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Permobil Blog / November 16, 2017

How to Choose a Cushion in Long Term Care

Part 18 in our LTC Seating & Positioning series intended to shed some light on the mystery of seating and positioning in the LTC setting. See the rest of the blog posts in the following links: Part 1 (Best Wheelchair Options in LTC)Part 2 (Posture Problems)Part 3 (Posterior Pelvic Tilt)Part 4 (Anterior Pelvic Tilt)Part 5 (Pelvic Obliquity)Part 6 (Pelvic Rotation)Part 7 (Fixed vs Flexible Postural Abnormalities)Part 8 (Windswept Posture)Part 9 (Incorrect Seating Dimensions)Part 10 (Issues with Current Wheelchair System: Seat-to-Floor-Height)Part 11 (Issues with Current Wheelchair System: Back Support)Part 12 (Issues with Current Wheelchair System: Legrest)Part 13 (Issues with Current Wheelchair System: Armrest)Part 14 (Issues with Current Wheelchair System: Head Support)Part 15 (Why is wheelchair seating & positioning important for our residents?)Part 16 (How to Measure: Step of a Seating Eval),Part 17 (How to Measure: Specific Measurements)

Choosing that perfect wheelchair cushion can be overwhelming with the hundreds of choices in the LTC market. But don’t be intimidated! There are really only two questions to ask yourself when selecting a wheelchair cushion:

  • Does the resident sit in an abnormal posture that places them at risk to fall from the chair and/or develop a contracture?
  • Is the resident at risk for, have an existing, or have a history of pressure injury?

The answers to these questions will guide you to the correct cushion category. Cushions are broken up into three catagories depending on the resident's particular needs.

  • Standard
  • Skin Protection
  • Skin Protection & Positioning

*Typically there is a fourth category for positioning only cushion. We believe that all residents who sit with a postural abnormality are at risk for wound development due to peak pressures on the bony prominences. Therefore, all positioning cushions SHOULD have skin protection properties.

Here are some things to consider when choosing the type of cushion:

Standard Skin Protection Skin Protection & Positioning
Resident has sufficient balance and strength to maintain goods posture for long periods of time Resident has comorbidities that place their skin at risk for breakdown (Diabetes, vascular insufficiency, nutritional defiency, etc) Resident has comorbidities that place their skin at risk for breakdown (Diabetes, vascular insufficiency, nutritional deficiency, etc.)
Can independently reposition self Difficulty repositioning self Poor balance and weak core, pelvic, and LE musculature
Ability to perform independent pressure relief Difficulty with performing independent pressure relief Minimal to no ability to reposition self
No skin breakdown or has a Stage 1 diagnosis At significant risk for a wound or has a wound at any stage Minimal to no ability to perform independent pressure relief
No significant postural abnormality May or may not be mobile Sit in one of the 5 postural abnormailites
Resident has good sensation Impaired sensation At significant risk for a wound or has a wound at any stage
May or may not be incontinent Incontinent Limited mobility or immobile
For short-term residents working on ambulation Skin at risk due to prolonged sitting in wheelchair > 4 hours per day Imparied sensation
Long-term resident that uses their chair minimally   Incontinent
    CONTRACTURE RISK from prolonged sitting in a postural abnormality
    FALL RISK from chair
    Progressive disorders
    Neurological impairment

**Remember to consider your resident’s functional needs, abilities, and risk areas when choosing the most appropriate wheelchair cushion. 

We understand how difficult it is to choose a wheelchair cushion when faced with hundreds of options. We have developed specific resources to narrow down the options and provide you with a premium selection that can meet any of your resident’s needs. Check out our decision tree and cushion comparison chart in our LTC Product Selection Guide for our top picks in each category.

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Ana Endsjo-1

Ana Endsjo
Clinical Education Manager LTC Division

Ana Endsjo has worked as an occupational therapist since 2001 in a variety of treatment settings. She has mainly worked with the geriatric population, dedicated to the betterment of the treatment of the elderly in LTC centers. Her focus has been on seating and positioning and contracture management of the nursing home resident. With this experience, her hope is to guide other therapists, rehab directors, nurses, and administrators through educational guides, blogs, webinars, and live courses in her role as Clinical Education Manager for the long term care division.

Categories: Long Term Care, Seating and Positioning, Cushion

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