Selecting Clothes

Posted by Nurse Linda in Life After Paralysis on September 29, 2021 # Lifestyle

A woman with short hair using a wheelchair and reading a bookSelecting new clothes can be fun as well as a challenge. There are things to consider in clothing when you have sensation, catheterization and other issues that impact your choices. Current fashion trends can affect the ease of use as well as create issues for your health.

Shopping is enjoyed by some, but for others, it is a chore. The ease of shopping online has many benefits. You can review items quickly. There is an abundance of selections. The descriptions of the items are generally complete with fabric content. There are also comments from people who have purchased the products with clues about fit, comfort, and value. Mostly, you do not have to leave home to shop online. No hassle, just click and go. Returns may be more difficult in getting to the post office or drop off-site.

There are sites online that have adapted clothing for sale. These may have snaps or Velcro fasteners that look like buttons, adaptors for zippers and Velcro openings for easy access for catheterization. Some of these items are rather expensive, while other sites have selections in the same price range as similar items. If you know someone who can do rudimentary sewing, they will be able to modify your existing garments. Check-in your neighborhood app site or local religious affiliations to see if anyone locally can help with this job. People who like to sew, sew a lot. This would be a project that they would love to provide for you.

A huge benefit to shopping in a store is the opportunity to actually see the product, hold it in your hand, and feel the quality. Getting through areas can be a challenge when using adaptive equipment. Going in a clothing section can sometimes feel like being in a maze if you cannot see above the racks. The aisles can be tight. Pushing through takes some extra effort. If you have a reacher, you might want to take it with you to access items that are higher on the shelf or rack.

Selecting your size should be a consideration. Sizes change over time, after an injury or during an illness. The correct size will help you avoid problems such as autonomic dysreflexia (AD), pressure injury and even deep vein thrombosis (DVT) if your clothing is too tight or constrictive. Clothing that rubs your body can create friction, shearing or pressure injury. Clothing can fit perfectly when you are lying, but when changing position, it can become too tight. It is especially important that you check your clothing when exercising or performing movement or transfers with your body. If you are uncertain about your size, measure yourself while in your normal sitting position, as that is the position where your body will most likely be the widest.

Check the fabric content of your possible purchase. Breathable fabrics such as cotton or cotton-containing fabric allow air to circulate around your body. Items that are 100% cotton have breathability and stretch but fail to keep their shape. This can cause the fabric to bunch up, creating a wrinkle for pressure injury or trigger an episode of AD. Socks and underwear are particular culprits with this, but other clothing can do the same. Cotton with a bit of lycra for maintaining shape works better to avoid these issues.

Speaking of underwear, many women’s panties are made fully of nylon which is not breathable. This can lead to infections from lack of air circulation in the urinary and vaginal areas. Men’s underwear is generally cotton with some lycra for shape. For men and women, excretions from the rectal area, such as gas, includes some unseen moisture or fecal matter that is contained in the garment, which can spread to other openings in the area leading to infection.

When catheterizing, women might remove underwear or move the underwear to the side. Men will drop the top of the underwear below the penis. You want to have a size that will accommodate this. Always check the fabric content of underwear. There are many brands that advertise fabric wicking or a feature to keep sweat from the body. These often retain the moisture in the fabric, which can lead to increased infections.

Clothing should be checked for fabric content as well. Clothing made from rough fabric can irritate the skin, especially where it can rub, like where the inner, upper arms rub against the body, between the legs, in the groin and behind the knees. Softer textures reduce irritation.

Some individuals opt for athletic wear due to comfort and stretch. There are some advantages. Pants can have snaps down the side, which makes access for catheterizing easier. Getting the pants on and off can be quicker with the side snaps. If you opt for this fashion look, be sure the snaps are not rubbing against your skin, especially if compressed by the sides of your chair or if you are in bed for a rest. Athletic wear is easy to get on and off, generally provides easier access for catheterization and moves with the body. Be sure you have a size that does not bunch up or wrinkle when you are sitting or lying.

Other individuals prefer a different look. This might include jeans or pants. Be sure you have an adequate size with no bunching under your body. If the seams leave pressure marks on your body, the item has the potential to create a pressure injury or trigger an AD episode. You may need a different style or size. Pockets, buttons, rivets on jeans are all red flags for pressure and AD triggers.

The fashion trend of skinny jeans is one that is perhaps best left behind. The trend is starting to fade. This style is a perfect trigger for AD and pressure injury. Jeans may fit snuggly if you put them on when in bed, but when moving to the seated position, they become constrictors at the waist, in the groin and behind the knees. As the day passes, your body collects a bit of edema in the lower legs. The combination can be a recipe for pressure injury, AD and DVT.

Extra careful consideration should be paid to footwear. Shoes are important protectors for the feet of everyone. They are valuable assets to individuals with decreased sensation. If you bump something, your shoes will help to protect you. They also are key to keeping the bones of your feet in alignment. Measure your feet periodically in a dependent position (hanging down) to get the correct length and width of your foot. People often overlook the width, which is as important as the length. Make sure your toes are flat within the shoe. Tone (spasticity) can cause the toes to curl under or flair out. Shoes can be purchased that have side openings rather than the typical top opening. Big manufacturers make some of their traditional shoe lines in the adapted style.

Try on shoes. Manually, feel for the fit. Use your hands or have someone gently press on the toe of the shoe and on the sides to make sure your foot fits in your shoe. There should be a little extra room at the toe. The sides of the shoe should fit around your foot without feeling tight. If you exercise or perform movements to your feet, be sure to check your shoes for changes in fit and rubbing. Also, check shoe fit for edema in your legs and feet as the day wears on.

Always wear socks with shoes to avoid rubbing and to absorb possible moisture from between your toes. Cotton socks tend to bunch up, so use cotton with a bit of lycra to hold their shape. If you use compression stockings, many styles and colors exist. Compression stockings are sold in stores and online that have decorative styling as well as traditional colors. Make sure the compression is the amount equivalent to your medical-grade stockings.

Consider the weather when selecting clothing—warm clothes in the winter and cooler clothes for the summer. You may not feel the temperatures, but your body does. Overheating or being too cold can lead to heat exhaustion and heatstroke or frostbite. This should be for your entire body, including your head and feet. Body temperature regulation and management can be a serious issue. In the summer, use cooling towels, drink cold fluids, sunscreen, and take shade. In the winter, bundle up with a sweater, winter coat, and a blanket, if necessary. Cool or heat your vehicle prior to getting in it. Dressing for the weather includes socks and shoes in the winter and footwear appropriate for the summer. For example, sandals can leave your feet open to sunburn.

Everyone likes to dress for special occasions. Wearing something different or fancy can add to the excitement of the event. Check for wrinkles and crinkled clothing to avoid issues. Some evening wear, especially for women, is made from non-breathable fabric, so allow time to relieve your body from overheating. Women and men remember to check shoes if using rental shoes or new dress shoes. The fit of dress shoes is not as forgiving as athletic shoes, and they are generally not breathable for your feet.

Dressing in cultural ensembles is a wonderful way to celebrate your heritage. Be sure to check fabric content and watch for wrinkles. Some have volumes of fabric that can be quite bulky for sitting. If your garment is being made specifically for you, perhaps some of the back bulk can be reduced or at least pulled to the sides, so you are not sitting directly on it. Also, you might consider a shorter length in the back as for any gown when sitting to avoid tripping or getting it caught in your wheels.

The point is to consider your tastes and desires in fashion. Think about the best adjustments or alterations to fit your specific health needs. Then, have a wonderful time! Nurse Linda

Pediatric Consideration:

Children’s clothing generally has easy to open and close fasteners for those who are just learning to work them. There is also access to the diaper area, which can be an asset for catheterizations. In the school-age and teen years, you will need to be covert in clothing adaptions as these age groups do not want to have something that is not the ‘look’ for that age.

Shoes are particularly important in fit for children. Their shoes fit today, but tomorrow; the shoe is too small. Check frequently for the fit of the child’s shoe. Assess if the foot or toes are curled within the shoe due to tone (spasticity). Look at the length of the child’s foot without the shoe and then feel for the length within the shoe. The shoe should be a bit longer than the natural length of foot.

Parents with challenges in hand control might want a child’s clothing adaptions to make the adult’s life functional added with child safety. Some will look for gently used children’s clothing with fasteners that are a bit worn, making it easier to snap and unsnap. Overalls are often used on babies as the straps on the back are secure to the child's garment, which makes picking up the child easier and safer. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.