PRE-DRESSING SKILLS

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Υποβλήθηκε από panagiotaxirou στις Κυρ, Φεβ 09, 2014.

Pre-Dressing Skills
 
Dressing is a complex activity that requires many pre-requisite skills to be able to perform successfully. Below is a quick reference guide to pre-requisite skills to gain an understanding of the demands the activity places on the child.
 

  1. Motor skills – a child needs to be able to move limbs and body in a full range of movements both with and against gravity. For this, the child must have adequate muscle strength and flexibility at their joints.

 

  1. Co-ordination – a child needs to be able to create co-ordinated movements, using both unilateral (i.e. using one arm) and bilateral skills (i.e. using both arms). Hand dominance is important for movements that require fine motor skills, such as fastening buttons. A child needs to be able to cross their midline to complete tasks, e.g. removing a jumper.

 

 
 

  1. Balance – a child must be able to maintain their balance whilst changing posture/position with and without vision occluded.

 

  1. Fine Motor Skills – a child must be able to reach, grasp and release objects in order to complete tasks such as buttoning or holding the item of clothing.

 
 

  1. Perception – a child must be able to have various perception skills, such as form constancy (i.e. knowing various sizes and shapes of buttons are all still buttons) and spatial awareness (i.e. knowing the position of body in space related the position and size of arm holes). 

 

  1. Stereognosis – the child must be able to feel objects to know their relation to their body without relying on sight, i.e. finding arm holes with jumper over head or doing back buttons.

 
 

  1. Body Schema – A child must have good awareness of body parts and where their body is in space. A child must be able to differentiate their left and right to know which arm hole is correct.

 

Pre-Dressing Skills Activities

  1. Dressing should not be seen as a chore. Try to keep it fun, e.g. play dressing up games, dressing toys, having fun. Dressing dolls: using age appropriate dolls to dress up provides the child with increased sense of body schema and organisation of clothes. Provides a way of completing dressing skills whilst being able to use vision skills.

 

  1. Musical dressing up (a variation of musical chairs): the children put items of clothing on from a pile until the music stops, at the end of the game the child with the most clothes on is the winner.

 

  1. Using a variety of large shirts or smocks, get the children to get ready for wet play, painting or cooking.

 

  1. Button boards or play cubes.  These can be made to give the child practice at certain types of fastening.

 

  1. Cloth button or popper book.  Parts of a picture have to be buttoned or 'popped' on.

 

  1. Matching sock game.  Place a variety of socks in a pile, the child has to find pairs and put them on.

 

  1. Wooden shoe - a shoe shaped piece of card or wood with holes in can be used to practise lacing and tying shoes.

 

  1. Bow book.  A fabric book with different types of materials to make a bow, e.g. ribbon, laces, apron strings, etc.

 

  1. Package wrapping.  Making parcels and tying them up with different sorts of ties.

 

  1. Play ‘Simon Says’ and get the child to identify various body parts. Start with arm, leg, tummy. Move onto ankle, elbow, knees. Build upon this by asking the child to touch left arm, then right leg. Finally being able to locate left elbow, wrist, etc.

 

  1. Completing threading activities. Getting them to copy a pattern of various sized beads on thread (wool is better for larger beads) to improve pattern recognition. Adapt the task by getting the child to pull desired bead from bag without looking to improve stereognosis.

 

  1. Complete lacing activities using lacing boards to develop fine motor skills such as grip, release and eye-hand co-ordination.

 

  1. Labelling clothes. Let the child develop labels for their clothes, i.e. front, back, etc. NB. Ensure that you are able to remove them. OR get an old white t-shirt and paint on labels. This will help raise body awareness and will assist with orientation.

 

  1. Posting coins. Let the child use pincer (finger and thumb) grip to post coins into a money box. Once child has mastered this, post pennies through slit in piece of paper. This will help develop pre-button skills.

 

  1. The ‘hokey kokey’. Get child to participate in this song, could be part of group to enhance body awareness.

 

  1. Completing jigsaws and form boards will assist with visual perceptual skills.

 

  1. Foot massage. Give the child a foot massage to provide sensory input to increase awareness of feet. This can also be achieved by walking on various surfaces barefooted, grass, concrete, etc. Do these as a preparation for putting on shoes and socks, tying shoelaces.

 

  1. Clothes Pictures. Make a picture representation of the clothes the child is wearing and get him/her to talk through what order they are going to undress/dress in, this will improve motor planning and organisation. These pictures can then be used as a reference point for future dressing sessions.

 
 
General Principles

  1. For the child to be able to learn new skills the environment must be appropriate. Think about the noise levels and distractions; other children in the room, computers, pictures on walls, toys and smells e.g. from the kitchen.

 

  1. Allow extra time for the child to be able to learn the new techniques. Progress at the child’s pace and give lots of praise for practicing skills even if they are not successful at completing the task.

 

  1. Success is important; therefore begin with breaking the dressing activity into small, straightforward steps. Tackle one step at a time and give help where needed with the other steps of the task, e.g. help the child to pull the t-shirt over their head and then allow them to put their arms through the sleeves.

 

  1. Undressing is usually easier than dressing. Dress in front of the mirror to provide visual cues and use to check all is correct before going out

 

  1. Start with undressing.  Undressing before bed and helping to put on pyjamas is a good time to start as you have more time at night than in the morning. If there is weakness on one side of the body, put clothes on the weaker side first, and then take the weaker side out of the garment last when undressing (see dressing hemiplegic child).

 

  1. Follow a consistent sequence and technique when dressing:
    • Clothes can be placed in a pile in the order in which they need to be put on.
    • Follow the same technique for each garment, e.g. t-shirt is put over the head first and then the arms are put through the sleeves.
    • The order and technique can be written down so that it can be followed by other carers and school staff.  You could use pictures as a visual prompt to help the child remember the clothing order/technique.

 

  1. Describe actions and parts of the body as you are helping the child to dress, eg ‘put right foot in,’ ‘now stand up whilst I pull your trousers up your legs.’

 
 
Positioning
 

  1. Ensure that the child is sitting in a stable position, e.g. on the floor (where it is easier for the child to reach their feet) or sitting on a chair or firm bed with their feet supported. If sitting balance is poor, try sitting against a wall. Some children may sit better in a corner where both walls give added support. Alternatively stand against a wall.

 

  1. Sit next to, in front of, or directly behind the child during activity.  Guide the child through the task. 

 

  1. Instead of automatically correcting a mistake, get the child to look (maybe in a mirror) and feel if all is correct. Then encourage them to identify and sort out what needs to be done, e.g. t-shirt needs pulling down; shoes ‘feel wrong’ because they are on the opposite feet.

 

  1. Try to avoid fastenings, tight clothes and lots of layers. Instead use loose fitting clothing, e.g. tracksuits, sweat shirts. Use clothes with wide neck and arm holes to make it easier to locate these. Initially it may be easier to practice with clothing a size too big.

 

  1. Try not to watch all the time; the child may do more when left alone.

 
 
Ensuring Clothes are the Correct Way Round

  1. Wear t-shirts, sweat shirts, pants etc with a picture on the front. Point the picture out to the child.

 

  1. Identify the back of all garments through having a label or using coloured thread. If necessary, and to avoid confusion, remove other labels, e.g. inside seam of knickers. Encourage the child to find this mark to identify the back of their clothing.

 

  1. Alternatively for top half garments, mark the inside, bottom front edge of the garment with coloured thread. Lay the garment out flat on a table (or the floor) front facing downwards. Roll up the bottom, back edge of the clothing to give a good grip to reveal the special mark identifying the front.

 

  1. Choose a coat with a contrasting lining. Encourage body awareness by naming parts of the body and then piece of clothing that covers.

 

  1. Lay clothes out flat in front of the child in the order that they are going to be put on. Place the end which is going to be put on first, nearest to your child. Place arms into the garment first so that it is easier for the child to see what they are doing. Then put the garment over their head.

 
 
 
Gripping the Clothes

  1. Roll up clothing to create ‘more’ to grip, e.g. roll up bottom edge of the t-shirt before putting on.

 

  1. Use adult’s hand over child’s hand to assist grip (hand-over-hand technique).

 

  1. Avoid slippery fabrics.

 

Different Ways to Learn Dressing Skills
There are two main ways which can also be used for learning other skills:
Backward Chaining
Here the adult begins the task, with the child only doing the last step. Gradually the adult does less as the child is able to do more of the task themselves. This way the child always gets the reward of finishing the task, e.g. the adult puts the   t-shirt over the child’s head and helps them to get their arms through the holes. The child then pulls down the t-shirt at the front.
 
Forward Chaining
This is when the child starts the task (e.g., putting the t-shirt over their head), and the adult helps with the later stages the child needs help with (e.g., putting their arms through the sleeves). The child needs to be motivated to begin the task themselves.
Always demonstrate the correct technique first, telling the child what you are doing at each stage e.g. I am unbuttoning the shirt, I am taking your arm out of the sleeve, and so on. Try to maintain the same order of this activity time for consistency 
 
An Example of Backward Chaining
Taking off a shirt: Let the child remove the last half of their arm from the sleeve, let the child remove their whole arm from the sleeve, let the child remove shirt with one arm in and one arm half in, let the child remove shirt when pulled off shoulders, let the child remove the shirt.
T-shirt: : Let the child remove the T-shirt from their head, Let the child remove T-shirt from their neck, Let the child remove T-shirt with one arm in and one arm out, Let the child remove the T-shirt with one arm in and one arm half out, Let the child remove the T-shirt with both arms in and T-shirt pulled up to shoulders, Let the child remove the T-shirt.
 
Alternate Method (Needs more skills in co-ordination and crossing midline).

  1. Let child remove the T-shirt from arms in air.
  2. Let the child remove the T-shirt from head.
  3. Let the child remove T-shirt with crossed arms over head.
  4. Let the child grasp bottom of T-shirt with crossed arms and bring towards head.
  5. Let the child remove T-shirt.