What type of cushion to use is one of the most important decisions you make when setting up your wheelchair. The right cushion can keep your skin safe, improve your posture and enhance your stability. The wrong cushion can lead to pressure injuries, spasticity and pain.

Cushions come in all different types, from foam, to air, gel, honeycomb, custom and more. So which is the best for you? Like with most mobility aids, the best wheelchair cushion depends on your body, your level of mobility and your daily life. Here are nine things to consider when getting your next everyday wheelchair cushion.

Pressure Relief

This is what my rehab therapist told me to put “on the top” of the list. Joking, but it’s true. Pressure relief is often the top concern of therapists who do seating evaluations. If you have limited or no sensation, have dealt with pressure injuries before, or have difficulty repositioning yourself, finding a cushion that evenly distributes pressure is critical to keeping pressure sores away.

Custom cushions like Ride Designs Custom 2 (see Cushion Types, below) often show the most even pressure mapping — where you sit on an electronic pad that plots areas of low and high pressure. ROHO air cushions come in a close second. Important note: Many wheelchair users overinflate their air cushions, which helps stability but negates the pressure distribution benefits. For proper pressure relief, you have to sit in the air cells, not on top of them.

Gel cushions, like the ubiquitous JAY J2, often score in the midrange for pressure relief, as do lesser-known Supracor Stimulite cushions made from a rubberlike honeycomb structure. Off-the-shelf foam cushions often score worst for pressure relief, but there are huge variations based on the shape, density and contour of the foam. Pressure mapping of different materials can vary a lot based on your body type and seating position. So, if pressure relief is your primary goal, it would be ideal to map a variety of cushions with a qualified therapist.

Stability

When you transfer off the pressure map and go about your day, stability becomes an important part of selecting the right cushion. A high-profile ROHO that maps great and feels good when you’re upright might lose some of its luster when you bend forward to pick something off the ground and the change in pressure vaults you out of your seat. Single-compartment air cushions offer the least stability of any cushion type. Air cushion manufacturers combat this problem by offering cushions that can lock the airflow between different compartments. ROHO offers cushions with two compartments (Dual Compartment) and four (Quadtro Select). Ki Mobility’s StarLock cushion lets you lock the air in every cell. Multicompartment air cushions offer better stability than single-compartment, but they’re still not as stable as most other cushions.

Foam cushions typically offer the best stability. Contoured foam offers more stability than flat foam, and a custom foam cushion like the Ride Designs Custom 2 will lock you into your seat better than any other cushion on the market. (More on this below.) Stimulite and gel cushions also offer good stability. Combination cushions — like the ROHO Hybrid Select, ROHO Hybrid Elite, Vicair Active O2, JAY Fusion with air insert or the Permobil Corpus Ergo Air for power wheelchairs — offer the stability of foam with some of the pressure-distribution benefits of air cushions.

Postural Support

If you have wonky hips, scoliosis or any other postural issues, then postural support or correction can be an important consideration. Most cushion types, whether gel, foam, combination or honeycomb, come with contoured options designed to keep your legs in place and your pelvis in a neutral position. Multicompartment air cushions can also accommodate some postural issues. How well they work depends on your body’s particulars and your level of function. In a nonparalyzed body, muscles do the work of postural support. The fewer working muscles you have, the more you may benefit from external postural supports.

Custom cushions, like a one-off from a seating clinic or one from Ride Designs, can provide excellent postural support and correction. But remember that posture isn’t a static thing: If you’re going with a custom cushion, be prepared to do regular follow-up visits with your seating professional to make sure that your cushion still fits your body. A custom cushion that no longer fits properly can cause pressure injuries, edema and/or increased spasticity. Also, remember that the more postural support you have, the more you’re going to be locked into a single position. This can be great for some. For others who have the function to move around more — like scooting forward in your seat to get dressed or reach for a cabinet — being locked in place isn’t always a good thing.

Transfers

Air cushions suck for transfers. They don’t provide a stable surface for a hand or sliding board when you want to get out of your chair. Of course, this can be overcome with strength and technique, but it does add a degree of difficulty. Foam, gel, honeycomb and combination cushions all provide a more stable surface to transfer from. Cushions with a deep seating pocket — which can be great for pressure immersion, stability and postural support — can also make transfers more difficult because you have to get your butt back out of that pocket.

Durability

With a foam cushion, you should be checking for compression or deformation after a year of use. Of course, they can and do last longer, but the more that foam compresses, the less effective it is for pressure reduction, and uneven compression can cause stability and postural changes. Air cushions can last for years, or you can poke a hole the first week you have it and suddenly be sitting on your seat rails. If you have an air cushion, always have a backup and patch kits — which is doubly important when you’re traveling. Gel cushions used to start getting stiff after a couple of years, although manufacturers say this is less of an issue now. Still, if you have either a gel or honeycomb cushion, it’s a good idea to start thinking about a new one at the two-year mark.

Adjustability/Modifiability

Multicompartment air cushions are simple to fine tune. You unlock the airflow valve, shift your weight and positioning, and lock it again. Vicair cushions, which have compartments filled with air packets, are similarly easy to adjust. To let yourself sink into a section more, remove some air packets. To make a section firmer, add more packets.

You can take an electric carving knife to foam or honeycomb cushions to cut out a section without compromising the integrity of the rest of the cushion. Why would you ever want to do that? Maybe you’re downgrading your cushion from everyday use to sports-only and you need to modify it to fit on a handcycle or in your sports chair. Maybe you’ve had a pressure sore on your coccyx. If you cut a notch where your coccyx normally rests, you can let it free-float.

Combination cushions are difficult to modify, although the air cells at the back do offer some adjustability. Cushions with a gel pocket are also hard to modify or adjust. If you can’t or don’t want to make structural changes to your cushion, Stimulite offers a wedge that you can use to raise the front by 1 or 2 inches.

Cleanability

How you clean your cushion might not be something you think about, but you’ll be happy you did when an accident happens. Air cushions are made from rubber and are easy to spot-clean or handwash. Vicair O2 cushions can be machine-washed, and Stimulite cushions can be machine-washed and machine-dried. Gel cushions tend to have waterproof covers. Some foam ones do, others don’t, so if you have incontinence issues, it’s worth checking. Waterproof covers do inherently limit breathability though. Cushion manufacturers say airflow is important, especially if you can sweat, are active and/or live somewhere humid.

Weight

Weight is an under-discussed consideration for cushions, at least for manual wheelchair users. You can spend thousands of dollars to reduce weight by a few pounds with advanced frame materials but then negate all those weight savings by putting a heavy cushion on it. Don’t choose a cushion solely based on weight — but if you’re waffling between two similar options, the weight can “tip the scales.”
Gel cushions are the heaviest. A 16-inch-by-16-inch JAY J2 Deep Contour weighs a whopping 6.27 pounds. Ironically, some air cushions aren’t that light either. A 16-inch-by-16-inch high-profile ROHO weighs 4 pounds. But Vicair air cushions can weigh as little as 1.6-1.8 lbs, making them one of the lightest cushions out there. Honeycomb and combination cushions are often in the midrange. A Stimulite Contoured weighs 3.25 pounds and a ROHO Hybrid Select, 3.2 pounds. Foam is even lighter. A Ki Mobility Axiom S cushion weighs about 2.2 pounds, depending on size, and a Ride Designs Java comes in at 2.3 pounds. The Ride Designs Custom 2, also foam, comes in at 1.8 pounds.

Price

I know, everything is expensive. Most quality wheelchair cushions retail in the $450-$550 range, which can bring an insurance copay of $100 or more, plus the cost of appointments at a seating clinic. You can find deals at online DME shops if you don’t want the insurance hassle or don’t have insurance, but you’re still going to pay around $350 or more for a good cushion. Although, for less than $100, you can find a simple foam cushion like the Axiom G, or a simple gel cushion like the Elements from Comfort Company.

A custom cushion is only available through a seating specialist and can run into the thousands of dollars.

If you’re broke and without insurance, or the type of person who thinks poorly of the medical-industrial complex, do-it-yourself options are available. You can buy a variety of foam types and densities anywhere from JOANN Fabrics to Walmart, all of which can be cut, glued or duct-taped into whatever configuration you want, although you’ll need to figure out a cover … pillow case anyone? Or you can buy a 2-inch thick hexagon gel cushion off Amazon for $30 and cut it to whatever size you need. DIY is decidedly not therapist-approved, but can be an option for those with good sensation and mobility or if you need a backup or sports cushion without forking over a ton of money.

Final Thoughts

That was a lot. The most important takeaway is that every type of cushion has its pros and cons. Spend some time thinking about what you like about your current cushion, and what you don’t. Think through what considerations are most important to you and try to find a cushion that balances them. Don’t be afraid to ask for help. A good seating specialist, be they a physical therapist, occupational therapist or assistive technology professional, will listen, ask questions and understand that your needs extend far beyond the clinic.