For long-term wheelchair use, obtain an appropriately fitted chair and pressure-protective cushion, and inspect vulnerable skin
Prolonged pressure can damage skin, which may heal slowly and become infected. A nursing-home trial found fewer pressure injuries over the sitting bones with skin-protection cushions, though the combined result including the sacral and tailbone area was inconclusive. Fit matters too; a generic wheelchair and a new cushion are not automatically a suitable seating system.
What it takes
The source estimates several hundred to over RMB 1,000 for a pressure-protective cushion in China. A daily skin check can take about a minute.
What you may gain
A randomized trial in 12 nursing homes recruited 232 residents during 2004–2008. Participants were at least 65, used a wheelchair at least six hours daily, and had Braden scores of 18 or below. Everyone received a fitted wheelchair. One group used a skin-protection cushion made with air, viscous fluid plus foam, or gel plus foam; the comparison group used 7.6-cm segmented foam. Follow-up lasted six months or until a pressure ulcer occurred. Ischial-tuberosity ulcers occurred in eight comparison participants, 6.7%, versus one, 0.9%, with skin-protection cushions, P=0.04. Combining ischial and sacral/coccygeal ulcers gave 21 cases, 17.6%, versus 12, 10.6%, P=0.14, without a statistically clear difference.
Context & considerations
Evidence is B because the sample was small, the primary result was close to the significance threshold, the secondary result was inconclusive, and older nursing-home residents differ from younger wheelchair users. Both groups had fitted chairs, so the results apply within that seating context rather than establishing that a cushion alone solves every pressure problem. For mattresses and repositioning in bed, see chapter 17, entry 8. For assistive-device subsidies, see entry 7.
Research & references
Brienza D, Kelsey S, Karg P et al. (2010). A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushions. Journal of the American Geriatrics Society, 58(12), 2308–2314. https://doi.org/10.1111/j.1532-5415.2010.03168.x