Choosing Childrens Daily Living Equipment

PRIVATE PURCHASE OF EQUIPMENT

If you decide to buy equipment privately it is strongly recommended to seek the advice of an occupational therapist on the suitability of that equipment to your condition or situation. It is also recommended that you try out the equipment, if possible, before purchase.

You can arrange to visit a supplier’s showroom (if they have one). Contact details of suppliers can be found under ‘Disabled Persons Products & Services’ in the Golden Pages and some may have a website with details of their products and services which you can view online. Another source of information on suppliers of assistive technology, aids and appliances is the Access Directory. This directory is produced commercially each year and copies are widely available (see Useful Publications).

Sometimes suppliers organise exhibitions of different types of equipment in various locations around the country allowing people to see and try equipment. These exhibitions are often advertised in the local paper or on local radio. You can also request to be put on a supplier’s mailing list so you will be notified if there is an event being held in your area.

Some companies will give equipment for a try-out period before purchase. Enquiries should also be made about maintenance (if it will be required), maintenance contracts (if relevant) and whether a user manual is provided with the equipment (essential).

When purchasing from any supplier, it is important to remember that it is their business to sell. There may be several suppliers of that particular piece of equipment or different manufacturers of the same type of equipment, so always shop around.

DISABLED PERSON’S GRANT

The Disabled Person’s Grant may be applied for in situations where changes need to be made to a home to make it suitable accommodation for a person with a physical disability, severe learning disability or severe mental illness. It is administered through each local authority.

At present (2006) most local authorities do not apply an income limit for eligibility ie it is not means tested (you should check with your own local authority if the grant is means tested or not and if so, the income thresholds which apply). Owner/Occupier may receive up to 90% of the cost of the work to a maximum of €20,320. Local authority tenants may receive the grant for the entire cost.

This grant applies to housing that is at least one year old and other restrictions apply to new buildings. Some county councils state that if the adapted property is sold or otherwise transferred within 10 years of the work being done, an agreed sum will be repayable to that council.

Applications are made to your local authority and the process will include having a medical report, and an assessment and report from an occupational therapist. You can contact your local community care services to request an occupational therapist’s assessment. Some areas will contract private occupational therapists to provide this service. Architect’s drawings and builder’s costings may also be requested. Building should not commence until the grant has been approved and payment is not made until work is completed and inspected. For more information, contact your local authority.

Bath overlays

These are removable bath-shaped overlays that sit across the rim of a standard bath enabling the child to be bathed at a higher level. The overlay bath is filled from the bath taps, and the water drains into the bath after use.

Bath lifts and hoists

A small range of manual lifts and one powered bath lift designed for children offer support in a reclined or semi-reclined position. The devices are removable so that the bath to be used by other members of the household.

Bath boards and seats

A child who cannot get in and out of the bath independently but who has good sitting balance may be able to use a bath board and/or seat. A bath board spans the bath rim to provide a platform to sit on; a bath seat provides an intermediate seat between the top and bottom of the bath. Grab rails positioned on the wall alongside the bath board/seat provide a secure handhold when transferring in and out of the bath; and a slip-resistant mat on the bottom of the bath reduces the risk of the feet slipping.

Adjustable-height baths

The height of all these baths can be raised, either mechanically or electrically, so that a parent does not need to bend over the bath to wash the child.

An older or more able child may be able to step into the bath at its lowest level and then be raised to a convenient height for the parent to assist with washing. This style of bath is not often used in a domestic setting.

Foam supports

These are sponge foam cushions designed for infants and sculptured to provide a degree of support for the head and body. They can only be used with a shallow-filled bath and may be particularly useful for stabilising a small, floppy baby.

Hammock supports

The majority of hammock bath supports comprise a frame with a fabric or mesh cover that supports the child in a semi-reclined position. Some have straps or foam blocks attached by Velcro that help to keep the head, trunk or legs in position.

Consider the following:

• The sizes on offer and whether the hammock support will fit in your bath.
• The postition of the support in the bath. Compromises may have to be made. The lower the support sits in the bath, the less water will be needed to surround the child for washing and playing, but the parent will have to stoop further down.
• The material of the support. An open mesh will allow the water to circulate around the child and is more pliable than a close-weave plastic mesh.
• The material of the frame. A plastic frame which is lighter than metal will make the support easier to lift in and out of the bath.
• Angle adjustment to offer a choice between a more upright or reclined position. Flexion at the hips may be required to prevent extensor spasm. A larger angle of recline can make hair washing easier. A more upright position may make it easier for the child to play with bath toys.
• Detachable mesh at the head end, again to assist with hair washing.
• Storage and transportation. You will need to store the hammock support after use somewhere where water can drain so that the mesh can dry, and where it will not impede other family members from taking a bath. Models that fold up or flatten out can make storage and transportation easier.

Bath cushions and inserts

These are either contoured or mouldable to provide the child with additional support. In some instances they can be used to decrease the depth of the bath so that it is easier to access, or to reduce the need for a parent to bend.

The mouldable supports are filled with polystyrene beans and will shape themselves around the body of the child. The shape can be fixed semi-permanently if air is extracted using a foot pump. They are secured to the sides and bottom of the bath with suckers. Mattresses are available which work on a similar principle except that the air is dispelled into a separate chamber.

Head floatation devices designed for swimming can also be used to keep the head above water, although a child with poor head control is likely to need a more complete body support.

Sitting supports

These have a seat and a backrest and will provide support for children who cannot sit upright unaided.

Consider the following:

• Babies and small children may be able to use some of the standard baby bathing equipment, such as the support rings that attach to the base of the bath with suction cups.
• The height of the back support. A lower back support may provide greater freedom of movement; a higher backrest gives more support.
• Some may have adjustable backrests allowing the parent to recline the back rest or to position it fully upright depending on the needs of the child.
• If the seat depth can be adjusted it can be lengthened as the child grows.
• The type of support straps ie a lap belt or full harness.
• Whether a pommel that can help to keep the hips abducted and help to maintain the position of the child in the chair is required; however, it may impede personal cleansing.
• How high up in the bath the seat sits. Compromises may have to be made. The lower the support sits in the bath, the less water will be needed to surround the child for washing and playing, but the parent will have to stoop down further.
• Check how easy it is to lift the seat in and out of the bath and the size and shape of your bath to fit the frame of the seat.
• Storage of the bath chair to leave the bath free for other family members to use.

Suction backrests and grab bars

These are available for children who need a limited amount of support when sitting with their legs stretched out in the bath. The width of most backrests is adjustable and suction cups secure them to the sides of the bath. The grab bar can be used in conjunction with a sitting support. The suction cups may deteriorate with age and lose their grip.

Static shower chairs and stools

These are freestanding so can be lifted in and out of the shower as required. They are more appropriate for an older, more independent child. Stools tend to have little or no back support; chairs have a higher, more supportive backrest.

Selecting the correct height is important. To support him/herself in a sitting position, the child must be able to place both feet flat on the floor. An adjustable height stool/chair can be altered in height as the child grows.

Wall-fixed shower seats

These fix to the wall, usually via hinged brackets, so that they can be folded up out of the way of other family members who want to use the shower. The seat should be fixed at a height to suit the child's needs. A few seats, fixed on a wall bracket that allows some height adjustment, may be useful to cater for the needs of a growing child.

Mobile shower chairs

These shower chairs allow the child to transfer or be lifted in and out of the shower chair in the space of the bedroom and then moved into the bathroom. User-propelled and attendant-propelled versions are available. Larger wheels can make it easier to push the chair in and out of the shower. These chairs can provide a high level of support for a child, some can be adjusted with growth and can have a recline or tilt facility for children who require this to prevent their head and/or body from falling forward in the chair. Additional side supports and head supports are available.

Shower chairs with a toileting facility

This type of chair reduces the number of transfers that need to be made between the bed, toilet and shower. Larger children who are physically less able may need to be hoisted into the chair.

Consider the following:

• Is wheeled access into and around the toilet/bathroom possible?
• The clearance over the toilet. The chair must fit easily over the toilet bowl, but too wide a gap means splashing may occur.
• The height and position of the toilet cistern and the push handles of the chair to ensure positioning of the chair is not impeded.
• The size of the seat and aperture. The seat must be supportive but should also allow for the child to clean him/herself or to be assisted with cleaning after he/she has used the toilet.

Shower chairs for children generally have a range of supportive accessories including a pommel/splash guard, head and trunk supports, foot supports and safety belts and harnesses.

Larger children or children requiring less support will be able to use an adult shower chair which can be fitted with cushion inserts to reduce the internal seat dimensions to give appropriate support.

Shower cradle

There is a small range of shower cradles that comprise a mobile chassis onto which a nylon mesh cradle or a hammock-type bath support is fixed. The angle of the mesh cradle is fixed on some models and adjustable on others. The more upright the support, the less space it will occupy. If a cubicle is to be used, check its area as many of these supports are too long for a standard cubicle.

On some cradles, the mesh supporting the head can be detached and folded down to make it easier to wash the hair.

Tilt-in-space/reclining shower chairs

A small range of shower chairs for children have a reclining backrest or a tilt-in-space seat unit to give a semi-reclined or tilt-back position. These could be considered as an alternative to a shower cradle.

Shower stretchers

Wall-mounted shower stretchers can also be used as changing tables and fold up against the wall when not in use. They are made of a perforated material and can be used over a bath - folding down to rest on the bath rim - or in a shower area with two supporting legs which rest on the floor. On some, the angle of the backrest can be adjusted, while the height of others can be adjusted electrically so they can be positioned at a comfortable height for the parent.

How the parent will lift the child onto the shower stretcher must be considered. A hoist may be required.

Shower trolleys

These are mobile showering tables, often with a reservoir to catch the water during a shower. They are large and not often used in the family home because they are difficult to manoeuvre in a restricted space.

Trainer seats

These plastic seats, commonly available in high street nursery shops, reduce the toilet seat aperture to give a more size-appropriate seat. Trainer seats are secured either by positioning them under the standard toilet seat, or they snugly fit into the toilet seat aperture from above.

Older children will need one that will take their extra weight. Those with a front splashguard are useful for keeping the legs apart.

Consider the following:

• The child will find it easier to keep stable on the seat and will manage toileting tasks better if feet are supported on a box step.
• A front pommel/splash guard will make it more difficult for the child to get on and off the toilet. A box step should help with transfers.
• A child may also need wall rails or a toilet frame for additional support during transfers and while sitting on the toilet.

Toilet support seats and frames

These comprise a more supportive seat unit (usually incorporating a backrest, side support, lap strap or harness) that either clamps to the toilet bowl or is freestanding. The toilet-fixed units tend to be less stable than freestanding ones and fixing must be routinely checked to ensure the seat remains secure. Freestanding frames are more bulky and awkward to move away.

Any additional equipment used with a standard toilet can be inconvenient for other family members. A storage place for items when they are not being used will need to be found.

Consider the following:

• Support seats made of shiny rigid plastic may be uncomfortable and hard to sit on and the skin may stick to it after a few minutes.
• The size and shape of the aperture is critical for comfort. An oval shape is usually preferred.
• The size of the pommel - if too wide it may dig into the inner thighs.
• Moulded armrests may provide support for the child when he is sitting on the toilet, but may hinder assisted or sideways transfers.
• Some models provide foot support which is more stable and comfortable for the child. Also the best position for bowel evacuation is to have the feet supported, with the knees slightly higher than the hips ie mimicking a squatting position.
• For children who find it difficult to sit up straight, check the level of support provided given by the straps and harnesses.

Static potty chairs and commodes

Potty chairs comprise a standard potty inserted into a chair frame to provide a higher sitting position and better all round support. Many have a grab rail at the front for added security. Commodes tend to have a slide-in/lift-in pan, similar to adult commodes, but with more postural support provided by a lap strap, harnesses or hip/trunk support pads. On most models the seat height or the height of the footboard can be adjusted to give a supported sitting position.

• Ensure that the size is appropriate for the child and that this is reviewed regularly.
• Some designs encourage the child to lean forwards, which has been found to be a more effective position for bowel action.
• Some seats and backrests are wooden which may not be comfortable to sit on for long periods of time. Check whether optional cushions are available.
• Splash guards/pommels encourage the child to keep his/her legs apart - which will help him/her to perform.
• The wider the base, the more stable the potty chair will be. However, if the feet are on the floor the child may be able to push the chair over backwards.
• Some models can be folded or dismantled for storage or transporting.

Mobile potty chairs

These can be used either with a commode pan or can be wheeled over the toilet. They have a huge advantage if space within the bathroom is limited because the child can be transferred onto the chair in an adjacent room where space is less restricted. Door widths, floor surfaces and thresholds should be checked to ensure they do not impede the smooth passage of the chair from room to room.

Some chairs are also waterproof and can be used a shower chairs. Mobile chairs tend to offer a higher level of support than static chairs and are more adjustable.

It is important to enable the child to retain his/her dignity and privacy. If clothing needs to be adjusted in another room in preparation for toileting, then a blanket or similar should be used to cover up whilst the child is in transit.

Musical potties and toilet trainers

These are potties or accessories for a standard toilet that have an integral electronic sensor which detects temperature increase or moisture and plays a tune to encourage toileting.

Urine deflectors

These are moulded into many potty chairs and trainer seat, but can also be bought as an accessory to be clipped onto a standard toilet bowl/seat.

Changing mats

A limited range of changing mats for older children is available, but it may be possible to use an exercise mat eg an Airtex mat. These are lightweight, cushioned, can be cleaned and feel warm to the touch. A child who may roll off will need a raised border cushion around the edge of the changing mat. If a changing mat is used on the floor the parent needs to consider his/her back when lifting their child on and off the mat and when attending to him/her.

Changing tables

These provide a surface on which children can be cleaned, changed and dressed. Height-adjustable models reduce the amount of manual lifting and bending involved. Mobile versions are also available. It may be necessary to use a hoist to help with transferring an older child or more dependent child.

Specific factors to consider

• The appearance of the equipment. Whilst seating should be functional and appropriate, consideration should also be given to aesthetics.
• The cost of a seating system should not be the deciding factor when choosing. Systems that appear to be expensive may turn out to be more cost effective in the long term, eg if the system can be adjusted for comfort or adapted as the child grows or his/her condition changes.
• Seating systems should be practical and easy for the parents and the child to use. Look at ease of adjustability, manoeuvrability, cleaning etc.
• The measurements taken to determine the correct seat size for a child are the same as those for an adult ie seat height, depth and width, backrest and armrest height.
• Children often grow taller more quickly than they do in width.
• Children requiring postural support will need a chair with adjustable seat dimensions and support pads so that an exact fit is possible.
• Many chairs have activity trays as accessories but if they are always used in preference to a group table this may prevent the child interacting with his/her peers.
• Trays and tables with a semi-circular cut-out will allow the child to have their forearms supported while they play/work.
• Meal times may be more integrated if a supportive chair can have a podium or raised wheeled base to turn it into a high chair for use at, or adjacent to, the family table.

Beanbags

These are filled with polystyrene beads and covered in a flame retardant material which may also be waterproof. The beads mould around the body and, whilst they might provide a relaxing medium they are unstable, do not encourage a symmetrical position and are difficult to transfer in and out of. They are not recommended for prolonged sitting.

Adjustable armchair seating

These chairs are generally popular with families for home use as they look like ordinary armchairs and the easy-to-clean vinyl or fabric upholstery can be chosen to match other chairs.

Some models are multi-adjustable to grow with the child and to enable him/her to sit in a variety of supported positions including:

• a reclined position,
• with legs stretched out in front on a leg rest,
• lying on his/her side.

Most have adjustable-width armrests and a contoured backrest, with head support and wings to help to support the child when sitting up. Harnesses, lap straps and trays are available for some models as well as waterproof covers that can be put on under the upholstered covers.

These chairs are usually adjusted by the company reps to provide the correct amount of support for the needs of the particular child. Later, a therapist or parent can be shown how to alter it as the child grows or condition changes. The least number of adjustable moving parts means the less possibility of parts breaking so only take adjustable features/options as required.

Chairs with no solid structural components on which the children can injure themselves are available for children who have epilepsy or self-injurious behaviour.

Corner seats

These chairs have a V-shaped backrest that provides support at the back and sides of a child sitting on the floor. They are useful for children that are developing sitting balance but who are inclined to fall back or sideways if they overstretch. Many have a pommel at the front to help keep the legs abducted. The likelihood of extensor spasms can also be reduced by raising the seat a few centimetres up from floor level, or by sitting the child on a forward angled wedge.

Tumble forms

This style of seating is made from firm density foam which has a stain- and urine-resistant surface. The seats are shaped to provide a slightly concave interior to give some side support, head support and a pommel to keep the legs apart. They are non-adjustable so sizing must be reviewed from time-to-time. They do not provide good postural support for children who have low or fluctuating muscle tone and can hide rounded or curved positions of the spine or neck. They are used for floor sitting with a wedge to alter the angle from a more upright to a more reclined position. A low, wheeled base enables the chair to be moved around.

Care should be taken as the plastic covers may split and unless these are patched, the foam inner will get damaged.

The outer plastic cover can be hot and sweaty to sit on; a stretch towelling cover is available.

Consider the following:

• Transferring an older child in and out of a floor sitter can be difficult for parents. Try to encourage the child to crawl in and out. A removable pommel will make transfers easier.
• Many of these chairs are quite portable and therefore easy to use in different environments.
• Lap and chest straps are available to secure the child into the seat
• Padded cushions will give added comfort to wooden corner seats.
• Some of the hammock-type bathing supports can to be used as floor sitters and will provide some postural support.
• Low-level tables are available from some suppliers for use with floor level seating.

Support chairs

These chairs have a wide range of accessories which bolt or screw into them to provide support and good positioning. They are used mostly in schools and nurseries.

Some have flat seats; some have a choice of seat angle to provide a more stable sitting position; others have a contoured, moulded or bucket seat that will provide more stability, but will be less flexible as the child grows.

Consider the following:

• Chairs are often available either as a basic chair with an optional range of accessories, or as a complete package including a variety of accessories. Sometimes it is cheaper to buy the complete package and not use all the accessories.
• Comfort needs to be considered because it is often difficult for the child to change position. The thin foam upholstery provided on many of these chairs may flatten and need replacing.
• Children do not seem to be as prone to developing pressure sores as adults, but the risk increases with age and body weight. The skin condition of older, immobile children should be monitored daily. Also the type, position and tightness of harnesses and straps needs to be considered; and the clothes should be free from wrinkles under his/her back and bottom.
• Check how easy it is to remove harnesses, straps and pommels in order to get the child out of a chair, especially in an emergency.
• Pommels and lap straps should not be used as a means of stopping a child from sliding forwards in the seat - a proper seating assessment needs to be done.
• Chairs with wheels or castors are not necessarily designed (or stress tested) to be pushed around with the child seated in it. They may be provided only to help manoeuvre an unoccupied chair. Check with the manufacturers.
• Knee blocks should only be used under strict guidance from an occupational or physiotherapist as they can put undue pressure on unstable hip joints.
• The footrests or footboard are generally not designed for weight bearing whilst the child is transferring in and out of the chair. The chair may tip forwards if used in this way.
• Children of small stature or those working in chairs with a high seat which raises them up to the same level as their peer group may need to be assisted in and out of the chair.
• Children who sit down heavily in a chair, rock repetitively or fall sideways will need one with splayed legs, a larger base board or skis for increased stability.
• The ease with which chairs can be adjusted varies. Some requiring an Allen key; others have large, easy-to-turn knobs. Ease of adjustment may need to be weighed up against the possibility that the set up may be inadvertently changed by other children turning, twisting or taking off the knobs - if the knobs are lost the chair may become unsafe and unusable.

Types of seat

Many chairs have a backward sloping, ramped or human shaped cushion to encourage the child to sit with his/her thighs in a horizontal position to promote an upright position and to reduce the risk of sliding forwards.

Some children benefit from leaning slightly forwards in a seat that angles down towards the front of the chair combined with chest and foot support. This can increase the ability of a child to use his arms for activities such as eating, working and playing. However, the child’s ability to maintain this position for long periods of time needs to be monitored for fatigue as this is a more active sitting position.

Chairs with a straddle/bolster seat

This type of seating is useful, for example, for a child with cerebral palsy who has good upper body strength but whose legs push tightly together. Sitting astride the bolster forces the legs apart and induces more normal muscle tone making it easier for the child to have control of his/her arms for activities such as eating and school work. A big problem with this type of chair is how to get on and off it. More able children may be able to step on and off, otherwise lifting or hoisting may be necessary.

Modular seating

Modular systems are made of interconnecting components that can be re-adjusted as the child grows or if his/her support needs changing. Some modular systems can only be adjusted by a company representative or therapist who has had special training. These systems are usually covered in stretch padded towelling.

Permanently moulded seating

A permanently moulded seating system is a unique system moulded to match the contours of a child. The shell is then padded to increase comfort. A well fitting mould will support the weight evenly and not cause pressure areas to develop. If the system is to be used as a static seat indoors as well as on a mobile base outdoors, care must be taken to try to accommodate indoor/ outdoor and winter/summer clothing. Re-moulds are necessary as the child grows or needs alter.

Ensuring the safety of a child that is inclined to wander

An alarm system that monitors pressure can be used to alert the parents that the child is getting out of bed. A pressure mat alarm can be placed at the bedroom door to alert the parents that the child is moving out of the bedroom. To give the child the freedom of the bedroom but to prevent him/her from moving to other rooms, two sets of door handles - one above the reach of the child or just one handle high up - may provide a solution.

Parents can also use baby alarms to monitor activities but, as the child gets older, he/she should be allowed a degree of privacy if at all possible.

Requesting assistance

A standard baby alarm can be used by the child to call for assistance, but not all baby alarms allow for two-way communication so the parent is unable to re-assure the child that help is on the way.

A two-way intercom can be a better solution. Some systems are available that are hands-free operated. Older children should be able to turn-off their intercom station if they require some privacy.

Epilepsy alarms

Epilepsy alarms monitor the vital signs or movement of a child, and trigger an alarm should a fit occur. These alarms can greatly decrease the anxiety felt by parents about the safety of their child at night.

Anti-suffocation mattresses and pillows

Standard anti-suffocation mattresses and pillows are available from high street nursery shops. These are made of foam with a dimpled surface which creates air cavities between the pillow and the cover, even when supporting the weight of the head.