Seating systems can be comprised of off-the-shelf components, things like a standard cushion that we order by dimension, a certain width and certain depth, or an off-the-shelf back. We can also have a custom made linear, contoured, or even a molded seating system. Each part of the seating system, the seat, back, and any secondary supports, can be either linear, which means a flat surface, or contoured. The list of the main positioning systems available in the market today are off-the-shelf cushions and backs, planar or linear systems where all the components are flat surfaces, generic contours, aggressively contoured where we are customizing a little more towards an individual, and finally molded, which is absolutely molded to the client's specific body shape.
Off-The-Shelf Seating Systems
When do we look at an off-the-shelf cushion versus other seating options? Some of the advantages of these off-the-shelf cushions is that they are removable. It is easy to just pull this off of the sling upholstery or seat pan that it sits on. That allows the chair then to be folded either side to side, as in a more traditional wheelchair, or in some of our rigid wheelchairs, the back canes fold downward and we end up with kind of a box. Sometimes, with those rigid ultralight chairs, the back canes fold-down, the rear wheels pop off, and that cushion might get in the way of the back canes folding down as much as necessary, and so again, the cushion can be removed.
The cushion can also be used on more than one mobility base. If the client has a manual chair and a power wheelchair, then the cushion could go back and forth. You can also take that cushion out and use it on other surfaces. A great example of this is on an airplane. If we have a client who has pressure concerns, or they are at risk of developing pressure ulcers, we need to make sure their skin is protected on other surfaces as well. During the long trip, sitting on something like an airplane seat puts them at a pressure risk. These cushions are generally easy to maintain. We can unzip covers, wash them, etc.
As with everything that we recommend, there are always contraindicators. It is very important to be aware of those, because there is certainly no one product that can meet everyone's needs. Postural control may be inadequate for some clients. These cushions are designed to provide a limited amount of postural control. Pressure distribution may be inadequate; it depends on the cushion. There are some that are designed to prevent pressure ulcers and do so very well. Linear seats, as they have a flat surface, tend to accommodate growth better, because you can simply pull that cushion out further. Often part of a linear seat is tucked underneath the back so we have some available growth for future needs, particularly in pediatrics. With a contoured seat, it is not as simple as pulling the seat forward, because the contours now are in the wrong spot. We have to have a different way of accommodating growth.