Hygiene and Skin Care for ALS Patients
The person with late-stage ALS will need to have his basic hygiene and skin care provided by others. You will probably need to give the person with advanced ALS a bed bath at least once a day, and provide oral care, such as brushing his teeth. Having the client sit up in a chair or wheelchair at least once a day is a help to his body and mind, as well as to your ability to change the bed sheets, turn the mattress and so forth. A mechanical lift allows even a small caregiver to safely lift a large person and transfer him between a bed and a chair. A paralyzed person must be turned from side to side every few hours, including during the night.
It’s very uncomfortable to stay in one position for long periods of time. Special mattresses called alternating pressure pads can help prevent skin discomfort and damage by inflating and deflating air pockets underneath different parts of the body on a rotating basis. Soft booties and elbow pads and other such devices can also be useful, as can special pillows and other kinds of supports, but there is no substitute for frequent turning of the patient.
Contractures, or abnormal tightening of muscles so that joints become immobilized, are a common problem in many people with neuromuscular disorders. A doctor, nurse or physical therapist can show you how to exercise the patient’s limbs and position him in bed or in a chair so as to prevent or minimize contractures. ALS doesn’t have any direct effect on bowel and bladder function, but, in a paralyzed person, these functions are often somewhat altered.
Provisions have to be made for collecting and disposing of urine and feces, and constipation and fecal impaction may occur in people who can’t use voluntary muscles to defecate. A doctor or nurse can advise you and how to develop a bowel routine to prevent these complications. Suppositories and stool softeners can be helpful at this stage, especially if the person isn’t able to eat a normal diet. Adequate fluid intake will help prevent urinary and bowel complications.