Clinicians and ATPs often face the challenge of selecting the right product. When I first started out as a clinician, it was difficult knowing where to begin, with all the options that exist in the market today.
When we look at cushions, it seems like they are all essentially the same, made of foam and various other materials like air and gel, but how do we select the right one for our client? Typically, we select a cushion through trial and error, asking more senior clinicians for their opinion, maybe pressure mapping, or just using the patient report if they have sensation. When we look at selecting a cushion for an individual, it truly is a client centered approach. You must go back to basics. What is your goal? Sometimes the goal is just to provide comfort, whereas other times the goal is to prevent continuous skin breakdown, or even accommodate or correct a reducible or non-reducible positioning need. Sometimes, you may look for all three of those in one cushion.
When picking a cushion, I first make sure we have addressed the positioning of a client in their chair. Have we set up a chair at the right angles to accommodate the user based on their clinical presentation? Once we’ve addressed initial positioning setup of the chair, then we can look at what we need from our seating surface. First, we must remember that a cushion is a medium to help with our goals. A cushion is not going to eliminate a pressure injury in and of itself. This is a balance. A person must take responsibility for their skin health and that includes following the guidelines of when and how long to perform an effective weight shift from any seating surface. If a weight shift is not being performed, a cushion will not eliminate one’s pressure injury risk.
Once someone understands a cushion will not solve the problem of a wound, but can help with its prevention, then the choice of what medium and support may work best for an individual can be addressed. Looking at different materials that are out there, you need to consider what is easiest for the client to manage and allows them to perform functional tasks. Maybe I want a medium in air for its skin protection properties, but when my client is sitting on it, they can’t reach as far without losing their balance. Or, maybe they aren’t willing to manage the air pressure weekly. In that case, the cushion won’t optimally meet the needs of the client.
In the case of aggressive positioning, sometimes you may select a cushion with a large sacral well that has good pelvic support, but now your client is unable to get out of the deep well to perform his or her transfer independently. These are some of the scenarios we need to assess and see if there is a way to work around them. Perhaps we need to look at a material that better meets the client’s functional requirements along with positioning and skin protection.
I encourage those working with their clients to be very aware of advocating for someone’s needs. If a client cannot carry out a sufficient weight shift and they are at a high risk of skin breakdown, then you need to advocate for the proper skin protection cushion. If you know they may develop or already have developed a postural asymmetry, look at the positioning or skin protection and positioning cushions that are available.
When it comes to the decision-making process, if a client needs something more customized, don’t be afraid to try it. Reach out to professionals in the industry and the representatives of these products and get advice and guidance. Ultimately, we want the best for our clients. For further guidance, check out this helpful wheelchair cushion guide from Quantum and Stealth Products on optimizing skin health and selecting a seating surface. You can also download the guide below.
When looking at custom, know there are options like molded systems that truly transform from a cushion to an orthotic type device, which keeps the client in an advantageous position, preventing further asymmetries down the line. If a mold is not what you are looking for, know there are options to build or create your own cushion using the various materials offered within a cushion line. Like our Stealth Products® Custom Cushion, you can use any of our cushion components to design something that meets your client’s exact needs.
About Alex Chesney: Alex is an occupational therapist and clinical sales manager for Quantum Outside Sales. She lives in Texas and enjoys fitness, working out, and taking her two rescue dogs, Brinkley and Riley, on walks!