Information on the personal care aspects of living with MND includes: toilet (inc. toilet aids), bathing (inc. bathing aids), hair care, ear care, eye care, mouth and tooth care, nail care, shaving and dressing.
Toilet (inc. toilet aids)
Problems in using the toilet and the bathroom can be particularly stressful and embarrassing for both the person with MND and the family. Independence and privacy are important concerns, but must be weighed against the need for safety. Many small aids can maintain both independence and safety.
People with weak hands may have problems dealing with their clothes and with cleansing. Wheelchair users may have problems with space around the toilet, and with their ability to transfer from chair to toilet seat, with or without help.
- Toilet tissue packs with paper in separate leaves (easier than toilet rolls).
- Bottom wiper with looped handle and wall rack.
- Portable bidet which fits into WC pan.
- Medic-Loo that fits onto the WC, is connected to the electrical and water supplies, and provides a spray washer and warm air drier operated by either a hand or foot switch.
- Leg weakness and wasting may mean that rising to standing from the toilet seat is a problem.
An occupational therapist may suggest:
- Grab rails that may be fixed or hinged so that they can be raised out of the way.
- A toilet frame, where rails cannot be fitted safely or effectively.
- A raised toilet seat.
- Mobile commode chairs can be used in confined spaces, and can be wheeled directly over the toilet.
- Where access to the toilet is impossible, building alterations may allow access.
When these solutions are impractical, other alternatives are available:
Waste storage devices:
- Urinals or feminals
- Uribags are fantastic for men. They are relatively cheap and can be reused for months on end. They fold up small enough to easily be carried in a pocket for urgent calls of nature, they can be used discreetly in a car without the need to try to get someone into a toilet and not being solid can be much easier to use in bed than rigid urinals as they can be used without the need to roll over. These are available from most continence aid suppliers and Independent Living Centres. A female equivalent is also available.
- Commodes - standard or chemical.
Bathing (inc. bathing aids)
Although the development of pressure sores is uncommon in MND, good skin care is important. Warm baths or showers are refreshing and have a soothing effect on muscles.
Getting in and out of the bath may require special aids. Showering is usually easier.
Continue normal routine if possible. This may be possible with the help of the aids listed below.
- Bed baths can be an effective alternative to a bath or shower. Nurses can give physical help and advice on good skin care.
- After washing, thoroughly dry the skin, especially between fingers and toes and in skin folds in the underarm, breast and groin areas.
- Regular changes of position during the day and (less frequently) at night are advisable.
- Special mattresses, cushions and pads help relieve pressure and improve comfort.
An occupational therapist can advise on bathroom modification. For safety and independence they may recommend:
- A bath board fitted across the bath, or a bath seat fitted into the bath.
- Grab rails.
- Tap rails.
- Non-slip bath mat.
- A mobile shower chair, with a ramp into the shower.
- Tap turners (they fit most taps).
- Lever taps.
- Flannel mitts.
- Long-handled sponges or lambs wool pads for reaching the back and feet.
- Magnetic or suction cup holder for soap.
- Liquid soap in a plunger or tipping dispenser.
When difficulties increase for the patient and the carer:
- A mechanical hoist, with rails mounted on the floor, for lowering a patient over and into the bath on a plastic seat.
- A seat that can be raised and lowered mechanically can be fitted in the bath.
- A mobile or ceiling mounted hoist.
- Warm the room.
- Experiment with a small towel with hand-sized loops sewn on both ends.
- Dress in a lightweight towelling robe or cape after a bath or shower.
- Use a wall-mounted electric drier to blow warm air over the whole body.
If hair-washing is difficult an occupational therapist may be able to suggest easier ways.
- Baby shampoo does not sting the eyes and may be better to use than some others.
- Have a helper wash the hair while the person with MND sits at a stand or tray.
- Use a tray for washing hair in bed.
Wash the ears daily in warm water, rinsing well before drying thoroughly. Do not use cotton wool buds to clean the inner part of the ear. Ask the district nurse or doctor for advice if wax is a problem.
Some people find that because of muscle weakness blinking is less frequent and the eyes feel dry and sore.
- Use a small wad of cotton wool soaked in clean warm water to cleanse the eyes outwards from the nose. A separate piece of cotton wool should be used for each eye. The person doing this should have well-washed hands before starting.
- To relieve soreness, eye drops can be prescribed by the doctor.
Mouth and Tooth Care
- Brush teeth carefully to prevent damage to the gums. If possible do so after meals, making sure that excess moisture is not allowed to collect inside the mouth to cause temporary swallowing problems. It may be helpful to use an electric toothbrush.
- Swabbing the mouth with a cottonwool bud soaked in a solution of bicarbonate of soda and water (half a teaspoon to a glass of water), will help to keep the mouth fresh and clean.
- A persistently dry mouth may feel better with the use of an artificial saliva spray, available on prescription.
- Nails should be kept short to avoid scratching the skin
- Toe nails should be cut straight across, fingernails rounded and rough edges smoothed away. If any problems develop it may be necessary to consult a podiatrist.
Some nail-care aids are:
- Nailbrush fixed to basin or wall with suction pads (for cleaning dentures, too).
- Easy-grip scissors or clippers.
- Large-handled Nail file
- Nail file attached to table with Blu-tak.
It is best not to rush. If one side of the body is weaker than the other it is usually easier to dress on the weaker side first and undress on the stronger side first.
Clothing can be adapted to make dressing and undressing easier; occupational therapists can suggest modifications. Some clothing manufacturers specialise in this area - addresses can be obtained from the Independent Living Centre.
- Elastic shoelaces or valcro straps offer an alternative to lace-up shoes.
- Investigate various aids for putting on socks and stockings.
- Use hooks for doing up buttons.
Electric shavers are easier to use than traditional razors for people with limited movement or in need of help. They also enable new techniques, for example holding the razor still and moving the face over it. You may want to try putting a larger handle on the razor.