There Are So Many Cushion Options: Where do I start?
Over the next several weeks, we will be discussing cushions and how to choose the right cushion for your client. It can be challenging to pick a cushion for a client when there are so many options out there today. Some of the questions I commonly get are: Where should I start? How do I narrow down the options? What will work best for my client? Can I just keep them on the same cushion they already have?
Let’s start by first considering the client goals and your goals as the therapist. These might include goals such as: positioning goals, skin protection goals, or function-based goals. Often, we might have multiple goals for seating that we are trying to meet. Take a look at the chart below. Here are a few examples of goals that we might be trying to meet with the cushion. We have to remember that one cushion may not be able to achieve all of our goals, but what is most important? Where can we have overlap? How can we achieve the best outcome for our client?
Once you decide what goals you are trying to accomplish then you can begin to look at what design of cushions you should be considering. Let’s consider two examples.
Client 1: The therapist’s goal and the client’s goal are both to maintain the client’s posture thereby allowing the client to have increased function. The current cushion does not maintain the client’s position, allowing the client to collapse into a posterior pelvic tilt and therefore decreasing their range of motion with shoulder flexion for overhead activities.
Client 2: The therapist’s goal is skin protection. The client has a history of multiple pressure injuries on his ischial tuberosities bilaterally. The client has been limited in their sitting tolerance due to pressure and therefore the therapist is looking for the best possible skin protection cushion for their client.
For these examples above would the Client 1 and Client 2 benefit from the same cushion? Perhaps, but not likely. Look at the example of two cushions below. Which cushion would you trial with each client?
You could trial both cushions for each client, but in this case if we had to choose, we would choose the air-cell based cushion for client 2 and the contoured foam cushion for client 1. How did I come to this conclusion?
The next step is to understand the design and materials of cushions to determine when or why you might choose one cushion over another. Next week we will begin with discussing the design behind cushions and how they work.
For this week it is important to remember that there is not one cushion that works for every client! In fact, every client even with the same cushion will have a unique interaction. We can even go as far to say that the same client on the same cushion will likely have a different interaction with that cushion each time they sit on it as they sit slightly different each time and many clients move around throughout their day.