Choosing a wheelchair cushion, Part 1

Posted by Matt on 7/21/2016 to Wheelchair Accessories
Choosing a wheelchair cushion, Part 1

Do you know you need a new wheelchair seat cover but do not know where to start? Perhaps your old seating arrangement is just no longer working out for you due to a progressing health condition, or it could be the case that you were never properly seated in the first place.

You might have even been putting off getting a new wheelchair seating, because it is a lot of hard work. Getting a (proper) seating should be done by a professional — very often, in fact, a team of professionals — in coordination with your physician.

Whether you are about to begin this process with professionals in your area, or whether you have already done all this and are still having seating cushion problems, let us give you the low down on what your options are when it comes to cushions. Very often, your local mobility product supplier will show you different “samples” of cushion foams and gels that you can feel with your finger, but feeling samples with your hand will not give you much of an idea about what it will feel like to sit on the material.

Right now, we will look at wheelchair cushion types in general. Later, we will show you our various gel-like cushion offerings, especially our line of Action Akton Polymer Products.

Types of cushions

According to this article on Disabled-World.com, there are six types of wheelchair seat cushions:

  • Foam cushions
  • Gel cushions
  • Air or dry flotation cushions
  • Urethane honeycomb cushions
  • Alternating pressure
  • Positioning systems

It’s a good idea to have a working knowledge of these six general categories when deciding on a cushion. We sell polymer cushions, which are much like gel cushions but without some of the downsides, and we highly recommend them. However, we still want you to be aware of your other options on the market should you decide you need something else.

Foam cushions

Foam cushions used to be considered old-fashioned, because they do not breathe easily and can “bottom out,” that is, become all the way compressed to the point that the user experiences very little padding or weight distribution. If the foam causes the user to sweat, it can lead to rashes or skin breakdown. Furthermore, bottoming out can lead to hip pain, pressure sores or other problems.

However, foam is by no means a bad option if used correctly and for the correct purposes. In fact, many gel cushions have a foam base to provide foundational support. If you are not at risk for pressure sores or are not going to be seated for long periods of time, a foam cushion may be the right answer for you. If you do get a foam cushion, it’s important to change seating positions frequently in order to avoid pressure sores, and you will need to fluff up the foam occasionally so that it does not bottom out, which defeats the whole purpose of having a cushion.

Gel cushions

Gel cushions are usually, in fact, a combination of foam and gel cushions: foam to provide a soft yet stable base, and gel on top to provide for appropriate weight distribution. This latter feature is important for people with atrophied muscles or bony prominences, as well as people with abduction or adduction, in which the legs drift apart or together, respectively. The gel not only conforms to the shape of the posterior, but also can be bought with appropriate burrows to hold the upper legs in a healthy posture.

Like any cushion type, there are certain downsides to gel cushions. For one thing, traditional ones can leak gel if punctured, and once punctured, they cannot be easily repaired if at all. However, gains have been made in the “gel world” recently, and we are proud to say our lines of cushions feel like gel cushions but since they are made of special polymers — NOT liquid gel — they will not leak.

Another possible downside can sometimes be the unwieldy feeling gel cushions may have when the user hits bumps in the road, or when the user plops down into the seat. This is because gel cushions are generally not made to receive and cushion heavy impacts. Rather, the gel material works over time to conform to the posterior shape. This is actually a good thing, because you want a seat that fits you and can hold you in a steady posture. However, the “impact loading” limitation should be kept in mind. Note: Our cushion products are not made traditionally, and their polymer structure actually does allow for some impact loading.

Air or dry flotation cushions

These are called “dry” because instead of using highly-engineered gel material to achieve proper weight distribution, air cushions use air, usually located in individual cells that naturally conform to the shape of the user’s posterior. Air cushions can be highly effective at relieving pressure sores, joint pain and coccyx pain. Indeed, it is very comfortable for the user, who feels like they are sitting on a cloud.

Some possible downsides include excessive “impact loading” and air leakage.

Just as the gel cushions have low impact loading (that is, they don’t bounce well or have very much “give”), air cushions have high impact loading. This can be good, but the disadvantage is that healthy posture may be harder to achieve. If the user’s hips are unaligned and the user therefore sits crookedly, the air cushion will relieve their hip pain quite well, but it most likely will not cause them to sit straight. This is part of the give-and-take decision making required for deciding on a cushion.

And like the gel cushions, air cushions can leak; they just leak air instead of gel. Fortunately, air cushion punctures can be easy to repair as long as the puncture is not located on a seam. Have you ever patched a bicycle tire? Well, it’s the same way with air cushions. Submerge the cushion in soapy water, look for the bubbles to locate the leak, then patch up the leak with a patch kit.

Urethane honeycomb cushions

These cushions rely not just on a certain kind of material (gel, foam, etc), but on the structure and shape of the cushion itself. Often, gel or foam technology may still be used with these cushions, especially for underlying support. However, what is unique about these cushions is their honeycomb or grid structure, in which some of the cells collapse under the user’s weight while others stay upright, providing for advanced weight distribution. (See our Action Akton Shear Smart Pads and EquaGel Straight Comfort Gel Wheelchair Cushions, which have similar features).

Possible downsides to honeycomb cushions are hard to predict, as there is such great variety in the market. It really all depends on what kind you get and to what degree they offer a desired balance between equal weight distribution and healthy posturing.

Alternation pressure

Alternation pressure cushions use air to achieve weight distribution, but unlike normal air cushions that use individual cells, these cushions use a pump with a battery to alternate pressure points in the seat. These should be considered for use by people with severe pressure sore problems and frequent recurrences. They function much like hospital air mattresses. The cushion is divided into cells that are inflated and deflated in an alternating cycle.

The good part about these cushions is that they are very handy for people who cannot change posture or rise from their seat for periodic reliefs. The pressure alternates between the back area of the posterior and the front area where the legs and hips are located.

The possible downside to alternation pressure cushions is that they rely on battery power and, like normal air cushions, are prone to leak if hit by a sharp object, such as a set of keys in one’s back pocket, for instance. Many of these batteries, however, can be charged relatively easily, sometimes even using the wheelchair’s own batteries.

Positioning systems

Positioning systems represent one of the most advanced techniques of wheelchair seating. Positioning systems are created by making a computer image of the exact, three-dimensional shape of your body and manufacturing a foam seating area that perfectly matches your body’s contours. The advantage to a positioning system is that it coddles your entire seating area, including possibly your back, resulting in great stability and comfort. Furthermore, you can choose the foam material that suits you best, from soft to hard. Unlike regular foam cushions, an advanced positioning system is not as prone to bottom out or lack proper weight distribution, because the whole system is already shaped exactly to your body.

However, you can probably already see the downside to a positioning system. With these, you are restricted to sitting in one position. Therefore, this technique should only really be used by people who cannot move around much. Also, if you gain or lose a significant amount of weight, or if you’re a child and are growing every year, you may not fit in the positioning system later on and will have to go about getting a new one.

Stay tuned for tomorrow’s installment on “choosing a wheelchair cover,” where we will dive in to examine our various offerings.

© Copyright 2016 The Wright Stuff, Inc. Articles may only be redistributed in its unedited form. Written permission from The Wright Stuff, Inc. must be obtained to reprint or cite the information contained within this article.

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