The Power of Occupational Therapy Students in Supporting Adaptive Fashion

Lydia Oh, OTR/L, Post-Professional OTD Candidate at New York University

Occupational therapists use client-centered methods to maximize the individual’s quality of life and occupational performance. The broad scope of occupational therapy allows for niche practice areas related to particular occupations, such as dressing. Adaptive fashion includes clothing, shoes, and accessories that are designed or modified to meet the needs of individuals with disabilities. While adaptive equipment, such as button hooks and dressing sticks, are vital tools to increase dressing skills, adaptive fashion promotes a sense of inclusion, identity, and independence for all. These inclusive options should be offered to clients interested in expressing their personal styles and enhancing their participation in activities by wearing well-fitting, appropriate attire, including for work or formal events. Many brands such as Target, Tommy Hilfiger, Converse, and Nike have expanded their traditional representations of fashion to be inclusive of adaptive design. From magnetic closures for individuals with hand tremors to clothing without tags for children with sensory needs, adaptive fashion is on the rise.

Fieldwork sites often require their students to present an in-service or project on a topic area related to occupational therapy. To raise awareness of adaptive clothing options, fieldwork students can create a list of adaptive fashion companies, examples of adaptive fashion, and resources to share with other professionals. There are also plenty of affordable, do-it-yourself methods to create adaptive apparel for your clients:

• Shoelaces can be tricky for children with cerebral palsy and attention disorders, due to the fine motor coordination and sustained attention needed to successfully tie them. A visual demonstration created by Spohr (2016) demonstrates a simple, time-efficient way to swap shoelaces out with Velcro straps. There are also shoes manufactured with detachable or adjustable components, such as zipper openings around the tops of the shoes; Velcro backings on the heels of the shoes; and shoes made with flexible, compressive material making them easier to slip on and creating adequate room for ankle foot orthoses (BILLY Footwear, n.d.; Nike, n.d.).
• For individuals with sensory concerns, consider clothing made with wider necklines, softer materials, and seamless designs. Another option is weighted clothing that appears as everyday wear, such as a denim vest (Fun and Function, n.d.).
• Magnetic closures are a great alternative to buttons, which often pose a challenge to individuals with tremors and upper extremity impairments. A YouTube tutorial presented by Lippincott (2016) shows how to swap out traditional button-down closures for magnets without taking away from the appearance and style of the shirt. When used with children, be sure the magnets are secure enough not to be swallowed.
• Velcro can easily be attached to pants or shirts. This may be useful for individuals with visual impairments or decreased finger dexterity. There are resources that demonstrate how to adapt pants with buttons and button-down shirts with Velcro closures (K-P, 2017, 2019).
• For individuals who use assistive devices for mobility, such as a wheelchair, consider the length of lower body clothing. Long, ill-fitting clothing often becomes dirty from being dragged on the ground and interferes with the functionality of the device. Clothing for individuals who use wheelchairs should be designed to prevent pressure ulcers and make toileting easier than it is with traditional clothing. These designs may have snaps along the sides of the pants, elastic waistbands with a higher waistline in the back, longer zipper pulls, and no back pockets for reduced pressure (IZ Adaptive, n.d.).
• Adaptive onesies for infants have also been on the rise, to make it easier for caregivers to access medical tubes and lines. Consider creating a covert opening on clothing for those with medical ports and lines, such as from brands like Tubesies (n.d.).

The COVID-19 pandemic has highlighted the need for face masks for people with differing abilities.

• Rebirth Garments has created a line of adaptive face masks that can be altered by size, fabric, and accessible attachments. The option to have clear, lip-reading centers, typically used for those in the deaf and hard-of-hearing community, add to the accessibility features of the masks (Rebirth Garments, 2020).
• You can make a no-sew face mask with a clear lip-reading window following a step-by-step guide by St. Blaine (2020). There is a free, printable face mask pattern for both adult and children’s sizes, and the face mask can be made using household materials (St. Blaine, 2020).
• Cavanaugh et al. (2020) has created a guide to help families and professionals find face masks for children and explains how to prepare children to wear masks. Ideas include wearing face masks with designs that interest children and creating social stories.

As always, it is important to consider a child’s developmental needs prior to opting for adaptive apparel. It is also important to ensure that an individual’s health will not be affected by adaptive clothing (e.g., individuals with pacemakers should not use magnetic closures. Use adaptive apparel wisely and consult a physician as needed.

• Ball of Wax (2020) is an adaptive fashion resource that is meant to guide people with disabilities, caregivers, and health care professionals in finding adaptive apparel from a variety of brands.
• Runway of Dreams (n.d.) is a nonprofit organization that supports the adaptive apparel industry by showcasing individuals with disabilities in fashion and promoting the need for mainstream adaptive apparel.

During these unprecedented times, it is important to remember the foundation of occupational therapy: reinstating meaning and purpose into the lives of individuals through holistic methods. Clinical instructors and students often learn from each other because of the questions asked and the interests formulated during their time at fieldwork sites. Students have the opportunity to share resources and trial new ideas among their cohorts, fieldwork placements, and clients, including ideas for adaptive fashion.

By enhancing someone’s identity, adaptive fashion can shape the outcome of the events that make up their life, from attending weddings and holidays, to being viewed professionally, to running errands. Occupational therapy students and professionals alike have the power to collaborate with clients on adaptive fashion to enhance their health and well-being.

Ball of Wax Community. (2020). Building a community. https://www.ball-of-wax.com/

BILLY Footwear. (n.d.). Fashion meets function. https://billyfootwear.com/

Cavanaugh, B., Aponte, C., & Shamlian, K. (2020, August 19). Masks toolkit. University of Rochester Medical Center. https://www.urmc.rochester.edu/strong-center-developmental-disabilities/resources/masks-toolkit.aspx

Fun and Function. (n.d.). Denim weighted vest. https://funandfunction.com/denim-weighted-vest.html

IZ Adaptive. (n.d.). IZ. https://izadaptive.com/

K-P, S. (2017, April 04). Adapt button down shirts to Velcro closure. Human Touch Occupational Therapy [Blog]. https://humantouchot.com/adapt-button-down-shirts-to-velcro-closure/

K-P, S. (2019, January 19). Adapt button waistband pants to Velcro closure. Human Touch Occupational Therapy [Blog]. https://humantouchot.com/adapt-button-waistband-pants-to-velcro-closure/

Lippincott, C. (2016, April 16). How to: Magnetic buttondown [Video]. YouTube. https://www.youtube.com/watch?v=LUmkzJ0LsSo

Nike. (n.d.). FlyEase. https://www.nike.com/flyease

Rebirth Garments. (2020). Gender non-conforming lingerie for all bodies. https://www.etsy.com/shop/RebirthGarments?ref=simple-shop-header-name&listing_id=836211267&section_id=29272279

Runway of Dreams. (n.d.). The foundation. https://www.runwayofdreams.org/the-foundation

Spohr, H. (2016, February 10). DIY Velcro shoes. http://thespohrsaremultiplying.com/hair/diy-velcro-shoes/

St. Blaine, E. (2020). No-sew cotton face mask with a window. https://learn.adafruit.com/no-sew-cotton-face-mask-with-a-window/assembly

Tubesies. (n.d.). Tubesies. https://www.tubesies.com/

Lydia Oh, OTR/L, is a practicing occupational therapist and candidate for New York University’s Post-Professional Doctor of Occupational Therapy program. Her research interests lie in assistive technology and dressing, web accessibility, and rehabilitation across the lifespan.