Dressing After a Stroke: One-Handed Techniques

Why stroke makes dressing hard

• Weakness or paralysis on one side, so one hand cannot grip, push or pull.
• Loss of sensation, making it hard to feel clothes or the position of the limb.
• Poor balance, especially standing to dress.
• Neglect, where the person does not notice the affected side, forgetting to dress or to put in the arm.
• Poor coordination and planning (apraxia), in which the person knows what to do but cannot sequence it.
• Visual problems, such as loss of part of the visual field.
• Fatigue and slowness.
• Pain, especially the shoulder.
• Memory and attention difficulties.

These vary widely, so the first step is an assessment. See walking aids after a stroke and stroke recovery at home guide for the wider picture.

The golden rule: dress the weak side first, undress it last

This is the central rule taught by occupational therapists.

• Dressing: put the affected arm or leg into the garment first, while you have two usable hands to manage it. Then dress the stronger side.
• Undressing: take the garment off the stronger side first, then slide it off the affected side last.

This way the weak arm is never stretched or trapped, and the good hand can do the work.

Before you start

• Sit down. A firm chair with arms, or the bed edge, with feet flat on the floor and good back support. Standing to dress after a stroke risks a fall.
• Choose a warm, private room with good light and space.
• Lay out clothes in order within reach, with the first garment on top.
• Pick easy clothes (see below).
• Allow time. Do not rush. Rest when tired.
• Wear non-slip shoes or socks on the floor.
• Keep a mirror nearby to check.
• Support the weak arm on a pillow or the lap.

Putting on a front-opening shirt or blouse

1. Sit and place the shirt on your lap, with the inside up, the collar toward your knees and the sleeve openings at the sides. 2. With your good hand, pick up the affected arm and slide the hand into the sleeve opening on that side. Pull the sleeve up past the elbow. 3. With your good hand, pull the shirt up the affected arm and over the shoulder. 4. Lean forward, reach behind your neck and bring the shirt round to the other side. Put your stronger arm into its sleeve. 5. Straighten the shirt and fasten the buttons from the bottom up, using a button hook if needed, or use Velcro or magnetic closures.

Putting on a pullover or kurta over the head

1. Sit and spread the garment on your lap with the back facing up and the neck opening toward you. 2. Put the affected arm into its sleeve first, and pull the sleeve past the elbow. 3. Put your good arm into its sleeve. 4. Gather the back of the garment with your good hand, lean forward, duck your head and bring the garment over your head. 5. Pull it down over your body, and adjust the affected arm.

Putting on trousers or pyjamas

1. Sit and cross the affected leg over the good knee, using your good hand to lift it, if safe and balanced. If you cannot, lift the leg with your hand under the knee. 2. Slide the trouser leg over the foot of the affected leg and pull it up to the knee. 3. Put the good foot into the other leg. 4. Pull the trousers to the knees, and straighten. 5. Stand, holding a stable support such as a table or rail, or lean on the bed and roll from side to side, pulling the trousers up one side at a time. 6. Sit and fasten; use elastic waists, Velcro or a large zip pull.

If standing is unsafe, lie on the bed and bridge the hips, or roll from side to side, as the therapist teaches.

Socks and shoes

• Sit and cross the affected foot over the good knee, if possible, or bring it up with your hands.
• Use a sock aid: slide the sock onto the aid, drop it to the floor and put in the foot, then pull the cords; see dressing aids.
• Shoes: choose slip-on or Velcro shoes, or use elastic laces. A long shoehorn helps. Put on the affected foot first.
• Check the foot for pressure marks, since reduced sensation hides pain.
• Never go without proper shoes; see walking aids and footwear.

An ankle-foot orthosis, if prescribed for foot drop, goes on before the shoe, as the therapist teaches.

Bras, vests and underwear

• Front-opening bras or sports bras that pull over the head, or a bra with Velcro fastening.
• Vests that stretch.
• Elastic-waist underwear, pulled on as for trousers.
• Bra aids that help hook a back closure; see your therapist.

Fastenings and clothes that help

• Velcro, snaps, magnets and large buttons.
• Elastic waists.
• Loose, stretchy fabrics like cotton jersey.
• Front-opening garments.
• Wide sleeves and necks.
• Slip-on or Velcro shoes.
• Zip pulls and rings.
• Adaptive clothing with openings designed for easy dressing.
• Simple colours and patterns, and labels at the back.
• Saris and dhotis can be difficult; consider simpler garments, or ask a therapist about methods for traditional clothing; preserve cultural choices where possible.

Protecting the weak arm and shoulder

• Never pull on the weak arm to dress it. Lift it gently from underneath, supporting the elbow.
• Keep the shoulder in a good position, forward and supported.
• Do not force a stiff or painful joint. Tell the therapist about shoulder pain.
• Support the arm between steps on a cushion or the lap.
• Check skin for pressure marks or tight cuffs.

See positioning pillows after a stroke.

How families can help

• Let your parent do as much as possible, even if slow. Offer help only when needed.
• Stand by, not in the way, and protect privacy.
• Cue gently: "Which arm first?"
• Learn the technique from the therapist, so that you guide, not take over.
• Keep the same routine each day: the same order, the same chair, the same clothes layout.
• Praise effort.
• Keep a log of what is easy and hard, for the therapist.
• Choose day clothes, which help morale and activity, over staying in nightwear.
• Be patient, since progress comes in small steps.

If your parent has neglect or confusion, simplify: lay out one garment at a time, use verbal prompts and keep the room quiet.

When dressing is too hard

If your parent cannot dress safely even with practice, a carer will need to help. Do so with respect: explain what you are doing, close doors, let your parent do the parts they can and follow the weak-side-first rule. See dignity in intimate care.

When to ask a professional

An occupational therapist is the key professional, teaching dressing techniques and recommending aids, ideally at home. Ask a physiotherapist about balance and shoulder care. See a doctor if your parent has new weakness, sudden confusion, severe shoulder pain, or if they are losing ground. Call 112 for stroke signs such as sudden weakness, facial droop, slurred speech or loss of vision. Our care advisors can arrange a therapist visit and supply adaptive clothing and aids.