A Look at Wheelchair Cushions

The Right Cushion Gives You a Smoother Ride

by Bill Greenberg

With so many brands and models to choose from, and a huge array of options available, most wheelchair users agree: Shopping for a new wheelchair can be both complex and frustrating.

But whether youre buying your first chair, or youre a veteran wheelchair user, Stanford University Medical Center occupational therapist Jody Greenhalgh offers the same advice: Dont forget the cushion.

"Who wants to spend all day, every day, sitting on a metal frame covered in canvas?" she asks. "Talk about uncomfortable."

But your personal comfort is far from Greenhalghs chief concern.

OTs are "trained to look at every aspect of a patients physical condition, to help optimize their function," she explains. "Were going to look at a number of issues, when helping a patient select a cushion for their chair."

Greenhalghs concerns include everything from the cushion users comfort to skin protection, posture, and the ability to get in and out of the chair safely and easily.

"Posture is especially important for people with neuromuscular diseases because it affects respiration — which is a biggie — along with circulation and swallowing," she adds.

Of course, the major skin care issue is pressure sores — a topic explored in "The Lurking Dangers of Pressure Sores" (Quest, vol. 6, no. 1, 1999).

Because of the significant health considerations involved, wheelchair cushions are considered "durable medical equipment," meaning their cost should be covered by health insurance. But Greenhalgh warns that you may have to do battle to get your insurance company to approve the cushion you need. (See "Keeping Your Insurance Coverage on Track.")

"This is a pet peeve of mine," Greenhalgh says. "A lot of insurance companies only want to pay for the cheapest cushion out there, because they say its just a cushion. But thats just not acceptable to me. It has to be the right cushion for the patient. Otherwise you could be looking at serious health problems later."

So Many Choices

For those just starting out, Greenhalgh recommends Gary Karps excellent books, Choosing a Wheelchair: A Guide for Optimal Independence and Life on Wheels: For the Active Wheelchair User (published in 1998 and 1999, respectively,by OReilly & Associates — see www.oreilly.com/catalog/lifewheels/).

Choosing a Wheelchair offers a chapter on cushions, backing up the assertion that choosing the right cushion is an integral part of choosing any wheelchair.

For example, Karp writes, "The actual length of footrests, the height of the chair back, the position of the armrests, and other features are influenced by how high or low you will be sitting on a cushion."

If it sounds like Karp and Greenhalgh are on the same wavelength, its probably because Greenhalgh contributed directly to Karps Life on Wheels (Chapter 6: Wheelchair Selection).

When selecting a wheelchair cushion, one of the first choices youll make is whether to go with a cushion filled with air, foam or gel. Which one is best for you? That all depends.

In Choosing a Wheelchair, Karp outlines some of the pros and cons of each type.

Air flotation cushions offer the advantages of being lightweight, waterproof and providing even pressure distribution. Some models inflate to the users specific needs, and air flotation cushions normally wont "bottom out" if theyre properly inflated. The disadvantages include the possibility of air leakage or puncture, and the user needs to check the air pressure frequently.

Foam cushions are also lightweight and generally inexpensive and they never leak. You can get foam cushions in a range of densities, and they can be cut to relieve sores. They tend to have excellent short-term memory, meaning they hold their shape well, but they often lose shape over time, and old compressed foam can actually lead to or exacerbate pressure sores. Foam cushions also tend to wear out faster.

Gel cushions offer excellent pressure distribution and comfort, and often come with supplemental inserts to stabilize the users legs. On the downside, however, gel cushions tend to be heavier than air or foam and are less able to absorb impact. Also, some designs allow the gel to push out to the sides, which can cause either loss of shape or leakage.

Its important to enlist the aid of an occupational therapist, who can help you make sure the cushion you use is the one that best accommodates your relative strengths and weaknesses.

Defeating Decubiti (Pressure Sores)

Joel Lerich, president of Rand-Scot, believes strongly in the companys popular line of wheelchair cushions called Bye-Bye Decubiti (BBD) — and not just because he sells them.

"Ive sat on these cushions for about 30 years," says Lerich, a mechanical engineer who became a quadriplegic as the result of an automobile accident.

"Ken McRight [who invented the BBD cushion some 50 years ago] had it right in the first place. Float the customer on a layer of air that is contained in a very soft, medical-grade rubber enclosure. That way, theres no shear [friction on the skin caused by sliding], simply because a fluid like air cannot sustain shear."

BBD dual-chamber cushions from Rand-Scot offer extra stability.

Rand-Scot offers variations of two basic air-filled cushions: single-chamber cushions, meaning the entire cushion is inflated to a uniform level; and dual-chamber cushions, which allows one side to be inflated more than the other to compensate for leaning.

"Best of all, pressure is distributed across the entire sitting surface," Lerich adds. "There are no pressure points holding the person up."

Among the most affordable cushions available, BBD cushions are priced as low as $135 for a single-chamber cushion and $219 for a complete single-chamber cushion kit, which includes the cushion, a cushion cover, a pump and a patch kit. Dual-chamber cushions start at $175 for the cushion and $215 for the system.

Rand-Scot also guarantees all its cushions for one year after purchase.

Space-Age Shear and Pressure Protection

For many years, the biggest knocks on foam-based cushions were that they didnt hold their shape well over time and were difficult to clean.

But that was then. This is now. Todays foam cushions are far more advanced than those of years past.

For example, Action Products uses a Space Age material called AKTON Polymer in its line, which starts with the Commuter Cushion, priced at $89. AKTON polymer looks and feels like a gel, but is "more body friendly" and wont leak, flow or bottom out, the company says. The cushions move with the users body, instead of against it, helping reduce pressure and shear, the two leading causes of pressure sores.

Supracor uses layers of honeycomb material in its ventilated cushions, including (from left) the Stimulite Sport Cushion, the Contoured Pediatric Cushion and the Stimlulite Contoured Cushion. ( The Pediatric Cushion was misidentified in "In Search of a Good Night's Sleep" in the May-June issue of Quest.)

Another Action product, the XACT Contour Cushion, starting at $389, also features the AKTON polymer cube pad, which provides shear and pressure protection for the pelvic bones and the coccyx (tailbone). The pad is said to make XACT cushions very effective for tilt-in-space power chairs. AKTON Polymer is easy to clean with standard disinfectant, wont absorb odors or body fluids, and is easily repaired.

Another alternative is Supracors Stimulite Honeycomb pressure-relief and positioning cushions, such as its Stimulite Classic Cushion, which starts at $448. Made from a soft, flexible form of aerospace honeycomb, the ventilated cushion has three fusion-bonded layers, each of a different stiffness, that enable bony protuberances to sink freely into the cushion while supporting the surrounding anatomy. Stiffer honeycomb is used for internal side bolsters with added support. The honeycomb cells contour to body shape, uniformly distribute weight to relieve pressure, and flex with movement to absorb shock and prevent shearing. Perforations in the cell walls circulate air and evaporate moisture.

More Customization

	The Low-Profile Quadtro Select Cushion can be customized with the push of a knob

For an even higher-tech approach, check out the Quadtro Select Cushion, featuring the patented ISOFLO Control system, available from the Roho Group, starting as low as $409.

The control system locks the air into place in four quadrants, minimizing undesired motion and memorizing your preferred seating position. The cushion also can be adjusted and fine-tuned by a knob while youre seated.

Signature 2000 lets you customize your entire chair — seat and back. Custom seat or back cushions start at $896.40, with a vast array of customization options.

Each Signature 2000 system is custom-fitted, using a portable simulator that allows a clinician to capture the contours of the body, correcting or accommodating any physical imbalances. Once youve determined the exact shape and contours of your body, cushions are created using both firm and soft foam to achieve maximum comfort and support.

Sometimes, Youve Got to Squirm

Often the best way to achieve maximum comfort is to be able to alternate your seating position. But not everyone has the ability to do this at will. Thats the principle behind the cushions offered by Aquila.

	Aquila's Airpulse PK features an automatic alternating-pressure system.

The Custom Air cushion, which starts at $575, is a two-zone manually inflated cushion that allows you to inflate each section to different pressures, so that problem areas such as protruding bones can be supported at a lower pressure. Not only can you set the pressures to your comfort level each day; you can make adjustments for added comfort throughout the day.

At the other end of the Aquila spectrum is the Airpulse PK, which starts at $1,995, and is an automatic alternating-pressure system. Alternate cells inflate and deflate together, changing contact points throughout the day to prevent development of sores from consistent pressure in one spot. Four pressure selections and 10 cycle-time selections, controlled by microprocessors, let you fully customize the cushion to what your doctor or OT advises.

Get the Complete Picture

With the wide variety of cushion choices available, youll want to get expert help in selecting the best system for your needs and lifestyle. And when it comes to wheelchairs and cushions, the occupational therapist at your MDA clinic can assist.

"Our job is to look at the complete picture of a patients life," Stanfords Greenhalgh explains. "Were going to look at your individual needs — at home, at work, wherever you go. How can we help you maximize your functional abilities, minimize your disabilities, and achieve the best quality of life available? Thats what were here for."

Once youve selected and purchased your ideal seating system, dont forget the all-important step of having it professionally fitted and adjusted, just as you did when you bought your wheelchair. Then make sure to follow the manufacturers recommendations regarding proper care and timely replacement of your cushion.

"If you have the right cushion, and you take proper care of it, you can easily get it to last a year or two before you need to replace it," Greenhalgh concludes.

A breathable cover works in conjunction with Supracors Stimulite Mattress Overlay to complete the Stimulite ventilation system. Quests article "In Search of a Good Nights Sleep" (May-June) incorrectly explained the system.

Wheelchair Cushion Product Manufacturers and Dealers