There’s More to the Wheelchair Cushion Than You Think

By Kevin Wallace, ATP, CRTS
Rehab Technology Specialist
ATF Medical

When providing mobility equipment for a seriously injured worker, the least expensive piece of equipment can be the most important. Consider the wheelchair cushion. 

These cushions provide shock absorption, padding and support between the wheelchair seat pan and the injured worker’s body so they can sit more comfortably. This is hugely important for people who spend 14-18 hours a day in their chairs. 

And that’s just the start. The correct cushion helps maintain the spine and pelvis in proper alignment to reduce the risk of postural issues. Kyphosis (hunching forward) or lordosis (spine curves inward) can result from an improper pelvis positioning. The wrong position can also hamper vascularization, the process of growing blood vessels into tissue to improve oxygen and nutrient supply. 

Perhaps most important, wheelchair cushions play vital roles in preventing pressure injuries, also known as wounds or pressure ulcers, which can be quite difficult and expensive to treat. People who use wheelchairs most of the time, especially those who have no sensation in the lower body, are at elevated risk for these. 

Cushions protect the skin from shear-inflicted wounds as well as facilitating pressure relief techniques to re-establish circulation to prevent compression pressure injuries. Keep in mind that not all pressure injuries are due to the wrong cushion or micro-climate. Poor nutrition, incontinence and not adhering to a pressure-relief program are other significant factors.

In short, the right cushion prevents the development of complications while enhancing the injured worker’s mobility and quality of life. Selecting the right cushion for an injured worker, however, is no easy trick. It takes a collaborative team of specialists, often comprised of an occupational therapist, Assistive Technology Professional, and/or physical therapists to evaluate the injured worker and recommend the best fit for them. 

Bodyweight and mobility level impact the choices. And controlling the micro-climate, the local environment and temperature around the injured workers’ skin, dictates much of the selection. 

An injured worker can experience increased temperature and moisture buildup due to prolonged sitting and limited airflow. Managing the micro-climate involves moisture control, temperature and air flow, and some designs and materials do this better than others. The right cushion can prevent skin irritation and keep the skin dry. And when it also distributes weight properly, it reduces the pressure injury risk.

Just as no two injured workers with the same diagnoses are exactly alike, neither are their cushions or the materials used to construct them. The most frequently used cushions are foam, gel, air and hybrid. Here are some pros and cons of the various types.

Foam

Foam cushions conform to a person’s body, providing structure and stability. Lightweight, they come in a variety of sizes, shapes and densities. Those constructed of viscoelastic foam heat up when someone sits on it and then conform to the body’s contours. When the fit is right, the user can sit on a set of keys without even feeling them!

On the flip side, foam cushions lose their shape faster than other types. Temperature and moisture control can be difficult, and they are less able to distribute pressure than air or gel cushions. Additionally, while their covers can be washed, foam cushions cannot and odors occur, so frequent replacements are needed. 

Air 

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 to the bony parts of the buttocks and spine that are prone to pressure injuries. However, correctly inflating the cushions for pressure relief requires a knowledgeable user. 

The injured worker must have postural stability to use air cushions, so they are great for pressure relief, not so much for positioning. It’s also harder to transfer on and off an air cushion than foam. Still air cushions are easy to maintain and durable and can be used by people with a variety of diagnoses, including spinal cord injuries and mobility impairments. 

Gel

This type typically 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 pressure injuries from shear 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. In hot areas, 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 but are not for those with significant pelvic asymmetry. 

Selecting the Best Cushion for an Injured Worker

Recommending the most appropriate cushion for a specific injured worker requires wide knowledge of numerous manufacturers and hundreds of features. At the same time, the ATP, OT or other specialist must conduct a thorough, holistic evaluation of the person’s physical, functional, clinical, and behavioral condition along with their home’s environment.

In some cases, this includes real-time pressure mapping to inform the selection and determine points where pressure injuries are likely to develop. The injured worker sits as they normally do on a sensor pad placed on a wheelchair. The device gathers and analyzes baseline pressure distribution data and converts it into an image shown that highlights areas of high pressure (red) and low pressure (blue or green). 

When the worker is then correctly positioned on the pad, the new image shows the difference in pressure. The difference is usually startling, making real-time pressure mapping an extremely effective patient-education When injured workers visualize the pressure of their poor position in the chair compared to correct positioning, they’re more apt to strive to stay in the right position. 

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.

Wheelchair cushions are so much more than accessories. They are essential tools that prevent complications and promote quality of life -- that is when the cushion is a good fit for the injured worker. 

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BIO 

Kevin Wallace, ATP, CRTS

Rehab Technology Specialist

ATF Medical

As a Rehab Technology Specialist for ATF Medical, Kevin Wallace sees workers’ comp patients in clinics and through telehealth visits to evaluate their conditions and needs and determine the most appropriate equipment for their unique conditions. He also delivers, sets up, and fits the equipment, educating injured workers and families on its use so they can derive the maximum benefit of the complex rehab technology. Wallace’s role also involves educating other ATF Medical staff on seating and positioning, complex rehab technology, and emerging technologies. 

A graduate of East Stroudsburg University in Pennsylvania, Wallace has worked in the rehabilitation field for 33 years. He started with a day program for people with special needs, then worked for Web Medical, where he fit patients for mobility equipment, before joining ATF Medical in 2018.

About ATF Medical

ATF Medical provides all the medical equipment and adaptive housing projects required for a complex workers’ compensation claim. 

Specialists assess injured workers and their homes and recommend and implement solutions to foster mobility, independence, and safety. Clinically driven, outcomes-oriented solutions include DME, such as complex rehab chairs, home access equipment, and hospital beds. ATF Medical stays involved for the life of the claim, fitting equipment to injured workers and educating them on its use and care and maintaining and servicing DME for the life of the claim. In addition, the company provides a pressure injury prevention program and efficient, cost-effective home modifications. 

Known for its stellar service, ATF Medical takes work off the desks of claims representatives by managing the myriad details of ordering and scheduling and ensuring that work is done on time and within budget. Clients include workers’ compensation ancillary service providers, carriers, employers, and other payers. 

Formerly known as After the Fall, ATF Medical was founded in 2001. For more information, visit www.atfmedical.com or call 877-880-4283.

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