Disability equipment, for less!

Wheelchair Seating

PLEASE NOTE: This page is for information and guidance only, 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 seating issues. Taking care of yourself and your skin is YOUR responsibility. 


Captains Comfortable Wheelchair (Full Size)


For medium and high risk users, getting an appropriate wheelchair cushion is an ESSENTIAL and not simply a "desirable."

Whilst some may have enjoyed only positive experiences, for others, getting help and advice regarding seating can seem a disjointed process, slipping between the gaps of wheelchair retailers, wheelchair cushion retailers, seating clinicians, and realising, disappointingly, that it isn't an exact science. Who can advise on HOW to use a chair, sit, check posture, etc... There is, in my opinion, a whole lot more we could 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.

 Finding Your Own Route With Wheelchair (Full Size)

Issues (you may encounter.. In no particular order of aggravation):

  • Expense - picking the wrong chair or cushion can be an expensive business, but how do you know what is the right one?
  • Posture - there are products and people addressing this? You'll need to satisfy yourself that retailers are selling what you need rather than what they have to sell! Sling backs are pretty standard on many wheelchair but offer little by way of posture support. There are plenty of lightweight back supports (e.g. Jay). Also, think about the footplate as part of seating: if the cushion is not set up right and doesn't properly support your thighs/legs, this can contribute to feet not sitting on the footrest squarely and your feet slipping off.
  • Comfort - without trialling different products, how do you know what to expect. If you've only experienced mediocre how do you know what good feels like? And if you have only had good, how can you know it's good!?
  • Pressure Relief - pressure mapping equipment exists and works. How can and how often should you get to use it? Wheelchair clinics, wheelchair services, wheelchair cushion retailers and specialist cushion manufacturers all carry this equiment. Check your local suppliers to see who can help. Some services can be massively oversubscribed. I found Consolor to be helpful.
  • Skin Tissue Breakdown - check your skin regularly and if something doesn't look right, seek medical attention immediately. You will need to stay off your bottom, on bedrest, until it has healed, as not doing so can risk severe further damage. There can be various and variable contributory factors including pressure, sheer / rubbing, an infected hair folicle, or heat / moisture (e.g. sweat). As well as rest, a sore may specialist dressings and medical attention to aid healing. A speciailst will likely check for major or low lying infections, as these can hamper healing.
  • Holistic Approach and Cohesive Impartial Information - so I buy a cushion from one retailer separately from a wheelchair from another retailer with no co-ordinated timings or external advice from someone on posture or product advice and with my best interests at heart ..? How is that a sensible buy?

An extra that was offered to me on a new wheelchair was Ergonomic Seating. I tried it on a demo chair for a short while and tried pressure mapping in this with a variety of off-the-shelf cushions. Remember 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 Ischial Tuberosities (the boney bits under my pelvis) protrude even more which made me more susceptible to pressure sores. 

As an aside, I also trialled the Italian designed TARTA backrest [pictured below], currently available through Spokz and Gerald Simonds (in the UK) who have both had training on the product. This was my first foray away from a sling back and 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. After some time, I then moved on to a Jay 3, which I have found even more supportive, though it looks a little clunkier at the back!

TARTA wheelchair backrest BACK VIEW (Full Size)TARTA wheelchair backrest FRONT VIEW (Full Size)

>> Please note, these are a couple of products and brands, but there is a wide range number of products available to choose from, which support a variety of needs. <<

Whatever way you find and choose your seating products, I would recommend addressing 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.

 

Another option for speciailist seating, especially for non-active users, is going down the bespoke seating route. Kieran Cheer of Consolor invited me over to their laboritories to find out how this works. It was a fascinating process! Consolor have recently moved near to Totton, Hampshire, which is just off junction 2 of the M27.

consolor logo - improving posture, encouraging comfort (Full Size)

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.

Consolor Kieran Cheer creating the beanbag mould for bespoke wheelchair cushion (Full Size)

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.

Consolor Kieran Cheer scanning bespoke wheelchair cushion mould (Full Size)

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..

Consolor tech Ed creating 3d models for Robot cutting bespoke wheelchair cushion (Full Size)

The Consolor robot carving foam for a new consolor bespoken wheelchair cushion (Full Size)

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).

Pressure mapping the new consolor bespoken wheelchair cushion again with Kieron Cheer (Full Size)

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!)

Consolor's Tracy cutting fabric for the bespoke wheelchair cushion cover (Full Size)

testing finished seat (Full Size)

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. 

Other bespoke wheelchair cushion companies also exist! 

 
Trouble-shooting:

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?

  • Your GP - they can refer you on and check for any signs of infection - which would inhibit replair.
  • The GP can refer you to a local dressings nurse and also a specialist tissue viability nurse.
  • If you have a specialist consultant (like a Spinal Injury Centre outpatients department and / or seating clinic) these are an obvious port of call. Seating can be complex and it may require working through various possibilities to see what is actually going on.
  • Otherwise you may want to revisit Wheelchair Services.
  • Finally remember you can also talk this through with your Seating Retailer who will have experience of sorting any issues.

*** And Finally ***

For an overview of seating and wheelchairs, please view our Pressure Mapping and Seating Sections on Choosing a Manual Wheelchair Page.

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