Three Keys to Successful Toileting

Using the Rifton HTS to Improve your Bathroom Experience

By Elena Noble, MPT

For people with disabilities (and their caregivers), few daily activities loom larger than toileting. Success in the bathroom can make or break your day. To make your toileting experience successful I look at three factors that deal with positioning, comfort and transfers.

1. Positioning for Function

Photo © 2017 by Rifton Equipment. Used by permission.

Good positioning on the toilet is not only concerned with using adaptive seating to accommodate and align the body, but with adopting the best possible position for voiding –the forward-leaning, knees-higher-than-hips position. Research shows that this position makes elimination easier and reduces constipation and bowel disease.

The adjustability of the HTS makes this kind of positioning possible. Here’s how:

• Use the tilt-in-space function to tilt the chair into a slightly posterior position.
• Move the trunk into the ideal forward-leaning position by adjusting the backrest slightly forward.
• Add the anterior support which allows your client to lean or brace the upper extremities for stability.
• The adjustable footrest provides the recommended base of support for the feet. Raise the footrest as needed to position the knees slightly higher than the hips if appropriate.

Although not everyone tolerates this semi-squat position, the basic principles stand true and make an excellent goal to work towards.

2. Making a Long Sit Work

When it comes to comfort while toileting the HTS makes a statement, especially for those who need additional time to void. Padded with soft polyurethane foam (yes, it’s cleanable!), the weight bearing surfaces of this adaptive toilet make for a soft sit. There is also contouring built into the chair frame. The leg troughs for example channel the lower extremities into optimal abduction.

And here’s another key to a comfortable and successful toileting experience: Provide a feeling of stability. Voiding happens when the abdominal muscles are relaxed, when a person sits in a well-balanced position. Without adequate support on a toilet, someone with severe disabilities has a continuous fight to maintain an upright posture and therefore can’t relax.

With the HTS, providing stability is quite simple. The appropriate placement of the postural supports such as the headrest, laterals, chest strap, butterfly harness, abductor, hip guides and ankle straps provides for secure and comfortable seating- even for an individual with severe involvement.

Positioning Hint: Adjusting the tilt-in-space and backrest angle helps create comfortable and stable positioning especially for those presenting with spasticity or hypotonia.

For people with disabilities, having a commode that not only fits them but grows with them is critical. For this reason the HTS comes in three sizes and with features allowing each size to grow with the user. For example, the HTS seat depth adjusts over a wide range, and this is matched by each of the positioning supports.

3. Transfers

Unfortunately many still believe that children and adults with severe disabilities do not have the capabilities to void on the toilet. Thankfully schools and day-hab facilities that deliberately make the effort to give everyone an opportunity to use the toilet show otherwise. But in spite of these positive outcomes, many parents and caregivers avoid toileting altogether because the transfers to and from the toilet are too strenuous.

The design of the HTS facilitates transfers- anterior tilt and flip-away footrest for sit-to-stand transfers, removable armrests for sliding transfers and a durable footrest intended for use as a step into the commode. But the HTS in and of itself is not a transfer device. The most successful and least demanding toilet transfers use a standing aid such as a padded table or the Support Station (for clothing adjustment) in combination with the HTS with the client participating as much as possible in the transfer process.

Activity-Based Toileting and So Much More

With easier transfers, comfortable and good positioning, the HTS contributes to an activity-based toileting experience, providing toileting opportunities and improved participation for many. Which leads us, finally, to the portability kit. It’s great to conquer the toileting challenge at home or at school, but what about on the road with your family? People previously confined to their homes because of inadequate community facilities now have the option to comfortably toilet anywhere they go.