The Memory Unit OT

It’s no secret that OTs address dressing skills (see what I did there). That being said, it’s one thing to provide ADL retraining to someone who has strong cognitive skills and understands their need to re-learn these skills. It is an entirely different thing to provide ADL retraining to someone whose cognitive skills are impacted and who may not fully understand their need for self care intervention.

So let’s talk about that.

First and foremost, we as the therapist have to fully know and understand what aspects of the task need work. Yet another reason why a comprehensive evaluation is so essential. (If you need to start there, I’ve got a Free Eval Kit just for you!)

From there, we get into the knitty gritty.

I start with a simple choice.

Especially in instances of cognitive impairment, adding the task of selecting an entire outfit at the beginning of the session can just add overwhelm and distress to the situation. So if the goal is to improve the physical act of getting dressed rather than the ability to select an outfit, I’ll do that part.

I’ll pick two options to present to the Resident. This still provides autonomy but limits the amount of overwhelm.

I provide dressing training in it’s real context, in real-time, as much as possible.

Sometimes it doesn’t always happen. But the best time to train in dressing tasks is when the Resident actually needs to get dressed. Patients on a short-term skilled unit likely won’t have a problem practicing dressing techniques mid-day. But Residents on the long-term or memory care units will likely have better success and be more agreeable to therapeutic training within the context of their typical morning or evening ADL routine.

If I can help it, I avoid using adaptive equipment.

This might sound a little counterintuitive since OTs are the “adaptive equipment people”. And sure, adaptive equipment has a time and place. But wouldn’t you rather just bend down to pull up your pants instead of using a stick with a hook on the end? Me too. And so would our Residents! Plus, many Residents with neurological diseases like dementia find adaptive equipment more of a hinderance than a help. A reacher is one thing, maybe a shoe horn. But a dressing stick and a sock aid just don’t make sense to them. And they’ll be capable of more for a longer period of time if they continue to don and doff clothing without adaptive equipment.

I’m not afraid to use exercise to meet a dressing goal.

Now, this isn’t the only technique I use. But here’s the thing. If you can’t lift your foot off the floor, it’s going to be hard to put pants on. If you can’t stand up, it’s going to be hard to fasten a belt. If you can’t maintain balance in standing, it’s going to be hard to pull your pants up. If you can’t reach behind you, it’s going to be hard to pull a shirt down in the back or fasten a bra. There are physical and biomechanical aspects to dressing that we have to address. And while I’m all for using repetition to improve dressing skills, strengthening and balance training are essential to treating the whole picture.