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Wheelchair Cushions

People who are confined to wheelchairs are at great risk for decubitus ulcers (pressure sores). A number of factors are included in the formation of these ulcers including: 1) insufficient vascularization in areas of high pressure, typically under bony prominences' 2) the collection of sweat on the skin due to inadequate air flow, 3) the presence of local areas of elevated temperature, and 4) shear stresses on the skin A number of studies point to interface pressure between the body and the seating surface as the primary contributor to the formation of pressure sores. In response, manufacturers have developed a number of wheelchair seat cushion alternatives to combat this breakdown. In fact, over 200 models of wheelchair cushions were on the market as of 2001. However, outside of manufacturers' marketing claims, there is no readily available information to judge the effectiveness of these cushions, or to help select the best product for a particular user.

Cushion Characteristics

Sprigle et al. proposed the following criteria for Defining and Describing Cushion Characteristics:

A. Material and Construction

• Cushions using Cellular Materials - Foam (Convoluted, Segmented), Flexible Matrix, Viscoelastic Foam or Matrix, Nondeforming Foam or Matrix
• Cushions Containing Fluid - Viscoelastic Fluid, Air Cushion, Water Cushion
• Other Construction - Solid Elastomer and Solid Gel, Cushion with Displacing Solid Elements

B. Physical Characteristics

• Surface Characteristics - Unloaded Contour Depth, Loaded Contour Depth, Contour, Cut-Out, Segmented, Convoluted Foam
• Features - Preischial Support, Lateral Pelvic Support, Medial Thigh Support, Lateral Thigh Support
• Other - Bonded, Compartment or Chamber, Stiffness, Flat or Curved Base

D. Dimensions

These various characteristics, combined with a number of cover material options, offer a myriad of possibilities, which can be manipulated to provide various performance properties. These properties should optimally provide the wheelchair user optimal comfort, stability, and postural support, as well as aid in the prevention of pressure ulcers.:

Examples of Various Cushion Designs

• 
  Convoluted Foam Cushion.
• 
  Segmented Foam Cushion.
• 
  Low Profile Segmented Air Cushion.
• 
  High Profile Segmented Air Cushion.
• 
  Foam and Viscoelastic Foam Cushion.
• 
  Foam and Viscous Fluid Cushion.
• 
  Honeycomb Cushion.

3rd Party Payer Information

The Centers for Medicare and Medicaid Services (CMS) publishes the Healthcare Common Procedure Coding System (HCPCS) code set, which classifies similar products that are medical in nature into categories for the purpose of efficient claims processing. Some examples of these codes include:

• E2601: HCPCS Long Description - General use wheelchair seat cushion, width less than 22 inches, any depth,
• E2603: HCPCS Long Description - Skin protection wheelchair seat cushion, width less than 22 inches, any depth,
• E2605: HCPCS Long Description - Positioning wheelchair seat cushion, width less than 22 inches, any depth,
• E2607: HCPCS Long Description - Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth, and
• E2609: HCPCS Long Description - Custom fabricated wheelchair seat cushion, any size

These codes are used for billing purposes, but are not particularly helpful for describing wheelchair cushions in a way that consumers can use to choose the cushion most appropriate for their situation.