This SpinTip will help you determine when your cushion is in need of replacement. There are two areas you have to assess vigilantly:

The integrity of your skin, and
The integrity and function of your cushion.

Skin Integrity

Get to know your skin and what it is trying to tell you.

Examine your skin every day, especially in the evening after you have been sitting up. This is when your skin will give you the most information about your seat cushion. Pay particular attention to the places where bones are close to the surface of the skin.

The skin over your ischials is the most likely place to break down from sitting up. One ischial bone is located in each cheek of your buttocks; many people call them their ‘sitting bones.’ If your muscles have atrophied over time, your ischials will be easy to locate. To do this, lay down on your side and pull you knees up toward your chest as far as you can. You should feel the ischials clearly under the skin.

While you are examining this skin over the ischials, also examine the skin over the coccyx and the sacrum located between the base of your spine and the top of the ‘crack’ between your buttocks, and the skin over the back of your thighs.

You are looking for discoloration, scar texture, tissue feel and comfort.

• Discoloration: In light skinned people, discoloration would be red; in darker skinned people, the discoloration would be blue or purple tinged.
   
• It is likely that, when you first get off of your cushion, you will see redness (the medical term is erythema) on the skin that was bearing your weight while you were sitting. Everyone’s skin reacts differently to pressure. Most wound experts will tell you that if that redness does not go away after about one hour, you may be seeing the first signs of skin damage. This is good to use as a rule of thumb.

  Keep in mind that your skin might react differently to pressure. For some people, the skin is always red. For others, the redness that results from sitting will disappear in one hour. And for others, the redness takes a few hours to go away, but does disappear. Learn what is normal for your skin, so that you can detect abnormal immediately.

  Redness that is a normal reaction to pressure will turn white momentarily when it is pressed with a finger. This redness does not indicate skin damage.

  It is the first sign of tissue damage if the redness does not turn white when you press it. You must be as concerned about this type of redness as you are about an open ulcer—it is damaged tissue.
   

• Scar Texture: Old scars on your skin will change in texture. Sometimes they feel soft, almost like original skin. Sometimes they dry and peel. And sometimes they feel tough and leathery. If you have scars from old ulcers or skin damage, you must get familiar with what the normal feel of that scar is. Any change in the scar texture may be a sign that it is irritated from something.
   
• Tissue Feel: Feel the tissue under the skin. This does not mean pressing the skin between your finger and the bone under the skin. Pick up the skin over the bony prominences by gently pinching it, lifting it away from the underlying bone, and rubbing the tissue between your fingers. Feel the tissue under the skin of your forearm to practice, and to get a feel for what normal tissue feels like. You should not feel any firm spots, hard lumps or mushiness. If you feel anything abnormal, have it checked out by a wound specialist immediately.
   
• Comfort: Even if you do not have sensation in your buttocks, your body often tries to tell you somehow that it is uncomfortable. This can come in the form of discomfort in another part of your body like your back or neck. Or you may experience an increase in spasticity. Or your bladder or bowels may act differently than normal.