Transferring A Stroke Patient: Shower Chair Accessibility

Getting a wheelchair-bound stroke patient into a shower chair requires careful preparation and execution. It is essential to ensure the patient's safety and comfort throughout the entire process. Before initiating the transfer, it is crucial to explain each step to the patient, allowing them to understand what movements they need to make. This is particularly important for maintaining their balance. Additionally, the environment should be set up appropriately, with the wheelchair positioned directly next to the shower chair, brakes locked, and footrests moved out of the way.

The transfer process itself involves physically assisting the patient. It may require more than one person, depending on the patient's level of mobility. The patient should be helped to sit up and moved to the edge of their bed or chair, allowing them a moment to sit and ensuring they don't feel dizzy. Their outside leg should be placed between your knees for support, and then, counting to three, you should slowly stand up, using your legs to lift and shift your weight. As you pivot towards the shower chair, the patient should push off the bed or chair and help support their weight. Once their legs are touching the seat of the shower chair, you can lower them into it.

Use a transfer tub bench

A transfer tub bench is a great option for a wheelchair-bound stroke patient to gain access to the shower safely and comfortably. Here are some detailed steps and tips on how to use a transfer tub bench:

Step-by-Step Guide to Using a Transfer Tub Bench:

• Prepare the Bathroom: Ensure that the bathroom is ready for the patient's shower. This includes purchasing and placing anti-skid material on the floor, both inside and outside the bathtub, as well as a bath mat for added stability.
• Position the Transfer Tub Bench: Place the transfer tub bench inside the tub, ensuring it extends outside to the side. This will allow the patient to sit and slide into the tub without stepping over the side.
• Adjust the Height: Adjust the height of the transfer tub bench to a comfortable level for the patient. This will ensure that they can easily lift their legs over the side of the tub and sit down.
• Assist the Patient: Help the patient transfer from their wheelchair to the transfer tub bench. Communicate each step to them, providing verbal cues and physical assistance as needed. Ensure they are securely seated.
• Showering: Once the patient is comfortably seated, you can begin showering them. Use a handheld showerhead for their comfort and ease of use.
• Exit the Tub: After showering, assist the patient in exiting the tub by helping them lift their legs over the side and back into their wheelchair.

Tips for Using a Transfer Tub Bench:

• Ensure the transfer tub bench is sturdy and secure before use.
• Communicate with the patient throughout the process, explaining each step and providing verbal cues.
• Take your time during the transfer process, allowing the patient to understand and adjust to each movement.
• If needed, seek assistance from another caregiver or a professional occupational therapist to ensure the patient's safety.
• Consider using a shower cap if the patient does not need to wash their hair.
• Always check the water temperature before showering to ensure it is lukewarm, neither too hot nor too cold.
• Use latex gloves for the caregiver and ensure all necessary shower accessories are within reach.

Employ a shower chair with rubber tips

Employing a shower chair with rubber tips is a safe and effective way to bathe a wheelchair-bound stroke patient. This method ensures that the patient does not have to stand or lift themselves over the side of the tub, reducing the risk of falling.

To begin, ensure that the shower chair is placed securely in the correct position inside the shower or bathtub. Adjust the chair's height, if possible, to match the patient's needs. Check that the rubber tips on each leg of the shower chair are intact and in good condition, as these will provide stability and prevent the chair from sliding.

Next, assist the patient in transferring from their wheelchair to the shower chair. This step may require more than one caregiver, depending on the patient's level of mobility. Communicate each step to the patient beforehand, allowing them time to process the information and maintain their balance. Physically assist the patient, using verbal cues throughout the transfer.

Once the patient is seated in the shower chair, ensure that they feel secure and comfortable. You can then proceed with the shower, following the patient's preferences and any necessary care protocols.

After the shower, carefully assist the patient in transferring back to their wheelchair. Dry them off completely, and help them put on clean clothes and any necessary accessories, such as glasses or contacts.

Install grab bars

Grab bars are an essential safety feature for wheelchair-bound stroke patients, providing stability and aiding mobility when sitting and standing. They can be installed on various surfaces, including drywall, tile, and concrete, but it's crucial to ensure they are firmly secured with screws or fasteners directly into a wood stud. Here are the steps to install grab bars:

Determine Placement and Locate the Stud:

Start by deciding where to place the grab bars. Horizontal grab bars around toilets should be installed between 33 and 36 inches from the floor, ensuring they are at a comfortable height and position for the user. Use a stud finder to locate the wall studs, which are typically spaced 16 or 24 inches apart. If the tiled wall is adjacent to another room, you can look for studs in that room and transfer the measurements.

Remove the Escutcheon:

The escutcheon is the flat metal piece surrounding the bar. Gently tap or pry it from the back to loosen and remove it.

Position the Grab Bar:

Use the stud finder to locate the stud's centre, then place the grab bar on the wall at the desired height. Ensure the mounting holes align with the studs. Use a level to check the alignment and mark the mounting holes with a pencil.

Drill Holes into the Stud:

Remove the grab bar and use a drill with an appropriate drill bit to create pilot holes as marked. Choose a drill bit that is recommended for tile if drilling into tiled surfaces. Be careful not to overtighten screws when drilling into tile to avoid cracking.

Fasten the Grab Bar:

Secure the grab bar to the wall using the provided screws or panhead screws. Ensure you don't overtighten the screws to prevent damage to the tiles.

Complete the Installation:

Slide the escutcheons onto the ends of the grab bar and snap them into place. Apply silicone caulk to the back of the escutcheons to protect against water damage. Test the strength of the installation by applying moderate pressure to the grab bar.

Additionally, consider the following tips for a successful grab bar installation:

• Grab bars can be placed vertically, horizontally, or diagonally, depending on user needs and preferences.
• If you cannot locate a stud, use an anchoring device or wall anchors to secure the grab bar.
• When drilling through ceramic tiles, use glass/tile drill bits to avoid cracking the tiles.
• Choose smaller-diameter bars for individuals with reduced grip strength.
• Textured grab bars provide a better grip for wet hands.

Use a gait belt

Gait belts, also called transfer belts, are assistive devices that can help safely transfer a person from a bed to a wheelchair, assist with sitting and standing, and help with walking around. They are especially useful if the care recipient is partially dependent and has some weight-bearing capacity.

• Before putting on the belt, inform the patient that you will be using it and reassure them that it will be removed as soon as the transfer is complete.
• Position the patient's wheelchair so that their legs are near the back of the tub and in line with the shower chair.
• Place the gait belt with the buckle in front of the patient's midsection, slightly off-center for comfort. The belt should be placed over the patient's clothes, not directly on the skin. If the patient is thin or frail, place a towel between the belt and their body.
• Tighten the belt until it is snug but not uncomfortable. You should be able to slide two fingers between the belt and the patient's body.
• Stand facing the patient and practice good body mechanics. Keep your knees bent and your back straight. Put your arms around the patient's waist, placing one hand under the belt with your palm facing outward, using a firm grasp.
• Straighten your knees while holding the belt with one hand and place your other hand on the patient's back.
• Slowly lift and transfer the patient to the shower chair, providing verbal cues throughout the process.
• Once the patient is seated in the shower chair, ensure that they are securely positioned before starting the shower.

Remember, a gait belt should not be a substitute for good body mechanics when transferring an individual. Do not overexert yourself, and always ask for assistance if needed.

Modify the bathroom to improve accessibility

Modifying the bathroom can drastically improve a stroke patient's quality of life, health, well-being, and independence. Research shows that disabled people are 22 times more likely to be unable to use the whole bathroom without assistance. Additionally, falls in the bathroom are two and a half times more likely to result in injury compared to other areas of the home. Here are some ways to modify the bathroom to improve accessibility:

Widen Doorways

Standard bathroom doorways are typically 24 inches wide, while manual wheelchairs can be up to 30 inches wide. To address this, consider replacing the door hinges with offset or "swing-clear" hinges, allowing for the full width of the doorway to be utilized. Ensure there is adequate room for the door to open to at least 90 degrees. If space is limited, an alternative is to mount the offset hinges on the outside of the door frame so that the door swings outward.

Install Grab Bars and Handrails

Grab bars and handrails can provide crucial support and stability for stroke patients when getting into or out of the bathtub or shower, and when using the toilet. These can be bolted to the walls to ensure safety and reduce the risk of falls.

Choose the Right Toilet

The toilet is often the lowest seat in the house, making transfers challenging. Consider raising the toilet seat height to make it easier for the stroke patient to sit or stand. This can be achieved through a seat elevator, a toilet elevator, or by replacing the standard toilet with a higher "comfort height" or "ADA-compliant" toilet. Additionally, installing a bedside commode can be helpful, allowing the patient to use the toilet without travelling far.

Modify the Shower

A level-access shower can greatly improve accessibility for wheelchair users. These showers are almost level with the bathroom floor and have a small lip of 10mm or less, allowing for easy entry without assistance. Structural changes may be required to accommodate the lower tray, but level-access showers can have a similar or slightly smaller footprint than traditional showers. Additionally, consider installing a shower chair with armrests and rubber tips on the legs to prevent sliding.

Create a Wet Room

Wet rooms offer a cost-effective and stylish solution for accessible bathrooms. The floor is sloped towards a built-in drain, sealed with a waterproofing layer, and finished with non-slip flooring. The absence of a shower tray or door makes access much easier for individuals with mobility challenges. Wet rooms also provide easy maintenance, reduce the risk of trips and falls, and are more hygienic due to the lack of grout lines.

Enhance Safety with Non-Slip Mats and Lighting

Non-skid bath mats with suction cups and textured surfaces can provide stability and reduce the risk of slipping on wet surfaces. Additionally, consider installing red or orange night lights to guide the stroke patient to the bathroom at night, as these colours are less likely to disrupt their internal clock compared to white or blue light.

Frequently asked questions