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What is a pommel?

A pommel refers to an object resembling a ball, or the protuberant part of a saddlebow.

What is a pommel cushion? 

A pommel cushion is a cushion with an upward-projecting protuberance at its front part.  This modification prevents a wheelchair-borne patient from slipping down on the seat.

When are pommel cushions indicated?

Two main indications of pommel cushions are posture support, and hip positioning.

Pommel cushions are mainly indicated for patients who have weak trunk muscles or weak muscles of the lower extremities, and tend to slide down in their wheelchairs.   Pommel cushions help prevent forward sliding and decreases the risk of falls from the wheelchair.  Pommel cushions may also be used for patients with spasticity of the lower extremities to maintain both hips in the abducted position when seated on the wheelchair.

Patients with altered mental status can often benefit from adaptive devices that aid wheelchair positioning and decrease risk of falls from a wheelchair.  A logical progression of wheelchair safety devices to prevent falls would be:

1. provide wheelchair cushion to all patients
2. add a personal wheelchair alarm to patients who have poor balance and increased fall risk or patients with prior history of falls
3. change standard cushion to pommel cushion to patients who have weak trunk or lower extremity musculature
4. add a lap buddy or change wheelchair alarm to seatbelt alarm for confused patients with poor balance who tend to stand up without supervision
5. change lap buddy to lap tray for confused patients who cannot be restricted by a wheelchair
6. remove all devices and provide a merry walker

When all devices fail to restrict patient movement, and patient is still at high risk for falls, the possibility of a chemical restraint should be discussed with the attending physician.

A picture of a pommel cushion can be found here:  http://www.sammonspreston.com/images/products/6760L.JPG

Sources:

Sammons Preston Professional Rehab Catalog 2007, pp. 982-984

Online Medical Dictionary (2008).  Accessed at http://cancerweb.ncl.ac.uk/cgi-bin/omd?pommel