How to choose cushioning

When it comes to sitting comfortably, it’s important to consider the value of high quality, correctly sized cushions.

And, believe it or not, the right cushion choices don’t just come into play when you are sitting – it also influences how easy transfers in and out of wheelchairs will be, as well as the smaller details, like whether you’ll have sufficient clearance under tables.

Cushioning can be a bit of a mine field, with lots of different brands and styles readily available. When we prescribe cushioning for clients there are some straightforward things we check before making our recommendations, but even then, it can sometimes also take a bit of trial and error to get right.

Here’s a bit of a how-to-guide on cushions – but remember, we’re always happy to help so feel free to give us a call on 9381 2087.

Working out your prioritised needs and matching these with the features of the cushion usually requires a few questions! And it may also help if you can sit on different types of cushions to see how they influence your posture, your functional sitting, and your comfort levels. It would be helpful to consider:

• The material/s the cushion is made from – this might be foam, gel, air or a combination of these – each offers different properties depending on what you might be looking for.
• The cover- this needs to have enough elasticity in it so that you can conform to the shape of the cushion and maximise the contact with the cushion surface. If incontinence or regular spills need to be considered there are special solutions available. And if temperature regulation is an issue there are solutions for this too.
• The shape of the cushion and how this matches the shape of your bodyIf the aim is to maximise surface area contact and promote even weight distribution, the shape of the cushion can help – for example if the cushion is contoured to the body shape (not flat) this can improve surface area contact.It may also be that your body shape is not symmetrical, or your pelvis does not sit evenly on the surface of the cushion. In this instance it may be useful to have a cushion shaped to either match your posture. For example, it may have additional height built up just on one side to accommodate the position of your pelvis.Cushions can also be made to counteract body forces and movements to gain more postural control. In this case the cushion is constructed so as to actively promote improved sitting positions. In these types of situation we usually find some kind of pelvic support (usually in the form of a pelvic belt) is essential.

Different materials are used to construct cushions to offer a variety of solutions for different postural and pressure care needs. The typical materials seen are foam, gel, air or a combination of 2 or more of these. Each material has its own pros and cons so we really like to try to find out more about your lifestyle and the intended use of a cushion before narrowing options. We find that often a combination of materials can be used to offer solutions that work to overcome the cons. For example,

Foam cushions can use a combination of foam densities from firmer to softer to offer stability and integrity underneath a softer sitting surface to help with conformity and comfort.

Gel conforms to bony prominences and moves with body, but often works better in partnership with foam to protect against ‘bottoming out’ and reducing the overall weight of the cushion. It also allows for shaping to occur within the cushion that can assist with postural control and stability.

Air often offers excellent pressure redistribution but some people can feel unstable on an air cushion. Some cushions therefore combine air and foam to provide excellent pressure relief in essential areas whilst offering some stability for transfers or pelvic positioning.

The cushion needs to fit into your wheelchair, however it also needs to fit your body shape. It is best if you are not sitting on the edges of the cushion. Also, if there is anatomical shaping to the cushion these need to match your body shape and size. When it comes to length, there is a just right fit, and usually that is a 2-5cm space from the back of the knee to the front of the cushion.

Getting the right fit is really important to making sure you are well supported and able to maximise the benefits of the cushion. If the cushion is too long it may press into the back of your knee and make your legs uncomfortable. A cushion that is too long may over time encourage you to slide forward in your seat, resulting in your pelvis going into posterior tilt which consequently can make your back/bottom uncomfortable and, in the worst-case scenario, lead to pressure problems. This posture also means you will be predominantly sitting on your sacrum (something it is not designed to do!)/ If the cushion is too short you may not distribute the body weight evenly through the thighs and put too much pressure through the sitting bones. Again this increases the risk of developing pressure problems.

If there has been a history of pressure areas or you have high risk factors for pressure injuries then looking after your skin is critical. There are many factors that contribute to maintaining good pressure care, and the sitting cushion surface is just one of them. Whilst a lot of emphasis is placed on the type of cushion recommended (ie air, foam, gel) the cushion is only one part of the picture, you also need to consider

• The fit and size of the cushion
• Conforming to body shape to allow immersion into the cushion
• Good postural support for the whole body to promote even weight distribution
• Using an appropriate cover on the cushion
• Regular repositioning
• Equally effective 24hr positioning when you are not sat on your wheelchair cushion

If you are experiencing discomfort, or the cushion does not feel the same as it did when you first started using it then it may be time for a review. Also if you have had a major change in weight, surgical intervention, a change in postural positioning, a pressure injury, a change in wheelchair use or a change in transfer methods then you may need to check that the cushion you are using is matching to your new circumstances.

Some cushions are low maintenance and do not need to be checked as regularly, whilst others need resetting every day or every other week. When deciding on the right cushion for you make sure the maintenance, care, and set up requirements are a match for you, because if the cushion is not used correctly it can potentially do more harm than good. It is also worth knowing the shelf-life of the cushion and when it is likely to need replacing in the future. It is dependent on frequency and duration of use, but there will be recommended review dates for different cushion types. For example foam may need to be checked every 3 months for ‘bottoming out’; whereas air may need to be checked daily to ensure it is inflated to the correct level.