Apparel Needs in Rehabilitation Therapy by Sandra Tullio-Pow Submitted in partial fulfillment of

279 Pages·2016·14.97 MB·English

Mapping the Clothing Taskscape: Apparel Needs in Rehabilitation Therapy
by
Sandra Tullio-Pow

Submitted in partial fulfillment of the requirements for the degree of
Doctor of Philosophy

Department of Human Ecology
University of Alberta

© Sandra Tullio-Pow, 2016
Abstract
Dressing is an activity taken for granted until a person’s balance and synchronized movements are
impaired due to illness, injury, disease, or surgery. This study conceptualized and operationalized
the clothing taskscape (CT)—selecting, shopping, dressing, toileting, eating, exercising, sleeping,
laundering, and storing—to analyze apparel needs and ways people who have experienced a
disabling event interact with clothing. The CT was designed to: map the use scenario and identify
the relationship between personal ability and clothing environment; determine compensatory
interventions in terms of clothing modifications that improve functional abilities; and distinguish
how clothing and independence in dressing enhance well-being and self-image in rehabilitation
therapy (RT). The study was framed by a 2-part research question: What factors along the CT
impact functional limitations and self-image for people in hospital RT programs, and how can such
criteria inform design to address this population’s needs? Ethnographically oriented methods were
used to examine the clothing context and its meaning to people through field observation of RT
sessions and patient routines with personal support workers (PSWs; n=46), and interviews with
occupational therapists, physiotherapists, PSWs, and patients (n=34). Precedent analysis was used
to source and evaluate clothing in the marketplace; specific garments were purchased and used as
probes to invite dialogue during participant interviews and to gauge receptivity to garment
innovations. Results reveal patients’ experience related to clothing, disability, and functioning as
well as clothing’s social and psychological aspects. Design recommendations are made to mediate
difficulties people have when dressing in relation to fabric choices, garment silhouettes and
fasteners, circumference of garment openings, dual waistbands, pockets, loops, and visual clues to
guide garment orientation and product development opportunities. Study results may impact
fashion designers, specialized product developers, design educators, and rehabilitation therapists.
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Preface
This thesis is an original work by Sandra Tullio-Pow. The research project, of which this thesis is
a part, received research ethics approval from the University of Alberta Research Ethics Board,
Project Name “MAPPING THE CLOTHING TASKSCAPE: APPAREL NEEDS IN
REHABILITATION THERAPY”, No. Pro00052870, 15/01/2015.
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Dedication
This dissertation is dedicated to my father, who supported his children in their quest for
higher education, an opportunity he never had and to my mother who taught me how to juggle
multiple balls in the air and most importantly, which ball could be dropped.
iv
Acknowledgments
Once you make a decision, the universe conspires to make it happen – Ralph Waldo Emerson
This statement certainly sums up my PhD journey. It all began at an annual apparel
conference and an impromptu discussion with Dr. Betty Crown and Dr. Rachel McQueen about
Ryerson University’s new MA program in Fashion. I expressed my desire to pursue a PhD—
which prompted the recommendation, “You must speak with Megan”—and this decision began a
series of events that eventually lead to the completion of this dissertation.
I am especially grateful to my supervisor, Dr. Megan Strickfaden: thank you for
suggesting that I look deeply into Ingold’s concept of taskscape. I could not have wished for a
better supervisor; with your advice, I have transformed beyond my comfort zone as an intuitive
designer to become a design researcher.
This research was completed with tutelage from an academic team. I want to offer
heartfelt thanks to my committee members who assessed multiple drafts of my thesis as they
guided me along this journey: Dr. Anne Bissonnette, Dr. Patrick Devlieger, and Dr. Mary
Ruppert-Stroescu. In addition, I sincerely thank Dr. Susan Ashdown for her review and
thoughtful critique of the final manuscript.
I was privileged to have a strong circle of female mentors who nurtured me in many
ways. I have special thanks for Professor Lucia Dell’Agnese for her advice and leadership as I
embarked on my academic career. I am indebted to both Dr. Joyce Nyhof-Young and Dr. Hong
Yu, each of whom honed my research skills through the many projects we worked on together
before I began my coursework at the University of Alberta.
Completion of this degree would not have been possible without the incredible support of
my Chair, Robert Ott, and the encouragement of the School of Fashion faculty, all of whom had
to assume additional service duties while I was on leave.
Writing up the research was aided by advice I received from Dr. Charles Davis, Dr. Ben
Barry, Dr. Robert Desjardins, Mari Bergen, and Maurice Barnwell, as well as from Ingrid Mida
and Kirsten Schaefer. I am especially appreciative to Mark Poulin for his patient and thoughtful
editing expertise and to Amanda McGroarty for her prowess at transforming my hand-drawn
diagrams into the crisp, well-designed graphics found throughout this document.
Leaving family and friends and moving west was not without its challenges. I am
especially thankful to Dr. Arlene Oak, my friend Linda Marie Johnson, and my cousins Paul
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Punyi and Maureen Rooney for providing me with a home away from home. I could not have
done it without you all!
This research would not have been possible without financial support from the Dean of
the Faculty of Communication and Design at Ryerson University, the Canadian Federation of
University Women, as well as numerous scholarships provided by the University of Alberta and
the Department of Human Ecology.
A number of rehab facilities were skeptical about allowing a fashion designer into their
hospital to do research. I am extremely grateful to a doctor (who must remain anonymous) for
making the necessary introductions that eventually lead me to the team of therapists and care
workers in this study who in turn introduced me to patients and facilitated my observations and
interviews. I will be forever grateful to the occupational therapists, physiotherapists, and care
workers for allowing me to accompany them while they worked. Losing one’s health is an
especially traumatic experience; I have immense gratitude for the patients who agreed to share
their journey of recovery with me.
And finally, I would like to recognize my family for watching over and nurturing my
sons David, Cameron, and Geordie while I was living in Alberta or at home, secluded in my
office writing. Thank you to my mother and father, my sister Carla, my brother Gerald, my Zia
Carol, and my cousin Eileen. Behind every successful woman is a sometimes impatient man;
thank you Sandy for holding the fort through thick and thin!

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Table of Contents
Page
Abstract ...................................................................................................................... ii
Preface........................................................................................................................ iii
Dedication .................................................................................................................. iv
Acknowledgments...................................................................................................... v
List of Tables ............................................................................................................. xii
List of Figures ............................................................................................................ xiii
Glossary of Terms ...................................................................................................... xvi
CHAPTER ONE: INTRODUCTION ........................................................................ 1
Researcher Background and Approach ............................................................ 2
Purpose of the Study ......................................................................................... 4
Justification for the Study ................................................................................. 4
The Clothing Taskscape ................................................................................... 5
Clothing Environments and Disablement ......................................................... 7
Significance of the Study.................................................................................. 9
Chapter Summary ............................................................................................. 10
Overview of the Thesis Structure ..................................................................... 10
CHAPTER TWO: LITERATURE REVIEW ............................................................ 12
Clothing Choice: Communication, Identity, Behaviour, and Well-Being ....... 12
Identity .................................................................................................... 12
Behaviour ................................................................................................ 13
Well-Being .............................................................................................. 14
The Design Process: From Ready-to-Wear to Functional Apparel .................. 15
Development of Ready-to-Wear Fashion ............................................... 16
The Functional Design Process ............................................................... 19
Conceptualizing User Needs: FEA and Other Models ..................................... 21
Modifications to the FEA Model ...................................................................... 23
Design Anthropology: Exploration and Complexity ........................................ 25
Practical Challenges ......................................................................................... 27
Methods of Defining User Needs ..................................................................... 28
Documents and Data ............................................................................... 30
People ...................................................................................................... 33
Garment and Fabric Artifacts .................................................................. 36
Gaps in the Apparel Research Literature .......................................................... 36
Enhancing Ability: Occupational Therapy and Dressing Practice ................... 38
Remedial and Functional Training Methods .................................................... 39
Chaining .................................................................................................. 39
Assistive Dressing Devices ..................................................................... 40
Factors That Limit Dressing Independence ...................................................... 41
vii
Modifying the Clothing Environment .............................................................. 42
Reducing the Burden of Care ........................................................................... 43
Clothing Fasteners ............................................................................................ 43
Gaps in the Literature Related to Dressing Methodology and Fasteners ......... 45
Chapter Summary ............................................................................................. 46
CHAPTER THREE: RESEARCH DESIGN AND METHODOLOGY ................... 48
Research Design ............................................................................................... 48
The Clothing Taskscape .......................................................................... 50
Taskscape Pilot ....................................................................................... 51
Research Questions ................................................................................. 53
Preparing for Fieldwork .......................................................................... 53
Data Collection ................................................................................................. 54
Setting ..................................................................................................... 54
Recruitment and Participants .................................................................. 56
Data Collection Framework .................................................................... 58
Phase 1: Field observation with OTs/OTAs and PTs/PTAs .............. 60
Phase 2: Field observation with PSWs ............................................... 63
Observation interviews .................................................................. 63
Materials collected during observation sessions .......................... 65
Phase 3: Clothing precedent analysis and artifact probes .................. 65
Phase 4: Patient interviews ................................................................. 69
Phase 5: Interviews with OTs/OTAs, PTs/PTAs, and PSWs ............. 71
Compensation.......................................................................................... 72
Summary of Data Collection Framework ............................................... 73
Data Analysis.................................................................................................... 73
Data Types and Management .................................................................. 73
Detailed Iterative Data Analysis ............................................................. 76
Data Analysis Procedure ......................................................................... 77
Data Reduction and Analysis .................................................................. 78
Chapter Summary ............................................................................................. 80
CHAPTER FOUR: RESULTS .................................................................................. 81
A Day in Rehab ................................................................................................ 82
Selection ........................................................................................................... 83
Selection From Home Wardrobes ........................................................... 84
Clothing Selection and Routine .............................................................. 85
Daily Clothing Selection ......................................................................... 85
Garment and Footwear Selection Criteria ............................................... 87
Lounge Dress .......................................................................................... 89
Therapeutic Effects of Clothing .............................................................. 90
Feelings Evoked by Mirrors .................................................................... 91
Summary of Selection Phase................................................................... 92
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Shopping ........................................................................................................... 92
Transient Product Need ........................................................................... 93
Personal Shoppers and Retailers ............................................................. 94
Shopping Barriers ................................................................................... 95
Summary of Shopping Phase .................................................................. 96
Dressing ............................................................................................................ 96
Body Abilities, Motions, and Dressing Positions ................................... 97
Dressing Tools ........................................................................................ 100
Familiar Tools ......................................................................................... 102
Dressing Principles ................................................................................. 102
Clothing Attributes and Independent Dressing ....................................... 105
The Bra .................................................................................................... 107
Socks and Shoes ...................................................................................... 110
Summary of Dressing Phase ................................................................... 112
Toileting ........................................................................................................... 113
Body Movements .................................................................................... 114
Toileting Options .................................................................................... 114
Wearing Incontinence Pads—Just in Case.............................................. 115
Disposable Underwear ............................................................................ 116
Underwear Preferences ........................................................................... 117
Toileting Routines ................................................................................... 118
Garment Preferences ............................................................................... 120
Summary of Toileting Phase ................................................................... 121
Bathing ............................................................................................................. 121
Sink Side ................................................................................................. 122
Shower Room .......................................................................................... 124
Comfort ................................................................................................... 127
Feelings ................................................................................................... 128
Summary of Bathing Phase ..................................................................... 128
Eating ................................................................................................................ 129
Clothing and Mealtimes .......................................................................... 130
Eating Ability .......................................................................................... 130
Adequate Clothing .................................................................................. 131
Summary of Eating Phase ....................................................................... 131
Exercising ......................................................................................................... 131
Motivation and Incentives ....................................................................... 132
Patient Attitudes ...................................................................................... 134
Exercise to Enhance Toileting Abilities .................................................. 134
Exercise Clothing and Footwear ............................................................. 135
Summary of Exercising Phase ................................................................ 137
Sleeping ............................................................................................................ 138
Evening Routines .................................................................................... 138
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Sleepwear Preferences ............................................................................ 139
Hospital Gown ........................................................................................ 139
Summary of Sleeping Phase ................................................................... 141
Laundering ........................................................................................................ 141
Wardrobe Options ................................................................................... 141
Garment Care .......................................................................................... 142
Laundry Management ............................................................................. 142
Clean and Dirty ....................................................................................... 143
Hospital-Supplied Garments ................................................................... 144
Summary of Laundering Phase ............................................................... 145
Storing .............................................................................................................. 145
The Physical Space ................................................................................. 146
Organization ............................................................................................ 147
Storage Spaces ........................................................................................ 148
Organizational Strategies ........................................................................ 150
Home Adaptations................................................................................... 152
Summary of Storing Phase ...................................................................... 154
Chapter Summary ............................................................................................. 154
CHAPTER FIVE: DISCUSSION .............................................................................. 156
Interrelationships Within the Clothing Taskscape ........................................... 156
The Body: Physical and Emotional Factors ............................................ 162
Environmental Factors ........................................................................... 163
Strategic Wardrobe Selection ........................................................................... 165
Matched Sets of the Right Clothes .......................................................... 165
Therapeutic Effects of Clothing .............................................................. 166
Clothing Silhouette, Fabrics, and Fasteners ........................................... 167
Silhouette attributes ........................................................................... 168
Fabric attributes .................................................................................. 171
Fastener attributes ............................................................................. 172
Visual Cues to Aid Garment Orientation ................................................ 176
Pockets .................................................................................................... 177
Addressing Problem Garments ......................................................................... 178
Socks and Shoes ...................................................................................... 179
Trousers ................................................................................................... 182
Underwear and Brassieres ....................................................................... 185
Disposable underwear ........................................................................ 186
Brassieres ........................................................................................... 186
Educational Resources...................................................................................... 189
Chapter Summary ............................................................................................. 191
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