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¶ Introduction
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¶ Ingress, Standing and Seating
Entering and exiting a bathtub can be challenging, even for those without mobility issues. It requires adequate hip flexor strength to lift the knee over the tub's edge and enough lower limb stability to balance on one leg. Properly positioned grab bars and transfer poles can help facilitate these movements safely, but their effectiveness is reduced if grip strength is weak. For anyone with weakness, it’s essential to maintain three points of contact at all times while entering or exiting the tub, moving only one hand or foot at a time.
For individuals with ALS, one of the initial challenges is standing in the shower long enough to get clean. The muscles in the feet and ankles work continuously throughout the shower, which can lead to fatigue. In the early stages of lower limb weakness, leaning against a wall may offer some temporary relief.
Shower chairs and benches help individuals avoid standing for long periods. Wide benches that extend outside the tub provide a convenient space for both sitting and standing. In contrast, narrow chairs can be more challenging to use, particularly if they don’t have adequate grab handles for pushing off when standing up. Grab bars and transfer poles may not be positioned effectively to assist with rising from a narrow shower chair inside the tub. It’s essential that individuals can safely sit down and stand up from the chair or bench.
Lower limb weakness which has advanced to a point where sitting and standing from a bench becomes too difficult necessitates the use of lifts, possibly along with special tubs that have an opening in the side for easier entry. Many individuals will resign from showering at this time, and instead resort to sponge baths in a chair or bed.
¶ Washing
¶ Showering
An individual that has good use of their arms and hands should have minimal difficulty showering, whether from a seated or standing position. Hand, arm, and shoulder weakness makes gripping cleaning products difficult, along with reaching the top of the head and other parts of the upper body. Further weakness will require assistance from another person. Alternative methods and assistive devices for such difficulties are limited.
¶ Sponge Bathing
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¶ Shower Chairs and Benches
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