QSCIS
Queensland Spinal Cord Injuries Service

Key principles of showering and toileting aids

Showering and toileting aids increase the risk to skin integrity because

the person being naked when using or transferring onto the equipment
educed seating surface area of equipment with apertures such as commodes, benches with apertures and toilets
increased difficulty for toilet transfers where there are smaller circulation spaces
increased difficulty of transfers onto shower commodes due to higher seat clearance
machine-made seats having limited padding or heat-welded seams which can be sharp
using the equipment in wet and slippery environments

Common problems with showering and toileting aids

Only dry trials: Dry trials do not allow for an accurate assessment of the conditions in which the equipment will be in use such as the person being naked, wet and sitting for a prolonged time or reaching/leaning to do cares.
Padding: Consider need for padded equipment for people who have sensory deficits including benches and toilet seats.
Shear and friction: Can occur during repositioning to perform repetitive bowel tasks
Sacral pressure: Positioning the sacrum on the rear of the seat aperture increases stability although increases pressure over the sacral region
Natal cleft stretching or splitting: This can occur because of too much weight shift and movement forward into the aperture this can result from poor posture or the aperture being too big.
Reduced stability and balance in an upright position: Positioning stability can be achieved with an appropriate combination of thigh, trunk and leg support. Seat-to-backrest angle, tilt-in space function, armrests and leg rest supports should all be considered to achieve stable seating in a commode.
Poor equipment maintenance

Ischial pressure: Skin breakdown can occur when the ischial bones make contact the internal rim at the side or front. This can be a result of inappropriate aperture shape and size, postural changes. The risk is higher with poor quality seat padding at the aperture.

Side opening seats: A complete cut-out of the seat and frame creates corners that cause points for increased pressure. An alternative could be a 'bite', which enables the person to reach close to their thigh for hygiene and toileting needs as well as retain pressure distribution over the thigh.

It is important to maintain equipment and to check for:

Brittleness of the vinyl where it loses stretch and conformity. This may appear as creases or cracks in the covering.
Exposure of the baseboard, often along the inner rims of apertures where foam has lost resilience. Clinicians can assess this through palpation of the foam.
Damage to the foam such as water ingress. Damage can be noted when air is expressed from the seat when sitting on it as visible compression of the foam.