COVID-19 Updates

by Sandra Mackay - Occupational Therapist - Cerebral Palsy Scotland
Published 25 March 2020

Hands are usually the most common way we pick up germs from the surfaces around us. Door handles, phones, light switches, filing cabinet keys, wheelchair brakes, shopping trolleys, covering our mouths when we cough – all ways we can pick up germs. The best way to prevent spreading germs is by washing our hands properly and regularly.

For some people with neurological conditions extra care must be taken to make sure hands have been properly washed.

There are a variety of reasons why handwashing can be tricky. Some of these will be explored below.

Washing hands before touching your own or someone else’s face will prevent germs being spread to eyes, mouth and nose – and so help prevent illness. Some people with a neurological condition are unable to bring their hands to their own face. The positive aspect of this is that they are less likely to touch infected surfaces and then spread germs to their eyes/mouth/nose. However, it means that they will be dependent on others to wash their face or to help them manage coughs, sneezes, tears and runny noses.

General advice for carers

Muscle tightness / contractures

e.g. fisted or some fingers bent into the palm

adult lower arm, wrist and hand. Palm upwards, third, fourth and fifth fingers curled towards palm

Adult male lower arm, wrist and clenched fist, facing downwards

Muscle tightness around hands and wrists is a feature of many neurological conditions. Sometimes this is ‘dynamic’ in that it is possible to move parts. Sometimes it is ‘static’ meaning the tissues have become stuck in that position. Whether dynamic or static, it is important to make sure every ‘nook, cranny and crease’ is cleaned and dried completely.

For some people it can help loosen their hands, to first bring their arm away from their body. Check with someone who knows the person how to do this.

Ideas to help someone with a tight hand / curled fingers to wash their hands

Weakness / reduced hand movements

Adult's lower arm, wrist and hand resting on surface. Fingers and thumb are relaxed and slightly curled.

Some people will have difficulty washing their hands due to lack of strength or poor active movements of arms, wrists or fingers. This can take many forms e.g.

Ideas to help someone who lacks strength or movement to wash their hands


adult hand with showerhead running water onto fingers. The index and middle finger are coloured blue, the fourth and fifth finger are coloured red.

Some people may have changes to what they are able to feel. For example

Ideas to help someone with changed sensation to wash their hands


It is important to remember that good hand-hygiene is always important, not just at this time. Good hand-hygiene not only helps to prevent spread of germs (and illnesses), it is important for other parts of health. It helps a person feel fresh and comfortable, it prevents unpleasant smells and helps to stop skin breaking down and causing infection.