Hygiene and pain

Skin hygiene can be significantly compromised when there is the development of contractures or when spasti-city is high. Both result in difficulty of access to skin flexures, in particular in the distal upper limb, but also at the elbow (Figure 33.4) or less commonly behind the knee. This may lead to skin breakdown with pain, maceration, infection, and malodorous flexures.

Figure 33.3 Palmar skin breakdown following hypoxic brain injury.
Figure 33.4 Elbow flexor spasticity and flexure breakdown following traumatic brain injury.

Hip adductor spasticity may lead to difficulties with perineal access and the development of painful excoriation and skin maceration in the groin area. Infections, either fungal or bacterial, may accompany this skin breakdown. Shoulder adductor spasticity may lead to similar problems of access to and breakdown of skin in the axilla.

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