Possible solution found to SMA patient’s discomfort in wheelchair
Different type of cushion could relieve pain and pressure when sitting
One of my patients, Michael, who has spinal muscular atrophy, has continued to experience increased pain and pressure along his coccyx and into his right hip while sitting in his wheelchair all day. He is unable to move his lower extremities independently and is reliant on sitting in his wheelchair during the day and being transferred to his bed when he is unable to sit any longer. Because of this, it is imperative he is comfortable and supported while sitting in his chair.
Michael has been unable to tolerate sitting for extended periods of time since getting a new wheelchair this year. We have attempted several activities to reduce the pain, such as mobilizations and dry needling. These activities help for a few days, but the pain continues and has increased in intensity. With this, we decided it would be best to have the cushion reevaluated in hopes of being able to get a new cushion for his chair.
Two assistive technology professionals (ATP) came to his physical therapy appointment, and with more people available, we transferred him in and out of his wheelchair a few times to test out different cushions. The ATPs had a cushion for Michael to try that performed independent weight shifting. It works by having bladders full of air in different locations throughout the cushion.
At various times, they inflate and deflate to offload different areas of his hips. Although it was awkward in the beginning because of the shifting, over time this seemed to be more comfortable for him.
With this cushion, an app would be added to Michael’s phone so he could control the cushion. He would be able to set the different bladders to inflate and deflate at different intervals as well as completely deflate if he needs to sit lower, such as getting in his car. There would be a few modifications to make it more suited for Michael, such as reducing the thickness and height to ensure he can fit into his van.
Although the process of getting a new wheelchair cushion isn’t quick and easy, Michael has been complaining of right hip and tailbone pain for a few years. We’ve made slight changes with activities, including manipulations and dry needling, once getting his new chair, but the pain always returns. There have been bony changes to Michael’s tailbone and the risk of pressure ulcers continues to increase as he continues to experience reduced adipose tissue in his hips and weight continues to increase into his coccyx, or tailbone.
The process of getting the new cushion started by having the ATPs come out and assist in fitting him for a new cushion. Once that was decided, we as his therapists had to write a letter of medical necessity explaining to Michael’s insurance why he needs a new cushion. We emphasized the risk of him developing pressure ulcers in the future if no change is made. Once that was finalized, it was sent to the ATPs who will fill out paperwork and submit it to insurance.
Patient perspective
Being able to reposition when sitting for a prolonged time is important for someone who spends the majority of their day in a wheelchair. Without the ability to reposition, patients are at a greater risk of developing pressure sores and ulcers. This has been a constant problem for me, and my physical therapist has been working diligently to help.
Trying a new cushion may seem like a minuscule thing for most, but trying a new cushion for someone who has no ability to shift and reposition in their chair is like climbing a mountain. Now that we’ve seemingly found a cushion that will help, I’m hoping and praying that insurance will pay for it, as nearly $8,000 is impossible for me.
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