Improve Lives Through Pressure Injury Prevention

Physical therapist with patient in wheelchair

Share The Benefits!

Our goal is to empower you to serve your patients better. That is why we are providing everything you need to do this yourself confidently.

1. Concepts 2. Materials 3. How-to Videos 4. Ongoing Care 5. Resources 6. Join Network

1. Important Concepts

There are 2 main concepts of pressure relief in cushions: off-loading and immersion. The Foam Cut Out process is an Off-loading technique. The concept of immersion aims to minimize pressure beneath bony prominences by distributing the pressure more evenly over larger surfaces. On the other hand, the concept of off-loading involves completely unweighting high-risk areas, such as bony prominences, by recessing the surface beneath the sitting area.

Off-Loading

Pressures are redistributed to soft tissues and trochanters.

Developed by John Rogers and Dr. Shannon Stauffer, the off-loading technique involves custom-fitting cushions (FCCs) to alleviate pressure on bony prominences by redistributing weight. Current research, including studies utilizing MRI and pressure mapping, confirms the effectiveness of off-loading cushions in preventing tissue deformation.

Immersion

Pressures under pelvis are distributed evenly.

The immersion technique uses mediums like air, gel, or fluid for pelvis support. While this technique provides a broad application for pressure relief, advancements in pressure mapping have shown that it does not effectively prevent tissue deformation.

2. Materials

Foam Cushion— Sunset Medical

Laminated foam: 1" of 4# foam laminated over 3" of 5# foam with knit nonskid cover. Cushion width should match the wheelchair width. Cushion depth should be 2" shorter than the seat to popliteal fossa length.

Permanent Marker

The permanent marker is best able to write directly onto the foam to easily see what to cut.

Electric Knife

A simple electric carving knife is all you need to easily cut the foam. We recommend the 9 in Black & Decker but any electric carving knife will work.

Trash Can Liner

Use a thin layer trash can liner that is large enough to cover the whole cushion and allow the plastic to be recessed into the cutout. This will protect the cushion from moisture.

Cutting Template

We can provide the measurements for you to easily create your own template you can use for most fitment situations.

3. How-to Videos

Step 1

Cutting the Foam

Step 2

Trochanter Cutout

Step 3

Palpation for the Ischial Tuberosity and the Trochanter

Step 4

Palpation for the Ischial Tuberosity and the Trochanter

Video Case Examples

Case 1

T2 Paraplegia Fixed Right Pelvic Obliquity

Case 2

T2 Paraplegia Multiple Co-factors

Case 3

C6-7 Tetraplegia

Case 4

Limited Hip Range of Motion

4. Ongoing Care

Initially, Skin Checks After 1-2hrs

After receiving your new FCC it is important to check your skin frequently for the next 24hrs. Conduct an initial check after 1-2 hours. Do not sit longer than 8 hours without checking your skin.

Frequent Pressure Relief

Pressure reliefs are recommended every hour for a duration of 2 minutes throughout every sitting period. When recovering from a flap surgery, perform pressure reliefs every 15 minutes for 15 seconds.

Daily Monitoring

Monitor and inspect areas which are at high risk for pressure injuries before you go to bed using a mirror or phone.

Replicating Your Cushion

In general, your foam cutout cushion should be replaced every year if it is successful. If the cutout is too complicated to replicate, you can trace the cutout with paper to create a template.