One of the biggest fears of wheelchair users is acquiring a pressure injury. A pressure injury is an area of damage to the skin and the underlying tissue caused by constant pressure or friction. Anyone who has suffered from a pressure injury knows how debilitating and life-changing living with a wound can be. Once a pressure injury happens, the healing process might require bed rest, home health wound care, hyperbaric treatment, hospitalization, intravenous antibiotic, time lost with family, working, and even the ability to be independent. The healing process for people with mobility impairments can take months or years due to a lack of blood flow in the lower extremities. One of the most critical pieces of equipment other than a properly fitted custom wheelchair is a custom-designed cushion. I am thrilled to say I have never had a pressure injury in 33 years of living with a spinal cord injury. I believe many factors have contributed to my ability to stay wound free. My functional electrical stimulation (FES) and standing routines are part of the reason for my excellent skin health. The other important factor is having access to custom cushion technology. An adequate custom cushion redistributes a person's weight and allows the blood supply to return to the buttocks' boney areas. Custom cushions are prescribed by a physician and chosen after an assessment by an assistive technology professional and a physical or occupational therapist.
Other ways Wheelchair users can prevent Pressure Injuries
5 Types of Wheelchair Cushions
- Get a proper wheelchair evaluation that includes a physical or occupational therapist and an assistive technology professional (ATP).
- Ask your ATP to conduct a pressure mapping evaluation.
- Turn at night every 2 hours and strategically place pillows or foam wedges in high-risk areas like the sacrum, coccyx, ischium, the heel of the foot, trochanter (hip), elbow, ankle, toes, and the back of the head.
- Christopher and Dana Reeves Foundation have a page about skincare, which includes information about additional ways to prevent pressure injuries.
- Foam Wheelchair Cushions are popular, provide firm support, and relatively inexpensive. One of the cons of foam cushions is that they lose their shape quickly and need to be replaced more often them other types of wheelchair cushions.
- Gel cushions have a foam base and carving out a well to place a gel pouch under the ischial tuberosity and coccyx (tailbone) area. The gel pouch can have overfill on the left or right side to compensate for a person's skeletal deformity, which causes them to lean left or right.
- Air Flotation Wheelchair cushions have air-filled cells that, if properly maintained, can relieve pressure effectively. One downside to using an air floatation cushion is that the end-user must frequently monitor the cushion's air pressure. The end-user must periodically inflate the cushion to avoid a pressure injury from developing or worsening.
- Urethane Honeycomb Wheelchair Cushions are a newer technology that utilizes a honeycomb design that allows increased airflow. Urethane honeycomb cushions are comfortable, easy to wash, and durable. I find that they bottom out when you put pressure on them, which makes transfers more challenging. A firm material on the front of the cushion helps me get a better push off of the cushion to my car or the bed.
- Automatic Alternating Cushion System specifically designed to prevent pressure injuries. These automatic alternating air cushions provide pressure relief to compressed tissue by stimulating the action of a pressure lift by inflating and deflating the internal air bladders. The user must stay diligent about checking for leaks and making sure the batteries are functioning.
People with mobility impairments should do frequent skin checks. If you see any redness or areas that look different, make an appointment with your physician as soon as possible. A skin change might be an indication that it is time for a new wheelchair cushion. You can ask your physician for an order for a new wheelchair cushion if it’s appropriate. When you set up the evaluation for a new wheelchair cushion, tell your assistive technology professional (ATP) and your physical or occupational therapist about any history of pressure injuries. Pressure mapping your old cushion is an excellent way to find out where you need increased pressure relief. Make sure you are doing frequent pressure reliefs during the day and turning every two hours at night. The National Pressure Injury Advisory Panel website
has lots of useful information about skincare and wound prevention. Being diligent about your skin is one important way to live your best life possible.