Whether you are an OT working with a young child with cerebral palsy or an aging adult with multiple sclerosis, adaptive equipment has its place in occupational therapy intervention across the lifespan and for multiple health-related conditions.
For OT students or new graduates, incorporating adaptive equipment education into therapy may seem overwhelming at first…simply because you haven’t been exposed to the most common adaptive equipment yet.
With that in mind, we have decided to list several pieces of adaptive equipment that students and new OT practitioners should be familiar with fresh out of school. But first, let’s answer a couple relevant questions.
What Items are Considered Adaptive Equipment (AE)?
There is a clear difference in definition between “adaptive equipment” and “durable medical equipment (DME)” which is important to understand for education and insurance purposes. Adaptive equipment, or adaptive devices, are specifically designed to improve or maintain someone’s functional participation in activities of daily living and mobility.
If a person halts in restorative recovery (i.e. strength, functional activity tolerance, etc.) and still struggles with ADL participation, AE takes them one step further in their independence. Adaptive equipment can range in complexity, from tying a rope ladder to the edge of the bed to installing a heavy-duty shower bench. The differences between AE and DME boils down to medical necessity and what is prescribed by a physician.
According to Medicare, DME is:
“…any equipment that can withstand repeated use when used for a medical reason. The equipment must have an expected lifetime of three years and it must not be considered useful to someone who is not sick or injured” (Romanoski & Snope, 2018).
Examples of DME include walkers, wheelchairs, power chairs (if needed for home use), lifts, crutches, commode chairs, hospital beds, and even some respiratory equipment such as home oxygen.
Does Insurance Cover Adaptive Equipment?
Typically, no. According to Medicare, Medicaid, and the majority of private insurance companies, AE is not considered medically necessary equipment. Rather, insurance companies view AE as equipment of convenience. Outrageous?
A well-practiced OT who works with a wide variety of medical conditions that impact functionality would say yes! However, that is a fight for another day.
Let’s use the following scenario for some clarification:
Cynthia is a 58 year old female who recently transitioned from the hospital to skilled nursing to participate in continued rehabilitation for a right-sided total hip arthroplasty. While at the facility, the OT evaluated her for therapy services and recommended she use a shower chair, a hip kit, and a raised toilet seat. She lives alone in a very old, split-level home and already owns a walker for mobility secondary to rheumatoid arthritis. She has a tub-shower combination, a rather low toilet seat, no grab bars anywhere in the home, and no other AE.
Yes, a woman with a history of rheumatoid arthritis could benefit from using multiple pieces of AE, but for simplicity purposes we’ll only focus on equipment mentioned. Insurance will more often than not cover the AE while she stays in skilled nursing.
However, when she discharges, she is on her own for purchasing the shower chair, the hip kit, and the raised toilet seat to be used in her own home if she requires it (Medicare Interactive, 2020). Sometimes, patients can find loopholes in coverage through Medicare Advantage plans and other insurance policies if they look hard enough.
The following is a comprehensive list of basic adaptive equipment that students and new OTs should be aware of broken down into ADL/IADL categories.
Dressing
Button hook: primarily used to button shirts with the use of one hand.
Dressing stick: long sticks with hooks on the end in order to don and doff lower-body clothing; minimizes the need to bend over at the hips.
Shoe horn: long, contoured item used to slide the user’s shoes over their heels with greater ease; prevents the need to bend over or to cross the legs over to secure the shoe over the heel.
Reacher/grabber: multi-purpose stick with a manual trigger that pulls the grabber on the end closed; used to reach for small items that are inconveniently out of reach such as the floor or high cupboards. Can also be used for dressing.
Sock aid: equipment piece that cups over the foot; the user dresses the cup with a sock and pulls it over the foot with two ropes in order to pull the sock onto the foot; minimizes the need to bend over to don socks.
Toileting
Raised toilet seat: comes with and without side rail and back supports; used commonly for hip surgeries and other injuries to open the hip angle and to minimize quadriceps muscle recruitment in sit-to-stand transfers.
Toilet aid: longer stick with an adhesive feature (or clip) to secure toilet paper for perineal care; used by persons who struggle reaching underneath or behind themselves to properly wipe after toileting.
3-in-1 commode: The 3-in-1 bedside commode can be used as a raised toilet seat, a separate toileting commode, and a shower chair; used by persons with moderate to severely limited mobility. This can also be used for post-operative patients temporarily.
Showering/Bathing
Grab bars: Can be permanently installed in the walls for toilet and shower/tub transfers. Suction-cup models are available but are not nearly as sturdy and should only be used as a “touch-point,” therefore we typically don’t recommend these.
Non-slip mats: placed in the bottom of the shower or tub to prevent slippage and falls.
Removable showerheads: a showerhead that is hooked to a cord and can be taken down by the user while showering; useful for persons who need to bathe while sitting.
Shower chairs: comes in many different makes and models: back/no back, arm-rests/no arm-rests, height-adjustable legs, suction-cup feet, bariatric/standard weight capacity, etc. Shower chairs generally fit best in walk-in showers and minimize risk for falls in persons with compromised standing balance or decreased activity tolerance.
Tub benches: practical for tubs and shower/tub combos; commonly tub benches are draped over the edge of the tub so the user can slide into the shower without doing too much work lifting the legs over.
Long-handled sponge: elongated plastic handle attached to a sponge or loofah; useful for persons who struggle with bending at the hips to wash the lower body.
Soap dispensers: installed in the shower or tub to prevent dropping soap bottles; comes with easy-to-push buttons to access soap which is beneficial for persons with arthritis, weakness, and motor coordination issues.
Tub clamp rail: handle that clamps to the edge of the tub so that bathers can transfer out of the tub safer and easier.
Leg lifter: easily used for other transfers and bed mobility, leg lifters have a loop that wraps around the lower leg so that the user can easily pull the leg over the edge of the tub or into bed.
Hygiene
Toothpaste dispensers: alternative containers with single-hand push-down features.
Elongated sink faucets: temporary placement of a faucet sleeve to ease the user’s reach of the water.
Built-up toothbrushes: Thicker handles for toothbrushes for ease of fine motor coordination and grasp.
Adaptive hair brushes: Thick-handled brushes, open-handed handles, etc.
Self-feeding
Universal cuff: hand strap that secures feeding and hygiene utensils for persons who lack the grasp and fine motor coordination.
Built-up silverware/utensils: Thick-handled silverware or slide-on handles.
Weighted silverware: Heavy-handled silverware for tremor-like hand movements.
Off-set silverware: Bent/angled silverware for limited hand range-of-motion.
Nosey cups: cut-out cups for persons with limited neck motion and/or swallowing precautions.
Plate guards: metal or plastic guards placed around the edge of the plate to prevent food from sliding off and easing the scooping process.
Dycem: rubber-like meal mats to prevent plates from sliding on the table while eating.
Rocker knife: a rounded knife that requires a gentle rocking motion for use; beneficial for one-handed meal preparation or weak hand strength/grasp.
Can openers: range from manual, ergonomically-friendly devices to electric openers; useful for single-hand use and weak hand strength or limited dexterity.
Jar openers: range from manual clip-on jar openers to electric jar openers; useful for limited hand use.
Cutting boards: specialty adaptive boards such as the Swedish cutting board that can be used for cutting foods single-handedly or with ease.
Knob turners: turners that can easily adhere to knobs and buttons such as those on ovens or cupboard doors; some models come with extenders for persons with limited reach.
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And that’s a wrap! We hope this list gives you a solid run-down on the “must-know” pieces of adaptive equipment for a wide array of conditions. If you get overwhelmed, keep in mind the rehab and medical equipment professions continuously produce new and innovative adaptive equipment products, so don’t feel like you have to know 100% of the pieces all of the time.
That being said, all novice practitioners should enter the occupational therapy world with a basic knowledge of common AE and should try to stay updated on new equipment coming out to better their patients’ care.
References
Romanoski, L. & Snope, K. (2018). Durable Medical Equipment that supports activities of daily living, transfers, and ambulation. PM&R Knowledge Now: The American Academy of Physical Medicine and Rehabilitation
Types of medical equipment Medicare covers for home use, Medicare Interactive.
This post was originally published on January 27, 2021 and updated on July 31, 2023.
