If you’ve just bought a powerchair, you’ve probably spent hours obsessing over battery range, motor torque, and folding dimensions. But there’s one part of the chair that often gets ignored until it starts causing real pain: the seat cushion.
Most “out of the box” cushions provided with folding chairs are perfectly fine for a quick 20-minute trip to the shops. But if you’re spending six, eight, or twelve hours a day in your chair, that standard piece of foam can quickly become your worst enemy. In the mobility world, we talk a lot about “pressure sores” or “pressure ulcers,” and they are no joke. Once they start, they are notoriously difficult to heal.
Here is a plain-English guide to choosing the right cushion to keep your skin healthy and your back comfortable.
1. The Risk Spectrum: Where Do You Sit?
Before you buy anything, you need to know your “risk level.” In the UK, Occupational Therapists (OTs) generally group users into four categories:
- Low Risk: You use the chair for short bursts, you have full sensation in your “seat” area, and you can easily shift your own weight.
- Medium Risk: You spend 4–6 hours a day in the chair. You might have some reduced sensation or find it slightly harder to reposition yourself.
- High/Very High Risk: You spend most of your day in the chair, have significant mobility issues, or have a history of skin breakdown.
The Rule of Thumb: If you can’t feel your toes or “pins and needles” in your legs, or if you can’t lift yourself up every 20 minutes to restore blood flow, you should be looking at High Risk (usually Gel or Air) cushions immediately.
2. The Material Breakdown: Foam vs. Gel vs. Air
Each material does a different job. There is no “perfect” cushion, only the one that fits your lifestyle.
Foam (The Lightweight Basic)
Standard foam is great because it’s light and stable. Most budget folding chairs come with this.
- Pros: Cheap, makes transferring in and out of the chair easy because it’s firm.
- Cons: It “bottoms out.” Over time, the foam loses its spring and you end up sitting on the hard plastic or metal base of the chair. It also traps heat, which can make skin sweaty and vulnerable.
Visco / Memory Foam (The Moulding Choice)
This is a step up. It reacts to your body heat and “slumps” around your shape.
- Pros: Great for posture and feels “huggy.”
- Cons: In a cold UK winter, memory foam can turn rock hard until your body heat warms it up. It also makes “sliding transfers” harder because you’re sitting in the cushion rather than on it.
Gel (The Cooling Heavyweight)
Gel cushions usually have a foam base with a silicone gel “bladder” on top or a honeycomb gel structure.
- Pros: Fantastic for temperature regulation (it stays cool). It’s excellent at “shearing”—that’s the friction caused when you slide forward in your seat.
- Cons: They are heavy. If you’re trying to keep your chair lightweight for lifting into a car boot, a gel cushion can add 2–3kg to the weight.
Air (The Gold Standard)
Think of brands like Roho. These are made of individual rubber cells filled with air.
- Pros: The best pressure relief available. You literally “float” on air, which distributes your weight perfectly.
- Cons: High maintenance. You have to check the pressure with a hand pump every week. If it gets a puncture, it’s useless until patched. They can also feel a bit “wobbly,” which isn’t great if you have poor core stability.
3. The “Hand Test”: Is Your Cushion Dead?
Cushions don’t last forever. Foam usually needs replacing every 12–18 months. Here is how to tell if yours has given up the ghost:
- Sit in your chair normally.
- Have a partner slide their flat hand under your “sitting bones” (the bony bits of your bum).
- If they can feel the hard seat base through the cushion, you have “bottomed out.” Your cushion is no longer protecting you and needs replacing immediately.
4. Don’t Forget the “SSKIN” Rule
In the NHS, they use the acronym SSKIN to help people avoid sores. It’s worth memorising:
- S (Surface): Are you on the right cushion?
- S (Skin Inspection): Check for red marks every night. If a red mark doesn’t go away 20 minutes after you’ve got out of the chair, it’s a warning sign.
- K (Keep Moving): Shift your weight every 15–30 minutes. Even a small “lean” to the left or right helps.
- I (Incontinence): Moisture is the enemy. Keep skin dry.
- N (Nutrition): Stay hydrated and eat well; healthy skin heals faster.
Final Thoughts
A good cushion isn’t a luxury; it’s an essential piece of medical equipment. If you’re unsure, ask your GP for a referral to your local “Wheelchair Service.” They can often provide high-spec cushions for free if your clinical need is high enough.
Need more help with your chair setup? Getting the cushion right is only half the battle. If you find yourself leaning to one side or feel “swamped” by your seat, check out our guide on Choosing the Right Seat Width: The 1-Inch Rule for Powerchair Ergonomics.
For those living with specific conditions like MS or Parkinson’s, the way you interact with your chair is vital. We’ve put together a deep dive on Choosing the Right Powerchair Controls for Long-Term Comfort.