What You Should Know About Wheelchair Cushions

What You Should Know About Wheelchair Cushions



An unfortunate fact-of-life for many wheelchair users is the potential for acquiring pressure sores. These can

rob a victim of their health, independence and quality of life. The reasons have been identified and docu-

mented through research and experience. Uncontrolled pressures, inappropriate technology, poor nutrition,

incontinence, lifestyle issues, stress, poor hygiene, poor care and aging are the usual causes for pressure sores

with the cushion being the usually-blamed culprit.



There are other possible contributing factors that need to be examined. Pressure sores on or near the seating

area does not, necessarily, begin or end with the cushion but it may be the easiest place to start the investigat-

ion. A good, upright sitter, with a "sacral sore", who does not go into a "sacral-sitting" position, probably, did

not get the sore from the cushion. The cushion was, probably, nowhere near this area while the individual

was seated in the chair. (Sacral-area-sores are pressure sores (from slouching and/or poor posture) that are

near the anal canal, deep and contaminated by bladder and/or rectal-contents that can be cured by techniques

such as good wound care, physician techniques and proper-fitting cushions.)



Other reasons include bed-surface, recliner-chair, a gurney, turning-frequency, stretcher, the shower or

commode equipment with seat-cutouts, lift-slings and lumbar-pads. Questions should be asked such as

"How often does the patient use these devices and for what period of time?" and "Is the equipment being

used properly and is it in good working order?"



When it comes to pelvic-area sores, the cushion will, most likely, be the cause. The pelvic-area is in contact,

regularly, with more than just the wheelchair-cushion, itself. Search-for-causes should begin with car seats,

airplane seats, unpadded shower benches and chairs, transfer-boards and anything else that the victim sits in-

or-on, besides the wheelchair. Sitting-up in bed with the hips flexed more than 30º will affect the pelvic area,

considerably. Dragging this area across a transfer-board or hard-landing surfaces, sitting on a transfer-sling

all day, not doing weight-lifts or shifts and over-extended "sitting-times" should be avoided at all costs.



Investigations should be thorough. Check the cushion - make sure it is in good condition, adjusted and placed

properly. Pummels (rounded-knobs) are effective but not when the cushion is placed on the chair, backwards.

Air-cells are great pressure reducers but not when they are facing downward. Over-or-under inflation of air-

flotation-cushions can cause many problems. Worn out cushion-bases and seat-hammocks can inhibit press-

ure pressure- reducing characteristics. Confirm that the user is actually able to place them-selves in proper

alignment with reliefs and seat-contours.



Some cushions have been known to have their covers on backwards. Look at the cover and confirm that the

cushion is aligned with the cover. Often, strange items are found under the cushion or cover such as wallets,

keys, books, assorted supplies, medicines, etc. When this occurs, they change the cushion-dynamics and

become a point of increased pressure. It should be clear by now that wound prevention and pressure

management involves more than just "swapping" cushions. The contributing factors are varied, complex and

changing. In most cases, it is impossible to single out just one cause of the problem and pronounce it as the

primary offender. It is a multi-dimensional problem. The solution is also multi-dimensional and should be

approached that way. Cushion-problems do not make the other possible related problems non-existent.



A stable pelvic position is the most important key to prevent "sacral-sitting" meaning with "the proper

posterior pelvic tilt"; i.e., no slouching, no slumping and no forward-sliding without any postural limitations

and/or deformities. The two main reasons for "sacral-sitting" is that the seat-depth is too long and/ or an

incorrect seat-to-floor height. The correct seating-position is when the hips are all the way back in the chair

against the back-rest and one-to-two inches from the end of the cushion to the back of the knee. With a stable

pelvic-position, focus can be on upper-extremity positions and what back-rest to chose.



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