Affected side first
After his left-hemisphere stroke, his right arm is weak. When putting on a button-front shirt, the affected (right) arm goes into its sleeve first, while the garment is loose and there is plenty of slack. He then brings the shirt around his back and slides his strong left arm into the other sleeve. When undressing, the order is reversed: the unaffected side comes out first, so the weak arm is freed last with the most slack. Dress the affected side first and undress the unaffected side first.
Why this sequence works
The weak arm has limited range of motion and strength, so it needs the garment to be as open and loose as possible. Putting the strong arm in first would tighten the shirt across the back and make it very difficult to thread the weak arm. The same principle applies to trousers, sweaters, and other clothing. Dressing while seated with good support, for example in a chair with armrests or on the edge of the bed with feet flat on the floor, also improves balance and safety.
| Instruction | Appropriate? | Reason |
|---|
| Put the shirt over the head first | No | Harder with one weak arm; does not set the sleeve order |
| Right sleeve first, then left | Yes | Weak arm gets the full slack |
| Dress lying in bed | No | Less practical; does not build sitting balance |
| Let the nurse dress him | No | Prevents relearning and independence |
Why the other instructions are wrong
Pulling a button-front shirt over the head is awkward with one weak arm and does not solve the problem of which side goes first. Dressing lying in bed is less practical and gives up the chance to build sitting balance, which supports later activities such as transfers and walking. Having the nurse dress him to save energy prevents relearning; rehabilitation promotes independence in activities of daily living, with supervision and assistance only as needed. Watch out! Options that sound protective, such as saving energy or avoiding falls in bed, often undermine rehabilitation goals.
Exam takeaway
Rehabilitation nursing encourages the client to do as much as safely possible, allows time, breaks tasks into steps, and uses adaptive aids such as Velcro closures or long-handled tools when needed. Key point! For clients with hemiplegia, the weak limb goes into clothing first and comes out last.