Caring for a person with paralysis at home involves managing complex physical, logistical, and emotional needs. The specific demands of home care depend largely on the level of the person’s neurological injury. For example, a high-level injury in the cervical spine requires more extensive assistance than a lower-level injury affecting primarily the legs. This article provides practical guidance for caregivers on establishing safe routines, adapting the living space, and proactively managing unique health challenges.
Essential Daily Physical Care Routines
Establishing a consistent daily schedule for physical care is fundamental to maintaining health and preventing complications. Maintaining skin integrity is a high priority, requiring thorough visual and tactile skin checks twice daily. Caregivers must inspect bony prominences, such as the tailbone, hips, heels, and ankles, for redness or discoloration that does not fade when light pressure is applied (non-blanchable erythema).
Skin checks should be integrated into bathing and dressing routines, ensuring the skin is kept clean and dry to reduce the risk of breakdown. Bathing may require using a shower chair or bath bench for support and safety. Range of motion exercises must be performed daily to prevent joints from stiffening and muscles from shortening, which is known as contractures.
Managing elimination is another cornerstone of daily care, as paralysis often disrupts voluntary bladder and bowel control. Bowel programs typically involve scheduled movements, sometimes assisted by suppositories or digital stimulation, to promote regularity and prevent impaction. For bladder management, intermittent catheterization (emptying the bladder at regular intervals) is a common routine. This method reduces the risk of urinary tract infections compared to indwelling catheters. Consistency in these routines is the primary factor in long-term success.
Safe Transfers and Positioning Techniques
Moving the paralyzed person safely between surfaces, such as from a bed to a wheelchair, requires the caregiver to use proper body mechanics. When performing a transfer, the caregiver should keep their feet shoulder-width apart, bend their knees, and lift using their leg muscles, keeping their back straight and avoiding twisting. The person being transferred should be positioned as close to the caregiver as possible to reduce strain.
For individuals who can participate, techniques like the “head-hips relationship” are used; the head moves opposite the hips to shift weight and clear obstacles. Sliding boards bridge the gap between two surfaces, allowing the person to slide across with assistance. Care must be taken to protect the skin from shearing forces when using sliding boards. If the person cannot bear weight or requires maximum assistance, a mechanical lift (hoist) is the safest method for moving them between the bed, chair, or bathroom.
Appropriate positioning prevents prolonged pressure that leads to skin damage and helps manage muscle tone. When seated, pressure relief maneuvers, such as leaning forward or side-to-side, should be performed for one to two minutes every hour to restore blood flow. When lying in bed, the person must be repositioned every two hours to avoid sustained pressure on bony areas. Specialized pressure-reducing cushions in the wheelchair and an alternating pressure mattress on the bed help distribute body weight and reduce the risk of tissue injury.
Adapting the Home Environment for Accessibility
The home structure must be adapted to facilitate safe movement and independence for a person using a wheelchair or mobility aids. Doorways and hallways often require modification, generally needing a minimum clear width of 32 to 36 inches to accommodate a wheelchair. Entry modifications include installing ramps with a gradual slope (ideally a 1:12 ratio) or using vertical platform lifts to overcome steps.
Within the home, grab bars are a necessary safety addition, particularly in the bathroom near the toilet and inside a roll-in shower. Traditional doorknobs should be replaced with lever-style handles, which are easier to operate with limited hand dexterity. Essential equipment, such as an adjustable hospital bed, allows caregivers to change the person’s position for comfort and care tasks.
The home layout should prioritize an open-concept design with clear, unobstructed pathways and adequate turning space (typically a five-foot diameter for a wheelchair). Low-pile or non-slip flooring is safer and easier for wheelchair movement than thick carpeting. Strategic placement of storage and light switches at accessible heights (between the person’s shoulder and knee) can foster greater autonomy.
Monitoring and Preventing Common Health Complications
Caregivers must monitor for specific medical complications unique to paralysis. Pressure ulcers, or bedsores, are a significant risk due to the inability to shift weight and lack of sensation. These ulcers are clinically staged based on the depth of tissue damage. Stage 1 is non-blanchable redness of intact skin, while Stages 3 and 4 indicate full-thickness tissue loss that extends into the fat, muscle, or bone.
Autonomic Dysreflexia (AD) is a life-threatening condition that can occur in individuals with a spinal cord injury at or above the T6 level. AD is an uncontrolled reflex of the autonomic nervous system, typically triggered by a noxious stimulus below the injury level, such as a full bladder or bowel. The primary sign of AD is a sudden, severe spike in blood pressure, often accompanied by a pounding headache, sweating, and flushing of the skin above the injury level.
The immediate response to a suspected AD episode is to sit the person upright to help lower blood pressure and rapidly identify and remove the triggering cause. Deep Vein Thrombosis (DVT), the formation of blood clots, is another complication due to reduced lower body circulation. Caregivers should monitor for unilateral swelling, warmth, or redness in the limbs, which can indicate a clot requiring urgent medical attention.
For individuals with high-level injuries, compromised respiratory function is a concern because the muscles used for coughing and deep breathing may be weakened. Regular assisted coughing techniques or respiratory devices may be necessary to clear secretions and prevent pneumonia. Monitoring vital signs, including heart rate and blood pressure, is a proactive measure that can provide early indication of serious complications, especially for those at risk for AD.