Choosing Assistive Devices - · PDF fileJani Grisbrooke, MSc BA(Hons) DipCOT SROT, Lecturer in Occupational Therapy, SchoolofHealthProfessionsandRehabilitationSciences,UniversityofSouthampton

Choosing Assistive Devices

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Choosing Assistive DevicesA guide for users and professionals

Helen Pain

Lindsay McLellan

Sally Gore

Line drawings by Sarah Ifield

Jessica Kingsley PublishersLondon and Philadelphia

All rights reserved. No part of this publication may be reproduced in any material form(including photocopying or storing it in any medium by electronic means and whether or not

transiently or incidentally to some other use of this publication) without the written permissionof the copyright owner except in accordance with the provisions of the Copyright, Designs

and Patents Act 1988 or under the terms of a licence issued by the Copyright LicensingAgency Ltd, 90 Tottenham Court Road, London, England W1P 9HE. Applications for thecopyright owner’s written permission to reproduce any part of this publication should be

addressed to the publisher.Warning: The doing of an unauthorised act in relation to a copyright work may result in both

a civil claim for damages and criminal prosecution.

The right of Helen Pain, Lindsay McLellan and Sally Gore to be identified as authorsof this work has been asserted by them in accordance with the Copyright, Designs

and Patents Act 1988.

First published in the United Kingdom in 2003by Jessica Kingsley Publishers Ltd

116 Pentonville RoadLondon N1 9JB, England

and325 Chestnut Street

Philadelphia, PA 19106, USA

www.jkp.com

Copyright © 2003 Helen Pain, Lindsay McLellan and Sally GoreIllustrations © Sarah Ifield

Library of Congress Cataloging in Publication Data

Pain, Helen, 1950-Choosing assistive devices : a guide for users and professionals / Helen Pain,

Lindsay McLellan and Sally Gorep.cm.

Includes bibliographical references and index.ISBN 1-85302-985-8 (alk. paper)1. Self-help devices for people with disabilities--Evaluation. I. McLellan, D. Lindsay.II. Gore, Sally, 1952- III. Title.

RM698 .P355 2002617’.03--dc21 2002025465

British Library Cataloguing in Publication Data

A CIP catalogue record for this book is available from the British Library

ISBN 1 85302 985 8

Printed and Bound in Great Britain byAthenaeum Press, Gateshead, Tyne and Wear

CONTENTS

ACKNOWLEDGEMENTS 8

PREFACE 9

PART 1

CHAPTER 1 Introduction 13

1.1 Background 131.2 The purpose and range of this book 18

Summary of section 1.2 191.3 The process used in this book 20

Summary of the process 251.4 Getting information about assistive devices 25

References 32

CHAPTER 2 Methods used in Evaluating Assistive Devices 35

Introduction 352.1 Classification of evidence 352.2 Informal evaluations 362.3 Focus groups 372.4 Delphi technique 382.5 Surveys 392.6 Formal trials 42

Summary 45References 46

PART 2

CHAPTER 3 Seating 51

Introduction 513.1 The importance of good seating 523.2 Standard seating needs 553.3 Special seating needs 653.4 Pressure distributing products 88

Key points 100References 101

CHAPTER 4 Toileting and Continence 115

Introduction 1154.1 Difficulties once at the toilet 1204.2 Not getting to the toilet to pass urine 1484.3 Problems with bowel continence 159

Key points 160References 161

CHAPTER 5 Bathing and Showering 171

Introduction 1715.1 Keeping ourselves clean 1725.2 Bathing 1805.3 Showering 214

Key points 234References 235

CHAPTER 6 Assisted Moving and Handling 243

Introduction 2436.1 Devices to assist your independence 2466.2 Devices to assist when someone helps you 2556.3 Care assistant operated devices that do the task for you 2636.4 Self-operated devices that do the task for you 2796.5 Cleaning and maintenance 288

Key points 290References 291

PART 3

CHAPTER 7 Conclusion 301

Introduction 3017.1 The decision-making process 3017.2 Product design 3047.3 The impact of the environment 3057.4 Implications for information providers 3067.5 Implications for assistive device providers 3077.6 Implications for research 3097.7 Implications for education and training 3107.8 Hopes for the future 312

References 313

Appendix I Decision-making and problem-solving 317

References 319

Appendix II Organisations Involved in assistive Technology 321

Appendix III Glossary 323

Appendix IV Literature Search Strategies 327

SUBJECT INDEX 329

AUTHOR INDEX 333

Acknowledgements

We would like to thank those who have reviewed chapters of this book in draft form, fortheir interest, encouragement and invaluable comments and advice:

Kay Day, Dip COT SROT, Dialability, OxfordMandy Fader, PhD RN, Disability Equipment Assessment Centre at University College

of LondonSusan Farr, Dip COT SROTPeggy Frost, MSc Dip COT SROT, Derby Disability Equipment Assessment CentreJani Grisbrooke, MSc BA(Hons) DipCOT SROT, Lecturer in Occupational Therapy,

School of Health Professions and Rehabilitation Sciences, University of SouthamptonCheryl Honeycombe, Dip COT BSc(Hons) SROTSusan Jackson, MSc MCSP SRP, Lecturer in Rehabilitation, School of Health

Professions and Rehabilitation Sciences, University of SouthamptonJulian Pearce, MSc MSCP SRP, Lecturer, School of Health Professions and

Rehabilitation Sciences, University of SouthamptonSusan Strong, Dip COT SROT, Southampton Wheelchair ServiceHelen White, RGN, RHV, Director PromoConLesley Wilson, BNSc(Hons) RGN, Southampton Continence Advisory Service

Helen Pain would like to give special thanks to her family who have been very supportiveand provided lots of encouragement.

We would also like to thank Sue Wilkin, Medical Devices Agency, for her encourage-ment in the initial phase of planning this book, and staff in the Southampton DisabilityEquipment Assessment Centre for their support and patience, particularly as the book wasnearing completion.

Preface

The authors have worked in the field of assistive device evaluation for more thanten years. Over that time they have become increasingly aware that there is littleevidence to support practitioners and users in their choice of device to meet thespecific requirements of a situation. There is much written about factors to throwinto the equation, but no formula to solve the messy puzzle that is generated.

The need to begin the process of mapping possible solutions to such problemswas the driving force behind writing this book, which attempts to bring togetherresearched evidence and professional knowledge in a systematic way so as tocreate decision pathways or guidelines. Once a set of requirements has been iden-tified, the guidelines can be applied to help select the device that is most likely tomeet it.

The guidelines are not hard and fast recommendations. Even if they hadundergone extensive field trials and were refined further, the individual nature ofeach situation would inevitably mean that the guidelines would still need to beapplied flexibly and sensitively. They should therefore be regarded as collectionsof evidence ordered in a sequence that is logical for most (but doubtless not every)situation, and be used systematically to identify possible solutions. They seek toenhance, not circumvent, the professional advisers’ role, and provide practitionerswith evidence to support their practice. We believe that they will also help staffnew to working in this field to develop their expertise more quickly and to applythe principles developed here to solving new problems.

Another force that brought this book into being was appreciation of howdaunting the choice of assistive devices (ADs) can seem to those who requirethem. People who have newly acquired disabilities, and/or whose disabilities arecomplex, often look to professionals to guide their choice, simply because theyfeel unqualified to enter into the decision-making as an equal partner. We do notfeel this is right, and hope that this book will facilitate the decision-making part-nership, either by a potential AD user working through it first, or through its useas a workbook jointly with a professional.

Throughout the text, the potential user of assistive devices is addressed as‘you’ because it is appropriate that practitioners should try to put themselves inusers’ shoes when negotiating solutions with them.

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Part One

Chapter 1

Introduction

1.1 BackgroundIf you have a disability and find a task difficult, you are faced with a choice.Broadly speaking, you either avoid the task, get someone to do it for you, or find agadget to help you do it. If you decide a gadget would be your preference, findingthe one that is best for you is not always easy.

First, you have to know where to look. In recent years, many products havebecome available in ordinary shops that a person with a disability can use withease. This has been possible because of improved design and an increasedawareness of people’s differing needs. In addition to the gadgets in general retailoutlets, there is a wide range of more specialist products, which are availablethrough specialist suppliers, mail order and equipment provider services.Equipment provider services in the UK are either statutory, run by health andsocial services, or are charitable organisations such as the Red Cross. The special-ist products are commonly called assistive devices or assistive technology. In the UK,such specialist products are also often called equipment, adaptive equipment or dis-

ability equipment. The term assistive device is widely used throughout the world andso will be used in this book.

Second, you have to choose a product that will match your requirements. Formany this is either a trial and error exercise, or else one looks for advice fromsomeone with experience. This book attempts to make the choice more system-atic and transparent.

Third, you have to incorporate the gadget or assistive device into youreveryday life. This may require familiarisation and adjustment over a period oftime.

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