Toilet Frames, and Bathroom Equipment to help with “sit to stand” for adults with muscular dystrophy or related conditions who have difficulty standing up from a seated position

You can download this factsheet as a PDF document: Toilet Frames and Bathroom Equip (154 kb)

Compiled by Yvonne Masset, National Occupational Therapy Advisor, with some information taken from chapters 8a & 8b of Muscular Dystrophy Campaign's Adaptation Manual (2nd edition) by Philippa Harpin.

More information about Bathroom “sit to stand” equipment

Many adults with muscular dystrophy and related conditions are able to walk, but find it increasingly difficult to stand up from a sitting position (and to sit down again in a controlled fashion) and need the help of specialist equipment.

This fact sheet covers a range of toilet frames, with particular emphasis on bathroom equipment to assist with sit to stand. It includes the following information:

The method of standing up
Choice of equipment and the importance of assessment
Recommended features of equipment
Supply of the equipment – timing and funding
a) Toilet frames that rise horizontally
b) Toilets that rise horizontally
c) Other toilet frames
d) Risers that lift at an angle
e) Shower seats
f) Baths
Contact Details

The method of standing up

This is usually achieved in one of two ways:

Positioning the legs in a wide stance with the knee joint locked and the legs straight; leaning forward on to a stable surface such as a table; bringing the feet closer together and then either climbing up the furniture or pressing on the thighs in order to extend the back and to balance;

Twisting sideways; leaning heavily on one arm; pushing the legs out to the rear so that the knee joint is straight, and levering the body up using furniture as support.

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Choice of equipment and the importance of assessment

Most people with neuromuscular conditions find that equipment that throws them forward with their knees flexed (ie equipment which lifts at an angle) is inappropriate, because it is then impossible to straighten the knees to stand up. Fortunately, there are several pieces of equipment that have proved to be useful.

The equipment should be assessed prior to ordering. If statutory funding is to be sought, it is usually extremely helpful if the person responsible for arranging the funding is at the assessment.

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Recommended features of equipment

The ideal features are:

A seat which rises horizontally on which the user can inch forward without being thrown forward, although a minor push at the last stage in the process of standing up can be helpful to some disabled people.

A seat which, depending on the user's height rises to a sufficient height (usually between 790 and 870mm) to enable users to lower themselves to their feet with the knees braced back.
Armrests which rise up with the seat to provide stability and something to hold on to at the side of the thighs while the user is standing and slowly extending the back to achieve balance.
No protrusion at the base of the equipment to get in the way of the feet.

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Supply of the equipment – timing and funding

Most people with a neuromuscular condition choose to struggle to stand up for many years because they feel that this physical activity keeps their muscles active. Whilst this decision is a personal one, it may be more productive to accept the use of equipment at an early stage in order to conserve energy for more worthwhile activities. In addition, one of the difficulties of initially using this equipment is the need to alter the method of standing up. Therefore, it is important to consider these items when standing up is just beginning to get difficult, because it is easier to adapt when less disabled.

Early supply will save the frustration of struggling, particularly if there is a delay while funding for the equipment is sorted out. When the need can be identified by forward planning, this may help Social Services to budget the funding. Also, if the equipment will be needed for several years, it is more likely to be funded than items that will only be needed for a short time.

If the equipment requires installation, it may be considered as part of Disabled Facilities Grant funding, depending on local policy.

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a) Toilet frames that rise horizontally

Porta Toilet Riser by Huntleigh Healthcare

TA Toilet Lifter by Moderna (via Nicholls and Clarke)
Easi-Seat by Easy-Seat
Clos-o-Mat Lifter by Total Hygiene

For contact details, see below.

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b) Toilets that rise horizontally

Pressalit Care now supply a toilet with an electric motor, so that the whole toilet pan can rise, or be lowered. The seat stays horizontal throughout. It will lift someone of up to 200kgs (30 stone) from 425mm up to 825 mm from the floor. Fold back horizontal arm supports and a backrest can be fitted; these rise up with the toilet pan. The rise and fall mechanism is controlled by a remote control unit on a curly lead.

The motor (as well as the cistern) is contained in a mounting 790mm wide and 235mm deep, which sits behind the toilet pan. The whole unit (motor plus pan) will protrude either 935mm or 785mm from the back wall, depending on what style of pan is chosen. Two models are available, depending on whether the toilet plumbing is in the wall or in the floor.

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c) Other toilet frames

The Daily Care frame does not rise at all, but is included here as it is the only frame which provides support for non-ambulant users of shower toilets.

MD toilet frame (Daily Care Ltd)
This frame was specially designed for use with the Clos-o-Mat shower-toilet and a ceiling hoist, to provide support for non-ambulant users, but without adding another seat. The user sits directly on the toilet seat, so that their bottom forms a seal. This allows the most effective washing and drying action; a superimposed chair with a secondary seat will be a poor compromise. The frame has a mesh backrest, a folding height-adjustable footrest and folding armrests for lateral support (these can be installed at four different heights). The frame is floor-fixed for stability. The overall width is 610mm. If necessary the frame can be made to a special size. Because the frame prevents access to the usual elbow flush lever (on the cistern), an alternative flush control will be needed eg hand held / super-sensitive version. The frame is also suitable for use with the Gerberit shower-toilet. As above, note this frame does not rise.

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d) Risers that lift at an angle

These are also listed here, for the sake of completeness, and to alert readers and professionals to the fact that not all frames will be suitable for those with muscular dystrophy. The following powered frames all lift at an angle, ie they tilt forwards as they rise up:

Solo Toilet Lift (from Mountway)
This consists of a toilet seat mounted on two side “supports”. It sits around the toilet pan, and the seat rises up at an angle, to assist the user up to their feet. The controls can be sited on the end of either armrest, or in a hand held unit. Fold-up armrests are optional, but there is no backrest. Because the Solo lifts at an angle it is unlikely to suit those with muscular dystrophy or a related condition (see page 1).

Mountway Solo Lifting Seat (from Total Hygiene)
This is a version of the Solo (above), which has to be modified for use with a Clos-o-mat shower. It can either be fitted at the time the Clos-o-mat is installed, or at a later date. Again, because it lifts at an angle it is unlikely to suit those with muscular dystrophy or a related condition.
Carendo (from Arjo)
This is a large item of equipment on wheels. It has a commode aperture seat, backrest with head support and armrests, and it can be used for both toileting and showering. It was designed to assist carers who are helping more dependent users in hospital or residential care settings (eg those who may need to be wheeled from the toilet to shower area or those who may be transferred via a hoist). Although it will lift the user either horizontally or at an angle, it was not designed for the purpose of independent transfers, and is unlikely to be suitable for use in a domestic home due to its size (width 650mm, minimum depth 850mm).

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e) Shower seats

Many adults with muscular dystrophy have difficulty standing safely whilst showering, but if they sit down on a shower seat or chair, they are unable to stand up again independently. The solution is to use an powered height-adjustable seat which rises sufficiently for the user to stand up, and yet which can be lowered near enough to the floor to allow bathers to sit with their feet firmly supported on the floor, and also to reach down to wash their feet. The seat should have a supportive backrest and arms that project beyond the front of the seat to provide support when standing.

Shower chair (from Astor-Bannerman (Medical) Ltd)
This wall-mounted seat was designed for people with muscular dystrophy. It is powered and can be lowered to within 100mm of the floor with a range of 820mm of height adjustment. The maximum height that can be achieved will be influenced by the height at which it is installed. The seat operates via a hand held control. The SC.ES model has armrests that can be folded back if required, and which are the recommended length to provide sufficient support when standing. The SC.EL model does not have armrests. There are 3 seat options, all of which fold back against the wall when not in use; the standard high-tension waterproof fabric, a padded seat or a padded commode seat. When the seat is padded, so is the backrest. Special seat sizes can be made to order. The maximum user weight is 100kg / 16 stone.

Shower chair 410 (from Pressalit Care Ltd)
This is a fold up shower seat, with backrest and armrests, which is attached to a wall-mounted vertical bracket (incorporating a motor), giving the seat a height range of 500mm. It is operated via a hand held control, which can be hooked onto the armrest. This 500mm of travel is within a range of approximately 190mm up to 810mm, depending on height of installation. (ie if the seat is installed with the lowest height at 190mm, it can travel up to 690mm, or if installed at lowest height of 310mm, it will travel up to 810mm).

There are 2 seat styles to choose from; one has a solid seat with drainage channels (code R7256) and the other has a commode aperture (R7258). These code numbers include a backrest and armrests, which rise up along with the seat. The backrest can be installed at the correct height above the seat to suit the user’s requirements (ie it can be set higher for a taller user). The armrests attach to the backrest, and can fold back if required. The seat (plus backrest & armrests) come in a choice of 5 colours, and the user weight limit is 150kg / 23.5 stones

(The electric motor could be fitted to one of Pressalit’s wall-mounted horizontal tracks, which might be necessary to create space in a very small bathroom, or if the room would be used by different people, such as a school changing area. Depending on the height of installation, the seat could rise by 500mm within a range of either 190-810 mm, or 290-910 mm).
TA Mobile Shower/Toilet Lifter (from Moderna at Nicholls & Clarke)
This is a version of the TA Toilet Lifter in section a) above, but with 4 small wheels. It can therefore be used over the toilet as well as in a shower, in which case a helper would need to push the user from the toilet to the shower area. Alternatively, if required only in the shower area, it could be left in the correct position next to the shower - this would suit someone who is independent, ie able to walk to/from the shower, but who requires powered assistance with “sit to stand”. It is operated by a rechargeable battery, and is free standing (does not require installation).

The differences between this model and the TA Toilet Lifter are:

Lifting range is not quite as high. The seat rises from 480 to 880mm.
User weight limit - 100kg/16 stone.
Backrest - a waterproof fabric backrest; a helper would hold the corners to push the chair.
Seat - square seat with horse shoe commode aperture. (No lid)
Footplates - these rise along with the seat. They can be flipped up to the side, so they are out of the way for front transfers, but they are not detachable.
Castors - 4 castors, with brakes.

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f) Baths

A number of firms manufacture baths that have integral seats that swing in and out of the bath and can be raised and lowered electrically into the bath. The seat should pivot from the corner of the bath so that it projects as far as possible from the side of the bath to ease the process of transfer, and should have the maximum range of height adjustment. This may be essential for achieving the height needed to stand up, and eventually the minimum height may be equally important to ensure that a sliding ‘downhill’ transfer can be achieved from a wheelchair that may not have a height-adjustable seat.

Specialist baths with integral electric seats:
Arjo Solo and Arjo Sovereign baths.
With one exception, these baths all have a seat that supports the bather in an upright position; for many adults this may be the ideal sitting position to facilitate leaning forward to wash, and a suggested model is the Arjo Solo. However, many bathers prefer to recline in the water, in which case the Arjo Sovereign baths are ideal. Please note that Arjo are currently altering their Sovereign range - at the time of writing full details are not yet available.

Further details of these baths are included in Chapter 8a “Equipment for Adaptations”, in 2nd edition of Muscular Dystrophy Campaign’s Adaptations Manual.

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