The bathroom is the most dangerous part of the house for anyone with physical disabilities. It is difficult to move about on small, slippery surfaces, and falls onto hard tile can cause significant injury. Stroke survivors may need considerable personal assistance to complete the most basic activities of daily living. Fortunately, there are many approaches that make it easier and safer to use the bath, sink or toilet.
Your occupational and physical therapists can provide training in personal care techniques. Some home modifications and devices are described below. Many simple items, such as non-slip flooring and scrub brushes, are easy to purchase and install. Important safety devices like tub benches and toilet chairs are available from medical supply stores and home health services by prescription, and may be covered by your insurance. Professional installation will be required for major bathroom modifications, such as sturdy handrails and replacement fixtures. Please be sure to discuss bathroom safety with your stroke care team before moving to any new home environment.
Balance and Stability while Bathing
When getting into a shower or tub, the use of a cane, walker, wheelchair, or scooter can be supplemented by grab bars secured to the walls. Grab bars assist with stability when one is getting into or out of the bathtub or shower as well as balance while standing in a bathtub or shower. A person with good upper body strength can hold on to the grab bars while moving or standing to provide more support to the body. A bathmat or non-skid bath decals on the floor of a shower or tub can help a person feel more stable while getting into and out of wet and often slick area. Flooring outside the bathtub or shower should be a non-buckling and non-slick surface, which can be obtained by the use of rugs with non-slip backing.
A transfer tub bench is a seating device in the tub that extends beyond the side of the tub. The extended part of the bench is used for sitting and sliding across into the tub without having to step into the tub. The person must lift their legs over the side of the tub instead. This device is often used with a hand-held shower, since the person remains seated while showering. A shower chair provides a place to sit in either a shower or bathtub. This bath device usually has rubber tips on the legs to prevent sliding. A shower chair can provide stability for someone with difficulty balancing and a place to rest for those who have difficulty standing for long periods of time. When used with an adjustable showerhead, the person can remain seated for bathing. A foldout bath bench can be used in either a walk-in or roll-in shower to enable easy transfers from a wheelchair or a walker. This provides a place to sit rather than stand, which lessens the likelihood of a fall. A roll-in shower eliminates the hazard of stepping over the side of a conventional tub. A person can safely enter the shower with her walker or wheelchair as needed.
Being unable to control water while bathing is a potential safety hazard for stroke patients. To prevent burning, water control knobs and handles should be easy to operate. Levers on controls have long handles that can be easily operated using the whole arm. To allow a person to turn on the water before entering the tub, one can use offset faucet handles, which are controls placed closer to the side of entry. This reduces the distance a person must reach to turn on the water.
For stroke patients with impaired vision, adjustments may need to be made to allow them to read the heat settings on a water control knob. Knobs with high color contrast and large words are easier to read. It may be helpful to mark desired settings with colored stickers to ensure that the individual can set the control to the correct temperature. The use of a thermometer to prevent burning may be necessary for individuals whose sense of touch is less sensitive due to their stroke.
An adjustable shower head or a hand held shower allows the stream of water to be raised or lowered. This is especially useful when using a bath chair or bench, as a person who is seated is much lower than one who is standing in the shower.
Washing and Drying
When an individual has limited movement, it may be difficult for him to wash some parts of his body. To aid in this process, one can use a long-handled sponge. The sponge holds soap and water and releases it with little needed pressure. A large sponge may be used to wash large areas such as the back, legs, and feet. A small sponge with a brush may be used for getting between body spaces such as under nails and between toes.
It may also be difficult for a stroke patient to access soap. Squeeze bottles and soap pumps may be easier to use than bar soap, which is slick and can easily be dropped. These containers can be secured with suction pads, Velcro or in some cases, mounted directly to the walls. Once these containers are stabilized, the soap can be dispensed using only one hand. In order to ensure that towels can be easily accessed, they should be located at heights that are best suited for the individual. A lower bar or additional hooks may be necessary.
Using the Toilet
Many of the same problems a stroke patient may face when entering the bathtub or shower are associated with using the toilet. Therefore, the similar use of a cane, walker, wheelchair, scooter, handrails, or grab bars can help an individual to stabilize herself when sitting on and getting up from the toilet. In addition, the floor surrounding the toilet should not be slick. If bath rugs are in front of a toilet, they should have some sort of backing to prevent sliding, such as non-skid tape.
Changing the height of the toilet may make using the toilet less difficult. A raised toilet seat or a toilet seat riser reduces the distance from a standing to sitting position so a person does not have to squat or bend down as far to reach the seat. Risers are usually made of plastic and can be placed on top of the toilet seat or between the seat and toilet rim. Some have grab bars attached or are part of a commode chair.
A three-in-one commode chair has three features: a raised seat, grab bars on both sides of the chair, and a removable bucket. This proves to be very useful for an individual who has difficulty getting to the bathroom, as it can be kept nearby the bed or sitting area. The grab bars on either side can prevent a person from falling and also can be used to push up on or lower the body down to the seat. This combination chair can also be used over an existing toilet with the bucket removed.
Because accidents due to incontinence are often unavoidable, it is a good idea to keep a pair of clean garments in all bathrooms. Stroke survivors may also feel more comfortable if they wear disposable under-garments.
Using the Bathroom Sink
Faucets are often easier to use when the handles are lever handles, which allow a person to turn water on and off with a fist or arm movement. Finger movements and grasping is often difficult for stroke survivors, so handles that require these types of movements may need to be replaced.
A person in a wheelchair will find it difficult to reach the sink unless the sink is a cut-out or roll under sink, which provides room for legs underneath the seat while in a seated position. Someone who uses a walker or cane may find it helpful to use a roll under sink so they can sit on a chair while at the bathroom sink. A cabinet under a sink may be removed to provide the space. In addition, pipes should be covered or insulated to avoid leg burns.
Someone who is forced to use only one hand will find it difficult to use items such as nail brushes and soap bottles. Suction pads can be used to hold tools in place on a counter top. Using the suction pad as a stabilizer reduces the need for using a hand to hold the object. Squeeze bottles and soap pumps may be easier to use than products’ original containers. Brushing teeth can be made easier by increasing the size of the toothbrush handle and using a flip-top for dispensing toothpaste. A toothpaste squeezer may also be helpful for people with limited grasping ability.
To ensure that the individual is able to set the water to the correct temperature, it may be useful to mark the desired settings just as one with limited vision or feeling would do for their bath faucet. When shaving, an electric razor may be easier to handle and safer than a regular razor.