Selecting a wheelchair cushion can be challenging. Best practice instructs us to start with off-the-shelf products first to determine if the geometry and materials used can meet the medical and functional needs identified in the clinical evaluation, as these products are generally more affordable than custom solutions.
Many clinicians find themselves sifting through numerous products, leading to questions like, "Which off-the-shelf cushions should we consider? Which products are adjustable? Which products can be further adjusted if my clients' needs change?"
Let's explore a few off-the-shelf options, starting with ROHO® cushions. Many end-users and even a few clinicians are less aware of the adjustable positioning options provided by several ROHO cushion designs.
The QUADTRO SELECT, CONTOUR SELECT, and Hybrid Select cushions, for example, offer the ISOFO valve in the front/center of the cushion. After initially setting the appropriate inflation for the user, the ISOFLO can be “locked” to prevent the air from flowing into other sections. Using this adjustable technology, a pelvic asymmetry (such as a reducible or non-reducible obliquity) can be either corrected or accommodated.
Using the ISOFLO, you can also create an anti-thrust shape for the ROHO cushion, thus reducing unintended forward pelvic migration on the seat. Or maybe the consumer just needs their ROHO to “feel more stable.” The ISOFLO, when in the “locked position,” blocks the air from moving to different segments of the cushion while providing the appropriate immersion into the ROHO cells for optimum pressure distribution. These tools for adjustability, provided within these off-the-shelf cushions, may address identified needs without requiring a more costly custom cushion.
Another noteworthy product is the ROHO Hybrid Select, a dual-material cushion with foam in the front, ROHO air cells in the back, and an ISOFLO valve. This dual-material cushion not only provides the ISOFLO valve to address minor asymmetries, it also provides a removable air cell section in the center of the pelvic well to shift the cushion from a full-contact design to an off-loading design. This hybrid cushion can be adjusted as the end-users’ needs change without requiring additional parts or a replacement of the cushion entirely.
In addition to ROHO, several off-the-shelf Comfort cushions offer adjustability. The ATI (adjustable technology insert) can be used under an Embrace or M2 cushion, inside the cover, to add further contouring to meet positional needs. The multiple aluminum “fingers” can be adjusted to increase lateral thigh support, address a mild obliquity, or just provide more contour behind the sit bones for increased pelvic support.
These adjustable off-the-shelf products should be considered before moving to a custom seat to ensure best practices are followed. However, these products may not be able to meet the need for significant postural asymmetries. For example, if a client has more than a 1-inch pelvic obliquity or a significant leg length discrepancy, a custom cushion like the Comfort Inception or a custom ROHO cushion may be necessary to provide adequate support and pressure distribution.
Selecting the right wheelchair cushion is essential for ensuring comfort, postural support, and effective pressure management. Starting with off-the-shelf products is a practical first step. For clients with identified postural asymmetries, maximizing use of adjustable technologies provided in several off-the-shelf cushions during clinic trials, is the next step in the prescription process before ruling in custom seating.
Catherine Sweeney, PT, ATP/SMS
Regional Clinical Education Manager
Catherine Sweeney, PT, ATP/SMS joined Permobil as Regional Clinical Education Manager in 2019. Prior to this, she spent the bulk of her career at Providence Portland Medical Center, where she co-founded the outpatient seating clinic program in 2004. As lead seating specialist, Catherine worked to expand access to wheeled mobility services through staff education in OP satellite clinics, home health, and outlying Providence hospitals.
Catherine served as the RESNA PT SIG co-chair, and is co-founder of the Northwest Assistive Technology Access Coalition with a passion for improving Oregon Medicaid recipients access to assistive technology. She has presented at both the RESNA and International Seating Symposium conferences 2021.