This document provides techniques and recommendations for dressing and completing activities of daily living for individuals with various physical impairments or limitations. It describes methods for putting on and removing pants and socks while seated for those with poor balance. It also outlines strategies for dressing and hygiene tasks tailored to the needs of people with paraplegia, tetraplegia, limited range of motion, incoordination, and low vision. Adaptive equipment like dressing sticks, reachers, and front-opening garments are emphasized.

1. S H A M I M A A K T E R
L E C T U R E R
D E P A R T M E N T O F O C C U P A T I O N A L T H E R A P Y
B A N G L A D E S H H E A L T H P R O F E S S I O N S I N S T I T U T E
( B H P I ) , C R P - S A V A R
DRESSING TECHNIQUES FOR
PERSON WITH POOR BALANCE,
LOW VISION, PARAPLEGIA

2. PERSON WITH POOR BALANCE
SHOULD USE THIS METHOD:

3. REMOVING PANTS
 Placed locked wheelchair or chair against a wall.
 Sit.
 Unfasten the pants.
 Work the pants down on the hips as far as possible
by shifting weight from side to side in the chair.
 Use the unaffected arm to work the pants down
past the hips.

4.  Remove the pants from the unaffected leg.
 Cross the affected leg over the unaffected leg.
 Remove the pants from the affected leg.
 Uncross the legs.

5. SOCKS OR STOCKINGS
 The following method is used to put on socks
 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.

6.  Or, if the patient has adequate flexibility, crossing
the ankle over the thigh makes the foot easier to
reach. The same process is used for the unaffected
foot.
 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 wrinkles are
smoothed.

7. ADLs FOR THE PERSON WITH
PARAPLEGIA

8. Donning shirt
 Balance body by putting palms of hands on
mattress on either side of the body. If balance is
poor, assistance may be needed.
 Open garment on lap with collar toward chest.
Put arms into sleeves and pull up over elbows.
Then hold on to shirt tail or back of dress, pull
garment over head, adjust, and button.

9. Removing shirt
 Sitting on wheelchair or bed, open fasteners
 Remove garment in the usual manner
 If the usual manner is not feasible, grasp collar
with one hand while balancing with other hand.
Gather material up from collar to hem
 Lean forward, duck head, and pull shirt over
head
 Remove sleeves, first from supporting arm and
then from working arm

10. ADLs FOR THE PERSON WITH
TETRAPLEGIA

11. Donning Front opening or pullover
garments, SCI Level C5-7
 Position the garments across the thighs with back
facing up and neck towards knees
 Place both arms under back of garment and in
armholes
 Push sleeves up onto arms, past elbows
 Using a wrist extension grip, hook thumbs under
garment back and gather material up from neck to
hem
 To pass garment over head, adduct and externally
rotate shoulders and flex elbows while flexing head
forward

12.  When garment is over head, relax shoulders and
wrists and remove hands from back of garment.
Most of the material will be gathered up at neck,
across shoulders, and under arms
 To work garment down over body, shrug shoulders,
lean forward, and use elbow flexion and wrist
extension. Use wheelchair arms for balance, if
necessary.
 Garment can be buttoned from bottom to top with
aid of buttonhook if hand function is inadequate.

13. ADLs FOR THE PERSON WITH
LIMITED ROM

14. Lower-extremity dressing activities
 Use dressing sticks with a neoprene-covered
coat hook on one end and a small hook on the
other for pushing and pulling garments off and
on feet and legs
 For socks, use a sock aid
 Eliminate the need to bend to tie shoelaces or
to use finger joints in this fine motor activity by
using elastic shoelaces or other adapted shoe

15. Upper-extremity dressing activities
fasteners such as Velcro-fastened shoes or secure
slip-on shoes
 Use reachers for picking up socks and shoes,
arranging clothes, removing clothes from hangers,
picking up objects on the floor, and donning pants
 Use front-opening garments that are one size larger
than needed and made of fabrics that have some
stretch
 Use dressing sticks to push a shirt or blouse over the
head

16.  Use larger buttons or zippers with a loop on the pull-
tab
 Replace buttons, snaps, hooks, and eyes with Velcro
or zippers
 Use one of several types of commercially available
buttonhooks if finger ROM is limited.

17. Process of catheterization
 Assemble the equipment
 Wash hands and penis or vulva and urethral
opening. Clean gloves may be used, if desired.
 Lubricate the catheter tip with water-soluble
lubricant. Males holds penis at sides, and insert
catheter with firm, gentle pressure. Females
separate labia, palpate meatus or use a mirror,
and insert catheter into the bladder.
 Push catheter in until urine starts to flow.

18.  Allow urine to flow until it stops, gently
pressing on abdomen or bearing down to empty
bladder.
 Slowly remove the catheter, holding catheter
tip as it is removed to prevent spilling.
 Discard disposable cathters, or clean reusable
catheters with soap and water, rinse, dry, and
store in a plastic bag.
 Wash hands with soap and water.

19. ADLs FOR THE PERSON WITH IN
COORDINATION

20. Dressing activities
 To avoid balance problems, the client should
attempt to dress while sitting on or in bed or in
a wheelchair or chair with arms and feet
planted firmly on floor. The following
adaptations can reduce dressing difficulties:
 Use of front-opening garments that fit loosely
can facilitate their donning and removal

21.  Use of large buttons, Velcro, or zippers with
loops on the tab can facilitate opening and
closing fasteners. A buttonhook with a large,
weighted handle may be helpful
 Elastic shoelaces, Velcro closures, other
adapted shoe closures, and slip-on shoes
eliminate the need for how tying

22. ADLs FOR THE PERSON WITH LOW
VISION/ LIMITED VISION

23. Dressing activities
 Light closet to improve acuity. Hang matching
outfits together on the same hanger
 Place safety pin on the label of the backs of
shirts/pants/dresses so that clothing is
oriented correctly who worn
 Pin socks together when placing