Honeycomb Cushions

An unfortunate fact of life for many wheelchair users is the potential for acquiring pressure sores. These sores are the criminal element of the wheeled world. An encounter with these felons can rob a victim of their health, independence, and quality of life. In these cases Justice is myopic, the victim always does the time.

These robbers work alone or may work in gangs, often striking the same victim several times. They are extremely patient, taking their time and casing out the site. At other times they strike quickly and quietly. They are often repeat offenders who will return to the same crime site to work their mischief over again. The culprits are known, the clinical detectives have identified them, yet the long arm of clinical retribution often reaches out and grabs the wrong suspect.

Through profiling we are able to determine who the potential victims may be. They are identified as "at risk". It doesn't matter how they got there, rating scale, history, clinical observations, or just bad luck. The list of suspects through research and experience have also been identified. Uncontrolled interface pressure, inappropriate technology, poor nutrition, incontinence, lifestyle issues, stress, poor hygiene, poor care, aging, and a roster of physiological bad guys that would easily confound Sherlock Holmes. Yet, when the suspects are tossed into a lineup the wheelchair cushion is always the first to be fingered.

In defense of the cushion, there are other possible contributing factors that need to be looked at. Pressure sores on or near the seating contact area do not necessarily begin or end with the cushion. The cushion may be a convenient fall guy who is taking a guilt by association rap. While the cushion should always be suspect, it should not be so at the risk of letting the other suspects go free. There is some detective work that needs to be done here. It should start with checking out the cushion's alibis.

Was the cushion in the vicinity of the crime? A good upright sitter, with a sacral sore, who does not go into a sacral sitting position probably didn't get the sore from the cushion. The cushion was probably nowhere near the area while the individual was seated in the chair. Look to one of the other suspects, bed surface, recliner chair, gurney, stretcher, turning frequency, shower/commode equipment with seat cutouts, lift slings and lumbar pads for some clues. How often does the victim use these devices and for what period of time? Is the equipment being used properly and is it in good working order?

When it comes to ischial sores count on a rigged jury. The cushion will most certainly be found guilty. But is it? The ischials of most wheelchair users are regularly in contact with more than just a wheelchair cushion. Some prior offenders that need to be investigated are car seats, airplane seats, unpadded shower benches and chairs, transfer boards, and anything that the victim sits in regularly other than the wheelchair. Sitting up in bed with the hips flexed more than 30 degrees will load the ischials. Dragging the ischials across a transfer board, or hard landing transfers, sitting on a transfer sling all day, not doing weight lifts or shifts, over extending sitting times, should qualify as accessories to the crime.

Be thorough in your investigation. Make sure that the cushion wasn't framed or set up. Check the cushion, make sure it is in good condition and adjusted and placed properly. Pummels are effective, but not when the cushion is placed on the chair backwards. Air cells are great pressure reducers, but not when they are facing down. Over or under inflation of air flotation cushions can cause problems. Worn out cushion bases and seat hammock can inhibit pressure reducing characteristics. Make sure that reliefs, buildups and cut outs are the right size and located properly. Confirm that the user is actually able to place themselves in proper alignment with reliefs and contours.

Inspect the cushion. Some cushions have been known to disguise themselves by wearing their covers backwards. Take a peek under the wrapper and confirm that the cushion and cover are in sync. Frisk the cushion. Some strange accomplices have been known to hide under the cushion or cover. Some disclosures have been; wallets, keys, books, assorted supplies and meds, bunched up pads, fruit, a can of beer, another cushion, a small tool kit, phones, pagers, a tennis ball, a baby bottle, hair brushes, and any combination of these plus countless others. When these items are under the cushion they change the cushion dynamics, when they are under the cover they become a point of increased pressure.

It should be clear by now that wound prevention and pressure management involves more than just swapping cushions. The contributing factors and circumstances can be varied and complex and changing. In most cases it may be impossible to single out one element in the event and pronounce it as the primary offender. It is a multi-dimensional problem. The solution is also multi-dimensional and should be approached that way. Deal with cushion issues, but don't forget the other issues.

Ziggi Landsman
www.usatechguide.org

Trying to decide on a new cushion gives most users a wonderful opportunity to indulge in some serious head scratching. The experience also lends itself well to a bit of confusion and some intense anxiety. Presently there are a large number of cushions being offered up. Of course these cushions come in every conceivable shape, size, and form. While it is impossible to answer the age-old question of “which cushion is the best one”, it is possible to at least set you on the right path toward that perfect cushion.

There are some prerequisites that you should take care of before deciding on which cushion to lay your hard earned and your butt down on. First, familiarize yourself with some of the products that are available. Get on the Internet and just browse the cushion manufacturers pages. Try to stick with manufacturers rather than retailers. The manufacturers information is better, as long as you ignore the accompanying hype. Take note of the different materials the cushions are made of, the different shapes and contours, cushion weight and types of covers. Start to formulate some thoughts on which types might work for you.

Next, start thinking about some of those hidden booby traps that you may roll onto. If you have limited use of your arms and need to be able to move the cushion during transfers, or into a car, or from one chair to another then stay away from heavy cushions. Realize that some cushions require more maintenance than others. Some need to be pumped up with air, others need to be pounded into shape regularly, while some are just sit and go. How much maintenance are you willing and able to deal with? If incontinence is a problem, make sure that an incontinence cushion cover is available and that the cushion and cover are washable. If you are just making it under desks and tables in your wheelchair, or if you don't like sitting up high, than stay away from those high cushions. You may have to adjust your wheelchair seat height if you choose one of these. If possible talk to other cushion users. Find out what they like and dislike about their cushions. How it holds up to daily use and how easy it is to live with.

Once you finish all your homework you're ready to move on to the next step. Find some professional help. Try to locate a facility in your area that has a seating clinic or a seating and mobility clinic with experience in your particular type of disability. If you are a sixty year old quadriplegic you may not be well served by the seating clinic at the local children's hospital. Your cushion is an extremely important piece of equipment; it is worth the trip to a clinic. While we're on clinics, prior to making an appointment, ask if the clinic has pressure-mapping equipment. Pressure mapping equipment makes it possible for you to see a visualization of the pressure between you and your cushion. It's really great! You can try different cushions and see how they handle pressure. You can move around on the cushions and see where the pressure goes. You can also do your pressure lifts and shifts and see if they really eliminate pressure. It is a great tool and a super learning experience.

Realize that seating is more than getting something soft under your butt. It's also about your posture and how you are positioned in the chair. Roll in front of a mirror; decide what you don't like about your posture. Is your trunk leaning to one side? Is one hip lower than the other? Are your legs to far apart or to close together? Do you tend to slouch while sitting? These are the types of things you and the clinic team will be looking for. Write them down, also make some notes about what you do and don't like about your present cushion, along with information on any pressure sores you have had. Take your notes to the clinic with you and read or give them to the staff there. The seating specialist can see and even touch you, but they cannot get inside of your head unless you help them. The notes will help them to help you. Make your wishes, thoughts, and ideas known to the clinic staff.

Ziggi Landsman
www.usatechguide.org