If the person has a paralyzed arm, clothing is removed from which side first?

On certain occasions, a patient who has had a stroke will need assistance in dressing themselves due to weakness on one side of the body or in certain limbs.  Assisting your patient with daily activities helps the patient to feel that they are in control of their situation.  Before you assist a patient with dressing, wash your hands carefully to avoid transmission of germs.  Ensure that a clean set of clothes is available and ready to wear.  Greet your patient, and explain that you want to help them get dressed or change clothes.  Then, follow these steps to assist your patient:

1. Teach the patient that the safest way to get dressed is to undress the weak side of the body first.  While your patient will need your help at first, you can increase the patient’s independence and reduce the risk of falls later on by teaching the proper way to change clothes.
2. Assist your patient in removing clothes as needed.  You will want to let the patient complete as much of the task as possible without your assistance.  Set the dirty clothes aside and move the clean clothes within easy reach of the patient.
3. Throughout the process, you will need to monitor you patient to ensure they do not become fatigued or dizzy.  Be ready to help the patient sit or lie down if needed.
4. Instruct the patient to dress the strong side of the body first.  For example, if the patient is stronger on the right side, have him or her place their right arm in the right sleeve first.  Again, allow the patient to complete as much of the task as possible without assistance.

When the task is complete, ensure dirty clothes are placed in the appropriate receptacle.  Wash your hands again.  Helping your patient learn self-care skills such as dressing will allow the patient to regain their independance and will speed recovery.

Expert Tip By Tanya Glover, CNA

Dressing a dependant patient can be a challenge, and each one is different. What works for one may not work for another. Our patients are all individuals and this is something that we sometimes forget. During this part of your skills test, it is important to remember not to pull, push or otherwise roughly manipulate your “patient”. For me it helped to talk to my “patient” during the process, letting them know each thing I was doing and allowing them time to help or respond to the care I was providing. In fact, talking to your “patient” during any of the skills you are tested on (aside from hand washing) is a good idea. It will help you feel less nervous and allow you to talk yourself through each step aloud.

The main thing, aside from patient safety, is to allow your patients to do as much dressing as they are able to do. A mistake we all make at one point or another is doing every little thing for them. This takes away from their independence. Even if your patient likes this type of care, encourage as much self care as possible. If you don’t let them do the things they can, their muscles will atrophy and then they really will be helpless. Even dependant patients can do a little something to help with their dressing activities. If they can lift their arm a few inches to get their shirt on, let them do it! If they can help slide their feet into their own shoes, allow it! Keep their bodies as active as possible and you will have preformed a job well done.

As occupational therapists in the rehabilitation centre, we often encountered problems during the dressing or undressing of people with hemiplegia (half-sided paralysis). Below are some important tips to make this daily activity run more smoothly.

General advice

• Some people with hemiplegia have problems with the order of everyday actions: apraxia. They no longer know how and in which order they should put on their garments. Putting the items of clothing in the correct order goes a long way to helping them
• When dressing, we recommend that you always start with the paralysed side. When undressing it's the other way around: first bring the garment over the healthy side. In this way you avoid twisting the paralysed arm and causing damage to the shoulder. It's also just easier to do it that way. A small reminder: you must take good care of the paralysed limb and keep it 'warm': insert it first when dressing and remove it last when undressing.

Underwear

Women often have difficulty putting on a bra. The method in this videoclearly explains how you can put on your bra with one hand. Too difficult? Then choose a bra with a magnetic front closure.

Tops

• When putting on a shirt, a person with hemiplegia on one side often has problems closing the button on the sleeve of the side that is not affected. This can be remedied by sewing together this button with elastic thread. This is how to make an elastic sleeve cuff.
• A cardigan or shirt with magnetic buttons is even easier. Make sure that the velcro or magnets are always properly closed when you put the garment in the washing machine.

Pants

• Pants with buttons and zippers require a lot of skill from people with hemiplegia. Pants with an elastic waistband offer a solution to this problem. This also makes going to the toilet easier and safer. So Yes has fashionable trousers with elastic for both women and men.
• Do you wear an orthosis? Then the legs of the elasticated trousers are wide enough to hide the leg device. For women, there are also elasticated (wheelchair) trousers with wide legs.

Shoes

• When putting on stockings and shoes, put one leg over the other and let the paralysed arm hang as loosely as possible.
• For shoes with laces, it is possible to thread the lace so that it can be tied with one hand. However, this requires a lot of practice and skill.
• There are also shoes with Velcro or special fasteners such as elastic shoelaces or Zubits.
• The trainers from Friendly Shoes are easy to put on and take off one-handed thanks to the long and easy-to-handle zip. The ideal solution for people with hemiplegia. They also look very fashionable.
  

Jackets

Unzipping a jacket with one hand is not easy. A jacket with magnetic zipper can solve this problem. Simply hold the two ends together until they snap together and pull upwards. You can also see how the zipper works in the following video.

There are a lot of videos on YouTube where people with half-sided paralysis demonstrate how to dress or undress most easily. Of course, you can always contact us with all your questions.

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