Choosing the Right Wheelchair Cushion

My first complex rehab technology (CRT) evaluations were in the early 1990s (although it was not called CRT in the 90s). In the beginning, I recall relying heavily upon the rehab technology professional working on the evaluation team with me. I told him what my patient needed and he told me what equipment would meet that need. My job was to justify the selection, which could be difficult since I didn't really select the specific pieces of equipment.

As I gained a little experience and became more familiar with the options, I realized I had started to develop my "favorites" and "go-to cushions." Eventually, I began making recommendations based on patient goals and understanding the unique benefits of each cushion. As a clinician working with individuals with disabilities, you may find yourself in a similar position when you determine that the patient you are treating needs a permanent wheelchair and seating system.

So how do you increase your knowledge and learn to make the best cushion selection for your patients' needs? Here are some tips that have helped me along the way:

• Examine the cushions that you are recommending, even if you rely on your trusted advisor.
• Examine the materials used and become familiar with how they perform over time². (See Material Selection in Cushions)
• Monitor durability, wearing patterns, patient feedback, and outcomes of cushions you recommend.
• Learn how manufacturers apply scientific properties when designing and selecting the material used in their cushions. (See Cushion Properties)
• Compare cushions within a category from the same manufacturer's line. Learn what makes each cushion unique.
• Compare those cushions with different manufacturers' products within the same category.
• How is the cushion designed to meet the intended goal/solution? (See Cushion Design Principles)
• Gain an understanding of the type and amount of maintenance a cushion will require daily and over time.
• Remember that all butts are not the same - what works well for one person may not work the same for everyone.
• Have an open mind - try different materials and designs.
• Follow up - even if everything was "perfect" on delivery, check to see if the product is performing as expected after delivery. And then see how it lasts over longer time periods.
• If a product is not performing to expectation, look at ways to modify it or exchange it if possible.

Feature Match

It is impossible to know every cushion on the market and how they will perform for every individual. So how can you improve your ability to recommend the best cushion for your patient? This is one of the most important parts of your seating and mobility services. As clinicians, our role is to ensure that the recommended cushion meets the needs and goals of the individual. Individuals are looking for clinicians to provide clinical support that they cannot get when ordering directly online. Steps to follow for cushion selection:

1. Know the seating goal - perform an extensive seating assessment¹. Common seating goals include:
   • Comfort
   • Pressure management
   • Positioning
   • Function and stability
   • Heat and moisture dissipation
   • Vibration dampening
2. Think about and discuss with your team how best to achieve the identified goals. Consider cushion properties, design, and materials.
3. Request cushions from a few manufacturers that are designed to meet your expectations for both you and your patient's goals to examine in-person as opposed to relying on images online or in print.
4. Examine/compare these cushions with regard to material and design.
5. Try to narrow down the potential cushions to two or three.
6. Allow the individual to try each of the potential cushions you identified with the evaluation team.
7. Review in detail everything you know about the top two or three recommendations with the client.
8. Final recommendation should be based on client preference, your clinical experience, and input from your team members on performance and funding.
9. Recommend with confidence.
10. Follow up as necessary.

As with all parts of the seating and mobility assessment, the more information you gather and the more tools you have to use, the more it will enhance the cushion selection process. This collection of tips is just one more tool to add to your seating and mobility toolbox.

Linda Bollinger, PT/ATP/DPT
Clinical Education Manager
Sunrise Medical
Linda.Bollinger@sunmed.com

References

1. Sherman, S. (2017, November). Selecting a cushion based on seating goals. Retrieved from sunrisemedical.ca/education-in-motion/clinical-corner/november-2017/selecting-a-cushion-based-on-seating-goals
2. Watanabe, L. (Ed.). (2010). How to choose the right cushion medium for your client's needs. Mobility Management. Retrieved from mobilitymgmt.com/articles/2010/07/01/cushion-medium.aspx