A ROHO cushion is an air-filled seat cushion designed to prevent pressure injuries in people who spend extended time sitting, particularly wheelchair users. It works by using rows of interconnected, flexible air cells that conform to the shape of your body, distributing your weight evenly instead of concentrating pressure on bony areas like the tailbone and sit bones. Originally developed in the 1970s by engineer Robert H. Graebe, ROHO cushions are now manufactured by Permobil and remain one of the most widely prescribed therapeutic seating surfaces in rehabilitation medicine.
How the Air Cell Design Works
The core idea behind a ROHO cushion is surprisingly simple: air equalizes pressure the same way water does. Each cushion is made up of individual air cells that are interconnected, meaning air flows freely between them. When you sit down, your body sinks into the cells (a process called immersion), and the cells rise up around your contours (envelopment). This spreads your weight across the largest possible surface area rather than focusing it on a few pressure points.
Because the cells are flexible and move independently, they also reduce friction and shear forces. Shear happens when your skin stays in place while deeper tissue shifts, which can cut off blood flow and cause tissue damage. The non-slip surface of the cells combined with their independent movement means your skin and tissue move together as you shift positions, rather than dragging against a rigid surface. The restoring forces pushing back against your body stay equal at all points, so no single area bears more load than another.
Profile Options and Cell Heights
ROHO cushions come in three main profiles, each with a different air cell height suited to different levels of risk:
- High Profile: 4-inch (10 cm) cells. Designed for people at high risk of pressure injuries, including those with existing wounds that need to heal. The taller cells allow deeper immersion, which maximizes pressure redistribution.
- Mid Profile: 3-inch (7 cm) cells. Suited for moderate to high risk users. This is a common choice for everyday wheelchair use, balancing pressure relief with a lower seat height.
- Low Profile: 2-inch (6 cm) cells. Prioritizes stability over maximum pressure relief. Best for people at lower risk of skin breakdown who need a firmer seating surface for transfers or active mobility.
The right profile depends on your specific situation. Someone with impaired sensation in their legs, a history of pressure ulcers, or an inability to shift their weight independently will generally need a higher profile. Someone who transfers frequently in and out of their chair or has good trunk control may prefer the lower, more stable option.
Setting Up and Adjusting Inflation
Getting the inflation right is the most important part of using a ROHO cushion, and it’s the step most often done incorrectly. The cushion ships fully inflated and needs to be deflated to match your body. The general process involves sitting on the cushion, then slowly releasing air until you can feel about an inch of air cell material between your sit bones and the surface beneath the cushion. Too much air and you’re perched on top without immersing. Too little and you “bottom out,” meaning your body presses through the cells to the hard surface below, eliminating the cushion’s protective benefit entirely.
Some ROHO models are “Sensor Ready,” meaning they have a quick-disconnect port where you can attach Permobil’s Smart Check device. This small electronic monitor reads your cushion’s inflation level and compares it to a stored target range, giving you a simple confirmation of whether your cushion is properly inflated. This is particularly useful for people who can’t reliably perform a manual hand check, or for caregivers managing cushion setup across multiple seating sessions.
Cleaning and Maintenance
ROHO cushions are relatively low maintenance, but they do need regular cleaning, especially in clinical or shared-use settings. The cushion itself can be hand washed with mild dish soap or laundry detergent. For disinfection, a solution of nine parts warm water to one part household bleach works well. Keep the cushion wet with the bleach solution for 10 minutes, then rinse thoroughly with fresh water. Most commercial germicidal disinfectants are also safe at their recommended dilutions.
The cover should be washed separately. For routine cleaning, a gentle machine cycle in cold water with mild detergent is sufficient. For disinfection, you can machine wash in hot water or hand wash using the same 9:1 water-to-bleach ratio. Checking inflation daily is a good habit, since air cells can slowly lose pressure over time from temperature changes or minor leaks.
Insurance Coverage
Medicare and most private insurers cover ROHO cushions as durable medical equipment, but the specific code and documentation requirements depend on the cushion’s classification. Skin protection cushions, positioning cushions, and combination cushions each fall under different billing codes, and each requires different clinical justification.
For skin protection coverage, you typically need documentation of a current or past pressure ulcer, impaired sensation, or an inability to perform functional weight shifts. Positioning coverage requires documented postural asymmetries. If your cushion serves both purposes, the documentation needs to address both sets of criteria. In most cases, a physical or occupational therapist will evaluate your seating needs and provide the clinical justification your supplier needs to submit the claim. Your durable medical equipment provider handles the specific coding, but knowing that coverage hinges on documented medical need can help you prepare for the evaluation.
Who Benefits Most
ROHO cushions are most commonly used by people with spinal cord injuries, those recovering from or at risk for pressure ulcers, and anyone who sits in a wheelchair for most of the day. They’re also used in geriatric care, where fragile skin and limited mobility make pressure management critical. The adjustable air system makes them versatile enough to accommodate significant changes in weight or body shape without needing a new cushion.
The tradeoff compared to foam or gel cushions is stability. Because you’re sitting on air, a ROHO cushion has a less firm feel, which some people find makes transfers or reaching tasks more challenging. The higher the profile, the more pronounced this effect. For active wheelchair users who prioritize performance and trunk control, a lower profile or a different cushion type may be a better fit. For anyone whose primary concern is protecting skin integrity, the pressure redistribution of a ROHO is difficult to match.