Choosing a cushion like an expert

Every wheelchair user needs a cushion, but the most expensive cushion is not always the best. Occupational therapist EMILY MOUTON explains

Not all wheelchair users spend the same amount of time on their wheelchairs. They are built differently, with unique diagnoses, risk for pressure sores, environments, support systems and secondary symptoms such as extension spans. One cushion cannot serve the same purpose for every person, nor can it be made from the same material or come with the same price tag.

So, which is the best cushion? It depends on their functions, namely whether they are required:

  1. To assist with pressure care by distributing the pressure evenly.
  2. To assist with postural support.
  3. To allow for increased sitting tolerance.

For a paraplegic wheelchair user, what’s needed most from a cushion is to help with pressure relief to prevent pressure sores. For an elderly person who cannot mobilise independently, the cushion needs to be comfortable and allow for longer periods of sitting without causing fatigue.

A quadriplegic user or cerebral palsy user who has increased tone in their pelvis has greater postural needs and the cushion should supply that support.

The best cushion is the adapted cushion. Cushions are generic sizes and pre-ischial shelves are at standard distances; however, people don’t come in standard sizes. It’s therefore the ethical responsibility of the person who is setting up the wheelchair user to adapt the cushion to the user’s needs.

This is true for low-profile foam cushions but also for high-end cushions such as gel and air-filled cushions. Wheelchair users should consult with a therapist with sound knowledge on different cushions before buying one. Therapists are encouraged to use clinical reasoning in deciding which cushion should be ordered for their client.

A quadriplegic user, for example, who sits with his family around a fire at night should not get an air-filled cushion but rather a thicker gel-filled cushion. The user with maximal postural needs should have a cushion where the base layer can be adapted to have a maximal height pre-ischial shelf to prevent the pelvis from rotation and the skin from shearing forces. The user with an ultra-light wheelchair should not have a cushion with a heavy base.

To sum up: many factors should be taken into consideration when ordering and supplying a wheelchair cushion – not just a pretty box or the heavy price tag.

Make sure you are sitting comfortably with the right entry-level cushion. Cushions should be chosen according to your specific needs and in consultation with your seating specialist or therapist. See the selection available from South African companies.

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