Verdict: 4.5 out of 5. The ROHO Quadtro Select High Profile remains the dominant clinical choice for wheelchair users with high pressure injury risk, and for most users in that profile it is the right cushion. The half-point deduction is for the maintenance burden, the user-management demands, and the existence of credible alternatives (JAY, Vicair) that fit some users better. For the highest-risk users, the ROHO performance advantage in pressure redistribution is real and clinically meaningful.
What it is
The ROHO Quadtro Select High Profile is an air-cell pressure-redistribution cushion. The cushion consists of an inflatable bladder containing many interconnected air cells (the manufacturer’s specification table gives the High Profile cell height as 4.25 in. / 10.5 cm, against 3.25 in. for the Mid Profile and 2.25 in. for the Low Profile). The interconnected cells allow air to redistribute under the user’s weight, conforming to the body and redistributing pressure across the entire cushion surface rather than concentrating pressure at bony prominences (ischial tuberosities, coccyx, greater trochanters).
What makes it a Quadtro Select is the ISOFLO Memory Control, and it is worth being precise about how it works, because it is commonly described wrongly. It is one control, not four valves, and it has two positions. With the green knob pushed in, the control is unlocked and air moves freely through the whole cushion. With the red knob pushed in, it is locked, and the air is held in four separate compartments.
The operation manual sets out the sequence: inflate with the control unlocked, adjust the air down to the correct level, then seat the user in the posture they actually sit in, let the air transfer, and only then push the red knob to lock. The shape is set by the body rather than dialled in numerically, and the lock holds it. Permobil states the cushion may suit people who need accommodation of pelvic asymmetry up to approximately 3 in. / 7.5 cm, correction of pelvic asymmetry, or different positioning of the left and right femur.
ROHO was started in 1973 by Robert H. Graebe, an electrical engineer who spent two decades working on the problem in his basement before leaving his job to build cushions. The company moved to Belleville, Illinois in 1982 and is still there, exporting to more than 70 countries with every cushion made in the USA. Permobil acquired ROHO in 2015. Permobil states the cushion technology has been through more than 90 scientific and clinical studies. The Quadtro Select line is the flagship and is reviewed here in its High Profile configuration.
Price and availability
We do not print prices, because they move and because almost nobody in Canada buys this cushion at list. Ask the dealer for the quote and ask the therapist what the funded price is, which is often a different number.
In Ontario, seating cushions fall under the Assistive Devices Program as positioning devices. ADP pays 75 per cent of the approved price and you pay 25 per cent, and it pays 100 per cent if you receive Ontario Works, the Ontario Disability Support Program, or Assistance for Children with Severe Disabilities. Income is not considered. You need an assessment by an occupational therapist or physiotherapist registered with the program, and Ontario aims to review an application within eight weeks. Other provinces run their own programs on their own rules; check yours rather than assuming Ontario’s apply.
The sentence that costs people the most money. Ontario states that if you order or buy the device before the assessment, application and registration steps are done, you are responsible for paying the full cost. Buying first does not get you a partial refund. It forfeits the subsidy.
Availability is broad. Motion Specialties now trades simply as Motion and has branches in Alberta, British Columbia, Manitoba, Ontario and Saskatchewan, so it is a national name but not a coast-to-coast one; regional independents and hospital-based equipment programs cover the rest. Permobil also runs a distributor locator. The cushion ships in many sizes and correct sizing is not optional: the manufacturer’s own instruction is that there is no weight limit but the cushion must be properly sized to the individual, and that the cushion and cover must be compatible sizes or the benefit may be reduced or eliminated.
There is no fixed replacement clock. Ontario’s ADP funds a replacement on one of three grounds: your condition or function has changed and the aid no longer meets your needs, your body size has changed and it no longer fits, or it is worn out, no longer covered by warranty, and cannot be repaired at a reasonable cost. That third route is why the warranty length below matters more than it looks. Lost aids are not covered, and neither is damage from misuse or neglect.
Category 1: accessibility (4 out of 5)
The cushion does well on accessibility for the people it is built for, with some friction around maintenance.
In-use accessibility. Once correctly inflated and positioned, the cushion is invisible during normal use. The user sits on it; it does its job; no ongoing interaction is required during sitting.
Inflation management. This is the main accessibility consideration, and the manufacturer is not casual about it: the operation manual says, in capitals, to check inflation frequently and at least once a day. The check has a number attached to it. Slide a hand between the cushion surface and the user’s bottom, find the lowest bony prominence, and release air until you can barely move your fingertips. ROHO states the cushion is most effective when there is half an inch to one inch (1.5 cm to 2.5 cm) of air between the user’s bottom and the seating surface. Over-inflation stops you sinking in and cancels the benefit; under-inflation does the same by letting you bottom out. Both raise the risk to skin and soft tissue.
For users with hand-function limitations, the inflation check is non-trivial. Some users cannot do it independently and rely on caregivers. This is a real accessibility limitation.
Inflation pump, and a warning. The cushion ships with a ROHO hand pump. It requires hand strength and a few seconds of pumping, and people with limited hand function may struggle with it. It is tempting to reach for an electric pump instead. Do not. The manual states that using any inflation device other than the supplied hand pump may damage the cushion and void the warranty, and says the same about substituting a pump, cover or repair kit not provided by ROHO. If the hand pump is not workable for you, that is a conversation for the seating therapist and the dealer, not a problem to solve with a compressor from a hardware store.
Cover access. The cover unzips for cleaning. The zipper is the standard separating type and requires bilateral hand function.
Repair. Air-cell punctures happen occasionally, from sharp objects, transfers gone wrong, and very rarely manufacturing defects. A repair kit ships with the cushion, and ROHO’s own instruction is that it is for pin-hole sized holes. Anything larger goes to warranty service rather than to a patch. Using a repair kit that did not come from ROHO may void the warranty.
Cognitive demands. Pressure-management cushions ask something of you every day: weight shifts, awareness of your skin, attention to the inflation. Users with cognitive limitations may need caregiver support for these tasks.
Category 2: maintenance (3.5 out of 5)
ROHO’s maintenance burden is the cushion’s biggest drawback.
Daily inflation check. This is the honest weak point of the product, and it is worth being straight about the gap between the instruction and the practice. ROHO’s instruction is unambiguous: check inflation at least once a day, and check skin at least once a day as well. Plenty of long-term users check the cushion less often than that. We are not going to tell you that is fine, because the cushion stops working when the air is wrong and the failure is silent. If daily is not realistic for you, the question to put to your therapist is what else in the routine can absorb the risk, not whether the instruction can be ignored.
Cover washing. ROHO’s instruction is machine wash cold at 30°C with mild detergent on a gentle cycle, or wipe clean, then tumble dry low. To disinfect, hand wash cold with one part household bleach to nine parts water and rinse thoroughly, or machine wash hot at 60°C. Remove the hook fastener pieces from the bottom first. How often depends on use intensity. Replacement covers are available through dealers, and it is worth knowing the cover carries a shorter warranty than the cushion.
Air-cell cleaning, and the things that quietly destroy the rubber. Close the valves, use a mild dish or laundry detergent and a soft brush or cloth, rinse with fresh water and air dry out of direct sunlight. Do not machine wash or machine dry it, do not use abrasives or dishwasher detergent, and do not use anything containing petroleum or organic solvents. Two cautions matter more than they sound. ROHO says oil-based lotions and lanolin degrade the material, which is awkward if skin care products are part of your routine, so keep them off the cushion. And ROHO notes that the US Environmental Protection Agency, Health Canada and other agencies have issued warnings about ozone generators, that prolonged ozone exposure degrades the rubber, and that it may void the warranty. If you run an ozone air purifier in the room where the chair lives, that is a real problem.
Puncture detection. A slow leak is hard to catch early. People often notice the cushion “feels different” over several days before working out that one compartment is losing air. ROHO gives a test: check every valve is closed tightly, look for visible holes, and if none show, close the valve, immerse an inflated section in a sink or tub, and watch for bubbles. Pin-holes take the repair kit; larger leaks go to warranty service.
Pump maintenance. The hand pump is generally durable but can fail. Replacement pumps are inexpensive.
Storage between uses. Most people keep the cushion on the chair full-time and there is no particular storage routine. It packs down small for travel, and it is light: ROHO’s specification table gives an average of 3.25 lb (1.5 kg) for a nine-by-nine-cell High Profile, while Permobil’s current product page gives 3.8 lb (1.7 kg) for the QS99C, so call it three to four pounds and expect it to vary with size. One handling note from the manual: never carry or pull the cushion by a valve. Use the yellow rope, the base, or the cover handle.
Long-term durability. ROHO does not publish a service life, and we are not going to invent one. What is published is the warranty, 36 months on Select cushions, and Ontario’s replacement rule, which turns on the cushion being worn out, out of warranty and not economically repairable rather than on it reaching a birthday. In practice these cushions last years, and they last less well with heavy incontinence exposure, rough handling, heat, ozone, and oil-based lotions.
Category 3: learning curve (4 out of 5)
The cushion has a real learning curve, but it is bounded and most users get over it.
First fitting. Should be done by a seating clinician (OT or PT with seating expertise) at the initial cushion fit. The clinician sets the four-quadrant inflation levels, demonstrates the inflation check, and trains the user on weight shifts.
Inflation skill. Most users learn the “hand slide” inflation check within a few weeks. The motor skill is straightforward; the cognitive habit (remembering to do it) takes longer.
Weight shift habit. Pressure-management cushions are most effective when paired with regular weight shifts (lifting briefly off the cushion every 15-30 minutes). Most users learn this as part of the broader pressure injury prevention regimen.
Using the ISOFLO. This is the part people get wrong, usually because they have been told it is four separate adjustments. It is not. Unlock, let the air find the shape of the body in the posture you actually sit in, lock, then recheck each compartment. Permobil designs it to be adjusted by the user while seated, with a push of a button, and the colour coding is deliberate: green open, red closed. The first setup still belongs with the seating therapist, because they are checking the underlying posture as well as the air.
Recognizing bottoming out. People learn the feel of it, the wheelchair frame coming through the cushion at specific points, and learn that it means re-inflation now rather than later. The objective version of the same check is ROHO’s half-inch to one-inch of air under the lowest bony prominence.
Category 4: solo use (5 out of 5)
The cushion is a solo-use product. Once it is fitted, you manage it yourself from then on.
Daily independence. The cushion does its work invisibly. You do not have to think about it while you are sitting.
Self-sufficiency. Most people can do the maintenance themselves. The minority who cannot do the inflation check rely on caregivers; for the majority, the cushion is part of independent living.
Travel, and a correction worth carrying onto the plane. The cushion travels well and packs down. But it is not true that altitude leaves it alone: ROHO’s manual carries an explicit caution that changes in altitude may require adjustment, and to check the cushion when you change altitude. Air expands as cabin pressure drops, so a cushion set correctly on the ground can be over-inflated at cruise, which is exactly the state that stops you sinking in and cancels the protection. Check it when you land, and check it again if you have driven up into the mountains.
Category 5: caregiver and family integration (4 out of 5)
For users with caregivers involved in transfer and positioning support, the cushion’s place in the routine is generally well-managed.
Caregiver training. Care attendants and family caregivers should know the inflation check, the basic positioning, and the signs of pressure injury. This is standard education for caregivers of users with significant pressure injury risk.
Transfer protection. During transfer (chair to bed, chair to car, chair to commode), the cushion should ideally travel with you. Many transfers shift you on it, so it often needs straightening afterward.
Bedside use. Some users with sleep posture issues use a cushion at bed level (under a positioning wedge). This is non-standard but works for some users.
Category 6: interabled use cases
Not particularly relevant: cushions are primary equipment for the wheelchair user, not partnered equipment.
Category 7: conditions where it works well
High-risk pressure injury prevention. Complete tetraplegia, complete paraplegia, prolonged immobility, history of pressure injury. The ROHO is the clinical default for highest-risk users.
Reduced sensation. Users with reduced sensation below the level of injury cannot feel developing pressure problems. The ROHO’s redistribution capability protects users who cannot self-detect.
Long-duration sitting. Users who sit for 12+ hours per day. The cumulative pressure exposure makes high-quality redistribution worth the maintenance cost.
Larger bodies. ROHO’s manual states plainly that there is no weight limit, and that the constraint is sizing rather than weight: the cushion must be properly sized to the individual. The Quadtro Select High Profile is built from 6 by 6 cells at the small end (12.75 in. wide by 11.75 in. deep) up to 14 by 12 cells (26.25 in. wide by 22.0 in. deep). Heavy-duty covers are made for the larger sizes.
Asymmetry. Pelvic obliquity, leg-length difference and surgical asymmetry are what the ISOFLO lock is for. Permobil puts a boundary on it: accommodation of pelvic asymmetry up to approximately 3 in. / 7.5 cm. Beyond that, the answer is a different seating solution, not more air.
Active wheelchair sport. Some athletic users prefer ROHO for its conformance during high-activity sitting.
Category 8: conditions where it doesn’t work
Users requiring deep postural support. ROHO’s air-cell instability is poor for users with severe postural support needs (some advanced MS, severe CP). Foam and hybrid systems, including cushions from Vicair and from JAY, often work better.
Sensitivity to the materials. The cushion is not PVC, and it is worth saying so because that claim circulates. ROHO’s specification lists neoprene rubber air cells with nickel-plated brass valves, and the ISOFLO control in polycarbonate, polypropylene and aluminium. Neoprene sensitivity and nickel sensitivity are both real, so if you react to wetsuits, knee braces or cheap jewellery, raise it at the fitting rather than after.
Users with poor inflation discipline. ROHO asks for your attention. If the inflation check is not going to happen, a lower-maintenance foam or hybrid cushion will outperform a neglected ROHO, and that is worth saying to the therapist out loud.
Cognitive impairment without caregiver support. Without inflation maintenance, the ROHO underperforms. Users with significant cognitive impairment and no consistent caregiver support are sometimes better served by foam alternatives.
Cost-constrained mid-risk users. People at moderate risk with no provincial coverage may find a JAY or Vicair cushion gives adequate protection at lower out-of-pocket cost.
Category 9: manufacturer practices (4 out of 5)
ROHO has been manufactured continuously since 1973 and has been in Belleville, Illinois since 1982, where Permobil says it employs around 230 people and produces over a thousand cushions a day. Permobil acquired it in 2015.
Engineering. Strong. Decades of clinical use with well-characterized performance.
Warranty. Get this number right, because it is the one people underestimate. ROHO’s limited warranty covers defects in materials or workmanship for 36 months on Select cushions, 24 months on other Dry Floatation products, and 6 months on covers, from the original purchase date. It does not cover misuse, accident damage, or acts of nature, and substituting accessories or modifying the product voids it. If a cushion is failing at two years, it is in warranty, and outside Canada the route is through your country’s ROHO distributor rather than direct.
Disposal. ROHO states that when properly used and disposed of there are no known environmental hazards associated with the components, that disposal should follow the regulations in your jurisdiction, and that the cushion must not be incinerated. Neoprene is not a material with a well developed consumer recycling route in Canada, so in practice end-of-life cushions go to landfill unless your dealer runs a take-back.
Disability community engagement. Long-established. ROHO has historical equity in the seating community and supports clinical education widely. Patient-community engagement is moderate.
Pricing transparency. Open via dealer quotes. List pricing is generally not directly published.
Long-term product support. Replacement parts and covers are reliably available. Permobil ownership has not disrupted product support.
Verdict
4.5 out of 5. The ROHO Quadtro Select High Profile is the right cushion for users with high pressure injury risk and the capacity (independently or with caregiver support) to maintain it. The clinical performance for the highest-risk users justifies the maintenance burden.
The half-point deduction is for the maintenance demands and the cognitive load. For users with significant cognitive limitations and inconsistent caregiver support, the ROHO is sometimes outperformed in practice by lower-maintenance alternatives (JAY, foam, Vicair) even though the ROHO’s theoretical pressure performance is superior.
For users new to wheelchair use with high-risk profiles, the ROHO Quadtro Select High Profile is the default starting point and is usually the right one. For users with experience and specific reasons to prefer alternatives (cognitive load, sensitivity to neoprene or nickel, postural support needs), the alternatives deserve real consideration.
Where to buy
- Motion, with branches in Alberta, British Columbia, Manitoba, Ontario and Saskatchewan
- Regional Permobil-authorized dealers, found through Permobil’s distributor locator
- Hospital and rehabilitation centre seating clinics, which often hold trial stock
- Veterans Affairs Canada for eligible veterans. Note that in Ontario you cannot claim the same aid from both VAC and ADP
- Your provincial assistive devices program, which is the route most people should start with
Always go through the clinical assessment, and go through it first. Self-purchased cushions without proper sizing and setup are common and often disappoint. In Ontario, buying before the application steps are complete also means you pay the whole cost, not a reduced one. The assessment is the cheap part of this.
Related LU content
- Power assist for manual chairs, where the same Permobil ownership question comes up
- Ultralight manual chairs, which is the usual pairing for this cushion
- Brand Spotlight: Permobil, the parent company
- Brand Spotlight: Sunrise Medical and Quickie. Sunrise owns JAY, which is the main competitor here
- Our adaptive equipment repair coverage, where cushion maintenance sits
- Cushion alternatives worth knowing by name: JAY, from Sunrise Medical, and Vicair, the Dutch maker of the SmartCell cushions
The ROHO has been the standard answer to the highest-risk pressure injury prevention question for decades. The technology has been refined; the fundamental design has not been displaced.
Frequently asked questions
What is the ISOFLO Memory Control on the ROHO Quadtro Select?
It is one control with two positions rather than four valves, and it is commonly described wrongly. With the green knob pushed in the control is unlocked and air moves freely through the whole cushion. With the red knob pushed in it is locked, and the air is held in four separate compartments. The operation manual sets the sequence: inflate with the control unlocked, adjust the air down to the correct level, seat the user in the posture they actually sit in, let the air transfer, and only then push the red knob to lock. The shape is set by the body rather than dialled in numerically, and the lock holds it.
How often does a ROHO cushion need its inflation checked?
The operation manual says, in capitals, to check inflation frequently and at least once a day. The check has a number attached to it: slide a hand between the cushion surface and the user’s bottom, find the lowest bony prominence, and release air until you can barely move your fingertips. ROHO states the cushion is most effective when there is half an inch to one inch, or 1.5 cm to 2.5 cm, of air between the user’s bottom and the seating surface. Over-inflation stops the user sinking in and cancels the benefit, and under-inflation lets the user bottom out. Both raise the risk to skin and soft tissue.
Can you use an electric pump to inflate a ROHO cushion?
No. The manual states that using any inflation device other than the supplied ROHO hand pump may damage the cushion and void the warranty, and it says the same about substituting a pump, cover or repair kit not provided by ROHO. The supplied hand pump requires hand strength and a few seconds of pumping, which people with limited hand function may struggle with. If the hand pump is not workable, that is a conversation for the seating therapist and the dealer rather than a problem to solve with a compressor from a hardware store.
How is a wheelchair seating cushion funded in Ontario?
Seating cushions fall under Ontario’s Assistive Devices Program as positioning devices. The program pays 75 per cent of the approved price and the applicant pays 25 per cent, and it pays 100 per cent for people who receive Ontario Works, the Ontario Disability Support Program, or Assistance for Children with Severe Disabilities. Income is not considered. An assessment by an occupational therapist or physiotherapist registered with the program is required, and Ontario aims to review an application within eight weeks. Other provinces run their own programs on their own rules, so confirm the terms with the program in your own jurisdiction.
What happens if you buy the cushion before the funding assessment?
Ontario states that if you order or buy the device before the assessment, application and registration steps are done, you are responsible for paying the full cost. Buying first does not get a partial refund, it forfeits the subsidy. On replacement, the Assistive Devices Program funds one on three grounds: your condition or function has changed and the aid no longer meets your needs, your body size has changed and it no longer fits, or it is worn out, no longer covered by warranty and cannot be repaired at a reasonable cost. Lost aids are not covered, and neither is damage from misuse or neglect.
Sources
- ROHO, Inc., ROHO DRY FLOATATION Wheelchair Cushions Operation Manual (revision 04/21/15). The source for every specification, caution, adjustment instruction, cleaning rule and warranty term in this review. Hosted as a PDF by EnableNSW.
- Permobil, ROHO QUADTRO SELECT HIGH PROFILE Cushion. Current product page: intended user profile, pelvic asymmetry accommodation, current weight figure, and the 90-plus study count.
- Permobil, History of ROHO. Founding date, Belleville manufacturing, production volume and the 2015 acquisition.
- Government of Ontario, Mobility aids. Assistive Devices Program coverage of positioning devices, the 75 and 100 per cent rates, the assessment steps, the replacement grounds, and the rule that buying before approval means paying in full.
- Motion, Our Locations. Provinces served.
- Vicair, Vicair cushion. Company location and SmartCell technology.
