Not everyone who has recently left the hospital or is reaching an older age needs to run out and purchase adaptive equipment for their home. With that in mind, what types of medical conditions or functional circumstances would justify the need for a toilet riser? Let us take a look at a few common ones:
- Age-related conditions: The wear-and-tear of age can wreak havoc on the body, especially on muscles and joints that are essential for simply standing up and lowering oneself into a seat. That would include primarily hamstrings, glute muscles, quadriceps (thigh muscles), hips, knees, and ankles. Conditions that could negatively impact muscle and joint flexibility are arthritis, osteoporosis, and muscle atrophy which can make sitting and standing up painful and more labor-intensive than necessary.
- Orthopedic surgeries: Surgeries conducted on the knees, hips, and back can severely limit someone’s ability to stand up from and sit down on a toilet for several weeks secondary to pain and precautions. Typical surgeries include total hip surgeries, total knees, spinal rod placements, vertebrae repairs or fixations, etc. Often, post-surgeries require a person to wear an orthotic device (leg immobilizer, TLSO or back immobilizer) which can further contribute to limited movement in performing sit-to-stand transfers.
- Lower limb fractures: Fractures can result from bone/joint break down due to old age or from traumatic incidences that can reduce a person’s capacity to complete any daily living activity. Standing up from a toilet seat can already be difficult enough if it is a lower-rider that is not up to suggested Australian Standard or if the user is abnormally tall. To add a fracture to one of the lower limbs (i.e. ankle fracture, femur fracture, etc.) would be taking out one foot to bear weight on, which means the person can only rely on one leg to stand up on.
- Hemiplegia: Hemiplegia is a paralysis of one side of the body, which can include the arm and/or the leg as a result of a brain injury or a stroke. In some cases, people will fully or partially recover from hemiplegia. For others, they are in a permanent state of decreased sensation, decreased range of motion in their joints, and decreased muscle recruitment. If hemiplegia affects one of the legs, then the individual will have a very difficult time safely bearing weight through that leg placing them at a huge risk for falls.
- Amputations: Lower limb amputations have more obvious repercussions on transferring to and from the toilet, especially if the affected individual lacks a proper prosthesis to bear weight on for safe standing and stabilization. Now the individual’s body solely relies on one leg to stabilize the entire body in a sit-to-stand transfer.
Each physical condition will affect people differently regarding their movement and overall strength. Many concerns can be resolved by simply installing a grab rail or purchasing a toilet riser that has removable grab bars. Additionally, there are a few other elements of body mechanics that should be assessed before sticking an individual on a particular toilet riser:
- Core stabilization: Can the individual using the toilet riser safely sit on a heightened toilet seat symmetrically without falling over? People with degenerative conditions such as multiple sclerosis, ALS, muscle atrophy, secondary effects from stroke or brain injury, etc. will often demonstrate weakness in their torso and back extensors. The lack of core strength can contribute to abnormal positions such as leaning to the side or folding forward into their lap. If core strength is a problem already (in the absence of a toilet riser) then caregivers or users need to consider getting toilet risers with grab bars and a deeper seat to better prevent the individual from falling off of the toilet.
- Upper extremity use: If the user has disorders or injuries affecting their arms, then grab bars may be a useless element to combine with the toilet riser. Examples include amputations, recent shoulder surgery, hemiplegia/paralysis, etc. The essential muscles for pushing off of and lowering oneself onto the toilet using grab rails are shoulder muscle groups responsible for scapula (shoulder blade) motion and stabilization.
- Skin conditions and pressure-relief: The other factor combined with skin concerns is the user’s typical sitting duration on a toilet, which can be lengthened depending on bowel and bladder conditions. If the user has decent upper body strength, they most likely can pressure-relieve by pushing their body up from the toilet seat using grab rails. If the user lacks the upper strength capacity (and is at risk for buttock or thigh wounds), it would be beneficial for the user or caregivers to look into toilet risers that have extra padding.
- History of falls or loss of balance: Caregivers and users need to carefully assess their fall history, particularly in the last 6 months. Such questions would include: When was the individual’s most recent fall? Where did they fall? What were they doing when they fell? What movements or medical conditions may have contributed to the fall? How many other falls has the person had in the last 6 months? Falls for elderly persons commonly occur in bathroom settings because of slippery surfaces. If the individual has in fact fallen several times in the bathroom, then the caregiver can research toilet risers that provide optimal, external support. Examples include toilet risers with grab bars, toilet risers with secure locks, toilet risers with non-slip surfaces, etc. Types of toilet risers to avoid would be any kind of 3-in -1 commodes with unstable wheels and braking systems.
Toilet risers are not inherently designed to prevent accidents or falls. Toilet risers have one sole purpose: to elevate someone’s seated position in order to assist them in sitting and standing up. If caregivers are concerned about a loved one falling in the bathroom, they need to consider either getting a fall alarm for the bathroom or having someone present in or near the bathroom. If anything, toilet risers place the individual at a greater seated height which can worsen results of a fall if one occurs.