Year: 2025 | Month: October-December | Volume: 9 | Issue: 4 | Pages: 46-53
DOI: https://doi.org/10.52403/gijash.20250407
Effectiveness of WHO-Guideline Based Custom Wheelchair Cushions in Reducing Interface Pressure Among Spinal Cord Injury Patients: A Cross-Sectional Comparative Study
Sofia M1, Ranjith R2
1Assistant Professor (P&O), Department of Physical Medicine & Rehabilitation, Prosthetics & Orthotics Services, Christian Medical College, Vellore, Tamil Nadu
2Assistant Professor (P&O), Department of Physical Medicine & Rehabilitation, Prosthetics & Orthotics Services, SS Sparsh Hospital, RR Nagar, Bangalore. Karnataka
Corresponding Author: Sofia M
ABSTRACT
Background: Pressure ulcers represent a major health burden for individuals with spinal cord injury (SCI), particularly in resource-limited settings where commercial pressure-relief surfaces are economically inaccessible. The World Health Organization has proposed guidelines for low-cost pressure relief cushions, yet empirical validation remains limited.
Objective: To evaluate the effectiveness of WHO-guideline based custom wheelchair cushions compared to standard flat cushions in reducing interface pressure among SCI patients across multiple sitting postures.
Methods: This cross-sectional comparative study included 29 wheelchair-dependent SCI patients (80% male, mean age 29.5±9.17 years) recruited from a tertiary rehabilitation center in India. Participants underwent bilateral ischial pressure mapping using calibrated sphygmomanometer-based sensors while seated on both flat and custom-designed cushions. Measurements were obtained across six standardized postures: midline, trunk bent left/right, upright midline, forward flexion, and slump positions. Custom cushions incorporated WHO-specified pelvic wells with standardized dimensions. Data analysis employed paired t-tests with significance set at p<0.05.
Results: Custom cushions demonstrated statistically significant pressure reduction (p<0.001) across all measured postures. Mean ischial pressure reductions ranged from 39-44%: midline (120→73 mmHg), trunk bent left (119.5→72 mmHg), trunk bent right (119.5→72.5 mmHg), upright midline (126→70.2 mmHg), forward flexion (110.5→64.7 mmHg), and slump (130→78.4 mmHg). Forward flexion posture provided optimal pressure relief, while slump positioning generated highest interface pressures. General Comfort Rating scores improved significantly (1.66 vs 3.43, p<0.001).
Conclusion: WHO-based custom wheelchair cushions provide clinically meaningful pressure reduction compared to flat cushions, offering a cost-effective intervention for pressure ulcer prevention in resource-constrained healthcare systems.
Keywords: spinal cord injury, pressure ulcer prevention, wheelchair seating, developing countries, assistive technology, rehabilitation
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