Assistive technology enabling goal achievement and safe discharge home: A complex NDIS case study

Hayley Scott, Senior Occupational Therapist, Western Health, Victoria Sharon Neale, Grade Four Subacute Occupational Therapist, Western Health, Victoria

The introduction of the NDIS has enabled individuals to leave hospital and live full lives in the community. Occupational therapists play a pivotal role in assessing and advocating for NDIS participants to ensure their goals and disability needs are met. This often includes assessing and prescribing assistive technology (AT). Within inpatient hospital settings, occupational therapists are increasingly treating individuals with complex functional care needs and supporting hospital discharges into the community at lower levels of occupational performance than before. To support these participants, there is a need for increased AT innovation and development.

This case study highlights two key pieces of equipment that enabled NDIS participant “Amber” (pseudonym) to achieve her occupational goals.

Who is Amber?

Amber is a 24-year-old who presented to an inpatient rehabilitation ward in Victoria with a diagnosis of functional neurological disorder. Amber has a large body habitus and an extensive medical history, including lower limb fractures and mental health conditions. Amber made small gains while receiving inpatient rehabilitation; however, she remained unable to walk and required a hoist for all her transfers. She required assistance from two people for her personal care occupations and utilised a wheelie commode.

What were Amber’s goals?

“To get home so I can see Cara (her horse).” “To have a shower – as I feel disgusting.”

Occupational therapists play a pivotal role in assessing and advocating for NDIS participants to ensure their goals and disability needs are met.

What assistive technology did Amber require and what impact did this have?

To enable Amber to achieve her goal of getting home to see Cara, Amber needed to be able to sit out of bed and transfer safely to her wheelchair, wheelie commode/ bed within her home environment.

Amber had a range of physical impairments that impacted her ability to achieve this goal, including reduced sitting tolerance, lower limb dystonia, chronic pain, increased body mass index (BMI) and non-epileptic seizures. A 20inch, tilt-in-space wheelchair with elevating leg rests was prescribed to enable her to sit out of bed, and a portable ramp was installed within the garage to enable safe access to her home.

A hoist was also required; however, during assessment it was determined that a standard floor hoist would pose significant manual handling issues. Following a home assessment, a gantry hoist was deemed suitable to enable Amber to get out of bed without putting her carers at risk. This portable AT simulates a ceiling track hoist, can be quickly installed and eliminates the need for home modifications. A gantry hoist enables non-ambulant patients with increased BMI to return home as it reduces significant manual handling risks. After

Pressure fit ceiling track gantry hoist from Rehab Assist

four months in hospital, Amber reported that “getting home was the best feeling”.

Amber desperately wanted to achieve her goal of showering daily – being clean and feeling fresh was important to her as an occupational being. To achieve this goal, Amber needed to access a standard shower recess with a wheelie commode. A Showerbuddy was trialled and prescribed. This equipment allows non-ambulant patients to access a standard shower recess with minimal modifications. This is a game changer for timely discharge planning. Without this AT,

Amber would have had to wait months for home modifications. Amber reported: “I use this daily. Showers are the best part of my day, as I have fresh hair and I smell good.”

Where is Amber now?

Amber was safely discharged home with her NDIS package and all AT was funded for an initial hire period. Achieving these initial goals provided Amber with the stepping stones to achieve further goals, including attending her best friend’s wedding and using a power wheelchair to look after and train her horse. Amber continues to participate in outpatient rehabilitation, working on long-term goals of exploring alternative AT to return to work/ study, drive and, one day, ride her horse.

Innovations in AT and the unique skills occupational therapists possess to match individuals and their environments with the right AT have enabled not only Amber to return home, but many other individuals who would have otherwise required specialist disability accommodation.

For more information about the AT described, please visit the following websites:

Showerbuddy SB1 from Rehab Hire

Showerbuddy

bathcheck.com shower-buddy.com/wp-content/ uploads/2021/06/Custom_Bridge_ How_To_Measure.pdf

Gantry Hoist

rehabassist.com.au/free-standing-gantries/ rehabhire.com.au/shop/patienthandling/gantry-systems/

About the Authors

Hayley Scott

Hayley Scott is a senior occupational therapist on the inpatient rehabilitation ward at Western Health. She has nearly 10 years of experience working across inpatient and outpatient areas within a public health setting. She is passionate about providing evidence-based, high-quality care to patients, which involves prescribing various AT to support complex discharge planning.

Sharon Neale

Sharon Neale is a grade four subacute occupational therapist at Western Health. She has more than 20 years of clinical experience working in subacute inpatient and community settings of the public health system. Sharon is a strong advocate for the essential and valuable role occupational therapists play in supporting individuals to achieve their occupational goals sustainably with the right AT.

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