Let’s get it clear: What makes a good cushion?  6. The benefits to skin care of the right cover

Let’s get it clear: What makes a good cushion? 6. The benefits to skin care of the right cover

Check/Score according to a cushion covers ability to fulfill the users requirements.

Cushion additives.

This is the 6th post in a series that aims to start getting individuals believing more about what goes into a cushion that makes it excellent for someone, but maybe not so great for another..

Pressure, Shear, and Friction. Whats the difference, how do they relate, and why should each be managed in their own? THIIS August 2020 pp 52-53.

Additional products can be found at www.beshealthcare.net. Please contact barend@beshealthcare.net if you are interested in getting additional info on the subject.

Youve been fired! Flammability standards put to the test THIIS May 2020 pp 42-43.

What makes a great cushion? Performance THIIS March 2020 pp 62-63.
ISO 16840-10:2021 Wheelchair Seating– Part 10: Resistance to ignition of postural assistance gadgets– Requirements and test approach.

In this post we consider numerous components to consider when choosing the most suitable cover for a customers cushion.

To facilitate this, the cover has to have enough stretchability, and versatility, to enable for complete immersion into, and envelopment from, the cushion– any cover materials without these homes will lead to hammocking and insufficient potential envelopment. Example of body tissue stress resulting from contact surface stresses when sitting on a cushion. Issuing a water-resistant or incontinence cover may secure the cushion from the users outputs, but the water vapour permeability will have a large impact on whether the water vapour will condense or wick away. The cushion materials have more influence on positioning and pressure redistribution.

Know that some of these chemicals will be eliminated in cleaning procedures, and cushions that pass flammability tests when brand-new, may lose a few of this security after cleaning. Nevertheless, the washability of covers is very important– users are suggested to have 2 covers so that when one is in the wash, the other is readily available to put on the cushion to safeguard the skin– see part two3 in this series of articles.

In the August 2020 problem of THIIS, I covered the meanings of, and differences in between Pressure, Shear, and Friction. Static friction helps to keep us in our seats, but is also what grabs the skin and misshapes it: these shear forces lead to distortion of the shape of the cells in our skin and likewise our blood capillaries (shear stress)– too much distortion for too long result in cell death. This is on top of the damage from compression of the tissues and capillary from the pressures (axial pressure) created by gravity pulling down on the mass of our bodies (Fig. 1).

Figure 1. When sitting on a cushion, example of body tissue strains resulting from contact surface area worries. Complex pressures are developed inside the cushion.

For a lot of individuals, there is more flesh under the thighs than under the bony little bits of the hips. Therefore, there is more tissue under the thighs than there is under the hips to take up the shear stresses of sitting, therefore it is ideal if the product under the hips can, to some degree, relocation with the skin, while having grippier material under the thighs (to stop us slipping into posterior pelvic tilt, or out of the seat) (Fig. 2).

Both covers and cushions may have ingredients to their products, in specific, to improve their resistance to ignition. Considering that cushions might be placed versus bare skin, there are biocompatibility and REACH related requirements for these chemicals.

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Whereas friction, pressure, and shear can cause press ulcers, theres another aspect that has an influence on skin health, and thats the microclimate at the skins surface. Microclimate covers the effects of temperature and wetness.

Friction optimisation.
Shear decrease under ITs.
Breathable cover.
Microclimate management.
Ignition resistance.
Biocompatible components.

During transfers, there are 2 key sources of danger to skin tissues from the style of a cushion. The first associates with the slipperiness of the cover materials– the less the friction, the much easier to slide across it and the less grabbing of the skin and therefore less shear stress on the skin tissue.

Parts five and six cover the components of a cushion that resolve the integrity of the tissues of the skin: this short article focuses on the impact of the cushions cover.

What makes an excellent cushion? Pressure Care THIIS December 2020 pp 60-62.

In part five1 we covered the value of envelopment of the buttocks for maximising pressure redistribution. To facilitate this, the cover has to have enough stretchability, and versatility, to enable complete immersion into, and envelopment from, the cushion– any cover materials without these residential or commercial properties will lead to hammocking and insufficient possible envelopment. Any taut material is most likely to have an unfavorable impact around the ischial tuberosities– the area most at risk from pressure damage.

There are always components of compromise for each user: the procedure of examining the risk/benefit profile will show which cover service is the most proper for each customer. From the topics covered in this post, what the cover of a cushion is made from is crucial for optimising tissue stability, whether it is from enabling envelopment into the cushion, lowering the dangers from friction and shear stress, and keeping air circulating to optimise temperature level and wetness control at the microclimate level. The cushion materials have more impact on positioning and pressure redistribution.

Figure 2. Relative impacts of shear strain on thinner tissues under a bony prominence (ischial tuberosity) as compared to deeper tissues (under the thigh along the thighs).

Friction and shear.


In the first article, we determined the three essential components around which a cushion can be evaluated– functionality, posture management, and tissue integrity. In the 3rd and 4th short articles, we addressed the advantages of a neutral pelvis and stability for posture management, and contouring of the cushion to optimise positioning.

Immersion and envelopment.

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Click to read more from the Lets get it clear series from Dr Barend ter Haar.

The furnishing flammability standards and the REACH regulations in between them had actually started to get in the method of creating excellent cushion and cover products for ideal protection of the skin in medical items. For this reason, the flammability screening for cushions and other wheelchair postural assistance devices have been upgraded in the ISO 16840-10 standard4. For more information see the May problem of THIIS5.

Threats from transfers.

Cushion Cover Tissue Integrity.

Dr Barend ter Haar has actually been involved in seating and mobility for over 30 years, consisting of lecturing globally and developing worldwide seating standards.


When we concern moisture, this comes from the skin as water vapour or as sweat. Non-breathable cover materials typically lead to water vapour not having the ability to dissipate away, and thus causes moisture build-up. Moisture on the skin leads to maceration (the wrinkling of the skin we get with having our hands in water for too long), and macerated skin is more prone to the impacts of friction and shear. Additional sources of wetness can come from leaking wounds, and faecal or urinary incontinence.

The cover of the cushion is probably the most crucial component of a cushion for caring for the tissues of the skin, because this is the part of the cushion closest to the skin. For that reason the materials that the cover is made from will have an effect on the center of immersion and envelopment, on friction and hence shear stresses on the skin, and on the microclimate at the skins surface. In this post we think about numerous components to think about when picking the most suitable cover for a customers cushion.

In conclusion.

The take-home message is, once again, that the material that the cushion cover is made from is crucial to the health of the users skin. Issuing a water-resistant or incontinence cover might protect the cushion from the users outputs, however the water vapour permeability will have a big impact on whether the water vapour will condense or wick away. How much do we desire to secure the cushion versus safeguarding the user?

Taking temperature initially: if a cushion has actually been stored overnight in a cold environment, then sitting on this cold surface area could motivate capillary closure, and for that reason limit the transfer of nutrients to the tissues. If the temperature level is too expensive, this results in the danger of sweating and moisture accumulation. An important side-effect of higher temperature levels is that for each one degree centigrade of increase in temperature results in 13% more metabolic need: 13% more oxygen and nutrients required, and 13% more co2 and metabolites to be dealt with.

The 2nd connects to the degree of contouring of the cushion– the higher the profile of any median and lateral thigh supports, the greater the quantity the user will require to be or lift raised for a lateral (or forward) transfer.