HOUSE & HOME
Wheelchair
LIFE
Ramps
Let's start from the outside and work our way in. When preparing your home for a wheelchair, one of the first, and most obvious, things you encounter are ramps to overcome the barrier of stairs. Depending on your home, your wheelchair, and your physical abilities, ramps will take on different sizes and shapes. You can have ramps built, or you can buy commercially-available ramps. Click here to see lots of ramp options for your home, transportation, and even portable sets (I have a pair of the telescoping portable ramps pictured to the left and on the site. I don't use them often, but they are nice to have when needed). More ramp options here at eBay®.
Remember that in your own home you're not necessarily limited to the government standard of 12:1 ratios; that's 12 foot of run (length) for every 1 foot of rise (height). It may turn out that the 12:1 ratios are best for you, but a more steep or less steep ramp may be preferred when evaluating space limitations or other considerations. I have a steeper ramp in my garage so that it doesn't extend past where I enter and exit my van by the side door. I'm certainly not "advocating" steeper ramps (oh no ... that could be dangerous), but be prepared to think creatively. Here's a YouTube® video of a very creative idea for hiding ramps out-of-the-way for occasional use. Wish I was that inventive.
Depending on where you live, installation of ramps may require a building permit. If you get a permit, the governmental entity may require you to build your ramps with the 12:1 ratio. Use your best judgment, or get help from someone whose judgment you trust. Here's a pretty good online article touching on some considerations for building a residential wheelchair ramp.
Doors & Doorways
Next consideration is your doors and doorways (and hallways). If you have a wide chair, you may have to do some remodeling if you want to stay in, or move into, a particular house. That's a fairly important consideration when you're choosing your wheelchair(s), and deciding where to live. By the way, I stumbled on a website for accessible home listings., and then another.
If a doorway is wide enough, but the door won't quite open far enough to let your chair through, there's a little trick that may help. Off-set hinges (pictured here) may solve your doorway problem by allowing the door to open further and get completely out of the doorway.
Another trick I employ – because I have many people coming and going in my house – is getting rid of key locks. Instead, I installed number-code locks with key pads on my doors. That way no one has to keep track of keys. I just give the code to people I trust (it can be changed if someone proves untrustworthy). This also allows me to provide access to the house for new people when I am home alone and can't get to the door. I can tell them the code over the phone ... almost everyone has a cell phone these days.
I also have a motorized sliding glass door. See it here. It was custom-made from an old garage door opener, built into a bench on my deck. So it's not commercially available that I know of. But if you know somebody that's handy, they might be able to do something similar for you. There are plenty of creative solutions to help us adapt and overcome. We just need to think outside the box.
Bed
A few things should be considered when deciding what kind of bed to sleep on, and how to set it up. Probably the two most important are: skin integrity and access. I have changed the kind of bed I use a few times over the years. I started with a "tube" soft-side waterbed. Then I switched to a 'thin-fill' soft-side waterbed. I chose waterbeds because of the skin integrity issue. Waterbeds redistribute weight better and help prevent pressure-sore, at least in theory. Soft-side waterbeds are simply easier to get into and out of than traditional waterbeds (with all the waves and sinking down in). Several years ago, when my back felt better after a vacation, during which I slept on a traditional mattress (not a waterbed), I bought a regular King-size mattress and box-spring. Then, after a while I discovered – again while on vacation – memory-foam toppers for mattress. They are wonderful. That's what I have now. They are very comfortable, they protect against bedsores, they don't inhibit getting into or out of bed (I had assumed they would), and they're not very expensive. I found mine here at Overstocks.com for only $150 (for a 4-inch thick King-size). Some mattresses come with pillow tops or memory-foam built-in. Of course, peoples’ needs and wants will be different. You can look into a multitude of options.
Access to your bed is another matter. For my transfers, I need the surface of my bed to be the same height as the top of the cushion on my wheelchair. In order to achieve that height, after adding a 4 inch foam-topper, we simply removed the "feet" from the bottom of the bed-frame legs. It happened to work out well. For previous beds that had considerably lower profiles, I had to raise the bed. We had a 4 x 4 piece of treated lumber cut to exact lengths (I think it was 2.5 inches) and put underneath the feet. So we had six blocks of wood that each measured 4" x 4" x 2.5" that were placed under each foot of the bed frame, and then a wood-screw was driven through the holes in the plastic feet, into the block of wood to keep it in place. That made the top of the bed sit at the perfect height, without ever falling off the blocks.
You might also consider how much room is needed around your bed to get in and out of your chair. If you use a Hoyer® lift, you will obviously need more room, and some clearance under your bed. The type of transfer method you employ will dictate how much space you need around your bed, and where the bed is positioned. See Elevators & Lifts below, and the Wheelchair LIFE sections on Sleep and Transfers for more considerations.
To protect your bed from "catheter issues" or other issues, use a plastic sheet or even a tarp between the mattress-pad and bed or topper. It’s also a good idea to keep your night bag in a bucket of some kind, in case it leaks or isn’t closed properly. I use a short/flat one that can tuck away under the bed.
Shower/Bath
What I'm about to tell you might be quite surprising. You don't "need" an accessible shower or bath. When I was first injured, a very good man who owned a construction company donated the materials and labor to put in a wheelchair accessible shower. For years, I would get transferred to the shower chair from bed, roll into the shower, then get back in bed to get dressed, then up again in my regular chair. It was quite an ordeal, and I always got cold. As you probably know, quadriplegics' circulatory systems are not great, and we're ectothermic. Many years later I learned I could get just as clean with a good bed-bath (using "body-wash") and washing my hair after I got up in the chair (we dont sweat normally). It makes my morning routine go much faster, and is less difficult on my nurses ... and me.
Washing your hair outside of the shower is fairly simple. Roll up a bath towel and put it around your neck (like Rocky in the gym). Then put a good washcloth in a basin or bucket of water to get it wet. Use the washcloth to get your hair and scalp wet. Lather with shampoo as normal. Scrape out as much of the suds as you can with your hands (or your nurse's hands), and then run a wet washcloth through your hair, rinsing and wringing it out in the basin, until your hair and scalp are squeaky clean. For the last rinse, we rinse the washcloth with fresh water in the sink. Dry as normal. It's really that simple. There are also rigid or inflatable set-ups for shampooing in bed. [See photo of inflatable basin to the left]
For those people who really want or need a shower or bath, there are several alternatives. Many ideas can be gleaned from the Internet. Again, think creatively. Your shower doesn't necessarily need to be in the bathroom (we built mine in the space where the washer and dryer previously were).
Supplies for Routine
You will likely have many Supplies for your morning routine. It is helpful to have them near your bed in a cabinet, dresser, or armoire. Have a consistent spot for storing supplies, especially if you can't get to them yourself. You'll need to be able to tell nurses and others where things are. I keep things tucked-away in a drawer and closets so that my house doesn't look like a ‘hospital’ or a ‘nursing home.’ You may want to keep things in a plastic tote basin so they are easier to get out in the morning. That also makes it a little easier to pack, when you go away for an extended vacation. You can simply put the basin in your luggage and cover it with clothes etc.
Home Controls/Alarms
Technology really can be a wonderful thing. There are several products available to give you more control of your home. Smarthome®, Control 4®, ASI Home, and HAI® (Home Automation, Inc.) have lots of options. There’s even a web site that lists home automation sites. Remember, the drawback is most of these systems require A/C electrical power. In storms and power outages, you may leave yourself vulnerable if you rely too much on electronics. You may want to consider generator backup. You can get home generators (for some or all of your home) that run on natural gas from your residential feed, and come on automatically when the power goes out. But they are not inexpensive.
If you do not have use of your hands you'll want some way to communicate with people inside and outside of your home. If you're married and sleep with your spouse (most of the time), this may not be as big a concern. But if you're like me and you rely on roommates in case of emergencies, you'll find that people are not always reliable. Even the best, most well-intentioned people may fall into a deep sleep, pass out after drinking too much, or not hear or be able to get to you for some other reason (people do get injured and even die). For this reason a voice-activated telephone might be what you need.
Remotes & Eyes
Remote controls can give you 'dominion' over many things. There are two types of remote controls, infrared (IR) and radio frequency (RF). Infrared operates on a beam of light, invisible to the naked eye, requiring a clear line of "sight" from the remote control to the infrared sensor on the device. Radio Frequency operates on radio waves in the air, inaudible to the human ear. Most electronics, such as televisions, DVD players, stereos, cable systems, satellite systems, etc. run on IR. But there are commercially-available converters that can convert IR signals to RF, and RF signals to IR. It may seem confusing at first, but remote controls can help you run many things, including some of the home control systems.
You can also use IR remote controls to control devices in other rooms of your home (or devices hidden in cabinets, for instance). In those cases, the line of "sight" is indirect and artificially provided by a "transponder." This can work in at least two ways. One, you can have a hard-wired receiver "eye" in the room where you have your remote control. The receiver has multiple fiber-optic leads that you can run through the walls, under the carpet, etc. to the electronic devices you want to control. The receiver's eye takes the infrared signal from the remote control and sends it down the fiber-optic leads (cables) where they are attached near the infrared "eyes" on the electronic devices. Or, you can have and IR receiving module in one room (where the remote control is) and an IR broadcasting module in the other room where your remote control is. The receiving module takes the light signal from the IR remote control and converts it to an RF signal and then broadcasts it to the receiving module, which converts it back to the light signal and broadcasts it in that other room for the electronic device eyes to "see."
Techie guys love to come up with ways to solve problems through technology. I am not very technology-savvy, but I have a little knowledge, and I enjoy it. Anything to adapt and overcome!
Speech Control
The speech-recognition computer technology outlined in the Computers section can also be incorporated through a computer to run systems in your home. Everything from light switches, to the garage door, to the thermostat. Some systems are so advanced that you can make a phone call to turn things on and off, or to adjust your thermostat and start a pot of coffee. The technology has gotten fairly sophisticated, aided by the “digital age.”
Desk
If you're anything like me, you'll work from, and spent a great deal of time in front of, a desk and/or computer. Whether you use a laptop or desktop, you'll want a good, comfortable working area. I have an office, in which my brother built a motorized desk that I can sit under and move side-to-side with the flick of a switch. You can see a little YouTube® demonstration video here.
It is raised because I want my telephones, keyboard, microphone, reading materials, water glasses, remote controls, and heater up by my head and neck (where I can reach them and feel the heat). That's because I operate these things with, and turn pages with, a mouthstick. I also don't have to use a goofy long straw for drinking. And it’s up high because my eyes are not as good as they used to be. I also have a foam pillow set up on the desk that I can move down in front of me, to lean my head on and take a nap if I want to. It all works pretty well, and I can be at my desk for many many hours. I also can watch cable TV and DVDs on my computer screen.
Computers and modems occasionally seize-up and need to be restarted or 'power-cycled.' It's not very convenient to wait for someone to either unplug a modem for five minutes, or perform a 'hard re-boot' of a computer by holding in its on-off button. Two things can help. For the hard-boot I have my desk-top machines stacked so I can reach the power button. We added a little self-adhesive hard-rubber foot to the button so I can hold it in myself. To power-cycle my cable-modem and router we have them plugged into a power-strip, which is plugged into a control module that can be turned off and on (in addition to lights, etc.) with the push of a button on a control panel mounted to my desk.
Mouthstick Holder
If you use a mouthstick (for quads they’re very important – see Mouthsticks), you will want a good mouthstick holder too. For years I experimented with various household items to lean the mouthstick against or set it in. But finally I decided to have my mouthstick holders made to exact specs. You can have them made out of metal, wood, plastic, whatever your fabricator decides. I prefer to have mine made out the durable Lexan® plastic. That way I can have my dictation machine, a highlighter (attached to another mouthstick), my cell phone, and mouthstick holder all right next to my keyboard (see picture).
Books & Reading Materials
I mentioned reading materials above. If you don't have use of your hands, you have to find a way to deal with papers. We are not yet in a paperless world, and may never be. Though I have a scanner and convert many things to PDF format for reading on-screen, I still get books and papers in traditional format. Books with spine binding don't stay open very well, and stacks of pages can get unwieldy. For most books, I have the binding cut off, and the pages spiral or comb-bound. Your local Kinko's or printshop can probably do this for you (I use a litigation support company). When I receive stacks of papers I need to review, I generally put a big black butterfly paperclip on the upper corner, or for big stacks, I have them three-hole punched and put into a three-ring binder. You can get three-hole punches to do up to 50 pages at a time. Kinko's or print shops can "drill" them for this too. These methods work pretty well, but they are obviously not appropriate for books you have to return. Check out the e-books discussion in the Computers section.
Heaters
Spinal cord injury folks (especially those injured above T6) often feel especially cold or hot. That's because we have compromised circulatory systems and are "ectothermic." That is, we are unable to regulate our own body temperatures internally (sometimes also referred to as poikilothermic or heterothermic, but still warm-blooded). So, our body temperatures fluctuate with the temperatures around us.
I personally get cold a lot more often than I get hot. I used to try dressing in sweaters, long underwear, or using heat lamps. But nothing works as well as a space-heater fan. The little portable, two-setting 1500 Watt combination heater-fans work best in my experience. The absolute best one I've ever had was the first one I ever got (my mom gave it to me as a gift) and it still sits on my desk. It was made by a company called Rival, which is no longer in business. If anyone can find some back-stock of these heaters, please send me some Feedback. I'd be willing to buy them ... at a premium.
Most of the heater-fans I've found, including my old favorite, have 2 knobs. One with four settings: Off, Fan Only, Low Heat, and High Heat. The other knob is a temperature setting, which doesn't control the temperature of the output, but instead controls the temperature at which the automatic shut-off shuts it down. The temperature setting can be changed fairly easily, even with a mouthstick (smooth, not ‘clicky’) to turn the heat or cold off or on.
I have another heater-fan by my bed for when I get especially cold or hot. The 'fan only' setting also produces a nice concentrated stream of room temperature air to help cool down. The heat settings help immensely when I’m cold. I take one of these heater-fans with me whenever I travel. They are a great energy saver and a lot less expensive (and bothersome to others) because I don't have to heat the whole room or house. The concentrated stream of heat works amazingly well. Be careful, though, and don't plug them into extension cords (that will draw more amperage through the cord and greatly increase the chance of fire. If you have an SCI at T6 or above and you've not tried a 1500 Watt heater-fan yet, I'll bet you'll fall in love ... and you'll want to take one with you.
Kitchen
In the next few sections I share some kitchen-related tips. But, I don't cook, so, hopefully, others may have some input, on counter-tops, cabinets, utensils, etc. that they'll provide through Feedback. If we get good stuff, I can post here.
Refrigerator/Freezer
For paras, high-functioning quads, and others who can access the fridge, a side-by-side refrigerator/freezer makes it easy to reach both compartments from a chair. This may sound pretty obvious, but there was a government agency that once considered requiring refrigerator-freezers in accessible dwellings to be a goofy shape and size that actually had LESS freezer space than a side-by-side ... all in the name of "preserving dignity." Their argument was, "people in wheelchairs can’t reach the back or the top shelf of a side-by-side." My response, "So what???" Though people in chairs cannot reach 100% of the space, the side-by-sides offer MORE accessible space than is offered by the 'dignity-preserving' model proposed by the Feds. Furthermore, when it was pointed out that the new "accessible fridges" were not commercially available, the government agency's response came, "If we spec them the manufacturers will build them." Very scary. Thankfully, rational heads prevailed, and side-by-side refrigerator-freezers were specified.
Cups
I learned right away that if you rely on others to hold your cup/glass/bottle/etc. when you drink, you will get spilled on. Period. So I learned to bite the cup, tip it up by lifting my head, and drink through my teeth. If you can't use your hands, that will save you lots of stains and clean-up. It helps a great deal if you have a large, sturdy, plastic cup with no lip around the top (a lip makes it a little tougher to keep a good seal). I used to bite bottles and even aluminum cans until my teeth took a beating. People would ask, "How do you do that?" I used to tell them I had a magnet surgically implanted in my nose. I remember a couple of gals believed it (I didn’t tell them magnets don’t work on aluminum). The plastic 30 oz. "tumbler" (as they call it in the 'biz') pictured here is perfect. Keep an eye on them. People like the feel and size of them, and they tend to disappear.
If you’re at a bar, a party or someone's house and you don't have the best cup, you may have to improvise. Doubling up on disposable cups (especially if they are good, like the Solo® cups pictured) works great. It may take a little practice to get good at drinking various beverages through your teeth without spilling. But it’s worth it.
Wristbrace/Fork/Toothbrush
If you have some arm mobility, but limited grasp, you may already know about wristbraces (or "wrist splints") with “palmar clips” to hold various objects such as a fork. They’re a great help for us 'higher injury' folks when it comes to eating, or for such things as brushing teeth. The photo with the fork gives some idea how it works, but I've found that it's cleaner and easier if your thumb is inside the plastic part of the brace, as shown in the picture, with my toothbrush holder. That way, when you're eating, your thumb doesn't get in the way, or drag through the food. Notice how the fork in the picture is bent? It’s a litte hard to see, but it just works better if the fork is bent so that the tines are lower than the handle, but also pointing the same relative direction as an un-bent fork. You'll also find that forks with wider or fatter handles stay in the palmar clip much better. That's important when you’re trying to stab some food (or a friend ... gently).
The toothbrush holder was designed for me by my brilliant/creative engineer brother. It works great (notice it's well aged). It's a pretty simple design that most fabrication shops should be able to make for you. If not, and you want one, send me some Feedback with how much you'd pay and I'll see if I can get someone to make some.
Tables
You'll notice that leg-room under tables varies greatly. Some have bigger aprons that stick down and prevent your legs from fitting under the table top. At home, you may be able to lengthen the legs, or remove part of the apron (to keep a "normal" table height for others). Get innovative with your surroundings to adapt and overcome. When you're out in a restaurant or at someone's home, you may need to get those creative juices flowing to figure out a solution. Just recently I went to lunch at a Restaurant where the first table they took us to have an especially thick top, that wouldn't allow my legs to fit easily underneath it (would have been a very tight squeeze). All I had to do was ask the host if they had any thinner tabletops. The table right next to the first table was thinner, and worked perfectly (by the way, I had a wonderful piece of fish at M & S Grill). If none of the tables work, you may have to ask for a tray to set on your lap, or look for a table that has an extender that slides or swings out from the side. Whatever you do, remember, don't get upset, and don't take on the 'entitlement' attitude.
If you can't get under a table at a bar or restaurant, politely ask a manager if there's any inconspicuous solution or alternative. If they can't or won't make an accommodation, you don't have to go back. I know the ADA (Americans with Disabilities Act) requires "reasonable accommodation," but stop and think about it for a minute. It's not worth it to DEMAND that the world changes just for us (when it's something we don't really NEED). It’s pretty egocentric, and it starts you down that portentous path to 'Victim Mentality.' Getting just what you want in those types of situations – that is, if all goes according to plan – isn't worth the bridges you may burn, the appearance of being an arrogant jerk, or, more importantly, the negative energy and bad self-image you can cause for yourself by selfishly pursuing your own self-interest at the expense of others. I know there's no such thing as a 'low-maintenance' quad, so I try not to be a 'pain-in-the-ass quad' on top of that. Believe me, I'm no shrinking violet. I fight peoples' battles for a living, and I "stand up" for myself ... when it's important. But I try to pick my battles. It's important to always assess the potential cost and benefit before fighting for something. It's not a good idea to fight just for the sake of fighting.
I suppose this is a good segue into some life philosophy stuff. A bit of wisdom that can help people in chairs, as well as able-bodied folks: People want control in their lives. From the time we are very young, we yearn for control. Watch a baby delight in repeatedly dropping something on the floor and watching people scurry to pick it up. If you think about the times when you're the maddest, you can generally trace the cause to frustration from your inability to control a situation, a person, or yourself. If we simply come to terms with the fact that most, if not all, of our emotional pain comes from a lack of control, it becomes easier to accept that we really don't have true control over much (perhaps the best examples are found in the all-too-common nasty divorces ... and the battles that follow).
Some people are more skillful or practiced at negotiating through life, and they give the impression that they are "in control." And, yes, some people have a great deal more power and influence than others. But they are not immune from being hit by a drunk driver or a stray bullet. And does power mean they are necessarily happier? No. Very often they are intoxicated by their power or influence, even to the point of addiction. The become infatuated with control and they aren't happy because they want more and more. Very often the mega-powerful believe power will bring them happiness, but when they get it they are not satisfied. Even the wealthiest and most powerful people in the world are not necessarily happy. Think of Howard Hughes, Adolph Hitler, Napoleon, or Alexander "the Great" ("When Alexander saw the breadth of his domain, he wept for there were no more worlds to conquer"). The short answer is: Realize that total control is an elusive dream and the sooner you realize that, the sooner you can find happiness.
Elevators & Lifts
There are some really bad, slow, wheelchair lifts and elevators out there. I've run into many that are loud, unreliable, cumbersome, and not user friendly. On the other hand, there are some pretty good home and commercial products available. My brother (the anomalous 'creative engineer') has invented a wheelchair lift that is absolutely brilliant. He has a patent and is working on executing a business plan with some partners, to market and sell his wonderful invention. It will revolutionize the home elevator market, and quite possibly the commercial small-elevator market too. They're still working out financing, so I'm not at liberty to disclose the details of how it works. But if you're in the market, send me some Feedback, they may be ready to install their remarkable product when you're ready to buy. It can be retrofitted in almost any home, easily and inexpensively. It is so simple, yet innovative. I hope my brother gets rich from the ingenious design. He came up with it (no pun intended) as a selfless gesture, to get me into his newly refinished basement. It truly is brilliant. If you can't wait for the best, click here for a site with various resources for lifts, stair-glides, etc. (the things I don't like, but some people need).
The other kind of "lift" you may already be familiar with is a person lift or a “patient lift” (I’m not a patient any more, so I don’t use that term). The most common is the Hoyer Lift®. These lifts are used to move people in an out of bed, bathtub, pool, or wheelchair. They basically consist of a cloth sling with straps or chains connected to an arm that can raise up and down on a post. They are a bit cumbersome, but are sometimes the best way to lift or move someone (especially large people). We were told we needed a Hoyer Lift© when I was first injured. But I don't use it. We use a slide transfer method to get me from bed to wheelchair, and a lift-flop-and-slide method to get me from wheelchair to bed. See more on that in Transfers. We used the Hoyer Lift for the swimming pool, but I've only been in a swimming pool three times over the past 23 years (for me, the benefits do not outweigh the hassle of changing clothes, transferring in and out, trying to get completely dry, changing clothes again, and getting repositioned in the wheelchair), and used the Hoyer only once. So I don't really have need for a Lift. I have been dropped on the floor and the ground several times. But, thankfully, I have strong friends/roommates who can pick me up, so we didn’t need a lift for that.
For those who cannot be picked up or transferred by the people around them, a Hoyer Lift may turn out to be a great tool. There are many different types and styles. Some with hydraulic cranks, and others with electric motors. A Google search will produce lots of web site pages with the various Hoyer Lift options.
They also make standing tables that can be found online. Again, Google® is a wonderful resource for finding what you want. Standing tables, apparently, help people feel better, and are supposed to be good for the joints and bones. I, personally, have never had much use for standing tables. So I cannot give you any recommendations one way or the other. If you have some experiences to share, send me some Feedback that we can post to help others.
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