  6 . The swing away removable solid wheelchair seat back  1  can then either be rotated in excess of ninety (90) degrees out of the individual with poor muscle strength&#39;s way while remaining attached to the wheelchair and allowing the individual access and egress from the wheelchair or the swing away removable solid wheelchair seat back  1  can be removed completely from the wheelchair to allow access and egress from the wheelchair. Individuals with poor muscle strength can remove the swing away removable solid wheelchair seat back  1  completely from the wheelchair when the securing bracket  8  has been disengaged from the right wheelchair posterior clamp  7 A. The swing away removable solid wheelchair seat back  1  can be disengaged from the wheelchair proper by rotating the swing away removable solid wheelchair seat back  1  via the upper connecting device  5  and the lower connecting device  5 A through an arc of zero (0) to one hundred and twenty (120) degrees and lifting the swing away removable solid wheelchair seat back  1  straight up which disengages the upper connecting device  5  and the lower connecting device  5 A from the left wheelchair handle clamp  6  and completely disengages the swing away removable solid wheelchair seat back  1  from the wheelchair proper. With the swing away removable solid wheelchair seat back  1  removed from the wheelchair individuals with poor muscle strength can egress from the wheelchair by transferring through the rear upright frame or push handles on the wheelchair for a posterior transfer. Similarly, with the swing away removable solid wheelchair seat back  1  removed from the wheelchair or rotated in excess of ninety (90) degrees individuals with poor muscle strength can transfer into the wheelchair by transferring through the rear upright frame or push handles on the chair for a posterior ingress.  
         [0029]     Materials of construction for the individual components of the instant device (i.e. the frame  4 , left wheelchair clamp  6 , right wheelchair clamp  7 , upper and lower connecting device  5  and  5 A respectively) preferably include those materials that can provide structural integrity and allow for mass requirements. Preferably, the material of construction for the individual components is metal (stainless steel, hardened steel, etc.) for machined pieces such as the left wheelchair clamp  6 , right wheelchair clamp  7 , upper connecting device  5  and lower connecting device  5 A, and plastic components (HDPE, Teflon, etc.) for components of the instant device such as the upper frame support  2 , the lower frame support  3 , left wheelchair back frame support  4 C and right wheelchair back frame support  4 D, and securing bracket mount  9 . However, the skilled artisan in the manufacture of this invention will reasonably expect the instant device to be constructed of any material which will meet the structural integrity and mass requirement criteria discussed while allowing the instant device to work in the manner described in the preferred embodiment of the instant device.  
         [0030]     Although the preferred embodiment discussed above relates to assisting access and egress from a wheelchair for individuals with limited dexterity as well as providing improved overall oxygenation to said individuals, the invention is not so limited. While various embodiments and applications of this invention have been shown and described, it is apparent to those skilled in the art modifications are possible without departing from the inventive concepts herein. The invention, therefore, is not to be restricted except in the spirit of the appended claims.  
       EXAMPLE  
     Prototype Device  
     Abstract  
       [0031]     Individuals with tetraplegia can easily swing away, and remove the Solid Wheelchair Back. It facilitates transfers and provides postural support to minimize the ill effects of long term positioning on sling upholstery. The design features tetraplegic releases to unlatch the wheelchair back. The Solid Wheelchair Back swings away and slides back to allow clearance of the wheelchair rear uprights and push handles for transfers. The Solid Wheelchair Back is closed by a gate-like, sliding mechanism and latches securely following transfer. The Solid Wheelchair Back is easy to remove for wheelchair transport in an automobile. The Solid Wheelchair Back Modification for posterior transfers is the product of creative problem solving to meet the needs of a subject with post polio syndrome and functional tetraplegia. The subject used a conventional seating system utilizing sling seat upholstery and zipper back upholstery because it allowed independence with transfers. The subject&#39;s sitting posture included the naturally occurring deformities from long-term use of sling upholstery, kyphosis, scoliosis, pelvic obliquity, pelvic rotation and a windswept hip deformity. The subject had very few pressure related skin problems and did not use a wheelchair cushion. The subject did report shifting of internal organs from recent radiological testing and is a regular visitor with the pulmonologist. Initial attempts to improve the subject&#39;s posture with a solid seat insert and basic therapeutic wheelchair cushion and an eight (8) degree angle back allowed a more upright posture and increased ease of breathing. The problem remains without ability to complete a posterior transfer, we had decreased functional ability to complete self-care and bathroom transfers. Following several calls to vendors and product searches we could not find a swing away removable solid wheelchair back to meet the client&#39;s needs. Biomedical engineering assistance on designing a solution to this complex problem resulted in the Solid Wheelchair Back.  
       Methods  
       [0032]     Once the Solid Wheelchair Back was fabricated the subject began several trials to adapt to the new seating system. The trials allowed time to master transfer techniques and resolve minor accessibility modifications to allow use of the new seating system at the office, home, and in the community.  
       Results  
       [0033]     Pulse oximeter measurements were taken in the subject&#39;s conventional sling back wheelchair with readings of eighty seven percent (87%) oxygen saturation. When transferred into the wheelchair with the Solid Wheelchair Back the subject&#39;s oxygenation saturation improved to ninety three percent (93%) oxygen saturation. The subject experienced some medical complications and subsequently had several weeks of therapy with an exercise program focused on pulmonary rehabilitation. Specifically working on breathing exercises, strengthening intercostals muscles and increasing tidal lung volume. At this last therapy session pulse oximeter readings were taken again in the wheelchair with the Solid Wheelchair Back. Oxygen saturation in the blood was then at ninety seven percent (97%).  
       Discussion  
       [0034]     In summary, the subject&#39;s use of the wheelchair with the Solid Wheelchair Back has experienced a remarkable improvement in pulmonary function. Part of the success can be attributed to improving posture in the wheelchair and decreasing the kyphotic and wind swept posture typically exhibited in the sling seating on the wheelchair. The eight (8) degree angle back allows the subject to lean back in the chair to open the shoulder, lungs and chest. The solid removable wheelchair back improved oxygenation and in combination with therapy has made a significant difference in the subject&#39;s pulmonary status.  
         [0035]     The following references were used throughout this disclosure. Applicant makes no statement, inferred or direct, regarding the status of these references as prior art and reserves the right to challenge the accuracy of any statement made in these references. These references are incorporated herein by reference.  
       REFERENCE CITED IN EXAMPLE  
       [0036]     Amos L. Brimner A. Dierckman H. Easton H. Grimes H. Kain J. Bednarski J. Moyers PA. (2001) Effects of positioning on functional reach. Physical &amp; Occupational Therapy in Geriatrics. 20(1):59-72.  
         [0037]     Bergen, A. F., Presperin, J. &amp;Tallman, T. Positioning for function: wheelchair s and other assistive technologies, Valhalla, N.Y. 1990, Valhalla Rehabilitation Publications.  
         [0038]     Bergen, A. F., Presperin, J. &amp; Tallman, T. (1991) Evaluation Criteria, Team Rehab Rep 2(4):34-35.  
         [0039]     Bergen, A. F., Presperin, J. &amp; Tallman, T. (1992) Planning Intervention, Team Rehab Rep 3(2):38-41.  
         [0040]     Bolin, I., Bodin, P., &amp; Kreuter, M., (2000) Sitting position posture and performance in C5-C6 tetraplegia. Spinal Cord. 38(7):425-34.  
         [0041]     Calliet, R. Sociosis: diagnosis and management, Philadelphia, 1975, F. A. Davis.  
         [0042]     Ferrarin, M., Andreoni, G., &amp; Pedotti, A., (2000) Comparative biomechanical evaluation of different wheelchair seat cushions. Journal of Rehabilitation Research &amp; Development. 37(3):315-24.  
         [0043]     Harms, M., (1990) Effect of wheelchair design on posture and comfort of users. Physiotherapy. 76(5):266-71.  
         [0044]     Janssen-Potten Y J. Seelen H A. Drukker J. Huson T. Drost M R. (2001) The effect of seat tilting on pelvic position, balance control, and compensatory postural muscle use in paraplegic subjects. Archives of Physical Medicine &amp; Rehabilitation. 82(10):1393-402.  
         [0045]     Johnson Taylor, S. and Kreutz, D., (1997) Powered and Manual Mobility. In J. Angelo, Assistive Technology for Rehabilitation Therapists. (pp. 117-158). Philadelphia: F.A. Davis  
         [0046]     Mills T. Holm M B. Trefler E. Schmeler M. Fitzgerald S. Boninger M. (2002) Development and consumer validation of the Functional Evaluation in a Wheelchair (FEW) instrument. Disability &amp; Rehabilitation. 24(1/3):38-46.  
         [0047]     Minkel, J. L., (2000) Seating and mobility considerations for people with spinal cord injury. Physical Therapy. 80(7):701-9.  
         [0048]     Parent, F., Dansereau, J., Lacoste, M., Aissaoui, R., (2000) Evaluation of the new flexible contour backrest for wheelchairs. Journal of Rehabilitation Research &amp; Development. 37(3):325-33.  
         [0049]     Pedersen, J. P., (2000) Functional impact of seating modifications for older adults: an ocupational therapist perspective. Topics in Geriatric Rehabilitation. 16(2):73-85.  
         [0050]     Perr, A. (1998) Elements of seating and wheeled mobility intervention.  
         [0051]     OT Practice. 3(9):16-24.  
         [0052]     Rader, J., Jones, D., &amp; Miller, L., (2000) The importance of individualized wheelchair seating for frail older adults. Journal of Gerontological Nursing. 26(11):24-32, 46-7.  
         [0053]     Rader, J., Jones, D., &amp; Miller, L. (1999) Individualized wheelchair seating: reducing restraints and improving comfort and function. Topics in Geriatric Rehabilitation. 15(2):34-47.  
         [0054]     Samuelsson, K.,Larsson, H., Thyberg, M., &amp; Tropp, H. (1996) Back pain and spinal deformity—common among wheelchair users with spinal cord injuries.  
         [0055]     Scandinavian Journal of Occupational Therapy. 3(1):28-32.