Caring for a Paralysed Patient at Home: A Caregiver's Guide

When a family member is paralysed after a stroke, spinal cord injury or another neurological illness, the family suddenly becomes the care team. In many Jaipur homes, a spouse, son, daughter-in-law or a hired attendant takes on turning, lifting, feeding and exercising, often with no training at all. Good caregiving protects the patient from complications, supports recovery and also protects the caregiver from injury and burnout.

This guide covers the essentials: positioning, turning, transfers, skin care, daily exercises and looking after yourself. A physiotherapist should demonstrate these techniques in person, because the right method depends on the patient's weight, strength and condition.

1. Positioning in bed

Good positioning prevents stiffness, shoulder pain and pressure sores, and it can help control spasticity.

Lying on the back

• Head on a pillow, not pushed too far forward
• The weak arm resting on a pillow, slightly away from the body, with the hand open
• A small rolled towel under the weak hip if the leg rolls outward
• Heels free of pressure: place a pillow under the calves, not directly under the knees

Lying on the side

• A pillow between the knees and another supporting the back
• The lower shoulder gently brought forward so the patient is not lying directly on the point of the shoulder
• The upper arm supported on a pillow in front of the chest

For patients who cannot turn themselves, change position about every 2 hours during the day and as advised at night, unless your doctor or nurse suggests a different schedule.

2. Turning and moving in bed

Teach the patient to help as much as possible. Even small effort is good practice.

1. Bend the patient's knees with feet flat on the bed.
2. Ask the patient to clasp their hands together or place the weak arm across the chest.
3. Stand on the side they are rolling towards. Place one hand on the shoulder blade and one on the hip.
4. Ask the patient to look towards you, then roll them gently towards you, using the knees as a lever.

To move up the bed, use a draw sheet with two people, one on each side, lifting and sliding together on a count. Do not drag the patient across the sheet, as friction damages the skin.

3. Sitting up at the edge of the bed

1. Roll the patient onto their side, facing the edge of the bed.
2. Bring both legs over the edge.
3. Place one hand under the lower shoulder and the other on the upper hip, and help them push up into sitting, using the lower arm if they can.
4. Stay in front or beside them until sitting balance is steady.

Sitting out of bed for meals, even with support, is good for breathing, digestion, alertness and morale.

4. Safe transfers

Transfers between bed, chair, commode and wheelchair are where most caregiver back injuries and patient falls happen.

• Place the chair or commode at a slight angle to the bed, on the patient's stronger side, with brakes on.
• The patient should wear non-slip footwear and have both feet flat on the floor.
• Stand in front, bend your knees and keep your back straight. Support the patient around the waist or with a transfer belt, never under the armpits or by the weak arm.
• On a count of three, the patient leans forward and you help them stand, pivot on their feet and sit down slowly.

For patients with paraplegia who have good arm strength, a transfer board can allow them to slide across with less help. Your physiotherapist can teach this.

5. Preventing pressure sores

Pressure sores (bed sores) develop when skin over bony areas is pressed for too long, especially in patients with poor sensation. They are much easier to prevent than to heal.

• Check the skin daily over the tailbone, hips, heels, elbows, shoulder blades and back of the head.
• Look for redness that does not fade within a short time after pressure is removed.
• Keep skin clean and dry, particularly in hot, sweaty Jaipur summers and in patients with incontinence.
• Keep bed sheets smooth and free of crumbs.
• Ask your doctor whether an air mattress or pressure-relief cushion is needed.
• For wheelchair users, shift weight or lean forward and to each side regularly.
• Good nutrition and fluid intake support healthy skin.

6. Daily range-of-motion exercises

Joints that are not moved regularly become stiff and can develop contractures. Move each joint of the weak limbs gently through its comfortable range 10 times, once or twice a day:

• Ankle: push the foot up towards the shin, hold 10 to 20 seconds, which helps prevent a tight calf
• Knee and hip: bend the knee towards the chest and straighten it
• Fingers and wrist: gently open the fingers and straighten the wrist
• Elbow: bend and straighten slowly
• Shoulder: lift the arm only to about shoulder height unless your physiotherapist advises more, supporting the elbow and wrist

Stop if a movement causes the patient pain, you feel a sudden block, or a joint looks swollen, red or hot. Never force a stiff joint.

7. Look after yourself

• Use your legs, not your back, when lifting. Keep the patient close to your body.
• Share tasks among family members where possible, especially heavier transfers.
• Take short breaks and sleep when you can. Caregiver exhaustion is real.
• If you develop back pain, get it checked early rather than pushing through.

When to see a doctor urgently

• New weakness, speech difficulty or face drooping: call for emergency help
• Fever, breathing difficulty or a wet cough, which may be a chest infection
• A painful, swollen, warm calf
• Pressure sores that are open, deepening, smelly or discharging
• In spinal cord injury: a sudden pounding headache, sweating and flushing, which can be a dangerous rise in blood pressure
• Burning urine, cloudy urine or no urine output

Physiotherapy at home in Jaipur

Caregiving techniques are much easier to learn when someone demonstrates them on your own bed, chair and bathroom. During home visits in Jaipur, Dr. Rohit Kumar trains family members and attendants step by step and checks their technique over time. Learn more about our stroke and paralysis rehabilitation at home, or see stroke rehabilitation in Vaishali Nagar, Jaipur.

To arrange caregiver training along with rehab, send a WhatsApp enquiry to LifeWell Physio.