Clinical Pathway: Toileting Hygiene

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The Recovr Rehabilitation System (RRS) can be used to facilitate increased elbow and shoulder range of motion and strength in order to maximize independence with self-care skills that require the resident to bring their hand to their perineum and lower back, such as toileting hygiene.

Impacted ADL: Toilet Hygiene: GG0130C

Impacted Outcome: Toilet Use: G0110I

• Range of Motion in Upper Extremity (G0400A)

Functional Abilities & Goals: Increase the resident’s ability to maintain perineal hygiene, adjust clothes before and after using toilet, commode, bedpan, or urinal.

Indications for RRS use to facilitate toileting hygiene:

• Stroke
• Spinal cord injury
• Brachial plexus injury
• Lower extremity orthopedic conditions
• Total hip and total knee replacements
• Balance deficit
• Parkinson’s Disease
• Generalized weakness
• Endurance training

RRS Set-up for toileting hygiene:

1. Use Kinect Settings to select the resident you’d like to track.
2. Use the Lesson Planner to select which arm to use, where targets will appear, and how frequently to provide rest breaks based on resident’s range of motion, endurance, and treatment goals. Use targets farther away from body to help facilitate reach. Select targets that will require contralateral and ipsilateral reach at various heights to simulate reach for toilet paper in a variety of environments.  
3. Use Required Elbow extension to determine the amount of elbow extension needed to hit on-screen targets. Selecting a higher percentage will require more elbow extension. Work toward achieving increased elbow extension in order to facilitate reach for toilet paper and clothing.  
4. With the patient in standing (using adapted equipment as needed), set the Start Position at the resident’s hip level to facilitate reach for toileting hygiene. As the resident plays, encourage him or her to touch palm of hand to lower back or buttock while reaching into start position.
5. During game play, consider providing manual facilitation to encourage trunk rotation and form with reach for wiping and clothing management. Work toward longer periods of game play for improved standing balance and endurance needed for toileting.

Tracking Progress Through RRS Data:

• Use the successful repetitions completed and shoulder range of motion metrics to track the resident’s progress over time with the RRS.
• Help to facilitate carryover of component skills learned with RRS by performing ADL-task practice before or after use of RRS using functional reach for toileting hygiene and clothing management.