This topic of discussion may not apply to all power chair users depending on their bathroom needs as well as their level of independence in completing bathroom and hygiene care. When we address bathroom needs, it encompasses toileting, bathing/showering, and basic hygiene care (teeth, hair, nail care, and perineal care). In unique cases, catheter and colostomy care might apply. It should be noted that not all power chair users are functionally paralyzed. There seems to be this stigma that only persons with severe spinal cord injuries or degenerative diseases that have resulted in leg paralysis use wheelchairs. A bigger assumption is that all individuals who lack functional movement in their legs are 100% dependent on others for bathroom assistance. If you are a power chair user who is completely or partially capable of performing their own transfers and participating in bathroom needs, then this information relates to you.
Before diving directly into bathroom use, let’s discuss basic transfer safety. Transfers include any or all of the above in order to move in and out of the chair: sit-to-stand, stand-pivot slide board, upper-extremity use only, and caregiver-assist.
- Sit-to-stand transfer: Some power chair users will have the ability to weight-bear into one of or both of their legs, but the balance will be most likely sketchy. Before even scooting to the edge of your seat, place the chair accordingly (45 degree angle to the toilet or shower seat), flip to foot plate up, and TURN THE CHAIR OFF. Do not ever make a transfer attempt while the control is on because even slightly brushing the joystick will send you to the floor. Use the available grab bars and one arm-rest to assist in pulling yourself to a standing position. You will have wanted to flip up the arm rest closest to your transfer destination to clear your path for a pivot.
- Stand-pivot transfer: You are already standing and should be holding onto something stable, whether that be a walker, a grab bar, or the arm rest of the power chair. For all stand-pivot transfers, get in the habit of memorizing your standing surface area and the friction of your shoes. Never pivot in socks or traction-less slippers since that frequently results in a fall. Either transfer barefoot, in non-slip socks, or in sturdy tennis shoes. If you are transferring to a toilet, pull down your lower-body dressings to knee level prior to conducting the pivot.
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- Slide board: Individuals who independently transfer with slide boards have probably been doing so for a long time. Do NOT attempt slide board transfers without practice and training from clinicians. Turn the chair off and flip up the arm-rest closest to the toilet or shower chair, place the slide board firmly under the thigh and lower buttocks with the other end lying flat on the seat surface. Commence sliding over if the slide board is level. Sliding back to the chair on an incline can be very tricky for those who lack upper body strength.
- ESSENTIAL TOOL: For caregivers to easily and safely transfer patients allowing them to move with independence while protecting caregivers from injury
- Easy, safe and secure transfers to assist a move between a wheelchair, bed, chair, sofa, commode or other sitting position
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- Upper-extremity use: This is commonly used by individuals who have acquired lower level spinal cord injuries resulting in paraplegia or those who have double amputations. Additionally, they have outstanding upper-body strength which allows them to move in and out of their chair using just their arms. One arm is placed firmly on an arm-rest while the other pushes firmly on the shower chair, stationery grab bar, or toilet seat allowing a smooth transition without the feet ever touching the ground. Lower-body clothing usually has to be removed by weight-shifting the thighs and buttocks in the chair prior to transferring.
- Caregiver-assist: Assist from another individual varies from a partial transfer assist (being a support) to a dead-weight lift. Either way, caregivers should consult with rehabilitation specialists or clinicians regarding safe body mechanics in transferring another person. When it comes to transferring someone in and out of the power chair, one item should be carefully considered: the height of the toilet or shower chair. If the toilet seat or chair are lower than the power chair seat, caregivers need to trust their gut and past experiences to see if the transfer is even worth it. Either avoid the transfer completely, or make sure there is another person available to assist in a potentially difficult lift.
Next, we are going to cover both residential and public bathroom use, residential being the one that can be controlled by the user and the public bathroom space being more unpredictable. Factors that are commonly (and should be) considered involve safety in functional transfers and maneuverability of the chair.
- Residential bathrooms: This question should have been answered prior to purchasing the power chair: Does the power chair fit in the bathroom in order for the user to safely complete their basic needs? Some bathrooms, based on permanent toilet, sink, and shower placements, simply do not allow the space unless serious remodeling takes place. Now that we’re past that, let’s review some adaptive ideas that don’t take a lot of time or money to acquire:
- Shower chairs: There are tub benches which suit a shower/tub combination well. Shower chairs with grab bars and height-adjustable legs are standard for walk-in showers. There are also roll-away shower chairs or 3-in-1 commodes where caregivers can transfer the individual from the power chair and then scooting into a walk-in shower with no threshold.
- Toilet risers: Risers come in various heights and should be measured against the height of the power chair seat. Risers can also come with grab bars if the individual’s bathroom lacks the space or structure for typical wall grab bars.
- Grab bars: Installing grab bars in a bathroom should be completed by a contractor who is knowledgeable of accurate measurements and stud installments. At least one grab bar should be placed by the toilet and another in the shower stall to prevent falls in transfers.
- Reacher: This is just a minor adaptation in which wheelchair users can use a reacher or a back scratcher to pull up or to push down the foot plate in between transfers. This is extremely helpful for people with weak core strength or reduced back extensor strength (muscles that give people the ability to sit up).
- Sink extenders: Sometimes modifying the entire bathroom counter is too expensive. For that dilemma, there are hoses or tubes available to extend the sink spout outward for teeth-brushing and hand-washing.
- Chair covers: If you plan on completing a shower with the power chair in the bathroom, bring in a couple tarps or garbage bags to lightly cover the chair control system and pads. Although most power chairs are durable, engines and control systems are not water-proof.
- Object placement: Before even transferring into the shower, consider where all of your needed objects are located: towels, soaps, clothes, reachers, long-handled scrubs, razors, etc. If all of the necessary hygiene objects are not within reach before showering, it becomes much more dangerous to gather those objects when you are wet and slippery.
- Emergency access: Have a phone (water-proofed in a Ziploc) or a Life Alert within arm’s reach in the event of an emergency including a health crisis or sudden fall.
- Public bathrooms: This includes any bathroom outside of the user’s typical living space, whether they are wheelchair-accessible or not. Frequent examples include, doctor’s offices, hospitals, gas stations, grocery stores, department stores, churches, malls, friends’ or families’ homes, etc. In the United States, public restrooms (if not located in a registered historical site) are designed to meet ADA (American Disabilities Act) guidelines. So typical bathroom layouts include at least 1 accessible bathroom stall that frequently includes grab bars and the occasional sink measured to wheelchair height. The bathroom also has at least one paper towel dispenser and/or hand dryer leveled for a seated position. Additional items should be researched and assessed when propelling a power chair into a public bathroom:
- Entry door size: Assess the door into the bathroom (not the stall) as well as any corners that your chair will have to take to access a stall. If you and the chair combined weigh over 600 lbs, there is a huge possibility that you will not fit into a public bathroom. ADA laws only require that public doorway widths be 36 inches.
- Additional equipment: Consider your rationale behind bringing additional equipment. Clip-on toilet risers (without grab bars) are reasonably sized and can be tucked away in a storage pocket on the chair. Reachers and/or back scratchers fit very well and take up little space. Depending on storage space and placement, some wheelchair users will bring a cane or a walker to assist with stand-pivot transfers if there are no grab bars in the bathroom.
- Scheduling bathroom trips: Go to the restroom at home prior to going on a community outing. This may prevent frequent use of public bathrooms and reduce the overall hassle and anxiety of your trip.
- Having a chaperone: If you are relatively new to bringing a power chair into a public bathroom, don’t be shy and have someone tag along with you. Even if you don’t plan on the person physically assisting you, you’ll have an extra voice to alert help in the event of an emergency.
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