Our topic for this month looks at what people do if they can not stand up from a toilet (sitting to standing) – yet may be able to walk or get in and out of a modern powered wheelchair, unaided. How do people manage inside and outside their home?
We will be adding links below to our guest bloggers and hearing about this dilemma which affects hundreds of thousands of people in the UK.
More to the point – what has it got to do with accessible toilets?
Well, we need to understand the complexity of normal body movement and posture – to learn about what can go wrong.
Only then can we see why so many people might not be able to use even the best of accessible toilets outside their home, such as Changing Places.
Human movement is amazing – when it works.
Because humans have a complex body to replicate, even the best robotic designers find it a major challenge to reproduce our abilities.
In a very simple form, humans need:
- A solid framework to attach muscles to (skeleton of the right shape and material)
- Muscles, tendons, connective tissues (allowing us to push, pull, bend, rotate etc)
- Nerves and brain function to co-ordinate / activate muscles (for tone, balance etc)
- Feedback and fine tuning network
- Fuel to ‘use up’ when performing the actions (nutrients, oxygen and a range of chemical exchanges to make electrical impulses for example).
Can you imagine how a problem with just one element of the above might prevent people form being able to remove clothing, sit on a toilet, clean themselves, stand up again etc.
Standing up from the toilet
From the muscles in your toes right through to the muscles in your head and neck (and all the electrical and chemical activity between your brain/spine/muscle) that’s a lot of things that need to be functioning well to go from a sitting to standing position.
So what type of impairments might someone have that could cause difficulty or an inability to stand up from a regular toilet?
The key problem areas are medical conditions which affect balance, muscle strength and co-ordination.
- Cancer (weakness, balance, thinking – varied effects on the body depending on severity/location)
- Stroke (balance and muscle weakness)
- Cerebral Palsy (affecting movement and co-ordination)
- Lower limb amputation(s) (balance, movement range)
- Spina Bifida (nerve damage with varying affects)
- Spinal Cord Injury (nerve damage with varying affects)
- Fibromyalgia (chronic pain condition)
- Osteoporosis (can cause limbs to twist, pain, joint movement problems)
- Chronic Fatigue conditions
- Chronic Arthritis and Rheumatoid Arthritis (range of movement, deformity, pain, balance)
- Multiple Sclerosis (can affect strength, balance, memory, thinking, vision)
- Neuromuscular Disease (hundreds of different types and sub-types causing muscle weakness e.g. Muscular Dystrophy, Motor Neurone disease, Spinal Muscular Atrophy, Guillain-Barre Syndrome, Polymyositis)
- Weakness caused by old age
- Brain disorders
- Medications (medication to lower cholesterol can cause limb weakness for example)
- Parkinson disorders (stiffness, balance, movement, thinking, co-ordination, fatigue)
- Leg trauma (fractures, sprains, strains)
- Spinal degeneration, abscess or tumour
Solutions at home
Some people manage at home by have a toilet seat riser – making a standard toilet seat 4-5 inches higher. Riser frames and other types are also available to provide a fixed height.
All wheelchair accessible toilets in the UK must be able to take the addition of a raised toilet seat (but are almost never provided probably because if you have that level of impairment you’re unlikely to be able to fit one without help).
Many people still find these too low or it leaves them dangerously high with their legs dangling in the air, unable to touch the floor for balance whilst seated. These people require the use of a toilet seat or toilet pan that can be electronically raised and lowered to suit their requirements.
Above, Aerolet vertical and tilt from Clos-o-Mat [Source: Clos-o-Mat.com]
Often people ‘drop down’ onto a lower toilet (and to be able to sit with feet on the floor for balance) then raise the toilet very high, so they can slide down onto their feet, to get off. Changing Places and ‘wheelchair accessible’ toilets do not provide a removable raised toilet seat nor height adjustable toilets as part of their standard of provision.
People who are unable to stand at all, or push up with their arms, will use a hoist to get to and from the toilet.
No solution outside the home
There are hundreds of thousands of people who can walk (or raise their wheelchairs up to help them stand) and don’t have full time carers or assistants with them, yet can not stand up unaided from the toilet.
Clinics might provide perch stools or extra high seats in hospital waiting rooms for example, yet provide only toilets with low seat heights. Hospital staff won’t help pull you to your feet because of policies which forbid lifting/assisting in this way. If that’s the level of support you get in a hospital – what about generally out and about?
Public venues could easily provide a raised toilet seat and staff to secure it, if they wanted to help people – but they don’t. Outside the home, if you can’t stand up from a toilet your can’t use it.
In one instance, this meant a disabled lady had to deficate into her hands in a standing position. We should be ashamed at not providing proper facilities in the UK.
This month, we are publishing the stories of individuals who have the dilemma of not being able to use toilets outside their home – and why Changing Places are not meeting the needs of people who need height adjustable / higher toilets.