"Bottoms Up!  The Role of Wheelchair Seating and Pressure Mapping on Wound Healing" Cathy Carver, PT, MS, ATP/SMS UAB/Spain Rehabilitation Center Birmingham, AL April 5, ,2019

Objectives Participants will be able to list the 3 common materials of which cushions are made. Participants will be able to give one pro and one con of each type of material of cushions Participants will discuss at least 2 things pressure mapping can’t do

Goals of Seating

Seating Support Surface Features

What Seating CAN DO

What Seating CAN DO If not done properly: Can increase pain Abandonment of equipment Increase energy expenditure Cause pressure injury Decrease function

What Seating CANNOT DO (must consider all the places people spend time to address their postural and pressure relief needs)

Clinical Decision Making What are some factors you should consider when choosing a cushion? The Team Good Principles MUST INVOLVE THE TEAM!!

Wheelchair Seating Principles of Seating and Positioning Comfort Skin protection – offloading vs. immersion Maintain optimal function – progressive vs stable Dx Reduce tone Optimize visual field and head/neck position Positioning/Posture (Accommodate versus correct) Provide dynamic stability Lifestyle, Caregiver, Environment, Compliance Material of cushion and cover

OFFLOADING The principle of taking pressure off of a small surface area and loading it onto a greater surface area that can withstand more pressure to prevent unwanted skin breakdown Brief explanation of offloading to remind people

IMMERSION The principle of conforming to the person’s shape by “sinking in” to the foam . This promotes pressure redistribution over a larger surface area, minimizing high peak pressures at the bony prominences. Brief explanation of immersion to remind people

Typical Materials Gel Air Foam Combinations Other - honeycomb

Foam Cushions Basic foam, viscoelastic foam Requires little to no maintenance Varying degrees of density and compression Heat retention If different densities and contours are used, good pressure relief can usually be obtained Typically break down quicker than air or gel Absorbs impact well

Air Cushions Maintenance Less stable May not offer as much positional support

Gel/Fluid cushions Ability to immerse and envelop into the material Typically provides good positioning support Requires some maintenance but less than an air cushion Heavy

Hybrid Cushions

Custom Cushions

Sling upholstery

Tension Adjustable Upholstery Lightweight Low profile Minimal postural support Easy to fold/load

Solid backrest Varying backrest heights and lateral trunk support Improved postural support Adjustable Increased weight

Custom Seating

Another Option Aquila Cushion – Custom cushions and Airpulse PK Use cautiously

Pressure Mapping – A Tool What it does – What it does NOT do – Demonstration Pressure now – biofeedback of pressure relief, can show pressure from bandages, clothing…MUST be used in conjunction with full assessment Does NOT – heat/moisture/shearing/various other positions (bed, car, etc), Stability, comfort, transfers, internal pressure, Diagnose, discount any pressure relief methods, tell skin integrity

Objective Measures of Pressure Mapping Dispersion Index Peak Pressure Index Sensing Area Coefficient of Variance (%) DI – localizes pressure distributed over a region divided by sum of pressure over entire mat PPI – avg of highest recorded pressure values within 9-10cm area SA – area of mat pt is sitting on CoV – how evenly a pressure is distributed across support surface; better to have low CoV but watch for high localized area

Pressure Relief Methods - MWC

Pressure Relief Methods - PWC Tilt – Recline Combination

Questions

Quiz time List the 3 common materials of which cushions are made. Give one pro and one con of each type of material of cushions Give at least 2 things Pressure mapping can’t do

Resources and References https://www.cgsmedicare.com/jc/coverage/lcdinfo.html Sprigle S, Press L, Davis K. Development of Uniform Terminology and Procedures to Describe Wheelchair Cushion Characteristics. Journal of Rehabilitation Research and Development. Vol 38 (4):July/Aug 2001. Hammond. Using the Science of Materials to Compare Wheelchair Cushions. ISS 2017

Resources "How to Choose the Right Cushion Medium for Your Clients Needs."Mobilitymgt.com. Mobility Management, 01 July 2010. Web. 11 July 2016. Smith, Hulet. "How to Choose the Best Type of Wheelchair Cushion."Rehabmart.com. Rehabmart, 12 June 2013. Web. 12 July 2016. Fisher, Kathy. "Wheelchair Cushion Selection - Making the Right Choice."Mobilitycorner.com. Mobility Corner, 01 Feb. 2008. Web. 12 July 2016 These are references from the last presentation

Websites www.invacare.com www.motionconcepts.com www.permobilus.com www.quantumrehab.com www.resna.org www.ridedesigns.com www.sunrisemedical.com www.aquilacorp.com www.freedomdesigns.com www.stealthproducts.com www.varilite.com www.comfortcompany.com www.therohogroup.com

Questions/Comments? THANK YOU!!!