What type of seat cushion is recommended for a wheelchair user with a pressure injury?

Wheelchair Cushion Selection for Patients with Pressure Injuries

For wheelchair users with existing pressure injuries, air-cell-based cushions are strongly recommended as they provide superior pressure redistribution compared to other cushion types.1

Types of Wheelchair Cushions for Pressure Injury Management

Air-Cell-Based Cushions

• Air-cell-based cushions demonstrate superior pressure redistribution qualities and are the preferred option for individuals with pressure injuries 1
• These cushions provide up to 57% greater immersion and significantly lower tissue stresses in muscle, fat, and skin compared to foam cushions 2
• Dual-compartment air cushions yield lower readings for all pressure parameters and better surface contact area compared to other cushion types 3
• Air-cell cushions like Roho® have shown superior pressure redistribution qualities compared to other air-filled cushions in patients with spinal cord injury 4

Foam Cushions

• High-density polyurethane foam cushions (3-4 inches thick) can be customized with ischial tuberosity cutouts and preischial bars to redistribute pressure 5
• However, foam cushions generally produce higher tissue stresses compared to air-cell-based alternatives 2
• Standard foam cushions may not provide adequate protection against the anatomical changes associated with chronic conditions like spinal cord injury 2

Gel Cushions

• Gel cushions combined with firm foam have been studied but show less favorable pressure distribution compared to dual-compartment air cushions 3
• These may be an alternative when air cushions are not tolerated or available

Cushion Selection Algorithm

1. First-line option: Dual-compartment air cushions for optimal pressure redistribution 3
2. Second-line option: Single-compartment air-cell cushions 4, 1
3. Third-line option: Customized high-density foam cushions with specific modifications for pressure points 5
4. Fourth-line option: Gel and firm foam combination cushions 3

Implementation Considerations

Patient Assessment

• Evaluate the location and severity of existing pressure injuries 6
• Common pressure injury locations in wheelchair users include sacrum (39%), heels (13%), and ischium (8%) 6
• Consider using pressure mapping technology to identify high-pressure areas at the user-cushion interface 3

Cushion Management

• Perform visual and tactile checks of pressure areas at least once daily 6
• Ensure proper inflation and maintenance of air-cell cushions according to manufacturer specifications 4
• Implement repositioning every 2-4 hours with pressure zone checks even with specialized cushions 6

Common Pitfalls to Avoid

• Discomfort may lead to non-adherence with certain cushion types - the Jay cushion has been associated with increased risk of withdrawal due to discomfort 6
• Relying solely on cushions without implementing regular pressure relief techniques (several times each hour) is insufficient 5
• Failing to regularly inspect and maintain cushions, especially air-filled ones that may lose pressure over time 4

Additional Preventive Measures

• Combine cushion use with early mobilization as soon as medically stable 6
• Use additional tools for pressure discharge (pillows, foam) to avoid interosseous contact 6
• Consider multicomponent interventions that include standardized pressure ulcer prevention protocols 6

Remember that while a properly fitted cushion can redistribute pressure, it should never substitute for regular weight-bearing relief performed several times each hour 5.