Dressing patterns in healthy individuals and brain-damaged patients: the MIlan Dressing Assessment

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Background: The ability to dress appropriately is a fundamental daily living skill that is often impaired by neurological disorders and can manifest as a specific form of apraxia (dressing apraxia). Despite its prevalence and impact on functional independence, standardized and reliable assessment tools for dressing skills remain limited. The aim of this study was to identify dressing patterns in healthy individuals and use them as a reference for introducing a new clinical tool to assess dressing skills. Methods: We conducted two studies, including seventy healthy participants (mean age = 48.73 ± 17.85 years; range = 20-87) and 22 brain-damaged patients (21 with stroke, 1 with a neoplastic lesion; mean age = 69.7 ± 13.1 years; range = 45-87). Dressing patterns for different garment types were identified among healthy participants and then used as a reference to assess dressing skills in brain-damaged patients using a 3-point rating scale across multiple garments, namely the MIlan Dressing Assessment (MIDA). Interrater reliability was evaluated using the intraclass correlation coefficient (ICC). Associations between dressing skills scores and demographic or clinical variables were assessed using Spearman correlations, while differences by lesion side and location, and neuropsychological deficits were examined using Mann-Whitney U tests. Results: Reliable dressing patterns were identified for eight garments in healthy participants; they were largely independent of demographic factors, though specific age-related variations emerged for five garments, and a sex-related difference was found for scarf wearing. Forty-five percent of brain-damaged patients presented with impaired ability to dress. In this clinical group, the MIDA demonstrated excellent inter-rater reliability (ICC = 0.93). Higher dressing skills scores were associated with lower neurological severity, greater functional independence, and better non-verbal reasoning skills. Dressing patterns differed in the presence of unilateral spatial neglect and constructional apraxia. Conclusion: The MIDA offers a novel structured framework to evaluate dressing skills and assess patients' residual autonomy during this complex everyday activity. This exploratory study provides a foundation for future studies aimed at defining its broader feasibility and role in clinical practice.

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