1. "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

2. 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

3. Goals of Seating

4. Seating Support Surface Features

5. What Seating CAN DO

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

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

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

9. 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

10. 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

11. 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

12. Typical Materials
Gel Air Foam Combinations Other - honeycomb

13. 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

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

15. 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

16. Hybrid Cushions

17. Custom Cushions

18. Sling upholstery

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

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

21. Custom Seating

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

23. 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

24. 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

25. Pressure Relief Methods - MWC

26. Pressure Relief Methods - PWC
Tilt –
Recline
Combination

27. Questions

28. 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

29. Resources and References
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

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

31. Websites www.invacare.com www.motionconcepts.com www.permobilus.com

32. Questions/Comments?
THANK YOU!!!