| -- End Ad Box ---> | | | | A typical example is the Roho cushion, designed with a |
| Although your wheelchair and cushion are separate | | | | group of small, interconnected rubber balloons |
| purchases, which chair you choose is significantly | | | | arranged in rows. Pressure is balanced by air shifting |
| affected by the type of cushion you will use. Chair and | | | | out to surrounding balloons, spreading pressure evenly |
| cushion are a team, each influencing the other. The | | | | against your skin. The whole system is closed so air |
| proper combination of chair and cushion will enable you | | | | floatation cushions can't bottom out the way gel |
| to sit in a neutral and stable posture and to operate | | | | cushions can. |
| the chair safely. | | | | If you have a pressure sore, you can tie off individual |
| Cushions come in various depths and sizes which | | | | balloons to reduce contact under that area, allowing |
| need to be accommodated by the size of your | | | | you to spend more time sitting as the sore heals. The |
| wheelchair frame. The actual length of footrests, the | | | | Roho Quadtro allows the user to inflate four quadrants |
| height of the chair back, the position of armrests, and | | | | separately for optimal positioning. Air cushions are |
| other features are influenced by how high or low you | | | | relatively lightweight, and are waterproof, allowing for |
| will be sitting on a cushion. Clearly, you need to decide | | | | double duty in the bathtub or on a boat. |
| which cushion is best for you before you can make a | | | | Crown Therapeutics, maker of the Roho cushions, also |
| final decision about which chair is best, certainly before | | | | offers air floatation products for the wheelchair back, |
| you specify the exact dimensions of your chair. | | | | supplemental lumbar or sacral support, full bed |
| Wheelchair cushion development is quite lively, as | | | | cushions, and even a product for a standard toilet seat. |
| designers and engineers continue the quest for the | | | | All are inflatable to adjust to your needs. |
| ideal cushion. A number of manufacturers, such as Jay | | | | A longtime presence in disability magazines has been |
| and Roho, exist solely for the design and production of | | | | an ad for the "Bye-Bye Decubiti" cushion. It is inflatable, |
| seating and support systems for wheelchairs. Most of | | | | comes in many different sizes and shapes, is made of |
| the major wheelchair makers, including Everest & | | | | heavy duty rubber, and--although different from the |
| Jennings, Invacare/Pindot, and Otto Bock Reha also | | | | Roho balloon design--is uniquely formed to minimize |
| offer an assortment of cushions. | | | | pressure at the bony protrusions on which we sit. |
| Cushion design is by no means a simple topic, and | | | | Air cushions can be less stable for those who move |
| there are many choices to make as you decide on the | | | | around a lot in their chair, but recent designs offer |
| right one for you. This chapter discusses the four basic | | | | either low profile or quadrant options that minimize this |
| types of cushions--foam, gel, air floatation, and | | | | problem. The balloons used in air cushions can be |
| urethane honeycomb--as well as designs and systems | | | | punctured, of course, and leaks do occur, although a |
| for more specialized needs. | | | | fairly heavy duty rubber is used. But patching them is |
| Cushion function | | | | easier than with the gel design. The hard part is |
| What kind of cushion you choose will depend on a | | | | submerging the cushion under water to find the leak |
| variety of factors, including how much time you spend | | | | (look for escaping air bubbles). |
| in your chair, how much you move around in your chair, | | | | The biggest drawback to air cushions is that they |
| and how stable your posture is. | | | | require more maintenance. It is necessary to check the |
| One important task of the wheelchair cushion is the | | | | pressure frequently, especially if you have pressure |
| prevention of pressure sores. Since, when we sit, only | | | | sores. |
| one third of the body's surface is supporting all of its | | | | Urethane honeycomb cushions |
| weight, blood flow is restricted. In the presence of | | | | Thermoplastic urethane honeycomb cushions are the |
| muscle atrophy--which is experienced in particular by | | | | most recent development in the world of cushions. |
| many people with spinal cord injuries--circulation is | | | | Because there are many individual cells--like a |
| limited further by the loss of muscle which once | | | | beehive--these cushions are able to distribute weight |
| served as a sort of natural cushion. An additional risk | | | | evenly, but there is no risk of leaking gel or of an air |
| of sitting is shear force, as we tend to slide forward in | | | | bladder being punctured. The many open spaces in the |
| the cushion, causing stress across the surface of the | | | | beehive structure of the cushion allow air to travel |
| skin. Resulting pressure sores (decubitus ulcers) can be | | | | more effectively. This design helps to protect against |
| very serious, leading to hospitalization, surgery, | | | | skin breakdown because your skin is kept cooler and |
| and--though rare--even death. The right cushion is a | | | | moisture is prevented from collecting. |
| primary tool for maintaining the health of your skin. | | | | Urethane honeycomb cushions are very light, absorb |
| The other crucial task for a cushion is postural stability. | | | | shock, and a low profile cushion can provide significant |
| Even if you are able to walk or are an amputee with | | | | support. These cushions can even be thrown into your |
| sufficient built-in cushioning, the right cushion helps to | | | | washing machine and dryer, making them attractive |
| support your spine. If you already have some | | | | for people with incontinence problems where the |
| asymmetry in your body, you need to be supported in | | | | cushion will be soiled from time to time despite best |
| a way that will not increase any spinal deformity. For | | | | efforts at bowel and bladder management. |
| manual chair users, greater stability in your chair also | | | | Supracor of San Jose, California, makes several |
| means you can push the wheels with more | | | | honeycomb cushions based on their patent. One type |
| confidence and strength. | | | | uses multiple layers of varying stiffness to allow your |
| It can't be repeated often enough--posture is key. Bob | | | | sit bones to sink into the cushion while deeper layers |
| Hall of New Hall's Wheels puts it well: | | | | provide overall support and weight distribution. Another |
| The wrong seating system leads to poor posture, | | | | type is contoured to provide adduction and abduction, |
| which leads to physical problems, which leads to | | | | plus a rear dish for pelvic positioning. There is not much |
| becoming more sedentary, which leads to a negative | | | | of a track record for urethane honeycomb cushions |
| emotional and personal experience. It's a dangerous | | | | because of their recent development, but there |
| chain of events. | | | | appears to be good prospects for this type of cushion |
| Foam cushions | | | | to evolve and become more widely used. |
| Foam technology has come a long way. No longer just | | | | Alternating pressure |
| the soft, airy stuff of the past, foam now comes in a | | | | The latest territory being explored in cushion design is |
| range of densities and with varying degrees of | | | | the use of an air pump to create alternating pressure, |
| "memory," holding its shape as you sit, contributing to | | | | of particular interest to those with more severe |
| your stability. The new foams can adapt to any shape, | | | | disabilities who are unable to perform their own weight |
| and still provide even support, spreading pressure | | | | shifts to relieve pressure. |
| across the sitting surface. Different foams are often | | | | Sitting for extensive periods of time without pressure |
| used in combination, layered for their various properties | | | | relief causes the muscle and fatty tissues to separate, |
| of softness, even support, and memory. | | | | putting the delicate skin layer in closer contact with the |
| Foam is relatively inexpensive, and it is easy to cut. A | | | | bone. This creates even more pressure on the skin. |
| therapist can experiment with shapes free of financial | | | | Lack of air circulation increases the temperature |
| risk. If you have an area of skin that is broken down or | | | | between you and the cushion. Moisture collects and is |
| on the verge, pressure can easily be reduced by | | | | trapped against the skin. All of this further increases |
| cutting out a portion of the cushion. (You should not do | | | | the risk of a sore. |
| this on your own, though, because only a doctor or | | | | One alternating pressure solution is the ErgoDynamic |
| therapist can identify the changes in your cushion that | | | | Seating System from ErgoAir in New Hampshire. This |
| will help relieve pressure while still maintaining | | | | system pumps air into and out of alternating portions |
| appropriate support.) | | | | of the cushion. The product is contoured for pelvic |
| On the downside, foam wears out faster than other | | | | stability, with a pre-ischial cross-bar design that |
| materials and loses its shape, but because of its lower | | | | prevents forward slipping--and therefore shear--on the |
| price, this might not concern you. If you choose a foam | | | | cushion. Special vent holes serve to allow the flow of |
| cushion, be sure to replace it when its time is up. Old | | | | air and moisture. In a five-minute cycle, compartments |
| foam that is compressed can allow pressure points to | | | | are inflated and deflated to shift support alternately |
| form that can lead to a sore. | | | | between the ischial (sit) bones and the hips. Both areas |
| If you choose a gel or air flotation cushion for daily use, | | | | get regular periods of complete pressure relief. The |
| it is a good idea to have a backup foam cushion since | | | | manufacturer likens it to a massage while you sit, with |
| gel and air flotation cushions can leak. | | | | the resulting promotion of blood flow. In some cases, |
| Gel cushions | | | | the makers suggest, a pressure sore can even heal |
| Gel cushion designs attempt, in effect, to replace the | | | | while you sit. This cushion system can be plugged into |
| consistency and support of atrophied muscle tissue. | | | | some power chair batteries or charged in a cigarette |
| Highly engineered gel fluids are placed in pouches and | | | | lighter in your car. |
| usually attached to a foam base, so that the cushion | | | | Alternating pressure products are of course |
| conforms to the pressures placed on it. As a result, gel | | | | heavier--given their use of batteries and air |
| cushions provide excellent pressure distribution and are | | | | pumps--and, like air floatation cushions, prone to |
| very comfortable. Many gel products also offer | | | | puncture. However, the technology for these |
| supplemental inserts to stabilize your legs. Your knees | | | | innovative systems is likely to evolve further in the |
| might tend to fall together (adduction) or apart | | | | future, as new materials and batteries are developed. |
| (abduction), so such an accessory can help keep your | | | | Positioning systems |
| legs straight which also aids your overall posture. | | | | Advanced needs such as significant spinal curvatures |
| Unfortunately, gel cushions are much heavier than | | | | or asymmetries in your body require more complex |
| other types, which can cancel out some of the | | | | kinds of trunk support. For example, the Pindot system, |
| benefits of your lightweight wheelchair. Gel suppliers | | | | recently acquired by Invacare and available from |
| such as Jay and Flofit offer lighter, active-use designs, | | | | suppliers around the country, is a support system |
| but these might not be appropriate for you if you are | | | | which customizes seat and back cushions to your |
| unable to do your own pressure-relief lifts. | | | | exact shape. First, a special chair takes an imprint of |
| If you bounce up and down curbs, or commonly | | | | your body's shape. A therapist views a computer |
| experience similar impact in your chair, a gel cushion | | | | image of the shape and can customize the contours |
| might not be ideal. When you sit in a gel cushion, there | | | | of your cushion. From your imprint and the therapist's |
| is no further "cushiness" to absorb impact, a concept | | | | specifications, a foam cushion that gives you optimal |
| known as impact loading. Other cushion types are | | | | support is manufactured specifically for you. The |
| better able to absorb impact. | | | | Pindot system is of most value to people who will not |
| Another drawback to gel cushions is the possibility of | | | | move around much in their chair. Since the cushion is |
| them "bottoming-out" as the gel is pushed aside by | | | | formed to your shape, you will only be comfortable in it |
| your weight. You can help prevent this distribution | | | | when you sit in the right relationship to the customized |
| problem by kneading your gel cushion once a day, | | | | contours. |
| keeping the fluids loose and spread evenly. Look for a | | | | Your needs might require the services of a rehab |
| design that divides the gel portion into several sections | | | | engineer who custom designs your seating system. A |
| so that all of the gel cannot push to the sides. | | | | rehab engineer might adapt existing products or build |
| There is also the chance of the gel leaking. While | | | | something from scratch just for you. Your therapist or |
| cushions arrive with patching kits, patches are | | | | dealer should be aware of such people in your area. |
| ineffective when the breach is at a seam, which is | | | | Often they are working in a major hospital or |
| often the case. A leak might be very minor, or it could | | | | university. The Veteran's Administration is also involved |
| be an extremely messy affair. | | | | in research and engineering that addresses the need |
| Air or dry floatation cushions | | | | for customized positioning systems. |
| Air floatation cushions support the body entirely on air. | | | | |