Occupational Therapy Product Advisory Service – Enquire Online

If you require specialist or technical information about the suitability of any Nottingham Rehab Supplies product to meet your needs we employ a qualified Occupational Therapist.

You can email your enquiry to productadvice@nrs-uk.co.uk or Tel: 0845 121 8110 8.30am – 4.30pm weekdays.

Below are some useful handy and useful hints about questions our Occupational Therapist is regularly asked.

Occupational Therapist - Frequently asked Questions

Bathing Aids & Equipment

Is my bathroom suitable?

Most bathrooms with a standard bath (1700mm) are able to accommodate most bathroom aids.
Although it is wise to check if there is enough space in the bathroom for the equipment and enough room in the actual bath for the user and the aid.

Points to consider:

• What are you seeking to achieve in the space you have?
• Depth of the bath – if you want to immerse yourself in the bath water, a bath lift or bath hoist may be the preferred choice.
• Using a bath board and a bath seat in conjunction will get you closer to the water
• The length of the bath, so when using bath aids, the user can still straighten their legs.
• The width of the bath, this will be needed to ensure that equipment is not too wide or unable to fit into the bath.
• It can be difficult to fit equipment to some Corner baths, careful measurement is needed.
• Take into consideration any carer’s needs and space required to help you.
• Equipment that can be used in combination with your aid e.g. long handled sponge, bath/shower mat, shower curtain, bath step or step stool.

How do I measure for a bath board?

• Measure the overall width of your bath from edge of rim to edge of rim
• The board must not overhang the bath in order to prevent it tipping
• The bath rim must be wide enough to accommodate at least 1.5” (4cm) of each end of the bath board

Are all bath boards the same and how do I use them?

There are many types of bath and shower boards with different specifications. Generally, they are fitted so that they rest securely on both rims/sides of the bath. They are then fixed against the side of the bath by brackets. Some products, like the bath bench are free standing; others are fixed to the wall by a bracket.

Bath boards are often used in conjunction with bath seats.

Points to consider:

• What is the user seeking to achieve? If they are looking at immersing their whole body, a bath lift or hoist may be the preferred choice
• Will the user be independent or assisted by a carer?
• Size of bath board (check the maximum user weight), seat depth is important for comfort, be aware of how much space the item takes up in the bath. The width of the bath should correspond with the width of the bath board.
• Is a backrest needed? This could provide a good sitting position and support for the user.

To use a bath board:

In principle the following procedure applies as a guide for all bath boards. However, as bath boards can vary, instructions relating to a particular product should be followed.

• With your feet firmly on the floor and your back to the bath.
• Slowly move backward until you feel the edge of the bath on the back of your legs.
• Lower yourself on to the board and move your bottom back until it is in the middle of the board.
• Lift one leg at a time over the side and in to the bath.
• Move your bottom across the board in small stages to the middle of the board.
• To get off the bath board carry out these instructions in reverse.

How do I stop the water from splashing
when I sit on my Bath/Shower board to shower?

You can tuck the edge of the shower curtain under the leg which is nearest the outside edge of the bath or Nottingham Rehab Supplies offer a Bath Board Shower Curtain which is shaped to accommodate a Bath board.

What if I already use a bath board but
have difficulty getting into position on the board?

Some bath and shower boards have an integral grab rail. A grab rail mounted on the wall above the bath may be of some help. Most people find them easier to use if they are fitted obliquely with the top end away from them so that the hand remains in a comfortable, neutral position, in relation to the wrist.
If the side of the bath is too high for you to sit on the bath board, a bath step or step stool may be beneficial.
Grab rails need to be fitted to sound brickwork, preferably on a solid wall (unless fitted by a suitably qualified, experienced person who may be able to mount them on a baton which spans the joists).

If I can’t fit a bath board what other equipment is available?

The Bath Transfer Bench has four legs that are height adjustable so that two can be placed inside the bath and two on the floor outside the bath. It can then be used to transfer over the bath for a wash down or used with an over bath shower. It features a supportive back, large easy to grip handle and built in storage for hand held shower and a soap dish.

The Nuvo or Medici 12” bath seat often comes near to the top of the bath. The Medici has a width adjustment mechanism ensuring that it fits securely to enable safe transfers. Both have a weight capacity of 190kg (30st).

A grab rail used in conjunction with a bath seat may be helpful for the user.

Using a bath step or step stool with handrail (outside the bath) reduces the difference in floor height when stepping in and out of the bath.

What are the benefits of a Swivel Bather?

• A swivel bather allows the user to be seated from the side of the bath and then rotate over the bath to wash or shower
• The rotating seat can be locked in four positions for safe transfers and usage
• The seat has a back and armrests which providing a greater degree of confidence and security
• Fits on top of the bath, supported on four slip-resistant plastic ends
• Adjustable Width, Heavy Duty and Corner Bath versions available

Showering

Shower Chairs - Points to consider

• Shower Chairs with backrests are suitable for users that require more support
• Adjustable height chairs assist with obtaining the optimum position for the user and increase ease of transfers
• Flat-bottomed shower chairs are suitable for acrylic shower cubicles. Shower chairs with legs may put undue pressure on an acrylic cubicle base and cause it to crack
• The Swivel shower chair can be fully rotated for easy access in restricted spaces
• Wheeled models can be beneficial where the user will be undressed in another room (eg: on the bed) then transported to the bathroom but these can only be used with level access showers

There is not enough room in my bathroom for a shower chair,
what other item could I use?

If you have a shower tray or cubicle there are wall mounted shower seats that will fold up against the wall for convenience. These are suitable for users that need minimal support, as they do not have armrests for stability. Some shower seats are floor supported by two legs under the front of the seat. Wall mounted shower seats should only be fixed to a solid wall by a suitably qualified person

Seat size and height, the distance the seat extends from the wall, the amount of space a seated user will require and the maximum user weight are important considerations.

The Height of the shower seat should be the lowest setting in which you can place your feet flat on the floor.

Maximum user weights:

• Kjaerulff Floor Supported Shower Seat 130kg (20st)
• Brentwood Folding Shower Seat 102kg (16st)
• Siesta Folding Shower Seat 160kg (25st)
• Floor Supported Shower Seat 190kg (30st)
• Rivera Shower Seat 89kg (14st)

Are there any height adjustable shower stools?

There is a wide range of Polyurethane Moulded Perching Stools and Malvern Perching Stools suitable for bathroom and shower use. These are available with and without backs and armrests, in fixed or adjustable height, extra wide and extra low versions.

The Shower stools and benches in our range have handles with the exception of the Corner shower stool. This triangular shower stool fits into a corner and is suitable where space is limited.

The height of the perching/shower stool is an important factor, you should be able to place your feet flat on the floor.

Toileting

I find it difficult to get from standing to sitting
and back up again, is there a toilet aid I can use?

There are a number of pieces of equipment that can be used when someone has difficulty getting on and off a standard toilet such as, grab rails, support rails, raised toilet seats, toilet frames and combined toilet seat and frames.

Grab rails are the most common support system, they can be used alone or in conjunction with other equipment such as raised toilet seats.

• They are simple, inexpensive and discreet.
• Can be used alone or in pairs, eg: one on each side of the toilet if room layout allows.
• For toilet transfers, having the grab rail fixed diagonally (lowest end towards the user) is the most comfortable and ergonomically correct position.
• Plastic grab rails are warmer to the touch.
• Ribbed or ridged rails can enhance grip but may collect dirt

How do I know where to position a toilet grab rail?

The general guide is to position the rail at half the user’s standing height. Most people find that it is easier to use if fitted obliquely with the top end away from them so that the hand remains in a neutral position to the wrist.
Grab rails need to be fitted to sound brickwork, preferably on a solid wall (unless a suitably qualified experienced person is fitting who may be able to mount on a baton which spans the joists)

Raised toilet seats are usually available in a choice of standard heights, 2” (50mm), 4” (100mm) and less often 6” (150mm). By increasing the height of the toilet seat, the user needs to exert less effort when lowering down to the seat and particularly when rising to stand.

Points to consider:

• The height required usually depends upon the height of the client and hip mobility. 4” usually meets most peoples’ needs
• In most cases, the existing toilet seat needs to be lifted so that the raised toilet seat can be fitted directly onto the porcelain. (The Novelle raised toilet seat clips directly onto the existing seat, whilst the Liberty and Dania raised toilet seat replace the existing seat)
• Standard toilets are usually 15 – 19” high (380 – 480mm), including the seat
• The aperture size (hole in the middle) is important for some people, particularly if they are larger and especially for gentlemen.
• A front cutaway allows for easier personal cleaning
• Check the maximum user weight
• Method of fixing – most raised toilet seats are fastened by means of brackets at the sides and usually at the front, some are easier to tighten/undo. This may affect your choice; if necessary check the method of fixing with the supplier. Even if the raised toilet seat is to be fitted by someone else, they can often become loose with regular use or if taken on and off by other family members.
• It is essential to check the security of the fitting prior to each use
• Soft, padded/cushioned or inflatable toilet seats may be better for people with thin, sensitive skin, thin people with bony prominences, or people who require a higher degree of comfort or have to sit on the toilet for a long time
• A raised toilet seat is portable and can be moved to another toilet or removed when other people wish to use the toilet

Which Raised Toilet seat has the largest aperture?

The Linton Raised Toilet Seat has a good sized aperture (size 275x240mm, 11x 9 ½”). The level surface of its seat makes it comfortable to sit on. At 35 stones (222kg), it has the highest maximum user weight of toilet seats in the Nottingham Rehab Supplies range.

How do I fit a Raised Toilet Seat?

Nottingham Rehab Supplies offer a number of raised toilet seats and each come with there own set of instructions.

Generally there is a set of brackets on the sides of the seat that fix the seat directly on to the toilet bowl.
The brackets will need tightening to hold the seat securely on the bowl.
To remove the seat, loosen the brackets.
Please always read and follow instructions for your raised toilet seat.

It is essential to check the security of the fitting prior to each use. Even if the raised toilet seat is to be fitted by someone else, they can often become loose with regular use or if taken on and off by other family members.

How do I keep my raised toilet seat clean?

They are removable and easy to clean using any standard bathroom cleaning fluid or disinfectant solution.

Do you do a portable raised toilet seat,
which is suitable to take on holiday?

The Inflatable Toilet Seat can be deflated for travel and inflated with a bicycle pump on arrival.

Do I have to use a toilet frame with a raised toilet seat?

Toilet Frames are to assist standing / lowering with or without a raised toilet seat. They are available in either free-standing or floor-fixed versions. Some are adjustable in height to assist with obtaining the optimum position for each user. A model with moulded hand rests will offer additional comfort when exerting pressure through the handles. Ideally a frame that can be floor-fixed should be used where the user is unable to push equally on both sides (for example after a stroke), or where general unsteadiness is a factor, otherwise they can tip.
They are available in different widths and maximum user weights to suit the user and environment.

Combined raised toilet seat and support frames are suitable if the toilet shape makes it difficult to fit a raised toilet seat. The height of the frame can be fixed or adjustable, they are also available in free-standing or floor-fixed versions.

Points to consider:

• Check that the frame and seat will fit the dimensions of the toilet pan
• Ideally a frame that can be floor-fixed should be used where the user is unable to push equally on both sides (for example after a stroke), or where general unsteadiness is a factor, otherwise they can tip.
• The Derby Companion toilet frame and seat is height adjustable and features a back rest for added support

How high should my combined seat and frame be?

It should be at the lowest possible height at which you can still place your feet flat on the floor.

What can I use if I find it difficult to manage
the stairs in the night and I have a downstairs toilet?

A commode is a free standing toilet that can be used anywhere in the house where access to a toilet is difficult. They can either be used temporarily, during illness or following injury, or on a longer term basis.
A commode is suitable for example, when the person is unable to reach the toilet in time (due to continence issues or physical barriers such as stairs); when a person lives just in one room; they are often useful at night (instead of finding the way to the toilet in the darkness or when sleepy). Commodes may be static or mobile, fixed or adjustable in height. Extra wide versions are available.

Points to consider:

• Seat height, your feet should rest on the floor for stability.
• Seat size and width between the arms
• Check the size and shape of the aperture required for ease of personal cleansing.
• Armrests, do they need to be removable?
• How and when the commode will be emptied - what size is the pan, does it have a handle and lid?
• Mobile Commodes can also be used over a toilet and can be easier to position for transfers.
• Folding commodes are easier to transport and store
• The maximum user weight, the Zenith Bariatric Commode has a weight limit up to 381kg (60st).

Popular items of equipment

Personal Care

Equipment to assist people who have difficulty bending and/or reaching

When bathing a number of long handled aids can help if you find bending or reaching difficult. Long handled toe washers and flexible sponges may be helpful for the user to wash their legs and feet. They can also be used to wash the client’s back and whole body if there is stiffness in the joints. A similar product is available to help with the application of lotions and creams.

Personal cleansing after toileting can present a problem for people who find a twisting movement difficult. We supply an Easywipe, which enables the user to overcome difficulties of personal hygiene. It is easy to use from the front; toilet tissue is wrapped around the head of the soft wiper and tucked into the grip mechanism. When cleansing is finished the tissue is ejected by pushing the button at the end of the easywipe and disposed of in the toilet. It can also be used with moist toilet tissues or wet wipes.

Another option is the Bidet bowl. It fits inside the toilet bowel converting a standard toilet to a bidet.

There are a number of aids to help users with dressing. If you find putting shoes on difficult there are 2 long reach Shoe Horns (metal and plastic). If tying up shoe laces is difficult there is the option of elasticised and spring shoe laces. They are designed to convert lace up shoes to a ‘slip on’, making them ideal for people with poor grip. Tight and stocking aids provide simple assistance when bending is difficult.

We sell a Dressing Assistance Kit (Item code: L63253) which consists of a plastic shoe horn, flexible sock and stocking aid, buttonhook/zipper combination, deluxe dressing stick and ready reacher. This set is useful in helping to maintain independence and dressing skills. Items in this kit are also available for purchase separately.

The Button Hook/Zipper Combination can make dressing and undressing much simpler and aid independence.

Around the Home

If you have difficulties managing everyday tasks, there is a variety of equipment to assist you around the home. Some of the more popular items are described below.

If you have difficulties in reaching or bending and picking items up a Reacher can be used. These products can help by taking the strain of extending to reach items. The Combi Reacher L61554 has a number of features including a rotating head, shoehorn, magnetic tip and comfortable easy grip, four finger trigger.

Try to store items that are used regularly in more assessable areas.

Storage solutions and kitchen utensils that are easy to use and grip can assist people who have limited hand function. There are also items available to help with food preparation such as cutting and spreading boards, cooking baskets, jar, and bottle and can openers.

There is a wide range of devices to help open screw top jars and bottles. Some simply improve grip whilst others provide an extended lever to assist with turning.

We supply tap turners for both crystal and crosshead taps. The Medici tap turner (Item code: F20729) is easy to fit and adjustable to suit almost any size of Crystal or Crosshead tap. The long shaped handle offers plenty of leverage and is pivoted for ease of use.

Kettle tippers work by placing the kettle on a platform that tilts forwards when gentle pressure is applied to the kettle handle. They are available for jug style and conventional style kettles.

Some Hints: Fill your kettle by using a cup or jug; these are lighter and easier to hold and lift. Only boil as much water as you need (if making a cup of tea for example). Half fill your kettle for ease of lifting and pouring. Travel kettles are useful and compact.

Eating and Drinking

If you have difficulty with eating and drinking you may find the following information helpful.

Weighted Cutlery can reduce uncontrolled movements, for people with limited control or tremors the extra weight gives the person more control when eating.

Angled cutlery can be beneficial for people with a weak grip or restricted movement at the shoulder, elbows and wrists. They are available with either a fixed or adjustable angle. The use of moulded, lightweight or larger handles can help ensure the cutlery is comfortable to hold and adaptable to any grip. Adjustable utensil straps or cutlery holders help prevent cutlery from slipping or turning in the hand. Examples of these types of cutlery are the Amefa, Caring and Goodgrips ranges.

Other cutlery ranges are specifically designed for one handed eating. The use non-slip mats, plate surrounds (to adapt existing crockery) or plates with a raised rim or lip can also aid one handed eating. Plates and bowls that have high sides or curved rims provide a barrier in which food can be pushed to manoeuvre it onto the spoon or fork. See our range Stay Put dinnerware, Medici and Manoy plates. People who are slower eaters might benefit from using the Steelite range of crockery which has heat retention properties or the Keep Warm dish.

When choosing drinking equipment there are many options and features to choose from to suit the individual. Some products have lids or inserts to reduce the risk of spillage such as the Non Spill Feeding Cup and the Easi 2 drink range. These may be useful for people who have a tremor.

Cups with handles and lids can be used for people who may spill or take a long time drinking as they keep heat in.

Two handles on a cup allow the weight of the cup to be distributed evenly for the user to hold. Moulded handles can help with gripping the cup and comfort for the user.

Angled drinking cups and mugs are used to reduce the amount of head and neck movement the user has to make or enhance the direct flow of liquid to aid swallowing. The Spill Proof cup features a two way valve that allows a continuous flow of liquid only when the soft spout is sucked, the valve seals again between sips. Two large angled handles make it easier to hold. The Novo cup is completely spill proof and the partial vacuum in the cup enables the drinker to have complete control of the liquid flow. Ideal for people who have limited wrist, neck elbow and shoulder movement, it can also be used when the drinker is not fully sitting up.

If lifting a cup/glass is difficult the Pat Saunders One Way Drinking Straws clip easily onto cups or glasses and come in two lengths. They contain a one way valve so that liquid stays in the straw even if the straw is moved from the user’s lips. This makes them suitable for people that are not able to suck strongly and prevents air begin sucked into the users stomach which can cause pain and discomfort.

Mobility

Carrying items when using a walking frame can be difficult. NRS supply 2 bags that are designed to be clipped on to zimmer frames so you can carry shopping and everyday items.

The Buckingham walking frame caddy has been developed to assist users to carry belongings, in addition it has a tray designed to accommodate a standard size dinner plate and mug holder. The maximum carry weight on this item is 2kg (4.4lb). Care should be taken not to over load the bags or caddy as this may affect the stability of the frame.

Wheeled Walking Frames may be used if the user finds it difficult to lift a traditional frame. They enable a more natural walking pattern as the user does not have to stop walking to lift the frame. However, they can lack stability.

Points to Consider:

Walking frames are used mainly for 2 functions: to reduce the weight taken through the lower limbs and to assist balance.

1. Frames can come in all shapes and sizes e.g. rigid, folding, gutter arm support, wheeled etc.

2. Most are lightweight.

3. Folding frames are useful if the user travels regularly, always take care when assembling folding frames to ensure that the locking mechanism is in place before use.

4. Frames with support for the forearm enable people with poor hand function, grip or pain in hands or wrists to use a frame whilst taking their weight through their forearms (some are called gutter frames).

5. They provide support as they have a very wide base and are stable.

How to Use a Walking Frame

The user should always be instructed in the use of a walking frame, poor technique may lead to instability and falls. They should be encouraged to take even steps keeping the frame forward and ensuring that all four legs of the frame are on the ground before taking a step. The correct height for a frame should allow the user to stand upright with flexed elbows whilst holding the frame without hunched shoulders. If the frame is too high the person will tend to use it for support rather than for transmitting load/weight (see section below).

Walking Sticks

Points to Consider:

1. It is usual to use the stick on the opposite side to that which is affected. This encourages a more natural walking pattern, increases stability and reduces the load on the affected leg.

2. Using a walking stick requires good handgrip and a degree of strength in the arm.

3. The type of handle needed should also be taken into consideration. A swan neck handle is useful for users that have problems with balance because it helps transmit the weight of the user vertically through the body of the stick. Whereas a moulded handle (anatomically shaped and available as right or left handed) will distribute pressure evenly across the palm of the hand, these may be more comfortable for people who have arthritis or difficulty gripping.

4. Walking Sticks can vary in weight; a lightweight stick may be beneficial for users who are frail and weak. We also supply a height adjustable folding walking stick with a contoured handle.

5. It is important that walking sticks are adjusted to the correct length for the individual user (see below).

Our heavy-duty crutches are more robust and have a maximum user weight of 30st/190kg. They are extra strong, made from anodised aluminium and supplied with non-slip rubber ferrules. The circumference of the armband is 12” and they are sold as a pair.

Trolleys & Wheeled Rollators

Points to Consider:

1. Trolleys are for use in the home environment whereas rollators are suitable for use both indoors and outdoors.

2. They both give the user support and security when walking. A trolley will help someone who is unsteady and has difficulty carrying things; however, they do not give the same amount of support as a walking aid that has been specifically designed for that purpose.

3. Trolleys and rollators are very mobile and may be difficult for some users to control in which case a two wheeled walking frame may be more suitable (see above).

4. Three wheeled rollators have a large swivelling wheel at the front and two fixed wheels at the rear. They are less stable than a four wheeled rollator. The model we supply comes with a useful bag.

5. Our Four wheeled rollators have two front wheels which are swivelling and two fixed rear wheels making them easier to manoeuvre than the fixed four wheel type. They all feature seats with a backrest and either a basket or bag for storage.

6. The-handle height must be taken into consideration, so the trolley/rollator can be pushed easily in an upright position and there is enough room for the legs when walking and pushing at the same time.

7. Consideration should be given to the floor surfaces on which it will be used, e.g. loose carpet or rugs may need to fixed in place or removed. Trolleys are usually best on smooth floors; they can be difficult to manoeuvre over thresholds and deeper pile carpets.

Nottingham Rehab Supplies offers a range of rollators to suit all users and applications. All are made from sturdy aluminium frames making them lightweight and easy to manoeuvre and have height adjustable handles. They all feature easy to use loop brakes for maximum safety (enabling the rollator to be stopped by squeezing the brakes and locked by pushing the brakes down) and have comfortable ergonomic handgrips. They fold easily for storage and transport.

How to measure the correct height for a walking aid.

For all types of walking aid that have a handle (walking sticks, crutches, walking frames) make sure that you are wearing the shoes you normally walk in and are standing as symmetrically as possible, with your feet slightly (shoulder width) apart. With your arms relaxed by your sides, ask someone to measure from the floor to the bone that sticks out on the little finger side of your arm, just above the wrist. It is at this height that the handle should be adjusted to.

Rubber ferrules should always be checked regularly to make sure that is has not become worn and there is still sufficient grip. Our ferrules come in black and grey and can be used with frames, sticks and crutches. We supply them in a range of sizes: 19mm, 22mm and 25mm in diameter.

Getting further help in deciding what you need

You may be entitled to an assessment of your needs from your local Council’s Social Services Department. Occupational therapists (OTs) help people improve their ability to perform tasks in their daily living and working environments. They will try and provide you with equipment and adaptations for example, changes required to bathrooms and kitchens to help you live independently and safely. OTs work in any health or social care setting. They mostly work in social services teams, helping people in the community, or as part of NHS Primary Care Trusts perhaps working out of GP practices and also in Hospital settings.

How to get an assessment

An assessment from an OT can be gained by either contacting or phoning to your local Social Services and referring yourself, or through your GP or any other healthcare professional. In some areas there may be a waiting list for assessments.

Self-Assessment

You can carry out a self-assessment on SARA. This stands for Self-Assessment, Rapid Access; it is an online self-assessment tool for older and disabled people and their carers. Completing the assessment helps you to learn about equipment that might assist you in everyday life. By answering questions about your needs, you will get ideas just for you, information on where you can buy or borrow equipment and helpful contacts. The system is run by the Disabled Living Foundation (DLF). For more information please visit the DLF website at www.dlf.co.uk

Getting the most out of an assessment

You might want to prepare for your assessment by writing a list of anything you want to talk through with the therapist. What is difficult for you? What kind of help are you having at the moment? Are some days much easier than others? If so, why do you think this is? Some people find it helpful to keep a diary over a couple of weeks.

During an assessment the therapist will focus on some of the following:

Your daily routines, such as personal care and domestic chores, and how well you are able to manage them

How much control you have over your own life, and how easy or difficult you find it to make decisions about the way you live at that moment

Your health and safety, including any risks to your wellbeing or mental health