Chapter 26
Equipment
Each person is unique and may require different types of equipment. Keep these things in mind when considering your equipment needs. Equipment can:
- Increase your independence
- Protect you against injury
- Protect your skin
- Provide postural support and prevent deformity
- Help prevent injury to a caregiver
- Improve your comfort
- Have high maintenance needs
Frequently, people see equipment and think it would be perfect for them. But once they buy it, they find out it does not do for them what they thought it would. Into a closet it goes. To prevent this from happening, consult your medical team. Ask if the particular item is useful with your injury. Whenever possible, try the equipment out first. Your therapist may be able to help set this up.
There are a few things that equipment should not do. It should not:
- Make life more difficult or complicated
- Be detrimental to you or your caregiver
- Increase the clutter in your home
- Break the bank
To ensure safety, avoid costly repairs, and extend the life of your equipment, it is important to perform routine maintenance care. Refer to your instruction manuals for proper care and function of all equipment. You are responsible for maintenance of your equipment. You can either do it yourself, have a caregiver assist you, or use a local medical equipment supplier. Before repair or maintenance is needed, identify someone in your community who can assist you. It is important to identify a supplier that is familiar with your specific equipment. This will expedite maintenance and repairs in the future.
Funding for equipment will vary between individuals. Depending on your insurance or care provider, there may be no assistance for the cost of the equipment or it may be covered completely. If necessary, your health-care provider can help write a medical justification for needed equipment. Most funding sources require equipment to be medically necessary. Funding for replacement equipment also varies.
Another variable between spinal cord injury facilities is the procedure for equipment ordering. Responsibility varies from facility to facility as to which discipline evaluates and orders equipment and as to how to obtain replacement equipment after your discharge. Learn the appropriate procedure to receive the fastest service. Plan ahead. Delivery can take several weeks.
A tremendous amount of medical equipment is advertised. Selecting the correct equipment can be confusing. Purchasing the wrong equipment can be costly. Your rehabilitation staff members have been trained to evaluate and recommend the equipment that will best fit your specific needs.
This chapter discusses some categories of equipment and general purpose of the equipment. Some general use reminders are also given.
WHEELCHAIRS
Many types of wheelchairs exist. A wheelchair can be for everyday use or only for sports. You or someone else can push manual wheelchairs. You can push them with your arms or feet or a combination of both. A power wheelchair moves by a motor that you or someone else can control, by hand movements, head movements, or breath control. It is important to match the type of wheelchair you get with:
- Your type of injury
- Your skill level
- Your home environment and community needs
- Your postural needs
- Your means of transportation
- Your skin protection needs
It is very important to get the right size wheelchair for your body. A poorly fitting wheelchair can contribute to shoulder, neck, and arm pain. There are many factors to consider. It is very important to have your therapist work with you to determine the best wheelchair for you. Whenever possible try out the chair you are selecting. Be sure the chair you are trying is set up like the one you will order so your test ride will be more accurate. You wouldn’t buy a new car without trying it out, would you?
Your wheelchair is your mobility. If you do not take care of your wheelchair you may be stranded somewhere when it breaks down. A few things to remember:
- Keep your wheelchair clean
- Keep the bearings clean
- Be sure the wheel locks are adjusted correctly
- Be sure the tires have the recommended air pressure
- Keep all nuts and bolts tight
- If you use a power wheelchair, be sure to maintain the batteries as recommended
CUSHIONS AND POSITIONING EQUIPMENT
People with SCI often do not have their back and stomach muscles working to help them maintain correct posture. Positioning equipment helps maintain posture. Positioning equipment is anything that is used to help maintain your body in a certain position. It can be used in bed or in a wheelchair. It can be used just to position one part of your body or the whole thing. A wheelchair cushion is a specific type of positioning equipment meant to pad your bottom when you sit. All positioning equipment should:
- Protect your skin
- Help maintain correct postural alignment
- Be comfortable
Positioning devices and cushions can be as basic as foam. Some cushions use air, gel, molded foam, or a combination of these. Others can be custom molded to fit you exactly. Most people do not need these.
Many people think that pressure mapping alone (a device that measures where you put most of your weight on the cushion) will tell them what cushion to use. This is not true. What is best for you depends on many factors:
- Pressure mapping results
- How much postural support you need
- Your skill level
- Your skin protection needs
- Your ability to care for the cushion (some are more complicated than others)
HOSPITAL BEDS AND MATTRESSES
Hospital beds can be used to increase independence. They can also provide caregivers with improved ease of care and personal safety. Hospital beds are available in fully electric or semi-electric styles. Wheels can be removed at home to make the bed the same height as the wheelchair. A wide variety of mattresses are available. It is very important that the mattress match your needs in regards to protection of skin, comfort, and ease of mobility. If you change your mattress it is important to check your skin more thoroughly the first few days for any increased pressure areas. Consult your medical team to assess the best bed and mattress to suit your needs.
Bed rails and trapezes are available. Trapezes can cause injury if used incorrectly.
BATHROOM SAFETY EQUIPMENT
There is a wide variety of bathroom safety equipment currently on the market. This equipment should be determined for your use based on your ability, skin protection needs, and body size. The size and layout of your bathroom will also factor into the equipment recommended. One example is a bathtub transfer bench. The bench extends over the side of the bathtub to make transfers easier and safer. Other examples include raised toilet seats, grab bars, and hand-held showers.
It is important to check equipment regularly for cracks in the surface and framework. Falls and injuries to the skin can occur if you use damaged or unsafe bathroom equipment. Grab bars should be installed securely following the manufacturer’s recommendation.
TRANSFER EQUIPMENT
Mechanical Lifts
Lifts are available for use with dependent transfers to increase your safety and the safety of your caregivers. Lifts work well for transferring to and from the bed, wheelchair, and shower/commode chairs. Some lifts allow transfers off of the floor.
Lifts can be electric or hydraulic. Most can accommodate weight up to 600 pounds. They are relatively easy to use, but can be dangerous if used incorrectly, used with the wrong sling, or broken.
A variety of slings are available. It is strongly recommended to use a sling that is easily removed. DO NOT sit or lie on the sling for any length of time as it might cause skin breakdown.
Be sure to get training for safe use of lifts.
Transfer Boards
Transfer boards bridge the distance between one surface and another to increase safety and improve independence. The type of transfer board will depend on your size and ability. Many shapes, sizes, and lengths are available.
Check equipment regularly. If your transfer board is cracked, replace it to decrease the risk of falls or injury. REMEMBER: When using a transfer board, ALWAYS LIFT your bottom. Sliding can cause skin breakdown.
EQUIPMENT FOR SELF CARE
Adaptive equipment is used to increase and improve independence and safety while performing self-care. There are devices for feeding, food preparation, dressing, bathing, grooming, toileting, and communication. For example, reachers, which come in many varieties and lengths, are used as an extension of your arm to access items from your wheelchair. A dressing stick can make it easier to put on or remove clothing.
Sometimes you only need an adaptive device during early rehabilitation. Once your muscle strength is improved or you learn special techniques, the device may not be necessary. For instance, an adapted spoon may be necessary at first to feed yourself. Some people learn to weave the spoon handle between their fingers. They no longer need to use an adapted utensil. Other times the use of an adaptive device is the only way a task can be accomplished with little or no assistance.
People have different opinions about the use of adaptive equipment. Some people do not like to use equipment. Others don’t mind. It’s your choice. A piece of equipment gathering dust on the shelf is a waste of money and space. Your therapist can help you to decide what equipment will be most useful.
UPPER AND LOWER EXTREMITY SPLINTS AND BRACES
Splints are prescribed to prevent or correct deformity, prevent joint stiffness, and decrease pain. Splints and braces can substitute for weak or absent muscle strength. They increase function and safety. They may be made of metal or molded plastic. They may be simple or complex with many moving parts. Splints and braces must fit correctly to be useful. Learn how yours should fit so that the splint or brace functions correctly and your skin is protected.
Your therapist will instruct you in the correct wearing schedule and precautions to protect your skin and joints. Be sure to look at your skin at least twice a day for pressure areas. If you notice a red spot that does not fade within 20 minutes, stop wearing the splint or brace and notify your therapist. You should also notify your therapist if you have swelling or pain.
AMBULATION DEVICES
Many different devices exist to help people walk more easily, including canes, crutches, and walkers. Specialized shoes and shoe inserts can also be used. Using special shoes or a cane can correct your walking pattern. Correcting your walking pattern can
- Increase your safety
- Increase the distance you are able to walk
- Increase your walking speed
- Decrease pain
- Prevent future muscle and joint problems
Because deviations in walking are very subtle, it is important to have a trained professional help determine what will help you best. Even if you have gained new strength in your legs and can now "safely" walk without your crutches, you should check with your health-care provider before throwing them away. There may be another reason for you to use them. The ambulation device may be helping to protect your back and hips from problems years down the road.
Remember to monitor your ambulation device and specialized shoes for uneven wear and cracks. These can lead to falls. Use your ambulation device as directed to avoid falls and to protect your joints.
EXERCISE EQUIPMENT
Individuals with SCI may have special needs regarding exercise. Your therapist will assist you in establishing a home exercise program that will meet your needs. Be aware of any restrictions or limitations due to your spinal cord injury. Exercise equipment supplements your home exercise program and can increase or maintain function.
It is not necessary for you to turn your home into an exercise gym. A lot of expensive equipment is purchased with great intentions and ends up not being used. A few small pieces of equipment can be recommended by your therapist that will ensure a successful home exercise program without taking up a lot of space and costing you a lot of money. Adaptive equipment is available for individuals with limited upper or lower extremity function.
DRIVER TRAINING AND ADAPTIVE EQUIPMENT
Technology has made it possible for people with very little muscle strength to be safe and independent drivers of motor vehicles. Many factors must be considered when selecting a wheelchair and vehicle combination. It is recommended that you work with an expert in this field to ensure the vehicle and wheelchair are compatible with the modifications that are necessary for your independence and safety. For information, see the chapter on Driver Training.
COMPUTER ACCESS
The use of computers and the availability of adapted access to computers have mushroomed over the past several years. General use computers routinely come with software that makes access easy to modify.
A computer can change the life of its user. A thorough understanding of the user’s abilities and goals is important before purchase of a computer and software. An assessment will determine factors such as how much memory is necessary, how mobile the computer must be, what input devices are needed, and how the output is to be received.
ENVIRONMENTAL CONTROL UNITS
An environmental control device is anything that assists people with manipulating functions in their environment, such as the heating and cooling system, lights, and other electronic appliances. It can be as simple as a garage door opener or as complex as a multitask, voice-activated environmental control unit.
People with SCI, especially those with high level quadriplegia, may be unable to activate environmental control functions in their work, home, and school environments in the usual way. They may be unable to open and close the door, turn on and off the light, operate the thermostat, or answer the phone.
Sometimes a person is able to perform all but a few activities. In this case it may be possible to modify just those devices. For instance, if the person has mobility but not strength in the upper extremities and is unable to pick up the phone receiver, a speakerphone can be used. One-item controllers such as X-10 modules are readily available and reasonably inexpensive. These allow the user to operate the device from a remote switch the way the remote control on the television works.
An environmental control unit (ECU) is a battery or AC powered device that can make it possible for people with extensive disabilities to independently perform tasks they would otherwise be unable to perform. It enables the user to manage several electronic functions through a single device. An added benefit to an ECU is that it can provide peace of mind through the ability to independently call for help.
An ECU can be set up for use while in bed, in the wheelchair, or both. There are one-room units available as well as multi-room units. Activation can be through the use of any type of a switch, through a sip and puff switch, or voice control.
There are advantages and disadvantages to all options. A thorough evaluation of your abilities and development of goals for use of the ECU are essential in order to select a unit that will meet your needs. Adequate training and technical support are also necessary to ensure successful use of the unit.
Funding for environmental control is often a challenge. Not all insurance companies or health-care providers pay for ECU. Your rehab team can help you brainstorm potential resources.
RESPIRATORY EQUIPMENT
Ventilators or continuous positive airway pressure (CPAP) may be required for some individuals with SCI. A suction machine or inexsufflator (coughalator) may be advised to assist with secretion removal and respiratory care. Your respiratory therapist, home health nurse, or medical equipment supplier will be able to answer questions about this equipment. A back up generator is essential for ventilator users. These are available at most hardware stores.
CONCLUSION
There is a tremendous amount of medical equipment advertised and available. Depending on your insurance or health-care provider, financial assistance may be available. It is important to consult your medical team to assist you in evaluating, recommending, and purchasing equipment to fit your specific needs. Remember, for all equipment, it is your responsibility to ensure safe operation and mechanical condition through regular maintenance.
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Equipment