Cushions have three main types of construction and combinations thereof: foam, gel and air. Cushions also come in a variety of shapes and styles: flat, contoured, modular and custom moulded. Stability in sitting is essential to maintain postural control and therefore allow good function.

Creating this stability begins with ascertaining the correct size of cushion through careful measurement of pelvic width and thigh length. The amount of contouring required is then worked out from the postural presentation that we note at assessment. The correct amount of pressure relief is determined by the pressure mapping we do. These three components together will enable us to prescribe the correct cushion for you.

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Sitting for prolonged periods of time can lead to skin and soft tissue damage. The correct cushion that gives good weight distribution and minimal high pressure points will reduce the risk of this damage occurring.

For further information on pressure management we recommend the NICE guidelines for pressure relief.

Pressure mapping is the ability to measure the pressure between two contacting surfaces. TT Mobility have an Xensor pressure mapping system and use this technology to measure the pressure between the body and the seat surface. We can trial and compare different products, particularly cushions, to see which suits you best.

Pressure mapping allows us at TT Mobility to verify our clinical recommendations and ensure best practice in pressure management.

The right back support is important for comfort and postural alignment. Supporting the spine properly prevents future health issues that may arise from sitting incorrectly for long periods of time.

Wheelchair manufacturers offer a choice of back support options with their products. These are standard items and offer basic support. If more support is required there are a range of inserts and accessories that can be added to the standard back of the wheelchair. If following clinical assessment the need for higher level of postural support and comfort is identified then a range of back systems are available.

These can be customised to meet specific individual needs and come in two levels of complexity.

2D These are third party modular systems that can be fitted to any compatible wheelchair and adjusted to suit clinical needs from a variety of seperate components.

3D These are individually custom made back supports used when body shape is complex and out of range of 2D systems.

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Seat systems are when the back support and cushion are integrated to create one unit. They are used when the whole body needs to be supported together and often form part of a 24hr postural management programme.

The key reason for prescribing these seating systems is that adjustments can be made to accommodategrowth and the associated change in posture.

Seat systems can be broadly divided into two catorgies.

Rigid - this is where once is set up it is fixed until the next adjustment is made.

Dynamic - this where components of the system can move to in response to changes in muscle tone and movement.

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There are many styles of manual wheelchair and the appropriate type is based on your lifestyle & activity.

Standard self propelled – these are traditionally designed wheelchairs for all purpose use. They have folding frame with a limited range of sizes and options.

Configurable self propelled – These are an adjustable version of the self propelled wheelchair which are generally lighter in weight. They also have options and accessories to meet more specific
clinical need and comfort.

Active user – These are high specification wheel chairs that are fixed frame, light weight & manoeuvrable.

Passive use – These wheelchairs are designed to be pushed by carers and range from the traditional design up to wheelchairs with tilt in space and comfort seating.

Powered add-on units can be attached to manual wheelchairs. Power packs to help the carer pushing the wheelchair and power assist can help the user to propel themselves.

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Powered mobility enables the user to access activities that otherwise would not be achievable. The drive mechanism of all power chairs are fundamentally the same, as is the wheelbase size. The main differences occur in the functions available and the configuration of the drive wheels. Most power chairs are compatible with the range of seat cushions, back supports and seat systems available.

There are a great number of possible permutations in the specification of a powered wheelchair in order to achieve its maximum potential.

Careful assessment of lifestyle, environment and clinical presentation is required for the prescription of the correct power chair design, functionality and seating.

When considering lifestyle there are power chair options for indoors, outdoors, or a combination of both.

Depending on the layout and space available in the environment the drive wheel configuration affects manoeuvrability. A mid wheel drive chair will cope with narrow tight turns, whereas a front wheel drive will perform well outdoors and rear wheel drive is a good all purpose solution.

Clincal assessment will identify whether you will need options such as powered tilt in space or a seat riser. Other options are available depending on the seating requirements.

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Scooters are used to travel longer distances outdoors in the local neighbourhood or towns. They are generally not suitable for use inside the home or very rough unpaved terrain. Scooters come in two speeds

4mph These can only be used on the pavement. There are different styles in this category, some of which can be folded to go into a car boot

8mph These can be used on the road and therefore need to be taxed with DVLA as a class 3 vehicle. If used on the pavement the speed must be limited to 4mph. These scooters are larger and heavier, and with suspension and a higher ground clearance, the ride quality is more comfortable.

Scooters are suitable for those who can walk short distances, and are confident with their driving skills.

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There is a range of paediatric specific manual and powered wheelchairs with the same considerations as mentioned above. For younger children there are special needs buggies which include the postural support not available in standard commercial buggies.

Paediatric cushions, back supports and seat systems are also available. Some seat systems can be transferable between a static base for indoor use in the home and school and a mobility base for outdoor distances.

With all children's equipment consideration is given to adjustment for growth, use at school as well as at home and importantly, for family lifestyle.

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