How To Choose The Proper Wheelchair Cushions

The goals of proper wheelchair cushions are to maintain alignment of the skeletal system, facilitate normal movement, inhibit abnormal movement, provide a stable base to optimize normal activity, decrease tone, correct or support skeletal deformity, prevent abnormal pressure which may lead to skin breakdown, and reduce or relieve pain.

Three Critical Areas

When looking for the right wheelchair cushions you need to consider your lifestyle and preferences, functional skills and physical abilities.

Keep in mind how your wheelchair will be used, where it will be used, if your home is accessible and how you will transport it. You need to consider what activity you need to be able to perform from the wheelchair. For example, dressing, transfers in and out of the chair, ability to propel or the need for assistance. All of these activities take trunk control and strength, and the ability to understand and safely use your wheelchair.

You will need to understand the general health and underlying disease or disability. Is your condition progressive or is there an anticipated surgery? If so, it may be beneficial to wait until after surgery as trunk alignment may change.

Consider your size, balance, abnormal tone, orthopedic issues such as scoliosis, dislocated hip, contractures, and pelvic obliquity. Sensory awareness, breathing difficulties, pain issues, and incontinence are all things to keep in mind when looking for proper fitting wheelchair cushions.

The Examination

A physical examination and postural assessment are necessary components of the evaluation of the patient's condition. The therapist or physician should use a systematic approach to achieve a skilled and thorough examination.

They will assess your general health, cognition and development, posture, skin, balance and coordination, body symmetry, and upper and lower extremity function.

A musculoskeletal exam should include assessment of the head and neck - including position abnormalities and strength; spine – scoliosis, kyphosis and lordosis; pelvic position – asymmetry, obliquity, anterior or posterior tilt; hip and knee examination for range of motion, foot range of motion, and upper extremity range of motion.

The neurological examination should assess tone and spasticity, abnormal reflexes and positions, muscle strength and coordination, sensory and proprioception.

The functional examination should assess your ability to complete activities in a seated position, head control, balance, reflexes, strength, arm and leg function and coordination.

Goals

After all information has been gathered, a proper fitting wheelchair cushion can be identified. Compromising may be necessary at times as the primary goal of a proper fitting seat cushion is to prevent pressure sores, however, gel foam cushions are heavier than the standard foam cushion. You may not use it if it doesn't meet your needs.

The general life of a cushion when used daily varies from six months to two years, depending upon the type of cushion. In addition to the exam your doctor and therapist will need your input to help select the proper cushion. With your goals and objectives included in the evaluation only cushions with the necessary benefits will be considered.

Documenting the process can be extremely effective in justifying to the third-party payer (your insurance company or medicare) why the particular wheelchair cushion is selected and why other, less expensive ones are inadequate for the stated medical goals.

Purchasing Wheelchair Cushions

You can purchase a seat cushion from a durable medical equipment (DME) dealer. In some cases, it may be provided by an orthotist or a rehabilitation technologist particularly if the cushion is fabricated specifically for you or requires some specialized custom feature. For commercially available seating systems, the dealer is usually a helpful resource for information regarding which equipment is available to meet the identified needs.

The dealer can suggest products from different manufacturers and explain how different products may be combined to produce a better result. He or she can also provide information on durability and reliability and should be able to advise you and your therapist on which options are reimbursed by the third-party payer.

Documentation For Payment

Most third-party payers look to the physician for the medical basis for providing a seating system. The physician is best qualified to document the patient's current medical status, the prognosis for the underlying diagnosis, the medical goals for the seat, and the implications of improper seating. The physician is also expected to provide information on whether surgery or other medical procedures are planned that may affect the use of the seat. The physician or health care professional is often responsible for generating a letter of medical necessity.

A prescription should include the medical condition, the duration the equipment or seat cushion will be needed, the patient's prognosis, and a definition of functional limitations (in other words ability to complete their normal activities of daily living). Note any other interventions that have been tried, specific medical equipment with justification and finally the signature and credentials of the prescribing individual.

Summary

When choosing a wheelchair cushion for your chair think about your lifestyle, physical abilities and preferences before buying. A thorough exam from your doctor or therapist will consider your physical, functional, musculoskeletal and neurological status. Cushions vary from lightweight foam to the heavier gel cushions.

Once you have determined the best cushion for you, then the next step is have a prescription written that will justify the cost to your insurance company. Your doctor or healthcare provider can assist you with this.

You will have a wheelchair cushion that will fit seamlessly into your wheelchair made just for you.



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