Caring for a person who has lost function on one side of their body, often called unilateral weakness or hemiparesis, requires specific techniques to ensure safety and comfort. This weakness most commonly results from a neurological event like a stroke or a traumatic brain injury. Adapting daily routines, particularly dressing, is a large part of caregiving that directly impacts a person’s sense of dignity and independence. The primary goal of using specialized dressing methods is to minimize strain on the affected side while promoting as much self-participation as possible.
Understanding the Weak Side Rule
The fundamental principle for dressing a patient with unilateral weakness is to always put clothing on the weak side first, and conversely, to take clothing off the strong side first. This simple rule, often summarized as “weak on, strong off,” serves a biomechanical purpose by reducing the manipulation of the affected limb. By dressing the weak side first, the stronger side remains free to maneuver the garment and assist with the necessary actions. This sequence minimizes the risk of inadvertently pulling, stretching, or forcing the affected arm or leg, which can prevent pain and potential injury, such as a shoulder subluxation or joint dislocation.
Before beginning the dressing process, it is important to position the person safely, usually in a seated position on a sturdy surface or lying down in bed. This stability ensures that the person is balanced and prevents falls, especially during shifts in weight. Throughout the process, the caregiver should encourage the person to use their strong side to help as much as possible, which reinforces their motor planning and promotes independence. Loose-fitting garments are preferable, as they require less effort and range of motion to put on and take off.
Step-by-Step for Upper Body Dressing
When dressing the upper body, the caregiver starts by preparing the garment, such as a shirt or sweater, by gathering the material. The sleeve for the weak arm is threaded onto that limb first, gently working the material up past the person’s elbow and toward the shoulder. The weak arm should be supported throughout this process to prevent it from hanging or pulling on the shoulder joint.
Once the weak arm is dressed, the garment is then brought around the back of the person’s torso. The caregiver or person can then pull the neck opening over the head. Finally, the strong arm is guided into the remaining sleeve. This sequence ensures that the weak arm is completed while the strong arm is still free to provide assistance and adjust the clothing as needed. After the garment is on, the fabric should be smoothed out and checked for twists or binding, especially around the weak side.
Adapting the Procedure for Lower Body
Dressing the lower body with one-sided weakness requires careful positioning to manage balance and movement. The person should be seated on the edge of a bed or a stable chair with arms, or they may remain lying down if they cannot sit safely. The process begins by guiding the weak leg into the corresponding pant leg or underwear opening first, working the material up to the knee. This is often accomplished by crossing the weak leg over the strong leg or by having the caregiver lift and support the weak limb.
Once the weak leg is in and the pants are up to the knee, the strong leg is inserted into its pant leg. The person can then assist in pulling the pants up to their hips. If the person is able, they can pull the pants up by leaning to the strong side and hiking the pants over the weak side’s hip, then shifting their weight to the weak side to pull the pants up over the strong side. For socks and shoes, assistive devices like a sock aid or a long-handled shoehorn can be highly beneficial, allowing the person to maintain a seated position and reach their feet without excessive bending. If assistance is required, the weak foot is dressed first.