Custom Back

Each selection may incur additional costs. Enter all measurements in inches to the nearest quarter inch.

Client Measurements
Enter all measurements in inches to the nearest quarter inch. Scroll down to the end to see all fields.
- A. Width at Trochanters Min char Max char
- B. Left Leg length Min char Max char
- B2. Right Leg length Min char Max char
- C. Width at Iliac Crest Min char Max char
- D. With at Mid-Thorax Min char Max char
- E. Width at Axilla Min char Max char
- F. A-P Mid-Thorax Min char Max char
- G. Iliac Crest Height Left Side Min char Max char
- G2. Iliac Crest Height Right Side Min char Max char
- H. Axilla height Left Side Min char Max char
- H2. Axilla Height Right Side Min char Max char
- I. Top of shoulder Height Left Side Min char Max char
- I2. Top of Shouder Height Right Side Min char Max char
- J.Length from Knee to heel Min char Max char
- K .Height to Top of Head Min char Max char
- L. A-P abdomen Min char Max char
Client Information
- Diagnosis Min char Max char
- Does client have current tissue injury? Min char Max char
  
  Yes No
- Does client have history of tissue injury? Min char Max char
  
  Yes No
- If client has current or history of tissue injury, please provide location(s) and stage(s) Min char Max char
- Height (In Inches) Min char Max char
- Weight (In Pounds) Min char Max char
- Sex Min char Max char
  
  Male Female
Mobility Base Specifications
- Wheelchair Make Min char Max char
- Wheelchair Model Min char Max char
- Wheelchair Frame Width Min char Max char
- Wheelchair Frame Depth Min char Max char
Shape Capture Method
- Scan or Client Measurements and Finished Product Dimensions Min char Max char
  
  Scan Client Measurements and Finished Product Dimensions
Ordering with client measurements and finished product dimensions (No Scan)
Enter all measurements to the nearest inch. Scroll down to the bottom to reveal all required fields.
- Desired Finished Back Height (A) * Min char Max char
- Desired Finished Back Width Outside L Lateral to Outside R Lateral (B) * Min char Max char
  
  When providing the desired, finished outside back width, consider that the width inside the laterals will be approximately 2" narrower than the outside width, and the client using the backrest will compress the foam approximately .25" - .375". Hanna Test
- Desired Finished Left Lateral Height (C) * Min char Max char
- Desired Finished Right Lateral Height (C) * Min char Max char
- Desired Finished Left Lateral Depth (D) * Min char Max char
- Desired Finished Right Lateral Depth (D) * Min char Max char
- Client seated height from mat table to top of iliac crest - left side (G) * Min char Max char
- Client seated height from mat table to Top of iliac crest - right side (G) * Min char Max char
- Client seated height from mat table to axilla - left side (H) * Min char Max char
- Client seated height from mat table to axilla - right side (H) * Min char Max char
- Client seated height from mat table to top of shoulder - left side (I) * Min char Max char
- Client seated height from mat table to top of shoulder - right side (I) * Min char Max char
B
Bundle
- Itemized or Bundled Min char Max char
  
  Itemized Bundled
Back Type
- Select one * Min char Max char
  
  Ride Custom Back Ride Custom Back for Commode
Ride Custom Back Size
Select one option below regarding measurement of the widest spot on client between trochanters (A) and axilla (E). For widths greater than 24", pricing will be individually determined and quoted.
- Select One * Min char Max char
  
  Widest Spot is less then 20 inch Widest Spot is 21 to 24 inch
Ride Custom Back Hardware and Mounting
Order the hardware size that matches the distance between mounting locations, not necessarily the wheelchair width.
Mounting FlexLoc to the Quickie Sedeo Pro seating system requires small FlexLoc mounting hardware with the Quickie Sedeo Interface bracket from Ride Designs and is only available as a single hardware set up.
Mounting FlexLoc to a Permobil seating system requires small FlexLoc mounting hardware with FlexLoc Adapter Plates from Ride Designs, and a Direct Backrest Frame from Permobil. Mounting FlexLoc to a Quantum seating system requires small FlexLoc mounting hardware with FlexLoc Adapter Plates from Ride Designs, and a Stealth Products Simple Solutions Adaptor Plate from Quantum Rehab.
Warning! Two (2) sets of FlexLoc hardware are required if the client presents with weight over 250 lbs, and/or overall back height measurement (as measured to trim lines on scan) greater than or equal to 28", and/or severe extensor tone, spasticity, etc.
Note: Ride FlexLoc hardware can be interfaced with most any wheelchair configuration. Contact Ride Designs customerservice@ridedesigns.com or 866-781-1633 for a solution to your mounting challenge.
- Select Quantity * Min char Max char
  
  Single Set of Hardware Double Set of Hardware (Not available with Quickie Sedeo Interface Bracket)
- Select Mounting for Single Hardware * Min char Max char
  
  Clamp Mount for Rounded Back Canes Quickie Sedeo Pro Interface Bracket FlexLoc Adapter Plate
- Select Mount for Double Hardware Min char Max char
  
  2 Pair Clamp Mount for Round Back Canes 2 Pair Adapter Plates
- Select Size * Min char Max char
  
  Small Mounting Distance 10 to 14in Medium Mounting Distance 15 to 18in Large Mounting Distance 19 to 21in XLarge Mounting Distance 22 to 24in Omit Hardware
- Additional Mounting Clamps (pair)
  Note: If ordering Double FlexLoc mounting hardware, two sets of mounting clamps are included.
  Min char Max char
  
  Yes No
- Select Attachment * Min char Max char
  
  Fixed Non Removeable Quick Release Option
Foam Options
- Select One * Min char Max char
  
  Ultra Breathable 3D Liner (available with scanned shape only) AccuSoft Foam Liner (increases each lateral support thickness by .5 inch and may compromise postural correction)
- For AccuSoft option select one cover Min char Max char
  
  Spacer Fabric Cover Wipeable Incontinence to Proof Cover
Supplementary Padding Reliefs Dimensions
- Select One Min char Max char
  
  Soft Fit Complete Back Soft Fit Centre Only
- Enhanced relief Min char Max char
  
  Yes No
- Did you draw the desired location(s) and shape of relief on clear,
  outer shape capture bag, or on cast if not using
  RideWorks?
  * Min char Max char
  
  Yes No
- Axillary support pad Min char Max char
  
  Left Right None
- Extend LEFT Depth Lateral Thoracic Support Min char Max char
  
  Yes No
- Add LEFT Measurements * Min char Max char
- Extend RIGHT Depth Lateral Thoracic Support Min char Max char
  
  Yes No
- Add RIGHT Measurements * Min char Max char
- Extended LEFT Height Lateral Thoracic Support Min char Max char
  
  Yes No
- Add LEFT Height Measurements * Min char Max char
- Extended RIGHT Height Lateral Thoracic Support Min char Max char
  
  Yes No
- Add RIGHT Height Measurements * Min char Max char
- Extended Back Height Min char Max char
  
  Yes No
- Add Back Height Measurements * Min char Max char
- Reinforced Lateral Thoracic Supports Min char Max char
  
  Yes No
- Vertical Back Reinforcement Min char Max char
  
  Yes No
Accessories
- Universal headrest mounting plate installed Min char Max char
  
  Yes No
- Integrated headrest/accessories mount Min char Max char
  
  Yes No
- Shoulder harness guides pair loose Min char Max char
  
  Yes No
- Shoulder harness guides pair installed Min char Max char
  
  Yes No
- Privacy Flap Min char Max char
  
  Yes No
- Size of Privacy Flap * Min char Max char
  
  Small Fits Wheelchair Widths Less Than 14in Medium Fits Wheelchair Widths 15 to 17in Large Fits Wheelchair Widths 18in And Larger
- Abdominal Support Panel Min char Max char
  
  Yes No
- Instructions:
  Before removing client from back shape capture bag, mark height of each ASIS on clear,outer bag.
  Measure up from this mark to establish desired height of abdominal panel needed.
  Ride Designs will install the abdominal panel for you to meet these specifications.
  
  Abdominal Support Panel Size:
  Min char Max char
  Small Height 4in (Two Straps) Medium Height 6in (Three Straps) Large Height 8in (Three Straps)
Covers
- Additional Breathable Cover Min char Max char
  
  Yes No
- Additional Wipeable Incontinence-Proof Cover Min char Max char
  
  Yes No
Growth
- Would you like a Growth Kit? Min char Max char
  
  Yes No
Special Instruction or Comments
- Text Field for Notes Min char Max char