Occupational therapists know that essential to any good bathroom design is understanding the needs of those individuals who use it daily. However, knowing those needs can be challenging, particularly when working with individuals with conditions we may not regularly see. So in this blog, we explore design hints and tips for one such condition – Spina Bifida. But before discussing those design considerations, we look briefly at the condition and how it impacts occupational performance.

Spina Bifida occurs when the neural tube that forms the brain and spinal cord doesn’t develop and close properly during a foetus’s development. There are three types of spina bifida, Myelomeningocele, Meningocele, and Spina Bifida Occulata. Myelomeningocele is the most severe type and tends to be the condition people refer to when discussing Spina Bifida. More detailed information about the types of Spina Bifida can be found on the NHS and Shine websites.

Types of Spina Bifida

Diagram of the three types of Spina Bifida: Occulta, Meningocele and Myelomeningocele

Most babies with Spina Bifida have surgery to close the gap, but damage to the spinal cord will usually have occurred. As with any damage to the spinal cord, the resulting sensory and motor impairments will depend on the spinal level at which the damage has occurred. So depending on the level, impairments can include:

  • Weakness or paralysis of the lower limbs
  • Loss of sensation in the lower limbs and buttocks
  • Bowel and urinary incontinence

Hydrocephalus can be associated with spina bifida, and this may result in motor and processing impairment if there is damage to the brain.

Hints and tips for bathroom design

The following hints and tips focus on adults and those children who have reached an age where adaptations to the bathroom can support their continued development in personal care activities, such as grooming, personal hygiene tasks and toilet. However, it is essential not to forget the value of providing equipment for babies and young children with Spina Bifida, as this equipment helps them participate in play and to learn skills critical for their development.

The following is not an exhaustive list of hints and tips. Instead, the list covers four critical areas that an occupational therapist may not routinely consider but which are critical to think about when designing a bathroom for someone with Spina Bifida.

Man in wheelchair washing hands at hand wash basin.

Tip Number 1: Design to reduce the risk of burns and scolds

A child or an adult with Spina Bifida will likely have reduced or possibly no sensation in their lower limbs, so they will not be aware of when they come in contact with hot surfaces, which may result in burns or scalds. So it is crucial to mitigate the risk of them coming in contact with hot surfaces or water.

Possible options to mitigate the risk of hot surfaces include:

  • Boxing in exposed water pipes
  • Positioning the heating source at a higher level
  • Installing low surface temperature radiators

Although not a design consideration, providing straightforward advice, such as always putting cold water into the bath first and using a thermometer to check the water temperature, can effectively reduce the risk of scalding. If you are recommending a shower as part of the design of the bathroom, then it is advisable to recommend a thermostatically controlled shower, which can be set to a temperature that will not cause scalding.

Tip Number 2: Design to prevent pressure damage to the skin

The combination of reduced circulation and sensation in the lower limbs and incontinence increases the risk of a person with Spina Bifida sustaining pressure damage to the skin. So when designing the bathroom, it is important to consider including pressure relieving properties of any surfaces on which the person may be sat for long periods, such as shower and toilet seats. In addition, you may want to discuss with the person the value of including a full-length mirror and good lighting levels, which can help them to check and monitor pressure areas.

Tip Number 3: Design to include storage and accessible shelving to support continence needs

Given the continence needs of children and adults with Spina Bifida, it is best to include storage to keep any products or equipment the person uses dry and clean. It is also key to discuss with the person where shelving or ‘worksurface’ should be positioned to help them better manage tasks involved in their continence needs. For example, a shelf near the toilet can be used to place catheter bags or pads during the task.

Tip Number 4: Design flexibility into a family bathroom

Image of full bathroom.

Commonly, you will be designing a bathroom that needs to be used by all family members, not just for the child or adult with Spina Bifida. This is where height-adjustable fixtures and fittings can provide the flexibility needed. For example, a height-adjustable sink can be raised to enable someone who performs an activity standing and then lowered to the height needed for the family member who performs tasks in a seated position.

While height-adjustable fixtures and fittings can be more costly, they often provide a more cost-effective solution as they can accommodate future changes in the person’s occupational performance, negating the need for further adaptations to the bathroom. For example, changes in wheelchairs are not uncommon for a person with Spina Bifida, but the transfer heights can vary from chair to chair. Unlike a fixed-height toilet, which might need to be replaced to enable the person to transfer onto a suitable height toilet, a height-adjustable toilet doesn’t have to be replaced, the person just moves it to the new transfer height.

Final thoughts

Bathrooms need to be designed to meet individual needs, and this is no different for a child or adult with Spina Bifida. Hopefully, this blog has provided some additional hints and tips to help you support the design of bathroom environments for someone with the condition.