Postural Support can be provided by the correct back, cushion and accessories can make the difference between pressure sores and health, the difference between sitting upright and getting scoliosis. Cushions and backs are available which provide gentle or aggressive positioning as needed. This is part of what our Rehab Technology Specialists learn in order to help you make informed equipment decisions.
Mild pressure reduction and positioning
General-Use Cushions and backs are meant to improve comfort and help the client’s ‘sitting tolerance.’ A person’s sitting tolerance is the length of time they can sit in their chair without having to return to bed due to discomfort. These are made of basic foam and may include some contouring. These are intended for individuals who are only in their chairs for short time periods and have sensation and the ability to change their position if they become uncomfortable.
Postural Support: Counter-clockwise in the image above are a headrest, a lateral trunk support, a hip belt, an abductor pommel, shoe holders, a tray and a dynamic chest support.
Moderate to high end pressure relief
A person would require greater pressure relief if they have postural deformity, lack of sensation, significant weakness or other risk factors which affect healing in conjunction with any of these other issues.
Greater pressure relief and positioning is provided by different types of cushions. The primary mediums used for pressure relief are foam, gel and air. Foam is the reliable standby and technology has allowed a wide variety of foams to be produced for different uses. For instance, closed cell foam is more durable and contours to the user’s body without ‘bottoming out.’ When a person bottoms out, this means their bony prominences that we are trying to protect are sinking through the cushion meeting with the hard support surface underneath.
Gel is good medium because it provides pressure relief and can be used as an overlay to more aggressive positioning supports. One of the negatives of gel is that it is more affected by cold and heat than foam. Air is usually the best pressure relief, but requires more maintenance and may not be appropriate for users with muscular or structural instability.
Basic Open Cell Foam Cushion
Air Cell Cushion
Closed Cell Foam Cushion
Gel Pressure Relieving Cushion With Foam Base
Air Cell Cushion
Mild to Aggressive Positioning
Positioning can be provided by accessories integrated into a cushion or back or separately. They can also be a function of the seat or a function of the wheelchair itself. In addition, manual or power positioning products can greatly improve pressure relief, circulation, and the ability to perform activities of daily living.
Custom-molded seating is required when a person’s needs cannot be met by “off the shelf” equipment. Often fixed scoliosis or contractures will require a molded seat and/or back to improve surface contact. Improving the surface contact reduces pressure points which could cause sores. It also improves stability and support which should help to prevent significant worsening of the existing deformities and allow greater use of the upper extremities. We hold custom seating clinics at least monthly at our Montandon office.
The most common positioning provided through the wheelchair itself is in the form of recline, tilt, elevating leg rests, or seat elevator. All of these functions can be ordered separately or used in conjunction with each other to provide improved outcomes for wheelchair users.
Recline - Changing the angle of the back in relationship to the seat. This reduces pressure on the buttocks, and opens the hip angle to improve circulation, respiration and digestive operation. One of the negative aspects of recline is that there is often sheer in conjunction with it which allows other positioning devices to be out of place and it is a contributing factor to pressure sores. According to studies, the use of both the recline and tilt functions together can provide the best pressure relief.
Tilt - Movement of the entire body in space to reduce pressure on the buttocks and improve stability. Because all the body parts move at the same time, it prevents the sheer and movement of seating components in relationship to the body which can happen with recline.
Elevating legrests are used to allow for fixed leg extension and to improve circulation when used in conjunction with tilt and recline to raise the lower extremities above the heart.
Seat Elevators provide vertical movement to assist with transfers and improve reach. It is not available on manual wheelchairs and is not covered by most medical insurances.
Standing Frame wheelchairs combine the benefits of standing with a manual or power wheelchair. They provide the medical benefits of standing and improved performance of activities of daily living. Please see the standers page for more information on the benefits of standing.
Many accessories and devices are available which can help improve a person’s comfort, positioning and control of their wheelchair. Call our office for more details or a seating evaluation to discuss what will work best for your situation.