# PWR-064 — Adaptive self-care independence: learner worksheet Release: Revision 7T · Full Tutorial Edition Estimated time: Estimated 13 min reading; practical time is provider-set Difficulty: Intermediate Equipment: Common household or practice equipment — A stable chair with provider-selected support.; A loose front-opening shirt and prescribed dressing aid if used.; Mirror, reach aid or labelled step card as selected.; A record for steps completed, assistance, time, effort, pain and preference. Space: Room-scale practice space Automated structural checklist: 10 of 10 structural checks present Evidence quality/context: G4; Detailed research depth Automated method-quality band: Comprehensive Method-rating basis: Structure coverage, instruction/check specificity, alternative distinctness, source troubleshooting, comparison depth and whether purpose/check fields are authored rather than derived. Editorial review: Pending manual editorial sign off ## Before you begin - [ ] I read the tutorial authority and stop conditions. - [ ] I have the required equipment/space or a declared accessible alternative. ## Canonical source context Independence can mean completing a self-care step, directing assistance or redesigning the setup—not doing everything alone. This lesson analyses one seated front-opening-shirt sequence. Bea chooses which sleeves and buttons she will manage, positions a stable chair and dressing stick, stages the limited-side cuff at her supported hand, delegates only named closures and records effort, pain, balance and preferred appearance. Target outcome: With an occupational therapist, Bea completes or directs the agreed shirt-dressing sequence with declared aids and assistance and no unsafe balance loss. ### Authority and setup conditions - The occupational therapist checks balance, skin, joint precautions, lines/tubes, cognition and preferred clothing. - Place the chair away from stairs and lock wheels when applicable. - Choose a garment and aid that do not require painful force or unsafe reach. - Agree whether the goal is doing, directing assistance or reducing burden. ### Required or supplied materials - A stable chair with provider-selected support. - A loose front-opening shirt and prescribed dressing aid if used. - Mirror, reach aid or labelled step card as selected. - A record for steps completed, assistance, time, effort, pain and preference. ## 1. Define independence for this task Ask Bea which parts she wants to do, direct or delegate and what a successful dressed state looks like. Why: Independence is person-chosen control, not absence of help. Success check: The dressing goal names the shirt, assistance and finish state. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The dressing goal names the shirt, assistance and finish state.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 2. Prepare seated setup Position the chair, feet/support, shirt, aid and helper on the side approved by Bea's OT before dressing starts. Why: Preparation prevents reaching and standing while entangled in clothing. Success check: All items are reachable without losing the safe base. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “All items are reachable without losing the safe base.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 3. Orient shirt Lay the shirt with collar and inside/outside markers visible; identify the first sleeve using the OT-taught method. Why: Orientation errors create repeated reaching and frustration. Success check: Bea can point to collar, inside and first sleeve. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Bea can point to collar, inside and first sleeve.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 4. Dress selected side first Guide the prescribed arm or limb into the first sleeve using approved aid or helper support; never pull forcefully on a painful joint. Why: Order can reduce range and protect a vulnerable side. Success check: The limb is supported and fabric is not twisted. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The limb is supported and fabric is not twisted.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 5. Bring shirt around Use selected reach, aid or helper handoff to bring the shirt across the back while remaining seated and stable. Why: Moving the shirt behind the back should be planned rather than improvised mid-task. Success check: No unsupported standing or extreme shoulder pull occurs. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “No unsupported standing or extreme shoulder pull occurs.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 6. Complete second side Place the other arm and settle the shirt using Bea’s preferred method and the minimum useful help. Why: Separating the steps lets assistance target the actual barrier. Success check: Both sleeves are on and assistance is recorded by step. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Both sleeves are on and assistance is recorded by step.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 7. Fasten or choose an adaptation Use large fasteners, loop aid, magnetic adaptation or directed help as approved; fasten only what is needed for the chosen finish. Why: Equipment or delegated help can preserve choice and reduce burden. Success check: Chosen finish is met without unsafe strain. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Chosen finish is met without unsafe strain.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 8. Review effort and redesign Record difficult steps, pain, time, balance and preference. Change dressing setup or aid before asking Bea to try harder. Why: Task and environment are valid treatment targets. Success check: One specific redesign follows the largest barrier. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “One specific redesign follows the largest barrier.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 9. Stage fabric at affected hand Open the cuff and gather limited-side sleeve into a short fabric ring. Keep the affected forearm supported on the lap or approved surface, then bring the sleeve opening to the affected hand instead of reaching the arm toward loose fabric. Why: Gathering the sleeve reduces shoulder travel, prevents the affected hand from searching inside a twisted sleeve and makes the first barrier visible. Success check: Affected hand enters the correct cuff, the seam remains untwisted and the affected shoulder stays inside its prescribed range. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Affected hand enters the correct cuff, the seam remains untwisted and the affected shoulder stays inside its prescribed range.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 10. Use a button-by-button handoff At each required closure, Bea either fastens it with the approved loop, directs the button helper to that exact button or chooses to leave it open. Button helper waits for the instruction before touching the shirt. Why: Step-specific direction preserves control and shows whether the obstacle is alignment, pinch, vision, fatigue or time. Success check: Each required button has a recorded method—self, aid, directed help or intentionally open—and the chosen finish is met. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Each required button has a recorded method—self, aid, directed help or intentionally open—and the chosen finish is met.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## Reflection What changed? ________________________________________________________________________________ What remains difficult? ________________________________________________________________________________ What will I repeat, adapt, ask for help with, or stop? ________________________________________________________________________________ --- Completion of this worksheet demonstrates tutorial participation only. It does not establish capability, qualification, safety clearance, diagnosis, treatment or independent validation.