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How to Choose the Right Wheelchair Cushion

An estimated 2.7 million Americans rely on wheelchairs for mobility and independence.¹ However, long periods of sitting can cause discomfort, pain, and poor blood circulation. Without appropriate support, pressure, friction, and shear from sitting can lead to dangerous and costly skin breakdown and pressure injuries. The Society of Actuaries reports that pressure injuries alone cost an average of $10,700 per case, or between $9.1 billion and $11.6 billion in total each year.²

Choosing the proper wheelchair cushion for your resident is vital in preserving skin integrity and redistributing pressure while encouraging proper pelvic positioning and postural alignment. With a variety of materials and styles designed to combat different issues, choosing the right wheelchair cushion based on the unique needs of your residents can reduce injuries and enhance comfort, sitting tolerance, mobility, and independence.

Determining Factors

There is no perfect cushion, only the right cushion for your resident. When evaluating your resident’s profile, consider the following needs:

• Postural Support: Determine the level of support your resident requires for proper positioning and alignment and if there is muscle atrophy.
• Skin Condition: Determine if your resident is prone to developing pressure injuries or has fragile or thin skin that tears easily.
• Mobility: Determine if your resident will be sitting for prolonged periods, if they are self-propelling, and how often they will be moving in or out of their wheelchair.
• Height: Factor in your resident’s height to ensure the thickness of the cushion will not prevent their feet from touching the footrests or ground and from moving in and out of their wheelchair safely.
• Weight: Determine if the cushion is rated to the correct weight capacity for the resident to ensure the cushion provides optimal stability, retains its shape, and won’t bottom out while extending the life of the cushion. This is especially important for bariatric residents that are at higher risk of developing pressure injuries.³

Cushion Materials

Wheelchair cushions come in a variety of materials, including foams, gels, air cells, and hybrid combinations.

Soft, spongy, and lightweight, foam cushions provide excellent comfort, durability, and mild pressure relief for improved sitting tolerance, making them suitable for self-propelling residents or those who do not have skin integrity issues. Ideal for minimal to moderate positioning needs, foam cushions come in a variety of thicknesses and densities, making them a reliable and popular everyday choice.

Latex foam cushions have elastic-yet-firm, high-resiliency qualities, enabling the cushion to contour to the body and retain its shape over time to provide all-day sitting comfort. Latex does not absorb moisture and naturally resists microbes such as bacteria, mold, and mildew, making it an ideal option for residents with mild incontinence issues.

Residents who sit for extended periods of time or are at higher risk of developing pressure injuries may require a premium memory foam cushion such as T-Foam™. T-Foam molds to body contours for optimal pressure redistribution and features "slow recovery" capabilities, allowing it to retain its compressed shape longer for greater relief of painful weight-bearing pressure points. Lightweight with an open-cell structure, T-Foam permits air to circulate freely through the material, preventing heat buildup and perspiration for cooler, long-term comfort.

Economical gel-foam cushions combine stability, pressure management, and shear relief for overall comfort and skin protection, making them ideal for residents with moderate skin issues and positioning needs. They may also be used to stabilize residents with atrophied muscles.

Premium gel cushions are a higher-end option that provides optimal shear and pressure relief using an advanced polymer material. T-Gel™ cushions are made of a soft, rubber-like elastomer gel that mimics skin-protecting fatty tissue, moving with the skin to minimize the effects of friction and shear while reducing the formation of pressure injuries. Ideal for residents with a higher risk of skin breakdown and pressure injuries, T-Gel cushions are available with a smooth surface for basic relief or a checkerboard surface that contains independent cells that offer better reaction to patient movement and greater air circulation for maximum relief. Additionally, styles with added T-Foam, coccyx cutouts, or stabilizing bases offer exceptional comfort, sacral relief, and high-level postural support.

Air cell cushions offer exceptional pressure redistribution and protection against pressure injuries, making them ideal for residents at high risk for skin injury. Typically, a bulb inflator is used to pump the cells with air to the desired comfort level. Individual air cells act as springs and adjust to the anatomical contours of the user. By shifting independently with the resident's movements, the cells help to reduce friction against fragile skin.

Bariatric Cushions

For bariatric residents, it is important to choose a cushion that won’t bottom out or lose its shape while distributing weight evenly to minimize pressure injuries. The Tri-Foam Bariatric Wheelchair Cushions offer both weight distribution and reduction of pressure while helping to prevent bottoming out. For extra support, Elite Gel Wheelchair Cushions combine foam with a viscoelastic gel topper to provide relief at critical pressure points and support optimal posture. Finally, the WAFFLE® Bariatric Seat Cushions evenly distribute weight, minimize material stress, and aid in pain management. Read our blog on bariatric cushions to learn more.

Cushion Covers

Cushion covers are essential to help extend the life of wheelchair cushions, providing both therapeutic and aesthetic value. Covers with two-way stretch are breathable to avoid causing hot spots and skin breakdown. Fabrics that are water-resistant or fluid-proof aid with residents who have incontinence issues while those with ripstop properties stop punctures from becoming tears. Nonslip bottoms help keep cushions in place and removable options are ideal for quick and easy laundering or cleaning.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4397418/
2. https://www.ahrq.gov/sites/default/files/publications/files/putoolkit.pdf
3. http://www.npuap.org/wp-content/uploads/2015/02/3.-Bariatric-Patients-K-Kennedy-Evans.pdf

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