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9.11 Countywide Children's Occupational Therapy Criteria for the Provision of Equipment

SCOPE OF THIS CHAPTER

This chapter details the eligibility criteria for the provision of equipment from the Children's Disability Service, Occupational Therapy team. Provision of equipment is usually only considered when a child requires higher levels of assistance than would generally be expected for a child of that age and minor equipment, which could be generally purchased from retail outlets, would not meet those needs.

RELEVANT LEGISLATION AND GUIDANCE

Relevant Legislation and Guidance

Chronically Sick and Disabled Persons Act 1970

Disabled Persons Act 1986

National Health Service & Community Care Act 1990

The Children Act 1989

Carers and Disabled Children Act 2000

The Disability Discrimination Act 2005

The Housing Grants, Construction and Regeneration Act 1996

'Guidance for Restrictive Physical Interventions', Department of Health (July 2002).


Contents

  1. Guidance for Provision of Equipment
  2. Criteria for Provision
  3. Shower Chairs
  4. Shower Cradle
  5. Shower Trolley
  6. Wall Mounted Shower table
  7. Swivel Bather
  8. Baths
  9. Toileting Equipment
  10. Sleeping and Beds, Equipment for Beds
  11. Moving and Handling
  12. Specialised Seating
  13. Eating and Drinking Equipment
  14. Portable Ramps


1. Guidance for Provision of Equipment

Equipment that is readily commercially available and accepted as not specialist disability equipment such as stair gates, fire guards, fridge locks, window or cupboard locks. The service can intervene only generally when the need exceeds the limitations of the non-specialist provision.

In some instances a child may be assessed as having both social care needs and health needs. In these instances only one item of equipment may be necessary to meet these needs. Consequently it may be necessary for joint funding via Continuing Care to be sought.

Washing/Bathing and Showering

Consideration of assistance with washing/bathing is based on the principle that the child is unable to effectively maintain their personal hygiene owing to their impairment.

Or

Where a child's personal hygiene needs are at significant risk of not being adequately met as parents/carers are unable or unwilling to sustain their current level of support.

Provision of equipment should only be considered when children require higher levels of parental/carer responsibility/assistance than would generally be expected for a child of that age and minor equipment, which could be generally purchased from retail outlets, would not meet these needs.

Points to consider:

  1. Relevant medical factors e.g. epilepsy, muscle spasms, ability to maintain body temperature, altered sensation;
  2. Relevant behavioural factors e.g. water phobia, smearing;
  3. Postural control requirements;
  4. Ease of transfers for child/carer;
  5. Use of one piece of equipment for two tasks e.g. toilet/shower chair;
  6. Carers ability to lift and fit equipment;
  7. Family situation and the needs of the household;
  8. Type and contours of bath;
  9. Long term needs and equipment/adaptation solutions;
  10. Continence, menstruation, etc;
  11. Developmental needs including play;
  12. Safety of child.


2. Criteria for Provision

  1. When child needs assistance from parents/carers to maintain personal hygiene beyond the age where this would normally be expected but this does not cause significant difficulty - use basis minor equipment/adaptations e.g. seats, rails;
  2. When a child has significant difficulty maintaining personal hygiene, even with assistance beyond the age where this would usually be expected - use full range of solutions, equipment/adaptations - see main adaptations guidelines.

Note: If a child has short term need for bathing equipment following acute episode or required for hospital discharge and case open to Social Care then:

  1. Provision of appropriate equipment;
  2. Sign post referral to appropriate Health Care professional.


3. Shower Chairs

To provide a supported / functional position to encourage independence and maintenance of independence in self care skills.

Consider

  1. Self propelled/assisted push;
  2. Dual use (e.g. toileting);
  3. Method and ease of transfer e.g. hoisted - assisted or independent;
  4. Level of support required;
  5. Shape of seat aperture / ability to change this in future;
  6. Environmental factors - space, layout of bathroom and pipe work;
  7. Ease of cleaning;
  8. Ability to use tilt in space for hair wash over bath;
  9. Duration of time taken to shower.


4. Shower Cradle

Where there is not acceptable alternatives (e.g. changing bench / shower chair, and the child is fully dependent on the carer).

And / or

The need to accommodate spinal deformities contractures and abnormal muscle tone

Consider

  1. Drainage;
  2. Cot sides - risk assessment required;
  3. Padding for safety and comfort;
  4. Ease of hair washing;
  5. Dual use (e.g. toileting);
  6. Environment (e.g. size of shower area and access into bathroom);
  7. Ease of cleaning;
  8. Ability of materials and accessories to accommodate child's posture comfortably;
  9. Anticipated duration of time to take shower.


5. Shower Trolley

The need to have two carers and/or/ access to both sides of the child.

And / or

If the environment does not allow the fitting of a ceiling track hoist in the bathroom.

Consider

  1. Environment (e.g. space, feasibility to manoeuvre between rooms etc.);
  2. One or two carers;
  3. Ease of cleaning and drying;
  4. Drainage of water;
  5. Child's body temp control;
  6. Childs sensory needs;
  7. Hydraulic or electronic height adjustment;
  8. Need for dual use when no changing facilities are available (e.g. showering / changing / drying).

Contra-indications:

  1. Severe respiratory problems can be increased if laid flat;
  2. Water can collect in the cushioned channels and, therefore, be aware of child's head position.


6. Wall Mounted Shower table

Consider when only one carer is required to carry out personal care.

And / or

If environment has space limitations.

And / or

If child has severe incontinence issues and requires cleaning frequently.

Consider:

  1. Low ceiling;
  2. Transfer of child on and off the bench - a child who is unable to transfer independently may require a ceiling track hoist to be installed, whereas a child who can transfer themselves would benefit from provision of an adjustable height bench;
  3. Fixed height or adjustable height - equipment at appropriate height for main carer;
  4. Weight, (e.g. ease of use to fold back to wall);
  5. Space to accommodate arc movement of shower bench, (e.g. when folded/unfolded child is suspended in sling;
  6. Is this to be used over the bath?
  7. Are cot sides needed - consider height and consequences/removable or fixed. Risk Assessment required;
  8. Padding for safety and comfort;
  9. Limiting the carer getting wet;
  10. Carers required for safe use;
  11. Multiple carers;
  12. Will it retain water;
  13. Drainage;
  14. Ease of cleaning;
  15. The gap remaining on wall side due to wall fixing brackets.


7. Swivel Bather

Consider when a child is not wishing to access a bath or it is inappropriate for them to do so.

And / or

When a child is able to transfer independently or with minimal assistance.

And / or

Where an over bath shower unit is already in situ or can easily be installed.

Consider:

  1. Width of bath edges (minimum 30 mm either side to ensure safe fitting);
  2. Safety of assisted transfer (e.g. environment);
  3. Operation and positioning of shower unit;
  4. Sitting balance.


8. Baths

Bath Board and Stool

To consider use when child in unable to complete a standing transfer in and out of the bath.

And / or

When the child experiences an acute episode of disability (e.g. post surgery).

Consider

  1. Width and shape of bath edges to accommodate bath board safely (minimum 25 mm ledge/rim either side of bath for secure fitting);
  2. Slatted, non slatted padded;
  3. Ability of child to slide along board;
  4. Depth of bath;
  5. Bath surface / contours;
  6. Integral bath handles/position;
  7. Ability to lift legs over bath side;
  8. Trunk stability;
  9. Use of non slip mat;
  10. Environmental factor (e.g. space).

Penguin Bath Support

Consider for the young babies who have not yet met physical development milestones and require support in the bath.

Consider:

  1. Moving and handling;
  2. Extension spasms;
  3. The need for regular review due to growth of child;
  4. Could be used in conjunction with adjustable height mobile bath.

High Mobile Bath

Consider for young babies who are difficult to lift in and out of a standard bath or who do not have a bath facility.

Consider

  1. Environment - where bath to be used;
  2. Filling and drainage;
  3. Storage.

Corner Bath Seat

To consider for the younger child who is developing sitting balance and the parent/carer is able to lift safely in and out of the bath.

Consider

  1. Sitting balance of child;
  2. Accessories required (e.g. lap belt, chest straps, pommel and grab bar);
  3. Bath surface and contours.

Bath Lift

When a child becomes too heavy for a parent carer to safely lift or assist the child in and out of the bath.

And / or

When a child is able to and willing to take on some independence in bathing. Requiring either non or minimal assistance in the transfer.

Consider

  1. Sitting balance / trunk balance;
  2. Type of bath (acrylic / cast iron);
  3. Bath lift to remain in situ or taken out of bath;
  4. Storage of equipment;
  5. Potential for entrapment when lift lowering;
  6. Integral bath handles;
  7. How low will bath lift sit in bath;
  8. Reclining back needed;
  9. Accessories required.

Bea Lift

Consider when a child becomes too heavy for a parent/carer to safely lift in and out of the bath.

Or

When the child requires more posture support than a standard bath lift can provide.

Consider

  1. Bath mat;
  2. Width of bath ledges (minimum 30 mm either side) for safe fitting;
  3. Space required to operate the lifting and lowering mechanism;
  4. Safety of child when raising and lowering.

Note: This equipment may reduce the opportunity for the child to play in the bath due to its positioning.

Bath Cradle / Supportive Seat

To consider for the more dependent child when full postural support is required.

Consider

  1. Moving and handling transfers;
  2. Weight of the seat in the bath;
  3. Ability of materials and accessories to accommodate child's posture comfortably;
  4. Adjustability;
  5. Ease of cleaning;
  6. Size of bath.

Bath Support Cushions / Padding

To consider for the more dependent child who requires full postural support in the bath.

Consider

  1. Moving and handling - ideal when a ceiling track hoist facility is available;
  2. Use in other locations;
  3. Cleaning and storage;
  4. Abnormal movement patterns;
  5. Longevity of use;
  6. Carer's ability to re-mould and position the bath support effectively.

Special High / Low Baths

"To be completed as an adaptation" - see Guidance for provision of adaptations

Body Dryer

"To be completed as an adaptation" - see Guidance for provision of adaptations


9. Toileting Equipment

Criteria: Consideration of assistance with toileting is based on the principle that the child is unable to use the toilet independently (appropriate to their developmental stage), or it is unsafe for them to continue doing so owing to their impairment.

Or

The child's ability to attend independence toileting skills is severely restricted owing to their impairment

Or

To promote development of independent toileting skills if specialist support or positioning is required owing to the child's impairment.

Provision of equipment should only be considered when children require higher levels of parental responsibility / assistance than would generally be expected for a child of that age and where minor equipment, which could be generally purchased from retail outlets, would not meet these needs.

Points to consider:

  1. Relevant medical factors e.g. epilepsy, muscle spasm, altered sensation, behaviour;
  2. Postural control requirements;
  3. Ease of transfers for child/carer;
  4. Use of one piece of equipment for two tasks e.g. toilet/shower chair;
  5. Carers ability to lift and fit equipment;
  6. Family situation and the needs of the household;
  7. Long term needs and equipment/adaptation solutions;
  8. Continence, menstruation, self catheterisation etc;
  9. Functional ability of child to maintain personal hygiene;
  10. Wherever possible toileting equipment should be provided which can be adjusted to the child's growth and development;
  11. Special Potty Chairs: should only be considered if a child requires additional positioning/support than a commercially available potty provides.

Toilet seat inserts and raised toilet seats

  1. Will not be considered where there is commercially available equipment;
  2. Inserts will be considered to increase the level of support for a child when using the toilet;
  3. Raised toilet seats will be considered to assist with safe transfers.

Consider:

  1. Stability;
  2. Aperture;
  3. Shape of bowl;
  4. Other family members.

Toilet frames

  1. Will be considered to promote independent transfers;
  2. Will be considered to provide an increased level of support

Consider:

  1. Height and width of frame;
  2. Soil pipe location;
  3. Use in conjunction with steps;
  4. Fixed or free standing;
  5. Hand grips;
  6. Other family members.

Potty chairs

  1. Will be considered if a child requires positioning/support additional to that which a commercially available potty would provide;
  2. Will be considered as a consequence of developmental delay when the child has outgrown the commercially available potties.

Consider

  1. Stability;
  2. Height off ground;
  3. Transfers on/off;
  4. Appropriate positioning and storage in house.

Mobile and/or modular toilet chairs

  1. Will be considered when wheelchair access to the toilet is difficult;
  2. Will be considered when this will reduce the number of transfers undertaken;
  3. Will be considered when postural support levels may need to increase/decrease;
  4. Will be considered if combined use for showering/toileting is appropriate;
  5. Will be considered to assist in toilet training.

Consider

  1. Dual use of chair, e.g. toileting and shower seat function;
  2. Child's ability to independently use chair;
  3. Carer's ability to lift and correctly position child if required;
  4. Stability;
  5. Shape of toilet and whether close coupled;
  6. Ability to access for child/carer to maintain personal hygiene;
  7. Storage;
  8. Compatibility if using in conjunction with closomat/geberit style toilet;
  9. Manoeuvrability;
  10. Storage

Commodes

  1. Will not be considered for a hospital discharge;
  2. Will be considered when access to a toilet cannot be achieved or is not considered safe or dignified;
  3. Will be considered as an interim measure whilst awaiting long term provision.

Consider:

  1. Static or wheeled;
  2. Transfers;
  3. Stability;
  4. Appropriate positioning and storage in the house.

Wash/dry toilets

"To be completed as an adaptation" - see Guidance for provision of adaptations


10. Sleeping and Beds, Equipment for Beds

Before considering provision of a bed, think carefully about the following alternatives;

  1. Is it possible to adapt the current bed?
  2. Is there a suitable bed elsewhere in the house?
  3. Would the family consider buying an alternative bed?

Should be provided to facilitate independence or assist gaining independence.

Or

To assist carers to carry out social and personal care and support safe moving and handling.

Or

Where there are major concerns for the child's safety due to their disability

Consider:

  1. Potential to adapt current bed;
  2. Is the need a health requirement e.g. pressure care; consider involvement of tissue viability nurse, respiratory care by health professional? If so, refer to Continuing Care for funding;
  3. Relevant medical factors e.g. epilepsy, muscle spasms, maintaining body temperature, ataxia, respiratory and pressure care - consider referral to continuing care;
  4. Postural control requirements;
  5. Ease of transfers for child/carers;
  6. Family situation and needs of the household;
  7. Long term needs and adaptations solutions;
  8. Environmental factors;
  9. Behaviour Management issues;
  10. Continence;
  11. Safety - too big for cot;
  12. High kneeling/pulling into standing;
  13. No safety awareness;
  14. Unable to independently reposition self (cognitive or physical delay);
  15. Tasks the bed is to be used for as well as sleeping. e.g. changing, physio exercises;
  16. Moving and handling equipment;
  17. Access to power point;
  18. Will an adult standard stock bed meet the need.

Often a child's assessment for a bed identifies both social and health care needs. Consequently a referral may be made to continuing care to support funding. - See guidance

NOTE -

  1. Specialist mattresses are provided by continuing care (health provision);
  2. At no time should a specialist bed be used as a form of 'restraint'.

Accessories for beds

Cot sides - Criteria

These should be considered where the child is at risk of injury from falling from the bed as a result of their disability.

Or

When a child experiences disturbed sleep as a result of behaviour and leaving the bed during the night.

NB Cot sides must always be issued with bumpers.

Points to consider:

  1. Potential for entrapment. Refer to current regulations;
  2. Height of the cot sides;
  3. The child's possible reaction to being enclosed/need for visibility;
  4. Breath ability of the bumpers;
  5. Mobility of the child in bed;
  6. Body temperature control;
  7. Accessibility for the carer;
  8. Internal bed measurements with bumpers;
  9. Securement of bumpers (permanent or removable);
  10. Cot sides door mechanism - Drop down, fold back, hinged door, removable;
  11. Type of fasteners on cot sides e.g. latches, spring clips, allen key;
  12. Depth of mattress;
  13. Full padding or partial padding;
  14. Is a sleep system being used?
  15. Compatibility of cot sides to bed e.g. movement, how to secure safely;
  16. The child's specific need for review e.g. schedule of 3, 6, 12 months;
  17. Air flow.

Mattress Elevators / Pillow Lifts

Criteria

These should be considered where the child is unable to independently move from lying into sitting.

Or

To assist in repositioning when a child experiences pain.

Points to consider

  1. Access to a power point;
  2. Can cause mattress to slip down bed;
  3. Double or single bed;
  4. Independent or carer use of controls;
  5. Other bed aids in use;
  6. Tissue viability;
  7. Slipping down the bed;
  8. Mattress compatibility - Foam or pocket spring, depth;
  9. Siblings.

Bed Levers

Criteria

These should be considered where a child has difficulty with bed transfers and bed mobility.

NB This device is not to be used to prevent children falling out of bed.

Points to consider

  1. Bed type e.g. slatted, divan;
  2. Bed size / single or double;
  3. Use in conjunction with other accessories;
  4. Mattress depth;
  5. Entrapment of head, neck, limbs;
  6. Securing to the bed.

Bed Raisers

Criteria

To be considered to enable independent or easier assisted transfer on and off of the bed.

Or

To improve the carers working position where the carers safety is being compromised with the bed being too low.

NB Consider the need to be able to transfer both on and off of the bed.

Points to consider

  1. Compressed height of mattress;
  2. Castors;
  3. Hoist access - Mobile, ceiling track or gantry;
  4. How many bed legs;
  5. Stability of bed when raised;
  6. Who raising the bed for - Child or Carer;
  7. Consider the timescale for review. If required for child's independent or assisted transfers, review will be necessary as the child grows.


11. Moving and Handling

Consideration to providing moving & handling equipment should be given when a child's disability has a significant detrimental impact on both independent and assisted transfers for both the individual and/or the carer/s.

Mobile Hoists

A Mobile Floor Hoist is a portable, self-contained hoisting unit. It provides carers with a safe, practical option which can be wheeled into position quickly and used in multiple locations.

The provision of a mobile hoist:

Will be considered when the need is either short or long term.

Consideration should be given when the child is unable to reliably and consistently weight bear for an assisted transfer and/or is totally dependent on a carer for all transfers.

Will be considered when carers are finding it increasingly difficult to either lift a child or assist with transfers.

Will be considered as a temporary provision whilst family's wait for ceiling track hoist provision to be installed.

NOTE - As part of 'good practice' mobile hoists should not be provided in preference to a ceiling track if the need is permanent.

Points to consider - Maintaining independence may need to be a high priority

  1. Environment where hoist is being used (space, storage, flooring etc.);
  2. Access of hoist with furniture/equipment/wheelchair etc;
  3. Weight of child;
  4. Height of lift required for clearance;
  5. Physical health of carer;
  6. Parking and charging of the hoist;
  7. Long or short term use - If long term, see section on ceiling track hoists;
  8. Siblings;
  9. Sling compatibility with spreader bar e.g. loops, clips;
  10. Type of spreader bar required;
  11. Does bed require raising and implications of this?

Gantry Hoists

Criteria

As for electric mobile hoists, but where the use of a mobile hoist is not possible due to environmental limitations.

Points to consider

  1. Access to charging point;
  2. Position and space of Gantry hoist feet/legs;
  3. Ceiling height;
  4. Bed height;
  5. Short or long term use - If long term, see section on ceiling track hoists;
  6. Child's weight;
  7. Clearing space for installation;
  8. Accessibility for equipment and carer;
  9. Position for over head unit when not in use;
  10. Environment where gantry is to be used;
  11. Leveling of gantry for safe use.

Ceiling Track Hoists

"To be completed as an adaptation" - see Guidance for provision of adaptations.

Slings

Criteria

Slings should be provided whenever the need for a hoist has been identified.

NB Correct sling provision is important and should be assessed for on an individual basis.

Points to consider

  1. All day sling or removable;
  2. Ease of removing;
  3. Ease of fitting e.g. 1 or 2 carers required;
  4. Where to be used;
  5. Requirement for toileting sling;
  6. Sling attachments e.g. loops/clips removable or tuck in;
  7. Hoist compatibility;
  8. Head support required;
  9. Chest straps;
  10. Boned or un-boned;
  11. Comfort/level of support required;
  12. Safety - e.g. behaviour, spasms, ataxia;
  13. Material;
  14. Tissue viability;
  15. Respiratory function;
  16. Equipment to be positioned in e.g. seating/standing frame.

Rotunda / Rota Lite

Criteria:

Provision should be considered when child/teenager can reliably weight bear but is unable to sufficiently move their feet for a safe assisted transfer.

Or

To assist personal care/toileting regime.

Points to consider

  1. Height of child;
  2. Upper body strength;
  3. Behaviour;
  4. Space;
  5. Hand grip;
  6. Height of equipment transferring to and from;
  7. Ability of Carer to position equipment;
  8. Storage;
  9. Upstairs and/or downstairs use (consider dwelling);
  10. Balance.

NB Must not be used unassisted.

Transfer boards

Criteria:

Provision should be considered when the child/teenager is unable to weight bear through their legs but has adequate upper body strength and control to complete an independent or assisted transfer.

Points to consider

  1. Good trunk balance;
  2. Heights of equipment;
  3. Distance between items;
  4. Safety awareness;
  5. Clothed or naked transfer;
  6. Tissue viability;
  7. Frequency of use;
  8. One sided weakness issue;
  9. Who will position the board?
  10. Where will the board be kept?
  11. Style of board;
  12. Arms on furniture - Removable or not.

Slide sheets

Criteria

Provision to be considered when a child is unable to re-position themselves.

Or

When Carer's need to move a child/teenager safely.

Or

To assist Carer's in sling application when rolling is inappropriate.

Points to consider

  1. Size - Length and width;
  2. Friction levels of material;
  3. Tissue viability;
  4. Number of carer's;
  5. Accessibility of bed;
  6. Is the slide sheet to be left in position?
  7. Pain.

Stand Aid

Criteria

Provision should be considered when a child/teenager has weight bearing ability. But limited upper body strength to be facilitated to stand from seated positions e.g. sit stand/stand sit.

Points to consider

  1. Shoulder stability;
  2. Balance;
  3. Respiratory function;
  4. Pelvic control;
  5. Environment - Space, flooring etc;
  6. Is hoist required for other transfers?
  7. Number of carer's;
  8. Type of sling;
  9. Frequency of use;
  10. Development of toilet regime;
  11. Power point position;
  12. Storage.


12. Specialised Seating

Consideration of assistance with seating is based on the principle that the child is unable to effectively maintain/attain a functional sitting position in an ordinary chair owing to their impairment.

Provision/Recommendation should only be considered following a full and detailed seating assessment of a child's needs by a qualified occupational therapist. Provision should be for a functional chair or to provide comfort.

Provision of a 'functional chair plus relaxing chair will only be considered in exceptional circumstances and following an individual assessment of need. However, a relaxing chair with support may be preferential to a functional chair.

Often a child's assessment for seating identifies both social and health care needs. Consequently a referral may be made to continuing care to support funding. - See guidance

Consider:

  1. Seating in stock must be considered as a first option;
  2. Seating system child uses at school/nursery;
  3. Postural Management;
  4. Purpose / function of chair and child's individual needs;
  5. Adjustability of chair in relation to child's growth and development;
  6. Stability / safety of chair;
  7. Range of accessories available e.g. head supports, lap belts;
  8. Ease of transfers for child / carer;
  9. Durability and re-usability of chair;
  10. Access to essential and social activities e.g. eating, play, social interaction;
  11. Rooms chair will be used in;
  12. Size of chair if to be used in a through floor lift;
  13. Ability of carer to move chair from one place to another;
  14. Pressure relief;
  15. Family situation and the needs of the household;
  16. Parental supervision.

NOTE - At no time should a specialised seating system be used as a form of 'restraint'


13. Eating and Drinking Equipment

Should be provided to facilitate independence and development

OR

To enable carers to feed a service user safely and as easily as possible.

Provision of equipment should only be considered where no suitable equipment is readily available from general retail outlets other than in exceptional circumstances e.g. a larger package of care.

Consider:

  1. Relevant medical factors e.g.
    1. Swallow;
    2. grasp;
    3. Biting reflex;
    4. Tremor;
    5. Ataxia;
    6. Visual impairment.
  2. Behavioural factors;
  3. Carer's ability to assist with feeding;
  4. Development;
  5. Safety of child;
  6. Posture;
  7. Social inclusion;
  8. Consider what is being used at school.


14. Portable Ramps

Should be considered to access to an essential facility for a child who is a wheelchair user.

Provision should be considered for a short or interim measure.

Consider:

  1. Gradient;
  2. Space/ turning space;
  3. Weight;
  4. Floor surface and stability;
  5. Direction wheelchair is to be pushed;
  6. Threshold;
  7. Up stands;
  8. If to be fixed or removable;
  9. Door width.

End