A stroke often results in hemiparesis, or weakness on one side of the body, which can turn the routine task of dressing into a complex challenge. The goal of assisting a stroke patient with dressing is to maximize their independence and maintain dignity while navigating these physical limitations. By employing specific techniques and preparing the environment, caregivers and patients can transform this potentially frustrating activity into a manageable part of the daily routine.
Preparing the Environment and Ensuring Safety
Before beginning the dressing process, establish a safe and efficient setting. The patient should sit in a stable chair with armrests or on the side of a bed. Ensure both feet remain firmly on the floor to provide a secure base and minimize the risk of a fall. Sitting conserves energy and provides stability, which is important since balance is often impaired after a stroke.
All clothing items should be pre-selected and laid out in the order they will be put on, starting with undergarments and ending with outerwear. Laying out the clothes minimizes unnecessary movement and helps the patient focus on the immediate task. The caregiver should explain each step beforehand to the patient, encouraging them to participate as much as possible with their unaffected side.
Essential Technique for Dressing the Upper Body
The foundational rule for dressing a stroke patient with hemiparesis is to always manage the affected side first when putting clothes on. Conversely, manage the unaffected side first when taking them off. This technique allows the stronger, unaffected limb to assist and guide the weaker limb, minimizing strain and discomfort.
To put on a shirt or jacket, place the garment on the patient’s lap or a stable surface with the collar facing away. The caregiver or patient uses the unaffected hand to gather the sleeve intended for the affected arm. Pull the sleeve completely over the affected hand and up the arm as far as possible. For front-opening garments, such as a button-up shirt, place the entire affected arm into the sleeve first.
Once the affected arm is fully in place, bring the garment around the back and slide the unaffected arm into the second sleeve. Finally, pull the garment over the head and adjust it down the torso. When undressing, the process is reversed: remove the unaffected arm from its sleeve first, pull the shirt over the head, and gently release the affected arm from its sleeve last.
Adapting the Process for Lower Body Garments
Dressing the lower body, including pants, shorts, and undergarments, involves a higher risk of losing balance. It is especially important to remain seated throughout the entire process. The technique starts by addressing the affected leg first to control its movement and reduce the need for awkward positioning.
While seated, slip the pant leg over the affected foot and pull it up to the knee. The patient can use their unaffected leg to cross the affected leg over it, providing a stable position for maneuvering the garment. Next, insert the unaffected leg into its pant leg, and pull the pants up to the hips while remaining seated.
To pull the pants up over the hips and waist, the patient can lean or “scoot” from side to side, pulling the waistband up incrementally with the unaffected hand. If the patient is able to stand safely, they may briefly use a stable support, such as a walker or grab bar, to pull the pants up fully. For socks and shoes, maintain the seated position and use tools like a long-handled shoehorn or sock aid.
Selecting Helpful Clothing Features and Dressing Aids
Selecting clothing with specific features can significantly streamline the dressing routine. Loose-fitting garments and those made of slippery, stretchy fabrics, like satin or knitted materials, are easier to maneuver over weak limbs than tight or stiff materials. Front-opening tops eliminate the need to pull an item over the head and are particularly helpful when they utilize adaptive closures.
Traditional buttons and zippers can be challenging due to impaired fine motor skills and dexterity. Adaptive clothing substitutes these with magnetic closures, large snaps, or hook-and-loop fasteners like Velcro, which require minimal dexterity. For lower body garments, elastic waistbands eliminate the need for difficult buttoning and zipping.
Dressing Aids
Various dressing aids further support independence by compensating for limited reach and dexterity.
- A button hook assists in securing small buttons.
- Zipper pulls can be modified with rings or loops for easier gripping.
- Long-handled reachers allow the patient to access their feet and lower legs.
- Sock aids help the patient put on socks without compromising seated stability.