The D-Slim PLUS wheelchair cushion with elastic top cover is a very affordable low-profile, light weight pressure relief cushion. The cushion can be customized anywhere in the field to suit the user’s needs. The cushion includes a contoured base, a top “interface” layer of high-quality foam, and unique features which enhance pressure management and positioning. The cushion was tested in an independent testing facility and has met all US Medicare requirements for the E2603 Skin Protection Cushion. The Design is consistent with the World Health Organization guidelines on the provision of manual wheelchairs in less resourced settings and can be delivered according to the wheelchair service training packages.