I teach a self-contained class of profoundly mentally involved students in a regular elementary school.
Lance (not his real name) is a fourth grader with a wonderful personality and cerebral palsy. He is cognitively fine and attends the regular classroom under inclusion, but the toileting issue needed addressing. When Lance and his family moved to our school, he was in the second grade and used the bathroom adjoining their classroom. When he entered third grade, however, there was no bathroom close by, and he had to be lifted to a commode in the boys’ bathroom.
Figure 1 Lance Prepares to Stand
Meanwhile, in the bathroom of our self-contained special ed classroom, we had installed a Support Station. We said to ourselves – wouldn’t this be wonderful for Lance. So we worked out a schedule and let him come here to us.
When Lance started coming in to our bathroom, he needed considerable help using the Support Station. He’s not heavy, so it wasn’t a big deal to people to just heave him out of his wheelchair when they had to. But he had never really had any standing practice on a regular basis. Since Lance could do academic work, that was always the big focus, and the therapy he’d get was on the side. So initially, someone had to be right there helping him.
When Lance gets ready to use the Support Station, we stress proper foot placement (Figure 1). We also stress using both hands since his left side is considerably weaker than his right. He tends to “forget” to use his left hand and requires frequent reminders. Lance uses the elbow curves to pull himself up, and then he reaches for the handholds when he's in the standing position (Figure 2). Then we buckle the Support Strap. We discovered that Lance does better without the Kneeblock (Figure 3). He has contractures at the knees, and when the Kneeblock is on, his feet are too far back. He ends up having to pull more with his hands and arms instead of using his legs to stand.
Fig. 2 Lance Transfers Independently
Lance has made gains, just from using the Support Station twice a day. It’s been a great experience, seeing his progress. He’s stronger and has loosened up some of those contractures just from using the Support Station regularly. He actually has started to help with pulling his pants up and down, and I think it’s just because he’s never had the opportunity where he has felt completely safe and secure like he does with the Support Station and the strap in place.
Lance uses the Blue Wave toileting system, and we roll it over the toilet. Our Support Station was installed as a stand-alone unit without the swivel feature, but I believe Lance could use the swivel independently if our bathroom was set up differently.
Lance just loves gaining the skills and becoming more independent. He has a new power wheelchair on order, with footrests that move out to the side and out of the way. In his current wheelchair, he can’t move the footrest, so it’s a problem getting in and out independently. One of the primary things his family realized, mostly from seeing how he did with the Support Station, is how much of a difference those footrests will make for his independence. Lance is getting some of those ideas in his head, too: “OK, this definitely can help things.”
Once we get the new wheelchair there won’t be any barrier. He’s learning to transfer in the bathroom context, but it could carry over to the classroom where he could probably get himself out of his chair and into a regular chair, instead of always having to be dependent on somebody else.
Fig. 3 Kneeblock Removed for Lance
Using the Support Station has even increased his skills with the Pacer, and he’s gotten his own personal one now, which stays here at school. The school staff and his family have really seen how big a change this is, that he can transfer in and out of the equipment. So not only has the Support Station encouraged inclusion by giving dignity to a student who deserves it, but it has also changed the way the school staff and his family see him and the possibilities for him.
For this story, Lance happens to be the star. But for my classroom assistants, the Support Station has also been a tremendous thing. It removes the risk of injury, and gives the opportunity for the sit-to-stand transfer. The way our bathroom is set up, we have room to take the gait trainer or the stander right in there next to the Support Station. So we work on pivot transfers with our classroom students, and go straight into the equipment from the Support Station
There’s no question that the Support Station is making a difference.