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Critical considerations when selecting rehab shower commode chairs

Copied from Raz Design Website. 
Sharon Sutherland of Seating Solutions LLC took the time to chat with Raz Design about all things related to seating and skin integrity. The following is an excerpt of our conversation with Sharon.
RD: Why isn’t more attention paid to the “other seat” (rehab shower commode chair)?
SS: Many clinicians have indicated that a possible reason for not paying as much attention to the “Other Seat” is because so much time is spent on prescribing the primary seating and mobility system. The decision around the rehab shower commode chair is unfortunately often a “box that gets checked” in order for the client to be discharged. This means that time is not spent analyzing the specific skin integrity and positioning needs of the client and translating these critical assessment findings into the parameters or features that are essential in the bathroom.
 
RD: What are the most important factors you consider when assessing a client for a rehab shower commode chair?
SS: Interestingly, many of the factors that are important to consider for this assessment are the exact same considerations that we make with regard to selecting the optimal seating and mobility equipment. For example;
  1. How many minutes or hours will the client spend on the toilet and in the shower/bathtub?
  2. Will the client need assistance carrying out these activities?
  3. What is the level of skin risk for this client on their seating surfaces and why?
  4. What are the key findings related to this client’s seated posture?
  5. Are there any postures needing accommodation?
  6. Are there any added stability issues from the seated position?
  7. What are the details of the bathroom layout?
  8. What is the client’s method of transfer: consider space, support needed and stability?
 
RD: What are some of the more overlooked assessment tools or guidelines when assessing skin integrity preservation in seating?
SS: An excellent guideline that we sometimes forget to use is the “Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline,” click here to see:  https://goo.gl/ovzFCF
Some very useful tools are, for example, calipers to measure the pelvic details and perhaps an interface pressure mapping system to look at the contact area and potential areas of pressure while trying the various rehab shower commode chairs available.
 
RD: What impact has pressure mapping had on your ability to assess a client?
SS: Here is a short list of what I have learned from interface pressure mapping in the selection of rehab shower commode chairs;
  1. Size, location and shape matters…when it comes to the relationship between the buttocks, (the bony structures/tissue) and the aperture;
  2. Seat material matters when it comes to load distribution, initially as well as over time;
  3. Back support matters when we are looking at positioning as well as load distribution;
  4. Utilizing tilt can be essential for both postural support as well as for weight shifting when bowel/bladder shower routines extend into the recommended skin integrity plan of care.
 
RD: Beyond the ITs and trochanters, what other anatomy should be considered of critical importance when discussing optimal seating and positioning?
SS:
  1. Femoral support
  2. Feet support
  3. Hip range of motion relative to sitting
  4. Lumbar/thoracic support
  5. Head support
  6. Upper extremity support
 
RD: Not all seating systems are made equally. What would you say separates the best seats from the rest?
SS:
  1. Quality and durability of the materials both inside the cover material as well as the cover material itself
  2. Ease of system adjustment as is often necessary on the spot
  3. Ease of care of the equipment for the client and/or their caregivers
  4. Durability and ease of use of the tilt mechanism where it applies
  5. Design compatible with the human form, which for me includes anthropometrics, skin integrity needs and positioning needs … or is the human just expected to fit?
 
RD: Seating systems are becoming increasingly complex. How do you match the needs and requirements of each client with the available options?
SS: The hands-on assessment is really the key to determining everything. With a detailed assessment, I can easily translate the assessment findings to key product parameters/features, which I have deemed to be essential for the client. With this information, I then try the proposed equipment with the essential features with that client. Once this is done, I am in a position to feel confident with my prescription. As well, I have the necessary information to submit for funding or reimbursement.
 
RD: You’ll be speaking at ISS 2017 this year. What are the most important things you want clinicians to take away from your presentation?
SS: I would love for clinicians to take away the message that says the hands-on assessment is critical: the information we are probably collecting anyway, related to other positioning and mobility, can be also used to determine the minimal essential features that are necessary in the rehab shower commode chair. Don’t forget to use tools (such as pressure mapping) that you might already have access to in seating clinic when making decisions for the bathroom. Remember, the client who you have deemed to be high risk for skin integrity issues will have those same/similar needs everywhere they sit or lie down.


Author: Chris Palmer

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