Q. I’m 58, with 30 years as a T10 para. About five years ago I started getting pressure sores on my ischial areas due to shoulder problems limiting my weight shifts. In hindsight, I should have switched to a different type of weight shift, like leaning forward. I’d never had skin issues before so I’d gotten out of the habit of daily skin checks. This led to multiple hospital stays, major skin flaps, and having both ischial tuberosities shaved down. Now the skin on my butt is so compromised I can only stay up in my chair for an hour or two. Now I’m scheduled for an eval at a wheelchair-seating clinic. Are there any cushion options for people with skin as fragile as mine?
— Cindy

A. Cindy, your story underlines the importance of doing daily mirror-skin-checks. Even with a perfect cushion, a pressure sore can crop up from a variety of skin insults — a bruise, weight gain or loss, or changes in weight shift frequency. Being evaluated at a wheelchair-seating clinic is vital for anybody with frail or aging skin. Although the clinician should be well versed on the latest and best cushion options for your needs, here are a couple cushion options you might want to ask the clinician about:

Aquila SofTech is an alternating pressure air cushion that automatically does weight shifts for you, as often as every 30 seconds. The key to the SofTech — and all Aquila cushions — is two groups of air bladders that alternate pressure from side-to-side via a battery-operated pump, which provides a gentle weight shift. The SofTech cushion is self-contained. It is a water-proof-coated foam cushion with air bladders, air pump and battery integrated into the cushion, which has a total weight of five pounds. All Aquila cushions are designed to prevent bottoming out.

The Aquila cushion pump is surprisingly quiet, similar in volume to the internal cooling fan in a laptop computer. The battery can pump up to 40 hours on a charge. A remote control enables five firmness (air pressure) settings, controls the length of time between air pressure shifts — ranging from 30 seconds to five minutes — and includes a battery status light.

Each Aquila cushion is custom built to address a client’s unique seating needs — from width and depth, number of air bladders, to off-loading areas where there is currently an ulcer, according to Steven Kohlman, Aquila’s president.

A 2014 study published in the Veterans Affairs’ Journal of Rehabilitation Research and Development used high tech instrumentation to look at ischial tissue health of 13 wheelchair users with SCI after using an Aquila alternating pressure air cushion for two weeks, in three-week intervals, for 18 months. The study concluded that the alternating pressure air cushion dynamically and continuously alters [reduces] ischial pressure distribution with sustained and positive tissue health effects compared with performing diligent weight shifts on the subject’s personal cushions.

Eric Schroeder, 42, of La Crosse, Wisconsin, who has spina bifida, spinal stenosis and chiari malformation, fought an ischial pressure sore for three years before it progressed to stage IV and he became bedridden for a year. “I heard about the Aquila SofTech from a surgeon,” says Schroeder. “My wound care clinic sent me to a surgeon because they felt it was time for a skin flap. My surgeon said he had success with several people who had pressure sores that healed while using the Aquila. He said he would rather have me try that route first.”

When Schroeder got his Aquila cushion, he was sitting in his wheelchair for only an hour at a time. His wound healed in three months. “It’s been three years since I got the Aquila and I haven’t had another pressure sore, and I’m up in my chair for 12 hours a day.”

Larry Yenter, 50, of Rochester, Minnesota, 26 years as a C5-6 quad, has been using an Aquila cushion for four years. “Before the Aquila, I kept getting pressure ulcers and tried lots of different cushions to stop them.” Over the years he had three skin flap surgeries with both ischial tuberosities shaved down. “When I heard about the Aquila, I was so excited I paid cash for it. I haven’t had any skin issues since I’ve been on it. Between my job as an accountant and an active life, I’m up in my chair at least 12 hours a day.”
MSRP for Aquila SofTech: $4,300; Medicare approved.

Ride Custom Designs (Aspen Seating) does custom-molded cushions and backs for people with severe skin integrity and/or orthopedic issues who have tried all other options. Aspen Seating requires traveling to their Denver clinic for a complete fit and molded cushion (takes about one week).

Ride cushions are an extension of Aspen seating. The Ride Custom cushion is custom molded to address similar challenges to those addressed by the Aspen Seating cushions, but it is less expensive and can be fitted close to home by working with a certified Ride provider (usually through a DME supplier).

Ride Designs and Aspen cushions protect tissue by transferring weight from high-risk ischial and coccyx areas to low risk areas. They are made of a patented, lightweight, composite material that allows air and moisture to pass through.

“I’ve been using an Aspen Seating system since 2006,” says Paul Callahan, 57, of Newport, Rhode Island, 35 years as a C3-4 quad. Callahan, a two-time Paralympic sailor and CEO of Sail to Prevail, developed pressure ulcers on both trochanters (hip bones) and his left ischium when his previous cushion failed during a race in the 2004 Paralympic sailing trials. “I had skin flap surgery to repair the trochanter ulcers and was told that the only way the ischial wound would heal is to stay off of it, so that’s what I did — stayed in bed for the better part of two years, but the ischium wouldn’t heal.”

Callahan found out about Aspen Seating from a friend. “I checked out the website, called them up and did my research,” he says. Around the same time a wound care nurse had told his wife that she should be prepared for her husband to deal with this the rest of his life.

Callahan flew to Denver and got fitted with an Aspen seating system. “When I got home with the cushion, the most amazing thing happened.  My pressure sore started to heal faster when I was up in my chair, on the cushion, than when I was lying in bed. So I said forget being in bed and returned to staying up in my chair 15 hours a day, and the sore ended up fully healing within a couple of weeks! I won’t sit on any surface without an Aspen seat under my butt — and I’ve remained pressure sore free to this day.”

MSRP for Ride Custom Cushion: $1,590: Medicare approved. Aspen seating system price varies depending on individual seating requirements. Covered by Medicaid and many private insurers, but not Medicare. As always, check with your provider.

A Smart Alternative From ROHO. ROHO cellular-designed dry flotation cushions have a reputation for providing outstanding skin and soft tissue protection, but adjusting and checking proper air pressure is vital to get the most protection from the design. This used to be a challenge for people with higher-level injuries, especially when relying on caregivers. The addition of the Smart Check inflation sensor makes proper pressure checking easier. The sensor, a small electronic device with a short tube and a quick-connect clip, fits onto a valve located on the corner of ROHO Sensor Ready cushions. While sitting on the cushion, you push a button and the monitor shows whether the cushion pressure is too firm, just right, or too soft — making it easy to dial in ideal pressure. The monitor can be tucked into a cushion pouch when connected so you can periodically check cushion pressure.

Presently the Smart Check is compatible with Sensor Ready cushions; ROHO plans on expanding the technology to more products.
MSRP: High and Mid Profile Sensor Ready cushions: $618; Hybrid Elite SR Cushion: $473.25; Medicare covered. MSRP for the Smart Check sensor is $160 and is not Medicare coded.

• Aquila Cushion,  www.aquilacorp.com
• Ride Designs/Aspen Seating,  www.ridedesigns.com
• Sail to Prevail, www.sailtoprevail.org/about-us
• VA Alternating Air Cushion Study, www.rehab.research.va.gov/jour/2014/518/jrrd-2014-01-0009.html
• ROHO, www.roho.com/?s=Smart+Check