Dress For Success: Strategies for Dressing After Stroke

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Dress For SuccessStrategies for Dressing After
Stroke

• Lori Blue, OT Reg (Ont)
• Tuula Jodoin, OT Reg (Ont)

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Dress for Success

• Increases confidence and comfort throughout the
  day
• Provides independence, a sense of control, and
  self expression
• Provides meaning and purpose
• Therapeutic physically, cognitively, and
  emotionally

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Possible Causes of Dressing Difficulties After
Stroke

• Hemiparesis
• Dressing is a bilateral task and hemiparesis
  makes all aspects of dressing more difficult
• May increase risk of injury during dressing tasks

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Possible Causes of Dressing Difficulties After
Stroke

• Perceptual Deficits
• Neglect Decreased awareness and attention of
  the affected side
• Figure-Ground Discrimination Difficulty finding
  objects as they may blend into the background
• Right-Left Discrimination Difficulty
  distinguishing between right and left

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Possible Causes of Dressing Difficulties After
Stroke

• Apraxia
• Inability to plan out movements despite having
  the necessary range of motion, strength, and
  co-ordination
• May cause difficulty in planning or initiating
  the task
• May account for inconsistencies in an
  individuals ability to dress

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Possible Causes of Dressing Difficulties After
Stroke

• Perseveration
• Difficulty with moving from one idea or movement
  to the next
• May interfere with an individuals ability to go
  onto the next step of the task

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Possible Causes of Dressing Difficulties After
Stroke

• Fatigue
• An individual may get easily fatigued during
  dressing
• May require frequent rest breaks
• Monitor for signs of fatigue
• Fatigue increases the risk for injury and falls

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Set Up Be Sure to Plan Ahead

• Have all necessary items within reach before
  starting, including assistive devices and
  mobility aids
• Have the individual positioned in a manner
  appropriate to his/her abilities
• It may be necessary to simplify the task

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Set Up Promoting Independence

• CUE NOT DO
• Provide choice whenever possible
• Respect premorbid clothing styles
• Allow adequate time to get dressed
• Adaptive clothing and assistive devices can
  facilitate independence

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Examples of Assistive Devices
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Dressing Techniques and Strategies

• Perceptual Deficits
• Clothing may need to be placed at midline or on
  the unaffected side
• Provide an anchor/cueing towards the affected
  side
• Use colour contrast
• Orient clothing prior to starting the task

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Dressing Techniques and Strategies

• Apraxia
• Plan and structure the task prior to starting
• Provide cues as needed
• Use labels to aid orientation of clothing
• Use consistent set up and sequencing
• Practice

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Dressing Techniques and Strategies

• Perseveration
• Have the person plan the task prior to beginning
• Provide cueing as needed
• It may be necessary to stop one task and redirect
  the person to go on to the next step

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Dressing Techniques and Strategies

• Fatigue
• Encourage the individual to take rest breaks as
  necessary
• Proper set up, adaptive clothing, and assistive
  devices may conserve energy

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Dressing Techniques and Strategies

• Hemiparesis
• Dress the affected side first
• Use the affected side as much as possible
• Use compensatory strategies to promote
  independence and protection of the affected side

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Hemi-Dressing Techniques and Strategies

• Shirt/Sweater
• Neither front fastening or over the head type
  shirt is necessarily easier for all individuals
• Dress the affected arm first undress the
  affected arm last
• Assistive devices button hook, Velcro closures,
  elastic loops for buttons at cuff, zipper pull,
  labels

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Donning a Shirt
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Donning a Shirt
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Donning a Shirt
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Hemi-Dressing Techniques and Strategies

• Upper Body Underclothing
• Fasten the bra in front vs. reaching around the
  back
• Pull strap over shoulder of affected limb first
• Adaptive clothing Velcro closures, front
  closure bra, sports bra, camisole
• May require assist to don bra despite all
  compensatory strategies

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Donning a Bra
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Donning a Bra
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Donning a Bra
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Donning a Bra
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Hemi-Dressing Techniques and Strategies

• Pants/Underpants
• Dress affected leg first undress the affected
  leg last
• Don underpants, pants, and footwear, prior to
  standing to pull up clothing to conserve energy
• Pull pants up over feet prior to standing
• Use appropriate mobility devices and level of
  assistance for standing

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Hemi-Dressing Techniques and Strategies

• Pants/Underpants
• Adaptive clothing drawstring waist band, Velcro
  closures
• Assistive devices long handled reacher,
  dressing stick, button hook, zipper pull,
  clips/suspenders/loops

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Donning Pants
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Donning Pants
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Donning Pants
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Hemi-Dressing Techniques and Strategies

• Skirt
• May be donned over the head and pulled down to
  waist while seated
• May require assist to stand to adjust skirt

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Hemi-Dressing Techniques and Strategies

• Socks
• Can don either sock first
• Position the body appropriately
• Sock aid may or may not be beneficial
• May require assist to don socks despite all
  compensatory strategies
• Assistive devices sock aid, long handled
  reacher to adjust socks, long handled shoe horn
  to remove socks

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Donning Socks
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Donning Socks
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Donning Socks
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Using a Sock Aid

• Squeeze to hold sock aid between knees.

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Using a Sock Aid

• Gather up sock and stretch over end of aid.

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Using a Sock Aid

• Slip foot into aid. Pull up on cord handles until
  sock is on foot and aid slides out of the sock.

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Hemi-Dressing Techniques and Strategies

• Shoes/Slippers
• Can don either shoe/slipper first
• Position the body appropriately
• One-handed shoelace tying
• Footwear with no heel support is NOT recommended
• Assistive devices Velcro closures, elastic
  shoelaces, long handled shoehorn, long handled
  reacher

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One-Handed Shoelace Tying
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One-Handed Shoelace Tying
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One-Handed Shoelace Tying
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Hemi-Dressing Techniques and Strategies

• Belt
• Put belt onto pants prior to donning pants
• Assistive devices belt fasteners may include
  Velcro closures, toggle, D-ring

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Conclusion

• Using appropriate compensatory strategies,
  assistive devices, and level of assistance can
  make dressing easier and less frustrating for the
  individual and the caregiver!