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The Forgotten Alternatives |
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| Wheelchairs and scooters address the issues of unrestricted mobility very well, however, for a person dependant upon a seated posture for mobility, saving energy is not the only deciding factor. A seated posture could also mean being able to freely use both hands for any given task and also maintain a secure sense of stability and safety while traveling over convoluted or sometimes unpredictable terrain. Unfortunately, most commercial wheelchair cushions do not include sufficient features to accommodate anatomical asymmetry. The result may be poor posture, back pain, the potential for skin trauma and a host of other issues related to a lack of a stable, safe and supportive environment.
Unfortunately for some consumers, the SSP may not be an option due to additional prevailing medical or care-taking considerations. The pelvic leveler is smaller, more flexible but mostly intended for use outside a wheelchair. A molded cushion, on the other hand, is softer, more flexible, requires fewer accommodating adjustments during the day and is more amenable to body weight fluctuations.
Lastly, custom molded cushions can be fabricated in a variety of
foam densities and are not restricted to exclusive use in a wheelchair,
a molded cushion can be fabricated for specific non-mobility purposes
such as a commode liner, shower seat or sofa/lounger adaptor. Consumers
should speak with their physician or therapist to determine whether
a custom molded cushion is appropriate for their lifestyle and physical
requirements. To expedite the process, consumers should also consult
with their insurance provider to fully understand funding limits
and qualification requirements.
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Quite
often information resources speak of energy saving alternatives
to using a prosthesis by suggesting either crutches, wheelchairs,
scooters or other mobility aids. For someone with a high level amputation
(hip-disarticulation, hemipelvectomy or more) choosing an alternative
to the daily use of a prosthesis is a very real and sometimes necessary
consideration. 
There
are, however, three other often forgotten alternatives to the conventional
wheelchair cushion; the “sitting socket prosthesis”
(SSP), the “pelvic leveler” and the “custom molded
seat cushion”. Each originates from a body mold taken while
the consumer is positioned in a seated posture. When completed,
a SSP is worn under the clothing in a similar fashion as a conventional
prosthesis. A pelvic leveler can be worn either under or outside
the clothing, depending on the intended uses. A custom molded cushion,
however, is used like a conventional cushion but is fabricated to
the specific asymmetrical profile and support requirements of the
consumer. Other distinguishing features are that the SSP tends to
be rigid and intimate fitting and may interfere with digestion or
other body functions. On the other hand, it is always with you no
matter what surface you intend to sit on. 
A
custom molded seat cushion is usually cooler to the skin and can
be further detailed to include additional accessories or cosmetic
enhancements, which increase postural stability or add visual symmetry
for the missing limb. There are two methods used to create the body
mold: plaster-of-Paris casting or the digitized casting mold. Both
are considered “mold-to-patient model techniques” and
require the consumer to sit on a beanbag-like seating simulator
while the appropriate postural alignment is explored and refined.
For best results the consumer will later conduct a trial fitting
of the cushion and offer feedback to the designer in order to fine-tune
the shape, performance and fit of the end product. As a final manufacturing
detail the cushion is outfitted with a waterproof finish and choice
of removable upholstery materials. 
Either
a Prosthetist, Orthotist or Rehab Specialist equipment supplier
(specializing in molded seating) can create the mold and send it
to a specialty manufacturer for fabrication. With proper medical
justification a molded seat cushion is covered by most insurance
and funding sources. DME dealers should use particular caution,
however, when billing Medicare. With recent changes there are only
a handful of manufacturers approved to fabricate custom cushions
and even fewer custom products that have received the coding verification,
E2609 & E2617 from SADMERC. The billing process for Medicare
is further complicated because there are currently no approved ICD-9
diagnosis codes.
