Shock Absorbers for the Body
Choosing the right wheelchair seat cushion involves more than picking a pretty color!
People have different needs, and there is no recipe of what is most appropriate for everyone. Selecting a wheelchair seat cushion is part of a cumbersome process that should start with a clinician’s interview to learn what a person’s needs are, then a more detailed physical assessment, followed by trying various cushions.
At the interview, it is important for the clinician to collect data about medical history and clinical needs. During the physical assessment, he/she evaluates deformities, posture, arm function, level of independence in transfer, and method used to transfer from one surface to the other. He or she also checks the skin for pressure ulcers and other variables that are important during the selection process.
For people with spinal-cord injury (SCI) at least one year postinjury, pressure ulcers are far and away the most frequent complication, with incidence rates of 14.9% in the first year, steadily increasing thereafter to 26.7% at 30 years postinjury (National Spinal Cord Injury Statistical Center, 2006).
Selection of a seat cushion is one of the most important aspects of pressure-ulcer prevention and care (Sprigle, 2000). Pressure ulcers are lesions caused by unrelieved pressure, resulting in damage to the underlying tissue (Kanj, Wilking, & Phillips, 1998; Margolis, 1995). They are often known as “bed sores” “pressure sores” or “decubitus ulcers” (Gosnell, 1987).
Pressure ulcers usually occur over bony prominences such as the ischial tuberosities, sacrum, trochanteric areas, and heels (Kanj et al., 1998). The degree of soft-tissue damage varies from case to case. The most commonly used grading system for pressure ulcers is the National Pressure Ulcer Advisory Panel staging system (National Pressure Ulcer Advisory Panel, 2007). This classification is based on the degree of tissue damage observed and the anatomical depth of the ulcer (see box, “National Pressure Ulcer Advisory Panel Staging System”).
Pressure ulcers have a significant impact on quality of life, morbidity, mortality, and overall healthcare costs for people with SCI. Conservative estimates of the SCI population in the United States range between 225,000 and 296,000 (National Spinal Cord Injury Statistical Center, 2006), with an associated pressure-ulcer incidence of 23–31% (Whiteneck et al., 1992; Chen et al., 1999; Garber et al., 2000).
Increased life expectancy and decreased mortality among the SCI population have substantially increased the incidence of pressure ulcers. Approximately 60,000 people die each year from complications of pressure ulcers (19).
In addition, an estimated $3.6 billion per year of the national healthcare burden can be attributed to the cost of medical care for pressure ulcers (13). On average, the treatment of Stage 2 ulcers, excluding the hospital costs, is more than $1,100, and Stage 3 and 4 can cost nine times more when including the hospital stay (14). These costs, however, do not take into account the added pain and discomfort, as well as the diminished quality of life and increase in the risk of death.
Weaver et al. (2009) reported the pressure ulcer is an important factor that delays the rehabilitation process of soldiers with SCI, because most often they require surgeries to repair the ulcers, activity restriction, and healing time before high intensity rehabilitation therapies can begin.
The third part of the cushion selection process is to try different types. However, it can be difficult to decide the most appropriate one because finding a balance between positioning, functioning, and the best distribution of seating pressure can be challenging.
In addition of the use of a pressure-ulcer risk assessment tool (Braden Scale, Norton scale, Waterlow scale, etc.), there is a more objective method of identifying whether a person is at a higher risk for a pressure ulcer. Over the last decade, the development of pressure-mapping systems has advanced the field of pressure-ulcer risk assessment for wheelchair users, and this is due to the ability to measure objectively interface pressure using computer generated data (Taylor, 1999).
One of the best means of judging a wheelchair cushion’s ability to reduce interface pressure is to measure the pressure at the buttock-seat interface using a pressure mapping system (Roesler, 1997; Sprigle, 2000). Pressure values and distribution are measured with a thin mat placed between the seating surface and the user’s buttocks. The mat contains sensors and is connected through an interface module to a computer. Data computed from the sensors are presented in two ways: (a) colored contour map and (b) numerical values (see chart, “Pressure-Mapping Output” on previous page). The map generates an image of the pressure distribution of the user’s buttocks for each cushion sat on. Red indicates high pressure; blue is low pressure.
Levy (1997) recommends that pressure-mapping systems should be used as an adjunct to support clinical decisions rather than for making decisions based solely on the results of pressure maps.
In conclusion, wheelchair users should consider all aspects before deciding which seat cushion is most appropriate for their needs at the moment. Follow-up evaluations are required in order to always have the best equipment.
2009 Cushion Comparo
How to Read This Comparo
Wheelchair seat cushions are arranged alphabetically by manufacturer, then by cushion (model) name.
Cushion manufacturers self-reported the data in the listed categories. “N/A” indicates no information on this category was available, or the category did not apply to a particular cushion. Manufacturers have reported the Medicare code for which each cushion has qualified.
A range of measurements is indicated by a “–” between the listed numbers (e.g., 13–16" indicates a range of 13" to 16").
Cushions and date are listed as space permits. In some cases, additional sizes, cushion accessories, options, applications, etc., are not listed in the comparo grid, but are available from the manufacturer.
This comparo gives readers a starting point when researching wheelchair seat cushions for a variety of client needs. For complete information on a specific cushion, contact the corresponding manufacturer in the Source List below.
3827 Creekside Lane
Holmen, WI 54636
6500 NE Halsey Street, Bldg. B
Portland, OR 97213
100 N. Florida Avenue
Belleville, IL 62221
7-11 Suffern Place
Suffern, NY 10901
700 Esminger Road, Suite 112
Tonawanda, NY 14150
5 Commerce Drive
Freeburg, IL 62243
13577 Larwin Circle
Santa Fe Springs, CA 90670
182 Susquehanna Avenue
Exeter, PA 18643
7477 Dry Creek Parkway
Longmont, CO 80503
851 Bridger Drive
Bozeman, MT 59715
401 Linden Center Drive
Fort Collins, CO 80524
4000 1st Avenue South
Seattle, WA 98134
One Invacare Way
Elyria, OH 44036-2125
4211 South Natches Court, Suite G
Sheridan, CO 80110
This article originally appeared in the May 2009 Mobility Management (www.mobilitymgmt.com) and is reprinted with permission. PN and Paralyzed Veterans of America do not endorse products or services. Readers are encouraged to thoroughly investigate companies prior to making purchases.
Shock Absorbers for the Body
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