What is important to personal hygiene? It sounds like such an easy question, but when you are dealing with traumatic brain injury and several other issues that deal with thinking problems this is a complex task. Many times this is difficult to figure out, especially in the first year or more following traumatic brain injury. It is something so many people take for granted everyday, until you no longer have that ability to perform the most basic of all functions.
After many traumatic brain injuries even the most basic of all functions are lost. You need to relearn every basic skill and that includes toileting, bathing, washing hair, shaving, brushing teeth, dressing, and other activities of daily living. You are not alone. Millions of people are going through this process of relearning, but no one is talking about it.
In this series I will go over the basic and everyday needs. This will help those who are struggling with everyday skills following a brain injury. You will find many ways to compensate over time, but you will also be able to relearn the things you have lost. It all takes time. No one knows how much time it will take, but with repetition things get easier and better.
As you think about becoming independent with your bathing, showering and washing up you need to think about what you need to perform those tasks. I will help you with this, but as time goes on you won’t need notes and you’ll be able to accomplish these things as you did before.
You always need:
- Towel
- Wash rag
- Soap
- Bathrobe
Get out your towel, wash rag and soap. Make sure you place it within reach of your tub or shower. A clean change of clothes should be organized where you usually get dressed. A bathrobe is helpful to put on after bathing or showering. Sometimes you may tire quickly and need to lay down. Do this if you feel light headed or out of energy. Bathing takes an exorbitant amount of physical energy. It gets easier over time.
You may need to adapt using a shower chair to prevent falls. You may need to shower instead of bathe because you have developed seizures and being in a tub unsupervised is not recommended and it’s simply NOT SAFE. Over time, you will improve but you need to be safe. Washing-up is the safest way when no one is around to assist if you are having great difficulty with thinking, falling or simply need help. Always keep yourself safe. When in doubt, stay safe and WASH UP.
You don’t want the water running over the bathtub and causing water damage to the bathroom and maybe other rooms in your home. Stay in the room you are running the water. DO NOT LEAVE, for any reason once you turn on the water. If you leave the room, the possibility of forgetting and being distracted is high. Even if you take a timer with you as a reminder, you may not remember why the timer is going off! Trust me … I know!
Never run the water too hot! Test the water before getting in. If you need someone to be in your home while performing these task…wait till someone is home!
Deutsch: eingebaute Badewanne (Photo credit: Wikipedia)
Showering
- Turn on the water before entering the shower
- Reach into the shower & check the water temperature and make sure it is not too hot, or too cold
- Make sure the shower curtain is inside the tub if it’s a shower-tub enclosure
- Carefully get in shower holding on to rails
- Use shower chair when needed
- Shower (as instructions below)
- If you have problems with turning on and off water, get help! It will get easier.
Tub bath
- Put the plug in tub before running the water
- Test the temperature of the water
- Run water a few inches high or less
- Turn off water
- Carefully get in tub holding on to handrails
- Bathe (as instructions below)
- Easier to get out of tub with water
- Pull plug out and let water drain out when done
Washing Up
- Put the plug in sink before running the water
- Test the temperature of water
- Run a small amount of water, about 2-3 inches
- Turn off water
- Begin washing (as instructions below)
- Pull plug out and let water drain out when done
***If you need handrails or assistive devices you can ask for an occupational therapy evaluation and they will do an in-home evaluation to determine what you need or what you can use to keep yourself safe. This is highly recommended.
If you have a shower chair and are not using it for showers, place it near the bath tub to help as you dry off. Always sit down while dressing or putting on a fresh change of clothing. Standing can cause a loss of balance and falls. Always sit to put shoes on.
Instructions for Bathing, Shower & Washing UP
- Wash with clean wash cloth
- Wash face first
- Wash arms, legs & feet
- Wash private parts
- Dry with towel
- Dry face first
- Dry arms, legs & feet
- Dry private parts
- Make sure any folds in skin are thoroughly dry
- Moisturize skin with a personal favorite lotion
- Use a sunblock for skin when possible
- Facial moisturizer with a sunblock preferred
- Use deodorant-Don’t use immediately after shaving…it will burn!
A refreshing bath or washing up does wonders for self-esteem. Usually one feels much better after getting cleaned up. With the cognitive challenged individual this can be an overwhelming task.
If they refuse to get cleaned up, offer them two options that work well for you. Help them problem solve. Ask them: “When do you want to get your shower at 7 am or 6 pm? Morning or evening?” Give them only two choices. Let them have control. Do not ask them “Do you want to bath or shower today?”. That provokes a YES or NO answer. You will likely get an angry “No” answer. Sometimes the defiant “NO” answer is because they either are overwhelmed or believe they just did that task.
Either way, the patient may or may not remember the last time they bathed. Eliminate all the frustrations for them. If you are trying to learn this for yourself, you may want to make a chore list that you check off as you do the task.
The unfortunate thing here, it won’t necessarily be accurate. Just because one has a chore list doesn’t mean one will remember to make that check mark that the task was completed. Don’t beat yourself up about whether you think you did it, or you didn’t do it!
Consider the task done, and move on. The next day is a new day! All the notes and charts one does with brain injury don’t necessarily work every day. These charts offer a tool to follow…at least most of the time! Even if it seldom works, eventually it will. Give it time! As time goes on you will find what works and what does not. Every person is different.
braininjuryselfrehabilitation 
meesher
June 29, 2012 at 1:16 am
This is what I learned about basic hygiene and cleanliness: at least appearing to be clean and also smelling as if I were: invest in a case of Benzalkonium Chloride Antiseptic towelettes.(Basic wet naps from any restaurant–also used often on kiddies who need quick clean ups). One box in the case will have 100 towelettes. They are used in hospitals and are available on eBay. I used these to clean my face, lady parts, hands, feet, underarms, and whatever else felt icky. They have to be torn open, but even in my most crazy moments, I can do this.I also carry them now in my purse. I tried keeping them in the glove box, but heat and sun dries them up. After using, throw them away. They do not sting my own eyes, but that is just me. My husband and I use the same brand of anti-perspirant, Mitchum. No sweaty underarms means no stink. I also use them on lady parts and on my tushie every time I use a toilet. Damn, I must be clean. Do not flush these things–your plumbing will not like them. I use panty liners for the days I forget to change panties. (I will never meet any of you, right?)
If female, find a way to wear your hair that involves a pony tail or bun. Those little hair thingies keep hair off the face and thus, less oily. Since I walk around in the house barefoot in summer, I use them on my feet, too. I started using talc on my body, after every bath.
My hub bought me a shower chair, and I simply use the towelettes to clean the non-porous seat of the chair before sitting. I also use the shower head (the snaky ones) to warm UP the seat prior. I cannot tell you how cold those things can get, even in summer. I do not use bar soap anymore, I use a brand name all over soap (OK, Neutrogena) and I use a hand mitt so that I do not drop the bar soap & wash cloth. All shampoos and body washes are kept ON the floor of the shower. No leaning. I suspect that I might have gone for 3-6 months without shaving my underarms and legs. SO? Disposable safety razors are now the only razors I will touch. When I shower, I make sure that someone is in the house while I am IN there. Hub used to shower WITH me. (Save Water, Shower With a Friend!) (old California bumper sticker.) When I get OUT, I wrap myself in one of those Velcro-
close bath wraps. Then I lay/lie on our bed, under the ceiling fan, to do the rest of the drying. I used to wash my hair every day. Now, I am lucky if it is once a week. The overhead fan helps in the drying process, but I still use a hand blow dryer, which we keep plugged in to an outlet that is NOWHERE NEAR the water. Hub helps me to trim my toe nails as I can no longer see my feet, with or without glasses. And if I bought new glasses, my vision would just change again, anyway.
In the evenings, while watching the news, I use a diamond nail file on my fingernails. I keep them short. Keeping ME up is a full time job.
Forget scents: clean is a good smell.
I use a hypo-allergenic moisturizer on all my body. It has a sunscreen.
I just proofed this: the wrap around thing is the best part. Hub installed a thingie in that shower stall that will not allow me to scald myself, but that does not mean I will not run out of hot water.
By the time I finish getting myself clean enough to leave the house, I am out of steam, and need a nap. SO?
brain injury self rehabilitation (BISR)
June 29, 2012 at 5:06 pm
What wonderful tips that I failed to add. I also use wipes all the time for nearly everything you mentioned. They are a staple all over my house and car. Would you mind if I put an addendum to this post copying what you wrote in the comment section. Thank you so much for adding this valuable information.
meesher
June 29, 2012 at 5:58 pm
Certainly, domain yourself silly Public domain.
brain injury self rehabilitation (BISR)
June 30, 2012 at 9:38 pm
What do you think the best way to post your suggestions and Wendy’s suggestions? Should I put an addendum or put a post of 2 of 2 or any other suggestions? These are excellent and I need to add them. You both are great at offering very personal experiences and others will learn when people can tell how they handle even the most personal situations. Thanks again.
Three Well Beings
June 29, 2012 at 4:17 pm
An amazing list! Until a few months ago and my relationship with my brain-injured friend, I wouldn’t have understood why this list is an important coping tool! You are providing such a resource for so many. I will be sure to pass this on and share it with my sweet friend. Debra
brain injury self rehabilitation (BISR)
June 29, 2012 at 5:08 pm
People don’t understand how complex a brain injury is, until they experience it or have someone they know going through it! I will be adding a valuable addendum to this soon. How is your friend doing?
meesher
June 29, 2012 at 6:11 pm
It’s just amazing that any of us can type or use a computer! I taught myself to type after the head injury and concomitant epilepsy. Still not sure I use the right fingers on the “correct” keys.
brain injury self rehabilitation (BISR)
June 30, 2012 at 9:41 pm
You do a great job typing and I’m fascinated that you were able to teach yourself typing after the brain injury. What method did you use to teach yourself typing? I was fortunate enough to have many years experience of typing, and it’s a skill I’ve maintained all along.
meesher
June 30, 2012 at 10:37 pm
Typing? It was a 110F day in Los Angeles. I was planning to stay indoors. Heat adds to my seizures. I took the Windows (something) tutorial more than 25 times and still was reading before typing. I guess the keypads just sank into my subconscious.
Michele
July 2, 2012 at 12:40 pm
You asked me to tell you how I learned to type after brain injury: The upstairs of our house, then, was darkened by hanging red felt squares over the windows, so everything looked warm and cozy.This was on the inside of the bedrooms where I spent all of my time in the early 90s. I went into my husband’s den where he kept his HP (computer) up all the time.I was so alone and wanted dearly to learn to use email so that I was not so alone. I spent one summer in 7th grade taking an elective course in typing–I never learned to type without looking at my fingers. Never. I still WATCH MY FINGERS! On occasion, I can type quickly and efficiently, and even spell (but the spell check really helps. When not looking at my fingers, I watch the monitor to see that I am not hitting the wrong keys. Nurse: you may use my email address for questions or statements just for me.
meesher@pacbell.net
brain injury self rehabilitation (BISR)
July 4, 2012 at 9:40 pm
What a fascinating way to learn how to type. You are truly an inspiration in what it takes to recover from brain injury. You demonstrate the self-determination it takes along a very lonely journey.
meesher
July 2, 2012 at 12:47 pm
And please, if you can, tell me what cognitive rehabilitation is? I would have to drive 45 miles one way to get this, and I think I am better off just using the computer. Also would like to ask you, is it creepy that my hub’s daughter gave me a purple (my favorite color) teddy bear, stuffed with something like small seeds, and I KNOW I sleep better with it in my arms. How crazy is that?
brain injury self rehabilitation (BISR)
July 4, 2012 at 9:35 pm
First, if a cuddly teddy bear helps you rest and sleep better by all means do so. There is nothing wrong with that.
As for cognitive rehabilitation there are many different avenues they take to teach techniques to compensate. The better cognitive rehabilitation centers use modern technology (iPhone) and (Mac computers) to use daily reminders and all the features to compensate. If you choose to try a cognitive rehabilitation center, try it and see if it works or is helpful for you. What is helpful for one, may not be for another. 45 miles is a long way to drive, considering you need to make a round trip and the amount of energy physical and mental it takes just to do the traveling. If you would find it helpful, is there any way you can stay nearby? Sometimes they have places nearby for the cognitive retraining. You might want to see if this would be an option for you.
wendy
July 5, 2012 at 2:17 pm
meesher,
I have a monkey I sleep with, he helps me to sleep better. He’s also been a neck pillow when I’ve been stuck in bed, and he’s just a fun little friend. My husband loves him too. He’s always picking him up and hugging him, saying “Monkey loves me more.” I tell him…yeah, just keep believing that. haha.
The purple teddy bear sounds perfect to me.
wendy
June 29, 2012 at 7:36 pm
Due to my vertigo, I can’t take a bath or shower without someone in the room with me. Washing my hair is a chore…the change of temperature on my head often makes me sick. I can’t wash my hair in the shower, because I have to close my eyes. If I have to do that with water running on me, I will start spinning every time.
I’ve had heart palpitations when in the tub before, that was very scary. I knew to run cold water on my wrist and that helps, but I didn’t think to unstop the tub. I could not think straight. That was the point where I decided I would not take a bath or shower without someone close by.
I often wash up in the sink. I’m lucky I have dry hair, and skin so I don’t have to wash my hair very often, and I don’t get stinky without a full bath or shower. If I’m feeling particularly bad and have a hard time getting out of bed, I will wash up with baby wipes. I always use flushable wipes when I use the rest room, to make sure I stay clean there.
Still I do find myself putting off washing my hair past the time I should. And I should probably take a full bath or shower more often sometimes. But I have to think…if I take a bath or shower I will not have the energy to do _______. I normally have to take a nap after bathing. It takes a lot out of me. I will often have increased symptoms of high CSF. My head will pound, I can’t see straight….ect.
I will admit, I can get out of the tub much easier than I used to. My legs seem to be listening to me better than they used to. That’s a great milestone!
Baby wipes have really saved me on days I need to wash up, but simply cannot stand up that long. It’s a choice again. I could do a complete wash up (a Navy bath my father would say), or I could save that energy and use it to go to the toilet when I need to. (that often means using a walker, or getting help.)
Always safety first, right!
again, another wonderful post.
You have such insight, and can vocalize it in such a nice and productive way.
A great educator!
brain injury self rehabilitation (BISR)
June 30, 2012 at 9:08 pm
It’s nice to know people are able to verbalize even the most personal things that one deals with through this difficult times. So many others don’t realize how much compensating one does just to deal with the simple activities of daily living. By sharing these things I’m hoping it will eventually help others. I’ve really liked what you have mentioned and another comment by meesher and not sure if I should add an addendum to the post, or make a Post 2 of 2 or what. Could you make a suggestion so I can put both of these together so others can learn? I will also ask meesher for suggestions. Thanks for sharing your personal experiences as well. Your comments are valuable.
meesher
June 30, 2012 at 11:13 pm
Dear Nurse Person (or should I just call you Sorority Sister?) I cannot find any names for you: when any poster posts with a “user name” it is presumed a published work. Just like a book. Authors use false names (there IS a nicer word for that, what IS IT?) something nym. Published works become “in the public domain” once they have been used often enough. But yes, treat me like I had been posting since year 1600. I will not remember writing things anyway, until I get half way through reading them.
brain injury self rehabilitation (BISR)
July 4, 2012 at 9:53 pm
Nurse Person, Sorority Sister, Edie, Edith (are my real name). This site is registered in my real name and my email address is also under my name as: edithflickinger@yahoo.com. Everyone can reach me there if they do not want to leave a message under comments.
wendy
July 5, 2012 at 5:42 pm
You are welcome to use any of my comments any way you’d like, it you think it will be helpful.
I find that people often don’t see an addendum to a post, so I’d suggest a second post if you want to add some other suggestions.
I noticed meesher suggested antiseptic wipes, I can’t use those. They are too harsh on most places of my body…and the smell gets to me. (I do have trouble with chemical sensitivity now.)
I can use those on my hands, and keep some in my purse for emergencies, but I have to keep my hands away from my face for a while. It does air out pretty fast though…luckily.
again, please use my comments any way you’d like.
brain injury self rehabilitation (BISR)
July 15, 2012 at 10:26 pm
I will take your advice and do a new post to include the many comments and suggestions that I left out. The wipes are great ideas. Sensitivity is really important, and unfortunately for you the type of product you need is more expensive and limited compared to what the market offers overall. You offer so much to help others and are not afraid to give details. Thanks so much.
meesher
June 30, 2012 at 10:56 pm
Thanks to all for sharing how s/he copes. And Nurse, thanks to however you added the spell check to this site.I’d like to start a string about how on earth any of us exercises, so that our muscles get stronger. I’ve tried sit ups. Those do not seem to kill me, although they are done on the floor, but just ’cause my tummy is flat, does not mean the rest of me is fit. After a particularly heinous extra head bonk/ seizure, I was in a hospital, with a Nurse Ratchet type person in charge. With our walkers, (all of us, for various reasons) were assembled in a concrete interior stair well (how stupid!) and told that if we could “walk” up five stairs, we would NOT be sent to a nursing home. I used my upper arm strength to PULL myself up, while my legs/feet searched for the next upper step. Had I fallen (again) I would have hit body parts on uncarpeted stairs, made of what seemed like stone or concrete. THEN I WOULD HAVE SUED. I think. If I remembered. The interior stair cases, in a building where there is an elevator, need to have, at the very least, some kind of padding, if they expect those of us who fall, to use them. And alarm bells. I know that their restrooms have strings to pull in an ER, but who would have known if I practiced walking upwards in a closed stairwell? I managed the five steps, but then I had to get DOWN those same steps. Try using a walker on a DOWN stair attempt. Nurse Ratchet (from “One Flew Over the Cuckoos Nest”)? certainly was not using her body to break our falls, but we had to do them to get OUT of the hospital and not be further traumatized by a threat of Nursing Home. Using a walker, with IVs attached to arms (or in my case, to feet) was terrifying. NO helmets were offered, and not even a hospital pillow was strapped to my adult tush/hips. What would the hospital have “thunk” up, had we fallen in a stairwell? USE ANY AVAILABLE ELEVATOR! Do not try “Stairs, 101”.
And during my epi meds, I have discovered I have left foot neuropathy. My neuro told me he could stick needles in my body to find out where the neuropathy originated, but when questioned, he told me he could not fix it, even if he found its origin. So now I sleep with an ice pad or a heat pad under the blankets, or what-not, trying to bring my foot back into the world. Anyone else with neuropathy? (How do you spell that word?)
brain injury self rehabilitation (BISR)
July 4, 2012 at 10:28 pm
I think it’s a great idea to add “Exercise” as a string. How would you like that to happen? What would be your approach so we can all benefit.
I’m sorry to hear about “Nurse Ratchet”. Obviously, she’s not in a position that she ever had difficulty walking or dealing with any medical issues or her approach would be very different. I can’t imagine practicing in a stairwell. That sounds dangerous to me, and safety should always be a priority.
Falls are frequent with brain injury, stroke, and a number of medical conditions including aging. The balance area in the brain deteriorates with age, causing falls as we age. We all need to be aware and prevent falls. Awareness could also come in the form of exercise to prevent falls when possible.
Neuropathy is correct. Most people with TBI, strokes, and chronic illness/injuries deal with some form of neuropathy. Ice and heat can be helpful. Trigger point injections (TPI) may also be helpful. I have no feeling in the left side of my neck and head…but have intense burning pain a lot. Sometimes…it’s just unbearable. Neurotin has been helpful for thoracic burning pain from a subarachnoid hemorrhage of brain and spine.
But the other was from a Carotid bleed…causing intense burning of the head, neck, ear and partial face. What are the options? TPI didn’t help in this case, but I only had one set of injections and could go back and try again. Does anyone have an answer what else is helpful for Neuropathy?
meesher
June 30, 2012 at 11:03 pm
OOOOh OOOOOH I just wondered, does anyone else have a change in body scent since the epi meds? Even though I perspire less (go figure that one) in hot weather, I notice that my underarms do not smell the same. Hub corroborates this. Kind of a sweet, fermented smell? ( I am so embarrassed. Did I spell that last word correctly?) Back to the wipes with something like alcohol in them, then Mitchum. We should all get the neuros to give us a prescription for the medicine or preparation that STOPS perspiration in overly sweaty people. That would solve many issues. How about the spray on shampoo. Does it work? I have dark hair, (as you can see) so I think that the dry shampoo product would be a nightmare. Anyone? AND do laser hair removal systems really work, or is that just a product hype? I see the adverts on late night TV when I cannot sleep, even with double sleep meds. No, I don’t do caffeine.
brain injury self rehabilitation (BISR)
July 4, 2012 at 9:48 pm
I know personally that the sweat smell does changes…and it can be a sweet smell. Good thing about this…don’t need the deodorant! But is this related to the change in body chemistry because of medications or brain changes? I don’t anyone cares, except for us with brain injuries that are experiencing these changes and wonder if anyone is taking note to help others in these situations. Great for pointing this out.
If anyone has experience with the spray on shampoo let us know. I’m not familiar with this. I also don’t know about laser hair removal, but anyone with more information please keep us informed with accurate information.
These are all good issues that we look at to make our life easier. Thanks for great comments.
wendy
July 5, 2012 at 5:25 pm
I’ve used the dry shampoo, but wasn’t thrilled with it. I used it after surgery when I couldn’t get my head wet for weeks. I didn’t feel like it got the roots clean, and that’s the oily part on me, my longer lengths never looks dirty, only the roots. It may be the brand I used, it was a spray on. I also had trouble with the smell of it. I’m much more sensitive to smells now. (oh I too have dark hair, it takes a while to brush the dry shampoo out, but it’s not a big, big problem…if you can find one that works..I think corn starch worked better for me.)
I don’t know about laser hair removal, I’ve heard from others that it takes numerous treatments before the hair stays away.
brain injury self rehabilitation (BISR)
July 15, 2012 at 10:10 pm
This is great information. Thanks for sharing.
meesher
July 4, 2012 at 11:59 pm
Thank you for the sweat expose’. It is summer, and although I wear light cotton jammies ALL the time, I notice that my face and underarms AND MY CROTCH are sweating. Panti-liners worked on the crotch, Mitchum antiperspirant works on MY FACE. Just a tiny dab, transferred from finger tips to forehead and UPPER LIP (RIchard Nixon?) keep them dry. The no-water shampoo must work for some people (My guess is blondes and people who are gray already) But if it is colorless, I would certainly like to know. At my age, my hair is still oily (sheesh) and I am often unable to wash my hair.
Thank you so much for responding to such private questions. Is the “sweat” smell changing because of my meds, or because of my age? Little old ladies stop sweating but I do not know why.I DO remember, prior to injury, driving down the Coast, in summer, stopping for a red light, furtively looking at any cars near me, and sticking my right arm into my clothing, to my left underarm, to get a swipe of the scent–is it bad? Is it wet? Luckily I used so much “product” in those days, I did not stink. And now, I still do that, but only rely on hub’s nose. He actually allows me to stick my fingers under this nose, when I cannot smell what I smell like. I had to change perfumes after head injury: he told me my old one had started to smell awful. Now I use a Donna Karan one that is pheromone based but stinks to ME. But if hub likes it, that is good for me.
brain injury self rehabilitation (BISR)
July 15, 2012 at 10:47 pm
It’s really difficult when we count on others to help us identify body odors and other personal things. We all sweat differently…some not at all and others profusely. It seems manageable, until one can’t smell or anticipate normal bodily functions. You point out how difficult it is to deal with the simplest things others take for granted. Comments from Wendy with regard to dry shampoo might be helpful.
Smells change, but the most significant that is concerning is if the smell is very foul. This is also true for foul smelling breathe. That may indicate a medical problem that needs attention. When the smell is foul you need to contact your physician. Of course, “sweet” smells can also indicate medical conditions but is often related to chemical changes. When in doubt and if it’s overly concerning contacting a medical provider to check certain blood chemistries could be helpful.
I personally, can’t use any perfumes. All of them give me headaches. I don’t know why…it’s just how it is! I do know with TBI the sense of smell is altered, and beyond that I simply don’t have the answers. Thanks you for all your great comments. They are helpful to so many others.