Open Backed Clothing for Wheelchair/ Lift/ Sling Use

I've been designing clothes for my mom as she has progressed through different stages of ALS.  I won't be using pictures of my mom out of respect for her privacy and dignity.

As my mom's left arm weakened to the point of immobility, she was unable to dress herself.  Unfortunately, her husband, her primary caregiver, has Essential Tremors, and therefore had a lot of difficulty with snaps, buttons, zippers...  He is also pretty oblivious to comfort and fit (I remember once he'd accidentally fastened my mother's bra so that the bottom band crossed directly over her breasts. Unfortunately, since she cannot speak, and has less sensitivity on affected parts of her body when I came by in the afternoon, it had been like that all day!  Ouch!)

Back opening dress

When mom was still using a walker, I made wrap dresses and purchased front-closing bras so that she could be dressed while sitting on the bed.  When she switched to the wheelchair full time, we tried switching her tops to back openings with velcro or snaps on the shoulders so that she wouldn't have to lift her arms as much or try to fit things over her neck brace (she was still trying to wear t-shirts - which had to go over her arm brace and her neck brace.).  This way the shirt could be pulled up over her arms, and then fastened in back.  Here's a link to how this works. 

Tulip shirt back

My mom had lost so much weight that I was able to cut her knit shirts open and overlap them enough in the back for her husband to make it work. 

Sewing

If you're fairly comfortable at adapting a pattern, then you could easily make something like this yourself by extending the pattern's shoulder on one side so that it would create a facing (I'd interface it) and add snaps or velcro to it. 

This free Tulip top pattern is designed to be sewn with the tulip hem on either the back or the front. It could probably be easily converted to being able to open it completely (instead of secured at the neckline) and use snaps or velcro at the shoulders.

I think this pattern would also work well with a g-tube/PEG.  Modified Tops for Nursing and G-Tubes.

Electric wheelchair

Once my mom got to the point where she needed to be in a wheelchair all the time to prevent falls.  We quickly started discovering issues with using the bathroom.  

First of all, the wheelchair didn't fit in the tiny little potty room, so someone had to help Mom rise from her wheelchair, then help her balance until she could hold onto a grab bar mounted on the wall.  She then shuffled until she was in front of the toilet.  We had a second grab bar installed there, and she held on to that for balance. Her ALS had progressed to the point that she only had the use of one hand, and that hand was holding the grab bar, which meant someone else had to drop her pants for her (and help pull them back up when she was done).  There was very little dignity to be found in this situation!

Suddenly we needed "open bottom" pants for my mom.

As she became less able to support her own weight, we quickly discovered that she needed a lift (including a lift in her spirits!).  The problem with lifts is that they lift you out of the wheelchair in a sling and then lower you onto the potty - which is great, except when/how do you lower your pants?!  The sling has a circular opening where your bottom "hangs out."  A quick bout of research (found an awesome site called Silvert's with some "open bottom options") and we quickly discovered this meant you had to go "commando" so your clothes had to discreetly cover you everywhere, except your bottom.

 That left mom with 2 options.

One, a tulip-backed dress with a cut-out for the bottom.  The person looks fully clothed when you're looking down from above.  The sides of the skirt are tucked under the person's legs and the back of the dress goes to the chair seat and stops.  We still had to add access to the PEG tube for feeding (see this post for details).

.Option two was pants, capris, shorts.  This was mom's preference, and with the purchase of a pair of Silvert's open-bottom pants and this video which showed me how they worked, I thought we were in business!  She tried out the pants for a couple of days before I made more, and I'm so glad we waited.

Step one, while still in a seated
position pull pants up over legs.

Secure adjustable waistband.
"Flap" will cover hips, but
the bottom is exposed when in
seated position.

In theory, these are awesome!  In everyday use?  Not so much.  The crotch seam was sewed so far toward the back that you couldn't easily access the front parts of the body that need "wiping."  That seam had to be opened up to allow the slit to come further toward the waist.  

In theory, the generous amount of fabric in these loose-fitting pants, and the fact that my mom never sits with her knees spread apart, keeps them from gaping open enough to show the opening.

The worst part?  To secure the snaps in the back - already difficult for her caregiver with Essential Tremors, Mom had to lean forward in her chair - which inhibited her breathing.  Not wheelchair-friendly at all!

Original design

Shifted to side closure instead of center back.

So I opened up the left side of the back "flap" and added some velcro strips (could use a separating zipper as well).  That way the flap could be slipped behind the person and then secured on the side (much easier than trying to secure it behind their back).

This worked much better so I altered a pair of her loose-fitting (she's lost about 70lbs on her liquid diet), elastic waistband, knit shorts.  Instead of Velcro, I used magnetic purse snaps (my new favorite closure!).  It's pretty easy to alter the shorts (although it helped to have matching color fabric for the new flaps needed for the side closure), but I've also drafted a pattern so I can make new ones in any colors I wish.

I can add more details if anyone is interested in doing any of these projects themselves.

Here's my updated tutorial post about altering pants to be open bottom pants.