Nov 24, 2012

Seatbelt Controversy: Safety or Restraint

By Elaine C. Pereira
Alzheimer's Reading Room

Elaine C. Pereira
After more than 35 years working as an occupational therapist, originally in an adult rehabilitation setting but for most of my career as a school therapist, I have received considerable training in maintaining client safety.

Therapists perceive and use seatbelts as safety belts. Belts secure physically challenged children and adults in wheelchairs so they can be transported safely or mobilize themselves without the risk of falling out and/or over.

Imagine a quadriplegic, someone compromised to the extent that Christopher Reeves was, without the support of belts to remain semi-upright in a chair. Tragically he would have slumped out and onto the floor, as would hundreds of thousands of other individuals dependent on physical assistance for safety.

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From the Non-Fiction Book Amanda, Perfectly Made, by Laurel Rausch Greshel

Amanda was getting along great using her new wheelchair in the pet shop until she leaned forward to take a closer look at some fish. She had stopped in front of an aquarium and … as she leaned toward (it), she fell forward and straight out of her chair and onto the ground! The people in the wheelchair place let us leave with our three-year-old in her first wheelchair without a seatbelt! On the way down, Amanda's head smacked some sharp-edged molding… pg 83

Transfer belts cinched around a patient's waist are used for gait training; in fact my dad needed one when walking outside after his stroke. Safety straps are used to secure babies in their car seats and high chairs. Laws require vehicles be equipped with seat belts and shoulder harnesses again for occupant safety.

Regardless of the terminology, regardless of what we call them, safety straps, lap belts, transfer belts, seat belts, shoulder harnesses, etc. are employed appropriately and out of necessity for everyone's safety.

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Seatbelts as Restraints

By striking contrast however "seatbelts," those same innocuous strips of webbing referred to so affectionately as safety belts, are perceived as unacceptable restraints in some populations, mostly non-ambulatory adults with disorienting dementia!

As my mom steadily progressed into Alzheimer's dark haze, her physical movements were less predictable and meaningful. Her arms flailed at times. She fidgeted with her shirt cuffs, shoelaces and blanket bindings. Although her upper body strength remained fairly stable, her legs did not. They were wobbly, weak and unable to support even her petite frame.

But like Houdini, Mom could maneuver out of bed using her arms to pull herself up and over the bedside railing, only to crash to the floor on withering legs. Only God knew where she was going, what she was "thinking" or what warped, distorted vision drove my mom to hurl herself out of bed.

Legally the assisted living facility was required to send Mom to the Emergency Room for "un-witnessed falls." So off she went, three times in fact just in the month of January 2011; alone and confused. Staff tried a bed pressure pad that sounded an alarm if the occupant exited the bed; it worked but usually she had already slid to the floor and back to the ER.

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Next staff tried a pommel insert in her wheelchair (an upward projection between the knees) to help keep mom in the chair. She couldn't fall out of the chair, but she certainly could push herself up and over the armrests and, you guessed it, onto the floor or into a plant or wall, resulting in more ER visits; three in late February.

I knew that a "No we can't do that" response would be the answer to my question "If I sign a release that my mom can have a seatbelt to secure her safely in her wheelchair, couldn't you use it? It has to be a better alternative than multiple emergency room visits and EMS runs!" But of course policy defines that belts are restraints!

I recognize that people have been mistreated by being shackled to bed railings, inappropriately confined or removed to a corner or closet. Straps certainly have and can be misused as restraints. Anyone fragile enough to need adult care—the very young and the very challenged—deserve patience, respect and quality treatment.

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That said, I'm not sure that I can agree with the policy that a seatbelt, which is used in a wheelchair to safety secure one non-ambulatory occupant can also conversely be perceived as a restraint for a different non-ambulatory occupant. Just because one individual has a diagnosis of Multiple Sclerosis, for example, and the other Alzheimer's, does not change the fact that neither person can support their own body weight without falling.

I, for one, would have much rather seen my mom safely belted in a wheelchair than to constantly worry that at any moment, regardless of how close by the staff were, she could flip herself out or pull herself up on the armrests only to crash on wobbly legs.

Seatbelt safety trumps an emergency room visit any day!

But I don't have to worry about the contentious seatbelt safety vs. restraint debate for my mom any more. She passed away July 8, 2011.

Elaine C. Pereira
Elaine C. Pereira is a retired school occupational therapist who worked with special needs children. She earned her bachelor’s degree in occupational therapy from Wayne State University and later completed her master’s degree. Pereira and her husband live in Michigan. Elaine is the author of - I Will Never Forget: A Daughter's Story of Her Mother's Arduous and Humorous Journey Through Dementia

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