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.
Its 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 patients
limbs and position him in bed or in a chair so as to prevent or minimize
contractures. ALS doesnt 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 cant
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
isnt able to eat a normal diet. Adequate fluid intake will help
prevent urinary and bowel complications.