Health & Wellness Newsletter – Feb. 2025

This Month: Skin Protection

I have a number of problem areas with my skin. My torn-up sweatshirt sleeves can corroborate the number of holes I’ve worn in my elbows. The insides of my forearms are constantly healing from scrapes inflicted during wheelchair rugby sessions. My shins and ankles will find any sharp surface on a handcycle and gravitate there on every transfer.

Of course, getting banged up while living an active lifestyle isn’t a phenomenon exclusive to wheelchair users. Ask any outdoor athlete, gardener or anyone else prone to physical labor, and their hands are likely to be as gnarled as my elbows are. What is unique for wheelchair users is that, because of poor circulation, wounds on paralyzed parts of our bodies often heal much more slowly than those in areas where we have full physical function. Learning how to protect your typical problem areas is critical.

An equally critical concern are pressure wounds, which are often — though not always — caused by a lack of movement. Most associated with the butt and sit bones, pressure injuries can pop up anywhere your skin presses against another object — think spine-to-backrest, hips-to-bed or legs-to-wheelchair frame — for long periods of time.

Let’s start with the more boring concern, because protecting yourself from pressure injuries provides one of the bedrocks for life as an active wheelchair user. If you can’t stay out of the wound care clinic or away from bedrest, you can’t get to the fun stuff. 

Cushions, Backrests and Beds

One of the first things to figure out is which cushion is best for you. Pressure relief is our main focus at the moment, but stability, posture, weight and a variety of other factors are important to consider as well. All other things equal, the less physical function and ability to move your body you have, the more important pressure relief becomes when you’re choosing a cushion. Typically, custom cushions like the Ride Designs Custom 2 or alternating air cushions like the “smart” cushions from Kalogon show the most even pressure mapping, though simpler (and less expensive) air cushions like those from ROHO and Star often hold up well to pressure mapping as well. For a full explainer — including how different cushion types score for pressure relief — read “How to Choose the Best Wheelchair Cushion for You.”

Which cushion best suits your needs will change over time based on your strength, health, activity level and a variety of other factors. Tim Gilmer, New Mobility’s editor emeritus, offers an interesting case study. An active T11 para, Gilmer spent years using ROHO cushions, which served him well until — due to advancing age and declining strength — he started using a sliding board for his transfers and had difficulty with the instability of his ROHO. He recently tried Kalogon’s Orbiter Med cushion, which provides alternating air for pressure relief, the ability to adjust inflation levels via an app and customizable positioning supports. Gilmer found the cushion easier on transfers while providing the pressure relief he needed. The cushion also offered an unexpected benefit: reduction of his neuropathic pain. You can read his full review here [note that while Kalogon sponsored this newsletter, they provided Gilmer with a cushion in exchange for an honest, independent review].

Backrests and beds are other potential sources of pressure injuries. Remember that backrest cushions degrade and can slide down over time, revealing a hard shell that can cause problems on your spine and other bony areas. Check your equipment and your skin regularly. Tired of the cheap, quickly degrading foam that most backrest manufacturers use, I recently started buying 1.5-inch-thick sheets of latex foam — the kind used in some high-quality mattresses — and cutting them to fit inside my backrest cover. It’s been an inexpensive, effective solution to a constant source of skin irritation.

For more information on how bed and mattress choice can impact your skin, stay tuned for our upcoming Gear Guide on Mattresses.

The Fun Stuff

When you’re out and about, a big part of staying healthy (and thus staying active) is learning from your injuries. I now use Mueller Pro Strips — a super sticky fabric-style tape — under a pair of arm sleeves to protect my forearms during wheelchair rugby games. Handcycle or mountain bike sessions now always include pants and a pair of knee-high socks. My elbows are still a work in progress, but I have started regularly putting a thick moisturizing cream on them — O’Keefe’s Working Hands is my favorite — during summer months. And I suspect a pair of fendered side guards are in my future.

Keeping skin protected in areas you can’t feel, or have impaired sensation, requires being observant — a trait to which I’m not naturally inclined, as my wife can attest — and diligent with post-activity skin checks. Sunscreen and moisturizer are your friends. Bare feet are not. You can read more tips for summertime skin protection — including how to avoid getting burned through your swimsuit on a hot pool deck. Wintertime skin protection tips include layering your extremities to avoid frostbite, remembering that wheelchair frames get really hot when positioned in front of a space heater and making sure you have sunscreen available when the snow hits the ground.

For anyone who regularly gets out of their wheelchair, Bob Vogel offers an excellent guide to “Beyond the Chair Skin Protection” It includes advice on everything from cushions to use for showers, bathtubs and toilet seats, as well as long-distance car trips and sports and recreation. One of the more interesting cushions we’ve seen for keeping your butt and hips protected while out of your chair is the Vicair AllRounder, which straps onto your body to stay with you as you move. Tim Gilmer has a review. 

Functional Fitness

Relieve Pressure, Balance Your Shoulders and Boost Your Energy

Pressure Relief doesn’t have to be boring. Here’s a one-minute workout that can be done in your wheelchair with no equipment whenever you need a quick reset.

Nutrition Tip

“Quite often, the main reason for non-healing wounds is inadequate protein. If you are doing everything else right but are still not healing, you need to get serious about eating protein. For healing to begin and carry through to completion, you will need to eat 1 to 1.5 grams of protein per kilogram of body weight daily.”

— Tim Gilmer, New Mobility editor emeritus and T11 para