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November 2015

Here are a few tips to help problem solve putting on and taking off coats and sweaters. 

Choosing a coat:

  • Have your child go shopping with you and see which type of jacket is easiest for them to put on and take off in the store.
  • Larger, stretchy clothing items will be easier than tight-fitting coats to put on and take off.
  • Wrist closures that are elastic can be more difficult to push hands through compared to open sleeves or adjustable Velcro or button openings for the hands.
  •  Larger buttons and zippers are easier to manage than small ones, and snap-style buttons and Velcro closures can often be opened/closed one-handed with practice.
  • Consider pull-over styles for kids who have trouble managing fasteners (zippers, buttons and Velcro).  
  • For children still in carseats, make sure to tighten their carseat straps appropriately without the jacket on.  If the straps do not fit over the jacket, then it is too large for them to wear in the carseat.

Tips for cueing:

In general, when cuing and encouraging your child to complete a new task, we suggest the following progression.  If at any point he/she is able to complete the task on her own, let him/her do so, and praise his/her effort, even if it means that you completed the task together with your hand over her/his hand.

  1. Ask your child to complete the task (“Can you please put on your jacket?”)
  2. Show your child what to do (“The first step is to put your hand through here.”)
  3. Bring his/her hand to the starting position using your hand (“Let me help you get started.”)
  4. Complete the task with your hand moving his/her hand (“Let’s see if we can do it together.”)

Putting the Coat On:

  • Different techniques work for different kids, so try each with your child to determine which is easiest for him or her. 
  • In general, most kids with hemiplegia put on their coat by pushing their affected arm into the sleeve first, then the stronger side.
  • Some kids prefer to place the coat on the floor in front of them first with the inside of the coat facing up and the top edge of the coat closest to their body.  They put their affected hand in the sleeve first, then their stronger hand, and lift the coat up and over their head to put it on the rest of the way.
  • If your child has trouble pushing their affected hand all the way through the sleeve, you can assist them by rolling the sleeve up for them.  Point to where they can use their stronger hand to help them pull their hand through all the way.
  • Zippers:  Use the affected hand to stabilize the bottom of the jacket, while the dominant hand fastens the zipper.  Many kids prefer to then switch and hold the bottom of the coat with their stronger side while they pull up the zipper with their affected hand. Adding a key-ring or other loop to a zipper can make it easier to pull up and down.  There is also now a magnetic zipper (magzip) that that can be attached at the bottom one-handed. 
  • Buttons: Always try larger buttons before smaller buttons because they are much easier to learn. Place finger through the hole in the shirt and thumb on the button. Use thumb to push the button through the hole on the shirt. This will take a lot of practice to determine how to move fingers to thread the button. Use adaptive equipment such as a button hook, elastic loops for buttons at cuffs, or replace buttons with Velcro.

Taking the Coat Off:

  • It is typically easiest to remove the arm from the dominant side first, and then use the stronger hand to pull the sleeve off of the assisting hand.
  • Many kids will use their mouth to help stabilize their sleeve to pull their stronger arm out.  If their assisting hand has trouble grasping the sleeve, you can show them how to use their elbow to stabilize the sleeve on a surface (tabletop, for example) while they pull their arm out.
     

If you have a topic or questions that you would like the Helping Hands blog to address, please email HelpingHands@kennedykrieger.org.

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