Spinal Cord Injury and Assistive Technology in the NDIS

Spinal Cord Injury - What is involved?

A Spinal Cord Injury (SCI) involves damage to the spinal cord which can impact your:

• movement
• sensation
• breathing
• organ function
• bladder and bowel function
• sexual function

Spinal Cord Injury and High Physical Support Needs

In some cases, people with a spinal cord injury demonstrate high support needs due the severe impact of their injury. High physical support needs involve a high level of person-to-person support and the use of assistive technology. 

Person-to-person support may involve one person or two people helping you with the various routines that make up your day, including showering, eating, drinking, toileting, etc.

These tasks typically involve manual handling, where you may require assistance to transfer or reposition. 

Manual handling involves the practice of safe movements and lifting to reduce the risk of injury to the participant and support workers involved. In this case, using assistive technology may be necessary. This is to keep you and your support workers or carers safe.

Due to the high complexity of your spinal cord injury, you may not have the capacity to operate some of your assistive technology. In these cases, assistance is required to operate devices to ensure your safety and the safety of others.

What Assistive Technology Will Help Participants with a Spinal Cord Injury?

There is a wide range of assistive technology that can support NDIS Participants with a spinal cord injury.

A common question our NDIS Navigators are asked is "What assistive technology can I use my NDIS funds for to help with my spinal cord injury?"

We asked our resident OT to tell us what type of equipment she regularly prescribes to assist NDIS Participants with a spinal cord injury.

Here are the main assistive technology solutions she mentioned:

• ​Mobility Devices such as a wheelchair
• Transfer Assistive Technology such as hoists and slings
• Bedroom Assistive Technology such as adjustable beds and pressure mattresses
• Bathroom Assistive Technology such as shower commodes and toilet equipment
• Living and Dining Assistive Technology such as seating and special trays
• Kitchen Assistive Technology such as tools to help you cut and prepare food

Mobility Devices to Support NDIS Participants with Spinal Cord Injury

Manual and Powered Wheelchairs

If your spinal cord injury has impacted your capacity to walk, you may require the use of a wheelchair.

A manual wheelchair involves a seat and backrest attached to a frame with two large wheels with push-rims. Either the user self-propels the wheelchair, or it is attendant propelled via handlebars positioned at the rear of the backrest.

A manual wheelchair requires the user to have sufficient trunk control to remain seated upright, as well as upper limb function required to propel the wheels.

Most people with a spinal cord injury level below C6 will have the capacity to self-propel a manual wheelchair. In addition to your injury, factors that may impact your capacity to self propel include:

• weight
• fitness
• strength
• level of pain
• the environment i.e. flat vs sloped surfaces.

If your injury is above C6, you may find a manual wheelchair does not effectively accommodate your seating and positioning needs. If this is the case, a powered wheelchair may be considered a more appropriate mobility device.

A powered wheelchair involves a base with motorised wheels that are controlled by a joystick. Attached to the base is a cushion, backrest, armrests and any other postural supports required.

A powered wheelchair offers a high level of customisation for seating and postural supports. This is often necessary for individuals with a high level spinal cord injury with a significant impact on their functional capacity.

To operate a powered wheelchair, the joystick can be placed at the front of the armrests for the user to operate, or at the top of the backrest for carers to operate (or both).

If a joystick cannot be operated due to upper limb impairment, alternative controls may be necessary, such as a head array wheelchair control system.

Transfer Assistive Technology

Mobile Hoist

A mobile hoist is a device that is designed to lift and carry (transfer) you from one surface to another. This may be from your bed to your wheelchair, or from your wheelchair to shower commode.

It has a mobile base that can be wheeled from room to room, so long as there are no steps inside the home or other obstacles. Typically, two support workers or carers are required to operate a mobile hoist.

Ceiling Hoist

A ceiling hoist is a device attached to a frame that is built into your ceiling. It can transfer you between surfaces, and can sometimes travel between rooms. It is usually easier to handle compared to a mobile hoist and usually requires one or two support workers or carers to operate.

Sling

Both a mobile hoist and a ceiling hoist require the use of a sling that attaches to the hoist via straps. A large fabric sling supports your whole body when you are lifted between surfaces.

Slings can come in all different shapes and sizes, and be made of different materials and straps designed for a variety of hoists.

Standing Hoist

If you can weight-bear, but require a bit of additional support to stand up, a standing hoist can help you with completing transfers i.e. standing from sitting at the edge of your bed, wheelchair, or recliner chair.

Various slings and straps are available to assist you in using your standing hoist. Typically, a standing hoist is operated by one support worker or carer, however assistance of two may be necessary depending on the requirements of the transfer.

Bedroom Assistive Technology

Hi-lo Adjustable Bed

Bedroom assistive technology involves a hi-lo adjustable bed.

An electronically powered hand remote is available to adjust the power features of the bed. 

The power features have various benefits, including:

• Raised back section - elevates the head and body for comfort, positioning, breathing, and eating.
• Lower limb elevation and knee break - supports the lower limb in an elevated position for comfort, pressure care management, management of swelling etc.
• Height adjustability - the bed can be lowered to assist you with standing transfers (if completed), or raise the bed to a height best suited for support workers or carers providing care to you in bed.

An adjustable bed is beneficial for someone with a spinal cord injury who has difficulty adjusting, repositioning and sitting up in bed.

Pressure Relieving Mattress

Various pressure relieving mattresses are necessary for individuals with a spinal cord injury.

Pressure-relieving mattresses may be:

• Foam mattress - consisting of various layers of foam to immerse the body and distribute pressure
• Alternating air mattress - Air cells within a mattress that are inflated and deflated by an automated pump to redistribute pressure throughout the body for pressure care management
• Combination of foam and air mattress - a pump-free mattress that combines air cells and foam padding to achieve comfort and pressure care management

A high level spinal cord injury will impact your ability to reposition in bed, increasing your risk of sustaining a pressure care injury. In these cases, an alternating air mattress which offers a high level of pressure relief may be necessary.

Bathroom Assistive Technology

Mobile Shower Commode

A mobile shower commode is a waterproof wheeled device that has a similar setup to a wheelchair. It may be helpful for you if you cannot stand to shower and/or require support for personal-care routines.

A mobile shower commode typically has an oval gap in the centre of the padded commode seat, similar to the inside of a toilet seat. This is beneficial as the commode can be wheeled over a toilet so that it can also be used for toileting.

A mobile shower commode requires an accessible bathroom. This involves level (flat) access into a shower recess which ideally does not contain glass screens or doors. The toilet seat needs to be low enough for the commode to wheel over.

Mobile shower commodes can be self-propelled by users who would typically self-propel their manual wheelchair. A mobile shower commode with a tilt-in-space function may be more appropriate for a powered wheelchair used that is mobilised by care supports. Emerging assistive technology involves mobile shower commodes that can be manouvered electronially, such as the HMN M2 JOYSTICK mobile shower commode.

Over Toilet Aid

An over toilet aid is a frame that can be positioned over your toilet to assist with sit to stand transfers. This is beneficial for people with a spinal cord injury who can stand and walk, and need a little more support with transfers.

An over-toilet aid can promote your independence and reduce the need to rely on a support worker or carer to get on and off the toilet.

Shower Chair

In some cases, a shower chair may be the support you require in the shower if standing and balancing during your showering activity is difficult.

Shower chairs come in all shapes and sizes, including shower stools with or without backrests and armrests.

Living and Dining Assistive Technology

Living and dining supports can often be overlooked when mobility and transfer assistive technology are prioritised. For someone with an spinal cord injury and high physical support needs, a standard couch or armchair is unlikely to meet your needs and sitting upright and maintaining comfort will be a challenge.

In this case, a disability-specific recliner chair with additional positioning features is required, to provide an opportunity to sit somewhere else that isn’t your wheelchair or bed for relaxation, leisure and social engagement.

A tray table on wheels that is compatible with the recliner chair is beneficial for eating meals and performing activities.

Kitchen Assistive Technology

Meal preparation aids can be beneficial for individuals with a spinal cord injury that may have difficulties engaging in the kitchen for meal preparation.

Some examples of kitchen and meal preparation aids include:

• Modified chopping board
• Spreader boards
• Modified knives and utensils (thicker or different handle designs)
• Easy open devices - one-touch bottle, jar and can openers
• Kettle tipper device
• Thermomix (in some cases if deemed appropriate following trial with an OT)

Summary

There is a wide range of assistive technology available, with only some of the useful daily living aids discussed above. To learn what is right for you, you may benefit from a Functional Capacity Assessment from an Occupational Therapist.

Find an Occupational Therapist

The MyCareSpace NDIS Navigators can connect you with support workers who have experience with spinal cord injuries in your area.

Find a Support Worker