The "Wheel Deal:" Wheelchair Considerations (Part II)

Nancy Chipman Ranalli, PT, Chief Physical Therapist, Easter Seal Rehabilitation Center

In the May/June 1997 issue of The AT Messenger, I discussed important considerations when obtaining the appropriate wheelchair to meet one's needs and to promote independence in mobility. This article will briefly discuss the importance of proper seating systems, focusing on seat and back cushions. Because it is imperative to receive a proper wheelchair assessment and training by qualified professionals prior to purchasing a wheelchair, specific brand names of cushions will neither be discussed nor endorsed.

Seat Cushions: The seat cushion is an essential part of a good seating system. This cushion serves a variety of purposes, including pressure relief, positioning, and comfort. Seat cushions range from a basic foam cushion without any contour or pressure relieving qualities, to a custom molded cushion designed specifically for the consumer, and a score of other styles in-between, including gel, air, and different densities of foam. When choosing a cushion, each consumer must be aware of his/her particular seating needs. For instance, if skin breakdown on the buttocks is a concern, a cushion which is designed to allow good pressure distribution would be appropriate. If the consumer has postural issues (structural limitations) which need to be accommodated, such as a curvature of the spine or the presence of bony prominences, a cushion which will allow significant flexibility with positioning may be recommended.

Back Cushions: The back cushion is also an important part of the total seating system. There are almost as many options for back cushions as there are for seat cushions. Some consumers require a back cushion that provides support to aid them to sit more upright, while others may prefer to have a very low back cushion to allow more freedom of movement. Again, each consumer must be aware of his/her desired outcome to choose the most appropriate back cushion and supports.

As noted in Part I of this article, it is in the consumer's best interest to take the time needed in the initial stages of purchasing a wheelchair to insure that the most appropriate wheelchair is obtained and to prevent problems once it is delivered. Getting assistance from professionals who understand wheelchairs and seating and positioning will allow one to make an informed choice.