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SCI Forum Reports

What About Cushions?

November 9, 2004

November 9, 2004 - What is the best wheelchair cushion for you? Should you have more than one cushion? Should you sit on a cushion in the movie theater? On an airplane?

According to Jennifer Hastings, a physical therapist at the Puget Sound VA, the answer to all of these questions is: "It depends." Hastings is a board certified clinical specialist in neurologic physical therapy who specialized in SCI rehabilitation for over 13 years and established the wheelchair seating clinics at both the VA and Harborview Medical Centers.

Factors influencing cushion choice

  1. Individual body type. Consider your body type before injury, whether you have an upper motor neuron (UMN) or lower motor neuron (LMN) injury, how long ago you were injured, how much muscle atrophy (shrinkage) has occurred. "UMNs will have spasticity-muscle contraction in your paralyzed limb-that maintains more muscle tissue, generally better circulation, and healthier skin," Hastings said.

    Body weight also matters, and in this case, "more isn't necessarily worse," she continued. "If you're really thin and sitting on just bone, even if you're light, you'll have different cushion needs than a person who weighs more" and has more padding.

  2. Postural deformities. "This is a nice clinical term that simply means you're shaped differently than average," Hastings explained. There are a variety of causes. An ischiectomy-surgical removal of part of the pelvic bone during flap surgery-creates a postural deformity because is results in an asymmetrical posterior. Range of motion (ROM) limitations can also cause asymmetries that play out to the seating surface.

  3. Personal skin situation. General health, skin history, movement, sensation, and age all affect skin health, strength and integrity. If you have a history of problems such as eczema or psoriasis, SCI tends to make these conditions worse. Scar tissue from prior skin breakdown or other injury needs more protection because it is not a strong as normal skin.

    Movement, such as shifting around or transferring in and out of the chair, can put more stress on skin. But it is also very beneficial to change positions. Sensation can be good for skin because it signals discomfort and causes you to shift position.

    General health is frequently overlooked in the cushion selection process. Nutrition and hydration must be adequate for good skin health. Any chronic condition that decreases circulation to the skin, such as diabetes or atherosclerosis, is a concern. "Some things you have control over," Hastings remarked. "If you have skin breakdown and you smoke, we can do all sorts of dressings, but to heal you have to quit smoking."

    Age is also important. "Skin is an organ that gets thinner and less elastic as you age, and as a result less able to tolerate stress," she continued. "Padding that comes from subcutaneous fat also gets thinner. That's normal aging. With paralysis some of these processes accelerate."

Key Cushion Concepts

"While clinicians think about skin protection and postural issues when selecting cushions for clients, you, the user, need to think about personal issues such as comfort, weight, maintenance, and aesthetics," Hastings said. "Both clinician and user need to be thinking about function ."

How do I know when my cushion is worn out?

Much the same way you know when your jeans or shoes are worn out, i.e., how do they compare to their condition when new? "Here's a hint: you might not remember," Hastings said. She advises people to weigh, measure and photograph their cushions when new.

It's worn out when:

And don't forget about bathroom equipment (such as toilet seats), Hastings warned. "It wears out too, and usually isn't replaced often enough. It's not nearly as expensive to replace as a cushion."

What cushion is right for me?

"It depends on your needs," Hastings repeated.

Contoured postural cushions are designed to provide postural support and distribute pressure optimally when the user is seated in the proper position. "If you shift your posture a lot on a postural cushion, that's not good," she cautioned. "It can create increased pressure areas instead of providing pressure protection. You need to think about who you are and how you move and sit."

The chair-cushion interface is important. Hastings' bias: choose the chair configuration first, based on the client's postural needs; then pick the cushion.

High risk skin- Why is it high risk?

Should I have more than one cushion?

The cushion should fit the chair, "so if you have two different size or shape wheelchairs, you need two different cushions," Hastings said.

What about other seating: sports equipment, car, theater, airplane?

Types of cushions

Cushion Manufacturers

Sunrise Medical http://www.sunrisemedical.com
Varilite: http://www.varilite.com/
Supracore: http://www.supracor.com
Roho Medical Products: http://www.roho.com/medical/index.jsp
Ride Designs (division of Aspen Seating): http://www.ridedesigns.com/
Otto Bock Rehab: http://www.ottobockus.com/
Flofit Medical: http://www.flofitmed.com/
Invacare: http://www.invacare.com