Pressure mapping & results and comments

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Pressure mapping & results and comments

Postby F3Head » 10 May 2019, 20:02

Hello,

Has anyone on the forum been pressure mapped for their wheelchair cushion? I recently went in to get pressure mapped with my Permobil F3 and the Corpus seating system and a 4 inch high-profile Roho cushion. I have uploaded two images hopefully of my results of the pressure mapping. The pressure map was created using a Comfort Company BodiTrak LT a Lenovo tablet and not Roho's more expensive pressure mapping system. Unfortunately I keep getting reoccurring sacral wounds, which are a major pain in the ass. Here's my results.

Oddly enough the pressure map revealed that my ischemia pressure was less sitting slightly more upright at roughly 40° than it was when tilted back to the maximum 50° angle (yellow and brighter). My OT therapist seemed to me be somewhat puzzled by the results of the pressure mapping. She did not expect to see more ischial pressure as revealed on the image at 50° tilt than at 40° tilt. Interestingly my sacral pressures are pretty decent (my problem area). Afterward, I tilted the powerchair through various degrees of tilt and determined that tilted all the way back did indeed result in greater pressure on my ischium (yellow and red) then tilted at roughly 40°. I'm going by actually tilting the chair back with my switches rather than the degrees seen on the images i.e. 50° tilted all the way back as far as possible. My OT did indicate she zeroed the pressure mapper before starting.

Furthermore, she indicated I experienced less cushion support than ideal behind my kneecaps and under my thighs which you can see on the images. Tilting through the range of my tilt/recline revealed the best pressure map results were roughly 3/4 of the way tilted back or 40°. We repeated the process numerous times with similar results. Overall my OT therapist indicated that my pressure map results were not that bad and she has seen much worse. Consequently, my therapist ordered a slightly longer 4 inch high-profile Roho cushion. Slightly longer by about 1 inch or another row of bladders. The idea being I would be more immersed into a longer cushion providing greater pressure relief. Looking for opinions or comments…

F3HEAD
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Demo Pressure Map Sitting 50° Angle Tilt #2 April 25, 2019.jpg
Pressure map sitting 50° tilt angle
Demo Pressure Map Sitting Approximately 40° Tilt Angle #1 April 25, 2019.jpg
Pressure map sitting 40° tilt angle
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Re: Pressure mapping & results and comments

Postby Burgerman » 10 May 2019, 20:26

Unfortunately I keep getting reoccurring sacral wounds, which are a major pain in the ass.

Spent a full year on a bed waiting for a 9 inch deep wound that tracked up my spine. And the last 3 years mostly on my bed, with ischeal and coxxys (cant spell) issues. Tried rohos, cant transfer well, unstable to sit on, so back to my usual Jay2.

Tried hoists in case it was caused by transfer boards.

Bought Salsa with tilt, recline, leg lift etc to test, which helps. And yes with RECLINE + TILT at even 30 degrees it reduces pressure with a sensor pad. Tilt alone doesent do it.

I have given up looking at maps, and listening to experts.
The map is just a tool, a helpful guide. But a tool is only as useful as the skills of the expert...
I can get onto a cusion ten times, and see 10 different results. Even on different days.

I decided that what matters is MOVEMENT. I decided this when I noticed that being out and about bumping about, using ramps, and off road with the dog, seemed to actually help rather than cause the issues. Give a chance for blood to circulate.

So I bought an alternating air cusion with 6 bars. The cushion base was hopeless, way too soft and made of some memory foam. But I tested it regardless. So after a few months getting up for 4 to 5 hours a day, the odd trip to the pub, for 2 months, and no recurence of sores. I made a cushion. It uses the air bars, and pump from the one I bought. And some firm foam for the base, and the edges and the front. And its my size. And it seems to be working better than the 6 diferent cushions I tested or my jay2 gel.

MOVEMENT is what you need. The bars alternate. So you are supported on 3 or the other 3 under the relevant area every 10 mins all day.
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Re: Pressure mapping & results and comments

Postby F3Head » 10 May 2019, 21:16

I feel your pain. I did the bed rest for 9 months myself with the Stage 4 sacral tunnel wound. 9 inches… I'm surprised they didn't do tunnel wound and flap surgery. I avoided that beauty because of a good doctor. I transfer with my Guldmann and Molift smart cleanly with all my chairs. I also do the full-tilt for about 10 minutes and extend my legs out completely and reduce the tilt angle to 40° for another 5 minutes. I'm a high level injury and not much movement so positioning is sometimes difficult for me without disrupting my seating position. I also use muscle spasms' when I can to stretch as you mentioned.

When I did my pressure mapping and asked the OT therapist about how long I should do the tilt back and recline she really didn't have what I thought was a good answer. She mumbled something like often and a lot. What ever that's good for. I know Permobil now has a cell phone app that is supposed to monitor your weight shifts but my chair is too old and it doesn't support the software. When you did your pressure mapping how much red or yellow did you get on your mapping screen?

Like you said it's hard to figure out where you get the best pressure relief. When I originally got my F3 they said 50° tilt was the best method. One thing I learned with my tunnel wound from a Ukrainian nurse. Who was a great nurse by the way and old-school was for me to get up out of bed even for a just short time just to get circulation of blood flow moving. That's the trick that set me on the path to healing. But I'm wounded now and I'm getting older and pressure wounds are becoming more of a problem.

Hopefully some others on the forum will have some input…

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Re: Pressure mapping & results and comments

Postby wheelie junkie » 11 May 2019, 11:15

I've suffered with pressure sore problems since my accident. Tried a number of cushions and been pressure mapped quite a few times. Attached the screen shots from my current cushion, despite the good map I'm just getting over a bad sore on right ischial. I have tried the smart check Roho, useless so have a pressure gauge. When I get mapped we record actual pressure in the cushion when we get the best mapand once a week check and adjust to that.If you don't have an accurate method of recording the pressure mapping is pointless, a finger test especially carried out by different support workers will never be accurate. You then need to consider room temperature, try sitting outside in the sun. Pressure will increase so not the same immersion into the cushion. So many variables you can't know that you have the right pressure. Gauge helps a lot and I wouldn't want to not have it.I tilt to 45º for 5 minutes once an hour, it moves weight from ischials to sacrum. I still think movement is best, I go out in my off road wheelchair/buggy rough terrain so always bouncing about and rarely have problems. Sitting still at my desk is the worst. C3 complete so no movement at all. Roho rep is visiting next week to try a shaped cushion which is meant to spread weight across my buttocks. It is unlikely it can pressure map any better than the deep quadro but could support me differently. I'm getting a similar Roho shower cushion, tried that this week and it really made a difference, I was sat up straight, not slumped to the left as I usually do, pressure was on both ischials not one.

IMG_0451 (2).jpg

IMG_0452.jpg

IMG_1494 (2).jpg
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Re: Pressure mapping & results and comments

Postby Burgerman » 11 May 2019, 15:33

I suffered all this for years. I am telling you. The secret is movement. If you cant do that as I cant, my alternating relatively cheap cushion really does seem to be the answer. Mapping doesent seem very useful. Once you have had a few ischeal issues the skin is thin and weak. And is damaged very easily when transfering or through sitting. And the only thing that seems to work is a cushion that alternates pressure in different areas.
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Re: Pressure mapping & results and comments

Postby wheelie junkie » 12 May 2019, 17:45

My left ischial was damaged about 4 years ago but recovered well, I now spend the majority of my time on it. Right is the total opposite, it never fully heals. Alternating cushion would be worth a try, at the moment I am up for a few hours then back to bed then up again. It means I can't plan on going far as I need to be put back on the bed. I looked at alternating cushions but they were super expensive and didn't get good reviews. Can't afford to waste that kind of money. Fed up with sores now I spend about 6 months every year with one.
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Re: Pressure mapping & results and comments

Postby Burgerman » 12 May 2019, 18:03

I had exactly your problem but maybe worse. Up for a few hours for 3 or 4 days and it was back. Another 3 or 4 months healing, rinse repeat.

Read all of these 5 pages.

viewtopic.php?f=2&t=8081&hilit=air+cusion&start=30
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Re: Pressure mapping & results and comments

Postby Scooterman » 12 May 2019, 18:27

Burgerman wrote:
MOVEMENT is what you need. .

What about a vibrating plate under seat cushion powered from WC? Is that a good idea or what? :dance
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Re: Pressure mapping & results and comments

Postby Burgerman » 12 May 2019, 20:36

Depends. We are after getting fresh blood to cells that have had enough pressure to stop localised skin blood flow. Oxygen starvation is what causes cells to die. If you are sat on an air cushion, you get 6 bars. At any one time one set or the other are inflated. Leaving the other ones deflated. So now those parts can get blood circulation. Oxygenated. Then 10 mins later, swap. Now the other parts of your bum get the blood...
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Re: Pressure mapping & results and comments

Postby F3Head » 12 May 2019, 22:09

Thanks guys… I should probably consider myself lucky. I went 30 years without any problems or injuries to my skin.

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Re: Pressure mapping & results and comments

Postby wheelie junkie » 13 May 2019, 10:29

Burgerman wrote:I had exactly your problem but maybe worse. Up for a few hours for 3 or 4 days and it was back. Another 3 or 4 months healing, rinse repeat.

Read all of these 5 pages.

viewtopic.php?f=2&t=8081&hilit=air+cusion&start=30


I have and am confused, did you end up replacing pump and controls or just repackage the air cells into new foam.? The foam I can probably get done, the rest would need a lot more effort. I sleep with a Tens machine electrodes around my ischial set to promote circulation, occasionally use through the day. When pressure sore free I use FES bike to promote muscle growth and help circulation. 90 minutes per day of passive movements to try and keep blood moving.
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Re: Pressure mapping & results and comments

Postby Burgerman » 13 May 2019, 11:08

I have and am confused, did you end up replacing pump and controls or just repackage the air cells into new foam.?


2nd one.
I threw away the stupid soft memory foam. I considered it as badly made packaging material. At best, what were they thinking. It was junk. So I simply made a cushion. Precut all the parts from eBay. And used a jay2 cover, and a new one off made to meaure cover.

I used conglomerate hard foam for the edges and front. And bottom. And thin layer of soft foam for the top. And dropped the 8 cells/pipes/pump box in.
Now I know how well it works, I will cut a rectangle from a Jay2 hard foam base next time... And use that.
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Re: Pressure mapping & results and comments

Postby wheelie junkie » 13 May 2019, 12:55

That might even be possible for my support workers to do. Just need to sort foam. Definitely worth a go as I am only just over a sore and the tell tale dry skin in centre of scar tissue is starting again. Only up for about 4 hours.
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Re: Pressure mapping & results and comments

Postby greybeard » 13 May 2019, 13:35

wheelie junkie wrote:
I sleep with a Tens machine electrodes around my ischial set to promote circulation, occasionally use through the day


Probably preaching to the converted, but be careful with those. After lumbar surgery I overdid the use of a cheap over-the-counter tens to relieve post-op pain and ended up with burns from the electrodes that still cause occasional discomfort (persistent itching) 8 years later.
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Re: Pressure mapping & results and comments

Postby wheelie junkie » 13 May 2019, 14:25

greybeard wrote:
wheelie junkie wrote:
I sleep with a Tens machine electrodes around my ischial set to promote circulation, occasionally use through the day


Probably preaching to the converted, but be careful with those. After lumbar surgery I overdid the use of a cheap over-the-counter tens to relieve post-op pain and ended up with burns from the electrodes that still cause occasional discomfort (persistent itching) 8 years later.


Did exactly the same with Tens trying to get belly flab turned to muscle, ended up with eczema.
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Re: Pressure mapping & results and comments

Postby wheelie junkie » 13 May 2019, 18:08

Would this option not be better as no need to replace foam https://www.alertamedical.com/en/produc ... ion-system

I will need to find a place for the pump as my vent hangs off the seat back.

The only concern is that the cushion is "high risk" not "very high risk"
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Re: Pressure mapping & results and comments

Postby Burgerman » 13 May 2019, 18:16

You only want the alternating part under your backside, and trapped in a rectangular hole. Because pressure distribution... You would need much lower pressure inder your knees/leg area than your backside. So your bum will sink, and your legs will rise...

So it isnt going to work properly. Hence lower rating. Look at a gel Jay2. The gel is at the back only. And thats why. Likewise the quadro or whatever its called roho cushion is much better than the big single chamber one. For similar reasons.
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Re: Pressure mapping & results and comments

Postby Burgerman » 13 May 2019, 18:18

I am even tempted to remove 2 bars and make a new cushion. With only 4. Why? The cells expand under my nuts! And my bum sinks. Be better if the block od 8 was a block of 4 - only where it matters. My nuts dont get sores...

Did you look at my DIY cushion? And my carer hiding her face? She needs to. :fencing


That cushion was a rip off price. I paid 300 and a bit. Was still a rip off price considering the floppy memory foam base was useless.
I like the pump. Its different and more modern than the one shown in your link.

If I make another I will use this. https://www.ebay.co.uk/itm/Wheelchair-C ... SwhT1bHjYl
I will only occilate (alternate) the part under my backside. With the pump I have. Or one I make.
The PINK and YELLOW part on this drawing.
The BLUE AND GREEN can remain very firm. Taking more of your weight. Look carefully. I would connect only the centre two connections to a pump.

I will pump up relatively hard the rest and just lock it off.

Alternatively, If its possible I may just ONLY use the PINK and YELLOW part in a new foam cushion. Cut with scissors.
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Re: Pressure mapping & results and comments

Postby flagman1776 » 13 May 2019, 18:27

burgerman, could you link back to your original thread on this, please? Any further details on your success at DIY.

This is a really important topic. Even though I can stand to transfer and (at present) shuffle a few steps with a walker... I spend 99% of my time sitting. This issue is like a time bomb... waiting to rear it's ugly head. Or maybe a dragon waiting to roast my butt with fire breath. I really need to stay ahead of the tissue breakdown, somehow. I'm sure I'm not the only one.
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Re: Pressure mapping & results and comments

Postby Burgerman » 13 May 2019, 18:30

viewtopic.php?f=2&t=8081&hilit=air+cusion&start=30

Working better than anything I tried so far.
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Re: Pressure mapping & results and comments

Postby wheelie junkie » 13 May 2019, 18:57

The link was to the manufacturer site, they must be using an old image. The one thing pressure mapping can help is show where there is no pressure, almost nothing under my thighs, most across the central area of my arse. Which is where I need the alternating cells but smaller and more of them would be better. Roho size cells but multiple inflation points definitely better. If you could design a cushion and make in small batches there would be a market.
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Re: Pressure mapping & results and comments

Postby wheelie junkie » 19 May 2019, 16:54

I've been trialing a Roho Control Select to replace the high profile Quadtro, wasn't sure about it but Roho rep felt that it would position me straighter and help spread pressure. My hips are oblique and pelvis tilts so I fall to one side. Initial impression was that I was sitting much straighter and felt secure, I've had problems moving in the seat causing shear, this felt rock solid. I'm recovering from a pressure sore, 4 months of bed rest and limited time up, had built up to 2 x 2 hour sessions a day in chair and was a little reluctant to try anything new. Started off with an hour up and checked sore, all looked good so I gradually increased time up checking as I did so. A week later the sore is actually improving despite longer hours up. Hardly any pinkness of scar tissue which for me is unusual.

Contour Select isn't as high as my Quadtro so we had to be careful with pressure setting but the shaping of the cells gives stability and spreads weight better. Wasn't sure about sticking with Roho after this latest sore but am a lot more positive after the trial. Just need my OT to try and find funding for one :) Alternating cell cushion is next on the list if this doesn't work.
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