Cushion Pros & Cons

The right wheelchair cushion can help wounds heal and prevent them in the first place. There's a vast selection, though, so we'll take a look at some of the advantages and disadvantages of them.

Pictured above is a Roho air cushion that a person sits in - rather than on it. Air cushions are manufactured with several interconnected air cells or chambers that are inflated with air. Users can adjust the air in the chambers to control firmness and support.

Because weight is distributed evenly across these, air cushions reduce pressure on the bony parts of the buttocks and spine, where pressure injuries tend to develop. However, correctly inflating the cushions for pressure relief requires a knowledgeable user. The injured worker needs postural stability to use air cushions, so they are great for pressure relief, not so much for positioning.

Foam: Foam cushions conform to a person’s body, providing structure and stability. Those constructed of viscoelastic foam heat up when someone sits on it and conform to the body’s contours.

On the flip side, cushions made of foam lose their shape faster than those made of other materials. Temperature and moisture control can be difficult, and they are less able to distribute pressure than air or gel cushions.

Gel

Typically, this type of cushion has a gel-filled interior or pocket surrounded by a foam base. The gel is situated to alleviate weight from bony prominences of the hip and spine. Gel also decreases the risk of shear-caused pressure injuries and provides better pressure distribution than foam.

These can be good for people who have paralysis or limited mobility and are at risk for skin breakdown. However, a person who has sensation in their buttocks may not be comfortable on a gel cushion. If it’s cold, the gel can become hard or be cold enough to be seriously uncomfortable. Conversely, if it’s hot, the injured worker will likely sweat and moisture contributes to compromised skin integrity, which can then lead to pressure injuries.?

Hybrid

Hybrid cushions combine two or more materials, such as a solid foam base with gel or air in certain areas. They offer the stability of contoured foam with the pressure relief of an air cushion. These can be used by patients with current skin breakdown and/or pressure injuries.

Cushion Tips

• Caution injured workers against ordering cushions online or playing with different cushions. The $20 cushions are ok for transfers or short-term use on a scooter, but not for 14 hours in a chair. The risks just aren’t worth it.
• Have a six-month follow-up after the worker has received a cushion. Are they developing any skin irritation? Is their posture correct? How is their seating tolerance? It’s better to change cushions sooner rather than later.
• Educate the injured worker and caregivers in the use, care and maintenance of their cushion. They need to understand how their cushion and their seating reduce the risks of pressure injuries and postural issues. And they especially need to grasp the importance of performing pressure relief techniques.
• Cushions can’t just sit there. Gel migrates, and these cushions should be kneaded (yes, like bread) at least every two weeks. Air pressure needs to be checked two or three times a week.
• Therapists in rehab facilities may have a bias toward a cushion type or manufacturer. And their favorites may work well in an institutional setting but not be the best fit for long-term use at home. Always have an ATP, OT or similar specialist evaluate the injured worker and recommend the best cushion for that person and their home environment.

ATF Medical specializes in complex rehab equipment, mobility equipment and accessibility solutions--including home modifications--for workers' compensation patients. Contact Brendan Swift or Katherine Nelson for more information.