ADAPTIVE EQUIPMENT MAINTENANCE PROTOCOLS
Contents
1. ADAPTIVE EQUIPMENT MAINTENANCE PROTOCOLS Developed by The D C Developmental Disabilities Administration Adaptive Equipment Task Force DEPARTMENT on DISABILITY SERVICES December 2012 TABLE OF CONTENTS Page INTRODUCTION scicccvstcudiatantidnad nia ddiavedintntisnensieritetianenin 1 ADAPTIVE EQUIPMENT MAINTENANCE 1 ANKLE FOOT ORTHOSES cnn 2 2 CANES EE 5 3 COMMUNICATION DEVICES cccccccccccccceeeeeeeeeeeeeetaees 7 4 DENTURES EEN 9 DEE EE ebe 12 6 HEARING AIDS iriri raa iaia eai 15 7 AHOSPITAL Eet 17 K Een sch icc ric ow a a a 19 GEET IMESU TENS BES ixcat hacen dincreh Gier E 23 9 SHOWER CHAIRS ee EEN 25 10 WALKERS 10 1 Rollator Walker ccccssssssssssssssssssessssseeees 28 10 2 Standard Walker 30 11 EIERE deet 32 APPENDICES Adaptive Equipment Checklists Manual Wheelchairs 0000sssssssseeeesessseeesssssseseeeseseeees 40 Power TEE 41 Wheelchair ne 41 WGK EE 42 Ankle Foot OrthoSes scssessssssssesssssseessessessssssneeeees 42 Shower EEN 42 Hospital E 43 COMMUNICATION DEVICES uk 43 Heanng EE 44 CPAP BiPAP Machines Introduction The proper adaptive equipment is an important aid in maximizing the independence and productivity for people with a variety of developmental disabilities Adaptive equipment decisions should be directed by the person with a disability and their support team and outl2. Page 30 Keeping the equipment clean The walker can be wiped down using an antibacterial cleanser Lysol or Clorox wipes also work well It is important to completely dry the walker using a towel If the walker gets wet be sure to completely dry all parts to prevent rusting The walker should be wiped down weekly or more often if the walker is soiled Responsibility for cleaning Cleaning should be done by someone who can safely bend and lift the walker to ensure a thorough cleaning A caregiver the person who uses the walker or a Direct Support Professional would all be appropriate people assigned to clean the walker Cleaning should be done at least weekly and additionally when soil is noted Storage A standard walker should be folded and placed in a dry place within reach of the person who uses the walker Responsibility for reporting a problem The person using the walker should be supported to report any problems with his or her equipment Any staff member working with a person is also responsible for reporting any identified problems When a problem is noted it should be documented in the progress notes and noted in any communication log specified by the service agency and include 1 the date identified 2 the exact nature of the problem 3 the name of the supervisor who was notified 4 any alternative plans for mobility that may be required The staff member reporting the problem should continue follo
3. Inspect the speaker and only clearing any wax that is easily visible flick the wax using the wax loop or the brush Do not insert the loop too far as this will damage the speaker Hold the hearing aids speaker is facing down and just brush the surface of the hearing aid Battery contacts should be cleaned regularly Use a cotton swab taking care not to bend the contacts Dirty battery contacts can cause improper device function Note Make sure the earmold and tubing are completely dry before attaching to the hearing aid See video on how to clean a hearing aid http www ehow com video 4399814 how clean hearing aid html Responsibility for cleaning Whenever possible the person using the hearing aid should be taught how and supported to clean it If this is not possible the Direct support Professional should clean the hearing aid daily Storage Store the hearing aid in a safe place that s dry and cool Responsibility for reporting a problem Any staff member working with a person is responsible for observing hearing aids for signs of wear or signs that the hearing aid is not functioning properly If a person can he or she should be supported to report any problems with the hearing aid If a person needs assistance it is the responsibility of the Direct Support Professional or any staff who notices a problem to report it No matter who reports the issue the type of problem should be clearly noted in the progress notes section of t
4. ambulatory aid for people with impaired balance mobility pain weakness and decreased safety The H 4 standard walker can provide increased stability to someone who has difficulty walking You will generally find instructions for use consultation report A physical therapist will recommend a walker for a person based upon the therapist s assessment of their mobility strength weight bearing status endurance lifestyle and safety When recommending a walker the therapist must consider the person s height and weight in order to prescribe the correct size walker A standard walker is recommended when a person s upper body strength is adequate enough to handle lifting the walker as they walk The physical therapist will also train the person and family member or caregiver on the proper sequence required for safe ambulation Proper sequence is based on each person s gait pattern weight bearing status and upper and lower body strength Keeping the equipment in working order To allow the walker to move across varying surfaces with ease tennis balls can be placed on the bottom of the legs Ensure that the rubber tips on the bottom of the walker are in good condition if not replace them Avoid overloading the walker with bags as this could cause the walker to tip e When opening the walker make sure that it s properly locked in place Refer to the user s manual that came with the walker for any additional measures
5. and helping the person to apply it in the home This information should be placed in the oral health dental section of the medical record Page 9 Keeping the equipment in working order The dentist can tell the person Direct Support Professional or caregiver how to properly care for and maintain the dentures Rinse the dentures well after using any denture cleanser ADA Look for denture cleansers with the American Dental Accepted Association ADA Seal of Acceptance a symbol of safety Zoch eg and effectiveness ss Keep dentures away from curious children and pets when it is not being worn Keep dentures in water when it is not being worn Do not let them dry out or they will lose their shape Keeping the equipment clean The gums tongue and palate must be brushed every morning with a soft bristled brush before the dentures are put in the mouth This increases circulation in the mouth and helps remove plaque Clean dentures daily Take it out of the mouth and gently rinse it well Be sure to rinse off all loose food particles Just like teeth dentures can have plaque on them they must be brushed daily to remove any plaque buildup To brush the dentures wet a soft bristled toothbrush or a special toothbrush used for cleaning dentures and put denture cleaner on it Gently brush all surfaces Do not use a hard bristled toothbrush It will damage the dentures A liquid soap can be very
6. handle cane may help the user be steadier when walking It is important that the height of the cane is correct for the user Small or large base quad cane Quad Cane This is a lightweight metal cane with 3 or 4 short legs These legs give a lot of support The legs also allow the cane to stand up when not in use This type of cane may be needed if it is hard for the user to keep their balance Canes are typically used to give support and balance during walking or when performing transfers You will generally find instructions for use in the attached instruction manual that comes with the cane Page 5 Keeping the equipment clean Use a mild soap and a soft damp cloth to clean the entire surface of the cane as needed and at least once a week Keeping the equipment in working order Ensure that all caps are firmly attached to the bottom of the cane and that there are no cracks on the cane Responsibility for cleaning and inspecting Whenever possible the person using the cane should be taught how and supported to clean the cane If this is not possible the direct support professional should clean the cane whenever necessary and at least once a week Likewise the cane should be inspected at least once a week to note any cracks bends or problems with the rubber fittings Storage Canes should be stored in an upright position next to the person s bed if they need to use it in the middle of the n
7. in good condition Casters in good condition Frame in good condition Handgrips present _______ Handgrips firmly attach to chair _____ Chair folds properly Seat rail guides present Seat rail guides are working properly Page 40 ______ Removable arms come off for transfer ______ Evaluating leg rests lock in place when raised ______ Handrails attach securely to wheels Handrails are free from loose chrome or rough areas _____ Chair has attachments to keep it from tipping ___ Keep tires inflated at proper pressure see stamp on tire or read manual ______ Pop off wheels lock securely in place on chair ______ Replace worn tires properly Mounts for communication device ______ Wheelchair is clean and in good condition POWER CHAIRS additional information L Not Applicable Age and type of battery All caps are present Moving parts are free of entanglements _____ Electrical connections clean and firmly in place Battery connections are free from corrosion ___ Keep track of battery charge indicator so battery is fully charged charge battery when gage is at half or according to manufacturer s recommendations WHEELCHAIR LIFTS Not Applicable _____ Always back the wheelchair onto the lift Get as close to the back of the lift as possible ______ Do not stand on lift with wheelchair while lift is in motion ______ Lock brakes on a manual wheelchair Turn off power on an electric wheelchai
8. the AFO needs assistance with communication it is the responsibility of the Direct Support Professional DSP or any other staff member who observes a problem to report that problem No matter who reports the issue the type of problem should be clearly noted in the progress notes section of the medical record or noted in any communication log specified by the service agency and include 1 the date identified 2 the exact nature of the problem 3 the name of the supervisor who was notified and 4 any alternative plans for mobility that may be required The staff member reporting the problem should continue following up until the problem is successfully resolved Reference http www orthomedics us Pages ankle aspx Page 4 2 CANES Most canes are made of metal wood or plastic Standard cane This type of cane is usually made of wood z or metal The cane may be 34 to 42 inches 86 to 107 cm d long and may have a rounded crook handle This cane is easy to use and is usually not very expensive A cane that has a wooden or plastic handle is better than a handle made of metal A metal handle may slip from the user s hand if the hand sweats In cold weather the metal handle may get too cold for the user to touch Straight handled cane This cane may also be called a T handle cane and is usually made of wood plastic or metal This type of cane may be needed if the user s hand is weak Using a T
9. the mattress to breathe If a slight new product odor is detected leave the mattress and box spring uncovered and well ventilated This new product odor will dissipate with time and fresh air e DON T bend fold drag or drop Unless a mattress or box spring is made entirely of soft material like foam or cotton or is specially built for folding it probably has a border wire inside that is not meant to be bent Therefore don t bend the mattress or the corners when applying fitted sheets going through doors etc DON T jump or walk on Jumping or walking on a mattress or box spring can damage the interior construction and possibly cause injury Before flipping and rotating a mattress check the user manual to determine if this is recommended Note Most mattresses have a weight limit Bariatric versions are available generally for people weighing more than 300 pounds Check with the vendor before purchase or rental as each mattress has different weight limits Keeping the equipment clean Methods for cleaning the mattress and mattress covers depend on the construction and materials used Check with the manufacturer s manual for recommended cleaning methods as this will affect the performance and warranty of the mattress Responsibility for cleaning and maintenance Direct Support Professionals or other staff designated by an agency supervisor Page 21 Responsibility for reporting a problem The s
10. to prevent dust and dirt from building up on the lenses Responsibility for reporting a problem Any staff member working with an individual is responsible for observing eyeglasses for signs of wear or signs that a new prescription may be needed If a person needs assistance it is the responsibility of the Direct Support Professional or any staff who notices a problem to report it No matter who reports the issue the type of problem should be clearly noted in the progress notes section of the medical record or noted in any communication log specified by the service agency and include 1 the date identified 2 the exact nature of the problem 3 the name of the supervisor who was notified and 4 any alternative plans for mobility that may be required The staff member reporting the problem should continue following up until the problem is successfully resolved References http www ifixglasses com looking after your glasses htm Downloaded 10 16 12 http www readingglassesshopper com resources about eyeglassesy glasses maintenance cleaning reading glasses Downloaded 10 16 12 http www livestrong com article 207143 how to clean eyeglasses with a scratch coat lens Downloaded 10 16 12 Page 14 6 HEARING AIDS Typically used for Hearing You will generally find instructions for use in the user manual Keeping the equipment in working order Always refer to the user manual Maintaining a hearing a
11. using a soft lens cloth 8 Should the fit become loose return them to the optician who will be able to make simple adjustments to make them fit properly again 9 Always use both hands when removing your frames This prevents snagging and reduces the chance of breaking a side temple 10 Wearing your sunglasses on the top of your head may look chic but it stretches them and they won t fit as a result 11 Visit the optician once a year for an annual check up PU Nm Keeping the equipment clean Regardless of finish eyeglass lenses can and will become dirty with daily wear This is especially true in regard to reading glasses as one puts them on and takes them off frequently Page 12 1 Wash your hands with warm water and mild hand soap to avoid transferring dirt and other grime to eyeglasses while cleaning them 2 Rinse eyeglasses with tap water If a pair of eyeglasses is really dirty from working out in the yard or doing some cleaning and they re covered in dirt or dust it s best to rinse them off with water before cleaning 3 Use the right cleaner Most of the time cleaning eyeglasses rids them of oils from skin or hair that get transferred to the lenses from fingerprints A special liquid cleaner specifically made for eyeglasses will help get the smudges off the lens or a formula can be made by mixing one part rubbing alcohol and one part water However the container for this mixt
12. If a piece of equipment is no longer needed DC Shares should be contacted about donating the piece of equipment to their loaner closet Likewise they should be consulted if a loaner piece of equipment is needed DC Shares 1301 Belmont Street NW Suite 1D Washington DC 20009 202 332 2595 phone 202 332 2597 fax 202 332 2596 tty http www dc shares org Page 1 1 ANKLE FOOT ORTHOSES AFO Typically used to An AFO is a brace that surrounds the ankle and at least part of the foot AFO s treat physical problems of the lower limb and is intended to control the position and motion of the ankle compensate for weakness or correct deformities AFO s control the ankle directly and can be designed to control the knee joint indirectly as well AFO s are commonly used to treat foot drop due to Stroke MS Multiple Sclerosis CP Cerebral Palsy Nerve Damage Spinal Cord Injuries Traumatic Brain Injuries and General Weakness AFO s can also be used for positional support for people with Excessive Muscle Tone Paralysis or Congenital Deformity and to immobilize the foot ankle in cases of Charcot Feet Fracture Arthritis or Wound Management Conventional AFO Conventional AFO s are comprised of a metal frame with leather reg straps attached to a shoe This AFO is used for patients with foot drop arthritic ankles diabetic wounds neuropathy and general weakness or instability This design is usually pr
13. age wear and tear or if an individual s condition has changed resulting in a need for new equipment References Adapted from WisTech Assistive Technology Program Wisconsin Department of Health and Family Services Division of Disability and Elder Services Developed as a project of the national Institute for Disability and Rehabilitation Research U S Department of Education under P L 105 394 http atresourcecenter org video mc index html http atresourcecenter org video pc index html Page 38 APPENDICES Page 39 ADAPTIVE EQUIPMENT MONTHLY CHECKLIST Provider Name Individual Name Date Equipment Checked by Please check all that apply MANUAL WHEELCHAIRS O Not Applicable Make of chair Model of chair When chair was purchased Chair provider and Weight bearing limit for chair bei Ee Tool kit is attached to the chair Nuts and bolts are tightened Do not tighten the crossbrace _______Crossbrace folds easily without sticking _____ Center pin moves freely never tighten this bolt Chairs with reclining backs or tilt mechanisms recline and return to upright ______ Wheel locks engage tires properly _____ Footrests present and in working order _ Upholstery in good condition Attaching hardware present and working ___ Seatbelt restraining straps in good condition and being used properly ______ Wheels
14. ative plans for mobility that may be required The staff member reporting the problem should continue following up until the problem is successfully resolved Understanding the cost of repairs and maintenance and what is covered by health insurance Wheelchairs will operate more safely and efficiently if the vendor performs essential maintenance regularly To avoid unexpected expenses and misunderstandings it is best to understand the services that are paid for by the individual s health plan usually Medicaid or Medicare and the services that will need to be paid for out of pocket How repairs are authorized and paid for As a general rule Medicare and or Medicaid will not pay for routine cleaning testing or regular check ups of equipment The vendor will know what charges can be billed to Medicare and Medicaid and what service charges will be the individual s responsibility to pay Page 37 The following general coverage restrictions apply Medicare Medicaid Rental wheelchairs the Medicare Replacement parts and labor rental includes service and maintenance charges are generally covered charges After 13 months of rental the however all labor requires a prior chair is owned by the renter authorization Purchased wheelchairs Medicare pays for reasonable repairs Recipient pays 20 copay Replacement equipment Medicare pays for replacement equipment if there has been permanent dam
15. ces the chair 5 Phone number of the public para transit service or private transport service Page 33 Certain maintenance tasks can be done by the person who uses the chair or staff With innovative design features today s wheelchairs present fewer potential problems however certain common equipment features must be monitored for failure as discussed below Regular maintenance can help extend the life of the chair and reduce the number and cost of repairs Regular service includes keeping the chair clean checking tires for wear and air pressure tightening screws and monitoring for worn out cushions pads positioning equipment and other parts If there is uncertainty about how to perform a procedure or a problem is encountered always contact the vendor All wheelchairs Check the frame for any cracks or breaks in the metal Any potential problems need to be reported to the wheelchair vendor for repairs The upholstery also should be monitored for cracks or tears where the fabric folds or where there are screws through the fabric Any problems related to fabric wear will need to be taken care of by the vendor If a seat cushion is used check whether it is still providing the padding and support the user needs Another regular activity is to check all nuts and bolts on the chair to verify that they are tightened except for the crossbrace pin If any parts need to be replaced be sure that the parts matc
16. e off when not in use This could greatly increase the life of the device and lessen the number of batteries needed Keep the battery fully charged and keep spare batteries on hand Replace dead batteries right away this keeps the device functioning well Keeping the equipment clean Generally these devices are best cleaned using a microfiber cloth for the display screen or keyboard Do not use any solvents especially on the display Keep hairspray heat and moisture away from the device These substances can damage it Responsibility for cleaning Whenever possible the person using the communication device should be taught how and supported to clean it If this is not possible the direct support professional should clean the device whenever necessary and at least once a week Follow any instructions for cleaning as directed by the manufacturer Page 7 Storage It is important to keep communication devices with the person using them at all time However depending on the individual it may be appropriate to use a carrying case when travelling Use the case that came with the device or one recommended by the device manufacturer Responsibility for reporting a problem Whenever possible the person using the communication device should be taught how to report problems with their adaptive equipment If the user needs assistance with communication it is the responsibility of the Direct Support Profe
17. earing limit for chair Page 42 Q Frame is sturdy and does not move Q There are no dents or damage to the frame LI Rubber stoppers are free of cracks or other damage LI All rubber stoppers are in place HOSPITAL BED L Not Applicable _____ Power cord plugged into a wall mounted outlet ______ Chassis Housing clean and in good condition ____ Plastic housings are intact All hardware is present and tight Check casters brakes if in working condition _____ Remove accumulation of lint and thread around casters Check the operation of brakes and swivel locks if the unit is so equipped ______ The AC power plug is intact ____ Inspect the line cord for signs of damage _______ Examine the strain reliefs at both ends of the line cord Be sure that they hold the cord securely ____ Inspect cables of sensors electrodes remote control and their strain reliefs and general conditions Examine all fittings and electrical cable connectors for general condition COMMUNICATION DEVICES C Not Applicable Make of device Model of device Date device was purchased Item Serial Vendor address phone number and website address Battery charged YES NO Device turns on and off and is in working order YES NO Are any pictures symbols missing YES NO Page 43 Are voice messages recorded YES NO N A Does device programming require updating YES NO N A Explain Is carryin
18. effective when used with a denture brush however toothpaste should not be used to clean dentures Some toothpaste varieties have abrasive particles that can damage the denture base and teeth Dentures are very delicate and can break if dropped even a few inches on a hard surface Stand over a folded towel or sink filled with cool water when handling dentures Page 10 Responsibility for cleaning If a person is able to complete his or her own oral hygiene with or without support he or she is responsible for properly cleaning and maintaining the dentures If necessary the Direct Support Professional can periodically check the dentures for cleanliness If a person needs assistance with oral hygiene it is the responsibility of the Direct Support Professional to properly clean and maintain the dentures Storage e Dentures should be kept in water when not in use If dentures dry out they can lose their shape e Dentures should be removed daily to allow the gums and tissues in the mouth time to relax Dentures are normally taken out at bedtime This is an excellent time to soak the dentures in water or in a denture cleaning solution a e Responsibility for reporting a problem If a person is able to complete and maintain his or her oral hygiene he or she should be supported to report any problems with eating speech pain or the denture itself If a person needs assistance it is the responsibi
19. ended by a licensed clinician to promote improved balance and safety when performing mobility tasks A rolling walker allows the person to push the walker as they ambulate as opposed to a standard walker which would require one to lift the walker with each step The rolling walker is ideal for someone with poor endurance or generalized weakness You will generally find instructions for use in a physical therapy consultation report A physical therapist will recommend a walker for a person based upon the therapist s assessment of their mobility strength weight bearing status endurance lifestyle and safety When recommending a walker the therapist must consider the person s height and weight in order to prescribe the correct size walker Page 28 Keeping the equipment in working order The rolling walker should be examined monthly for wear and tear or damage Replace and tighten any missing or loose screws or bolts The rubber tips should be clean and even if they become soiled or worn down replace the rubber pieces with new ones of the appropriate size A lubricant can be used on wheels that no longer roll smoothly but if this doesn t improve performance or the wheels have sustained other damage they should be replaced Keeping the equipment clean It is recommended to wipe down the walker with an antibacterial cleanser or Lysol or Clorox wipes Once the walker has been cleaned allow the walker to completel
20. escribed when skin integrity or lack of sensation is of concern Plastic Solid Ankle AFO Braces made of molded plastic offer a different dimension of support than the conventional metal and leather style A plastic brace that is molded to a model of a persons limb allows even skin contact which decreases the occurrence of pressure points by spreading the corrective force over a larger surface area Solid ankle AFO s are used to maximize the support of the leg in instances of ankle and knee weakness spasticity and for positional support Different versions of the Solid Ankle AFO are also used to immobilize the foot and ankle to manage wounds heal fractures and to decrease pain from arthritis Page 2 Plastic Articulating AFO Plastic Articulating AFO s incorporate an ankle joint to allow as much ankle motion as possible while blocking unwanted movement Molded Ankle Gauntlet Arizona Style AFO Commonly referred to as Arizona AFO s Molded Ankle Gauntlets are plastic solid ankle AFO s sandwiched between two layers of leather The inside of the AFO is lined with soft leather and is padded to cushion bony areas The leather that covers the AFO is stiffer more durable dress leather This design is often used when greater immobilization is needed The Arizona Style AFO is a good treatment option for arthritic ankle pain and for Posterior Tibial Tendon Dysfunction Prefabricated Carbon Fiber AFO Carbo
21. eted at least monthly and more frequently as needed Responsibility for cleaning The DSP who supports the person is responsible for cleaning the wheelchair The agency may assign a single person for monthly cleaning and maintenance but the general rule is if you see cleaning is required clean it following the procedure outlined above Page 36 Storage This depends on the function of the chair If the person is reliant on the chair for all mobility then the chair must be near the individual ready for transfers as outlined in the positioning therapy protocol If the person uses the chair only when travelling long distances then when not in use the chair should be store in a designated area of the residence where it can remain dry and protected from the elements Responsibility for reporting a problem The person using the wheelchair should be supported to report any problems with his or her chair Any staff member working with a person is also responsible for reporting any identified problems The staff member responsible for completing routine maintenance checks should follow maintenance protocols using the checklist found in this manual When a problem is noted it should be documented in the progress notes and noted in any communication log specified by the service agency and include 1 the date identified 2 the exact nature of the problem 3 the name of the supervisor who was notified 4 any altern
22. g case protective case available YES NO N A Is the attachment to the wheelchair secure YES NO N A HEARING AIDS L Not Applicable Verify LIRight ear aid Lett ear aid LIBoth Make of device Model of device Date device was purchased Vendor and phone number Date battery replaced CPAP BiPAP MACHINES Not Applicable Make of device Model of device Date device was purchased Vendor and phone number Mask inspected for signs of cracks or wear YES NO Tubing inspected for signs of cracks or wear YES NO Base unit in working order No unusual sounds from the motor YES NO Filter last replaced Date Issue s identified LI No L Yes List each piece of equipment Reported to Date reported Page 44
23. h those that were supplied by the manufacturer and vendor Check that all parts that fold swivel pivot and are removable do so easily For example be sure that removable arm rests foot rests and braces etc are working properly The crossbrace should fold easily without sticking The center pin should move freely this bolt is never tightened Wheelchairs with reclining backs or tilt mechanisms should recline and return to upright without difficulty Instead of using petroleum oil on the wheelchair use an all purpose silicone lube spray i e WD40 to lubricate the flex points on the chair The wheel lock needs to be checked to be sure that it engages and releases properly and does not rub against the tire The lock needs to operate in such a way that it can be engaged and released without having to use excessive force Also the casters front wheels can present a safety hazard when they are worn out Check casters for cracks in the spokes that may eventually cause the caster to collapse Page 34 Power wheelchairs Power wheelchairs need to be monitored to ensure that moving parts are free of entanglements from wires and cords All electrical connections need to be firmly in place and free of dirt and corrosion If any wires are loosened or removed be sure that they are reconnected in the right place Most power chairs will have color coded wiring to help prevent errors Incorrect wiring connections can damage the cha
24. he medical record or noted in any communication log specified by the service agency and include 1 the date identified 2 the exact nature of the problem 3 the name of the supervisor who was notified and 4 any alternative plans for mobility that may be required The staff member reporting the problem should continue following up until the problem is successfully resolved Page 16 7 HOSPITAL BEDS Typically used for Hospital beds are used for people who need special settings conditions to be optimally positioned in bed Common features include adjustable height for the entire bed the head and the feet adjustable side rails and electronic buttons to operate both the bed and other nearby electronic devices You will generally find instructions for use in the hospital bed manual Keeping the equipment in working order 1 Connect the bed s power cord directly into a wall mounted outlet Make sure that the wall mounted outlet will accommodate a heavy duty or hospital grade plug and that the outlet is in good working order Do not connect the bed s power cord to an extension cord or to a multiple outlet strip 2 Do not cover the bed s power cord with a rug or a carpet Rugs or carpets can prevent normal air flow which can lead to greater heat build up Covered power cords also are more prone to being walked on or having furniture placed directly on them 3 Chassis Housing Examine the exterior of the un
25. ho provides supports is responsible for cleaning The agency may assign a single person for monthly cleaning and maintenance but the general rule is if you see cleaning is required clean it following the procedure outlined above Storage The shower chair can stay in the shower if properly dried after each use Responsibility for reporting a problem Whenever possible the person who uses the shower chair should be taught to report any problems When a problem is noted it should be documented in the progress notes and noted in any communication log specified by the service agency and include 1 the date identified 2 the exact nature of the problem 3 the name of the supervisor who was notified and 4 any alternative plans for mobility that may be required The staff member reporting the problem should continue following up until the problem is successfully resolved Page 27 10 1 ROLLATOR WALKERS Walker with Wheels and a Seat Typically used for Rolling walkers are used to provide enhanced mobility and stability for people with difficulty walking impaired balance and poor endurance The use of an ambulatory aid helps the person to maintain functional independence and safety when performing mobility tasks When choosing a walker it is important to consider the person s height and weight as well as their mobility and cognitive status A walker is an ambulatory aid and should only be used when recomm
26. ia the internet If the shower chair becomes unstable or if the parts shifts when someone sits on the chair the screws and bolts may need to be tightened The shower chair is only to be used during bathing If the shower chair is equipped with wheels it should not be used to transport the individual from room to room The shower chair is not designed as a mobile unit Keeping the equipment clean Shower chairs can be easily cleaned Most shower chairs are constructed from a durable plastic which are intended to withstand water heat and moisture For daily use the shower chair should be completely dried using a towel or shami cloth after each use being careful to dry underneath the chair If the chair is used by only one person it is safe to thoroughly clean the chair twice monthly using a cleanser that will prevent mold and mildew a tile cleaner is the recommended type of cleanser A solution of ammonia and water will also work 1 3 ammonia to 2 3 s warm water All solutions should be properly labeled and safely stored Use a scrub brush to get between small spaces and hard to reach areas Always thoroughly rinse the chair with warm water after cleaning to avoid skin irritation and completely dry the chair to prevent mold bacteria and fungus If the chair is shared by more than one person the chair must be cleaned after each use Page 26 Responsibility for cleaning The Direct Support Professional w
27. icate the chair Page 35 Powerchairs DO DON T Wrap a clear plastic bag over the Dont allow moisture or liquids to power controls if travel must occur in come into contact with electronic the rain parts avoid operating in the rain Keep the battery charged If the Don t allow the chair to get out of battery charge indicator is less than 2 control turn off the power when plug it in for a recharge transferring or when using a Listen to the motor and become wheelchair lift familiar with the sounds that it makes Never allow the battery to You will then notice changes in sound discharge run down entirely this indicating that a belt bearing or other may require replacement of the moving part is malfunctioning battery Keeping the equipment clean Keeping the wheelchair clean will not only help keep the person using it healthy and free of infections but it will make it easier to identify equipment problems as they arise To keep the wheelchair clean wipe down the surfaces with a damp cloth Use a mild detergent or a stronger cleaner for stains and sticky spots Manufacturers often recommend using a car wax on the frame to make regular cleaning easier Use a sharp tool or pick and carefully clean the wheel axle or caster bearing of any accumulation of hair string or other items that can interfere with the rotation of the wheels Overall cleaning should be compl
28. id through daily cleaning and regular service is extremely important Proper care helps retain optimum hearing conditions extends the life of the hearing aid and ensures proper hygiene Handle the hearing aid with care Change hearing aid batteries often so they don t suddenly run out of power e Switch off the hearing aid when not in use If the hearing aid is not used for a long period of time remove the battery Change filters often so they don t collect wax or dirt Don t wear hearing aids in the shower swimming when using a hair dryer hair spray or other types of spray Keeping the equipment clean Clean the hearing aid every day preferably at night Obtain a hearing aid desiccant or dry aid kit from the audiologist It has silica crystals that will absorb moisture It is best to use this method each night after removing the hearing aid from the ear s Remove the battery keep the battery door open and place the hearing aid on top of the foam inside of the desiccant Close the lid and leave it there overnight The following morning remove the hearing aid from the desiccant and wipe the surface of the hearing aid with a tissue That will remove any wax that has adhered to the surface of the hearing aid Page 15 Next clear any wax from the speaker and the vent of the hearing aid Use the tool that came with the hearing aid which will generally include a brush and what is called a wax loop
29. ight If an individual does not need the cane in the middle of the night the cane should be stored in the closet A cane should never be stored lying on the floor as this could cause someone to fall and injure themselves Responsibility for reporting a problem Whenever possible the person using the cane should be taught how to report problems with their adaptive equipment If the user of the cane needs assistance with communication it is the responsibility of the Direct Support Professional DSP or any other staff member who observes a problem to report that problem No matter who reports the issue the type of problem should be clearly noted in the progress notes section of the medical record or noted in any communication log specified by the service agency and include 1 the date identified 2 the exact nature of the problem 3 the name of the supervisor who was notified and 4 any alternative plans for mobility that may be required The staff member reporting the problem should continue following up until the problem is successfully resolved Page 6 3 COMMUNICATION DEVICES Voice Output Speech Generating Devices are typically used for communication language expression You will generally find instructions for use in the user manual Keeping the equipment in working order Refer to the user manual Make note of the date of purchase This is important for warranty purposes Be sure to turn the devic
30. ined in the Individual Support Plan Depending on the specific piece of adaptive equipment a person with a disability can be assisted to communicate move about the community eat with enjoyment and safety and be as independent as possible in meeting their daily hygiene needs Some equipment is fairly inexpensive but many pieces of equipment are costly and require approval for purchase and repair Properly maintaining adaptive equipment is not only important for the cost savings but is especially important because of the importance the equipment plays in the life of a person with a disability Working wheelchairs mean that the person can get around their home participate in favorite community activities and keep their medical appointments Dentures improve a person s appearance and make it possible to eat nutritious foods Communication devices and hearing aids make it possible to communicate with the people around them and to express needs and desires This manual includes recommended maintenance protocols for eleven different types of adaptive equipment It is the responsibility of each staff member who supports a person with a disability to be familiar with all of the adaptive equipment that the person uses to interact with their environment Routine inspections cleaning maintenance and reporting problems are part of the job responsibility of Direct Support Professionals Qualified Developmental Disability Professionals Program Coordinators n
31. ir and result in injury due to a serious burn Batteries will last longer and perform better if they are kept charged Keep track of the battery charge indicator and plug in the charger when the gauge shows less than half a charge Check with the battery manufacturer for specific charging information Practical Advice All Wheelchairs DO DON T Check the tire pressure inflation guidelines are on the outside of the tire Inflate tires with a hand pump or bicycle pump Check to be sure that the wheel brake does not rub against the tire e Wash the upholstery with soapy water at least monthly Check nuts bolts and screws weekly and tighten as needed Check the front casters to see that they turn and pivot properly If caster nut is too tight it will flutter move quickly from side to side if it is too loose it will make the chair difficult to steer Check the wheel alignment Glide the rider less chair on a smooth surface if the chair veers to either side report to the vendor for repairs Inspect the chair for cracks in the frame these should be reported to the vendor Do not inflate tires at a gas station the high pressure can damage the tires Do not wash the chair in the shower or at a car wash excess water humidity can rust parts Do not attempt to oil the bearing on the chair this requires the care of the vendor Never use petroleum based oil to lubr
32. it for cleanliness and general physical condition Be sure that plastic housings are intact that all hardware is present and tight and that there are no signs of spilled liquids or serious problems 4 Casters Brakes If the device moves on casters check their condition Look for accumulations of lint and thread around the casters and be sure that they turn and swivel as appropriate Check the operation of brakes and swivel locks if the unit is so equipped Page 17 5 AC Plug Receptacles Examine the AC power plug for damage Attempt to wiggle the blades to check that they are secure Shake the plug and listen for rattles that could indicate loose screws If any damage is suspected open the plug and inspect it 6 Line Cord Inspect the cord for signs of damage If damaged report to the vendor 7 Strain Reliefs Examine the strain reliefs at both ends of the line cord Be sure that they hold the cord securely If the line cord is detachable it is recommended that the cord be affixed to the unit so that it cannot be removed by the operator 8 Cables Inspect the cables of sensors electrodes remote control and their strain reliefs and general conditions Carefully examine cables to detect breaks in the insulation and to ensure that they are gripped securely in the connectors at each end to prevent rotation or other strain 9 Fittings Connectors Examine all fittings and electrical cable connectors f
33. l dry place If a crack is noticed in the equipment it should be replaced Replacement rubber handles used on the built up utensils can be purchased at a medical supply store or on the Internet Keeping the equipment clean Plates cups and utensils can be cleaned using warm sudsy water and an appropriate dish detergent Equipment can also be sanitized in a dishwasher and should be cleaned after each use Page 23 Responsibility for cleaning Whenever possible the person who uses the equipment should be responsible for cleaning it with or without support If the person needs help a caregiver family member Direct Support Professional is responsible for sanitizing the equipment Storage The equipment should be safely stored in a cool dry place Responsibility for reporting a problem Any staff member is responsible for observing mealtime equipment for signs of wear When a problem is noted it should be documented in the progress notes and noted in any communication log specified by the service agency and include 1 the date identified 2 the exact nature of the problem 3 the name of the supervisor who was notified and 4 any alternative plans for mobility that may be required The staff member reporting the problem should continue following up until the problem is successfully resolved Page 24 9 SHOWER CHAIRS Typically used for A shower chair is a piece of adaptive equipme
34. lity of the Direct Support Professional or any staff who notices a problem to report it No matter who reports the issue the type of problem should be clearly noted in the progress notes section of the medical record or noted in any communication log specified by the service agency and include 1 the date identified 2 the exact nature of the problem 3 the name of the supervisor who was notified and 4 any alternative plans for mobility that may be required The staff member reporting the problem should continue following up until the problem is successfully resolved Page 11 5 EYEGLASSES Typically used to correct vision Keeping the equipment in working order Never place eyeglasses with the lenses down Use a mini screwdriver to keep the screws tight Keep them in a case when not in use Avoid leaving plastic sunglasses on the car dashboard or any exposed area in hot weather as they may distort 5 Clean the lenses with a lint free cloth micro fiber cloths are ideal and available from an optician or drug store 6 Never use paper towels facial tissue hand face towels or the customary hem of a shirt to clean lenses as the abrasive fibers can potentially scratch the lenses 7 Always use a specially formulated lens cleaner to clean lenses because many coated lenses will smear with unsuitable cleaning solutions Never clean dry lenses since small dirt particles could cause scratches or smudges even when
35. moothly minor problems need to be taken care of as well as having the vendor take care of major repairs Know the equipment and be organized The process of maintaining a wheelchair begins on the day that the new chair is delivered Read the warranty and talk with the vendor about maintaining the wheelchair Problems will be efficiently handled if you have the following information and tools available and close at hand e Owner s Manual This book contains valuable information about the wheelchair It describes how to care for the equipment items that are covered under warranty and the tools that are needed for simple maintenance Keep the owner s manual in an established place in the home and refer to it often for guidance Set of Tools Assemble and store a set of tools that will be needed on hand for maintenance and emergencies The following items can be attached to the chair in a pouch or box Phillips and flat head screw driver Allen wrench set crescent wrench spoke wrench and a tire repair kit Information amp Phone Numbers Prepare a card or notepad that lists important information and phone numbers for emergencies This card can be laminated and concealed in the chair The information should contain the following at a minimum 1 Name other contact person address phone number 2 Doctor s name and phone number 3 Wheelchair make model and manufacturer s toll free number 4 Name and number of the vendor who servi
36. n Fiber AFO s are extremely lightweight and durable This style of AFO is best used for isolated foot drop You will generally find instructions for use in the attached instruction manual that comes with the AFO and or the physical therapist doctor will provide the instructions for use and wearing schedule Keeping the equipment clean Use a mild soap and a soft damp cloth to clean the entire surface of the AFO Then allow the AFO to air dry Clean the AFO as needed or at least once a week Page 3 Keeping the equipment in working order Ensure that all straps are attached securely to the AFO and that they work appropriately and ensure that there are no cracks bends or problems with the body of the AFO Responsibility for cleaning Whenever possible the person using the AFO should be taught how and supported to clean the AFO If this is not possible the direct support professional should clean the AFO whenever necessary and at least once a week Likewise the AFO should be inspected at least once a week to ensure that straps are securely attached and in good working order and ensure that there are no cracks bends or problems with the body of the AFO Storage The AFO should be stored along with the person s shoes in their closet Responsibility for reporting a problem Whenever possible the person using the AFO should be taught how to report problems with their adaptive equipment If the user of
37. nt that allows people with limited mobility or impaired balance to bathe more safely in a walk in shower or a bathtub The person can sit down and shower which is optimal for people with poor balance generalized weakness poor endurance or various other medical diagnoses that affect endurance The shower chair provides additional support and increased safety for people for whom without the shower chair may avoid showering in the bathtub this impacts a person s self care independence Instructions for use are generally found in the instructional manual that comes with the chair The manual will offer a detailed explanation of the proper use of a shower chair A licensed clinician occupational or physical therapist will recommend the shower chair based on the person s functional status A formal training session should be completed by the caregiver or staff members who will be assisting the person to use the shower chair e S Te mm vu men Page 25 Keeping the equipment in working order The shower chair is easily maintained if properly cleaned and dried to prevent mold and mildew Check monthly for signs of cracks or bending The rubber stoppers often found on the legs to prevent the chair from shifting or moving may need replacement Refer to the owner s manual for information on replacement parts Parts may also be available at local medical supply stores as well as medical supply companies v
38. or general condition Electrical contact pins or surfaces should be straight and clean Fittings should be tight and should not leak If keyed connectors are used make sure that the keying is correct Keeping the equipment clean Use a damp cloth with mild soap to clean the mattress frame and wiring unplug bed when cleaning wiring Page 18 Mattresses Typically used for A hospital mattress plays a critical role in providing the person with the appropriate comfort and support The wrong mattress could cause discomfort sleeplessness unrest and even injury Therefore it s very important to consider all the details features and options that different mattresses offer Types of mattresses There are 4 types of mattresses typically used with hospital beds They are 1 innerspring mattresses 2 foam mattresses 3 pressure reducing foam mattresses and 4 air mattresses that can either be a alternating pressure b low air loss or c alternating air pressure Innerspring Mattress This is a standard mattress that does not have any built in components to prevent pressure ulcers It s vinyl cover is usually anti bacterial l anti static acid resistant and waterproof i ei Foam Mattress This type of mattress is generally more comfortable when compared to a standard inner spring type hospital bed mattress The person will not sink down into foam but experience a smooth consistent su
39. r Hit unfold deploy to lower the lift all the way to the ground Keep wheels of wheelchair off front lip or flap of lift ______ back wheelchair into van and position it facing forward to comply with the law wheelchairs must face forward Move straps on floor where needed Page 41 _____ Position back straps first above axle on back of chair do not crisscross straps ____ Position front straps best place is above the foot rest _____ Attach safety restraint lap belt across person and wheelchair to comply with the law safety restraint lap belt must be used even though wheelchair has a lap belt _____ Do a final check of all straps and safety restraints WALKERS L Not Applicable Type of Walker Non skid tip in each leg of walker All latches work in folding walker Al latches and buttons lock and work properly on height adjustments _______ Handgrips are firmly attached Replace and tighten any missing or loose screws or bolts Walker is clean and in good condition ANKLE FOOT ORTHOSES L Not Applicable Type of AFO LI If applicable Frame is securely attached to the shoe Q If plastic No cracks or bends observed LI Velcro straps functional LI If present Joints are movable Q If Arizona model leather is intact and laces are functional SHOWER CHAIRS LI Not Applicable Make of chair Model of chair When chair was purchased Chair vendor and phone number Weight b
40. rface without feeling bed springs like the inner spring types It is designed to aid in the prevention and treatment of pressure ulcers Page 19 Pressure Reducing Foam Mattress These mattresses have diversified levels of foam with the top layer typically made of die cut high density foam in the head and torso area and special high resilient foam in heel area providing a comfortable pressure reducing environment Alternating Pressure Mattress Alternates inflation and deflation of cells to constantly change pressure points and promote circulation It redistributes the users weight and relieves pressure Ideal for situations where maceration and heat build up are an issue the mattress is designed to resist moisture and is suitable for the prevention and treatment of all stages of pressure ulcers Low Air Loss Mattress Floats the person on air filled cells while circulating air across the skin to reduce moisture and help maintain a constant skin interface pressure True Air Loss utilizes 100 150 liters of air per minute to maintain normal skin temperature and moisture levels yet will not dry out therapeutic dressings Page 20 You will generally find instructions for use in the owner s manual Keeping the equipment in working order Use a protective pad A good quality waterproof pad is a must to keep the mattress fresh dry and free from stains Allow
41. ssional or any other staff member who observes a problem to report that problem No matter who reports the issue the type of problem should be clearly noted in the progress notes section of the medical record or noted in any communication log specified by the service agency and include 1 the date identified 2 the exact nature of the problem 3 the name of the supervisor who was notified and 4 any alternative plans for mobility that may be required The staff member reporting the problem should continue following up until the problem is successfully resolved Page 8 4 DENTURES Dentures or false teeth are prosthetic devices constructed to replace missing teeth They are supported by surrounding soft and hard tissues of the oral cavity Dentures are typically used for 1 Chewing 2 Providing a natural facial appearance and support for the lips and cheeks 3 Articulating and pronouncing words and 4 Improving self esteem You will generally find instructions for use The dentist will tell the denture wearer how to care for the dentures and the necessary equipment needed for example denture cleaning solution toothbrush denture adhesive etc The dentist will also check to see if the dentures fit properly and if any adjustments are needed If the person needs support to maintain his or her oral hygiene the Direct Support Professional is responsible for getting the information from the dentist
42. taff member who notices a problem should report it to their supervisor The supervisor should then contact the vendor in order for repairs to be made No matter who reports the issue the type of problem should be clearly noted in the progress notes section of the medical record or noted in any communication log specified by the service agency and include 1 the date identified 2 the exact nature of the problem 3 the name of the supervisor who was notified and 4 any alternative plans for mobility that may be required The staff member reporting the problem should continue following up until the problem is successfully resolved Page 22 8 MEALTIME UTENSILS Adaptive Plates Utensils and Cups Typically used to help people with impaired upper extremity strength or neurological impairments to 1 promote independent eating for as long as possible 2 assure maximum comfort and dignity during meals and 3 maximize food intake for people who have difficulty eating independently d r bei P eh You will generally find instructions for use in the occupational therapy or speech therapy evaluation Note It is often recommended to order two of each piece of adaptive mealtime equipment when financially feasible to avoid the person being without their equipment while waiting for replacements Keeping the equipment in working order The equipment should be properly cleaned dried and stored in a coo
43. ure must be clearly labeled 4 Use the right cloth It is also important to use the right type of cloth to clean eyeglasses Some textiles like a tissue wool or certain synthetic fabrics can scratch the lenses or leave behind unwanted fibers A microfiber cloth or a lint free towel works nicely to remove oily smudges because of the soft material and tight weave of the fabric 5 Hold the glasses correctly When you are getting ready to clean eyeglasses they should be held by the temple near the front of the frames to get a good grip without touching the lenses 6 Spray the front and back of the lenses 7 Gently wipe from one side to the other using a circular motion Use a gentle circular motion and wipe from one side to the other Don t just wipe across the lens or scrub back and forth Note that cleaner removes body oil not only from the lenses but the nose pads hinges and screws Don t neglect these areas when cleaning as body oil can loosen them and cause breakage Page 13 8 Clean the nose pads hinges and frame arms with the lens cloth using more spray if necessary Responsibility for cleaning Whenever possible the person wearing the eyeglasses should be taught how to properly care for them When that is not possible the Direct Support Professional who supports the person is responsible for checking the eyeglasses at least twice a day Storage When not in use keep eyeglasses in a case
44. urses and other therapists Each staff member is also responsible for following up on problems related to adaptive equipment until the problem has been resolved Whenever possible the person who uses the device should be taught how to inspect the adaptive equipment they use for wear clean it and report problems Proper and regular maintenance will ensure that the equipment is available for use and will extend the life of the equipment In general the instructions for use that come with the equipment should be followed and filed for future reference The Providers are required to complete the monthly adaptive equipment checklist by the 5t on the month for a person that has adaptive equipment needs identified in his her ISP If any problems are identified the Provider is responsible for documenting the adaptive equipment need on the adaptive equipment tracking form in MCIS within 24 hours of identifying the need Representatives from DDS DDA will receive an email notification that an adaptive equipment need has been entered This manual outlines the purpose and use of various pieces of adaptive equipment that are commonly used It includes simple to follow instructions for staff Each agency should include clear responsibilities for the inspection cleaning and maintenance of adaptive equipment within position descriptions In addition one person within each agency should be responsible for tracking the ordering maintenance and cleaning of equipment
45. wing up until the problem is successfully resolved Page 31 11 WHEELCHAIRS Arm Tire Seat Be Ki Be Cross brace Foot rest Typically Used For Wheelchairs allow people to be mobile and active and to sit up and engage in activities including meals Proper position also helps to maintain skin integrity You will generally find instructions for use in the physical therapy evaluation Make sure you are referencing the most current assessment Keeping the wheelchair in working order If a wheelchair breaks down it can be an inconvenience a hardship and may even put someone in danger The life of a chair will be maximized by taking care of problems before the chair is put out of commission and having a handy list of providers that can be relied on for repairs parts and maintenance Whenever possible the person who uses the wheelchair should be in charge of this process with or without support If not the Direct Support Professional DSP plays an essential role The user of the chair and those people who provide everyday supports will usually be the first people to notice when the chair is not functioning properly Page 32 A routine should be established that can be followed by the person support staff family members or other caregivers to monitor the chair for problems The routine should include basic daily and weekly cleaning and upkeep To keep equipment running s
46. y dry If the walker gets wet be sure to dry it off completely with a towel to reduce the incidence of rusting The walker should be thoroughly cleaned weekly and more often if the walker is soiled Responsibility for cleaning Cleaning should be done by someone who can safely bend and lift the walker to ensure a thorough cleaning A caregiver the person who uses the walker or a direct care professional would all be appropriate persons assigned to clean the walker Storage Walkers can be folded and stored in a closet or up against a wall they are light weight and can be easily stored in a car or van It is important that the walker be within reach and sight and easily accessed by the person who uses the device to reduce the incidence of attempts to ambulate without the device Responsibility for reporting a problem Whenever possible the person who uses the walker should be taught to report any problems When a problem is noted it should be documented in the progress notes and noted in any communication log specified by the service agency and include 1 the date identified 2 the exact nature of the problem 3 the name of the supervisor who was notified and 4 any alternative plans for mobility that may be required The staff member reporting the problem should continue following up until the problem is successfully resolved Page 29 10 2 STANDARD WALKERS Typically used for i A standard walker is an
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