1. We’re not supposed to use ring or donut cushions. How does the Isch-Dish differ from these cushions?
A ring or donut cushion is a closed circle that is one-size-fits-all. It puts a tourniquet effect around the ischials, effectively cutting off circulation to that area. And, it forces the body to carry weight all around the edge of the ring rather than on the femurs.
The ISCH-DISH is an open-backed pocket that encourages circulation rather than cutting it off. It is sized to the user to fit various ischial spans. The ISCH-DISH is anatomically designed to spread the load of the body to the length and width of the femurs rather than to the edge of the pocket or the ring around the ischial area.
2. Does the person have to sit in the exact same spot every time they use the ISCH-DISH? What if they miss and don’t land exactly in the front of the pocket every time?
The correctly fit pocket allows for some distance between the pelvis and the pocket sides to allow for natural movement of the pelvis. The pocket also naturally guides the user into the correct area of the cushion. Because the cushion is designed to match the anatomy, and because of the distinct shape of the pocket, the user knows when they are within or outside of the pocket. Should they land outside of the pocket, they will only be sitting on foam, a naturally pressure-dispersive medium.
3. Is the ISCH-DISH appropriate for a person who has had an ischiectomy?
Yes, it is the best thing for that person to sit on. The ischiectomy causes the person to sit unevenly on any other cushion because all other products cause ischial weight bearing. The person with an ischiectomy has uneven ischial levels, so they will sit unevenly. However, on the ISCH-DISH, the ischials are not weightbearing, so that this person will sit evenly, barring any other structural deformity that might cause an uneven pelvis.
4. What about sacral-sitters whose ischials don’t land in the pocket?
Move the cushion forward so that the pocket matches where the patient’s ischials naturally land. You may have to put a foam block behind the cushion to make sure it is located in the correct place on the seat consistently; otherwise people have a tendency to push the cushion all of the way back on the seat.
5. What about those with pronounced atrophy?
The perfect candidates! The cushion is designed to the anatomy, i.e., the skeleton. Therefore, thin atrophied persons do very well on this product. Also, they are at the highest risk for breakdown, and, so, should be on this product.
6. What about those patients who cannot reposition themselves?
Again, the perfect candidates. The ISCH-DISH is not a replacement for a good skin care program. However, it is the safest cushion one can sit on because of the elimination of pressure at the most likely area of breakdown. Although the user may need time to get used to the firmness of this product, most find it comfortable, useable, and posturally stable. As with any cushion they use, the users are very dependent on getting positioned correctly in the first place. After that, the ISCH-DISH will do as much or more than any other cushion to help keep the person stabilized.
7. If the front of the pocket is being used to help hold the ischials back on the seat, don’t you get breakdown on the front of the ischials?
The pocket of the ISCH-DISH acts in two ways to stabilize the pelvis. Primarily, it removes the ischials as pivot points by removing them as weight bearing points. Therefore, the pelvis has less of a tendency to rock. Secondarily, should the pelvis rock back or slide forward, the front wall acts to block the movement. You would think that breakdown on the front of the ischials would occur. In our experience we are not seeing this. My explanation is that (a) the anterior ischium becomes a secondary weight bearing surface, (b) the anterior ischium is relatively flat and has a larger surface area than the inferior ischium, and (c) the wall of the pocket is only foam, so that the anterior ischium is contacting pressure dispersive material.
8. How does this cushion accommodate anatomical difference?
Leg Length Discrepancies – At this time we cannot accommodate these problems. Suggest that the cushion be measured for the shorter leg.
Dislocated Hips – This product depends on intact hip joints. This includes “normal hips” and hip replacements. When a hip dislocates, the ball comes out of the socket. If it has not formed a stable position, do not use the ISCH-DISH. If it has formed a stable position, the cushion can be used.