Getting a child dressed after a brain injury

Helle Mills is a senior occupational therapist at The Children’s Trust. This blog is in response to a number of parents’ enquiries about getting their child dressed after an acquired brain injury.


Dressing following a brain injury

If your child has a brain injury, they are likely to require some form of support with their dressing skills. Some will require more support than others and this might be in the form of physical help and/or giving them prompts through talking to them.
A parent helps a child get dressed
Different children are affected by their injury in different ways, and the way their movement is affected is no exception. I hope to have set out some different ideas for children with different levels of physical ability.  

A Child who needs help with some things

If your child is more physically able, they will be able to participate in the routine. Ask them to identify what items they will need and talk through the order in which they will put the clothes on.

Encouraging them to plan and sequence the task, providing prompts as required. If they have difficulties with their balance they might find it helpful to sit on a chair or on the edge of the bed with someone supporting them as they stand up to pull up their trousers and adjust clothing. If your child is still at the stage of getting dressed lying on the bed, then get them to lift their bottom off the bed when dressing their lower body to enable you to pull their trousers on. They might initially require help to hold their feet to keep their knees bent.

Ask them to place their hands down by their bottom, which will help in having the hands in the right place to work on pulling the trousers up in the future.
 

A child who needs help with everything

If your child person has a disorder of consciousness (ie has minimal or no awareness of themselves or their surroundings), then they will be fully dependent on you for all their personal care. During all personal care tasks you will need to make sure that you have your child on a height adjustable bed or changing bench to minimise any risk of injury to yourself. Make sure you always follow good manual handling procedures; try not to lift, stoop, bend or twist as this will all put you at risk of injury, and this will make it very difficult for you to continue to care for your child. It is often easier if there are two people available to support with the dressing. First, try to imagine yourself lying on a bed with your eyes closed. If someone were to come in to the room and dress you without saying anything, you might feel very uncomfortable and unsettled. Try to make your child feel comfortable, reassured and safe when getting dressed. Make sure you always follow a consistent approach; by that I mean dress them in the same order every time, tell your child what you are doing and what is coming next to maximise their potential to anticipate the routine and potentially participate. Make sure you always respect their dignity by covering them and only have the necessary people in the room.

Increased tone

If your child has increased tone in their upper and/or lower limbs, it can be helpful to try to incorporate passive stretches before dressing. When dressing the top half, dress the most affected side first by placing your hand through the sleeve from the wrist end. Then hold on to your child’s hand while placing the sleeve over their arm. Then place the top over their head and finally dress the less affected side. Loose and stretchy clothes make the process easier. When dressing the lower half again dress the most affected side first. When adjusting the clothing roll your child from side to side getting them to participate as possible.  

Choosing

Provide your child with two or more options of clothing, depending on their ability to make clear choices. If your child is in the early stages of choice-making, the only give them a choice of two items (ie tops) in contrasting colours, and give them time to see if they will show a preference. This could be by using their eyes, voice or gesture.  

Giving Enough Time

If you’re asking your child to try to move their head or an arm to help with the dressing, then try to make sure you give them time to process what you’ve asked them to do. If you repeat the request too soon your child is likely to start the processing all over again and will not get to the point of trying to participate.
Silence can be awkward for the person waiting a response but time to respond is important for the child.  

Helpful links

Falkirk Council: Life Skills for Little Ones Hemihelp
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