Pressure Care And Cushions
If at risk of pressure sores or in need of postural support, an appropriate wheelchair cushion is key. The right cushion will stabilise the pelvis, protect the skin and position the body, while providing appropriate levels of comfort.
For those needing specialist cushions, we can source these from all the major manufacturers, including Sunrise Medical's JAY range, Invacare's Matrx, and Pride Quantum's Synergy. However, our preferred range is Sunrise Medical's JAY cushions, which are comfortable, lightweight, low maintenance, and highly configurable, allowing them to cater to a wide range of seating requirements. This page outlines some of the key factors affecting choice of cushion before profiling the most popular cushions from the JAY range.
We offer all our range of cushions for purchase - additionally for those whose need for a pressure cushion is immediate or short-term, we also hire out the Invacare Matrx Flo-Tech Solution, which is the NHS's go-to pressure cushion. This is available in a selection of sizes, and features a contoured foam base, and dual-layer gel sacs to provide a high degree of pressure relief.
To maintain skin integrity, the mass of the wheelchair user needs to be spread over as wide an area as possible, and away from bony prominences. Solid materials such as foams, viscos and gels can provide some pressure reduction depending on the type of material, but there is always a material counterforce that creates reactive pressure in critical areas and limits the ability to redistribute pressure from sensitive areas.
Liquids and gases displace, conforming to the form of the wheelchair user, without a counterforce. They also spread pressure evenly over the entire body surface in contact with the cushion. Surface materials need to be much larger than the materials within to avoid restricting displacement and compression. Enough depth to the liquid or gas is required to avoid "bottoming out", which undermines all the benefits they provide.
For those at highest risk of pressure sores, a liquid or gas filled cushion is the best option.
Humidity And Heat Reduction
Excellent pressure distribution can result in a side effect of humidity being created, as there is a uniform "immersion" of the wheelchair user's surface. Wicking the materials of the cushion can help to reduce this, but incontinence covers and the user's clothing have a bigger impact than this.
Foams and gels don't dissipate heat well, while air cushions sit at the opposite end of the spectrum. Weight shifting is critical to dissipating heat - for those that cannot do this, the composition of the cushion is vital, with gases and liquids ideal for those at higher risk.
Pressure reduction is not the only consideration when addressing the chance of skin breakdown. Solids such as foams, gels and viscos do not displace when moving over them. This counteractive response can result in friction and shear, resulting in damage. Gases and liquids displace, dramatically reducing this. However, low shear can be poor for stability and positioning, meaning that the key to appropriate shear reduction is focusing on doing so in critical zones, while others receive the diverted pressure and provide the client with stability and postural support.
Stability And Positioning
While backrests are key in providing stability and appropriate positioning, it is vital to have a stable, and appropriately positioned base. Additionally, a cushion can only function effectively if the wheelchair user is in the correct position. A deep well for the pelvis is needed, as well as a firmer surrounding structure. When the focus is on positioning over pressure reduction, a much firmer cushion is necessary. A custom configuration may be required if both skin breakdown and positioning are a concern.
Comfort And Seating Tolerance
While comfort is subjective, it is a key consideration. Softer cushions are typically considered more "comfortable", but can cause problems over the longer term. Appropriate seating tolerance balances all the above factors, providing pressure redistribution, shear reduction, stability and positioning, but also comfort too.
Other Factors To Consider
- Heavier users are at higher risk of "bottoming out" so must have a cushion that they are within the weight tolerance for.
- The seat to floor height of a wheelchair is crucial to many users, whether that be for transfers, or accessing their environment. Deep immersion will result in a higher cushion, raising the seat to floor height.
- Budget is always a concern, and more advanced cushions will typically be more expensive - however, over the long run it is always best to go for an appropriate cushion.
- Further pressure relief can be provided through powered positioning options, in particular high levels of tilt in space, as details on our dedicated Powered Positioning page.
Below are profiled some of the key products in the JAY range. All of them are available in a range of sizes to suit your requirements.
As the name suggests, this cushion is for those with basic needs, and features mild contouring. The focus is on comfort over postural support, and it is ideal for those who aren't at risk of skin breakdown and who can shift their weight independently. It features durable moulded foam, with the gentle contouring providing comfort and very mild postural support. An incontinence cover comes as standard, and due to its simplicity, the JAY basic is the most affordable cushion in the JAY range.
JAY Soft Combi P
The Soft Combi P features a pre-moulded incontinence resistant foam base. It features deep leg troughs and lateral support to the hips. It is designed for those at low risk of skin breakdown who can shift their weight independently, but need more positioning than the JAY Basic provides. The Soft Combi P provides lateral stability for people with symmetrical posture who need a relatively low to moderate level of support to the pelvis and thigh.
JAY Easy Visco
The Easy Visco is a further step up from the Soft Combi P, providing improved postural support and a degree of pressure redistribution too. This is provided by the soft moulded visco foam in the seat well, which helps to distribute weight to the thighs. It is designed for people who spend longer periods of time in a wheelchair, but who can self-adjust, and who need a level of extra stability and protection against skin breakdown provided.
JAY Easy Fluid
The Easy Fluid cushion provides higher levels of skin protection through a JAY fluid pad in the seat well. This allows it to cater to people with moderate risk of skin breakdown and shear, while the soft moulded foam base provides both lateral and forward/rearward stability for those with moderate postural support requirements. It remains suited to people who can shift their weight independently.
The JAY Balance lives up to its name - offering the perfect balance of skin protection, stability and comfort. It is designed for people at high risk of skin breakdown and shear, who cannot reposition themselves, and who need increased stability and positioning. The multi-layered contoured foam base provides this support, while also ensuring that the insert remains positioned correctly. A choice of either a JAY Flow Fluid or Roho Air insert is available, depending on the wheelchair user's exact needs. Additionally, three different cover materials are available - microclimatic, incontinence, and stretch.
Further adjustments can be made to the Balance via positioning components that can be slotted into place. This both allows precise adjustments to suit the user's exact size, and also allows further changes to be made should their requirements evolve.
All these cushions can be fitted to powerchairs regardless of manufacturer, whether they have a firm seat base or a canvas sling. Our product specialist are able to carry out expert consultations to determine which cushion is best suited to your needs. If required, an OT Assessment service is available, for those with the highest level of clinical needs. For further information, please contact us.