ATP Series

Optimal Seating on All Surfaces

• By Laurie Watanabe
• Mar 01, 2017

It is not the most glamorous topic, those other surfaces that complex rehab technology (CRT) wheelchair users sit on every day. But commodes and bath/shower chairs are part of your clients’ daily routines, and are critical to their overall health.

“The rehab shower commode chair (RSCC) is often the second-most important mobility device for clients,” says Nelson Pang, president of Raz Design. “Toileting and bathing/hygiene are how many clients start each day. Combining these routines can take up to several hours. Similar to a wheelchair experience, the risk of pressure injuries increases if appropriate seating and positioning is not provided in a RSCC.”

It’s ironic that a consumer so carefully measured and fitted for a seating system and wheelchair often uses bathroom equipment from pharmacies or big-box stores selling DME to seniors. Straight-backed, plastic shower chairs might be fine for that demographic, but Pang points out, “Factors such as hard, flat-shaped seats; oversized and incorrectly placed apertures; improper positioning can all significantly increase the risk of pressure injuries” in complex rehab clients.

COMPLEX NEEDS, REGARDLESS OF THE SURFACE

Clarke Health Care Sales Representative Wade Lawrence explains that functionally, it makes no sense when a consumer using complex seating turns to general DME for bathing and hygiene.

“People who are in CRT, most of the time they’re on a seating system like a ROHO [cushion] or a gel overlay of some type, due to the fact that they don’t have [intact] sensation,” he says. “A lot of them can’t weight shift.”

Using general DME, therefore, “would be like sitting on wood or a hard plastic seat without having their cushion. And most of consumers that are in CRT have some type of tilt or recline because they can’t shift their weight; that tilt allows them to shift their weight in a wheelchair. That’s why they can’t buy a standard shower chair or commode from Walgreens or CVS. One, it doesn’t allow them to weight shift. Two, it’s not going to give them the optimal seating that they’re going to need. If I were an ATP and I were getting that person a [CRT] cushion for their chair, I would want them sitting on that same surface for showering, bowel movements, those types of things.”

CUSTOMIZABILITY IN THE BATHROOM

The custom fitting that goes into a CRT client’s wheelchair and seating is also needed in the bathroom, Pang says.

“Compared to basic one-size-fits-all RSCC,” he says, “true rehab shower commode chairs provide more opportunities to reduce the effects of gravity on the client. ‘True rehab’ shower commode chairs, like their wheelchair counterparts, are prescribe-able, modular and adjustable. Prescribe-able means a chair can be uniquely configured to meet an individual’s specific needs; modular means it can be reconfigured in the field to accommodate changes in medical conditions; adjustable means it can be precisely fitted to the client, like a well-tailored suit.”

Topics routinely discussed during CRT assessments, such as seat-to-floor heights and transfers, should also be part of bath and hygiene discussions, Lawrence says.

“Our Ocean chairs have height-adjust to adjust seat-to-floor height,” he notes. “If consumers are transferring from another surface — their wheelchair or a bed — they can take our chairs and raise them or lower them so they’re not having to go up or down a surface. Because that takes a lot out of somebody, having to transfer from uneven surfaces. And it’s dangerous. Not so much when you start [bathing], but when you’re getting out: You’re wet, and there are opportunities for falls and slipping.”

MOISTURE VS. SKIN HEALTH

Perspiration, humidity and bodily fluids are known to raise risk of skin breakdown, and thus are often discussed during seating evaluations. In bathrooms, moisture is unavoidable — as are soap and shampoo. Those usually benign substances can endanger consumers who spend a lot of time in contact with them.

“One of our products is geared completely for that,” Lawrence says. “We have a special soft seat for our Ocean shower chairs. It’s a very soft overlay, and it has a non-slip surface with a Gore-Tex membrane. Think of it as something like Rain-X that you would put on your windshield: This non-slip surface doesn’t take on water. It feels like a standard foam cushion, but it’s not. The non-slip surface allows moisture and shampoo to slide away or to be rinsed off. You’re not sitting in something and soaking.”

Customized, adjustable equipment also facilitates time-consuming bathing, toileting, bowel and bladder regimens.

“Maceration, bacterial infection and incontinence dermatitis are a few of the issues that can occur due to improper hygiene,” Pang notes. “The key to minimizing the risks of these issues is to have thorough hygiene and bathing routines. Having well-fitted, properly prescribed rehab shower commode chairs make these routines easier to complete for clients and attendants.”

A CRITICAL PART OF COMPLEX REHAB

In other words, a complex rehab client’s functional and clinical needs don’t disappear whenever they roll into the bathroom.

“For RSCC’s, the seat is the most important consideration for reducing the risk of pressure injuries,” Pang says. “As with a wheelchair, a properly selected commode seat with the appropriate width, depth, aperture size, contour and softness can maximize contact area and minimize sitting pressures. An attendant-operated, tilting RSCC is recommended for clients who have prolonged toileting/hygiene/bathing routines, but do not have the ability to perform weight shifts. Dynamic tilt will transfer loads from high-risk seat surface to low-risk back surface. Adding modular recline to a tilt RSCC can provide even more weight transfer as well as, with the opening of the hip angle, facilitate catheter insertion, removal and other GU [genitourinary] care.”

Lawrence points out that much of the work related to this equipment is already done via the seating/mobility evaluation. “If you’ve been through the seating clinic to do a power or manual chair, you’ve got everything you need to fit a complex rehab bathing system to that patient, other than the simple question of ‘What’s your bathroom like?’” he says. “There’s no extra work other than ‘Let me get you a measurement sheet to measure your bathroom. Do you have a roll-in, do you have a tub?’ That’s it. It’s an easy add-on.”

The benefits of using complex rehab equipment in the bathroom, though, are far reaching.

“Just think,” Lawrence says, “about how long just a transfer takes.”

This article originally appeared in the March 2017 issue of Mobility Management.