The influence of hand use on dressing outcome in cognitively impaired stroke survivors

Introduction: The daily task of dressing oneself requires multiple complex skills, which are often taken for granted by those free from ill-health or disability. Independence in dressing allows an individual to maintain a sense of dignity and choice over his or her appearance. Occupational therapy aims to restore independent functional performance in daily activities. Dressing independence requires both physical and cognitive skills. For survivors of stroke, impairment of such skills can pose great difficulty to their dressing performance. Method: The aim of this study was to examine the effect of arm paresis and cognitive impairment on upper body dressing ability using a cognitively impaired cohort of stroke participants (n = 70), and to explore the importance of bimanual activity when dressing in the presence of cognitive impairment. Dressing ability was assessed at baseline and immediately following a 6-week period of dressing practice with an occupational therapist. Results: Thirty-six participants were able to use a bimanual dressing method at baseline. The chi-square test for independence indicated a strong association between dressing method (bimanual or unimanual) and independence in upper body dressing, p<0.001. The dressing success of the bimanual group was significantly greater than that of the unimanual group at both assessment time points. Conclusion: Cognitively impaired stroke survivors do perform better at upper body dressing when they are able to use both hands as compared with one, but those with arm paresis preventing bimanual activity may still improve their dressing performance significantly with practice.