Design of the advanced commode-shower chair for spinal cord-injured individuals.

The purpose of this development project was to design a new commode-shower chair that can be safely used by individuals with spinal cord injuries (SCI) and their caregivers. The need for this new design was consumer-driven. Patients and caregivers identified the following fatal flaws in the commode-shower chairs used in Spinal Cord Injury (SCI) centers: 1) risk for patient falls during transfers, propelling, and while leaning over for showering; 2) risk for pressure ulcers due to inadequate padding and seat positioning for lengthy bowel care regimes; 3) inadequate caregiver access to the perianal area of the patient to perform bowel care procedures; and, 4) wheel-related inability to properly position the chair directly over the toilet. The new, self-propelled chair addresses each of these concerns. Lockable, swing-away, pivoting armrests and improved, lever-activated brakes were designed to facilitate safe transfers. An innovative foot-lift was invented to facilitate washing of feet. Larger handrims were designed to aid in propulsion in wet environments. To prevent pressure ulcers, a chair frame and padding combination was designed to facilitate a seating position that optimally distributes body weight to prevent the development of pressure ulcers in the sacral and ischial areas. To address the common risk of heel ulcers, footrests, featuring edgeless, rounded heel cups, were designed. A new tubular chair frame, a new seat and smaller wheels were designed to enhance caregiver access and ensure proper chair positioning over the toilet. Following its successful clinical evaluation at the Milwaukee and Tampa VA Medical SCI Centers, the Advanced commode-shower chair is being patented by the Department of Veterans Affairs (VA). The VA has partnered with Everest & Jennings, to make this chair available commercially.