Abstract:
An exemplary embodiment providing one or more improvements includes cushions which support a patient&#39;s thighs and lower legs and which have cut out areas in the areas of the patient&#39;s popliteal fossa at the back of the patient&#39;s knees. By avoiding contact with the popliteal fossa complications such as compression of the patient&#39;s nerves and blood vessels are avoided. This prevents the harmful effects of pressure on the popliteal fossa in loss of sensation in the lower legs and feet, and occlusion of blood and lymph vessels in the lower legs. A number of embodiment cushions are disclosed, some embodiments comprised of a relatively firm core foam material with a relatively softer viscoelastic foam in areas which are in contact with the patient&#39;s skin.

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
       [0001]    This application claims priority to provisional application Ser. No. 60/897,780 filed Jan. 26, 2007. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0002]    Not Applicable. 
       THE NAMES OF THE PARTIES TO A JOINT RESEARCH AGREEMENT 
       [0003]    Not Applicable. 
       REFERENCE TO A “SEQUENCE LISTING,” A TABLE, OR A COMPUTER PROGRAM LISTING APPENDIX 
       [0004]    Not Applicable. 
       BACKGROUND 
     Description of Related Art Including Information Disclosed Under 37 CFR 1.97 and 37 CFR 1.98 
       [0005]    Therapeutic cushions are cushions used for the prevention or treatment of a disease or condition in a supine patient confined to a bed. Examples of therapeutic cushions include heel elevators and log roll cushions. 
         [0006]    Embodiments of the present application are cushions which achieve the desirable redistribution of pressure of a patient&#39;s body on the cushion while eliminating the risk of injury to the popliteal fossa. 
         [0007]    U.S. Pat. No. 4,639,960 discloses a pneumatic cushion comprised of wedge shaped components. The cushion maintains the popliteal fossa at an elevation of 120 to 150 degrees, but has no provisions for avoiding contact between that anatomical feature and the cushion. 
         [0008]    U.S. Pat. No. 4,665,573 discloses a contoured body support cushion with a convex structure in the area of the knees which raises the surface some 3½ inches where the popliteal fossa is located on the average person. 
         [0009]    U.S. Pat. No. 5,398,354 discloses a mattress with a hollow portion which receives a soft resilient pillow insert for cushioning the heels of the user. 
         [0010]    U.S. Pat. No. 6,256,822 discloses a patient support system mattress with side bolsters to prevent falling from the bed and a cutout saddle which allows easy entry onto the mattress. 
         [0011]    U.S. Pat. No. 6,634,045 (incorporated herein by reference) discloses a supplemental support which may be integral to or separate from a heel elevator support. 
         [0012]    U.S. Pat. No. 7,007,330 discloses a patient turning and lifting device which includes body support with side rails, a pillow, and a saddle support pad to support the patient&#39;s buttocks and thighs. In addition, inflatable bladders allow the patient to be shifted from one side to another. 
         [0013]    U.S. Design Pat. No. D357,740 discloses a lateral surgical patient support cushion which has a traverse notch area. It is comprised of two foam components connected at one end of the traverse notch area. 
         [0014]    Patent Application Publication No. US2005/0005358, incorporated herein by reference, discloses an aid which assists a caregiver in rotating and positioning immobile patients. The aid has a strong resilient foam core which resists compression by a patient, yet also has a yielding surface foam layer which avoids trauma to the patient&#39;s skin. 
         [0015]    The foregoing examples of the related art and limitations related therewith are intended to be illustrative and not exclusive. Other limitations of the related art will become apparent to those of skill in the art upon a reading of the specification and a study of the drawings. 
       BRIEF SUMMARY 
       [0016]    Embodiments include a therapeutic cushion for a supine or side lying patient comprising support means for the patient&#39;s upper leg, and support means for the patient&#39;s lower leg. The cushion has a contoured free space between the upper leg support means and the lower leg support means which prevents contact between the cushion and the patient&#39;s popliteal fossa. 
         [0017]    Embodiments include a heel elevator cushion for use by patients without injury to the popliteal fossa area at the back of the knees. Embodiments include a rectangular heel elevator support having a front end and a back end, a left and a right side, and a top and a bottom surface, the support having a width from the left side to the right side approximating or less than the width of a bed, the support having a length from the front end to the back end approximating the length of a patient&#39;s leg from knee to Achilles tendon, the support having from the top surface to the bottom surface a height adequate to stimulate circulation in the lower legs. The cushion includes a rectangular wedge-shaped supplemental support having a front end and a back end, a left and a right side, and an upper surface and a lower surface, the supplemental support having a length from the front end to the back end approximating the length of a patient&#39;s leg from the hip to the knee, the supplemental support tapering in height from back end of the supplemental support having a height approximating the height of the front end of the heel elevator support to the front end of the second cushion where the upper surface meets the lower surface. The heel elevator support and supplemental support are separated by a rectangular connector having a front end and a back end, a left and a right side, and an upper surface and a lower surface, the connector having a length from the front end to the back end approximating the length of a patient&#39;s popliteal fossa, the connector having a height less than the height of the front end of the first cushion adequate to prevent contact of a patient&#39;s popliteal fossa with the connector when the patient&#39;s legs are supported by the heel elevator support and the supplemental support. The back end of the connector is connected to the front end of the heel elevator support and the front end of the connector connected to the back end of the supplemental support. The supports are comprised of a core foam overlaid by a viscoelastic patient contact foam and the cushions are covered by a cover comprised of water-resistant elastomer material. 
         [0018]    Also disclosed are embodiments of a log roll cushion for supporting the thighs and lower legs of immobile patients without injury to the popliteal fossa area at the back of the knees. Embodiments include a cushion having a front and rear end, a left and right edge, an upper and lower surface, the cross-section of the cushion in the approximate shape of a hemisphere with a cut-out approximately between the front and rear ends of the cushion, the cut-out dividing the cushion into a front portion and a rear portion, the width of the cushion approximating the width of a bed, the length of the front portion approximating the length of a patient&#39;s thighs, the length of the rear portion approximately the length of a patient&#39;s lower legs, and the depth of the cut-out adequate to avoid contact of the cushion with the popliteal fossa areas at the back of the patient&#39;s knees. The cushion is comprised of a core foam overlaid by a viscoelastic patient contact foam and the cushion is covered by a cover comprised of water-resistant elastomer material. 
         [0019]    The following embodiments and aspects thereof are described and illustrated in conjunction with systems, tool and methods which are meant to be exemplary and illustrative, not limiting in scope. In various embodiments, one or more of the above-described problems have been reduced or eliminated, while other embodiments are directed to other improvements. 
         [0020]    In addition to the exemplary aspects and embodiments described above, further aspects and embodiments will become apparent by reference to the drawings and by study of the following descriptions. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0021]      FIG. 1  is a perspective view of a first embodiment heel elevator cushion in used by a patient. 
           [0022]      FIG. 2  is a cross-sectional view of the first embodiment heel elevator cushion taken along line  2 - 2  of  FIG. 1 . 
           [0023]      FIG. 3  is a perspective view of a second embodiment heel elevator cushion. 
           [0024]      FIG. 4  is a cross-sectional view of a second embodiment heel elevator cushion taken along line  4 - 4  of  FIG. 3 . 
           [0025]      FIG. 5  is a cross-sectional view of a first embodiment heel elevator support taken along line  5 - 5  of  FIG. 1 . 
           [0026]      FIG. 6  is a cross-sectional view of a second embodiment heel elevator support taken as along line  5 - 5  of  FIG. 1  when the second embodiment heel elevator support is used rather than the first embodiment heel elevator support. 
           [0027]      FIG. 7  is a cross-sectional view of a third embodiment heel elevator support taken as along line  5 - 5  of  FIG. 1  when the third embodiment heel elevator support is used rather than the first embodiment heel elevator support. 
           [0028]      FIG. 8  is a perspective view of a log roll cushion in use by a patient. 
           [0029]      FIG. 9  is a cross-sectional view of a log roll cushion taken along line  9 - 9  of  FIG. 8 . 
           [0030]      FIG. 10  is a perspective of a third embodiment heel elevator cushion in use by a patient. 
           [0031]      FIG. 11  is a cross-sectional view of a third embodiment heel elevator cushion taken along line  11 - 11  of  FIG. 10 . 
           [0032]      FIG. 12  is a perspective view of a fourth embodiment heel elevator cushion. 
           [0033]      FIG. 13  is a cross-sectional view of a fourth embodiment heel elevator cushion taken along line  13 - 13  of  FIG. 12 . 
       
    
    
     DETAILED DESCRIPTION 
       [0034]    Therapeutic cushions are cushions used for the prevention or treatment of a disease or condition in a patient confined to a bed in a supine or side lying position. Examples of therapeutic cushions include heel elevators and log roll cushions. It is anticipated that the popliteal fossa-sparing features of the disclosed embodiments can be used with other therapeutic cushions equivalent to the disclosed embodiments. 
         [0035]    Heel elevators are used in the prevention of the development of pressure ulcers, an important goal in the treatment of immobile patients. Heel pressure ulcers are caused by contact of the back of the heel with the bed or bedclothes. Heel pressure ulcer prevention in supine patients can be achieved by the use of cushions under the lower legs which support the ankles and feet, thereby preventing any contact of the heels with any surface. 
         [0036]    Another use for heel elevators is to improve circulation in the legs by elevating the lower legs above the level of the heart. Such elevation has the desirable effect of insuring adequate drainage of blood and fluid out of the lower extremities. 
         [0037]    When the lower legs and heels are elevated on a therapeutic cushion or pillows, there is always a small span that is created between the support surface and the posterior surface of the thighs. This is often tolerated well by the patient, but comfort and clinical efficacy can be greatly enhanced by also supporting the thighs. This has a positive effect on the redistribution of pressure, since a greater percentage of the overall area of the body is in contact with a supporting surface. By increasing the area of supported body surface the average pressure per surface area on the patient&#39;s skin is reduced. This effect is referred to as pressure redistribution. It is desirable to have the legs in contact with and supported by the greatest possible area of support as possible, as this reduces the average pressure of the support against the skin, thereby reducing the incidence of pressure ulcers. 
         [0038]    Supporting the thighs and lower legs with cushions is not without disadvantages. The most important disadvantage is that there will likely be a cushion surface in contact with the area at the back of the knee known as the popliteal fossa. The popliteal fossa contains easily damaged nerves, blood vessels, glands, ligaments, tendons and soft tissue. Pressure on the popliteal fossa forces the anatomical features contained in this structure upward against the bony prominent bony structures at the ends of the femur and tibia. The nerves, blood vessels, muscles, tendons and glands may be damaged by such pressure, with subsequent attendant injury to the lower legs and feet through congested blood flow and loss of sensation. 
         [0039]    In particular, pressure on or compression of the nerves in the popliteal fossa causes damage which reduces sensation in the lower legs and feet. Loss of sensation in the feet reduces the chances of early detection and cure of foot injuries. In addition, pressure on blood vessels in the popliteal fossa leads to congestion of blood flow to and from the lower extremities. Such congestion inhibits healing leading to progression of disease and often to amputation. It will be appreciated that a patient confined to a bed may be debilitated by vascular disease, diabetes, cancer or stroke, edema or other conditions; all of which make the popliteal fossa and the anatomical features contained inside more vulnerable to injury. 
         [0040]    The use of any therapeutic cushion runs the risk of stimulating the formation of pressure ulcers on the portion of the patient&#39;s body in contact with the surface of the cushion. This risk is reduced by the use of viscoelastic foam in the portion of the cushion in contact with the patient&#39;s body. An additional approach is to reduce the pressure of the cushion on the patient&#39; prominent body contact points, the so-called bony prominences such as the ankle, heel, and hip. Advanced practices achieve this reduction of contact point pressure by increasing the total area of the patient&#39;s body in contact with the body support, the redistribution of pressure. By expanding the area of contact of the patient&#39;s body with the support surface, the pressure on the bony prominences is reduced. 
         [0041]    Log roll cushions are cushions having the rough shape of a rolled up blanket which extends from one side of a bed to the other, hence the name “log roll.” Log roll cushions are placed under and raise the knees of a supine patient lying on his or her back. Such cushions are used to relieve the pressure on the patient&#39;s lower back and thereby reduce back pain. 
         [0042]    The Popliteal Fossa. 
         [0043]    The popliteal fossa or space is a lozenge-shaped space at the back of the knee-joint. Laterally it is bounded by the biceps femoris above, and by the plantaris and the lateral head of the gastrocnemius below. Medially it is limited by the semitendinous and semimembranosus above, and by the medial head of the gastrocnemius below. The innermost surface or floor is formed by the popliteal surface of the femur, the oblique popliteal ligament of the knee-joint, the upper end of the tibia, and the fascia covering the popliteus; the fossa is covered in by the fascia lata. 
         [0044]    The popliteal fossa contains the popliteal vessels, the tibia and the common peroneal nerves, the termination of the small saphenous vein, the lower part of the posterior femoral cutaneous nerve, the articular branch from the obturator nerve, a few small lymph glands, and a considerable quantity of fat. The tibial nerve descends through the middle of the fossa, lying under the deep fascia and crossing the vessels posteriorly from the lateral to the medial side. The common peroneal nerve descends on the lateral side of the upper part of the fossa, close to the tendon of the biceps femoris. On the floor of the fossa are the popliteal vessels, the vein being superficial to the artery and united to it by dense areolar tissue; the vein is a thick-walled vessel, and lies at first lateral to the artery, and then crosses it posteriorly to gain its medial side below; sometimes it is double, the artery lying between the two veins, which are usually connected by short transverse branches. The articular branch from the obturator nerve descends upon the artery to the knee-joint. The popliteal lymph glands, six or seven in number, are imbedded in the fat; one lies beneath the popliteal fascia near the termination of the external saphenous vein, another between the popliteal artery and the back of the knee-joint, while the others are placed at the sides of the popliteal vessel. Arising from the artery, and passing off from it at right angles, are its genicular branches. 
         [0045]    The use of any therapeutic cushion under the knees runs the risk of congesting blood flow and compressing nerves in the popliteal fossa, which is directly behind the knee. 
         [0046]      FIG. 1  is a perspective view of a first embodiment heel elevator cushion  100  in use by a patient.  FIG. 1  shows a patient lying in a supine position on his or her back, in particular the torso  14 , left leg comprising thigh or upper leg  15 , knee  16 , lower leg or calf  18 , and foot  19 . The popliteal fossa  17  is on the bottom side of or behind or underneath the knee. Also visible is the right leg comprising thigh or upper leg  20 , knee  21 , lower leg or calf  18 , and foot  19 . The popliteal fossa  22  is on the bottom side of or behind or underneath the knee. 
         [0047]    The first embodiment heel elevator cushion  100  is comprised of a heel elevator support  25  connected to a connector  75 , which is in turn connected to a supplemental support  50 . 
         [0048]    In use, the thighs  15  and  20  rest on the upper surface  56  of the supplemental support  50 . The popliteal fossas  17  and  22  are suspended above the hemispheric bore, groove or contoured free space comprising the upper surface  81  of the connector  75 . The lower legs  18  and  23  rest on the upper surface  35  of the heel elevator support  25  and in this embodiment are restrained from movement off of the heel elevator support by bolsters, also called ramparts or palisades. Left bolster  39  and right bolster  37  are located on the edges of the heel elevator support and extend above the upper surface  35  of the heel elevator support. The feet  19  and  24  are suspended over the back end  41  of the heel elevator support and the heels do not come in contact with any support surface or bedclothes. Suspension of feet and heels without contact with any surfaces helps prevent and treat heel pressure ulcers. 
         [0049]    The length of the heel elevator support approximates the length of a patient&#39;s lower legs, the length of the supplemental support approximates the length of a patient&#39;s upper legs, and the length of the connector approximates the length of a patient&#39;s popliteal fossa. In one embodiment the length of the heel elevator cushion is 29 inches and the width is 27 inches. The length of the heel elevator support is 13 inches and the height is 13 inches. The height of the bolsters is 1.5 inches and the width is 1.5 inches. The length of the upper surface of the supplemental support is 9.5 inches, the height of the supplemental support at the connector is 7.5 inches, and the length of the supplemental support at the bottom is 5.8 inches. The length of the connector is 10.2 inches. 
         [0050]    The thickness of the viscoelastic foam covering the upper surfaces of the heel elevator support and the upper surface of the supplemental support is 1.5 inches. 
         [0051]    In embodiments the length of the heel elevator cushion is from 24 to 36 inches and the width is 22 to 36 inches. The length of the heel elevator support is from 10 to 16 inches, the height is from 10 to 16 inches. The height of the bolsters is 0.5 to 3 inches and the width is 0.5 to 3 inches. 
         [0052]    In embodiments the length of the upper surface of the supplemental support is from 6 to 16 inches, the height of the supplemental support at the connector is from 6 to 9 inches, and the length of the supplemental support at the bottom is from 4 to 9 inches. The length of the connector is from 8 to 16 inches. 
         [0053]    In embodiments which support both legs of a patient the width of the heel elevator cushion approximates the width of a hospital bed, approximately 25 inches to 35 inches. 
         [0054]    In embodiments which support only one leg of a patient the width of the heel elevator cushion approximates one half of the width of a hospital bed, approximately 10 inches to 17 inches. 
         [0055]    In embodiments which are constructed of viscoelastic foam layered on top of structural foam the thickness of the viscoelastic foam covering the upper surfaces of the heel elevator support and the upper surface of the supplemental support is from 0.5 to 3 inches. 
         [0056]      FIG. 2  is a cross-sectional view of the first embodiment heel elevator cushion taken along line  2 - 2  of  FIG. 1 . In this embodiment the heel elevator support  25 , connector  75 , and supplemental support  50  are combined in a single piece of foundation foam material  29 , with the border between heel elevator support and connector indicated by dashed line  31  and the border between connector and supplemental support indicated by dashed line  33 . A layer  52  of viscoelastic foam covers the upper surface  56  of the supplemental support  50 ; and a similar layer  27  covers the entire upper surface of the heel elevator support  25 , including the upper surface of the right bolster  37 , and the upper surface of the heel elevator support  25 , not visible in  FIG. 2  but indicated by dashed line  35 . The viscoelastic foam layer on upper surface  35  is at  28 . The approximately hemispheric upper surface  77  of the connector, also termed a contoured free space, is low enough to prevent contact of the patient&#39;s popliteal fossas with any surface. The back end of the heel elevator support is at  41 . All surfaces of the first embodiment heel elevator cushion are covered by a cover  90 . 
         [0057]      FIG. 3  is a perspective view of a second embodiment heel elevator cushion  200 . In the second embodiment the heel elevator support  225  has a left bolster  239 , a right bolster  237 , a flat upper surface  235  and is covered on all sides by a cover  294 . The wedge shaped supplemental support  250  has an upper surface  256  and is covered on all sides by a cover  292 . The second embodiment heel elevator cushion  200  has a second embodiment connector  275 , in this embodiment comprising a left connector arm  277  and a right connector arm  279 . 
         [0058]    A variety of connector embodiments are contemplated, some connectors may extend from one side of the heel elevator support to the other, or may consist of a single arm. In embodiments the connectors must be stiff enough to maintain a cut out or distance between the heel elevator cushion and the supplemental support adequate to prevent contact between the patient&#39;s popliteal fossas and any portion of the heel elevator cushion or supplemental support, also termed a contoured free space. Connectors which are adjustable in length are specifically contemplated. Connectors that are welded or cut in such a way that they are a feature of the thigh support and or lower leg support cushion are also contemplated. Connectors with flexible connections with the heel elevator cushion and the supplemental support are contemplated, such as tape, adhesive, straps or other types of fasteners. Such flexible connections allow the folding of the heel elevator cushions for storage and shipping purposes. In addition, such flexible connections allow the supports to articulate when used with mechanical beds commonly found in the healthcare setting. 
         [0059]      FIG. 4  is a cross-sectional view of a second embodiment heel elevator cushion taken along line  4 - 4  of  FIG. 3 . In this embodiment the heel elevator support  225 , connector  275 , and supplemental support  250  are individual units. The heel elevator support  225  comprises a single piece of foundation foam  229  with a layer  227  of viscoelastic foam at the top and internal surface of the right bolster  237 . The flat upper surface is indicated by dashed line  235  and the viscoelastic layer by  228 . The back end of the heel elevator support is at  241 . All surfaces of the second embodiment heel support  225  are covered by a cover  294 . Embodiments that are not with a cover are also contemplated. 
         [0060]    The right connector arm  279  is a portion of the second embodiment connector  275 . The connector arm is connected at one end to the heel elevator support  275  and at the other end to the supplemental support  250 . 
         [0061]    The second embodiment supplemental support  250  is shown in  FIG. 4 . The foundation foam  254 , the upper surface  256 , the viscoelastic foam layer  252 , and the cover  292  which covers all surfaces of the second embodiment supplemental support are shown. 
         [0062]      FIG. 5  is a cross-sectional view of a first embodiment heel elevator support  25  as taken along line  5 - 5  of  FIG. 1 . Visible in  FIG. 5  is a foundation foam  29 , viscoelastic foam layer  27  which covers the areas of the support which may contact the patient user, in particular the upper surface  35  of the support, the internal surface  32  and top  34  of left bolster  39 , and internal surface  36  and top  38  of right bolster  37 . A cover  90  encloses the support. 
         [0063]      FIG. 6  is a cross-sectional view of a flat embodiment heel elevator support  425  as taken along line  5 - 5  of  FIG. 1 . Visible in  FIG. 6  is a foundation foam  429 , and viscoelastic foam layer  427  which covers the areas of the support which may contact the patient user. A cover  490  encloses the support. 
         [0064]      FIG. 7  is a cross-sectional view of a cavity embodiment heel elevator support  525  as taken along line  5 - 5  of  FIG. 1 . Visible in  FIG. 7  is a foundation foam  529 , viscoelastic foam layer  527  which covers the areas of the support which may contact the patient user, in particular the upper surface  535  of the support, the left leg cavity  540  and right leg cavity  550 . A cover  590  encloses the support. 
         [0065]      FIG. 8  is a perspective view of a hemispheric-shaped log roll cushion  300  in use by a supine patient. The elements of the patient are as in  FIG. 1 . The lower legs  18  and  23  of the patient rest on the surface  335  of the arc-shaped rear end  325 , the upper legs  15  and  20  rest on the surface  356  of the arc-shaped front end  350  of the log roll cushion, and the popliteal fossas  17  and  22  are suspended above the surface  377  of the hemispheric bore, groove, contoured free space, or cut out  381  on the top surface of the connector  375  between the rear end  325  and front end  350 . All surfaces of the log roll cushion  300  are enclosed by a cover  390 . The rear end  325 , front end  350  and connector  375  may be constructed of a single piece of foam or of pieces of foam which are attached to each other. 
         [0066]      FIG. 9  is a cross-sectional view of a log roll cushion taken along line  9 - 9 . Embodiments may comprise a single piece of foundation foam divided by dashed line  331  into a rear end  325  and connector  375  and dashed line  333  into connector  375  and front end  350 . Embodiments comprise foundation foam  329  with upper surfaces covered by viscoelastic foam, the rear end  325  upper surface  335  covered by viscoelastic foam  327 , and the front end  350  upper surface  356  covered by viscoelastic foam  352 . The surface  377  of the hemispheric cut out  381 , also termed a contoured free space, is shown. All surfaces of the log roll cushion  300  are enclosed by a cover  390 . 
         [0067]    In embodiments which support both legs of a patient the width of the log roll approximates the width of a hospital bed, approximately 25 inches to 35 inches. 
         [0068]    In embodiments which support only one leg of a patient the width of the log roll approximates one half of the width of a hospital bed, approximately 10 inches to 17 inches. 
         [0069]    In embodiments the length of the rear end approximates the length of a patient&#39;s lower legs, the length of the front end approximates that of a patients upper legs, and the length of the cut-out approximates the length of a patient&#39;s popliteal fossa. The depth of the cut-out is adequate to prevent contact of the patient&#39;s popliteal fossa with any surface of the log roll. 
         [0070]      FIG. 10  is a perspective of a third embodiment heel elevator cushion  400  in use by a patient. The elements of the patient are as in  FIG. 1 . The height of the third embodiment cushion is greatest at the rear of the heel elevator support at the patient&#39;s feet and tapers to the level of the bottom of the cushion at the rear of the supplemental support at the patient&#39;s hips. The patient&#39;s upper legs rest on the supplementary support surface  456 , the patient&#39;s lower legs rest on the heel elevator support surface  435 , the patient&#39;s feet  19  and  24  (and associated heels) extend beyond the rear end  441  of the heel elevator support, and the patient&#39;s popliteal fossas are suspended above the approximately hemispheric cutout area or contoured free space  481  and do not contact the surface of the connector  477 . 
         [0071]    One use for the third embodiment heel elevator cushion is to elevate the lower and upper legs above the level of the patient&#39;s heart and thereby improve the patient&#39;s blood circulation while simultaneously protecting the patient&#39;s heels against heel pressure ulcers. 
         [0072]      FIG. 11  is a cross-sectional view of a third embodiment heel elevator cushion taken along line  11 - 11  of  FIG. 10 . In this embodiment the heel elevator support  425 , connector  475 , and supplemental support  450  are combined in a single piece of foundation foam material  429 , with the border between heel elevator support and connector indicated by dashed line  431  and the border between connector and supplemental support indicated by dashed line  433 . A layer  452  of viscoelastic foam covers the upper surface  456  of the supplemental support  450 ; and a similar layer  427  covers the entire upper surface  435  of the heel elevator support  425 . The approximately hemispheric upper surface  477  of the groove or bore or contoured free space  488  of the connector  475  is low enough to prevent contact of the patient popliteal fossas with any surface. The rear end  441  of the heel elevator support is shown. All surfaces of the third embodiment heel elevator cushion are covered by a cover  490 . 
         [0073]    In the third embodiments which support both legs of a patient the width of the heel elevator cushion approximates the width of a hospital bed, approximately 25 inches to 35 inches. 
         [0074]    In the third embodiments which support only one leg of a patient the width of the heel elevator cushion approximates one half of the width of a hospital bed, approximately 10 inches to 17 inches. 
         [0075]    In the third embodiments the length of the supplemental support approximates the length of a patient&#39;s upper legs, the length of the heel elevation support approximates the length of a patient&#39;s lower legs, the length of the connector approximates the length of the patient&#39;s popliteal fossa. 
         [0076]      FIG. 12  is a perspective view of a fourth embodiment heel elevator cushion  500 . In the fourth embodiment the heel elevator support  625  has a flat upper surface  635  and is covered on all sides by a cover  694 . The wedge shaped supplemental support  650  has an upper surface  656  and is covered on all sides by a cover  692  which also covers the connector  675 . The fourth embodiment heel elevator cushion connector  675  is integral with the supplemental support  650  forming a combination supplemental support and connector and has a hemispheric cut out or contoured free space  677  at the top of the connector to accommodate the patient&#39;s popliteal fossa. The heel elevator support cover  694  is connected to the connector cover  692  by a hinge  696  which is made of the same material and is integral with and attached to the covers  694  and  692 . The covers  694  and  692  and hinge  696  may be constructed of a single piece of material. 
         [0077]      FIG. 13  is a cross-sectional view of the fourth embodiment heel elevator cushion taken along line  13 - 13  of  FIG. 12 . In this embodiment the heel elevator support  625 , comprises foundation foam material  629  and is covered by cover  694 . The rear end  641  of the heel elevator support is shown. The connector  675  and supplemental support  650  are combined in a single piece of foundation foam material  635 , with the border between supplemental support  650  and connector  675  indicated by dashed line  633 , and the cover at  692 . The approximately hemispheric upper surface or contoured free space  677  of the connector is low enough to prevent contact of the patient popliteal fossas with any surface. The heel elevator support cover  694  is connected to the connector  675  by a hinge  696  which may be made of the same material and is integral with the covers  694  and  692 . The covers  694  and  692  and hinge  696  may be constructed of a single piece of material. 
         [0078]    Other equivalent structures and materials for the hinge  696  are contemplated. For example, a fourth embodiment cushion without a cover uses a hinge constructed of a approximately rectangular flexible strap attached along the strap long edges to the bottom of the heel elevator support  625  and to the bottom of the supplemental support  650 . The strap hinge is attached to the supports by any suitable means such as adhesive, riveting, or sewing. 
         [0079]    The hinge embodiments have the function of connecting the heel elevator support and the supplemental support and maintaining them at a suitable distance from each other and a suitable orientation to each other. In addition, the hinges allow the vertical articulation of the supports which allow conformation to the articulation of many hospital beds. 
         [0080]    A number of heel elevator cushion embodiments have been disclosed along with a number of embodiments of heel elevator supports. It is contemplated that any embodiment heel elevator support can be used in any embodiment heel elevator cushion. 
         [0081]    Although embodiments in which the cushion or log roll is constructed of foam are disclosed, construction from other equivalent weight supporting materials is contemplated. Polyester fiber fill, various gel materials, water or other fluids, including air, are contemplated as filling materials. In such embodiments the fill material is contained within a cover impervious to the fill. 
         [0082]    The foundation foam used in embodiments is any suitable strong, resilient, high modulus of elasticity foam material, such as polyurethane foam, copolymer foam, or latex foam. In embodiments a preferred foam is polyurethane foam. Foam is available in variations; such as a 1 A high resiliency; HD high density, VE viscoelastic, which has very high density. Latex foam has the disadvantage of possibly inducing allergic reactions to the foam. In embodiments an antimicrobial additive is included in the foam. The foundation foam in embodiments has a density of 1.4 to 4.6 pounds per cubic foot and an indention force deflection of 30 to 80. 
         [0083]    The viscoelastic foams on the outer surfaces of embodiments are of lower density and lower resilience than that of the foundation foams, although the viscoelastic foams may have the same chemical compositions as foundation foams. Viscoelastic foams have a density of not less than 1.2 pounds per cubic foot and an indention force deflection equal to or less than 30. 
         [0084]    In embodiments viscoelastic foams are attached to the foundation foam by adhesives, such as polyurethane adhesive. 
         [0085]    In embodiments an antimicrobial additive is included in the foam. One antimicrobial is solutions of 10,10′-oxybisphenoxarsine, which is available from Rohm and Haas, Philadelphia, Pa. under the trademark VINIZEN. 
         [0086]    In embodiments the covers are comprised of water-resistant elastomer material. In embodiments a preferred material is thermoplastic polyurethane film manufactured by J.P. Stevens Elastomerics of Holyoke, Mass. 
         [0087]    In embodiments using elastomer material the covers are comprised of panels attached to each other by radio frequency welding. Other equivalent suitable methods for attaching the panels together, such as sewing, heat sealing, or gluing with permanent adhesives, such as epoxy adhesives, are contemplated. 
         [0088]    In embodiments intended for multiple uses the cover is comprised of water-resistant coated fabric material. In embodiments a preferred material is 70 denier nylon taffeta manufactured by Stafford Textiles of Toronto, Ontario, Canada. Other suitable fabric materials may be used, such as vinyl and rayon. 
         [0089]    In embodiments the fabric material cover is coated with a suitable water-resistant polymer such as polyurethane, butyl rubber, vinyl, and thermoplastic urethane. In embodiments a preferred coating includes polycast coat laminate and antimicrobial additives. 
         [0090]    In embodiments using fabric material covers, cover panels are attached to each other by sewing along the seams. In embodiments a zipper is used to allow the insertion and removal of the cushions from the covers. Other suitable methods for attaching the panels together, such as radio frequency welding, heat sealing, or gluing with permanent adhesives, such as epoxy adhesives, may be used. Other suitable equivalent means for reversible opening and closing covers, such as hook and loop closures, buttons, and snaps are contemplated. In embodiments there are no seams on the patient contact areas of the cover, in particular, on the upper surfaces. 
         [0091]    In embodiments the interior side of the cover, the side facing the cushion, is treated to make it waterproof, for example, coated with polyurethane or butyl rubber. 
         [0092]    In embodiments the upper side of the cover, the side to which the patient is exposed, is made of friction and shear reducing fabric, such as nylon or polyurethane fabric. 
         [0093]    In embodiments, a variety of materials may be used as a non-slip coating applied to the side of the bottom of the cover which makes contact with the sheet and mattress. Any durable suitable material which provides a slip-resistant or non-slip effect which prevents or retards the sliding of the cushion on the surface of the bed may be used. Non-slip material sold under the trademark SOFTGRIP BLUE #2915C by Ventrex, Inc., Great Falls, Va. Other suitable materials include tapes having an antislip surface and self-adhesive backing, such as tapes available under the trademark ANTI-SLIP GRIP TAPES from All-tapes.com, Chatsworth, Calif. Other antislip materials include general purpose tapes and treads available from Martinson-Nicholls, Inc. Willoughby, Ohio under the trademark  3 M SAFETY WALK and NAMCO trademark vinyl backing mats and nitrile rubber gripper backing are available from North American Mat Company, Hollandale, Minn. 
         [0094]    Therapeutic cushion and log roll embodiments are used by placing cushion or log roll under the supine patient&#39;s leg or legs with the popliteal fossa region over a void in the cushion or log roll. The functions of the cushions or log rolls of this application include prevention or treatment of heel pressure ulcers, improvement of blood circulation in the legs, and relief of back pain. 
         [0095]    While a number of exemplary aspects and embodiments have been discussed above, those of skill in the art will recognize certain modifications, permutations, additions and sub combinations thereof. It is therefore intended that the following appended claims and claims hereafter introduced are interpreted to include all such modifications, permutations, additions and sub-combinations as are within their true spirit and scope.