Jane is a 67-year-old retired woman, with a neurological degenerative disorder, who lives with her husband in a two-storey house. Jane worked for many years within the community as an advocate for adults with physical disabilities.

Jane has the most wonderfully positive outlook to life and until recently had followed an active and fulfilling life, enjoying various crafts and musical pursuits.

Jane had begun experiencing some upper and lower limb weakness, was finding her grip strength and dexterity gradually worsening, had begun falling and was noticing her balance was at times unsteady.  Crafting projects became more difficult to complete, playing the piano was effortful and sporting pursuits were ceased. Investigations revealed a diagnosis of a neurological degenerative disorder.

Jane was initially referred to occupational therapy services concerning her falls, reduced function, and difficulties with activities of daily living. Due to Jane’s past career, she had an awareness surrounding the possible future implications of her new diagnosis.  From her first contact with the occupational therapist, Jane was willing to engage and incredibly proactive in identifying plans for the future.

Jane was assessed holistically and began a rehabilitation programme focused on strength and balance exercises to assist with maintaining her current level of functioning and reduce the risk of falls.

Jane’s occupational therapist provided some assistive equipment for the home and together with Jane, was able to identify some adaptive measures to enable Jane to continue enjoying her hobbies and interests.

A management plan was also implemented due to an identified risk of pressure damage. Jane’s skin integrity has remained intact and continues to be considered in all aspects of therapy intervention. The occupational therapist also identified environmental difficulties and together with Jane and her husband, began planning future, larger home adaptations to facilitate access to all amenities. Jane and her husband were awarded a Disabled Facilities Grant to cover the costs of these planned extensive alterations.

The plans included the integral garage being converted to a ground-floor bedroom with a large en-suite wet room. Jane and her husband also received some additional funds from a local charity which allowed for the removal of an internal wall, giving full accessibility to a new craft and music area.

Jane’s condition was progressing, and the occupational therapist had identified a change in Jane’s demeanour.  Jane was becoming low in mood and uncharacteristically tearful. Through health coaching with the Occupational Therapist, Jane opened up about her deepening worries surrounding toilet hygiene and care. The issue of toileting was a very sensitive subject for Jane as she felt this was a pivotal transition in her health journey. Jane’s condition was fluctuating with good and bad days, the occupational therapist had built rapport and trust with Jane and was able to explore these bad days and what specific difficulties they brought. Jane was referred to the specialist bladder and bowel service and received training for self-administering rectal enemas to help manage her bowel function. Jane, unfortunately, found this to be problematic, both due to the time involved and her reducing dexterity. Despite this, Jane was determined to persevere though acknowledged this was beginning to negatively impact her well-being and quality of life.

The occupational therapist recommended a Closomat toilet be installed within the bathroom adaptation to ensure Jane’s independence with toilet hygiene could be retained in a more appropriate, patient-focused way.

The elbow pad switch along with the comfort padding on the arms enabled Jane to operate the controls easily. Jane’s seated posture improved significantly and with the use of the water jet as a less invasive method to stimulate her bowels; her time spent in the bathroom reduced.

This in turn has had a positive effect on Jane’s well-being, and the less time spent struggling with bowel function meant that her daily life was less disrupted. Jane has been able to re-focus on her hobbies and interests and regain her positive outlook.  Jane attributed her improved occupational performance outcome solely on the benefits her Closomat offered.  Jane continues to receive Occupational Therapy as her condition progresses. Further environmental modifications may be required to address any postural changes and moving and handling considerations, for example, an Aerolet Lifter.

The rehabilitative frame of reference (FoR) was used with Jane in this instance. This approach facilitates a person’s occupational performance and is particularly appropriate for people whose diagnosis is likely to worsen over time. The concepts within the FoR include adaptation and compensation which incorporate environmental modifications. Adaptations to the home fit within this FoR alongside adaptive techniques and behaviour modification.

Closomat’s solution: The Palma Vita wash and dry toilet.

The Closomat Palma Vita can be adapted for people with restricted mobility by adding the appropriate accessories, at initial installation and later, as needs change.  The heart of our toilets is the washing and drying experience: the most effective available in the UK.

The warm water washing is followed by thorough warm air drying – so you are left with the ultimate feeling of cleanliness and freshness.

Download the Clinical OT resource that accompanies this case study