Special Report: Paving the Way Toward Better Health

by Bill Dupes

The bathroom is one of the places in your home where the ability to do things independently is extremely important. While in the bathroom, most people want to be alone if at all possible.

Showering, bathing, shaving, brushing your hair, brushing your teeth. Though these are activities that many take for granted, people with limb differences can find them very difficult to do alone. Your daily grooming routine is made up of movements that require hand and wrist dexterity and flexibility, arm extension and rotation, balance, strength and coordination. When these movements are difficult or painful, grooming can be a frustrating or even risky experience without the aid of assistive devices.

Unfortunately, because assistive devices for independent living are produced by only a small number of manufacturers and there is only a small market for them, they can be expensive. Moreover, Medicare does not cover the cost of bathing equipment, including bath seats, hand-held shower heads or grab bars.

With a little thought and ingenuity, however, you can find ways to do these activities with homemade or easily available and inexpensive aids. You shouldn't neglect safety for convenience, however.

More accidents happen in the bathroom than in any other room in the house. In fact, the U.S. Consumer Product Safety Commission reports that more than 110,000 accidents occur in bathtubs and showers annually.

Get a Grip on Your Dental and Hair Care

Prosthetic hands and hooks often do not grip small or thin items as well as the human hand does. As a result, these items might be difficult to control or might slip out of your prosthesis. A simple and inexpensive solution for this problem is to add thicker, less slippery handles to such items as your toothbrush, comb, hair brush, bath brush and flossing device.

If you can't find these items with readymade built-up handles, you can make their handles larger and easier to grip by wrapping them with a short section of foam rubber tubing. Or you can simply insert some of the items into a bicycle handle grip. Also, if your prosthetic device has a limited range of motion and you can't quite get to those hard-to-reach spots with your bath brush, try attaching it to a wooden dowel or a flexible wire.

An easy technique for brushing your teeth without arms is to use a battery-powered toothbrush. If you can get toothpaste on it, turn it on, and get it in your mouth, you can use your mouth to move it around inside, letting the vibrating toothbrush do the rest.

Flossing with the traditional string-style floss would clearly be difficult for a onehanded person. Today, however, a onehanded person can take advantage of the newer “tuning fork” flossing tools, which do not require two hands.

If you have no hands and normally dry your hair with a hair dryer, you can mount it on the wall and simply move your head around in front of it until your hair is dry. The bracket that holds the dryer should allow movement, however, so that the dryer can be tilted in various directions.

When it comes to shaving, an electric rotary razor is much kinder and gentler than a blade. Flexible-headed razors require less hand movement to reach awkward places, and are often bulky enough to be used with a prosthesis.

If you use a wheelchair at the sink, any exposed pipes underneath should be wrapped to avoid burning your legs. Whether you're seated or on your knees in a locked wheelchair, a folded towel or a thin pillow on the front edge of the counter will make long periods at the sink much more bearable.

Finally, you'll probably like to look at yourself in the mirror to make sure you don't leave toothpaste on your chin or unknowingly leave the house with “bad hair.” Two simple ways to make sure that you have access to a mirror where you need it is to install a full-length mirror or to mount a magnifying mirror in a convenient location, preferably next to an electrical outlet.

Grab Bars

Grab bars help support you while you are getting in and out of the bathtub, reducing your risk of a fall. They can be installed on the walls or on the side of the tub. Wall-mounted grab bars, installed properly into walls that are in good condition, are considered more stable than tub-mounted bars. Tub-mounted bars don't require structural support from a wall and have the added advantage of easy removal, but they must be used with caution because they can easily (and suddenly) detach if fastened incorrectly. Test them carefully in advance by applying force in several directions before relying on them for support.

Although they come in different shapes and sizes, grab bars have common safety characteristics and requirements. Flanges on the ends of the bar should have sturdy screws for installation, preferably into wall studs. There should be enough room between the bar and the wall for you to get a good grip. They should be made of plastic or rust-resistant metal, with a rough surface to prevent slipping.

Bath Seats

A bath seat or transfer seat can help if you have difficulty with your balance. A waterresistant chair or bench is ideal because it allows you to sit at a normal height while washing. A bench that extends to the outside of the tub will enable you to sit down on it first and then slide to the inside. You can also use a regular plastic camper seat or patio chair, preferably with openings in the seat to allow drainage. Nonslip pads or sections of rubber hose glued to the feet of the chair will help to stabilize it and protect the tub enamel.

If you want to fly solo, you might try getting into the tub by sitting on a corner edge, leaning against the side wall for support, turning slightly and placing your feet one by one into the tub. Reverse the procedure to get out. A bench or chair placed beside the tub can be helpful, too (you might have to cut the legs so that the seat matches the height of the tub). A rubber mat on the side of the tub may also help to prevent slipping during transfer.

Keep Things Handy

Bathing is easier if everything you need is close at hand. If you bathe in a tub rather than showering, you can buy or make a shelf to sit firmly on the edges of the tub to hold soap, brushes or a magazine.

A more flexible option is a wire-frame shower caddy with suction cups that can be attached wherever you wish. You can also find a variety of rings and hooks to add more items to the caddy; the classic “soap-on-a-rope” is always handy, and some squeeze bottles of soap and shampoo are designed to hang on a hook as well. Other soaps and shampoos are available in pump dispensers.

Slippery When Wet

One of the most common problems that amputees encounter is maintaining balance while bathing and climbing in and out of the bathtub. Most tubs don't have adequate slip-resistant finishes. To reduce the chance of a slip injury, your bathtub floor should have either a rubber mat anchored with suction cups or nonslip adhesive strips. Bath strips should be placed close to each other so that very little of the bathtub floor comes in contact with your foot.

Various floor materials respond differently to being wet. Some new ceramic tiles and rubber-based linoleum have better slip-resistance. Keep the floor clear of rugs or small objects on which you could slip or trip, and use cleaning products that don't leave a slippery film.

Go With the Flow

Scalding is another hazard of showering. Always check the water temperature before you get into the shower. This is particularly important for people with diabetes. Diabetic nerve damage can leave your feet numb and unable to feel heat, cold or even pain. And if you can't feel pain, you might not notice any blisters until you have an infection.

You might want to try one of the many hand-held shower heads on the market, particularly if you shower in a seated position. Handheld units also allow getting into the tub without stepping directly into a stream of water, reducing the chance of slipping. Some models are made of rubber to fit over the tub tap, while some require installation but allow more freedom of movement. Make sure you can reach the mounting bracket from your seat and that the hose is long enough for you to spray all parts of your body. The handle should be easy to grip, and any knobs or controls should be easy to use (even when wet).

For more ideas, consult an occupational therapist or independent living specialist in your area. These professionals are trained to work with people of all ages and levels of ability to identify and recommend assistive devices or methods to help them cope with daily living activities.

Related Resources

American Occupational Therapy Association
301/652-2682
www.aota.org

Independent Living USA
Independent Living Centers Directory
www.ilusa.com/links/ilcenters.htm

Last updated: 08/18/2014
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