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.
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.
Issues (you may encounter.. In no particular order of aggravation):
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!
>> 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.
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.
Other bespoke wheelchair cushion companies also exist!
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?
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For an overview of seating and wheelchairs, please view our Pressure Mapping and Seating Sections on Choosing a Manual Wheelchair Page.