Vicair Cushion Research

All you need to know about Vicair wheelchair cushions


In the realm of wheelchair comfort and skin protection, Vicair Wheelchair Cushions stands out on the market due to the innovative technology that comes with the SmartCells system created by the company’s founder.
Designed with precision and crafted for optimal user experience, these cushions seamlessly blend high-performance skin protection with extreme ease of use. Join us as we delve into the features, benefits, and why Vicair wheelchair cushions are the go-to choice for those seeking comfort, stability, and skin protection.

A quick overview of the Vicair wheelchair cushion features:

1. The Vicair Advantage:

Vicair wheelchair cushions prioritize user-friendly high performance. The core advantage lies in their ability to redistribute pressure evenly, providing unparalleled skin protection. This feature is particularly crucial for wheelchair users, as it helps prevent the development of pressure sores and ensures a comfortable sitting experience.


2. Extreme Ease of Use:

One of the standout features of Vicair wheelchair cushions is their extreme ease of use. The design is intuitively crafted to simplify the daily experiences of wheelchair users. Whether it’s getting in and out of the wheelchair or adjusting the cushion for optimum comfort, Vicair cushions make it effortless, allowing users to focus on what truly matters.


3. Pelvic and Thigh Support:

Supporting the pelvis and thighs is paramount for maintaining a stable sitting posture. Vicair wheelchair cushions are engineered to provide optimal support in these crucial areas, enhancing overall stability and reducing the risk of discomfort or injury.


4. Fully Machine Washable:

Hygiene and cleanliness are integral aspects of wheelchair cushion maintenance. Vicair cushions understand this need and are fully machine-washable. This feature ensures that users can easily maintain the cushions, promoting a clean and healthy sitting environment.


5. Tailored for Comfort:

When seeking the highest comfort level, Vicair wheelchair cushions deliver precisely that. The design takes into account the unique needs of each user, offering customizable solutions for an individualized and luxurious sitting experience.


6. Sizes for Every User:

Recognizing the diversity of wheelchair users, Vicair cushions are available in three different sizes. This range allows users to select the cushion size that perfectly suits their body type and personal preferences, ensuring a tailored fit for everyone.


In the competitive landscape of wheelchair cushions, Vicair emerges as a frontrunner, redefining comfort, stability, and skin protection. As we navigate the intricate world of wheelchair accessories, the Vicair advantage becomes clear: an unwavering commitment to user-friendly high performance.


Vicair wheelchair cushion


Get your hands on Vicair Cushion Research

At Morton & Perry, we understand the crucial role occupational therapists play in promoting mobility and comfort for individuals who rely on wheelchairs.

As a gesture of appreciation for your dedication to the field, we have compiled all this invaluable Vicair research into easily accessible documents.

Simply click on the links below to access the wealth of knowledge at your fingertips.



Vicair cushions for active wheelchair users


Sliding & Pelvic Tilt

Uncover the nuances of sliding and pelvic tilt, equipping yourself with the knowledge to address these challenges effectively.

Washability research

Explore the results of our washability research, which will guide you in recommending and implementing proper cleaning practices for wheelchair cushions.

AGIDENS research

Gain insights from our AGIDENS research, providing a holistic view of factors influencing wheelchair cushion effectiveness.

Vicair wheelchair cushions


Microclimate at the skin

Discover the impact of microclimate on skin health and gain valuable insights into optimizing comfort for wheelchair users.

Postural Stability – One pager

Learn how our research can guide you in enhancing postural stability for wheelchair users, promoting comfort and long-term well-being.

Postural Stability – Literature review

Learn how our research can guide you in enhancing postural stability for wheelchair users, promoting comfort and long-term well-being.

Pelvic Obliquity – One pager

Delve into our findings on pelvic obliquity, gaining a deeper understanding of its implications and strategies for effective intervention.


washable wheelchair cushion


Pelvic Obliquity – Literature review

Delve into our findings on pelvic obliquity, gaining a deeper understanding of its implications and strategies for effective intervention.

Cleaning cushion

Access comprehensive information on maintaining optimal hygiene for wheelchair cushions, ensuring the longevity of the equipment and the health of your clients.


Understand the common issues related to wheelchair cushion misuse and equip yourself with strategies to address and prevent them.


Vicair Allrounder


If you have any questions about the Vicair wheelchair cushions, please call us or send us an email to [email protected].

We would love to hear from you.


Experience the Magic of the Independence Mobility Chair Animated Video

The spirit of the season is upon us, heralding a time of togetherness, joy, and celebration. At Morton and Perry, we believe in the power of spreading happiness and enabling everyone to join in the festivities. Our Independence Mobility Chair is not just a product; it’s a beacon of liberation for those facing mobility limitations, granting them the gift of freedom and inclusion in the merriment of life’s moments.

To capture the essence of the sheer happiness and sense of liberation that our Independence Mobility Chair brings, we would like to share a heartwarming animated video. This animation, crafted by our expert team at the Vela HQ offices, beautifully encapsulates the experiences of individuals whose lives have been transformed by the independence this chair provides.

In this enchanting video, viewers will witness:

The Gift of Freedom: Delve into the stories of individuals whose lives have been positively impacted by the Independence Mobility Chair.

Inclusion in Festivities: See how the chair becomes a gateway for users to actively participate in and relish the celebrations and events that once felt out of reach. From family gatherings to community events, this chair empowers individuals to engage and immerse themselves in the joy of these moments.

Empowerment and Smiles: Witness the transformation in the lives of users as they navigate through various activities with confidence, exuding radiant smiles and spreading cheer wherever they go.

This animated video is a representation of the impact that the Independence Mobility Chair can have, not only on an individual’s mobility but on their overall well-being and happiness. It’s a celebration of the freedom and joy that this product brings to those facing mobility challenges.

We invite you to join us in watching this heartening animated video, a visual journey that embodies the spirit of happiness and the gift of mobility that the Independence Mobility Chair bestows. Head to the Vela official YouTube channel to witness the magic this product can bring to individuals’ lives.

As you experience the heartwarming moments in the animation, we hope you’ll share in the joy it brings and recognize the life-changing difference the Independence Mobility Chair can make for yourself or your loved ones.


Watch animation here

How to Use the Independence Mobility Chair in a Step-by-Step Guide

At Morton and Perry, we take immense pride in bringing to our New Zealand products that empower individuals and enhance the quality of life of our people.

Our Independence Mobility Chair is a testament to our commitment to offer innovative solutions for those seeking freedom in their daily lives. Designed with both functionality and comfort in mind, this mobility chair is a game-changer for those looking to regain their independence.

We understand that mastering a new device can sometimes be challenging, especially when it comes to mobility aids. That’s why we are thrilled to share a valuable resource with our customers—a comprehensive tutorial video directly from the manufacturer, detailing step-by-step instructions on how to use the Independence Mobility Chair effectively.

This video serves as a comprehensive guide, carefully crafted by the experts who designed the Vela Independence chair. It covers every aspect of the chair’s features, functionalities, and operation, ensuring that users gain a complete understanding of how to utilize it to its fullest potential. Whether you’re a first-time user or someone looking to enhance your knowledge of the chair, this tutorial video is invaluable.

In this detailed video, you’ll learn:

Operational Functions: Understand each control and its functionality, from steering to speed adjustments, to make your navigation experience seamless.

Safety Measures: Learn about the safety features and precautions to ensure a secure and stable ride.

By watching this video, you’ll not only become proficient in using the Independence Mobility Chair but also feel confident and empowered in your ability to maneuver and operate it effortlessly.

This step-by-step guide is more than just a tutorial; it’s a gateway to newfound freedom and independence for individuals seeking reliable mobility solutions. Whether you’re a user, caregiver, or simply curious about the capabilities of this remarkable product, this video is a must-watch.

Visit our Independence Vela Chair page for more information, or head directly to the Vela YouTube channel to access the tutorial and embark on your journey to independence with the Morton and Perry Independence Mobility Chair.

Watch video here 

Introducing Morton and Perry’s Cutting-Edge Powered Wheelchairs: TA RS and TA LC

Morton and Perry, a leading innovator in mobility solutions, is set to revolutionize the landscape of powered wheelchairs in New Zealand with the launch of their two groundbreaking products: the TA RS and TA LC.

These cutting-edge wheelchairs are not only the fastest in the New Zealand market, boasting a remarkable speed of 15 km/h, but they also stand out as the lowest in the market, designed to offer users unparalleled accessibility and freedom in their daily lives.

Designed with meticulous attention to detail, the TA RS and TA LC are engineered to provide users with an unprecedented level of mobility and independence.

TAIQ RS Morton and Perry

One of the most remarkable features of these wheelchairs is their unique low-profile design, allowing users to navigate underneath standard tables in cafes and restaurants effortlessly. This transformative feature opens up a world of opportunities, empowering users to engage in social activities without the limitations typically imposed by traditional wheelchair designs.

The motor incorporated into these wheelchairs is a marvel of engineering, representing the most potent technology available on the market.

Crafted using cutting-edge European technology, this motor ensures not only exceptional power but also a remarkably smooth ride. This amalgamation of power and seamless functionality delivers an unparalleled experience, allowing users to traverse various terrains with ease while maintaining stability and comfort.

The TA RS and TA LC are not just mobility aids; they are a gateway to a more inclusive and fulfilling lifestyle. Morton and Perry have not only considered the functionality of these wheelchairs but also prioritized the user’s quality of life. By integrating top-notch technology and user-centric design, these wheelchairs empower individuals to lead more active and engaged lives.

LC wheelchair NZ

The significance of these innovations cannot be understated. Morton and Perry’s commitment to pushing the boundaries of what’s possible in the mobility industry has resulted in products that redefine expectations.

These wheelchairs transcend mere functionality; they represent a shift in perspective, offering users the ability to blend seamlessly into social settings and everyday activities, fostering a sense of normality and independence.

In a world where mobility aids are often seen as restrictive, the TAiQ RS and TAiQ LC stand out as beacons of liberation and empowerment.

Morton and Perry’s dedication to innovation has ushered in a new era of mobility solutions, where users can live life on their terms without limitations.

As these incredible powered wheelchairs hit the market, Morton and Perry are poised to transform the lives of many individuals, providing not just a means of transportation but a catalyst for greater societal inclusion and personal freedom.

The TAiQ RS and TAiQ LC are not merely products; they are a testament to the power of innovation and the boundless possibilities it can unlock.

Stay tuned as Morton and Perry redefine mobility and set new benchmarks in the industry, ushering in an era where limitations are a thing of the past, and independence knows no bounds.

To download a brochure for these products, please click the link below:


TA RS brochure

TA LC brochure


Does washing a Vicair cushion affect the pressure redistribution characteristics of the cushion?

Proper cleaning of wheelchair cushions is not only important for maintaining the equipment’s performance and durability but also for promoting user health, comfort, and overall well-being. It plays a critical role in infection control, hygiene, and creating a safe and clean environment for wheelchair users 1.

Unlike many wheelchair cushions that can only be cleaned with a damp cloth, Vicair O2 cushions don’t need any setup or adjustments before and after washing, the cushion can be put in the washing machine entirely, making a convenient feature. Agidens conducted a study to evaluate the impact of washing on the bacterial load of Vicair O2 cushions 2. The study involved washing the cushions in a common household washing machine at 60°C using a standard detergent (Areal), which resulted in a remarkable 99.99% reduction in bacterial load across all areas of the cushion.

In addition to the study of Agidens and since the importance of cleaning wheelchair cushions, we did an inhouse study according to the ISO standard

16840-2, to investigate the influence of washing on Vicair O2 cushions. The effect of washing on the pressure redistribution of the SmartCellsTM is assessed during pressure mapping, the contact area and immersion are the characteristics of interest.

For the study, two Vicair Adjuster O2 cushions, with dimensions 40x45cm, were utilized. The two cushions had SmartCells from the same batch and were uniformly filled to the standard filling grade. The cushions were classified as follows:

  1. Cushion 1: ‘New cushion’, served as a control and was neither washed nor used.
  2. Cushion 2: ‘Washed & used cushion’, washed 24 times and subjected to simulated use between washes.



To simulate real-world conditions, a specialized setup involving SmartCell abrasion was employed. The abrasion procedure entails subjecting the SmartCells to grinding between two pressure-applied plates, which are encased in rubber material. This setup mimics the typical wear and tear that occurs with regular use of a wheelchair cushion.

The cushions underwent a total of 24 wash cycles and were evaluated after the 2nd, 8th, 16th and 24th cycle. To ensure uniformity, both cushions were preloaded 20 times prior to the washing process to facilitate a consistent SmartCell smoothing effect and reaction pattern.

In typical daily usage, cushions are used after washing, leading to SmartCell smoothing. This observation was confirmed by Cushion 2, the washed & used cushion, which exhibited no significant deviations from the new cushion. Contact area variations were limited to a maximum of 3% reduction in contact area for the washed & used cushion in comparison to the new cushion. Immersion levels fluctuated, ranging from a 1.8% increase for the new cushion to a 2.4% increase for the washed & used cushion.

The first time a Vicair cushion is used after washing it can be slightly less flexible (just like your freshly washed jeans), leading to a slightly decrease in contact area and immersion. But this effect is cancelled out by shortly using the cushion, using the washed cushion makes it perform comparable to a new cushion.


It is noteworthy to mention t hat the washing machine should be loaded to only half its capacity with Vicair cushions, as displayed by the symbol on the label, in order to prevent contact between the cushion and the washing machine door, as this interaction could potentially lead to liner damage.

In summary, our findings indicate that the process of washing a Vicair cushion and subsequent usage thereof does not exert adverse impacts on the pressure redistribution characteristics of the cushion. The cushion can be subjected to washing with confidence, a procedure that effectively eliminates 99.99% of bacterial presence.


  1. Conijn, N., Helming, T., Van Der Heyden, B., & Kramer, C. (2023). The importance of cleaning your wheelchair cushion 04.3REV8.23.
  2. Op De Beeck, J. (2023). Test Report Disinfection Wheelchair Cushion.


Is there a risk of bottoming out when using a Vicair cushion incorrectly?

1 Introduction

Vicair cushions provide optimal skin protection when used correctly. But we must also keep in mind that sometimes a cushion is inadvertently placed incorrectly in a wheelchair. The cushion can end up backwards or rotated in the wrong direction in the wheelchair. It is also conceivable that a cushion could end up upside down in the cover, for example after cleaning, and therefore end up unseen upside down in a wheelchair. Incorrect placement can also be due to the fact that a wheelchair is often measured with two fingers (4cm) of space between the user’s calves and the front of the cushion. Thus, the cushion may be placed so far forward that it touches the user’s calves. For wheelchairs with an open back support, the cushion may also be placed too far to the back of the wheelchair.

Therefore the aim of this research was to find out what the risks are for the user when a cushion is used incorrectly. It is important to research whether there is bottoming out and how well the risk zones are protected against high-pressure forces. Bottoming out is defined as the state of support surface deformation beyond critical immersion whereby effective pressure redistribution is lost (EPUAP/ NPIAP guideline).


  1. Method

To answer the research question 6 different cushions are tested with the ISO indenter and skinny indenter. The following cushions were tested for this study: Vicair Adjuster O2 10cm, Vicair Vector O2 10cm, Vicair Active O2 9cm, Vicair 4 8cm, Jay J3 and ROHO Quadtro Select High Profile. These cushions were 40x45cm or the size closest to that. The Vicair cushions and Jay J3 are tested out of the box, the ROHO is adjusted to the corresponding testing weight. After loading 65kg with the ISO indenter, for 5 minutes, pressure distribution and immersion was measured in the positions:



  • Correct;
  • Rotated 90 degrees clockwise;
  • Backwards;
  • 4cm forward;
  • 4cm backwards;
  • Cushion upside down in cover;
  • Cushion & cover upside down is only tested for Vicair Active O2 and Vicair 4.



The immersion was also measured in all positions with the skinny indenter with a load of 130 kg to simulate a worst case scenario.

The pressures were measured (Xsensor pressure sensor mat) at five locations. These places correspond to the position of the tuberosities ischii left (LIT) and right (RIT), the trochanter major of the femur left (LGT) and right (RGT) and the coccyx bone.




3.1 Results

For the overview of all the results see table 1 and 2, this section discusses the most striking and important results.

3.1.1 Immersion at 65kg (ISO indenter)

The immersion generally decreases somewhat in improperly placed cushions compared to the correct position. This can be explained by the fact that the indenter does not enter the cushion at the correct position. The exception to this, is the test in which the cushion was placed 4cm too far back. With the Vicair Adjuster O2 and Vector O2, there was 1 to 2 mm more immersion but no bottoming out with at least 41mm of space below the lowest point of the indenter (table 1).

3.1.2 Immersion at 130kg (skinny indenter)

To simulate the worst case scenario the skinny indenter is loaded with 130kg, at this high load the limit of 25mm (stated by the Vicair Manual) below the lowest point of the indenter is exceeded in all Vicair cushions, except the Vector. To assure safe use of the cushion the Vicair manual states that the lowest bony prominence should be supported by at least 2,5cm/1” of SmartCells. This prevents the risk that the bony prominence touches the wheelchair seat.

Although the Adjuster and Vector have less than 25mm left (table 2) the pressure does not increase significantly, indicating that the definition of the EPUAP/NPIAP for bottoming out is not yet fulfilled. The Vicair 4 has the lowest immersion space left, 11mm (table 2), this is about the height of 1 SmartCell, increasing the risk of bottoming out. But according to the user manual of the Vicair 4, bottoming out is: “touching the bottom of the cushion with a bony prominence”, this is not the case yet, since there is still a SmartCell below the bony prominence.

3.2 Dispersion index and coefficient of variation

The dispersion index and coefficient of variation give an impression of the pressure distribution on the cushion. The dispersion index looks at the ratio between the high-risk zones that have been chosen and the pressure on the rest of the surface. The coefficient of variation looks at the distribution of pressure across the entire surface.

In almost all measurements, these values worsened when the cushion was not positioned correctly. When this was not the case, for example, when the cushion was placed too far back, this was offset by a decrease in contact area and an increase in average pressure. So it is important to assess all values in the whole context.

  1. Conclusion

With loads appropriate to the size of the cushion, there is no chance of bottoming out with improper placement of the cushion. With extreme loads, it is more important that the cushion is placed correctly in the wheelchair.

Forward and backward placement has a strikingly large influence on immersion and pressure distribution. It is therefore important that users and therapists are aware that the cushion is placed correctly in the wheelchair. With a correctly fitted wheelchair and an appropriate cushion, there is the possibility that the user will place the cushion too far forward in the wheelchair, thus resulting in inferior pressure distribution and immersion, but without creating any risk for the user.

If the cushion ends up upside down in the cover, this has a major impact on the performance of the cushion. The contact area decreases and the average pressure increases. It is therefore important that the risk of this is properly addressed with communication in the manual, quick installation guide and on the cushion itself. However, the risk of bottoming out is really small, and with that the risk of any damage to the user as a result of the misuse of the cushion.

How effective is washing your Vicair wheelchair cushion?


vicair washable cushions

Washing Vicair products at 60°C with a mild detergent reduces the bacterial load by 99.99%, as demonstrated in recent tests conducted by Agidens, and an independent test centre in Belgium specializing in process and cleaning validation (Agidens test report disinfection wheelchair cushions – 2023, written by (Op De Beeck, 2023))1.

Three Vicair cushions, namely the Vicair Adjuster O2, Vector O2, and Vicair 4, were tested by Agidens for bacterial load reduction after washing. To demonstrate disinfection capabilities using a washing program on a common household washing machine together with laundry detergent (Areal Colour).

The Vicair 4 cushion was included due to its “hidden” zippers, which may be more prone to contamination. As opposed to the two other cushions, the top and bottom sides of the Vicair 4 are both made of the same polyester fabric with a polyurethane coating, and there are no Velcro strips on the bottom side.

Eleven different test locations on the cushion, including difficult-to-reach areas, were identified as worst-case scenarios. After washing the cushions for one hour at 60°C, there was on average a remarkable 99.99% reduction in bacterial load across all test locations.

While the zipper and Velcro of the Adjuster O2 and Vector O2 cushions posed slightly more challenge for disinfection, they still achieved at least a 99.99% reduction in bacterial load. Except for the zipper of the Adjuster during run 3, with a bacterial load reduction of 99.988%, this was the location with the lowest reduction. At 2/3th of the locations (Liner [top, bottom, grooves, outside, and inside], SmartCells, and compartment walls), the bacterial count after washing was less than <10 CFU/ml (colony-forming units per ml), indicating no countable residual bacterial load.

Notably, the test showed no significant difference in disinfection efficacy between professional detergent and common household detergent.

The effectiveness of cleaning products is expressed in a log reduction. This means that the difference in the amount of bacteria load before and after cleaning or disinfection is considered. Log 1 indicates that 90% of the bacteria have been killed, log 2 represents 99%, log 3 is 99.9%, log 4 is 99.99%, and so on.

The log reduction achieved during all three runs was similar across all test locations. On average, the disinfection phase lasted 10 minutes, with temperatures ranging between 57°C and 61°C. A log reduction of 4 (equivalent to a 99.99% reduction in microbes) is generally considered sufficient for Class 1 medical devices. Except for the zipper of the Adjuster O2 cushion during run 3, the desired reduction was achieved at every test location of all cushions during the three runs.

The literature review “the importance of cleaning your wheelchair cushion” showed that a log 3 or 4 reduction is generally considered as being sufficient for Class 1 (low risk) medical devices.2 This indicates that a common household washing machine, in combination with laundry detergent, effectively cleans even the most challenging-to-disinfect areas of the cushions, making it suitable for this type of medical device. The open design of the cushion facilitates the easy penetration of water and detergent into the compartments and SmartCells 1, which is why the cushions can be cleaned effectively.


  1. Conijn, N., Helming, T., Van Der Heyden, B., & Kramer, C. (2023). The importance of cleaning your wheelchair cushion 04.3REV8.23. 2. Op De Beeck, J. (2023). Test Report Disinfection Wheelchair Cushion.

The effects of misuse of your wheelchair cushion


It is estimated that 10% of the population are people with disabilities. About 10% of the people with a disability require a wheelchair.

A wheelchair is appropriate when it meets the individual’s needs and environmental conditions; provides a proper fit and postural support based on sound biomechanical



One element of postural support is the wheelchair cushion. Wheelchair seat cushions are designed to provide comfort and aid against pressure injury development. To aid against pressure injuries, cushions are designed to reduce extrinsic risk factors known to increase the risk of pressure injuries, such as pressure and shear.


Manufacturers of wheelchair cushions should specify the an exact description of the intended purpose in the device’s instructions for use and should specify contraindications, warnings, and precautions.


Four commonly used wheelchair cushions are foam, foam/gel, interconnected air cell, and compartmented air cell cushions. Their instructions for use differ based on intended use/indications, expected lifetime, and precautions.

However, despite the clear instructions in the instructions for use of wheelchair cushions, there is still a risk that a wheelchair cushion can be misused with all the detrimental consequences that can result from misuse, primarily pressure injuries (PI’s), skeletal deformation, and loss of function.


 Risks of misuse of a wheelchair cushion

Healthcare professionals, clinical educators, carers, but also patients must be aware of how to apply a medical device in accordance with the instructions for use and the potential risk of developing a Device Related Pressure

Injury (DRPI) if medical devices are not applied correctly. This is particularly important in the community setting. Devices should be carefully selected to ensure a good fit with the user’s anatomy and contours. It should also

be possible to be able to adjust them in response to changes in tissue characteristics, volume, and contours.


Misuse of a wheelchair cushion could also lead to accelerated aging or failure of the cushion.


 Factors influencing misuse of a wheelchair cushion – disregarding the instructions for use

Wheelchair cushion manufacturers disclose in their instructions for use the maintenance of the cushion and when there is potential cushion failure. When an individual does not adhere to the instructions in the instructions

for use, this is considered to be misuse. Furthermore, these instructions for use instruct when and how to check for bottoming out, if an individual continues to use the cushion when bottoming out has occurred, this is also

considered as misuse and discouraged by wheelchair cushion manufacturers.


 Continuing use while cushion shows fatigue

After 6 month of use, 70% of foam wheelchair cushions show signs of fatigue. When a foam cushion ages, interface pressure magnitudes tend to rise over time.

If a cushion is used after the cushion has started to show material fatigue, the user is at a higher risk of developing pressure injuries since the cushion age has an inverse

relationship with cushion performance.

One study found a PI incidence of 26.4% in wheelchair users with chronic Spinal Cord Injury (SCI) and reasoned that this might be due to prolonged use of a foam cushion.

Foam cushions are not durable and deteriorate over time, even without use, and therefore should be changed more frequently (e.g. every six months instead of yearly).

The study by Kovindha et al. is not the only study that found prolonged use of a foam cushion. A study by Sumiya et al. found that foam cushions can be used upwards of 4 years before being replaced. This means

that cushions that are profoundly deteriorated, are still being used, which could lead to unacceptably high interface pressures.


 Over- or underinflation of air-filled cushions

Air-filled cushions, specifically rubber designed cushions with multiple air bladders, are at risk of over- or underinflation. When a wheelchair cushion is over-inflated, there is less immersion and envelopment, which

can lead to stability issues, higher interface pressures, and an increased risk of pressure injuries. When a wheelchair cushion is underinflated, this can lead to bottoming out, which also puts the user at a higher risk

of developing pressure injuries because tissue is not suspended in the material and hits the bottom of the wheelchair. Furthermore, the bladders of these cushions can be punctured or burned, rendering them useless.11 12



Unfortunately, there was very little literature on misuse. Therefore, we had to rely heavily on other search engines such as google scholar, but also on experts in

the fields. Despite all our efforts, we could include only seven studies in this review.

When we asked experts in the field for possible relevant literature, we were able to include fourteen articles to assess for eligibility based on the text.


Assess the incidence of misuse of a wheelchair cushion 

Only one of the seven studies (Key et al.6) reported the incidence of misuse during a visit at the seating clinic. Of the 166 patients included and followed-up by Key et al., 4

patients were reported to misuse their cushion.

However, these incidents of misuse were only caught during a visit at the seating clinic. Therefore, incidents of misuse outside of the seating clinic were not caught, which could mean that the true incidence of misuse is

higher than Key et al. reported.

Anecdotal evidence corroborates this suggestion.


Several experts in the field reported about wheelchair users they met whose cushions were placed in the wrong orientation or even upside down and came to them complaining about discomfort. Therefore, the true

incidence of misuse remains unknown.


 Assess the risk of misuse of a wheelchair cushion

We found one extensive review on device related pressure injuries (DRPI) which, although it was not specifically on wheelchair cushions, provided extensive evidence on increased risk of development of pressure injuries

when a device provides pressure and/or shear at the skin-device surface.7 We feel comfortable extrapolating these results to misused wheelchair cushions, since an offloading cushion that is sat upon whilst in the wrong

orientation, can possibly increase shear and compressive forces, leading to an increased risk of pressure injuries.

However, it can also lead to minor complications such as discomfort and backpain or neck pain resulting from poor posture.


Assess factors influencing misuse of a wheelchair cushion

This was the only aim that was somewhat satisfactorily met since we found the most literature on factors influencing misuse. Although the factors identified by these studies are very important and should be taken seriously, due to the low amount of data, this is probably not the complete picture. Experts in the field might be able to add factors to the list that are not identified in this review, but are encountered in their work.

All factors influencing misuse boil down to the same thing, not following the instructions for use as specified by the manufacturer



Therefore, this implies that a lot of incidents of misuse can be prevented by a sufficient understanding and following the instructions for use, especially the ‘use’ and ‘caution’sections of instructions for use, and in the case of foam cushions also the ‘expected lifetime’ section. However, there could be several reasons why an individual does not adhere to the instructions for use. Firstly, the instructions for use could have not been provided with the cushion. Secondly, the wheelchair user is unable to understand the instructions for use due to language barriers, intellectual disabilities, or learning disabilities. These reasons are very serious, and action should be undertaken to decrease the risk of misuse. Possible solutions could be graphic presentation of the steps one needs to undertake to correctly use the cushion, short video’s explaining how to use the cushion, or 1-on-1 instruction of the wheelchair user and/or caregiver.


Future directions

There is very little literature regarding misuse of a wheelchair cushion. Since proper use is needed to achieve pressure and shear reducing properties, more scrutiny is needed regarding misuse.




Misuse or improper use of a wheelchair cushion can be a cause of the development of pressure injuries. Especially when the wheelchair user has both physical and intellectual disabilities. All Vicair cushions are provided with a Quick Installation Guide which depicts the installation steps, skin checks with pictures and a QR code linking to the user manual.

The Vicair 4 wheelchair cushion consists of four compartments of equal size. This cushion can be placed in the wheelchair in any orientation, even upside down, without affecting the pressure redistributing, positioning,

and microclimate control properties. Therefore, a Vicair 4 should be considered when there is a risk that the user will misuse their wheelchair cushion.


Larissa de Groot | 04-2021 | 02.12REV4.21


Moisture at the skin cushion interface in wheelchair users

The skin performs a variety of important physiologic roles including protection from environmental exposure, preservation of internal homeostasis and thermoregulation amongst others. [Gray, 2011]

Moisture associated skin damage (MASD) pathophysiology is related to both recurrent chemical and physical irritation to the skin barrier, triggering inflammation and subsequent skin damage.


Multiple factors have a negative impact on the skin barrier function, including: chemical irritants in urine and feces, changes in skin surface pH, associated microorganisms, repeated skin cleansing activities, an occlusive perineal environment (due to the use of incontinence pads), and mechanical factors such as friction.


Exposure to moisture affects the integrity of the outermost layer of the skin which makes the skin more vulnerable to friction and skin tears. [Bostan, 2019]

Prevention and treatment of MASD include the removal of occlusive conditions, gentle skin cleansing, skin protection, and the application of therapeutic ointments. [Collier, 2016; Lumbers, 2019]


However, moisture management at the skin cushion interface should not only focus on personal hygiene but also on moving moisture away from the skin cushion interface.


Support surfaces with a microclimate management function show significantly lower skin hydration levels. [Denzinger, 2020]


Vicair O2 cushions, which have a perforated liner, are effective in moving away moisture from the skin cushion interface. This effect becomes even more apparent when a top cover is used.


The dissipation of moisture by the Vicair O2 cushions is so effective, that within 1hr, wet spots appeared on the surface underneath the cushion. [Call, 2016 (unpublished)]


Wheelchair cushions are often covered with incontinence covers to protect the cushion against moisture.

However, prolonged exposure to moisture makes the skin more vulnerable to MASD and pressure injury development. Therefore, the focus should be shifted from protecting the cushion against moisture to protecting the wheelchair user against moisture to prevent MASD and pressure injury development.


Postural stability and the effects of wheelchair cushions

Postural stability refers to the continuous process of postural changes during sitting. The capacity to maintain postural stability in a sitting position is a prerequisite to performing activities of daily living (ADLs) and reducing the risk of shoulder injury, but also social functioning, satisfaction with the equipment, and thus quality of life.

Deficits in postural stability can severely limit performance in these aspects of life. [Dean, 1997; Riley, 1995; Dyson-Hudson, 2004; Trefler, 2004]

There are several contributing factors to obtaining and retaining postural stability in a sitting

position, namely trunk strength, large base of support, anterior pelvic tilt, thigh support and

back support. Anterior pelvic tilt and thigh support can both be achieved using an appropriate

wheelchair cushion.

Several studies have been aimed at examining the influence of seat cushions on postural stability in sitting. These studies used interconnected air cell cushions, contoured foam cushions, and flat foam cushions, and one study also used compartmented air cell cushions: the Vicair Adjuster O2 and the Vicair Vector O2. [Assaoui, 2001; Vreede, 2018 (master dissterdation); Springle, 2003].

Both Vicair cushions allowed participants to reach significantly further on seated functional reach tests compared to the other cushions that were examined, which is indicative of increase of postural stability.

Postural stability is an important factor for independence and social functioning, which leads to an increase of the quality of life experienced by wheelchair users. Furthermore, the role of trunk control of shoulder injuries may be an important consideration in mitigating injury and improvement of wheelchair propulsion.

Therefore, the selection of an adequate wheelchair cushion is of utmost importance to ensure a satisfactory quality of life for wheelchair users. An increase of postural stability in a sitting position can be obtained by using a compartmented air cell cushion (Vicair, Wormer, The Netherlands).


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