Dressing Techniques for hemiplegia: occupational therapy

1. ADLS FOR PERSON WITH
HEMIPLEGIA
Shamima Akter
B. Sc (Honors) in Occupational Therapy
& M. Sc in Rehabilitation Science
Assistant Professor,
Department of Occupational Therapy
Bangladesh Health Professions Institute (BHPI)
Centre for the Rehabilitation of the Paralysed (CRP)
Chapain, Savar

2. Importance of practicing ADL
 ADL practicing provides possible functional problem
with solution
 The methods described here appropriate to the
person with hemiplegia who has lost the use of one
side of the body.
 Some patients post stroke will retain or regain
independence in their ADL. Techniques for weakness
and/or incoordination may be useful for those.
 Independence may interfere by cognitive-perceptual
impairment.

3.  Motor planning deficits, such as ideomotor apraxia,
may make learning new skills more difficult
 Problem of absent, decreased, or distributed
sensation affect performance of ADL.
 Training and/or environmental modification to
prevent injury is particularly important when
interacting with hot or sharp items.

4. Certain prerequisite abilities are considered important
for successful dressing. These are ability to:
- reach each foot,
- stand unsupported for 10 seconds, and
- maintain sitting balance when reaching down
- Patient with hemiplegia should dress while seated on
a stable surface with both feet on the floor to
increase stability
- Patients who have difficulty with one-handed
fastening may prefer Velcro
- As a general rule, the affected limb is dressed first
and undressed last

5. Method I: Shirt or cardigan garment:
Over-the-Shoulder Method

6. Donning shirt
The over-the-shoulder method that follows the following steps:
 Put the shirt on the lap, label facing up, collar toward the
abdomen, with the sleeve for the affected arm hanging
between the knees.
 Put the affected hand into the sleeve and lean forward to
let gravity extend the elbow and to slide the sleeve onto
the arm.
 Grasp the collar at the point closet to the unaffected side.
 Hold tightly to the collar, lean forward, and bring the
collar and shirt around the affected side and behind the
neck to the unaffected side.

7. Continue…
 Put the unaffected hand into the other armhole. Raise the
arm out and up to push it through the sleeve.
 To straighten the shirt, lean forward, work the shirt down
over the shoulders, reach back and pull the tail down, and
then straighten the sleeve under the affected axilla.
 To button, line up the shirt fronts and match each button
with the correct buttonhole, starting with the bottom
button

8. Removing shirt
The over-the-shoulder method that follows the following steps:
 To remove shirt, unbutton it
 Use the unaffected hand to throw the shirt back off the
unaffected shoulder
 Work the shirt sleeve off the unaffected arm, pressing the
shirt cuff against the leg to pull the arm out
 Lean forward
 Use the unaffected hand to pull the shirt across the back
 Take the shirt off the affected arm

9. DRESSING (SHIRT)
Method II: Shirt or Cardigan
Garment: Overhead Method

10.  The overhead method for putting on and removing
font-opening tops may be less confusing for a patient
with selected perceptual impairments or limited
reach in unaffected upper extremity. This method is
not suitable for coats.

11. Method II: Shirt or Cardigan Garment: Overhead
Method includes following steps
 Put the shirt on the lap, label facing up, and the collar
next to the abdomen; drape the shirttail over the knees
 Pick up the affected hand and put it into the sleeve
 Pull the sleeve up over the elbow. If the sleeve is not
pulled past the elbow, the hand will fall our when
continuing.
 Put the unaffected hand into the armhole/ other sleeve.
Raise the arm and push it through the sleeve as far as
possible
 Gather the back of the shirt from tail to collar
 Hold the gathered shirt up, lean forward, duck the
head, and put the shirt over the head

12.  To straighten the shirt, lean forward and work the
shirt down over the shoulders. Often, the shirt gets
caught on the affected shoulder and must first be
pushed back over the shoulder. Then reach back and
pull the tail down.
 To button, line up the shirt fronts and match each
button with the correct buttonhole, starting with the
bottom button.

14. Doffing shirt
Method II: Shirt or Cardigan Garment: Overhead Method
includes following steps
 Unbutton the shirt
 Leans forward
 Use the unaffected hand to gather the shirt up in
back of the neck
 Ducks the head
 Pulls the shirt over the head and then,
 Takes the shirt off the unaffected arm first
 Lastly from affected arm.

16. DRESSING
T-shirt, Sweater
Method III: Pullover garment

17. DRESSING SHIRT
The following steps are used for putting on a pullover garment.
 Position the garment on the lap, front of the garment face
down, bottom toward chest and label facing down
 Using the unaffected hand, roll up the bottom edge of the
shirt back, all the way up to the sleeve on the affected side.
 Spread the armhole opening as large as possible. Using the
unaffected hand, place the affected arm into armhole and
pull the sleeve up onto the arm past the elbow.
 Insert the unaffected arm into the other sleeve.
 Gather the shirt back from bottom edge to neck, lean
forward, duck the head, and pass the shirt over the head
 Adjust the shirt on the involved side up and onto the
shoulder and remove twists

18. The following steps are used for removing on a pullover garment.
 Starting at top back
 Gather the shirt up
 Lean forward
 Duck the head
 Pass the shirt over the head
 Remove the unaffected arm and then the affected
arm

19. DRESSING.
BRA
 The following methods are used for wearing bras
 The bra is placed around the waist and hooked in front, where
she can see what she is doing.
 In case of jogging bra, the dressing method is overhead method
describe for a shirt.
 Front-fastening bras are easier, because they do not need to be
twisted around the trunk once fastened.
 One end can be tucked into the waist band of panties or under
the affected arm until the other end is brought around, if
needed.
 It is fastened and rotated to the proper position, the affected
arm is placed through the shoulder strap, and the unaffected
arm is placed through the other shoulder strap. The bra is
pulled up into place. It is removed by reversing the process.

20. DRESSING.
PANTS

21.  Donning pants
 The following steps describe how to put on pants
(Ryan & Sullivan, 2011 cited in Radomoski and
Latham 2013).
 Sit, if a wheelchair is used, the brakes should be
locked and the footrests should be up and/or swung
out of the way. Move the unaffected leg beyond the
midline of the body for balance.

22.  Grasp the ankle or calf of the affected leg. Lift and
cross the affected leg over the unaffected leg.
Alternatively, cup the affected knee in clasped hands
to lift and cross the leg.
 Pull the pants onto affected leg up to but not above
the knee
 Uncross the legs
 Put the unaffected leg onto the other pant leg.
 Remain sitting; Pull the pants up above the knees as
far as possible.

23.  To prevent the pants from dropping when standing,
put the affected hand into the pant pocket or the
thumb into a belt loop. Alternatively, use a pant clip
to attach the pants to the shirt so they do not slide
down. Pants with elastic waistbands are also less
likely to slide when standing up.
 Stand up. Pull the pants up over the hips; button and
zip pants while standing. Person with poor balance
may remain seated and pull the pants up over the
hips by shifting from side to side; they should button
and zip the pants while seated.

24.  Removing pants
 Unfasten the pants while sitting. Stand and let the
pants drop past the kness or push down if wearing
elastic-waist garment.
 Sit; remove the pants from the unaffected leg.
Remove the pants from the affected leg
 Uncross the legs

25. DRESSING.
SOCKS OR STOCKINGS
The following method is used to put on socks or
stockings.
 Sit, if a wheelchair is used, the brakes should be
locked and the footrests should be up and/or swung
out of the way.
 Move the unaffected leg beyond the midline of the
body for balance.
 Grasp the ankle or calf of the affected leg. Lift and
cross the affected leg over the unaffected leg.
Alternatively, cup the affected knee in clasped hands
to lift and cross the leg.

26.  The sock is opened by inserting the thumb and index
finger into the top and spreading the fingers.
 The sock is put on the foot by slipping the toes into
the opening made under the spread hand.
 The sock is then pulled into place, and wrinkle are
smoothed.
 To remove, the leg is positioned as for putting the
sock on.
 The sock is pushed off with the unaffected hand.

27. DRESSING.
SHOES
 Sit, if a wheelchair is used, the brakes should be
locked and the footrests should be up and/or swung
out of the way.
 Move the unaffected leg beyond the midline of the
body for balance.
 Grasp the ankle or calf of the affected leg. Lift and
cross the affected leg over the unaffected leg.
Alternatively, cup the affected knee in clasped hands
to lift and cross the leg.

28.  A tie shoe is put onto the affected foot after the leg is
crossed over the unaffected one to bring the foot
closer.
 If the laces have been thoroughly loosened, the
person often can work the shoe on while the leg is
crossed over by grasping the heel of the shoe with the
unaffected hand and working it back and forth over
the heel until it goes on completely.

29.  Sometimes it is necessary to insert a shoehorn while
the leg is crossed over and then carefully lower the
foot with the shoe half on and shoehorn in the shoe
and finish putting on the shoe by repeatedly pushing
down on the knee and adjusting the shoehorn.

30.  Tie up the shoe laces: For a person with right
hemiplegia, start the lace on the right side of the
shoe so that the lace ends on the left side at the top.
 Tie a knot in one end of the shoelace. Thread the unknotted
end up through the hole nearest the toe of the shoe on the left.
 Take the lace across the tongue of the shoe and up under the
flap on the opposite side of the shoe.
 Continue to go across the tongue and up under the flap
on the next highest hole on the opposite side until you
reach the top

31.  Circle around toward the toe of the shoe and go under the part
of the lace that is going across the tongue to the last hole
 Circle around toward the top of the shoe. Pull free lace through
the loop down toward the ankle and uot to the left side
 Pull loop tight.

33.  Define ADL. What are the importance of practicing
ADL.