Clinical Considerations: Wheelchair Cushion Materials

Although cushions may look similar in design on the outside, the materials used on the inside can have a significant impact on their performance.

Understanding how materials perform will improve the clinician’s ability to select a cushion based on their client’s goals 

In this guide, we'll explore a wide range of cushion materials, their advantages and disadvantages, and tips for selecting the right one for individual needs.

Types of Wheelchair Cushion Materials

Foam:

Foam is a material which is formed by trapping pockets of gas. It can be a variety of densities, firmnesses and weights. Based on the uniformity of the cells, they will be more or less rigid. 

Elastomer

Elastomer is a man-made polymer with varying degrees of viscoelasticity. 

Gel

Gel is a solid jelly-like material that can have properties ranging from soft and weak to hard and tough. 

JAY® Flow Fluid

JAY Flow Fluid is a non-Newtonian fluid. A non-Newtonian fluid remains in a semi-solid or highly viscous state.  In a non-Newtonian fluid, viscosity changes when under force to either more liquid or more solid.

JAY AIR™

JAY AIR is a Newtonian fluid. A Newtonian fluid maintains its viscosity independent of stress. A Newtonian fluid only changes its viscosity in response to temperature. 

Advantages

Material	Advantages	Additional Considerations
Foam	Inexpensive and lightweight Low maintenance  Absorbs impact loads well  Firm foam can provide a level base of support  Soft foam can be used for comfort Viscoelastic memory foam has vibration-dampening properties Various densities can be combined for pressure relief, moving load from high risk bony prominences to lower risk areas	Compresses over time  Difficult to clean and absorbs moisture  May create tension on the tissue depending on the softness of the foam May create shear forces on the tissue depending on the foam design  May retain heat in hot climates and get harder in cold climates Memory foam may hold more heat than standard foam and it becomes more compressed over time, with less return  May increase pressure on bony prominences over time
Elastomer	Easy to clean Allows some compression Immersion is dependent upon the rigidity of the elastomer Can be lightweight depending on design, e.g. honeycomb structure Design may allow airflow which may improve microclimate  Has shear reduction qualities due to higher viscoelasticity properties	Limited displacement  Less immersive than lower density foam or fluids  More difficult to modify in the field in response to specific postural needs
Gel	Some movement and viscosity  Often easy to cut, modify and put in small places  Can offer good friction/shear control  Easy to clean	Heavy  Temperature sensitive  Holds heat but can feel cold to the touch initially  Limited displacement, less immersion than liquid, air, or most foams used in cushions
Jay Air	Lightweight Moves with the body Easy to clean Pressure distribution Can be used as entire cushion or within a foam base for stability  Provides good immersion while creating a large area of surface contact to distribute	Reduced stability, particularly in an air-only cushion  Risk of puncture  Frequent maintenance to ensure proper inflation  Sensitive to pressure changes, such as during air travel
Jay Flow Fluid	Good pressure distribution Conforms to the body Weighs less than gel Moves with the body Can help control shear Does not respond to load with counterforce of foam, thereby extremely good for pressure care  Provides good immersion while creating a large area of surface contact to distribute	Heavier than foam or air  Needs some maintenance  May require redistribution following use due to migration with pressure

Clinical Considerations

When considering cushion base materials, therapists should consider the following factors:

1. Client Assessment: Thoroughly assess the client's physical condition, mobility level, and risk of pressure sores.

2. Pressure Relief Needs: Determine how much pressure redistribution the client requires.

3. Postural Support: Assess the client's need for postural support to maintain balance and alignment.

4. Comfort and Sensory Preferences: Consider the client's comfort preferences and any sensory sensitivities.

5. Durability and Maintenance Needs: Evaluate the client's ability to maintain and care for the cushion.

6. Breathability Requirements: Assess the need for air circulation to prevent heat and moisture buildup.

7. Hypoallergenic Considerations: Be aware of any allergies or sensitivities.

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Selecting the right material for a wheelchair cushion is a crucial decision that impacts comfort, health, and quality of life. By understanding the different materials available and considering individual needs, users can make an informed choice that best suits their lifestyle and health requirements.