PLEASE NOTE: This page is based on my own experience and is NOT a substitute for specialist professional advice. It may be used to inform your own research on seeking solutions if you are experiencing any similar seating issues to the ones that have lead me to write this information page. Taking care of yourself and your skin is YOUR responsibility.
For medium and high risk users, getting an appropriate wheelchair cushion is an ESSENTIAL and not simply a "desirable."
In my experience, for over a decade I had only one criteria in choosing a cushion and that was avoidance of a pressure sore. My frustration is that there is a massive disjoint between wheechair retailers, wheelchair cushion retailers, seating clinicians and, frankly, the kind of person who can advise on HOW to use a chair, sit, check posture, etc... And there is, in my opinion, a whole lot more we should understand and expect from this humble, yet precious, piece of everyday use equipment. In principle, everyone would recommend that you should be looking to acheive comfort, better posture (avoiding further longer-term issues) AS WELL AS avoidance of any skin or pressure issues, though the practicality and responsibility of giving good advice is opaque. And it may be that your specific situation will prioritise one thing over all else.
The Problems (I experienced.. In no particular order of aggravation:)
My Own Background, which may benefit others..
I am a paraplegic full-time wheelchair user. For 11 years I had been using a Küschall K4 (2x chairs). Initially, I had two Vicair cushions. I had two winters with 5 months on bedrest (each) where I had what I erroneously believed was a pressure sore, but which was actually skin tissue breakdown. It was an open wound, probably caused by something like an ingrowing hair or infected spot. My mistake was not seeking specialist attention early enough. It was a wonderful local GP who looked at it and said 1) to take antibiotics to kill any low-level infection inhibiting repair and 2) to see a dressings nurse immediately to get it treated properly. At this point, it healed within two weeks (!!) and I learned another lesson. I have seen a number of people report the same issues on spinal injury forums and receive a host of varying advice and then come back with the similar stories. To alleviate skin heat breakdown issues, I bought an Isch-Dish cushion from Span America in the US (who were very helpful to deal with) which has a cut out underneath the ischial protrusions. It wasn't the most comfortable cushion but solved the skin breakdown issue.
After a series of hard-learned experiences - tissue breakdown, discomfort, poor posture and trying to figure out the diverse range of cushions without proper support - it's evident that clearer information on the subject would be wonderful.
The frustrating news for me is that there is NO ONE ANSWER. We are all individual with very individual needs. My suggestion is to understand that you may need to push and keep on pushing to find the right people to solve your requirements. Below follows a precis of my recent experience and learning.
In ordering a new chair, I chose ORacing with Steve Dent of Spokz (in the UK). It is a fully bespoke (i.e. made and welded to my exact specifications, rather than put together from off the shelf pieces) wheelchair. I tried Ergonomic Seating on a demo chair for a short while and tried pressure mapping in this with a variety of off-the-shelf cushions. Turns out that while ergonomic seating is a good thing generally and addresses posture, it doesn't suit everyone. I am tall and a complete injury so no spasms keeping gluteal muscles in shape. Ergo seating seemed to make my ITs protrude even more - that's just me.
Steve took a lot of time and care with the measurements and we discussed how I wanted to sit, rake, back, footrest, etc..
I also bought a super new TARTA backrest, currently available through Spokz and Gerald Simonds (in the UK) who have both had training on the product. I cannot underestimate the difference in posture and comfort of this backrest compared to the velcro slingback of my previous wheelchairs. Basically, I'd been slouching for 11.5 years and this was making me sit up more. Your backrest is part of your seating set up.
>> There is an increasing number of products available to choose from to support a variety of needs <<
I should say at this point that I have an Alexander Technique teacher who I've involved in this process (rather belatedly, admittedly). I believe that accepting poor equipment and not addressing bad postural habits only stores problems for further down the line. I've had this conversation with others, but it's a shame there appears to be no long term vision when it comes to NHS spend on prevention rather than treatment and cure. Anyway, like Ronnie Corbett, I digress...
My Isch Dish cushion pressure mapped alright. Bear in mind it wasn't causing any pressure problems, but wasn't perfect, to my mind, for posture and comfort and positioning and it was slammed by my spinal consultant as being a pressure risk (its cut-out loads pressure elsewhere) and not suitable for my needs.
Whatever way of your choosing and finding, I would address HOW you sit in your wheelchair and this includes the wheelchair, backrest AND cushion. They act as one, though they are regularly not treated as one at point of order.
FINALLY, after an incredibly helpful conversation with Kieran Cheer of Consolor (whom I googled looking for a local pressure mapping service provider), I popped over to see him in Bournemouth to learn about bespoke sculpted cushions. These are more appropriate where the user does not move in their seat.
I need to point out that while I saw an incredible level of knowledge and service from Kieran at Consolor (who cover a HUGE area of the country, extending up to another base in Derbyshire also) other bespoke wheelchair cushion companies do exist.
So for anyone wondering, here's the process showing how they make a bespoke cushion:
1. They take a mould using a kind of non-vinyl rubber bean bag filled with polystyrene balls. They ensure the mould is accurate and sucking all the air out until we they're left with a solid mould. Once I got out, I could see why I was showing IT hotspots on all previous pressure mapping sessions: mine went particularly deep into this mould.
2. Next, they photograph the mould using IR condensing over 250 images into a single 360º image which charts all the 3-D co-ordinates.
3. These 3-D co-ordinates are then plotted into a computer programme which instructs a robotic cutting arm to carve these contours out of foam - note that they have a choice of many different types of foams which do different things. At this stage, if they needed to mix layers or insert other elements, this is possible: e.g. different densities or foam with an open structure which doesn't absorb liquid, so it can be washed, chucked in the sea, etc.. etc..
4. This bespoke cushion is then pressure mapped again (me coo-ing and marvelling at the difference, comfort and positive change in posture - to ensure that it is safe to use).
5. Then it is given to the upholstery department who make a bespoke and fitted cover. (Note: with a zip that goes all the way round the base.. bye-bye all those years of trying to stuff a cushion and bodge bit of foam into one end of a cushion cover!)
I asked about the bespoke service and cost. Off-the-shelf medium-high risk cushions can cost upwards of £200-£500+. A bespoke cushion of this nature and simplicity cost around £500. When I look at the time and hi-tech machinery involved, this cost seems reasonable. I know that Consolor work with a huge number of Wheelchair Services.
I have listed off-the-shelf wheelchair cushion manufacturers on the manual wheelchair page (scroll to bottom for link) and these are perfectly adequate for a large number of people.
It is also worth noting that this bespoke process can be used to create seat backs, shower chair cushions, beds, hybrid cushions, sports cushions, etc.. for anyone of any age, size, curve or twist.
With all new cushions, you will need to monitor the skin on your bum very closely (yes, yes, that means getting out of your wheelchair to do this!). If you think anything is not quite right, or if you see an issue beginning (sheer issue, pressure sore, broken skin, etc..) get off the cushion and seek immediate medical help. So who should you go to?
*** And Finally ***
For an overview of seating and wheelchairs, please view our Pressure Mapping and Seating Sections on Choosing a Manual Wheelchair Page.