Assessment:
The occupational therapist, together with the person they are working with, focus on individual and environmental abilities and problems related to activities in the person’s daily life.
Assessment includes the use of standardised procedures, interviews, observations in a variety of settings and consultation with significant people in the person’s life.
Rebecca was referred to the paediatric occupational therapy team for an ‘assessment of toileting needs’ by her school-based physiotherapist. An initial assessment was carried out at her home address to understand the problems that Rebecca was having.
Rebecca is 13 years old and has a rare congenital diagnosis which causes a mild learning disability along with some physical challenges. The assessment took place at home, after school with her father, David also present. David has been Rebecca’s sole parent since her mum died when she was an infant, and he is fully involved in all aspects of decision making for Rebecca including her education, care and support. At the initial assessment, a review of all daily occupations was undertaken with David and Rebecca contributing as she was able. When asked what was important to her, Rebecca stated, “| don’t want dad to help me have a toilet” and David advised that Rebecca feels uncomfortable with him having to wipe her after opening her bowels.
A discussion and activity analysis were undertaken and Rebecca was able to be observed in the bathroom.
Although she could transfer on and off the toilet, Rebecca struggled with upper limb coordination and David said that she is not wiping effectively and she is refusing help from him, leading to issues with hygiene causing distress to them both.
Planning:
The results of the assessment are the basis of the plan which includes short and long-term aims of treatment. The plan should be relevant to the person’s development stage, habits, roles, life-style preferences and the environment.
David said that he had always assisted Rebecca with all aspects of personal hygiene and as she had grown, matured and reached her teenage years, neither of them felt comfortable with him managing this aspect of her daily life. David’s role as father was very important to him and saw this as very separate to his caring role and requested support to promote Rebecca’s independence and dignity.
Rebecca’s school had a Closomat wash and dry toilet installed which Rebecca had not used and therefore a plan was developed with the support staff at the school to introduce this into Rebecca’s school routine, to assist with the transition to using a Closomat toilet at home.
Intervention:
Intervention focuses on programmes that are person-oriented and environmental. These are designed to facilitate the performance of everyday tasks and adaptation of settings in which the person works, lives and socialises. Examples include teaching new techniques and providing equipment which facilitate independence in personal care, reducing environmental barriers and providing resources to lessen stress.
With the consent of David, a remote assessment by a product specialist from Closomat was arranged and Rebecca, her father and the occupational therapist were present. A review of the layout of the bathroom was undertaken and the product specialist advised that the simplicity of a touch-sensitive switch would support Rebecca to operate the wash and dry function on the toilet by pressing it once, therefore supporting her independence.
A Disabled Facilities Grant was applied for by the occupational therapist which paid for the cost of the Closomat Palma Vita wash and dry toilet and due to Rebecca’s age, the extended maintenance and warranty cover ‘Palma Life’ was funded which includes any future adjustments that may be required to the toilet.
Cooperation:
Occupational therapists recognise the importance of teamwork. Cooperation and coordination with other professionals, families, caregivers and volunteers are important in the realisation of the holistic approach.
As part of the assessment process, contact was made with the treating physiotherapist to establish if any intervention around upper limb coordination would assist in promoting Rebecca’s independence. The physiotherapist advised that despite working on this as part of a treatment programme, no progress had been made and therefore Rebecca was at her maximum level of functioning. David, as the father of Rebecca, was involved in all aspects of the assessment and intervention and Rebecca was supported to share what was important to her.
School was identified as crucial to the transition to using a wash and dry toilet and were an important aspect of the process.
Rebecca is now managing toileting completely independently, is not having any issues with hygiene and the provision of the toilet has allowed David to maintain his role as a father with less emphasis on being a ‘carer’.
For further information on the definition of occupational therapy see: https://wfot.org/about/about-occupational-therapy
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.
