1. The document provides instructions for donning and removing socks and shoes with assistance using various tools and techniques depending on the individual's abilities and limitations. 2. It also outlines criteria for dressing the upper extremities including strength, range of motion, balance, and hand function requirements. 3. Methods are described for putting on and taking off pull over garments like shirts, sweaters and dresses using wrist-driven flexor splints if needed. Precautions are also noted.

1. DONNING &
REMOVING
SOCKS:
SYED MASOOD

2.  Donning:
1. Sit in wheelchair or on bed if balance is
adequate in cross legged position with one
ankle crossed over opposite knee.
2. Pull socks over foot with wrist extension
grip and patting movts with palm of hand.
3. If trunk balance is inadequate and cross
legged position cannot be maintained, prop
foot on stool, chair.

3. 4.Use stocking aid or sock cone to assist
in putting socks while in this position.
Powder socks cone ( to reduce friction)
nd apply socks to it by using thumbs nd
palms of hands to smooth sock out on
cone.
5. Place cord loops of sock cone around
the wrist or thumb nd throw cone beyond
foot.

4. 6. Maneuver cone over toes by pulling cords
using elbow flexion. Insert foot as far as
possible into cone.
7. To remove cone from socks after foot has
been inserted, move heel forward off wheel
chair footrest.
Use wrist extension ( of hand not operating
sock cone) behind knee nd continue pulling
cords of cone until it is removed nd sock is in
place on foot. Use palms to smooth sock with
patting nd stocking motion.

5. 8. Two loops can also be sown on either side
of the top of the sock so that thumbs can be
hooked into the loops nd socks pulled on.

6. Removing:
 While sitting in wheelchair or lying in bed,
use dressing stick or long handled
shoehorn to push sock down over heel.
Cross legs if possible.
 Use dressing stick with cup hook on end
to pull sock off toes.

7.  SHOES:
Donning:
1. Use same position for donning socks as
for putting on shoes.
2. Use extended handle dressing aid and
insert in it tongue of shoe , nd dangle shoe
on toes.
3. Using palm of hand on sole of shoe, pull
shoe towards heel of foot.
One hand is used to stablize leg while other
pushes against sole of shoe to work shoe
onto foot.Use thennar eminence nd sides of
hand for this pushing motion.

8. 4. With feet flat on floor or on wheelchair
footrest nd knees flexed 90°, place a long
handled shoehorn in heel of shoe nd press
down on flexed knee.
5. Fasten shoes.

9. Removing :
 Sitting in wheelchair with legs crossed as
described previously, unfasten shoes.
 Use shoehorn or dressing stick to push on
heel counter of shoe , dislodging it from
heel ; then shoe will drop or can be
pushed to floor with dressing stick.

10. CRITERIA FOR DRESSING THE UPPER
EXTREMITIES :
1. Fair to good msl strength in pectoralis
major nd minor, Serratus anterior,
Rhomboids major nd minor.
2. ROM of 0 to90° in shoulder flexion nd
abduction
0 to80° in shoulder internal
rotation
0 to 30° in external rotation
15 to 140° in elbow flexion.

11. 3. Sitting balance in bed or wheelchair,
which may be achieved with the assistance
of bedrails, an electric hospital bed, or
wheelchair safety belt.
4. Finger prehension achieved with
adequate tenodesis grasp or wrist driven
flexor-hinge splint.

12. CONTRAINDICATIONS :
Same as that of lower limb.

13. PULL OVER GARMENTS :
Pull over garments include, Blouses, Vests,
Sweaters, nd Front opening dresses.
Donning :
1. Garment is positioned across the thighs
with back facing up nd neck towards knees.
2. Place both arms under back of garment
nd in armholes.

14. 3. Push sleeves up onto arms past elbows.
4. Using a wrist extension grip hook thumbs
under garments back nd gather material up
from neck.
5. To pass garment over head, adduct nd
externally rotate shoulders nd flex elbows
while flexing head forward.

15. 6. When garment is overhead, relax
shoulders nd wrists nd remove hands from
back of garment.
Most of material which is gathered up at
neck, across shoulders nd under arms.
7. To work garment down over body, shrug
shoulders forward.To hook wrists into sleeves
nd pull material free from undera.rms or lean
forwards, reach back nd slide hand against
material to aid in pulling garment down.

16. 8. Garment can be buttoned from bottom
to top with aid of button hook nd wrist -
driven flexor hinge splint, if hand function
is inadequate.

17. Removing :
 Sit in wheelchair nd wear wrist - driven flexor
hinge splints. Unfasten buttons ( if any)
while wearing splints nd using buttonhook.
Remove splints for remaining steps.
 For pullover garments, hook thumb in back
of neckline, extend wrist nd pull garment
over head while turning head towards side of
raised arm.

18.  Hook thumb in opposide armhole nd push
sleeve down arm. Elevation nd depression
of shoulders with trunk rotation can be
used to get garment to slip down arms as
far as possible.
 Hold one cuff with opposite thumb while
elbow is flexed to pull arm out of sleeve.