Assistive bathing following traumatic injury
By Lauren Hopkins, Occupational Therapist
Traumatic injuries can vary from spinal cord injuries, fractures, brain injury and/or other major orthopaedic trauma. For activities such as bathing that requires mobility and coordination, trauma can inhibit occupational engagement and independence with the need for assistance ranging from minimal support to full dependence on caregivers and/or assistive devices.
After a traumatic injury, the process of adapting to new limitations whilst also working to rehabilitate the body can present as a balancing act.
Traumatic injuries can have substantial effects upon physical, psychological, social, and emotional wellbeing of many. Depending on the severity of the injury, the outcomes of trauma can impact bathing in the following ways:
- Limited mobility – injuries affecting the legs, arms, or torso may prevent standing or sitting comfortably.
- Pain and discomfort – some injuries result in persistent pain which can make it difficult to bend, reach, or tolerate water temperature changes.
- Stability – the fear of falling or slipping in a wet environment following an injury can mean bathing can feel overwhelming.
- Energy – severe trauma can lead to extreme fatigue making it tiring to carry out an everyday activity.
- Increased dependency – following injury, many individuals’ loose autonomy and find themselves more reliant upon caregivers for support
- Aside from the physical limitations, trauma can play an emotional toll upon an individual’s wellbeing.
To overcome limitations and challenges following injury, adaptions can play a critical role in supporting individuals to regain some level of independence. I also remind MDT colleagues and family/caregivers that adaptions do not have to a permanent solution, whilst acknowledging that the return on investment needs to be considered, especially if the person requires rehabilitation alongside it. Adaptions can take various forms from physical modifications to the environment such as, installation of grab rails, non-slip flooring, and assistive devices such as, height adjustable baths. These devices not only help ensure safety but can also foster a sense of autonomy during a challenging recovery period.
Whilst adaptions can help make bathing possible, rehabilitation is also key for recovery. This usually involves working with Physiotherapists (PT), Occupational Therapists (OT) and other healthcare professions to restore strength, mobility, and independence.
Some examples of rehabilitation might include the following:
- Restoring strength and mobility – PT’s and OT’s support restoring strength and mobility for bathing through personalised exercises that work on rebuilding standing and sitting tolerance, upper and lower body balance and control, and improved hand-eye coordination (useful for holding onto a washcloth or shower head for example).
- Graded exposure – it is important to remember that rehabilitation is a gradual process and varies depending on the individual and their injuries. Graded exposure means breaking an activity down into more manageable steps. The purpose of graded exposure is to gently re-introduce your client to relearning prior skills whilst building their confidence to reintegrate into meaningful activities and routines. In my opinion, celebrating the small wins alongside the client is paramount to the progress of their graded exposure plan.
- Developing adaptive techniques – rehabilitation also focuses upon adapting techniques in order to engage in bathing with as much independence as possible. For example, for an individual recovering from a spinal cord injury they may learn how to transfer from a wheelchair to a shower chair using specific movements to reduce their risk of injury. Likewise, for an individual who has lost functioning in their dominant arm, they will learn adaptive techniques to use their non-dominant arm/hand for washing during bathing.
The balance between adaptions and rehabilitation is key following traumatic injury. As mentioned above, whilst some adaptions could provide immediate relief, in my experience they can also become a barrier, preventing individuals from pushing themselves towards full rehabilitation. On the other hand, a strict focus on rehabilitation only can sometimes be frustrating and discouraging for individuals who are not yet able to perform tasks like bathing independently or observe any progress.
Adaptions therefore should not be viewed as a single stand-alone solution but as one of the interventions that can enable comfort and safety during one’s rehabilitation journey. Remember, recovery from trauma can take time and it is not always linear. During this time, support from family members, caregivers and/or healthcare professionals becomes critical. The involvement of an MDT for an individual’s recovery ensures that both adaptions and rehabilitation strategies are integrated in a way that promotes long-term recovery and personalised goals.
All healthcare professionals should always work with their clients to find a balance that allows them to safely and comfortably manage personal care whilst developing their functional abilities. Including bathing as a central part of the assessment can support with sleep, pain (even if perceived) and mental health, and the products such as the Gemini MX platform bath exist on the market to ensure that anyone, regardless of need, and with a robust risk assessment, can safely and effectively bathe.
My take home from this blog is that traumatic injury can be a deeply personal and quite often challenging experience. Individuals who have experienced such trauma should be given the right tools, resources and support to navigate their journey that is meaningful to them. Finding the balance between adaptions and rehabilitation is essential to a successful recovery, fostering both physical and emotional wellbeing.