ATP Series

Cover Story: Choosing Cushion & Backrest Covers That Mesh with Seating Goals

• By Laurie Watanabe
• Jul 01, 2019

One of the factors that distinguishes complex rehab technology from durable medical equipment is the level of detail in the equipment. When it comes to wheelchairs, that means custom-fitted dimensions such as seat-to-floor heights, seat widths and depths, and placement of the handrim or driving controls to achieve optimal function.

For seating, that precision is applied to positioning systems and components, and to the wheelchair’s seat cushion and backrest. Seat cushions for complex rehab clients are designed to fit several different segments (and HCPCS codes), including skin protection, positioning, skin protection and positioning, and adjustable versions of those types. Aftermarket backrests are available in different heights and with different intensities of contouring to offer more support or less support and positioning as needed.

When seating and positioning is discussed, the bulk of the conversation tends to center on the cushion or backrest itself. But cushion and backrest covers — that most direct interface between the client and the seating — can also affect how successful a seating system ultimately is.

Mobility Management asked Susan Cwiertnia, PT, MS, Director of Medical at VARILITE, about the importance of seating covers.

The Goal of Covers

Covers seem to be such a small detail in a seating system, but Cwiertnia indicated that covers can actually achieve a number of goals, starting with protecting what’s underneath.

“Covers have many functions,” she said, “and one of the most important for both seat cushions and back supports is to protect the cushion inside. The cover protects from dirt, moisture, ultraviolet light exposure and other elements that can degrade cushion materials or impact their function for skin protection and positioning.”

A second goal is to help to manage the temperatures at the cushion/client interface.

“Temperature management is important because increased temperature leads to higher risk of developing pressure injuries,” A newer development in cover technology is the use of specialized materials made to decrease friction and shear — Susan Cwiertnia Cwiertnia said. “It is also important for individual comfort level. Some wheelchair users get uncomfortable and overheat while sitting in their chair because of the seating system. This is especially true for some users that need more positioning support that envelops their body, like a deep contoured back support or custom-contoured seating system.

“The elderly and other individuals can have reduced ability to dissipate heat due to blood vessel or neurological changes.”

Covers Are Not Created Equal

Because cushion and backrest covers have different jobs to do, they are designed differently using different materials.

“Covers can be made from materials to promote passive air flow to assist with temperature management, such as a spacer knit material or larger-pored reticulated foam,” Cwiertnia said. “Often, the covers are made to work specifically with the original cushion they were designed for, so it is important to use the manufacturer’s cover.

“A newer development in cover technology is the use of specialized materials made to decrease friction and shear.”

A cover can also impact how fully the wheelchair user sinks into the seat cushion. That’s where a cover’s ability to stretch comes into play.

“The stretch of the cover is important to allow the cushion to function optimally for skin protection with envelopment and immersion,” Cwiertnia said. “If the cover material does not adequately stretch, it could impact the immersion and decrease the envelopment because the fabric doesn’t ‘give.’ This effect is sometimes called hammocking and could cause increased pressure to develop in critical areas.”

Incontinence Cover Pros & Cons

Moisture resistance is a common and popular option for seat cushion covers, which can be exposed to rain and snow, bodily fluids, and food spills that can damage the cushions themselves. But there are advantages and disadvantages to choosing an incontinence cover.

“Typically,” Cwiertnia said, “incontinence covers use fabrics coated for moisture resistance or to make them water proof to protect the cushion inside. Sometimes, moisture from a spill or incontinence episode can lead to a pooling of fluid on top of the cushion.”

When that happens, she noted, “It is important to clean up the moisture and make sure that the skin surface is dried as soon as possible to prevent skin maceration from the moisture, which could lead to skin injuries.”

The properties that enable a cover to protect against occasional accidents or apple juice spills can also present other challenges and benefits, Cwiertnia added.

“The benefit of the incontinence cover can sometimes be a trade-off because the water-proof fabrics often don’t breathe as well as mesh or spacer knit fabrics and could have increased heat buildup,” she said. “In some cases, because the fabric weave of the incontinence covers is tighter to assist with moisture control, it might be easier for wheelchair users to scoot and transfer due to lower friction.”

Embracing Cover Variety

With so many cover choices available (see sidebar), what’s the best way for a clinician or ATP to select a cover for a particular client?

“The cover choice should be based on the individual’s prioritized needs for skin protection, incontinence and consideration for the environments the seating will be used in,” Cwiertnia said.

And you might consider a “more can be better” approach to covers as well.

“Sometimes one cover style won’t meet all needs all of the time,” Cwiertnia said. “Most people have different coats and jackets for different types of weather, such as a raincoat, light spring coat and a heavier winter coat. Many cushions have interchangeable covers, and investing in extra covers can be a good idea. Having a spare cover also means that the client can still use their cushion while they wash the cover.”

This article originally appeared in the July 2019 issue of Mobility Management.