Wheelchair seating is fundamental in seating and mobility prescriptions. Combined with the correct wheelchair base for an individual, seating can promote posture and positioning, provide stability, facilitate function, address pressure management and enhance comfort and sitting tolerance.
Generic wheelchair seating can be thought of as existing across a spectrum, from standard off-the-shelf seating to adjustable modular seating to adaptive seating. Standard, off-the-shelf seating is ready-made seating designed and fabricated by a manufacturer. Numerous choices exist in off-the-shelf cushions in terms of materials used, product designs and covers. For a refresher on standard cushions, refer to these past Clinical Corner articles:
Standard, off-the-shelf cushions may be appropriate for individuals who have low risk of skin breakdown through to individuals with high risk for skin integrity issues, depending upon the interaction of the cushion material and design. Off-the-shelf cushions may be prescribed for individuals who have symmetrical posture and who do not require extensive positioning needs. In addition, individuals with mild postural asymmetries, who are able to tolerate correction, may do very well with off-the-shelf cushions designed with contours to help facilitate positioning and pelvic immersion.
When standard cushions do not fully meet the positioning needs of certain individuals, modification of off-the-shelf cushions may be considered. Modification of off-the-shelf cushions also can enhance pressure management for some individuals. For more on this, refer to this Clinical Corner article: Modifying Off-the-Shelf Seating.
At the opposite end of the seating spectrum is adaptive seating, which typically is prescribed for individuals with postural asymmetries that cannot be reduced and with high risk of skin breakdown. Adaptive seating may be either configured or molded. Configured seating is tailor-made seating in which the dimensions of the seating and the materials selected are manufactured based on the specifications of the therapist and vendor, in response to the unique needs of the individual client. Molded seated is seating that is created based on a mold of the individual to create the unique shape of the individual for positioning and pressure management through creating full contact over a large surface area. For more on adaptive seating, refer to this Clinical Corner article: Adaptive Seating.
Adjustable, modular seating can be considered the bridge between off-the-shelf and adaptive seating. Modular cushions allow for modifications to be completed in the field, which provide for personalized positioning for an individual on the spot. Modular seating allows for contouring of the cushion to match the shape of the individual, through the inherent positioning components in the cushion. Because the contouring, shaping and angling can be completed with the client present, the cushion is ready to be used as soon as the adjustments have been made for the individual. If the client's presentation changes in the future, modular seating can be adjusted to meet the needs of the individual.
Another way in which adjustable, modular seating fits between off-the-shelf seating and adaptive seating is when seating is used to correct posture. Perhaps a client's postural asymmetry can be corrected to a neutral position, but the client is unable to tolerate the full correction. If the client is able to tolerate partial correction, adjustable seating can be used to provide the position of comfort and stability. In time, if the individual is able to tolerate further correction, an adjustable cushion is able to facilitate this as the positioning components are not fixed in place. A modular cushion can be adjusted to suit the changing needs of an individual over time, whether it is for correction or accommodation of a posture.
A modular cushion can be used to achieve positioning goals for the pelvis, hips, and lower extremities through adjustments to the base of the cushion. The graphic to the far left illustrates the base of an adjustable cushion. The placement of the positioning pieces can be adjusted to achieve different positioning effects on the cushion. Right and left sides can be adjusted independently. In addition, front and rear of the cushion can be adjusted to achieve different effects. The graphic in the centre illustrates the removal of the cells from the front of the cushion and addition to the rear of the cushion to accommodate lower extremity positioning for tight hamstrings and for pelvic positioning. The graphic to the far right illustrates building up cells up under thighs for enhanced pre-ischial support and control.
There are many other adjustments that can be made for positioning using a modular cushion. As well, different positioning components, such as 5° wedges, can be used to achieve other positioning effects.
Adjustable, modular seating bridges the gap between off-the-shelf and adaptive seating. Each have their place in seating and mobility. By understanding the different choices that are available, therapists can determine the best solutions for their individual clients.