The safe and dignified dressing of a paralyzed patient requires careful technique and preparation. The caregiver’s role involves protecting the patient from injury, such as joint dislocation or skin tears, while minimizing discomfort. Proper technique is also necessary to prevent injury to the caregiver by employing good body mechanics and avoiding excessive lifting. Preparation ensures the process is smooth and respectful, promoting the patient’s physical safety and overall well-being.
Preparing the Environment and Patient Positioning
Before beginning dressing, the environment must be optimized for safety and privacy. The room should be warm, and privacy must be ensured by closing doors and curtains. All necessary clothing items should be gathered and laid out in the order they will be put on to minimize interruptions and reduce the time the patient is exposed.
The patient’s position depends on their mobility. If the patient can sit up with support, dressing can be done while seated on the edge of the bed or in a locked wheelchair. For patients who must remain in bed, the bed height should be adjusted to the caregiver’s waist or thigh level to protect the caregiver’s back. Bed brakes must always be locked to prevent movement during transfers or repositioning.
Core Techniques for Upper and Lower Body Dressing
The foundational principle for dressing a patient with paralysis or weakness on one side is to “Dress the Affected side First, Undress the Unaffected side First” (DAF/UAF). This technique ensures the weaker, less mobile limb is handled minimally and avoids twisting or forcefully pulling the joint. For instance, when putting on a shirt, the sleeve is first gathered into a ring and slid onto the affected arm, which limits the need for extensive joint movement.
Upper Body
When dressing the upper body, the affected arm is inserted into the sleeve first, sliding the garment up to the shoulder. The caregiver must support the affected joint, particularly the shoulder, to prevent subluxation or injury. Once the affected arm is secured, the shirt is gathered up the patient’s back, and the head is guided through the neck opening. Finally, the unaffected arm is threaded through its sleeve, allowing the patient to assist with the final positioning of the garment.
When undressing, the process is reversed; the garment is removed from the unaffected side first. This creates slack that allows the clothing to slip easily over the more rigid or less mobile affected side. Movements should be slow and gentle, constantly checking for signs of discomfort or pressure points that could lead to skin breakdown.
Lower Body
Lower body dressing often requires the patient to be in a seated position or to use a mobility technique called “bridging” if they are in bed. The caregiver first slides the pants over both feet and up to the knees. If the patient can lift their hips, they are prompted to bridge while the caregiver pulls the pants over the buttocks.
If the patient cannot bridge, they are gently rolled onto their side, and the waistband is pulled over the hip. They are then rolled to the opposite side to pull the remaining fabric over the second hip. This side-to-side rolling motion is safer than attempting to lift the patient’s entire lower body. After the pants are fully on, any wrinkles must be smoothed out to prevent skin irritation or pressure sores.
Selecting Adaptive and Comfortable Attire
Choosing the right clothing simplifies the dressing process and enhances the patient’s comfort. Adaptive clothing is specifically designed with features like open-back tops, side-zip pants, and magnetic or hook-and-loop (Velcro) closures instead of small buttons or traditional zippers. These closures are easier for a caregiver to manage and allow the patient to participate more independently.
Fabrics should be soft, stretchy, and non-irritating, such as cotton or bamboo blends. Loose-fitting garments are preferred because they are easier to pull over limbs and minimize the risk of restricting circulation or creating pressure points. For wheelchair users, specialized pants with a higher back rise and flat seams are beneficial, as they prevent bunching up and reduce the risk of pressure sores from prolonged sitting.