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How an Innovative Chair Pad Helped Heal Pressure Injuries for a Wheelchair-Bound Patient

An observant wound care nurse and a wheelchair-bound patient suffering from a long-term pressure injury are the impetus for innovation at a Cincinnati soft goods manufacturer.

The Casco Prevention Chair Pad, a new wheelchair pad created and manufactured by Casco Manufacturing Solutions, provided the stability, comfort and cushioning needed to completely heal a patient’s pressure injury within 3 months of beginning continuous use.

Shelly Byington, RN, WCC, a quality consultant and health care expert with Casco, is a traveling nurse who calls on about 30 home-bound patients each week throughout mid- to southeastern Ohio. She often travels more than 300 miles a week tending to homebound patients under a doctor’s care.

A few years ago, Byington noticed that Mary, age 69, one of her wound care patients, was unsteady in her wheelchair whenever she shifted her weight to reach items on the floor or pick up a small grandchild. Mary had been suffering from a stage 3 pressure injury on her coccyx for 18 months. Byington began treating Mary at her home and ultimately referred her to be seen at a wound care clinic. 

Byington noticed that Mary’s pressure injury was located in the precise spot where her backside met her wheelchair pad surface.

“Mary had been on a wound VAC and had had traditional wound therapies with only slight improvements,” said Byington. She wondered if Mary’s wheelchair cushion had caused and continued to aggravate the nagging pressure injury. Byington and Mary’s doctor discussed the problem on a regular basis and tried a variety of chair pad options. 

Prior to Byington’s involvement, Mary had tried several different chair pads: an air-inflated pad, which made her wobble in her chair, and an egg crate pad, which didn’t provide enough support. 

“I noticed that generally the chair pads she had tried had not promoted wound healing,” said Byington. “I noticed Mary had difficulty keeping her cushion properly inflated, which caused additional tissue damage.” 

Creating A Better Solution To Reduce Pressure Points

In frustration, Byington went to Casco CEO Melissa Mangold and spoke to her about creating a new, higher-quality wheelchair pad that might be able to reduce Mary’s pressure points, allowing the pressure injury on her coccyx to heal. 

“We were at a trade show in Utah, and began talking about one of Shelly’s patients,” recalled Mangold. “We’d had great success in the past when Shelly recommended Casco mattresses to some of her patients, but she didn’t feel comfortable recommending the wheelchair cushions doctors told her were acceptable. So I said, ‘Hey, we’ve got the technology, and we care that whoever uses our products gets the best outcome possible, so why not try to help customers on a smaller surface?’”

The conversation set in motion a 2-year collaboration with Casco staff and Byington on designs, fabrics and foam cushions to create the Casco Prevention pad. The wheelchair cushion was designed to provide good core and body support and envelop Mary properly, relieving heat and pressure to prevent pressure injuries from forming, said Byington.

Mary, who has been in a wheelchair almost exclusively for 20 years due to complications from multiple sclerosis, said she noticed immediate improvement after beginning to use the Casco Prevention pad. Not only was the Casco pad more comfortable than her old one, she said it allowed her more stability in her chair. Best of all, her stage 3 wound began healing. 

Within 3 months of using the Casco Prevention pad, the wound was completely healed. Mary had been using the Casco Prevention pad continuously for 8 consecutive months when contacted for this story.

“I had tried a variety of other cushions,” she said. “One was a pad my doctor wanted me to have with an air tube in it. The problem was carrying the air tube with you to keep it inflated. Then my pad got a hole in it.”  

Next she tried a pad that elevated her too high in her chair. 

“I was completely unstable,” Mary said. “If I reached over to get something, it was hard to recover. When I sat on that pad, I was miserable.”

“The Casco pad gives her good core support and she has not redeveloped an ulcer,” said Byington. “So that’s huge for her. Once we got her healed, she has stayed healed and we’ve not had any other issues.”

The best thing for Mary is that she has been able to resume her usual busy lifestyle. “One thing I like about this cushion is that it’s 3 inches thick, which allows me to keep my feet on the ground to take care of my business,” she said. “Every year we go to Hilton Head—about 30 of us to the beach. We have 6 grandchildren my husband and I watch a lot. It keeps me young and busy.” Mary’s husband has been her primary caregiver for the past 10 years. 

A Closer Look At What The Chair Pad Offers Patients

Casco will feature the new Casco Prevention Chair Pad at its booth at the September 2019 Wild on Wounds conference in Las Vegas, Nevada. Mangold said the new wheelchair pad is an extension of her company’s and her personal commitment to provide comfort, compassion and care for others. 

“When patients are released from a hospital to a family caregiver, often caregivers don’t really know what to do,” said Mangold. “Patients don’t need 50,000 cushion sizes for a wheelchair; they only need a few. But they also need good-quality cushions for the kitchen chair, recliner and car. Anyone can go on Google and buy a piece of bladder or foam. But why put a parent or loved one on that? We’re going to make our wheelchair pads so they prevent pressure injuries, yet are affordable. We want caregivers to have the best outcomes for their patients.”

The Casco Prevention pad comes in 3 sizes: 18 in x 16 in; 18 in x 18 in; and 20 in x 18 in, which is the most popular bariatric size, said Mangold. The pads are 3-inches thick, with a Casco-blue polycarbonate cover. A webbed handle is located on the opposite side of the zipper so it doesn’t interfere with wheels or levers, and the wheelchair pad can hold a person who weighs up to 350 pounds. It is available for sale now through Grainger, Zoro,, and other retailers.

“We’ve designed the pad so patients can sit directly on the cushion,” said Mangold. “There is no need for a pillow case or cover fabric that could cause the pad to slide on a chair. The hand of the material is very quiet and soft—it feels like kid gloves—fine, soft, thin and pliable.”

Its polycarbonate material makes the cushion liquid-proof. Air molecules can pass through it, but not blood or urine, she added. “The poly-part of the fabric makes it liquid-proof,” said Mangold. “Polyurethane gives it the stretch and prevention properties. The carbonate gives the fabric more robustness regarding cleaning.”

Casco is taking its responsibility seriously to provide patients with comfortable, quality surfaces. The company is investing in a pressure-mapping system to use on its mattress and wheelchair pad products so patients of all sizes can be comfortable and remain pressure wound-free. 

Pressure mapping is used to assess pressure distribution on a wheelchair or mattress surface. A patient lies down or sits on a surface, and a computer screen displays a map of pressures, using colors from red to orange to yellow, which indicate higher pressures, to greens and blues, which indicate lower, healthier pressures. Knowing where a patient’s hot spots are can determine how a better surface can be built to support them.

What You Should Know About Pressure Ulcers

Pressure injuries affect 2.5 million U.S. patients and result in 60,000 deaths and more than $26 billion in U.S. health care expenditures, according to research recently published in the British Medical Journal Quality and Safety by William Padula, PhD, and Janet Cuddigan, PhD, board members of the National Pressure Ulcer Advisory Panel (NPUAP).1 

The nonprofit NPUAP is the nation’s leading scientific expert on pressure injury prevention and treatment. The 2 researchers recently testified to the House Committee on Appropriations on their increasing concerns about pressure injuries in the U.S. and presented steps that can be taken to improve health care for vulnerable patients. 

Evan Call, a research scientist at EC Service, Corp. in Centerville, Utah, provides product testing and development for hospital bed safety and performance, and wheelchair and cushion standards. He holds a number of patents and has published original research, according to the EC Service website.

There are about 3.3 million people in the U.S. who use a wheelchair, according to Disabled World, an independent health and disability news source that covers senior citizen and disability news.2 About half of those in wheelchairs are geriatric and in the end stages of life, said Call. “This is not an arena that garners a lot of attention, and it’s disgraceful that that’s the case,” he said. “Approximately 60 percent of people in wheelchairs suffer from a pressure injury at some point in their lives. These are painful and debilitating. People are also embarrassed by pressure injuries; they can have a severe odor.”

The average cost to treat an individual pressure injury in the U.S. in 2014 ranged between $500 and $70,000, according to the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline.3 The figure was obtained as the result of a collaborative effort among the NPUAP, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance. Updated statistics should be available in the fall of 2019. 

Call said temperature management for patient surfaces like mattresses and wheelchair pads is a topic that the Centers for Medicare and Medicare Services (CMS) needs to address. Currently, he added, the CMS doesn’t allow for a reimbursement process for surfaces that minimize temperature for patients. Minimizing temperature on patient surfaces like mattresses and wheelchair pads would reduce the formation of pressure injuries and the additional medical costs and patient pain associated with them. n

Casco is a third-generation, family-owned and certified, woman-owned manufacturer. It manufactures soft goods for industry leaders in institutional, health care, government, outdoor, and custom manufacturing markets and for private labels. Some of its products include hospital mattresses, C-Matt Replacement mattresses, mattress covers, and stretcher pads.

For more information about the Casco Prevention Chair Pad and Casco Manufacturing Solutions, visit

This article was not subject to the Today's Wound Clinic peer-review process.

Melinda Zemper

1. Padula WV, Pronovost PJ, Makic MBF, et al. Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis. BMJ Qual Saf. 2019;28(2):132–141. 

2. Disability in America Infographic. Disabled World. Revised June 2017.

3. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Osborne Park, Australia: Cambridge Media; 2014.

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