This is the second post in a series which aims to start getting people thinking more about what enters into a cushion that makes it excellent for one person, but not for another. In the very first article, we recognized the three key aspects around which a cushion can be evaluated– functionality, tissue stability, and posture management. This post unpicks elements around performance.
By Dr Barend ter Haar
Convenience is subjective. Barbara Crane, in the United States, interviewing wheelchair users as the background for her PhD thesis, established that convenience was the most important component to users ¹. The subjectivity behind convenience is why, in Switzerland, a clinician will recommend a choice of three cushions, each of which would appropriate for the users medical requirements, and the user then attempts and picks which cushion they choose.
For the clinician, tissue stability and positioning components of a cushion come at the top of the list, while for the user, when these aspects have been covered, functionality comes top of their list, and can make the distinction as to whether the cushion will be used, or simply left on the rack.
The weight of the cushion ought to be a vital part of the choice process. If the user will be moving the cushion from one website to another, how simple is it for that individual to lift and move it? If the user is getting a manual wheelchair, then every additional gram that the cushion weighs will equate to the additional effort that will be needed by the user or carer to move the chair.
Vibrations turning up through the wheels and the seat add to the levels of a users tiredness when propelling a manual wheelchair. A research study from the University of Pittsburgh compared four various cushion products and reported that air-foam cushions moistened vibrations much better than gel, air, or foam cushions ², so the products that the cushion is made from make a distinction to the users rate of fatiguing.
The clinician is most likely to improve compliance from users and carers when the quantity of required day-to-day modification of their cushion is minimal. The importance and quantity of everyday user/carer cushion– interaction will be dictated by how important it is for adjustments to be produced the cushion to continue to be medically reliable, so ideally pick a cushion where possible that requires very little day-to-day set-up interaction.
Upkeep and resilience
We expect components such as temperature, sunlight, and wetness to be the fastest source of aging cushions, it is not these elements, however instead, the faecal bacteria that are released with flatulence, that has actually been discovered to be the greatest aging component for cushions. Therefore it is idealthat the cushion and its cover can be readily cleaned and decontaminated.
Simply as we may have more socks than shoes, mainly since it is whats closer to the skin that requires cleaning most frequently, it is suggested that we have at least 2 covers for each cushion, so that while one cover is in the wash, the cushion can still be utilized with the other cover.
Under CE marking regulations for Instructions for Use, cushions are needed to be supplied with directions for approved techniques of cleansing and disinfection.
Enablement of day-to-day activities
Another area for consideration connects to transfers. The smoother the cover, the much easier it is to move.
Basic indicators of top and front are often required to make sure the proper part of the cushion is interfacing with the appropriate parts of the users body. Simple washing directions need to be provided. UK furnishing flammability guidelines require particular warning and associated labelling for cushions (Fig. 1).
A last, however possibly the most important aspect: how crucial is it and how most likely is it for the user that the cushion, if it fails, fails securely?
Dr Barend ter Haar has been associated with seating and movement for over 30 years, consisting of lecturing internationally and establishing worldwide seating standards.
Proper labelling is likewise important, particularly to assist unskilled carers.
If the one cushion is to be utilized in different applications, how easy is it to be taken from one gadget to another– exists a deal with? How strong are the hook-and-loop attachments?
In the first article, we identified the three key components around which a cushion can be assessed– performance, tissue stability, and posture management. The subjectivity behind comfort is why, in Switzerland, a clinician will prescribe an option of three cushions, each of which would be appropriate for the users clinical needs, and the user then picks and tries which cushion they prefer.
At the other end of the scale, whereas an air cushion provides exceptional immersion, a puncture instantly leaves the user at danger of tissue injury. If a gel cushion leakages, or the gel gets displaced, then what remains in place under the gel becomes critical for ongoing protection of the skin.
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Various products each have their own level of threat. Foam over time will tend to develop a set or the cells break down, and thus, the development of a failure to give ideal immersion to redistribute pressure forces is a sluggish (indiscernible) procedure.
The less pre-contoured shape there is to the cushion, the simpler it is to slide off it. This has actually to be stabilized with the value of the contouring for posture management requirements.
Crane, et al (2004) Development of a Consumer-Driven Wheelchair Seating Discomfort Assessment Tool (WcS-DAT). DiGiovine, C.P. et al (2000) Analysis of Vibration and Comparison of Four Wheelchair Cushions During Manual Wheelchair Propulsion Proc RESNA, 429-431
Figure 1. Flammability labelFail-safe
There is a new International Standard (ISO 16840-13) being prepared to evaluate the lateral stability of one cushion as compared with another.
There are lots of components that should be considered when selecting what may the most suitable cushion for an individual that go well beyond the immediate medical requirements of tissue stability and posture management. This article supplies a number of the pertinent items under the performance heading.
If the user will be moving the cushion from one website to another, how simple is it for that person to lift and move it? Basic indicators of top and front are typically needed to make sure the right part of the cushion is interfacing with the pertinent parts of the users body. UK furnishing flammability regulations need particular caution and related labelling for cushions (Fig. 1).
When selecting an appropriate cushion, the requirements of the user to bring out their normal daily activities should be taken into factor to consider. The stability of the cushion to allow this is essential if the user requires to reach away from their wheelchair to bring out their daily activities.