Why Pressure Injuries Are Serious
Pressure injuries (also called pressure ulcers or decubitus ulcers) are one of the most common and dangerous complications for wheelchair users. They occur when sustained pressure on skin — especially over bony areas — cuts off blood flow, causing tissue damage.
Key facts:
- People with spinal cord injuries have an estimated 25-85% lifetime risk of developing a pressure injury Source
- Severe pressure injuries can take months to heal and may require surgery
- They can become life-threatening if infected
- Prevention is far easier and cheaper than treatment
High-Risk Areas for Wheelchair Users
- Ischial tuberosities (sit bones) — the #1 location for wheelchair users
- Sacrum/tailbone — especially when sliding forward in the chair
- Shoulder blades — from leaning against the backrest
- Heels — from resting on footplates
- Elbows — from armrests
Prevention Strategies
1. Use the Right Wheelchair Cushion
Your cushion is your most important defense against pressure injuries. Types include:
Foam Cushions
Most affordable. Memory foam contours to your body shape. Good for low-to-moderate risk. Replace every 1-2 years as foam breaks down.
Gel Cushions
Gel layer distributes pressure evenly. Stays cooler than foam. Good for moderate risk. Heavier than foam but excellent pressure relief.
Air Cushions
Interconnected air cells that you inflate to the right pressure. Best pressure distribution available. Used by high-risk individuals. Brands: ROHO, Star Cushion. Requires maintenance (checking air pressure regularly).
Hybrid Cushions
Combine foam + gel, foam + air, or all three. Balance comfort, weight, and pressure relief. Popular choices: Jay, Varilite.
2. Pressure Reliefs
Every 15-30 minutes, perform a pressure relief:
- Wheelchair push-up: Push down on armrests to lift your buttocks off the seat for 30-60 seconds
- Forward lean: Lean your chest toward your knees for 1-2 minutes
- Side lean: Lean to each side for 30-60 seconds
- Tilt: If your chair has tilt-in-space, tilt back 45-65° for 1-2 minutes
3. Proper Wheelchair Fit
- Seat width: 1-2 inches wider than your hips
- Seat depth: 1-2 inches shorter than your thigh length
- Footrests: Adjusted so thighs are parallel to the ground
- Backrest: Supports without forcing you forward or back
4. Daily Skin Checks
Check your skin every day, especially:
- Sit bones, tailbone, hips
- Any area that contacts the chair
- Use a mirror or phone camera for hard-to-see areas
- Look for redness that doesn’t fade after 20 minutes of pressure relief
5. Keep Skin Clean and Dry
- Shower or bathe daily
- Use moisture barrier cream on areas prone to sweating
- Change clothing if wet from perspiration or incontinence
- Use absorbent cushion covers
6. Nutrition
Good nutrition is essential for skin health:
- Protein: Aim for 1.25-1.5g per kg of body weight daily, as recommended by the NPUAP/EPUAP guidelines Source
- Vitamin C: Supports collagen production and healing
- Zinc: Essential for cell repair
- Hydration: 8+ glasses of water daily
Stages of Pressure Injuries
The following staging system is based on the 2016 classification from the National Pressure Ulcer Advisory Panel (NPUAP, now the National Pressure Injury Advisory Panel). Source Important: In darkly pigmented skin, Stage 1 redness can be hard to see — watch for skin that differs in color, temperature, or firmness from the surrounding area, and do not wait for classic redness to act. Purple or maroon discoloration is not Stage 1; it may signal a deeper injury (see Deep Tissue Pressure Injury below).
| Stage | Description | Action |
|---|---|---|
| Stage 1 | Non-blanchable redness (erythema) on intact skin. In darkly pigmented skin, redness may not be visible — look for differences in color, temperature, or firmness. Purple or maroon discoloration suggests deep tissue pressure injury instead. | Relieve pressure immediately. Monitor closely. |
| Stage 2 | Broken skin, blister, or shallow open wound | See healthcare provider. Keep clean and covered. |
| Stage 3 | Deep wound extending into fat layer | Medical treatment required. May need wound care nurse. |
| Stage 4 | Deep wound exposing muscle, bone, or tendon | Urgent medical attention. May require surgery. |
| Unstageable | Full-thickness skin and tissue loss where the wound base is obscured by slough or eschar. Stage 3 or 4 will be revealed when cleared. | Urgent medical attention. Do not attempt to remove eschar without clinician guidance. |
| Deep Tissue Pressure Injury (DTPI) | Intact or non-intact skin with persistent non-blanchable deep red, maroon, or purple discoloration, or a blood-filled blister, from damage to underlying tissue. | Relieve pressure immediately. Seek healthcare assessment — DTPI can deteriorate rapidly. |
Shop Wheelchair Cushions at FinalMedic
We carry 34 wheelchair cushions including ROHO air cushions, Jay hybrids, gel cushions, and foam options. Plus wheelchair backs, positioning accessories, and skin care products.
Free shipping across Canada. Need help choosing? Contact info@finalmedic.ca.