Mary Barsoum

Literature Review

Introduction

Many people, both men and women decide to take part in hair removal. Hair removal has become prominent in many daily routines. One of the more popular methods of hair removal is shaving. However, there are people who may not be able to shave by themselves for multiple reasons: lack of muscle strength may make it difficult for someone to grip a razor; limited mobility in the shoulder, elbow, wrist, or individual fingers may make it difficult when shaving alone because it may be straining to move to certain positions to shave. These symptoms are commonly experienced by people with Cerebral Palsy (CP). Razors are mostly made for people without any muscular or mobility disabilities. To find a razor designed for people with muscular or mobility disabilities are making the razors difficult to find

Understanding Cerebral Palsy

Cerebral Palsy is a non-progressive brain disease (the disease does not get worse over time) that causes muscle weakness and obstructed mobility. CP is caused by damage to the cerebral cortex and the basal ganglia in the brain. These two parts of the brain control the skeletal muscles of the body which produce voluntary movements. Examples of skeletal muscles can be seen in Figure 1. Damage to the cerebral cortex and the basal ganglia most often occurs during the beginning of a child’s life: prenatal, perinatal, or postnatal. Possible sources of damage = include premature births, traumatic births, asphyxiation during birth, and any other traumatic physical events that occur after the child is born (Polzin, 2015).

Figure 1. Diagram of skeletal muscles in the human (East Tennessee State University, 2001)

CP can be affect different limbs. There are four different types of CP; Spastic, Athetoid,

Ataxic, and mixed. Spastic CP is categorized by muscle stiffness of a specific muscle or a group of voluntary muscles. Thus, causing the patient to have a permanent flexion, or bend, at their elbow or wrist. Athetoid CP affects mostly the face and neck. It can cause involuntary spasms of the face and neck, sometimes making it a challenge to speak. Symptoms of Athetoid CP include athetosis, which is a squirming movement. Ataxic CP affects the fine movements and precise coordination. People who have Ataxic CP may not be able to perform tiny and delicate

Barsoum 2 movements. Finally, someone who is classified as having Mixed CP may show multiple symptoms of different types of CP (Cerebral palsy, 2017).

Physical Limitations and Abilities of Cerebral Palsy

Each of the type CP, pinpoints different muscles that can be affected. For example, someone may have Spastic CP in both of their legs. This condition would be referred to as Spastic Diplegia

(Polzin, 2015). Because of the phenotypic diversity associated with CP, not every patient shares the same symptoms. Every patient who has CP has his or her own set of limitations. Examples of limitations include, lack of movement in the legs, permanent flexion, a bend, in the elbow or wrist, lack of control of individual fingers, impaired speech, etc. (Cerebral Palsy Alliance, n.d).

For example, a flexion in the elbow and wrist make it very difficult to shave legs; when shaving legs, the motion includes an extension of the arm and wrist which will then bend as the razor moves up the leg. With the current razor designs, this motion must be repeated to not miss and spots and get the optimum shave. Also, lack of control of individual fingers make it difficult to shave because the patient may not be able to hold the razor steadily or at all. Additionally, a person with CP may also have a weak trunk which can prohibit them from sitting up right

(Curran, M. E. 2017). Shaving legs often requires the person to bend down. So, people with CP risk falling if they try and bend over and shave their legs.

Current Shaving Techniques used by People with Cerebral Palsy

Currently, people with Cerebral Palsy remove their hair, both facial and legs, in multiple different ways. Because it is difficult to find shaving options that meet their physical needs, many people with CP use an electric razor when removing facial hair. This is because the blades are not out in the open, making it safe if they happen to lose their grip or shake while shaving.

Barsoum 3 Another way that people with CP shave is using a two-handed grip on a standard manual razor, such as Gillette or Venus. This position provides stability to the person shaving. While one hand is producing the shaving motions, the other hand stabilizes the hand holding the razor to limit squirming and shaking of the razor and prevent cuts or nicks. Although both of the previous examples work for removing facial hair, some people also like to remove leg hair. Some adaptive a razor handle extensions allow users used to reach towards the bottom of the body without having to bend over. Besides shaving themselves, people with CP may have a care giver who shaves for them using a special razor that is made to shave others. The problem with current shaving techniques used by people with CP is the lack of safety, comfort, and in some cases, independence. There are no products designed specifically for people with CP or symptoms similar to CP (see table. 1). Therefore, people with CP must rely on products that do not necessarily conform to their needs.

Current Products in the Market

Table 1. Name of Manufacturing Features Reviews Current Cost Product Details Gillette Treo Made to shave 1. Shave gel is Very positive Not currently someone else. built into the reviews available Dimensions of the handle because it is product are 2. Has a blade being tested. currently OverCap (a plastic However, a unavailable cover to protect sample may the user and the be requested blade while being if a form is transported) filled out 3. Can be held like a pencil or paintbrush

Barsoum 4 4. Uses disposable cartridges Gripeez Built-Up The grip is aimed to 1. Can be placed Positive ~$15.00 Grip reduce the amount on a razor reviews of muscle needed from the user

Maggard Razors Assembled razor N/A Very highly ~$22.95- Thick Stainless weight: 129 g rated (5 stars) $34.95 Steel Handle Handle length: 3” Safety Razor Assembled length: 3.38” Handle weight: 98 g Handle diameter: 0.64” Electric Razor Measures: 1. Secure grip N/A ~$32.95 Strap by 0.5”x 4”x 6” 2. Conforms to WrightStuff.Biz hand 3. Helps with weak hands 4. Thumb loops 5. Velcro straps 6. Fits razors

Razor Extension Material: Plastic 1. Velcro straps N/A ~$35.95 Handle by Length: 19” 2. Works with WrightStuff.Biz Weight: 0.25 lb. both electric and non-electric razors 3. Has a bend to reach hard places 4. Can hold an object with up to a 2” diameter

Barsoum 5 Weight Razor Weight: 1.5 lb. 1. Holds N/A ~$26.95 Cuff by disposable razor WrightStuff.Biz 2. Strap is made to fit over hand 3. Thumb Loops 4. Weights are used to balance shaky hands

Alternative Options for Hair Removal

Besides shaving, there are many other ways to remove hair such as waxing, laser hair removal, threading, and hair remover cream. Each method has its own benefits and limitations.

These other options, are analyzed in Table 2. Many of these options may not work for people with CP. For example, if any of these methods cause pain, depending on person, someone with

CP may not be able to express their pain because they may not be able to show physical symptoms of pain. Although, many of these methods can be done in the comfort of one’s home, someone with CP may not have the mobility needed to do it themselves and would therefore need a professional. Waxing requires a stable hand to apply the wax in the right area.

It also requires the user to quickly rip keep paper to remove the hair out properly. People with

CP may not have the stability, muscle, or mobility to do this themselves. Threading poses an even greater challenge because it requires precision as well and a good grip on the thread itself.

Besides the point that threading is not a good form of hair removal for legs, because of the large surface area, threading may be difficult for people with CP depending on what type of CP that they exhibit. Hair removal cream needs to be spread on and wiped off thoroughly. If the cream is on the skin for too long, skin irritation may occur. Some CP does not allow for full mobility. Therefore, hair removal cream may be difficult for some people with CP to apply to

Barsoum 6 certain parts of their body. For example, bending is required to apply hair removal cream to the legs, and people with CP may have a difficult time bending, depending on their symptoms.

Table 2. Type of Hair How it Works Pros Cons Removal Waxing Melted wax is spread 1. It can be done 1. The hair will have over the area where quickly need to grown the hair is to be 2. A professional is enough before being removed. A paper is not necessarily waxed to actually see then placed on the needed results wax and is pulled off, 3. Sometimes, 2. Results may not ripping the hair out. waxing can cause last a long time permanent hair (couple of weeks) removal or slowed 3. Skin irritation can growth of the hair occur if done due to damage of the improperly hair follicle caused by waxing Laser The laser will target 1. Reduces hair 1. The process takes the hair follicles growth a long time because based on the 2. Every part of the multiple treatments pigment. The laser body is eligible for are needed. will then burn the laser hair removal 2. The treatments root of the hair 3. The pain reduces cost a lot of money follicle. each treatment (between $200-$400) 3. Laser hair removal is not as safe with darker colored skin tones because there is little contrast between the hair color and the skin color. This proves difficult for the laser to tell what is hair is what is not. 4. If done improperly, the skin can be burned or scarred Threading A thread is twisted 1. Very sanitary 1. If done improperly, very tightly around because only the the hairs may break

Barsoum 7 the hair, then lifts the thread is used to instead of being hair from the hair remove the hair pulled out of the follicle 2. Very precise follicle completely 3. No chemicals 2. Skilled technicians needed may be hard to find 4. Very fast 3. If the hair is not 5. May stun hair long enough, it growth enough for it cannot be threaded to become 4. Not the best permanent approach for big areas. Usually done on the face 5. May create cuts if skin is soft 6. Could cause pain for some Hair Remover Cream Hair is made out of 1. No previous 1. Does not last a the protein keratin. experience required long time Most hair removal 3. Does not take a 2. Can smell bad creams use long time (10 3. Should not be used thioglycolic acid minutes max) on the face or any (TGA) to break down 4. Does not cost a lot sensitive areas keratin so that the of money 4. Different types of hair can be wiped 5. Does not cream are needed for away from the follicle necessarily cause each part of the body pain 5. Can cause allergic 5. Can be used on reactions most parts of the body

The Logistics of Hair Removal Cream

Although hair removal cream may be difficult for people with CP to apply, it does not require fine motor skills. Hair removal cream also decreases the danger of hair removal compared to an open blade or hot wax. The following information is based on the well known hair removal cream, Nair. The first step in using Nair, is to test the cream on a small part of the skin to see if any allergic reaction or irritation occurs. If no reaction or irritation is present, the next step is to

Barsoum 8 apply a generous amount of the cream onto the area where the hair is to be removed. The layer should be even and should cover all the hair. Rubbing the the cream can irritate the skin.

Although hair can usually be wiped away after three minutes, If the user has thick or coarse hair, the cream may need to stay on the leg for up to ten minutes. The hair and cream are easily wiped away with a wet washcloth. After all the hair and cream are wiped away, the skin is washed with lukewarm water to remove any residue. The entire process does not take more than 10-15 minutes (Nair™ lotion with aloe & lanolin.).

It is easy to cause skin irritation using hair removal cream. Allergies to the cream would be detected in the very first step. However, many other steps in the process may cause skin irritation such as, applying the cream, letting the cream sit too long on the area, wiping the hair away, and finally, patting the area dry. For someone with full mobility, these risks may not seem so major. To someone with CP though, the possible risks are a lot more probable due to their lack of physical stability, muscle strength, and mobility. Some possible side effects of using products like Nair include, skin irritation, in the form of rashes, chemical burns from the chemicals in Nair, and allergic reactions in the form of rashes, hives, and swelling. (Sherwood, C.

2017, July 18).

Barsoum 9 References

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Cruel, J. (2017, June 1,). The pros and cons of laser hair removal. Retrieved

from https://www.self.com/story/the-pros-cons-of-laser-hair-re

Curran, M. E. (2017). In Barsoum M. (Ed.), Questions about mobility and muscle weakness

Daily living aids. Retrieved from https://www.wrightstuff.biz/

Dugar, A.OverCap product design. Retrieved from http://aditidugar.com/overcap/

Gillette treo. Retrieved from https://gillette.com/en-us/handlewithcare

Gripeez built-up grip with mens safety razor. Retrieved from https://www.amazon.com/Gripeez-Built-

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Nair™ lotion with aloe & lanolin.

Pros and cons of hair removal creams (depilatories)  (). Retrieved

from https://hairfreelife.com/hair-removal-cream-pros-and-cons/

Reeves, A. G., & Valenstein, E. (1981). Disorders of the nervous system. Chicago [u.a.]: Year Book

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Barsoum 10 Scott, P. J. (2015). Cerebral palsy. Gale: Science in Context, Retrieved from

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Sherwood, C. (2017, July 18,). Dangers of nair hair removal. Retrieved

from https://www.livestrong.com/article/80270-dangers-nair-hair-removal/

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Company(Eds.), Safety razor system

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Torres, N. (2017a, September 8,). Threading hair removal 101. Retrieved

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