Tips on Shaving for Teenagers who have Hemiparesis

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This is a guest post by Marie Logan, OTR/L about teenagers and shaving when they have hemiparesis.  As children mature into teenagers there are undoubtedly times of transition that can be a bit awkward for them as well as their parents. As they grow older we expect our teenagers to begin to take care of them self. So what happens when your teenager is going through all of these changes and has a form of motor impairment such as hemiparesis?

As an occupational therapist at UAB IOT (Pediatric Neuromotor Clinic), we work with clients with hemiparesis on increasing their ability to complete age appropriate self-care and everyday living activities. Over time we have observed an increased amount of teenage clients interested in learning how to shave independently. Here are some tips we have found to be useful when teaching teenage clients to engage in independent shaving.

Selecting a Razor:

There are a few things to ponder when deciding on what type of razor to introduce to your teenager. First think about the available hand function your teen has in their affected hand. What size objects do they typically grasp and hold best in their hand? Can they open and close their hand to grasp an object? Can they move their wrist up and down when holding an object? Can they reach their arm out straight? Can they bend and extend their elbow?

Your teenager would most likely use their dominant, non-affected hand to perform most of the shaving activity, however, there will be times when your teenager will need to switch hands to reach certain areas such as behind the leg or the opposite underarm.

A razor with a large handle or base would be useful for a teenager who has an easier time holding larger objects due to limited finger use. A larger handle helps them to use their whole grasp to stabilize the razor in their hand. A small handle razor may be a good choice if your teen is able to maintain adequate control of cylindrical objects like a fork or pencil in their affected hand. Some razors come with a moisturizing strip around the blade that would decrease the need for applying shaving cream as long as the skin is not dry.

When And Where to Shave:

Suggest a time of day when your teenager will have plenty of time to focus on the task at hand. I usually recommend shaving in the evenings either before or during a bath. When first mastering the skill, shaving in a seated position on the bathroom floor will be the safest option. This position will help decrease distractions and reduce risk of injury from falling. In addition, I have found shaving in front of a mirror to be beneficial for teens working on the up and down motion of shaving on their face or underarms. As their skills improve, you can gradually increase the activity demands to shaving in a standing position next to the tub, and then a child who demonstrates advanced skill in shaving may perform the activity in the shower.

You will want to talk with your teen on the importance of waiting until they have mastered the skill before trying this activity during a real shower. Have the teen show you how they would perform the whole activity before giving the OK to trying in a real shower. Safety awareness, maintaining their attention and balance, and appropriate pressure of the razor on the skin are the key things you are looking for. Adding safe home modifications like a shower chair, grab bars, or a nonskid mat to the shower can offer support if the teen’s balance is an issue.

Work on the Stroke:

Teenagers should implement a light touch when shaving as they make a slow stroke over the area of skin. Knowing how much pressure to apply can be very challenging to teens with sensory or proprioception impairments. I suggest having teens practice holding and manipulating the razor in other activities before trying on their skin. You can have them practice applying shaving cream to a plastic ball or vinyl surface and cue them to work on making the stroke back and forth. Next have them practice the stroke on themselves while keeping the razor cover on to allow them to see and experience how the razor feels against their skin and in their hand. Remind them to “GO SLOW”. In the beginning teenagers typically want to make quick short strokes with the razor, but it is our job to cue them to slow down and think about the motion they want to achieve.

Cueing the teen to use the shaving cream as a visual tool will help them gauge how they are doing. The shaving cream will be their visual road map of what areas they have already covered and what area is next. Setting guidelines such as beginning location each time or knowing how many strokes to apply over an area will assist the development of a shaving routine for the teen to follow.

For example, cue the teen to start a shaving stroke at the ankle level and to end at or below the knee. Once the lower leg has been completed, then move onto shaving the knee and follow the same rules (bottom to top). When shaving the underarm, you may break the area up in three sections: inside, middle, outside. Start on the inside and work your way to the outside section with a top down motion.

Another visual cue to examine the amount of pressure that is being applied is to assess how much shaving cream is left on the area after they have completed a full stroke. If it appears no shaving cream was removed during the stroke, the teen should apply slightly more pressure through the razor. If all the shaving cream has been removed and they see their skin is red or bleeding, they will know too much pressure has been applied and they will need to adjust the next stroke by decreasing pressure. Extra attention should be given when shaving on or around bony prominences due to the change in contact of razor to skin.

Using Two Hands:

Along with safety, using two hands in the activity is one of the biggest concepts we try to teach our clients. Over time some teens can develop learned non-use because they simply forget to use their affected hand in activities. By implementing a specific job for that hand to perform you will promote a routine of using both hands and hopefully improve overall function. Depending on the level of available use in their affected side, teens should think of a way they can include that hand in the shaving routine.

Examples to use their affected hand:

•  To spread the shaving cream on the area
• Hold the shaving cream or razor so the non-affected hand can remove the lid
• Assist with washing the shaving cream off of the skin under the water
• Apply or rub lotion over the area after shaving
• Dry the area with a towel when shaving is completed
• Keep affected hand in rested position on the floor or countertop during activity

Safety:

Safety awareness is the most important element to shaving. Due to the nature of the activity there are risks to our teens when shaving independently. We have to teach them to focus their attention on the task and be mindful of what to do if an injury arises.

Below are the rules that are set when introducing a razor to teens.

1. Know where the razor is at all times.
   The plastic cover should remain on the razor until the teen has applied shaving cream and is ready to shave. There should be a designated spot the teen should practice placing the razor when they are finished. If the teen needs a break during the shaving activity, they should reapply the plastic cover and set the razor in the designated spot until they are ready to resume the activity.
2. GO SLOW:
   Rushing through the motion can lead to accidents, cuts, or razor burn. Therefore, we need to guide the teen into establishing a routine with predictable steps, rhythm, and outcomes in order to increase the likelihood of them performing the routine when they are shaving independently.
3. 3Ps: Practice, Praise, & Patience!
   Learning a new skill takes practice, practice, practice, and frustrations can easily arise. By providing ongoing praise for task completion and implementing safe behaviors you will increase your teen’s confidence as they master their new skill. Setting small achievable goals that allow them to be successful will also help build confidence in your teen as they master each task demand.