Wheelchair shopping can be expensive and overwhelming. Often the chair itself take priority but sometimes the extras, like a decent wheelchair cushion, are just as important.

Wheelchair Cushions make sitting for long periods more comfortable but they also play a part in temperature regulation, stability and preventing pressure injuries. There are literally thousands on the market so how do you know what to look for? This article will help explain the different elements of cushions to help you decide what you need.

Think about your own needs while you consider the following:

Positioning

Positioning is all about promoting good posture while using your chair. Good posture promotes good function, minimises fatigue and reduces injuries. Bad posture can quickly lead to musculoskeletal problems, poor circulation and pressure issues (among other things).

Wheelchair cushions form the base of support while sitting. If your cushion supports your legs in the right place and keeps your pelvis at a neutral angle you’ve got a good base of support.

Wheelchair cushions with cut out contours are a great way of promoting good posture, especially for those with poor control over their lower body. For those with sever skeletal deformities or asymmetries a custom-made cushion may be needed, this will be moulded to fit and support your body giving you as close to a neutral base as possible.

Balance

Although the purpose of the cushion is to give a stable base it can also help with dynamic stability. A stable, comfortable base for the lower body makes using your upper body easier and safer. This is particularly true for wheelchair users with poor core control. Keep your hips and back stable and you’ll be free to use your arms and shoulders more easily.

Having a good stable base also conserves energy, instead of spending a lot of energy supporting core muscles you can save that energy for actually getting through the day.

Many of the cushions on the market will have some degree of contouring and often have gel inserts that mould to your body as you sit on them, these envelop your bum and legs which provides support that changes as you move around.

Having the cushion fit securely in the wheelchair is also essential to getting the best balance. Once the cushion is fitted securely and moulded nicely to your bum you’ll feel much more secure in your seat. Manual (self-propel) chairs will be much more responsive and easier to push too.

The material on the wheelchair cushion should also be considered here, slippery leather-like covers might be less secure than a coarse cotton with velcro on the bottom.  The differences in stability can be dramatic. An unsuitable system can feel like your sat on a wobble-cushion-unicycle whereas a suitable system can feel more like a custom-made race car seat with 4 point harness.

Pressure management

Pressure sores can be serious, there are a number of factors than can put you at increased risk of pressure issues. These include:

• muscle atrophy, loss of muscle from medical conditions or lack of use.
• Inability to shift weight, not fidgeting or changing position.
• excess heat or moisture buildup, either through incontinence, sweat or overheating.
• lack of sensation, if you can’t feel when you’re developing pressure areas, or should be fidgeting.
• poor circulation, either through medical complications, lack of muscle movement or restrictive clothing.
• shear, a side-to-side movement of some layers of your skin (like rubbing your hands together), this can cause strain / pressure on your skin especially for those with excess or delicate skin and poor healing.   
• Finally, poor nutrition, which can affect your skin integrity and healing speed. 

If you’re at risk or have experienced  pressure issues in the past then a pressure management cushion is essential. These cushions are often filled with air or gel pockets. The pockets reduce pressure and move with you. The gel lets you sink in a bit, this is called ‘Immersion’ and it helps to spread your weight around and support the bony bits of your pelvis which reduces pressure.

If you’re at risk of shear, (often people with Ehlers Danlos Syndrome like me are) there are cushions with liquid layers that slide around a bit inside the cushion so that your skin doesn’t have to. This liqui-cel technology is often available in combination with foams and contouring too.

One thing worth considering here is your ‘Micro-climate’ (simply put the temperature and air flow around your bum). If over heating is an issue then there are plenty of airflow materials designed to keep your bum and thighs cool while sitting for long periods.

If you are looking at gel and memory foam cushions it’s also worth investigating how they do with low temperatures. Standard memory foam sets rock solid below freezing temperatures… this can be a problem if you leave your wheelchair in the car overnight!

Function

Optimal function of your wheelchair cushion often requires a bit of compromise and common sense. You can have the most incredible pressure relieving cushion that’s 10 inches thick but if you can’t reach to move your chair it’s essentially useless.

It’s worth remembering that when shopping for a cushion it has to work well with your wheelchair. This includes the width and length but also the depth of the cushion. It might not seem like much but a few inches difference can drastically change how you self-propel. The cushion also has to work well for you (or whoever puts the chair together and pushes it).

Often some elements of the wheelchair cushion will be at odds with each other. Many of the dense but supportive gel materials are very heavy (the lighter your chair the easier it is to push).

Air pocket cushions are great for managing pressure issues but they tend to be pretty wobbly, this simply doesn’t work for people with very poor core control or balance disorders.  Sometimes you can get around this with lateral (side) support on the back rest and arms but not always.

Memory foam materials are great for contouring to your body but they do tend to make things very hot. leather and plastic covers can be wiped clean but they also tend to get quite sweaty, air flow fabrics are less sweaty but harder to clean.

If you (like me) tend to toe-propel or pop your feet on the floor instead of using breaks you may find that the front edge of your cushion digs into the back of your knees. If this is the case then a waterfall (curved) front edge removes the problem.  This can slightly reduce the weight distribution in the cushion when not using your toes.

Like I said, this section is about compromise.

Comfort

This section isn’t just about how nice it feels to sit on. Comfort covers all aspects of actually using the cushion. Comfort pulls together everything I’ve already talked about as well as your personal style, budget, and more.

Your cushion and your wheelchair are just for you, at the end of the day your happiness it what matters most.

There are plenty of companies out there selling personalised wheelchair cushion covers so you take take your not-so-attractive pressure care cushion and give it some style. If you’re handy with a sewing machine you can probably do it yourself.

Since this section is all about your preferences it’s also worth thinking about finances. Wheelchairs in general are a lot of money, I would personally recommend investing in a decent cushion too. Think about it like furniture, you’re not getting the most out of a sofa if it has no cushions. The same is true for wheelchairs except your wheelchair also fills the role of ‘legs’ while you’re out and about.

Many high end cushions are hundreds of pounds. Not everyone is happy paying that but if you do decide to I’m sure your bum will appreciate it! I would personally suggest that when shopping for a cushion your take your chair with you and go to try some out. Mobility road shows and conferences are a great place to do this.

Folks in the UK it’s worth approaching wheelchair services first. Depending on your local authority and funding constraints they might be able to give you something that meets your needs on the NHS.

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I hope with this post I’ve broken down the elements you need to think about when cushion shopping, I deliberately haven’t named any brands so I don’t bias your future shopping. If you’re still totally lost feel free to ask questions or book a consultation with me.

As always questions, comments and shares are welcome. I’d love to hear your experiences.

JBOT