Improve Lives Through Pressure Injury Prevention
Share The Benefits!
Our goal is to empower you to serve your patients better. That is why we are providing everything you need to do this yourself confidently.
1. Important Concepts
There are 2 main concepts of pressure relief in cushions: off-loading and immersion. The Foam Cut Out process is an Off-loading technique. The concept of immersion aims to minimize pressure beneath bony prominences by distributing the pressure more evenly over larger surfaces (Fig. 1). On the other hand, the concept of off-loading involves completely unweighting high-risk areas, such as bony prominences, by recessing the surface beneath the sitting area. This redistribution of pressure directs it toward larger and less bony structures, such as the posterior thighs and trochanters.
Off-Loading
Pressures are redistributed to soft tissues and trochanters.
​Developed by John Rogers and Dr. Shannon Stauffer, the off-loading technique involves custom-fitting cushions (FCCs) to alleviate pressure on bony prominences by redistributing weight. This method was instrumental in drastically reducing pressure injuries among individuals with SCI and the elderly in nursing homes. Current research, including studies utilizing MRI and pressure mapping, confirms the effectiveness of off-loading cushions like the RIDE™ orthotic-style cushion in preventing tissue deformation and enhancing comfort for individuals with unique anatomical needs.
Immersion
Pressures under pelvis are distributed evenly. ​
The immersion technique, becoming more accessible in the early 1980s with the advent of off-the-shelf cushions, uses mediums like air, gel, or fluid for pelvis support. This method surrounds the bony prominences, allowing for an even distribution of pressure, which is essential in preventing skin breakdown. While this technique provides a broad application for pressure relief, advancements in pressure mapping have shown that it does not effectively prevent tissue deformation, which can lead to pressure injuries.
2. Materials
Sunset Medical
Laminated foam: 1" of 4# foam laminated over 3" of 5# foam with knit nonskid cover. Cushion width should match the wheelchair width. Cushion depth should be 2” shorter than the seat to popliteal fossa (upper leg length) length.
The permanent marker is best able to write directly onto the foam to easily see what to cut.
A simple electric carving knife is all you need to easily cut the foam. We recommend the 9 in Black & Decker but any electric carving knife will work. If possible, bevel the tip of the knife to make a sharp point for easier penetration of the foam.
Use a thin layer trash can liner that is large enough to cover the whole cushion and allow the plastic to be recessed into the cutout. This will protect the cushion from moisture and prevent the plastic from getting taut, thus eliminating any high-pressure surfaces.
Cutting Template
We can provide the measurements for you to easily create your own template you can use for most fitment situations.
3. How-to Videos
Video Case Examples
Initially, Skin Checks After 1-2hrs
After receiving your new FCC it is important to check your skin frequently for the next 24hrs. Conduct an initial check after 1-2 hours. Do not sit longer than 8 hours without checking your skin. If you have a pressure injury, consult your primary physician prior to sitting.
If you have an open wound and are cleared to sit by your primary provider, we recommend a progressive sit regiment by adding a ½ hour to 1 hour to each day.
Frequent Pressure Relief
If no immediate issues, then pressure reliefs are recommended every hour for a duration of 2 minutes throughout every sitting period.
When recovering from a flap surgery, or there is an active pressure injury, perform pressure reliefs every 15 minutes for 15 seconds
Methods
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Depression
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Side to Side
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Forward
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Power or manual seating - "Tilt Back Fully" and then "Recline the back"
Daily Monitoring
Monitor and inspect areas which are at high risk for pressure injuries before you go to bed using a mirror or phone.
Replicating your cushion
In general, your foam cutout cushion should be replaced every year if it is successful. If the cutout is too complicated to replicate, you can trace the cutout with paper to create a template to transfer onto your new cushion.
4. Ongoing Care
5. Resources
Our recommended foam providers.
​​[1] Sunset Medical
Steve DeLeo
Phone: 714 784-6800
Direct: 714 720-6225
[2] Spex
Spexseating.com
[3] Inception Permobil
Email: Erynn Troy PT Erynn.troy@permobil.com
Request Isch dish offloading cushion
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