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A Closomat Case Study

  • Adam Ferry

A Closomat Case Study

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This case study is written using the Person, Environment, Occupation (PEO) occupational therapy model (1996). Law et al developed the person, environment, occupation model as a response to an identified need of occupational therapy, which describes the theory and application of the interaction between the person (P), their environment (E) and the occupation (O) . The model gives a defined framework to enable Occupational Therapists to concisely clinically reason their intervention.
The following case study will therefore be presented using PEO (Person, environment and Occupation) model to support reflection and clinical reasoning processes.

Person
Diane is a 53 year old lady who suffers from a rheumatoid condition that impacts on range of movement across all joints but particularly affected the upper limbs, thoracic and cervical spine. This resulted in impaired range of movement at the shoulder joint, limiting the client’s ability to extend, flex and externally rotate.

She has previously been provided with a walking aid, equipment for the kitchen and bath to allow her submerge in the warm water.
She remains stoically independent and has set meaningful goals that focus on social activity and in particular remaining empowered to be spontaneous. One of the main components of this for Diane was her ability to wash adequately after moving her bowels. This had become more problematic in recent months due to a deterioration in her condition and the impact on range of movement through gross and fine motor skills.

Environment
Diane lives alone in a 3 bedroom, privately owned bungalow situated close the centre of town.

She has a reasonably sized bathroom which consists of a toilet, bath, shower cubicle and wash basin. She enjoys bathing very much as it relives her of some discomfort and allows her to relax at the end of the day, aiding sleep. The shower she uses in the morning so that she feels clean. Recently she has used the shower more frequently as does not feel adequately clean post-bowel movement but is able to use the lowered shower head to provide a wash she is satisfied with. This has however been using a lot more energy as she finds the whole process of washing & drying problematic.

Occupation/Task
Diane had arranged for some private domestic support to help with heavier domestic chores and described it as socially acceptable to have a cleaner but did not wish to entertain the idea of support with other activities of daily living including making food or drink and certainly not within personal care tasks which she felt would end her dignity and social roles.

Diane has led a very active social life and has a large group of friends. She is on the local golf club committee and enjoys meeting with friends regularly for coffee in the local town.

Recently Diane has become more withdrawn socially as is more fatigued by her new toileting routine as remains anxious that she is not as clean as she wants to be.

Outcome

Diane discussed the issue with her closest friend who supported her in researching the options.
Initially Diane re-contacted her Occupational Therapist who suggested the trial of long handled toileting aids. However, Diane was not keen on this idea as felt that although it might support cleaning to a degree would not help her to be as clean as she wanted to be.
The Occupational Therapist discussed other options including Bidet toilets and Wash/Dry toilets which Diane felt were better options generally. Although Diane would be purchasing privately the Occupational Therapist remained involved to offer consultancy and support.
They concluded that the Bidet toilet would not offer suitable drying options, nor would it give the ability to control/adapt water flow.
The option that Diane and her Occupational Therapist thought suited her needs was the Closomat Palma Vita. This equipment offers the option of using a foot controlled button to control washing and drying therefore future proofing against worsening dexterity. It also offers a range of custom programmes for cleaning and drying therefore allowing it to be truly client centred.
On contacting they confirmed that a site survey would be conducted within 5 days. Following this survey they provided a quote within 48 hours of £2,660 for the product and £510 for installation which included a visit to ensure the toilet’s settings were continuing to meet Diane’s needs and preferences.

The Palma Vita has changed Diane’s life, allowing her to maintain her roles and engagement in meaningful activities.
The ability to maintain independence and dignity is priceless!

Adam Ferry
Occupational Therapist
Director
The OT Service

1 POE https://vula.uct.ac.za/access/content/group/9c29ba04-b1ee-49b9-8c85-9a468b556ce2/Framework_2/lecture3.htm or https://journals.sagepub.com/doi/10.1177/000841749606300103
2 Not her real name.


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