New wheelchair

IMG_4188There are certain milestones along this journey of being a parent of a disabled child which are inevitable. Some are actually the omission of milestones: the missing of typical developmental steps, the absence of a first spoken word, there never – in our case – being a first step. Others are very much present: the diagnosis of impairment, the first feeding tube, the first operation.

One of the big ones is the first wheelchair. It’s possible to keep a baby, and then a ‘toddler’, in a buggy for a long time. At some point it becomes clear that the buggy is insufficient and some kind of wheelchair (or the compromise, a ‘Supportive Buggy’ is necessary). This will be for lots of good reasons to do with postural support. It is entirely possible to be convinced by the need for the wheelchair and sad about the arrival of it simultaneously.

Ben had his first wheelchair (more of a supportive buggy) when he was two. It was needed – he didn’t look at all comfortable in the buggy we had for him, and it was showing the strain of near continuous use. So we went for a fitting and a few months later it arrived. We heaved it up the steps to our house.

I wasn’t in love with it, but I could see the advantages. He sat well in it. It folded, so just as with his previous buggy we could lift Ben into his car seat and put the wheelchair in the boot. The slight difference was that doing so injured us almost every time.

Since Ben was still young he often slept in the buggy, and he was sensitive to bright sun, so we asked about a hood and rain cover for the wheelchair (as is standard with  a buggy). It turned out that as these were not ‘essential’, they would not be provided by wheelchair services, but we could choose to buy them ourselves. They arrived just after Max was born and I remember fitting them while James held tiny Max. They worked, but were incredibly clunky and would need to be removed every time we put the wheelchair in the car. They looked like something someone had made in their garage and were as far removed from the slick design of a buggy as you can imagine. I was really cross and after crying for a bit I wrote an extremely grumpy letter to the manufacturers which James had to tone down so that it was only quite cross. We sent them back and found our own solution. I have written before about the way things look here

Since then Ben has had two more wheelchairs, each a bit more ‘wheelchairy’ than the last. Over the last six years we have adapted our house and bought a “Wheelchair Accessible Vehicle” (a car with an in-built ramp, blog about it here) so we have fully accommodated the wheelchair into our lives. I see the wheelchair as an enabler for Ben, and we make do with hats and ponchos so there are no resentful conversations with suppliers of wheelchair hoods.

But what I still struggle with is the particulars of each wheelchair. Ben’s wheelchairs are supplied by our local service which is staffed by great people but, like all NHS behemoths, can be a bit inflexible.

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When we first discussed the possibility of Ben needing a bigger chair last year they showed me the type of chair they thought would be most suitable. Even allowing for the fact that it wasn’t the colour we would pick, and wasn’t set up for him, the chair I saw was really ugly. The base looked to me as though someone had rustled it up out of some spare scaffolding poles. I could see it was practical, and I was told that it was one of the most reliable chairs, but it was winning no prizes for elegant design. The seat was covered in weird synthetic fabric that had a clichéd care home vibe. It was enormous compared to his current wheelchair, and relied on a ‘knee block’ (literally a shaped block, fitted around the knees) to keep Ben in the right position, which he had never had before.

I knew Ben would need a new chair soon, and I respect the opinion of an Occupational Therapist who knew about seating for disabled people. But this was a chair that Ben would use every day, sometimes for 12 hours a day. We would see it every day – in our house, in our car, in family photos. In what other sphere of your life would you think about acquiring something like this and accept the first thing offered to you which happens to be the one in stock? Do people buy cars they hate the look of? Do people get dining chairs that they’re not sure they’re going to find comfortable? There is a huge market for buggies which people spend thousands on and have the kind of designers who formerly worked on Formula One cars.

Of course it would be replaced if Ben wasn’t happy and comfortable, but I really hate the clunkiness of wheelchair design. I resent spending a lot of time incorporating Ben’s needs into the design of our home which – if I do say so myself and may possibly have pointed out before – is beautiful AND fully accessible, only to have it cluttered up with something that may be technically good but is aesthetically shit. It’s unfair to have options for large purchases in every other aspect of our lives, but not this.

The wheelchair service was patient, told me to have a think about it, have a look at other options privately (while recounting some horror stories of chairs breaking and families having to arrange fixes themselves…). Meanwhile, Ben kept growing. An engineer came to adjust the eyegaze mount on the wheelchair and we had another conversation about the chair – we all knew his current chair wasn’t quite heavy enough to support the device, and that a bigger chair would be better. After listening to my monologue about scaffolding poles she mentioned that the base came in different colours. She emailed me later to say it definitely came in black.

And so, slowly, I came round to the idea. The seat fabric could also come in black which made it look a bit less healthcare setting. We eventually ordered the new chair, and it arrived last month. Ben very patiently sat through adjustments and we brought it home with us.

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You know when you are away from your kids for a few days and when you are reunited it’s like you are seeing them anew. You notice the size and the feel of them with a jolt – both familiar and novel. It was like that with Ben in the new chair – it was Ben in a wheelchair, which is our daily experience, but he looked taller and older and relaxed. It made me feel like I must have been squeezing him into a ridiculously small chair before, like we hadn’t noticed that he was now eight. Pushing the new chair is like a dream – no weird knobbly bits on the handle, much less veering unpredictably into gutters. It comes with a tray which is a perk. There’s even just enough room on the side bar for Molly to hitch a lift (don’t tell wheelchair services…)

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There’s of course a little hint of melancholy – it’s wider, it will be a bit harder to squeeze into small spaces. We won’t be able to carry him and it upstairs to friends’ first floor flats like we have done recently. These are sadnesses relating largely to physical barriers, not to Ben’s need for a wheelchair.

Ben’s not hugely keen on the kneeblock so we’re taking that slowly (not as unkeen as we originally thought though – turns out his shoes were too small and we hadn’t noticed which was making him understandably grumpy). It’s all come good in the end. Bring on the adventures.

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A House for Ben

We are adapting our house to make sure it works for Ben. We have moved out and have so far paid builders thousands of pounds to rip things apart and make a perfectly good house look like it’s been hit by a natural disaster.

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(Photo – what will be the lift, lift lobby and therapy/play room)

It’s a big, disruptive, expensive construction project of the kind we (hopefully) will only do once. We plan to move back in to the house next year and then never move again. Or at least not until the house doesn’t suit Ben any more, which we hope won’t be for an extremely long time.

This kind of project throws up a host of issues on every level from extremely detailed (what kind of sockets?) to big questions about the way we want to live our lives. Decisions about designing your family house go to the core of who you are and how you live (or want to live). I’m an architect and these are the issues that first drew me to architecture: how do buildings reflect who we are as people, what we care about and what we do day-to-day. This stuff is deeply personal and others in the same situation would make different decisions. We are extremely privileged to be in a position to be able to craft our house so carefully.

(Photo – hole for the lift in what was the kitchen)

Most buildings in the world are inaccessible to Ben but we can create a little island of utopian level access, where he can go (almost) everywhere and everything is designed to make all of our lives as easy as possible.

But how do you adapt a house for a disabled person who is currently six years old but will hopefully still be living there when they are twenty six?

How to you make a house perfect for the disabled child, whilst not compromising the personality of the property and making it a house for our whole family?

Should we compromise on the kind of house we want to live in to make it disability-friendly? Is it possible to have have a house that works perfectly for a wheelchair user but that isn’t the first thing you notice?

There are two principles that we have had from the beginning: the house needs to feel like a family house, specifically OUR family house with all of the characteristics it would have had if Ben wasn’t disabled; and the house needs to work perfectly for Ben and enable social connections for him – between family and with visitors. We are currently hyper-aware of some of the downsides of being in a house that hasn’t been specifically adapted. It’s getting harder to give Ben a bath, and even small changes in level get harder to get his wheelchair over as he gets heavier. Because it’s less easy to carry him, Ben rarely comes upstairs to our bedroom or to Max’s room.

If you go to as many adapted or accessible properties as I do, you’ll realise that ‘experts’ are often expert in how to make a house work for a wheelchair user and that isn’t the same thing as making a home for all of the members of the family in it. The cheapest and easiest way to adapt houses is often to tack an extension on to the back. This makes lots of sense, except it often involves siblings and parents sleeping upstairs and the disabled child never going to their bedrooms. If, like Ben, the child has carers then you can end up with unofficial zones within the house where the disabled person and carers spend most time in particular parts of the house and there’s not enough crossover with other members of the family.

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(Photo – widened doorway)

Ben will be at the centre of our house, literally. There are three floors, and his bedroom will remain on the first floor. We will all pop in and out, or wander past, his room all the time. It also means we, as parents, remain totally involved in every aspect of his life. Even if there are days when carers are spending most time with him, we are there in the background interfering and suggesting, as is the prerogative of a parent. This will be facilitated by a through-floor lift that will take Ben up to his bedroom, but also further up to our bedroom and Max and Molly’s.

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(Photo – Ben’s bedroom)

Downstairs we will have normal reception rooms (one for family-only since we so often have carers in our house now) with wide doorways, a lift lobby big enough to turn a massive wheelchair and level (or near level) floor finishes. Not a single step on the ground floor. One should not underestimate what a feat this will be involving much chat about thresholds, demolishing a conservatory and building a new dining room. We will have a patio on the same level as the kitchen and dining room, which will ramp down to the garden. Ben will use the same doors as all of us and it should be a mere matter of pushing him where he wants to go, without bumping over ledges and going through alternative doors. The rooms are big enough that when Ben is in even bigger wheelchairs we will still be able to get round him. There will be enough room around the dining table that he should be able to sit anywhere, not just in the one spot that means we can still walk past.

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(Photos – demolished conservatory, building new dining room)

The house will have pieces of specialist equipment, at vast expense, though actually these aren’t as numerous as I anticipated. You don’t need that much stuff if the whole design of the house is built around the idea of a wheelchair being able to get everywhere. The lift is a massive thing (physically and in expense) but a simple idea. There will be track hoists mounted on the ceilings of four rooms (which will mean Ben can be lifted in a sling between wheelchair and bed, for example, rather than being lifted by us). There will be changing facilities on two floors. And there will be a bath.

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(Photo – what will be Ben’s bathroom)

The bath has the subject of much conversation. It is, apparently, easier to shower people in wheelchairs. Easier for carers that is. But we generally operate on the basis of what Ben likes and needs, rather than what suits others. The boy loves baths, so we need a bath. And if that’s a whacking great big thing that goes up and down, needs the floor to be strengthened and a new heating system to produce sufficient hot water, so be it. It will be in a bathroom with two doors – one straight in to Ben’s room so he can go bath-to-bed in one carer-friendly straight line, and one on to the landing that leads to his brothers and sisters bedroom. Because the bath is essentially just a really expensive bath and so it will be the bathroom for all the kids.

We are lucky to be able to ask ourselves how we want our family to work, and therefore how we want our house to facilitate that, and to have the opportunity to alter the fabric of the building accordingly. It is all very exciting but it feels like a huge responsibility – like all construction projects, we’ll only get to do this once and we need to get it right.

(Photo – looking up three stories of the house through the hole made for the lift)

A friend of mine joked that once we have adapted our houses our kids will be able to visit each other, if not anywhere else. It’s not really a joke – as Ben gets bigger and his wheelchair gets heavier it is becoming harder for us to go to other people’s houses with him and we can’t visit places that don’t have disabled access. So the political becomes personal – we want to compensate for the world remaining inaccessible by making our house a truly welcoming place for Ben and his friends.

The way things look

I was struck by a conversation I had with an Occupational Therapist (OT) when Ben was very small – she is perceptive and (typical of all good therapists) sees her work in the context of the whole life of the children she treats. She was commenting on how lovely Ben was and said that would be useful to him because he would probably always need people to help him. It’s true – both that people are always more willing to go the extra mile for people who are smiley and engaging, and that Ben depends on people going out of their way for him.

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Partly as a result of conversations like that, I always try to make sure Ben looks good. I buy him nice clothes that work for him and us (jumpers we can get on/off, coats that fit in a wheelchair) and look smart after a day sat in a wheelchair. I buy things in cheerful colours that will suit his slight frame. I enjoy doing this – I do the same for his brother – but I think it’s particularly important for Ben. We have to maximise the chances of strangers seeing past a disabled child in his wheelchair and noticing the cool little kid. Of course we don’t always manage it (there are plenty of days when both our kids look like Dickensian orphans) but we try.

We are supported by my sister’s attempts to inject cool. I don’t know how many other children wear Nike Air Jordan’s over their ankle-foot orthoses.

[This could all be an elaborate excuse for me to spend more money in Scandinavian clothes shops but don’t tell James that.]

We can’t buy everything from mainstream shops but I seek out the best of the options. Ben dribbles sometimes and he wears a bib all the time so they can be changed easily without his clothes getting wet. Very early on we bought bandana bibs in bright colours which are kind of his trademark now. I hate the idea of him in baby bibs and have known to be quite stern on this front. He’s disabled, no need to infantilise him.

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If he does need specialist aids, I think they should recognise his age. A really good example of this is his hand splints.* ‘I’d really like to wear hand splints’, said no-one, ever, but the designer of these thought about them being for kids, decided against making them flesh-coloured in the hope no-one would notice them, and made them colourful. It’s probably not a coincidence that they were ordered by the OT mentioned above.

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But for some things, particularly equipment, there aren’t many options. It’s a constant source of frustration that things Ben needs are ugly and clunky.

I trained as an architect and care about how things look. I’d rather not have a sitting room filled with supportive chairs, standing frames and walkers but I have no choice. These pieces of kit are helpful and Ben uses them every day so we have to look at them. They are so specific that not many companies make them, so our choices are limited.

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Ben’s bed is the exact opposite of the hand splints. He was growing out of his cot and needed a larger bed that could be raised and angled. Everyone agreed we needed a “profile” bed. Our local social services only supply one kind of these. It’s a full-size single mattress and looks exactly like a hospital bed. The only thing that differentiates it from an adult bed is that it has cot bumpers on the side rails which are flesh-coloured. I can’t begin to understand why anyone would think that was a good idea.

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When I asked if there were any options that would be more suitable for a five year old boy, the therapist (not the one above) suggested we could put stickers on it. I have actually done this. It took an hour to stick stars on every available surface. Now Ben often has a scrunched sticker stuck to him when we get him out of bed, but the bed still looks like it should be on a ward and I resent the fact that while some boys get to sleep in beds shaped like cars, Ben gets the same bed that he recovers from anaesthetics in.

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I have loads of examples on this theme: the time that I ordered an expensive specialist hood for Ben’s supportive buggy which took months to arrive and looked like something a 15 year old made in their school workshop. Actually, not by me at 15 because I’m quite good at making things, but by someone who shouldn’t have taken Design & Technology as a GCSE option. I returned the hood and wrote a letter to the manufacturer explaining why this product was ugliest thing I had ever seen and didn’t even work. Then my husband rewrote the letter to be slightly less offensive and the company said they ‘value feedback from our customers and will act on the constructive elements of your letter’. Ha!

The poor aesthetics bother me, but so does the absence of real design expertise. It’s not good enough for a buggy to just provide the right postural support to a child; that buggy is also going to be pushed by parents and folded up hundreds of times. A buggy that repeatedly injures the adult folding it and causes grandparents to spit expletives is not a good piece of product design.

There is one unanticipated side-effect of all this frustration and lack of control. When Max first needed proper winter shoes I considered giving him Ben’s old boots. They’re specialist, supplied by his physio, but essentially just boots. They’re in pretty good condition since Ben never walked in them!

James told me I was being ridiculous.

So now when Max needs new shoes (which feels like every month), I take him to a shop and choose the shoes I like most. I don’t look at the price and I don’t care whether they are the prudent choice. It is a joyful luxury to choose your child’s shoes based on looks alone and I love it.

* Ben has his hands fisted most of the time and his wrists bent outwards. The splints, which he mostly wears at night, are an attempt to stretch out his wrists and fingers to avoid him losing range in the muscles.