Step by Step Toileting with the TRAM

David Anderson is a senior physical therapist with the New York City public school system. His school obtained a Rifton TRAM to help with toileting a particular student. After some trials, he and the school OT determined the best methods for using the TRAM for this purpose and created a set of instructions for the paraprofessionals working with this student. David shared it with us and we found it so helpful we’d like to share it here. It has been adapted slightly  for this purpose.

Steps for Using the Rifton TRAM for Toileting

TRAM battery and wheelchair position:

• Install battery, close the battery box, check for green light.
• Position wheelchair and set brakes. Remove both laterals and leg rests.
• Scoot client all the way back in wheelchair and remove both wheelchair arm rests.

Position the Body Support System:

• Position TRAM to face the wheelchair and spread the legs fully. Press the down button to lower the body support.
• With the client leaning forward bring TRAM toward wheelchair until the body support touches the chest and abdomen.
• Press the red-tipped caster swivel locks down and set the brakes.
• Buckle the body support around client’s trunk and tighten the strap. Do this incrementally until body support is snug and secure. 

Prepare Thigh Straps and Lift Client:

• Position the two thigh straps with the smooth gray side of the padding facing up. Attach one metal ring of each thigh strap to the yellow clips at the front of the body support system.
• Evenly shorten the straps until there is 1.5”of strap between the metal rings and the buckles.  Lengthen the webbing straps with rings at the other end of the thigh straps.
• With gray side of padding facing up slide the thigh straps under the client’s inner thighs toward the outer thighs as far toward the buttocks as possible and comfortable.
• Attach metal rings onto the gray clips. Evenly tighten the ends of the thigh straps that are attached to the gray clips.
• Release caster swivel locks and brakes.
• Raise the client up ensuring that thighs are parallel to the floor. Pull TRAM away from wheelchair.
• Rotate the leg expander to the narrow position.

Maneuver TRAM to Toilet and Adjust Clothing:

• Move the TRAM so that the client is positioned directly above the toilet. Lower the client until feet barely touch the floor.
• Press the swivel locks down and set the brakes.
• Tighten the rear end of each thigh strap while the rings attached to the gray clips remain in place. Unclip the metal rings from the gray clips. As each thigh straps is unclipped position client’s legs with feet firmly on the floor.
• Slide both thigh straps free and hang them over the front of the TRAM to stay out of the way. Pull the client’s pants down encouraging the client to use the forearm supports to temporarily bear weight.
• Lower the client onto the toilet seat using the down button.
•  Release the buckle at the back of the body support system and move TRAM out of the way so that the client can attend to toileting needs.

Return to TRAM and Wheelchair after Toileting:

• After toileting is completed return TRAM into position and attach the body support system as before.
• With the client using the forearm supports raise until weight-bearing is achieved through the feet, then pull up pants.
• Check that the front metal ring of each thigh strap is properly attached to the yellow clips on the TRAM. Then lengthen the other end of the thigh straps so there is plenty of slack.
• Thread thigh straps from inside thighs to the outside of the thighs, with gray side of padding up. Attach metal rings to the gray clips, and tighten the strap closest to the gray clips lifting the legs as needed.
• Raise the TRAM a bit until client is clear of the toilet. Release caster swivel locks and brakes. Move TRAM to face the wheelchair and expand base with the leg expander.  
• Move TRAM to position client over the wheelchair and set the brakes. Lower the TRAM until the client is seated in wheelchair.
• Lengthen the back of the thigh straps near the gray clips as needed and remove the metal rings from the gray clips.
• Slide thigh straps toward the front until they are free. Hang them over the front of the TRAM to stay out of the way.
• Release the belt buckle of the body support system (loosen the belt strap first if desired.)
• Release brakes and move TRAM away from the wheelchair.
• Re-attach the laterals and leg rests and armrests of wheelchair and make sure client is comfortable.