What Therapists Need To Know About Dynamic Custom Wheelchair Cushions And Protection From Pressure Injury
2-19-20 An article taken from Rehab Management Magazine
Determining the Best Cushion for Your Client
This is what therapists should know about dynamic cushions and the protection they provide against pressure injury
by Justine Kohlman and Siiri Koski
Medical professionals who work with individuals affected by a mobility impairment oftentimes are faced with making equipment recommendations for patients and clients who have complex needs. To satisfy those needs over the long term and optimize quality of life for this population, those medical professionals sometimes will need to recommend vital equipment that includes wheelchairs and wheelchair cushions.
Regardless of whether the wheelchair is a power or manual device, one of the single most important components in the overall seating and mobility solution is the wheelchair cushion. No wheelchair component has such a substantial impact on the end user’s health or is more important in preventing pressure injury. In fact, the cushion often may be the only form of protection between a metal seat pan and the soft tissue of the end user’s posterior and boney prominences.
See the Complete Picture
The therapist or seating specialist must look at each patient individually to assess their overall health in order to determine their specific needs. Once this assessment is completed, the clinicians should investigate what is best for their clients. When choosing a component as important as the wheelchair cushion, decisions should not be made in haste. A cushion should never be recommended based on which wheelchair cushion is easiest to order or which wheelchair cushion typically has been recommended in the past. When prescribing a wheelchair cushion, medical professionals must consider the benefits of the cushion as well as the end user’s physical and mental abilities to perform cushion maintenance and pressure relief.
Pressure Injury Can Be Fatal
When adding a static (non-moving) wheelchair cushion, the end user is required to perform effective pressure relief every 20 minutes or as prescribed. They are required to physically lift themselves up to relieve the constant pressure applied by a static cushion. It is important to keep in mind that tilt-in-space or reclining may not provide effective pressure relief. Clinicians must make their clients aware that work is required with static cushions, whether air, foam, or gel. If it is determined that the wheelchair user cannot relieve pressure effectively, relying on a static cushion puts that person at great risk of developing pressure injury. It should be known that pressure injury is caused by unrelieved pressure and can be fatal. Every static cushion—whether air, foam, or gel—requires the end user to generate his or her own pressure relief to avoid pressure injury.
Optimized Pressure Mapping
Pressure mapping is often used to determine which wheelchair cushion should be prescribed. When using a pressure mapping device, it must be properly calibrated to ensure accurate results. An uncalibrated pressure mapping device can skew the results by as much as 50%. Pressure mapping devices need to be calibrated on a regular basis even if not in use. If a cushion decision is made based on inaccurate readings, the resulting decision could have long-lasting negative effects.
The full scale on a pressure mapping device must be set to 200 mmHg. Professionals should be aware that there are brands of pressure mapping systems that let the operator set or change the scale. Changing the scale of the device offers inaccurate readings to the client. Any device that is not regularly calibrated or full scale serves no purpose in choosing a cushion.
Pressure mapping is truly a snapshot in time. When a therapist manipulates an air cushion—for example, by having the client lean in just the right position to find a favorable pressure reading—that pressure reading will change when the client moves even slightly. Pressure mapping sessions need to be taken over time to allow for immersion or changes in body position. The slightest movement will affect the pressure mapping. Not using a pressure mapping device in the way it was intended is a waste of the client’s valuable time and resources.
A Cushion That Heals
Pressure relief is essential in avoiding pressure injury, and a static wheelchair cushion that by nature is unable to offer any pressure relief is unlikely to offer significant benefit in the fight against pressure injury. Aquila Corporation, headquartered in Holmen, Wis, took up the challenge of developing a wheelchair cushion that could actively work to reduce the development of pressure injuries. As a result, the company has manufactured a wheelchair cushion designed to aid in the treatment and prevention of pressure injury. These cushion systems are designed to provide protections against pressure injury that are not achievable with static cushion technology, and to be particularly useful to mobility device users who cannot effectively perform pressure reliefs.
Aquila cushions are backed by the findings of a substantial number of clinical studies and are documented to have healed pressure injuries of all stages, including stage IV injuries.
A recent article published in Rehab Management examined pressure injury and clinical considerations for wheelchair cushion prescriptions. In their discussion about cushion materials currently available, the authors describe air, gel, foam, and honeycomb—all of which are static cushions. Missing from this discussion was dynamic (moving) wheelchair cushion technology—an important type of product available for use in complex seating solutions. To offer therapists and medical professionals the full view of wheelchair cushion technologies, it is important to know the risk of pressure injury associated with static cushions and understand the clinical benefits that a dynamic cushion can provide
Mature, Proven Cushion Technology
The Aquila automatic, alternating, custom-fabricated wheelchair cushion has been available for 21 years. It has been the subject of several studies in peer-reviewed journals and has had more clinical studies than any cushion, whether static or dynamic.
One possible reason this category of cushion may be overlooked in clinical discussions about wheelchair seating is that there are ineffective, even harmful versions of alternating cushions on the market. There are meaningful differences in the design, materials, and function among dynamic wheelchair cushions that are currently available, so therapists must be mindful to educate themselves about those differences. This includes reviewing the published data that back up the technology’s performance and supports the effectiveness of its customized features. Even though there are a number of dynamic cushions on the market, what distinguishes the Aquila cushion is that it is the only dynamic cushion that is custom made to offload under an existing pressure injury or compensate for boney prominences. The effectiveness of Aquila’s dynamic cushion is underscored by its use in published clinical studies and the fact that it has been issued a Medicare code. Likewise, the Aquila dynamic cushion is distinctive because it is custom programmed for client weight. All other dynamic cushions apply upward pressure directly to an existing pressure injury, which common sense indicates, will cause the injury to worsen.
Healthcare professionals who work with mobility device users and make recommendations for wheelchairs and seating products should be mindful that unrelieved pressure to the skin and tissue is the number one cause of pressure injury. It is to the benefit of all therapists to search out wheelchair cushions that have been used in clinical research and proven to aid in the treatment and prevention of pressure injury.
Aquila continues to work to deliver on its mission to offer its clients the cushion that will best meet their specific needs. To maintain a superior level of quality and performance each cushion is handcrafted according to client specifications, which includes building a client’s cushion in any size or shape. The company’s customization service includes hand sealing each bladder in a client’s cushion for the exact size, shape, and location while off-loading under any specific injuries. Customization continues with programming the circuitry to offer three firmness options based on client weight and offer 60-second cycle times. Aquila actively engages in discussion with its clients to fully understand their needs and use their input to build a seating system that is optimized specifically for them. Aquila also maintains a personal file for each client that keeps their vital information available for continuing use. Above all, the company strives to place a singular focus on the care and comfort of its clients.