Determination of Grab Bar Specifications for Independent and Assisted Transfers in Residential Care Settings

Introduction

The current Americans with Disabilities Act Accessibility Guidelines (ADAAG) for toilet and grab bar configurations are based primarily on the capabilities of young people, and as such may not account adequately for range of comorbidities and secondary conditions that are common among older people with disabilities. Previous studies indicate that there is a need for alternative ADA Accessibility Guidelines for the Elderly which are tailored to meet the unique needs of older adults.

Staff built toilet simulation with grab bars used to measure distance, obstructions and how people move through the space, sit, get up, etc.

Specific Aims

The purpose of this project is to identify, both objectively and subjectively, the spatial and configurational dimensions of grab-bars that effectively support both independent standing and one- and two-person assisted toilet transfers of older adults living in senior housing. Based on the literature, the critical technical requirements to be identified in the proposed research include:

  1. Grab bar configuration – Optimum positioning of grab bars at various points of transfer (standing from wheelchair, pivoting, disrobing, sitting on toilet, standing from toilet, donning clothes, pivoting, sitting in wheelchair).
  2. Grab bar extension - Overall Length of grab bar beyond front of toilet as measured by the length of grab bar from back wall minus length of toilet from back wall.
  3. Clear floor space for assisted transfer. Unobstructed floor space adjacent to toilet as defined by the depth of the space parallel to the toilet measured from the front of the toilet and the width of the space perpendicular to the toilet measured from the side of the toilet to the nearest obstruction.
  4. Distance between parallel bilateral grab bars. The distance between grab bars on either side of the toilet as measured by the distance from the center line of the toilet to the centerline of the grab bars.

Two young women posing with sensors on body, these women participated in the research

Research Design

To provide a convincing argument for changing or supplementing existing guidelines and standards, it is imperative that objective, quantitative data support traditional qualitative ones. As a result, the study will include both self-report data from elders and their caregivers (e.g., perceived difficulty, safety and preferences) and observational data from experts (e.g., OT observations of difficulty and safety), as well as objective biomechanical measures of forces, balance, posture and muscle activity. Thus the study will combine both field- and lab-based data collection procedures in a four-phased project, where each sequential phase is designed to build on the outcomes of the previous phase.

The four phases are as follows:

  1. Field Trial of Configurational Preferences. User preferences for configurations of existing bilateral fold down grab bars will be determined by allowing both residents and staff to adjust: 1) grab bar height, side and front distance from toilet, and position (vertical and horizontal); and 2) distance to closest obstruction (lavatory on one side, wall on the opposite side).
  2. Laboratory Force/Strain Analysis. Identification of critical locations for force measurement using finite element analysis (FEA) and subsequent force measurement using strain gauges to determine maximum loading and the stress/strain distribution within the grab bar.
  3. Laboratory Biomechanical Evaluation Determine relative efficacy of: 1) preferred configurations + 1 SD (90th percentile), and 2) ADA configuration for independent (Figure 1) and 1- and 2-person assisted transfers, based on biomechanical analysis of forces, torque, trunk flexion, balance and electromyographic (EMG) activity of leg and back muscles as well as self-report and observational data.
  4. Validation Field Trial Replicate Phase 1 and determine force data to validate the most efficacious configuration/dimensions from the laboratory testing in the field.