H30 Case report: thinking out of the box for the individual patient

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BackgroundLand van Horne decided to use standard beds for all Huntington disease (HD) patients. When this is inadequate for an individual patient, (mostly due to extreme choreatic movements, extreme risks of falling, unassisted bed exit or physical load caregivers) a specialized bed or bed adaptations are chosen with interference of the care team.Case historyTom is a 38 year old male who stays in bed most part of the day due to his severe progression of HD. Tom is physically strong and capable of instantaneously rolling over from prone to supine and backwards. He occasionally throws his legs over the bed rail. During care moments, which take place with two caregivers, he can be restless and sometimes aggressive. The risk of falls was reduced by using the bed rails turned up during care moments, but this redoubled the physical load of caregivers.The possibility of building a new bed from scratch was debated with a firm who develops products for the healthcare sector. The following requirements for a bed are important; the amount of time and the space needed to pull up the bed rail, the padding of the in- and outside and the width of the bed. In several sessions the requirements were discussed, the technical solutions were searched and consensus was received from involved caregivers, family and OT colleagues. After a satisfying draft and video animation a trail version was build. An implementation plan was composed, and with input from observations and complementary interviews of all involved a few adaptations were made.ConclusionsTom is using the individual designed bed for more then six months. In this time-lapse the risk of falls is reduced and the physical load of the caregivers is back to normal.Thinking out of the box made it possible to solve Tom’s case. This may also help other patients with HD.

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