Why the right cushion matters
Most pressure damage in wheelchair users begins where the body meets the seat. The ischial tuberosities — the two bony points you can feel when you sit on your hands — carry a huge amount of load, and if that load is not spread or regularly relieved, skin and deeper tissue can be damaged within hours. For families and carers, a cushion is not a comfort accessory. It is a piece of medical equipment, and choosing between foam and air is one of the most practical decisions you will make.
Both types work well. Neither is universally better. What matters is how the person sits, how much they weigh, how much they can shift their own weight, and how vulnerable their skin is.
Foam cushions: light, simple and dependable
Foam is the mainstay of everyday seating. These cushions are light, need no pump, cannot puncture and are easy to lift on and off a chair or into a car.
- Best for: people at lower or moderate risk of pressure damage, those who can reposition themselves, and anyone who needs a spare cushion that works without fuss.
- What to look for: high-density or contoured foam, or a moulded shape that supports the thighs and relieves the sitting bones. Flat, basic foam is rarely enough for a full day in a chair.
- Watch out for: foam compresses over time. A cushion that felt supportive a year ago may now be bottoming out, leaving the sitting bones close to the seat base. Check for flattening, cracking or loss of shape, and expect to replace a well-used foam cushion roughly every 12 to 18 months.
- Heat and moisture: foam traps warmth and moisture against the skin, which softens skin and raises the risk of damage. Breathable covers help, as does a change of clothing if someone perspires heavily.
Foam is also the safer choice for anyone who cannot be relied upon to keep an air cushion correctly inflated.
Air cushions: adjustable support for higher risk
Air cushions spread load across many small cells, so they can be tuned to suit the individual. That adjustability is their great strength and their main weakness.
- Best for: higher skin risk, previous pressure damage, limited ability to reposition, uneven posture, or a need to fine-tune support under each sitting bone.
- Types: single-compartment (often called static) air cushions suit most users; alternating or multi-section designs can help those who sit for long periods without moving.
- Inflation is everything: too firm and the cushion behaves like a board; too soft and the body sinks until it touches the base. Most cushions are set with the user sitting in them. A common check is to slide a flat hand under the heaviest contact point and feel for roughly 1 to 2 cm of clearance — always follow the instructions supplied with your own cushion.
- Watch out for: punctures, leaking valves and gradual loss of pressure overnight. Check the cushion daily and keep a repair kit or spare to hand.
- Weight and handling: air cushions are often heavier and more awkward to carry, which matters if the user or carer lifts the cushion in and out several times a day.
Matching the cushion to the person
Work through the following questions, ideally with a clinician who knows the person well:
- Skin risk: has there been redness, a blister or a previous pressure ulcer? If so, lean towards air or a hybrid design.
- Posture: a tilted pelvis, a curved spine or one hip higher than the other can make a standard foam cushion uneven. Adjustable air may compensate better.
- Weight and build: every cushion has a weight limit. A heavier user on soft foam will bottom out quickly.
- Independence: can the person shift position, do a pressure lift, or use a tilt function? If not, the cushion has to do more of the work.
- Practicalities: transport, storage, and whether carers can manage inflation and daily checks without difficulty.
Practical pressure care day to day
Whichever cushion you choose, the daily habits matter just as much:
- Check the skin at every transfer, and at least twice a day, looking for red patches that do not fade within 20 minutes. Report these promptly to a nurse or therapist.
- Encourage a weight shift every 15 to 30 minutes, or use tilt and recline if the person cannot manage it themselves.
- Keep the cushion clean and dry, and follow the manufacturer's washing instructions for the cover.
- Store spare cushions flat, away from radiators and direct sunlight.
- Keep simple records — photographs and short notes help a nurse or therapist spot changes early.
Getting a proper seating assessment
In the UK, a wheelchair service, community occupational therapist or tissue viability nurse can assess posture, pressure risk and cushion suitability, and can often provide equipment through the NHS. Ask for a review if the person's weight, posture, continence or mobility changes, or if you notice red marks that were not there before. A cushion is only one part of pressure care, but getting it right makes everything else considerably easier.
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