BATHROOM IMAGE/ISTOCKPHOTO.COM/MATHIER
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.”