Those of us with some form of paralysis know that a proper wheelchair cushion is crucial to help avoid pressure sores. However, for skin protection, having the right wheelchair cushion is only part of the equation. During our daily lives we sit on a variety of other surfaces that we may not think of in terms of cushioning, but should. Here are some “skin danger culprits” and options to cushion them and protect your skin.
In the Bathroom
Depending on skin integrity and how bony your butt is, sitting on the hard surface of a standard toilet seat presents a daily pressure sore danger. You may want to consider going to a padded raised toilet seat, which can be purchased for around $89. Allen Fiske, a T11-12 para, tried the padded toilet seats available at hardware and big box stores; however, he found they have harsh edges that dig into skin. Then Fiske found the “Cloud Soft Padded Toilet Seat” that retails for $98 (see resources). “It’s perfect,” he says. “Looks good, plenty soft, and after two years doesn’t show any wear.”
This writer prefers the ROHO Toilet Seat Cushion (suggested retail $268). It provides great skin protection and quickly deflates to take up minimal space for travel or visiting friends.
Tubs and shower benches also represent potential skin danger, especially when traveling. Shower benches in accessible rooms are usually rock hard and often have drainage grooves with hard — almost sharp — edges in them. A quick and easy improvised pad is one or two folded towels to sit on. Since I have no muscle protecting my butt, I use a ROHO adaptor pad (suggested retail $144) on shower benches. The 9.5-by-13.5-inch pad only weighs half a pound, towel dries in about 30 seconds and easily fits in a wheelchair daypack.
The base of a tub can also pose dangers. A smooth tub base can become slippery, especially with soaps and shampoos, which could cause a slip and result in a bump or bruise on an ischium (sit bone), or worse, a broken bone. Tub bases that are “textured” to prevent slipping can cause scrapes to an ischium or coccyx (tail bone). Again, a towel on the base of the tub makes a quick fix. A bath mat provides safer traction but has a little less padding.
For skin protection in the tub, New Mobility editor Tim Gilmer, a T11 para, fills an inflatable rubber “donut” cushion ($15 retail) with water, so it stays on the bottom of the tub. Drain the water out, and it rolls up to easily fit into luggage.
Arguably the most serious skin danger one may encounter when visiting friends are the sword-like tracks of sliding shower doors. This is another area where a bathmat — draped over the tracks — becomes a big safety feature. Draping a folded towel over the tracks also works, but the towel can slip, leaving you sitting on the tracks.
Sports and Recreation
A good skin protection option for activities outside your wheelchair is a strap-on style cushion that consists of a sling seat over a cushion, a strap that goes around the waist and straps for each thigh.
Kristy Hruzewicz, 38, in her 18th year as a T4 para, is an avid sailor who uses a Jay Protector strap-on cushion when she is sailing. “I also use a foam and gel cushion on my handcycle and on my cross country ski,” she says.
Fiske is also an avid sailor, and he lives aboard his 38-foot sloop, something he is able to do thanks to a custom molded Ride Designs strap-on cushion (an expensive option but many consider it the best protection). “Three years ago I underwent my second major skin flap surgery, and the doc said I’d have to give up my boat because it would be too hard on my skin. I’ve been back on my boat for two years, and thanks to the Ride Designs cushion, my skin looks great,” he says.
For this writer, the Vicair AllRounder strap-on cushion fits the bill. The cushion has separate chambers filled with individual air cells that can be moved to provide a custom fit. I use the AllRounder in adventures ranging from horseback riding, off-road handcycling, sailing and adventure racing to sitting on the floor playing with my daughter, Sarah, and service dog, Schatzie.
Car seats aren’t designed with skin protection in mind, so it is a good idea to sit on your wheelchair cushion in the car. Even better, use your old cushion as a dedicated car seat cushion when you get a replacement. Another option is to modify an old cushion to fit your car seating needs. Gilmer did this when he got a new cushion. His old cushion was a ROHO Nexus Spirit. He removed the low profile air cushion from its foam base and put it into a ROHO LTV cushion cover. “It works great as a car cushion, and I also use it when I’m flying since my high profile cushion makes me sit too high in the cramped airplane seat.”
For Mark Wellman, a 53-year-old T12 para, long drives are part of his job. He tows his climbing wall to put on adaptive climbing clinics around the country. Wellman uses a Ride Designs custom molded cushion for his truck. “It’s too easy to develop a pressure sore on long drives and I’m not taking any chances. With the Ride designs cushion, I don’t have to worry,” says Wellman.
Last but not least, the most important piece of equipment for skin protection is a mirror. Check your skin with a mirror every evening and morning for signs of trouble — areas of skin that are red, pink or otherwise discolored. Checking skin and addressing warning signs is the best way to prevent skin breakdown.
• Air Travel 101
• Cloud Soft Padded Toilet Seat
• Jay Protector
• Padded Raised Toilet Seat
• Inflatable Rubber Cushion
• Ride Designs
• ROHO Toilet Seat Cushion
• Vicair AllRounder