Selecting an appropriate seat cushion for a wheelchair is a process that requires us to consider a number of critical factors related to the individual we are providing the prescription for. Selecting a seat cushion is also dependent on the specific features, or key parameters, that any particular seat cushion is able to provide. Here we will focus on a simple checklist created to get us thinking about some of those key parameters (a similar list focusing on back supports can be found here). Other factors to consider when selecting a seat cushion include those related to the person, which will come from our clinical hands-on assessment, as well as those related to the technology, such as ISO standards and testing.
There really is no one-size-fits-all.
Every person will have different needs. Using our clinical decision making skills to translate the findings from our hands-on postural assessment and sharing our knowledge about the importance of respecting the body are both undoubtedly a necessary part of the job. And the job should be a fun one that we can execute confidently!
It might take a bit of practice, and that’s OK! I have countless stories of working with clients and prescribing seating systems that I truly thought were appropriate at the time (stories that I’m more than happy to share with anyone interested!). Looking back, I still cringe at some of the decisions that I made early on in my career, and feel that I could have better served those individuals if only I had access to more knowledge at the time. Thankfully my decisions have never been detrimental!
I strongly believe that there is a huge difference between prescribing a seating system that ‘checks all the boxes,’ doing the minimal amount necessary for that person, and prescribing a system that goes above and beyond by respecting every bit of that person from their physical form to their functional needs. I strive every day to provide the latter.
I believe that my job is to take the work out of sitting for the individuals I make recommendations for.
For me, past experiences have driven many of the changes that have shaped the way I practice today. My hope is that for you - a clinician who may not have the same number of years to experience the same fumbles as I have - my mistakes will help guide you towards a path of higher level thinking so you can breeze through the bits I wish I could do-over.
I’ve said it before and I’ll say it again - My goal at this point in my career is to provide other clinicians who may not be as experienced in this field of postural care as much insight and knowledge as I can.
It truly is a magical feeling when you ‘get it right’, so to speak, and I want nothing more than for as many of you to experience that magic as possible.
This is my personal checklist that I created for clinicians newer to the field of seating and for students. I made it because I’ve been asked a number of questions repeatedly by various clinicians, but more-so I created it because it is the kind of list that I wish I had access to when I first started to navigate through the world of posture and mobility. The intended use was for during an exhibition or in a suppliers showroom where many cushions are on display and to get clinicians thinking about the differentials in off the shelf cushion solutions.
Let us begin:
Can we answer these questions about the cushions we use or prescribe?
Seat cushion cover material: Is it taut or very stretchy?
Material inside the cover: What is the cushion made of?
Viscous Fluid, Air, Foam?
How many different layers of materials and what purpose do they serve?
What's the immersion & envelopment potential?
How far can the ischials/buttocks sink in and whats the cushioning effect?
Is there potential for the under surface of the trochanters to be loaded? How much loading can happen? A little, a lot, or none at all?
Under load, would the ischials potentially bottom out?
How does this cushion address shear forces?
How does this change with and without the cover?
Can modifications or adjustments be done on the spot to address positioning and/or skin integrity needs?
Microbial factors – Heat and moisture
Is the outer cover moisture resistant?
Does the cushion with cover permit air exchange?
If moisture goes through the cover - where does it go?
Is the entire cushion washable?
Can the cushion and cover be disinfected as per Covid-19 guidelines?
What is the weight of this fully assembled cushion?
What maintenance is required and what checks are necessary for optimal and safe performance?
Tips for testing on the spot -
It might not be very realistic to actually sit on every seat cushion in an exhibit hall, for an extended period, or change the shape of our body to simulate a persons buttocks that has significant atrophy. I recommend using your elbow to simulate the ischial tuberosity in the absence of being able to feel the subtleties with your buttocks. For example, bend your elbow and let the pointed end sink in to the cushion where the ischial tuberosities would usually be as you begin asking questions to whomever is showing you the cushion. You’ll be able to see and feel the immersion & envelopment more clearly than you may be able to appreciate with your fully clothed buttocks. If you continue to apply downward pressure to simulate ischial immersion ( approximately 4.5-6.5 cms) and move your elbow forward and back and side to side, you can simulate some of the shear forces that occur with movement. Are you bottomed out? Do you feel resistance when you move your elbow? Try this with and without the cover and observe any differences!
This list wouldn’t be possible without contributions from other clinicians, like you.
Do you have any suggestions for how to improve this simple list even further?
What questions would you ask that this list might have missed?
Are there any questions you think hold more value than others?
What questions do you have about these questions?