Analysis of Movements for Wiping the Anus from the Back After Defecation in Hemiplegia

Abstract

Assisting with post-defecation cleansing is said to cause psychological stress in both caregivers and care recipients. In the clinical setting, many patients with hemiplegia wish to acquire cleansing movements that involve approaching the perianal region from the back, but some find it difficult. Thus, this study aimed to elucidate the movement strategies for accomplishing these cleansing movements in patients with hemiplegia. Cleansing movements were measured using a 3D motion analysis device in 6 healthy individuals and 8 patients with hemiplegia, and results were compared between healthy individuals and patients with hemiplegia and between patients with hemiplegia with different motor function. Healthy individuals and patients with hemiplegia who could elevate the pelvis on the toilet seat performed the cleansing movements while elevating the pelvis at ＞10° and shifting the center of pressure of the buttocks forward. On the other hand, those who could not elevate the pelvis performed the cleansing movements while pushing off the floor with the leg on the unaffected side to shift the buttocks backward to the paralyzed side, and laterally flexing the thorax. Taken together, the function enabling the pelvic elevation at ＞10° and that enabling a posterior shift of the center of pressure of the buttocks on the toilet seat were shown to be important strategies for smoothly performing post-defecation cleansing movements that involve approaching the perianal region from the back.