Wheelchair cushion

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Wheelchair cushions are cushions specifically designed to provide comfort and protection against injury for wheelchair users. They also aid in properly positioning the user in the correct posture.

Contents

Wheelchair users are at great risk for pressure sores. [1] 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]
  2. The collection of sweat on the skin due to inadequate air flow. [3]
  3. The presence of local areas of elevated temperature. [4]
  4. Shear stresses on the skin. [5]

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. [1] In response, manufacturers have developed a number of wheelchair seat cushion alternatives. Over 200 models of wheelchair cushions were on the market[ where? ] as of 2001. [6] [ needs update ]

Characteristics

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 are intended to provide the wheelchair user optimal comfort, stability, and postural support, as well as aid in the prevention of pressure ulcers. [6]

The effectiveness of a particular choice of material and design has high variance with respect to a user's medical needs and activities. For instance, if a wheelchair user frequently moves on rough surfaces, gel cushions are less optimal as they are not as effective at absorbing impact. [7]

Sprigle et al. proposed the following criteria for defining and describing cushion characteristics: [6]

Material and construction
Physical characteristics

Design examples

Related Research Articles

Rheology is the study of the flow of matter, primarily in a liquid or gas state, but also as "soft solids" or solids under conditions in which they respond with plastic flow rather than deforming elastically in response to an applied force. Rheology is a branch of physics, and it is the science that deals with the deformation and flow of materials, both solids and liquids.

Polyurethane Polymer composed of a chain of organic units joined by carbamate (urethane) links

Polyurethane refers to a class of polymers composed of organic units joined by carbamate (urethane) links. In contrast to other common polymers such as polyethylene and polystyrene, polyurethane is produced from a wide range of starting materials (monomers) and is therefore a class of polymers, rather than a distinct compound. This chemical variety allows for polyurethanes with very different physical properties, leading to an equally wide range of different applications. These include: rigid and flexible foams, varnishes and coatings, adhesives, electrical potting compounds, and fibres such as spandex and PUL. Of these, foams are the largest single application, accounting for 67% of all polyurethane produced in 2016.

Ulcer (dermatology) Type of cutaneous condition

An ulcer is a sore on the skin or a mucous membrane, accompanied by the disintegration of tissue. Ulcers can result in complete loss of the epidermis and often portions of the dermis and even subcutaneous fat. Ulcers are most common on the skin of the lower extremities and in the gastrointestinal tract. An ulcer that appears on the skin is often visible as an inflamed tissue with an area of reddened skin. A skin ulcer is often visible in the event of exposure to heat or cold, irritation, or a problem with blood circulation.

In materials science and continuum mechanics, viscoelasticity is the property of materials that exhibit both viscous and elastic characteristics when undergoing deformation. Viscous materials, like water, resist shear flow and strain linearly with time when a stress is applied. Elastic materials strain when stretched and immediately return to their original state once the stress is removed.

Skin grafting

Skin grafting, a type of graft surgery, involves the transplantation of skin. The transplanted tissue is called a skin graft.

Mattress Large pad for supporting the reclining body, used as or on a bed

A mattress is a large, usually rectangular pad for supporting a lying person. It is designed to be used as a bed, or on a bed frame as part of a bed. Mattresses may consist of a quilted or similarly fastened case, usually of heavy cloth, containing materials such as hair, straw, cotton, foam rubber, or a framework of metal springs. Mattresses may also be filled with air or water.

Pressure ulcer Skin ulcer (bed sore)

Pressure ulcers, also known as pressure sores or bed sores, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combination with shear or friction. The most common sites are the skin overlying the sacrum, coccyx, heels, and hips, though other sites can be affected, such as the elbows, knees, ankles, back of shoulders, or the back of the cranium.

Stasis dermatitis refers to the skin changes that occur in the leg as a result of "stasis" or blood pooling from insufficient venous return; the alternative name of varicose eczema comes from a common cause of this being varicose veins.

Memory foam Component primarily utilized for making cushions or mattresses

Memory foam consists mainly of polyurethane as well as additional chemicals increasing its viscosity and density. It is often referred to as "viscoelastic" polyurethane foam, or low-resilience polyurethane foam (LRPu). The foam bubbles or ‘cells’ are open, effectively creating a matrix through which air can move. Higher-density memory foam softens in reaction to body heat, allowing it to mold to a warm body in a few minutes. Newer foams may recover their original shape more quickly.

Rheometer

A rheometer is a laboratory device used to measure the way in which a liquid, suspension or slurry flows in response to applied forces. It is used for those fluids which cannot be defined by a single value of viscosity and therefore require more parameters to be set and measured than is the case for a viscometer. It measures the rheology of the fluid.

Dressing (medical) Medical term

A dressing is a sterile pad or compress applied to a wound to promote healing and protect the wound from further harm. A dressing is designed to be in direct contact with the wound, as distinguished from a bandage, which is most often used to hold a dressing in place. Many modern dressings are self-adhesive.

Negative-pressure wound therapy Therapeutic technique

Negative-pressure wound therapy (NPWT), also known as a vacuum assisted closure (VAC), is a therapeutic technique using a suction pump, tubing and a dressing to remove excess exudate and promote healing in acute or chronic wounds and second- and third-degree burns. The therapy involves the controlled application of subatmospheric pressure to the local wound environment, using a sealed wound dressing connected to a vacuum pump. The use of this technique in wound management increased dramatically over the 1990s and 2000s and a large number of studies have been published examining NPWT. NPWT has many indications for use including:

Package cushioning Protective packaging

Package cushioning is used to protect items during shipment. Vibration and impact shock during shipment and loading/unloading are controlled by cushioning to reduce the chance of product damage.

A mattress pad, mattress topper, or underpad is designed to lie atop a mattress. Made from a variety of materials, its function is to provide a layer of comfort especially when the existing mattress is worn or uncomfortable, and have been shown to improve a user's quality of sleep.

Wheelchair Chair with wheels used by people with mobility deficiencies

A wheelchair is a chair with wheels, used when walking is difficult or impossible due to illness, injury, problems related to old age, or disability. These can include spinal cord injuries, cerebral palsy, brain injury, osteogenesis imperfecta, motor neurone disease, multiple sclerosis, muscular dystrophy, spina bifida, and more.

Microrheology is a technique used to measure the rheological properties of a medium, such as microviscosity, via the measurement of the trajectory of a flow tracer. It is a new way of doing rheology, traditionally done using a rheometer. There are two types of microrheology: passive microrheology and active microrheology. Passive microrheology uses inherent thermal energy to move the tracers, whereas active microrheology uses externally applied forces, such as from a magnetic field or an optical tweezer, to do so. Microrheology can be further differentiated into 1- and 2-particle methods.

Kristjan T. Ragnarsson, M.D., is an American physiatrist with an international reputation in the rehabilitation of individuals with disorders of the central nervous system. He is currently the Dr. Lucy G. Moses Professor and Chair of Rehabilitation Medicine at The Mount Sinai Medical Center in New York City.

Rheological Weldability (RW) of thermoplastics considers the materials flow characteristics in determining the weldability of the given material. The process of welding thermal plastics requires three general steps, first is surface preparation. The second step is the application of heat and pressure to create intimate contact between the components being joined and initiate inter-molecular diffusion across the joint and the third step is cooling. RW can be used to determine the effectiveness of the second step of the process for given materials.

Podiatrists have molded custom orthotics to address patients' foot malformations. Over the years they have developed numerous means to create the basis for their molds; plaster casts, foam box impressions, or three-dimensional computer imaging. None is very accurate: all produce proper fit under 80% of the time.Telfer S.; Gibson KS; Hennessy K; Steultjens MP; Woodburn J. (2012). "Computer-aided design of customized foot orthoses: reproducibility and effect of method used to obtain foot shape". Arch Phys Med Rehabil. 93 (5): 863–70. doi:10.1016/j.apmr.2011.12.019. PMID 22541310.</ref>

Gait deviations Medical condition

Gait deviations are nominally referred to as any variation of standard human gait, typically manifesting as a coping mechanism in response to an anatomical impairment. Lower-limb amputees are unable to maintain the characteristic walking patterns of an able-bodied individual due to the removal of some portion of the impaired leg. Without the anatomical structure and neuromechanical control of the removed leg segment, amputees must use alternative compensatory strategies to walk efficiently. Prosthetic limbs provide support to the user and more advanced models attempt to mimic the function of the missing anatomy, including biomechanically controlled ankle and knee joints. However, amputees still display quantifiable differences in many measures of ambulation when compared to able-bodied individuals. Several common observations are whole-body movements, slower and wider steps, shorter strides, and increased sway.

References

  1. 1 2 Ferrarin, M; Andreoni, G; Pedotti, A (2000). "Comparative biomechanical evaluation of different wheelchair seat cushions". Journal of Rehabilitation Research and Development. 37 (3): 315–24. PMID   10917263.
  2. Kosiak, M (1961). "Etiology of decubitus ulcers". Arch Phys Med Rehabil: 19–29.
  3. Stewart, SFC; Palmieri, V; Cochran, GVB (1980). "Wheel chair cushion effect on skin temperature, heat flux, and relative humidity". Arch Phys Med Rehabil. 61 (5): 229–33. PMID   7377945.
  4. Finestone, HM; Levine, SP; Carlson, GA; Chizinsky, KA; Kett, RL (1991). "Erythema and skin temperature following continuous sitting in spinal cord injured individuals". J Rehabil Res Dev. 28 (4): 27–32. doi: 10.1682/JRRD.1991.10.0027 . PMID   1941646.
  5. Bennet, L; Kavner, D; Lee, BK; Trainor, FA (1979). "Shear vs . pressure as causitive factors in skin blood occlusion". Arch Phys Med Rehabil. 60: 309–14.
  6. 1 2 3 Sprigle, Stephen; Press, Larry; Davis, Kim (2001). "Development of uniform terminology and procedures to describe wheelchair cushion characteristics". J Rehabil Res Dev. 38 (4): 449–61. PMID   11563498.
  7. Fleming, Joe. "Wheelchair Cushion: Selection and Maintenance". Vive Health. Retrieved 6 January 2017.