Product philosophy

At first glance a wheelchair cushion can seem like a very simple product — "it's a cushion you sit on, how complicated can it be?" is a comment we often hear. But the wheelchair cushion is a hugely important part of the user's life: it is the product that carries the user's body for up to 16 hours a day, throughout life. Our bodies are not designed to bear such pressure — on the tailbone, ischial bones and skin, or on the skeleton and back muscles. Even a very small fault, a specific pressure point, or a build-up of heat and moisture can lead to a small skin wound or problems in the back and muscles. Because the user cannot relieve the injured area by simply "not sitting", what at first seems a trivial redness can develop into severe pressure ulcers — or force the user to lie face-down in bed until the wound heals.

We believe the ultimate cushion should be comfortable, soft, pressure-redistributing and relieving, while also being stable and positioning. It is also extremely important that a cushion breathes — that moisture and heat are quickly carried away from the body so the skin does not soften (as after a bath), become oversensitive and break down. At the same time, many users have incontinence, which means many cushions must be "waterproof". Clearly, several of these requirements contradict each other: how can a cushion relieve one area without loading another? How can it be soft yet stable? Incontinence-protected yet optimised to breathe? The truth is that no cushion can do all of this — each individual user must be considered when deciding exactly which cushion is right for them. Is stability more important than pressure redistribution? Is incontinence protection more important than breathability? All of this makes the wheelchair cushion — seemingly simple — a genuinely complex product.

There are, in our view, certain truths that everyone involved with wheelchair cushions should know:

• The cushion must breathe. Within a few minutes the skin becomes irritated if it cannot breathe — over time this leads to serious injury.
• Waterproof incontinence covers protect the cushion — not the user. No incontinence cover breathes as well as ordinary fabric, and some fully sealed covers (e.g. gallon) do not breathe at all. Anyone who has sat on a plastic or rubber seat knows the discomfort, and the feeling of soaked trousers on standing up. Imagine sitting on that material all day on a warm summer's day: the skin becomes moist, sensitive and damaged — and the user ends up bedridden. A significant share of Swedish wheelchair users still sit on rubber or plastic today; we believe this type of cover should be avoided, except possibly in shower and bathing facilities.
• Both the cushion base and the cover must breathe. A breathable cover achieves nothing if the cushion does not breathe — and vice versa.
• To relieve one part of the body, another part must carry more load. The term "pressure-relieving cushion" is meaningless unless it states which part of the seating surface is relieved: a 70 kg person must load the cushion with 70 kg somewhere. To relieve the ischial tuberosities, other parts of the seating surface must carry more.
• Preventing problems is far easier, cheaper and less painful than treating them. When a non-wheelchair-user gets a numb backside, they take a walk — relieving the seat and loading the feet. A wheelchair user does not have that option, other than lying in bed. A small wound under the ischial tuberosities can tie the user to bed for weeks while it heals — entirely unnecessarily, when the right cushion could have prevented it from the start.

At Nimacare we work continuously to design cushions and covers that meet users' needs as fully as possible. We believe a cushion's most important tasks are to carry, stabilise, relieve and position the user — and to breathe. Our cushions are built from open gel cells, polyurethane foam and viscoelastic foam: materials that breathe very well while being soft, supportive, stable and durable — in our view the optimal materials to start from.

We believe a cover's most important tasks are to keep the user in place in the chair, to be comfortable to sit on — and to breathe. We have developed three types of cover: incontinence-protected covers with maximum breathability, ordinary non-protected covers with maximum breathability, and 3D mesh covers with extra-high breathability. Much has happened in material development in recent years — above all fabrics that breathe while being waterproof (most people know Gore-Tex and similar fabrics). This matters greatly for the wheelchair-cushion field, as it allows us to make products that breathe despite being incontinence-protected.