The MIlan Dressing Assessment (MIDA) offers a novel structured framework to evaluate dressing skills and assess patients' residual autonomy during this complex everyday activity, demonstrating excellent inter-rater reliability (ICC = 0.93) and associations with neurological severity, functional independence, and non-verbal reasoning skills.
Key Findings
Results
Reliable dressing patterns were identified for eight garments in healthy participants, largely independent of demographic factors.
Seventy healthy participants were included (mean age = 48.73 ± 17.85 years; range = 20-87).
Dressing patterns were largely independent of demographic factors, though specific age-related variations emerged for five garments.
A sex-related difference was found for scarf wearing.
These patterns served as a normative reference for the clinical assessment tool.
Results
Forty-five percent of brain-damaged patients presented with impaired ability to dress.
The clinical sample included 22 brain-damaged patients (21 with stroke, 1 with a neoplastic lesion; mean age = 69.7 ± 13.1 years; range = 45-87).
Dressing impairment was assessed across multiple garments using a 3-point rating scale.
The high rate of dressing impairment highlights the clinical relevance of standardized assessment tools for this population.
Results
The MIDA demonstrated excellent inter-rater reliability in the brain-damaged patient group.
Inter-rater reliability was evaluated using the intraclass correlation coefficient (ICC).
The ICC was 0.93, indicating excellent inter-rater reliability.
Reliability was assessed across multiple garment types using the 3-point rating scale of the MIDA.
Results
Higher dressing skills scores on the MIDA were associated with lower neurological severity, greater functional independence, and better non-verbal reasoning skills.
Associations between dressing skills scores and demographic or clinical variables were assessed using Spearman correlations.
Neurological severity, functional independence, and non-verbal reasoning were all significantly associated with MIDA scores.
These findings suggest that dressing performance reflects broader neurological and cognitive status in brain-damaged patients.
Results
Dressing patterns in brain-damaged patients differed in the presence of unilateral spatial neglect and constructional apraxia.
Differences by neuropsychological deficits were examined using Mann-Whitney U tests.
Both unilateral spatial neglect and constructional apraxia were associated with altered dressing patterns.
Differences by lesion side and location were also examined, providing information on the neural correlates of dressing impairment.
Results
Age-related variations in dressing patterns were observed for five of the eight garments assessed in healthy participants.
Healthy participants ranged in age from 20 to 87 years, allowing evaluation of age effects across the adult lifespan.
Age-related variations were specific to five garments, while patterns for the remaining garments were age-independent.
A sex-related difference was additionally found specifically for scarf wearing.
What This Means
This research suggests that the ability to dress oneself — a fundamental daily living skill — is frequently impaired after brain damage such as stroke, with 45% of brain-damaged patients in this study showing dressing difficulties. To better understand and measure these difficulties, the researchers first documented how healthy adults (aged 20-87) naturally go about putting on eight different types of clothing, finding that these dressing patterns are largely consistent across people regardless of age or sex, with some exceptions. These normative patterns were then used as a reference to build a new clinical assessment tool called the MIlan Dressing Assessment (MIDA).
The MIDA uses a 3-point rating scale to evaluate how well patients dress across multiple garments, and it showed excellent agreement between different raters (a statistical measure called the intraclass correlation coefficient was 0.93 out of 1.0), indicating it produces consistent results regardless of who administers it. Patients who scored better on the MIDA also tended to have less severe neurological impairment, greater overall independence in daily life, and better non-verbal reasoning abilities. Specific neurological conditions — particularly unilateral spatial neglect (difficulty attending to one side of space) and constructional apraxia (difficulty assembling parts into a whole) — were associated with distinct patterns of dressing difficulty.
This research matters because standardized tools for evaluating dressing skills in neurological patients have previously been limited, making it difficult to systematically identify impairments or track recovery. The MIDA provides a structured, reliable framework that clinicians could use to assess a patient's ability to dress independently, which is an important marker of functional autonomy. The authors note this is an exploratory study with a relatively small sample, and future research will be needed to confirm its broader usefulness in clinical settings.
Banco E, Guidali G, Rossetti A, Rossi I, Casati C, Chessa C, et al.. (2026). Dressing patterns in healthy individuals and brain-damaged patients: the MIlan Dressing Assessment.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1852682