Abstract:
Occupational therapists that specialize in accessibility play a critical role in promoting independence and improving the quality of life for individuals facing mobility challenges. This case study delves into a particular scenario involving a client experiencing weight-related health challenges affecting his ability to navigate stairs, necessitating the use of a gurney to leave the house. Focused on proposing an efficient, sustainable, and cost-effective solution, this document details the recommendation and installation of an aluminum wheelchair ramp, contrasting its advantages over wooden alternatives, especially in wet environments. The study further explores the multifaceted benefits of this intervention, from health and psychological aspects to safety and financial considerations, particularly in the context of a rental property.
Introduction:
Occupational therapists often encounter clients with diverse needs stemming from various health conditions. One such case involved a client with obesity, rendered incapable of walking up and down the stairs due to underlying medical issues. Living in a rented home, the client’s condition necessitated frequent medical appointments, for which they relied on a medical transport service’s gurney. This situation not only restricted the client’s independence but also posed significant logistical challenges and safety risks.
Alternatives Considered:
In the comprehensive evaluation of our client, several interventions were considered to improve accessibility within their rented home. Enhancing the client’s autonomy, safety, and well-being was paramount. Below, we explored the alternatives deliberated and the rationale behind the final decision to install an aluminum wheelchair ramp.
1. Stairlift Installation: A standard stairlift as well as an inclined platform lift (IPL) were considered. However, for our client, the stairlift was not the optimal solution due to several factors:
– Weight Capacity: Standard stairlifts as well as IPL’s have weight limits that wouldn’t accommodate our client’s needs.
– Structural Modifications: Installing a stairlift on a rented property often requires significant alterations to the home, which this landlord opposed. Additionally, stairlifts are not portable and can’t be easily taken to a new residence.
– Cost: The purchase and installation of a standard stairlift can be cheaper, though this doesn’t include ongoing maintenance and repairs when installed in a wet environment.
2. Vertical Platform Lift (VPL): VPLs are like mini elevators installed on the side of staircases.
– Space Requirements: VPLs require sufficient space at the top and bottom of the stairs, which wasn’t available at the client’s residence. A landing would have had to been built in order to install.
-Installation Complexities and Cost: The installation is more complex and invasive than ramp setup. It’s also typically more expensive, posing a challenge for a client living in a rental. In this scenario a level concrete pad and an electrical outlet would have had to been installed as well.
3. Ramps (Various Materials): Ramps of different materials, including wood and steel were considered.
– Wooden Ramps: While less expensive upfront, they require frequent maintenance and have a shorter lifespan, especially in wet conditions. They can become slippery when wet, posing a safety hazard.
– Steel Ramps: Though durable, steel ramps are heavy and susceptible to rust in wet or humid environments, demanding regular maintenance.
4. Portable stair climber: Portable stair climbers are devices that attach to wheelchairs, allowing them to ascend and descend stairs with the aid of a caregiver. While innovative and useful in specific contexts, they present several limitations:
– Caregiver Dependency: Portable stair climbers require the presence and active participation of a caregiver to operate the device. This dependency conflicts with the primary goal of enhancing the client’s independence in navigating their living space and the outdoor environment.
– Physical Strain on Caregivers: The process of using a stair climber, especially for a client with significant weight-related challenges, can place considerable physical strain on the caregiver. This strain raises concerns about potential back and musculoskeletal injuries, especially when used frequently.
– Weight Restrictions: Most portable stair climbers have weight limits that might not accommodate all clients, particularly those with higher body weights. The client’s comfort and safety during the transfer are paramount and exceeding the recommended weight capacity posed significant risks.
– Staircase Specifications: The effectiveness and safety of stair climbers also depend on the staircase’s width, angle, and condition. Not all staircases are suitable for stair climber use, especially in older residential buildings or rental properties where significant modifications are not possible.
– Safety Concerns: Navigating a stair climber requires skill and strength. An error in operation can result in falls or injuries, both for the client and the caregiver. Considering the client’s specific health and mobility challenges, the risk factor was deemed too high.
Given these considerations, the decision to install a semi-permanent, low-maintenance, and safe solution in the form of an aluminum ramp was deemed the most appropriate and holistic approach to improving the client’s mobility, health, and quality of life. In addition, it also addressed minimal disruption to the property, aligning perfectly with the client’s circumstances.
The Intervention – Aluminum Wheelchair Ramp:
After a comprehensive assessment, an aluminum wheelchair ramp was recommended and installed. The choice of aluminum offered numerous advantages over a wooden ramp, crucial for the client’s specific circumstances:
1. Superior Traction in Wet Environments: Aluminum ramps often come with built-in traction surfaces. Unlike wood, which can become slippery and hazardous when wet, aluminum maintains consistent traction, crucial for environments with frequent rain or moisture.
2. Durability and Low Maintenance: Aluminum withstands environmental elements better than wood. It doesn’t rot, splinter, or warp, reducing the long-term maintenance costs and ensuring structural integrity over time.
3. Portability and Flexibility for Renters: For clients in rented homes, aluminum ramps present a valuable feature: they’re semi-permanent. They can be installed without significant alterations to the property, a practical solution for rental situations. If the client moves, the ramp can be disassembled and reinstalled at a new location.
4. Health Benefits: Regular attendance at medical appointments is vital for managing the client’s health conditions. The ramp simplified this process, eliminating the physical strain and logistical difficulty of using a gurney. This consistent medical care helps manage the client’s weight and accompanying health conditions more effectively.
5. Psychological Benefits: Independence is closely tied to psychological well-being. The ramp provided the client with the freedom to leave the house with ease, combating feelings of isolation and helplessness. The ability to enjoy the outdoors and engage with the community provided positive effects on his mental health.
6. Safety for Client and Caregivers: The ramp’s stable, traction-enhanced surface reduces the risk of falls, a crucial consideration given the client’s mobility and weight challenges. It also makes it safer for caregivers to assist the client, reducing the risk of injury related to lifting or supporting the client’s weight.
7. Cost Considerations: While the upfront cost of an aluminum ramp can be higher than a wooden one, the reduced maintenance, durability, and portability represent significant long-term savings. This foresight is particularly beneficial for clients who do not own their homes or might relocate.
Conclusion:
This case study underscores the holistic benefits of tailored home modifications, with the installation of an aluminum wheelchair ramp significantly enhancing the client’s quality of life. It reaffirmed that occupational therapy interventions should extend beyond immediate physical needs, encompassing the client’s psychological well-being, safety, financial circumstances, and living situation. By prioritizing client-centered solutions, occupational therapists can profoundly impact individuals’ lives, promoting autonomy, health, and dignity.