Personal care and clothing

Particular aspects of the skin in people with spinal cord injury (SCI)

The skin of the disabled body parts is more likely to dry out since the innervation¹ of the skin glands does not function properly. Temperature-regulating perspiration is only possible above the paralysis level, although vegetative perspiration may occur, which is triggered by a malfunction in the vegetative nervous system (especially in people with tetraplegia).

Due to the lack of sensitivity or reduced sensitivity, the risk of injury through mechanical or chemical irritation (burns, frostbites) is increased.

What needs to be considered regarding skin care?

• Rinse off washing lotion and soap well with clear water since the skin will dry out otherwise.
• All washing lotions degrease the skin and irritate the acid shield of the skin.
• pH-neutral soap helps to regenerate the natural acid shield of the skin more quickly. If skin is very dry, also avoid using soap or washing lotion at times.
• After washing or showering, dry the skin well; there is an increased risk of fungal infections, particularly in the genital area, in the armpits and between the toes.
• Body lotion should not be put on directly after washing the body; wait a while first (e.g. do it in the evening). Normal skin does not need lotion every day. If you have dry, flaky skin, it is advisable to rub in cream; otherwise, there is a risk of micro injuries which will be points of entry for bacteria, thereby increasing the risk of skin infections.
• Intimate care should be performed every day. In the case of a permanent catheter or fungal infection, intimate care needs to be performed twice daily (morning and evening). Flaky reddening and cracks in the skin are indications of fungal infections which generally have to be treated with an antimycotic² cream (consult your GP). It also helps to expose the skin to the air and to keep it dry.
• The skin needs extra protection during the summer months – apply sunscreen with a high sun protection factor.

Nail care

Careful nail care is very important. Nail fungal infections and ingrown toenails occur frequently in people with SCI. It is recommended to have regular pedicures done.

Skin control and relief

In order to recognise pressure sores, erythema and changes such as fungal infections at an early stage, it is important to check the skin regularly. Due to a lack of sensitivity, changes are often recognised very late. It is therefore even more important to observe carefully to be able to react quickly.

Clothing – what do I have to watch out for?

There are some points to bear in mind when choosing clothes. Particular attention must be given to the skin.

Risk of pressure sores

Modern clothes frequently have decorations which can lead to pressure sores: trouser pockets with studs and buttons, thick seams (frequently found on jeans), details with sequins, studs, etc. It is important to bear this in mind when choosing clothes. Depending on where the details are located, it is advisable to remove them, especially in places where they come into contact with the wheelchair. Such details may include pockets, studs and buttons on trousers, or decorations on the back and on the thighs.

Shoes should generally be worn one or two sizes larger. If shoes are too tight, pressure sores can form. Shoes which are made from soft material (leather, fabric, etc.) and which are enclosed are suitable. Shoes which are not held in place at the heel (such as flip flops) do not stay on the feet well. High heels for women are not suitable because the heels generally do not stay on the footrest, creating the risk of toppling.

Independence

It is difficult to dress by yourself if your fingers are restricted. This can be simplified with a few simple tricks and aids:

• Keyring on your zipper.
• Sew loops onto your underwear, tights/stockings, etc.
• Use the belt loops to pull up your trousers.
• Use a button closing aid for shirts, polo shirts, trousers, etc.
• Extend the zip on trousers or sew in an additional zip to save you having to pull down your trousers when you empty your bladder.

Climate

People with tetraplegia have particular trouble regulating their body temperature; many complain about feeling cold and wear warm clothes. As they are only able to perspire to regulate their body temperature in the area above the paralysis, they may overheat. Choose appropriate clothing. Lightweight cottons and loose-fitting clothes are suitable in summer.

They are at risk of hypothermia in the winter months; this goes unnoticed because of their lack of sensitivity. This must be taken into account during outdoor activities, and the clothing must be selected accordingly, using thermal underwear, for instance.

Weight management

People with spinal cord injuries tend to be at risk of putting on weight because their lack of muscle mass results in a much reduced metabolic rate, and they are restricted in their movement. If their weight increases, this has a major impact not just on their mobility, but also on their physical well-being. It becomes more difficult to maintain independence, and the risk of pressure sores is exacerbated as they have a harder time fitting into their wheelchairs.

Personal care is made more difficult when your mobility is diminished by an increase in weight. It also becomes more difficult to get dressed by yourself and for your caregivers to assist you, which in turn severely restricts your daily routine.

¹ functional care

² acts against fungi