We caught up with commode seating and positioning advocate Jacqueline Abel, who’s an Occupational Therapist at Specialist Rehab Services (SRS). Jacqui shared her thoughts about why it’s so important to get a person’s positioning in a shower commode right, as well as some of the challenges OT’s like her are up against.
What are some of the key challenges OT’s face in achieving the correct positioning in a shower commode or wheelchair?
Change: One of the key challenges is client’s that have lived with a disability for a long time and are reluctant to change to new equipment. Quite often clients have sat a certain way for a long time using compensatory, destructive postures to remain stable whilst seated on the commode. This is mostly due to shower commodes being very simply constructed with little to no positioning support. As a result, clients would hook arms around push handles, sink into the very large apertures in the seat instead of using lateral supports to remain stable in the shower commode.
Postural asymmetries: Client’s with significant postural asymmetries are very difficult to seat on a traditionally flat commode seat. When seated in their wheelchairs they have the option of using a contoured cushion which can accommodate for postural asymmetries such as pelvic obliquities, pelvic rotation, discrepancies in hip range of motion. Commode seats cannot be significantly contoured as an aperture is needed for bowel cares and therapists must look towards providing stability in sitting using external supports such as laterals, hip and thigh guides along the seat of the commode.
Decrease muscle strength and range of movement issues: Another challenge that therapist face is a decrease in strength and fatigue in the trunk, pelvis and lower limb muscles causing the person to slide forward when sitting in the shower commode. When setting up a wheelchair, a therapist can use seat rake (front seat to floor higher than the rear seat to floor measurement) to provide proximal stability when seated in the wheelchair. This option is not readily available in shower commodes therefore many clients seated on a shower commode often say they feel as if they are going to fall forward and out of the shower commode. Back angle adjustment enables the OT to accommodate for the loss of hip range of movement.
Body proportions, size, and shape: As we all know people come in different sizes and shapes therefore one size does not fit all. If the OT fails to take measurements of the client’s seat width and depth, depending on the client’s size they may not be fully supported on the commode seat, either their size and tissues that overhang on the sides of the commode causing skin marking from the armrests or the client is not fully supported under the femurs.