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Design and Customization of Wheelchair Cushions

By Madison Eckles



Introduction


Assistive Technology (AT) plays a vital role in helping individuals with disabilities live much more independent lives [1]. While wheelchairs usually receive the most attention when discussing mobility support, the design and customization of wheelchair seat cushions are frequently overlooked. For individuals who spend many hours of their days seated, the right seat cushion can help support correct posture, reduce pressure, and improve the overall quality of life.


What Are Wheelchair Seat Cushions and Why Do They Matter?


Wheelchair seat cushions are the supportive base that are between the user and chair itself. The cushions are meant to distribute pressure, support proper posture, and increase comfort. Many individuals rely on these cushions to help mitigate the risk of pressure ulcers which can lead to pain and costly medical care. Pressure ulcers, or now commonly known as bedsores, occur when there is an extended amount of time on tissues under the skin limiting the blood flow; this is most common in bony areas of the body [2]. Some symptoms of this include swelling, changes in skin color and texture, pus-like drainage, and soreness [3]. Research shows that having tailored and customized cushions can redistribute load and reduce injury risk [4].


The Role of Cushion Design and Customization


Not all cushions are equally effective. Flat foam pads may offer minimal cushioning but do not adequately redistribute the pressure, leaving areas such as the tailbone exposed to increased load and an increased risk of pressure injury [5]. Research comparing the custom cushions to standard air, gel and foam cushions shows that custom cushions improve pressure distribution, reducing injury risk. In a recent study, custom-contoured cushions showed lower peak pressure, lower mean pressure, and a larger contact area[6].


These custom cushions are developed by mapping the user’s seated pressure profile and targeting the high-pressure areas by adding additional support where it is needed most. By increasing the total contact area and minimizing the pressure over bony prominences, pressure mapping is designed to better accommodate individual anatomy and sitting posture. 


User Centered Outcomes and Comfort


Beyond pressure metrics, researchers also emphasize the importance of posture support and real-world usability [7]. Not only do custom-contoured cushions redistribute pressure but they can also improve lateral and anterior stability, helping individuals maintain an upright posture. This helps reduce the body movements that can lead to fatigue or any additional musculoskeletal issues [8].


Barriers to Access and Equity


Although there is clinical evidence which supports that custom-contoured wheelchair cushions reduce pressure injury risk and improve posture, many wheelchair users face significant barriers to accessing this customization. Many individuals already face barriers to non-customized wheelchairs, and the lack of cushion customization only exacerbates these barriers [9].


  • Cost: Customized options are often expensive and are not consistently covered by insurance or funding. As a result, many users must rely on standard cushions that may not meet their needs or they must go without appropriate seating altogether due to out-of-pocket costs.


  • Clinical Access: There is limited availability in trained clinics and wheelchair delivery systems restricts access to proper seating assessment. Inadequate follow-up with patients further to contribute to lack of customized options.


  • Awareness: A lack of awareness between users, providers, and policymakers about the benefits of customized cushions reduce the prioritization. Without the adequate education and advocacy, effective cushion customization remains underused. 


Conclusion


Wheelchair seat cushions are much more than just simple padded accessories to wheelchairs, they are a critical component of assistive technology that directly influences user’s health, autonomy and quality of life. Research continues to show that being thoughtful with design and customization, specifically in pressure mapping and user-specific needs lead to improvements in comfort, posture support, and pressure injury prevention compared to a one-size-fits-all approach.


References


[1] World Health Organization. (n.d.). Assistive technology. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/assistive-technology 

[2] Mayo Foundation for Medical Education and Research. (2024, February 22). Bedsores (pressure ulcers). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/bed-sores/diagnosis-treatment/drc-20355899 

[3] Mayo Foundation for Medical Education and Research. (2024a, February 22). Bedsores (pressure ulcers). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893 

[4] Gonzalez-Cely, A. X., Blanco-Diaz, C. F., Bastos-Filho, T., & Rodriguez-Diaz, C. A. (2024). Real-time posture identification system for wheelchair users preventing the generation of pressure ulcers. IEEE Transactions on Human-Machine Systems, 54(5), 546–553. https://doi.org/10.1109/thms.2024.3422267 

[6] De León-Hernández, A., Martínez-Hernández, A., Bolivar-Tellería, I., Bosch-Sánchez, A., Cabrera-Padilla, M. F., & López-López, C. O. (2025). A method for custom-contoured cushion fabrication based on pressure mapping for wheelchair users to prevent pressure ulcers: Feasibility quasi-experimental study. JMIR Rehabilitation and Assistive Technologies, 12. https://doi.org/10.2196/68612 

[7] Hosking, J. (2023). The clinical effectiveness of custom-contoured seating for wheelchair users with Neuromuscular Disorders: A scoping review. Assistive Technology, 37(1), 41–53. https://doi.org/10.1080/10400435.2023.2250404 

[8] Liampas, A., Neophytou, P., Sokratous, M., Varrassi, G., Ioannou, C., Hadjigeorgiou, G. M., & Zis, P. (2021). Musculoskeletal pain due to wheelchair use: A systematic review and meta-analysis. Pain and Therapy, 10(2), 973–984. https://doi.org/10.1007/s40122-021-00294-5 

[9] Gowran, R. J., Bray, N., Goldberg, M., Rushton, P., Barhouche Abou Saab, M., Constantine, D., Ghosh, R., & Pearlman, J. (2021, March 24). Understanding the global challenges to accessing appropriate wheelchairs: Position paper. MDPI. https://www.mdpi.com/1660-4601/18/7/3338 


 
 
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