What type of cushion or foam pillow can be used in a chair to reduce pressure ulcers?

Advanced Static Cushions for Pressure Ulcer Prevention in Chair Seating

Advanced static cushions, particularly foam cushions with high specifications and viscoelastic properties, are recommended for reducing pressure ulcers in chair seating, as they effectively redistribute pressure from high-risk areas like the ischial tuberosities and sacrococcygeal regions. 1, 2

Types of Recommended Cushions

High-Specification Foam Cushions

• Viscoelastic foam cushions with density of 40-60 kg/m³ are superior to standard foam cushions with lower density (33 kg/m³) 3
• Solid foam cushions appear to be more effective than convoluted (egg-crate) foam cushions 3
• These cushions conform to body contours and redistribute pressure effectively

Orthotic-Style Off-Loading Cushions

• Specifically designed to remove pressure from high-risk areas
• Can reduce peak pressure index under ischial tuberosities by up to 60% compared to standard flotation cushions 4
• Particularly beneficial for individuals with limited mobility who cannot reposition themselves

Gel and Foam Combination Cushions

• Combine the pressure-redistributing properties of foam with the conforming properties of gel
• Help maintain skin integrity by reducing shear forces 2

Evidence-Based Effectiveness

Research demonstrates that specialized cushions significantly reduce interface pressure compared to standard cushions:

• Orthotic-style off-loading cushions reduce peak pressure index to as low as 39±18 mmHg compared to 97±30 mmHg with standard flotation cushions 4
• The dispersion index (ratio of pressure under high-risk areas to total pressure) is significantly lower with specialized cushions (8%±3% vs 16%±3% with standard cushions) 4
• Dynamic air cushions with alternating inflation/deflation sequences can further enhance blood perfusion in compressed areas 5

Implementation Considerations

Risk Assessment

• Perform risk assessment to identify individuals at high risk for developing pressure ulcers 1
• Consider factors such as mobility limitations, age, nutritional status, and existing skin conditions

Proper Cushion Selection

• Match cushion type to individual risk factors and needs
• For individuals at highest risk, consider advanced static cushions with proven pressure redistribution properties
• For those with existing pressure ulcers, orthotic-style off-loading cushions may be most appropriate 4

Repositioning Protocol

• Even with specialized cushions, implement regular repositioning every 2-4 hours 2
• Use 30-degree tilted positions to relieve pressure on vulnerable areas
• Perform visual and tactile checks of pressure areas at least once daily

Common Pitfalls to Avoid

• Using standard hospital foam cushions for high-risk individuals - evidence suggests higher-specification foam cushions are more effective 1, 3
• Relying solely on cushions without repositioning - even the best cushions require complementary care strategies 2
• Overlooking moisture management - ensure cushion covers are breathable and moisture-wicking to prevent skin maceration
• Neglecting regular assessment - cushions may compress over time and lose effectiveness

Additional Considerations

• For individuals with existing pressure ulcers, consider hydrocolloid or foam dressings to promote healing 1
• Nutritional support, particularly protein supplementation (1.2-1.5 g/kg/day), can enhance tissue integrity and healing 2
• Early mobilization as soon as medically stable is crucial for optimal pressure ulcer prevention 2

By implementing these evidence-based recommendations for chair cushion selection and use, healthcare providers can significantly reduce the risk of pressure ulcer development and promote better outcomes for individuals with limited mobility.