For some people, a wheelchair is their pair of shoes.  For people who have jobs that have them on their feet all the time every day, it is important for them to have the correct shoes that are also comfortable.  For example, you dont often see mail carriers walking their routes while wearing stiletto high-heel shoes, or nurses clacking along the hospital halls while wearing tap shoes, or NBA players running up and down the court in thigh-high boots.  

For a person who spends most of the day sitting in a wheelchair, he or she would like to be able to sit on more than a strip of plastic or leather during daily activities. When a person is uncomfortable the whole demeanor can change from being positive to grumpy, impacting life in ways that is not conducive to meeting goals. Sitting on a thinly cushioned wheelchair seat is really not a problem if it is done sporadically or for a short duration of time, but spending the entire waking time sitting on such an uncomfortable seat can become unbearable.  Much like someone wearing a brand new pair of unbroken-in dress shoes every day from the moment he or she wakes up until crawling back into bed at the end of the day.

When someone buys a pair of shoes there are certain ways to go about it to make sure that the shoes will fit correctly and when the shoes are broken in they will feel good in the long run. Making sure they can be kept clean and shined when needed, and of course, look good too.  Purchasing a wheelchair cushion is really not so much different.  

When purchasing a wheelchair cushion there are certain criteria to look for.  A wheelchair cushion should help maintain the alignment of the skeletal system, facilitate normal movement while also inhibiting abnormal movement, creating a stable base to optimize ones normal activity while also preventing abnormal pressure on the body, helping to reduce or relieve pain.  The right wheelchair cushion should also correct or support skeletal deformity when warranted.

The individuals physical condition is important when considering the correct wheelchair cushion.  It is vital to discern the lifestyle and preferences of the user, his or her functional skills and physical abilities.  For a person who will be using a wheelchair for the majority of the time, he or she should have a physical examination and a postural assessment to evaluate his or her own unique condition.  By having an exam and postural assessment done, the user and the caregiver will have a better understanding of the users general health, posture, cognition and development, skin texture, body symmetry, balance and coordination, and upper and lower extremity function.

Other assessments should include a musculoskeletal exam of the head and neck, and related assessments such as including position abnormalities and strength, pelvic position such as asymmetry, obliquity, anterior or posterior tilt, and a hip and knee examination for range of motion as well as the range of motion for the feet and upper extremities.  

A functional examination should assess the users ability to find out what activities can be done from a seated position and deduce the users balance, reflexes, head control, and strength along with leg and arm function and coordination.   A neurological exam should assess tone and spasticity, muscle strength, abnormal reflexes, and sensory input and proprioception.  

Once the condition of the user is assessed and realized, next comes the assessment of the conditions of where and how the wheelchair will be used.  Will the wheelchair be used only outside of the home or primarily inside the home or facility?  Is the home or facility wheelchair accessible?  If going outside of the home or facility, how will the wheelchair be transported if the need arises?  Also, what type of activity will the user have to rely on the wheelchair for with assistance in their daily activities? For example, when the user transfers in and out of the chair, will the user be dressing while in the chair, and will the user need to relieve him- or herself while sitting in the wheelchair? Is the user able to self-propel, or will assistance be required? All of these activities necessitate various levels of trunk control and strength and therefore lead to a better understanding on what type of wheelchair cushion would best suit the unique user.                                             

After all of the user information is gathered, the proper fitting of the wheelchair cushion can be more thoroughly identified.  The primary goal of a wheelchair cushion is to prevent pressure sores/skin tears and to be comfortable for the user.  For example, wheelchair cushions that consist of gel foam may seem to be the best fit but they are heavier than the standard foam cushion and might not fulfill the personal needs of a specific individual. When purchasing a wheelchair cushion the user must understand that the cushion will not be a one-time buy.  Since the average life of a wheelchair cushion will vary between six months to two years, wheelchair cushion users can search for a different type if dissatisfied with the current choice, and research more about other types of wheelchair cushions that are available.   

The wheelchair frame is also important in finding the correct wheelchair cushion fit for the user.  Because wheelchair cushions come in a variety of different depths and sizes, besides finding what works best physically for the user, the wheelchair cushion must also correctly fit the size of the wheelchair frame.  Included in the fitting determination are the actual length of the footrests, the position of the armrests, the height of the chair back, and how high or low the user would like to sit on the cushion in reference to the wheelchair frame.

Depending on factors such as how much time the user will spend in the chair, the stability of the user, and how active the user will be, the choice of a wheelchair cushion can become quite interesting.  In finding the right wheelchair cushion, the user can choose from four basic types of wheelchair cushions gel, foam, air floatation, and urethane honeycomb.

   

Foam cushions are not just the soft, airy stuff of earlier wheelchair cushion days.  Foam now comes in a variety of densities, including a memory foam density that will hold the shape of the user, increasing their stability.  One good thing about foam is that it is relatively inexpensive and easy to cut, leading to the ability to fit-to-shape without a large financial risk.  Also, if there is an acute pressure sore bothering the user, the pressure point on the cushion can be reduced by simply cutting out a portion of the cushion.  One problem with a foam wheelchair cushion is that it wears out faster than other cushion materials and will also lose its shape, yet, due to the lower cost of foam, this might not be a huge problem to the user. 

   

Another type of wheelchair cushion is the gel design.  These highly engineered gel fluids are placed into individual pouches and are usually attached to a foam base, so it will conform to the body pressure placed on it.  In this design, gel cushions provide very good pressure distribution and great comfort to the user.  Unfortunately, there are a couple of drawbacks to most gel cushions, one being the heavier weight than most other wheelchair cushions which can interfere with some of the benefits of a more lightweight wheelchair.  Another problem is the possibility of a gel cushion bottoming-out, which is the gel being pushed aside during the day by the weight of the user.  This can be prevented in redistributing the gel by kneading the cushion once a day which will help keep the fluids loose and able to spread evenly.

   

Air or dry floatation wheelchair cushions are able to support the users body entirely on air. Designed with a number of small, interconnected rubber balloons arranged in rows, the pressure is balanced by the air shifting out to the surrounding balloons which spreads the pressure evenly against the users skin.  Due to the whole system being a closed system, the air floatation cushion will not bottom out in the way a gel cushion might.  Much like a foam cushion, if the user has a pressure sore, the air cushion can be altered by tying off individual balloons to reduce the contact of the sore skin area.  Because air cushions are waterproof and lightweight, they can be used in a bathtub or out on a boat.  One drawback of an air wheelchair cushion is that is can be less stable for the active user, but newer designs such as quadrant options are now offered and can minimize this problem.  It seems that the biggest drawback of air cushions is that they require more maintenance by checking the air levels and possible balloon air leaks.

Urethane honeycomb wheelchair cushions are formed like a beehive.  They are made with many individual cells which allow the cushion to distribute the users weight evenly, and unlike the gel or air cushion, there is no risk of leaking gel or punctured air bladders.  The many open spaces within the beehive structure of this cushion allows air to travel more effectively therefore keeping the users skin cooler and preventing the build-up of moisture. This aids in protecting the users skin from breaking down and causing pain and possible infection.  The urethane honeycomb wheelchair cushions are quite light and can absorb bumps and shocks very well, while a low profile honeycomb cushion can provide significant support to the user.  Another great benefit of the urethane honeycomb wheelchair cushion is that it can be thrown into a washing machine and dryer with no ill effects, making this choice a more attractive cushion for people with incontinence problems.

Much like the importance of a pair of comfortable and supportive shoes for a person who spends the entire day on his or her feet, a comfortable and supportive wheelchair cushion is as important, or maybe more so, for the person who spends the entire day sitting in a wheelchair.  Choosing a wheelchair cushion should be as relevant and time consuming for the wheelchair-bound individual as it is for the nurse or the mail carrier who must select the correct pair of shoes for their respective profession and environment. Being confined to a wheelchair is not a choice, but the comfort level can be. Making the right wheelchair cushion choice to match the right conditions for the right individual is simply the right thing to do.  Everybody, no matter what level of health or condition, wants to be safe and comfortable and a simple thing as a correct cushion can go a long way to perfectly fulfill these wants and needs.

Bill Stock

Executive Editor,

Content & Social Media Services

and

Hulet Smith, OT

Rehabmart Team Leader & CEO