Wheelchair Cushion Options for Severely Compromised Skin

In an issue of New Mobility Magazine in 2017 there was an article where a wheelchair user wrote in to describe her problems with daily skin checks due to shoulder problems and the medical complications that followed.  She is asking the editor for wheelchair cushion advice.  The editor offered his input and provided a solution which is an automatic alternating wheelchair cushion. 

This issue deserves another look since it points out a shortcoming with any static wheelchair cushion and the progressive problems that result if the pressure relief regimen required with static cushions is not followed. 

A static wheelchair cushion is one which does not have the ability on its own to bring any physical change or initiate any action.  In other words, a static cushion is one that remains motionless and unable to affect any change from constant pressure by itself.  A static wheelchair cushion requires the user to do their own pressure relief by lifting up or moving and leaning every 20 minutes.  If the wheelchair user does not do a manual pressure lift or is unable to do the pressure relief as the person in this inquiry, it quickly becomes a problem with very serious consequences as she describes.

The solution suggested by the contributing editor is a fully automatic alternating wheelchair cushion which provides pressure relief by itself.

Below is the question and the response for anyone that may be able to benefit from this information. 

1. I’m 58, with 30 years as a T10 para. About five years ago I started getting pressure sores on my ischial areas due to shoulder problems limiting my weight shifts. In hindsight, I should have switched to a different type of weight shift, like leaning forward. I’d never had skin issues before so I’d gotten out of the habit of daily skin checks. This led to multiple hospital stays, major skin flaps, and having both ischial tuberosities shaved down. Now the skin on my butt is so compromised I can only stay up in my chair for an hour or two. Now I’m scheduled for an eval at a wheelchair-seating clinic. Are there any cushion options for people with skin as fragile as mine?
   — Cindy
2. Cindy, your story underlines the importance of doing daily mirror-skin-checks. Even with a perfect cushion, a pressure sore can crop up from a variety of skin insults — a bruise, weight gain or loss, or changes in weight shift frequency. Being evaluated at a wheelchair-seating clinic is vital for anybody with frail or aging skin. Although the clinician should be well versed on the latest and best cushion options for your needs, here are a couple of wheelchair cushion options you might want to ask the clinician about:

Aquila SofTech is an alternating pressure air cushion that automatically does weight shifts for you, as often as every 30 seconds. The key to the SofTech — and all Aquila cushions — is two groups of air bladders that alternate pressure from side-to-side via a battery-operated pump, which provides a gentle weight shift. The SofTech cushion is self-contained. It is a water-proof-coated foam wheelchair cushion with air bladders, air pump and battery integrated into the cushion, which has a total weight of five pounds. All Aquila wheelchair cushions are designed to prevent bottoming out.

The Aquila cushion pump is surprisingly quiet, similar in volume to the internal cooling fan in a laptop computer. The battery can pump up to 40 hours on a charge. A remote control enables five firmness (air pressure) settings, controls the length of time between air pressure shifts — ranging from 30 seconds to five minutes — and includes a battery status light.

Each Aquila alternating wheelchair cushion is custom built to address a client’s unique seating needs — from width and depth, number of air bladders, to off-loading areas where there is currently an ulcer, according to Steven Kohlman, Aquila’s president.

A 2014 study published in the Veterans Affairs’ Journal of Rehabilitation Research and Development used high tech instrumentation to look at ischial tissue health of 13 wheelchair users with SCI after using an Aquila alternating pressure air cushion for two weeks, in three-week intervals, for 18 months. The study concluded that the alternating pressure air cushion dynamically and continuously alters [reduces] ischial pressure distribution with sustained and positive tissue health effects compared with performing diligent weight shifts on the subject’s personal cushions.

Eric Schroeder, 42, of La Crosse, Wisconsin, who has spina bifida, spinal stenosis and chiari malformation, fought an ischial pressure sore for three years before it progressed to stage IV and he became bedridden for a year. “I heard about the Aquila SofTech from a surgeon,” says Schroeder. “My wound care clinic sent me to a surgeon because they felt it was time for a skin flap. My surgeon said he had success with several people who had pressure sores that healed while using the Aquila. He said he would rather have me try that route first.”

When Schroeder got his Aquila wheelchair cushion, he was sitting in his wheelchair for only an hour at a time. His wound healed in three months. “It’s been three years since I got the Aquila and I haven’t had another pressure sore, and I’m up in my chair for 12 hours a day.”

Larry Yenter, 50, of Rochester, Minnesota, 26 years as a C5-6 quad, has been using an Aquila cushion for four years. “Before the Aquila, I kept getting pressure ulcers and tried lots of different cushions to stop them.” Over the years he had three skin flap surgeries with both ischial tuberosities shaved down. “When I heard about the Aquila, I was so excited I paid cash for it. I haven’t had any skin issues since I’ve been on it. Between my job as an accountant and an active life, I’m up in my chair at least 12 hours a day.”
MSRP for Aquila SofTech: $4,300; Medicare approved.

As a side note, the Aquila SofTech cushion has been further improved and now operates via a wireless remote control which replaces the wired remote control.  With this latest version of the SofTech cushion there is a side panel on the cushion which has an on and off switch.  Once the desired firmness is selected, the user can operate the wheelchair cushion by either the cushion switch or the wireless remote control.  Battery re-charging is also done at the cushion side panel.

Aquila custom fabricated automatic wheelchair cushions can be seen on www.aquilacorp.com.