Dressing

girlEver tried to dress using just one hand?  Try it today.  Then imagine being six years old and trying to dress with one hand.  On good days, it’s challenging, and on bad days, it’s a big stressor.  On this page, you’ll find ideas to help your child with hemiplegia or hemiparesis learn to dress independently.  Of course, each child is different and your child will probably come up with his or her own special style.

Take a deep breath and relax.

Most children with hemiplegia or hemiparesis learn to dress themselves.  Their challenge is to dress with little to no use of one hand and your child will find unique ways to do this.  One child will expect Mom or Dad to help them discover adaptive methods while another may be very determined to do it “my way.” We suggest that you encourage them to do it “my way.”  This will help your child begin his or her journey towards independence and will increase their self esteem when they feel the excitement and success of mastering a task like putting on their socks or shoes.  Make it fun – not stressful.

When to Start?

We suggest asking your friends when their child started doing a task. Then, add a few months to that, since it often takes our kids longer to start and to master a task. It’s not a race – your child will find his or her own time table for successful dressing.  The reason that we suggest that you keep up with when other children are doing certain tasks is because so many of us are used to doing things for our children and we may miss that it’s time to let them start taking responsibility for some of their own self care.  This isn’t limited to parents of children with special needs. Parents of typically developing children do this as well.  The point is that children feel good about themselves when they master a task like dressing, so it’s good to start young.

Time Management

Try dressing with just one hand – it takes longer – sometimes a LOT LONGER. You’ll need to allow additional time for your child with hemiplegia to dress. When they’re learning new tasks, it may be best to let them start on a weekend when the family doesn’t feel rushed to get out the door to work or school. Start with loose pajamas. They’re easier to put on.

Practice makes perfect (or close enough)

It takes time to learn a new skill.  Introduce one new item of clothing at a time and practice until your child either masters the skill or you both decide that it may be something to work on sometime in the future.

Rehearse the order in which items go on – shirt, pants, socks, shoes – whatever works best for your child.  Tune into your child’s learning style. If they learn best by talking, then talk about the order of dressing. If your child is a more sensory type learner, then act out the order of dressing.  Talk, act, pretend dress, play a game, quiz them, model and demonstrate for younger children. The repetition helps when they’re in panic mode (like about to go to the playground at school).  The repetition will give them more confidence as will also cover all learning styles.  Play a game with your child. You dress yourself and leave out an item. Let them figure out what item you’re missing. Make it fun

If your child is struggling with a task that has many steps, help them break the task down into smaller, micro steps.

Thoughts from parents of children with hemiplegia

Oh, if only every therapist had a child with hemiplegia. My son’s therapist was always on our back about letting him dress himself as I always used to help him, too. What she didn’t take into consideration was the time it took him to do it himself. Of course, if I had an extra hour in the day, it might have worked but I didn’t. Besides, the frustration he endured trying to do it himself just was not worth it to me. He’s now a teenager and can dress himself just fine. He might need help here and there but for the most part he can do it. – Kelli in PA

Our son did not fully dress himself until he was 8 years. But the occupational therapist did work on some independent skills – zippers, buttons, etc. – but bottom line, I knew he could if he tried. So instead of working on it at home (in the moment) he got 5-10 minute of 1 hour session. Doing that small amount weekly, he is an independent dresser and bather when he needs to be. It doesn’t stop him from negotiating – Mom will you tie my shoes…..if I put them on…?! One thing I have done (still do on *those* days) is to give one direction then walk away.  I start 30 minutes before we are out the door. “Get shoes out of the bucket; put socks on; choose which gloves/hat/shoes” helps and over time it becomes routine/familiar. – Kelly-Ann

I have a 7 yr old daughter with right hemiplegia. She can take pants off and on but can’t do zippers or buttons. Putting on tops is ok – either over head or from back. She can’t pull anything off over her head. We started with panties, moved to socks, pulling up bottoms (which I still zip/button), then pulling on tops. Tops/blouses were the hardest. This whole process has been a few years in the making. This year I had a tailor put Velcro on her school uniform bottoms and snaps on the button down blouses. With Velcro shoes and at least 15 minutes she can now get dressed independently. You can’t imagine how proud she! Most mornings I get a “ta da” and a BIG smile when she’s done. I really wish I had done this earlier! It makes her so happy! We used to leave all shirts untucked to cover the zipper until someone could help after using the bathroom anytime we weren’t around.

Socks

Tight hamstrings can make it difficult for children with hemiplegia to bend over and reach their feet which can add to the challenges of putting on socks and shoes.

Buy tube socks. Tube socks don’t have a “heel”, so it doesn’t matter which direction you put them on. Buy socks that are a little larger than needed so that they’re not so hard to pull up with one hand.  Most children find it easier to put on socks if they’re sitting on the floor. The most difficult part is getting started, so make sure the top of the sock has a pretty large opening. You may want to cut the elastic at the top of the sock to make the opening larger. Yes, I know – the socks will probably fall down without that elastic, but who really cares?  Success is most important!  Once they’ve mastered the no elastic opening, move on to a sock with elastic.  When they’ve mastered tube socks, you can try socks with heels.

Tights

Yes, your child can learn to put these on. Ask your friends when their daughters started doing this, then have your child try at that age. This is something to be tried after socks have been mastered.  Buy thick tights so that they won’t tear with all the pulling and tugging. You will need to roll the tights down to the toes and help your child get started. Once you have the foot in, she can probably start pulling them up with your help. This will take several months, maybe years of practice, and by the time she masters it, she may decide that she doesn’t like the style. Leggings may give her a similar look without all the work. Some of our children have sensory issues and the tights are just very uncomfortable and “itchy”.

Underwear and Panties

These are usually pretty simple for children with hemiplegic cerebral palsy to master.  It seems easier for most to put on undergarments while in a sitting position.  Buy them just a tiny bit larger than needed. Most children will put both legs in, then alternate pulling one side up, then the other, until they have them pulled up.

Bras

There are a variety of methods girls with hemiplegia use to put on a bra. Some women hook the bra together, then put it on over their head.  Others hook the bra in front, then twist it around to the back. Still others, use a front-closing bra.  Our girls sometimes have problems with the strap falling off the affected side.  You can purchase plastic devices that will hold the straps together in the back. These are available at many large retailers.  Some of our girls may be smaller on the affected side, so the bra may not fit properly. One option is to go to a specialized bra store and have bras custom fitted.  A few manufacturers sell each bra side independently, so you can buy the proper cup size for each side.

Swimsuits

Same advice here as with underwear and panties. Some girls prefer a two piece swimsuit because they don’t have the hassle of trying to pull down a one-piece to go to the restroom.  With practice, our girls can learn to tie their swimsuits straps. Tops that criss-cross in the back help avoid the problem of straps falling off the shoulder.

Shirts

Put shirt on affected arm first and then pull over head, putting unaffected arm in last. Or place shirt, front side down, on bed and dive in with both arms.

Putting on a Coat

Amanda sent in this tip for helping individuals with hemiplegia put on a coat.

My son, who has left hemiplegia, learned to put his coat/cardigan/jacket on the floor inside up with the collar facing him. Then he reaches down to put both arms through the sleeve holes at once and lifts it up over his head. It is great to help him try to stretch his left arm by himself while at the same time allows him to use both arms simultaneously. I don’t know about any of your children but Jake seems to be able to achieve a lot of maneuvers with his affected left limb if he does the same action with his unaffected right limb at the same time – a kind of mirroring. He first learned the coat technique when he was about two and a bit and it gave him such enormous pleasure that he was independent in this way and could put a coat on like his peers. 

Those Pesky Buttons

Most children are able to learn buttoning one-handed, albeit a year or two later developmentally than when most kids button. There are many adaptive devices which are designed for one handed buttoning, all of which work adequately, but we find that most people would rather learn to button using one hand (except for that last pesky button on the sleeve for the unaffected arm). The best place to see all of the options is in the Sammons/Preston catalog, which most OT or PT departments will have. Lastly, there is always the option of modifying the clothing with Velcro or other fasteners.

If your child has absolutely no use of the affected hand, he’s going to have problems buttoning the cuff button.  Try the elastic cuff extender technique.  “A button on elastic thread which can be used on any long sleeved garment. The elastic is fastened around the button on the sleeve and the button it is fastened to is put through the button hole. The sleeve can then be pulled over the hand. Describes button device made with a standard button and thin elastic thread which is crocheted into a chain and tied to the button in a loop.” (Source – Sokaler, R A TITLE: Buttoning Aid JOURNAL: American Journal of Occupational Therapy REF: Vol 35 no 11, Nov 1981: p 737 : 2 1981.)

Zippers

For a child with hemiplegia, it’s difficult to manipulate the typical zipper pull. Attaching a key chain, handle, or ribbon to the end of the zipper and makes pulling it up or down easier. This also works for backpacks and purses. See Adapting Clothing for more information.

Pants

A parent contacted us with this dressing dilemma.

My five year old is unable to snap his jeans due to his hemiplegia and he can no longer if into toddler jeans. I’m having a hard time finding elastic waist jeans that do not button or snap. I know that eventually he’ll figure out what he needs to do to snap his jeans, but for now, he either gets angry that he can’t do it or he goes around with his pants falling down. I know I could keep him in sweat pants or track pants, but I don’t want him to feel different from his friends.

This is a common problem for kids who have hemiplegia or hemiparesis. Many do eventually learn to snap and button jeans, but it can take some time as they build strength and coordination in their hands. Practice helps, so keep encouraging him when he’s a little older.

Elastic waist jeans, without snaps and buttons have been sighted at these retailers:  Target, Lands End, Kohl’s (Carter brand for early elementary age), Wal-Mart, and K-Mart. You might also try pants with an adjustable waist or drawstring.

Check out Dapper Snappers – elastic strips with snaps on them that attach to the rear belt loops. The child can wear regular jeans with a larger waist and still pull them up and down.

To put pants on, have child sit on the floor and put the non-affected leg in first. This is a great habit for when they begin standing to put their pants on so the time spent standing on the affected foot is lessened (helps with balance issues). Make the button hole extra large so the child can loop it over and catch the button hole on the button. Attach a small keyring to the zipper to use as a zipper pull.  The child can stand with his knees together and use his knees for the tension to pull up the zipper and keep from giving himself a wedgie when pulling up pants.  Recommend doing the button first to keep the sides of the pants together, then do the zipper.

Some parents recommend using bib style pants in the winter since they usually have a zipper from the pant crotch up to the top of the bib. Having this zipper open gives lots of room to maneuver around while putting on pants. The bib style pants also have shoulder straps that help keeps the pants up.

Jeans

If buttons and snaps are just too difficult to maneuver, replace them with commercial grade Velcro.

Belts

If your child isn’t ready to fasten a regular belt, try a belt with a magnetic buckle. Dapper Snappers carries these.

Start belt in belt loops on affected side, looping it through the back, then grabbing with unaffected hand to finish looping through belt loops in front. Or, you can just put the belt through before putting on the pants. The belt buckle should be on the unaffected side so the child can pull the belt tight with the buckle serving as the resistance to help the belt tighten.

Mittens

Polar fleece mittens that fasten with Velcro are useful. Gymboree and Gap Kids carry these.

For the child with hemiplegia, it is often times very difficult to keep a mitten on the affected hand. Many mittens are lost as they fall off when the child is playing outside and buried in the snow somewhere, to reappear in the spring. The ones that snap to the coat are often to difficult for our children to reattach, using yarn and crocheting a single strand and then sewing it to the mittens make sure this doesn’t happen. This then strings through the coat. It can also be tightened before the coat is put on and this helps keep the mitten in the coat sleeve while playing outside. You will have to loosen it though once done, so they are able to get the mitten off and on while at school.

Other Adaptive Clothing Resources

Adaptive Dressing Booklet

www.easyaccessclothing.com