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Berg Encyclopedia of World Dress and Fashion

Global Perspectives

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Joanne B. Eicher and Phyllis G. Tortora (eds)

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Disability, Its Effect on the Body, and the Clothing Perspective

Kate Carroll

Encyclopedia entry

DOI: 10.2752/BEWDF/EDch10712

October 2013

Abstract

Disability affects the body in various ways, which in turn affects clothing from a variety of perspectives. Clothing for people with disabilities has changed over time, from early attempts to accommodate physical disability into design to clothing that is being embedded with twenty-first-century technology to enhance quality of life. In the early twenty-first century retailers are selling everything from adaptive clothing to fashion-forward products. In the product development process, a variety of materials and fastenings are being utilized, incorporating new technological developments where applicable. Clothing is being successfully adapted for various types of disabilities, and educational and design programs are encouraging people to think about people with disabilities in the design process. Other crucial issues for those with disabilities include shopping and accessibility, as well as twenty-first-century marketing developments, including the attention of the media and celebrity involvement.


The bodies of individuals with disabilities may appear and function differently from societal norms; consequently, for these individuals, choice of clothing in the fashion market is limited. Clothing approaches for people with disabilities has changed over time, from early attempts at accommodating physical disability into design, to clothing that is embedded with twenty-first-century technology to enhance quality of life. In product development various styles, materials and fastenings are used, incorporating new technological developments where applicable. Clothing is being successfully adapted for various types of disabilities, and educational and design programs are encouraging people to consider people with disabilities in the design process. Other crucial issues for those with disabilities include shopping and accessibility, as well as marketing developments, including attention of the media and celebrity involvement.

The World Health Organization has stated that “disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. Impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives.”

Such a definition emphasizes the dual nature of disability—that not only the body but also society plays a role in defining a person’s degree of ability in life situations. Clothing is in part a social phenomenon: people wear clothes to cover nakedness, to satisfy the social mores of the culture in which they live, to express themselves, and to define their place within a larger group. Clothing is part of a person’s interface with the outside world. For persons with a defined disability, clothing not only performs these functions but is also used in evaluating disability. On Dr. Sidney Katz’s six-item Activities of Daily Living Scale, two of the items directly use clothing in the evaluation process (dressing—gets clothes and dresses without any assistance except for tying shoes; toileting—goes to the toilet room, uses the toilet, arranges clothes, and returns without any assistance). In addition, the Lawton-Brody Instrumental Activities of Daily Living Scale lists doing laundry and going shopping as two out of eight measurement activities. Clothing therefore plays an important part in the lives of people with disabilities as a measure of their physical activity and independence.

Disability can be present from birth or acquired through accident, illness, and disease. There are four major categories (visual impairment, hearing impairment, physical impairment, and cognitive or language impairment), which may affect the body in a variety of ways and degrees: poor muscle control; weakness and fatigue; difficulty walking, talking, seeing, speaking, or sensing; problems with motor skill control or reaching; and inability to use limbs.

History

History from the perspective of people with disabilities has been inconsistently documented, and thus there is a lack of information on clothing within this area. Before the social innovations and interventions of the early twentieth century, people with disabilities were for the most part excluded from society. Some specific attempts were made to help wounded veterans returning from war with debilitating wounds, such as the establishment of the Hotel des Invalides in Paris in the late 1600s. Other than religious efforts, however, there was little government-mandated care of people with disabilities. Strict laws governing immigration into the United States were in part to blame for the lack of public awareness of disability, and in some respects disability was regarded as primarily a working-class problem, due to injury on the job and chronic illnesses associated with extreme poverty, as historians Paul Longmore and Laurie Umansky point out. Medical history sources likewise do not yield much information. Most of these focus on case specifics rather than on the individual and his or her environment. In the United States in the 1890s, hospital schools for “crippled” children began to adopt a rehabilitation approach, which marked a change in Western industrialized society’s attitude toward people with disabilities.

The origins of research into clothing for people with physical disabilities in the twentieth century are entrenched in this idea of rehabilitation and self-help. Rehabilitation of individuals describes a process whereby an individual participates in improving a quality of life that has been diminished in some way. Researcher Adeline Hoffman says that the idea of clothing as a rehabilitative tool in children’s hospitals began when doctors, therapists, and nurses found that the acts of dressing and undressing improved the physical and cognitive skills of children with disabilities. The incorporation of clothing into a rehabilitative program was found to increase mobilization of joints and muscles. In the 1930s caregivers and hospital staff working with hospitalized children were trained to assist them with dressing and undressing as part of their hospital treatment.

In the 1940s, a change in philosophy involved an increase in the teaching of independence skills, and clothing, together with the acts of dressing and undressing, became a key factor. In the 1950s, charts were used as teaching aids for “handicapped” children in hospitals to show them how to dress independently. Concurrent with these efforts, independent researchers began investigating the therapeutic value of clothing and self-help skills and started to work on clothing designs for children to aid in skills development. Through this effort, researchers turned from using existing clothing as an independence tool to addressing the specific clothing problems of people with physical disabilities through applied projects. Some investigators in clothing extension services committed themselves to exploring the needs of adult hospital and rehabilitation patients. They did this by identifying and developing aids to increase patient comfort and assist in grooming and dressing. The identification of functional features in ready-to-wear clothing also became an important research topic, and extension agencies issued instructional booklets advising how to choose and alter commercial clothing and patterns for medical patients, the elderly, and people with physical disabilities.

Xeni Collections, Fashion for the Unconventional: coat with free seat suitable for women in wheelchairs to put on independently and complete for those able to stand. It closes using magnets to address the needs of those who have difficulty with manual dexterity and find buttons and zips impossible. Courtesy of Xeni Collections. Photographer: Dominic Dodd. Model: Tracey Warren.

At the Institute of Physical Medicine and Rehabilitation in New York, fashion designer Helen Cookman was appointed to investigate the clothing problems of handicapped patients. Cookman’s objectives, however, went further than just helping people achieve independence. She was concerned about producing good-quality and fashionable clothing for this group of adults and wanted to see items developed and tested prior to ready-to-wear distribution. The result of her research, after a three-year period, was a specialized line of clothing for men and women with physical disabilities. The line consisted of seventeen garments, made from a variety of fabrics, including nylon, polyester, and even some luxury wool fibers, and constructed using durable techniques. Six of the designs were subsequently produced by a nonprofit organization, Clothing Research, Inc., of New York City.

In the late 1950s, Clarice Scott of the U.S. Department of Agriculture Research Service conducted an in-depth survey on clothing with seventy homemakers with various types of physical disability. Their primary disability was ambulatory, but hands, arms, and shoulders were also involved. The survey compiled the respondents’ clothing likes and dislikes with respect to various styles and design features. Important factors used as guides in Scott’s survey were comfort, convenience, safety, protection, serviceability, fabric, and attractiveness. A government bulletin was published that contained designs for approximately twenty women’s garments, with pictures and pertinent details about clothing construction. Three dresses, three blouses, three skirts, an indoor wrap, a bolero jacket, slacks, shorts and pedal pushers, four aprons, a dress protector, and two pockets were described in detail.

Apart from extension services, small businesses started to focus on the production of clothing for specific needs. For example, Mrs. Van Davis Odell founded Fashion-Able in New York in 1965, a business that designed and marketed undergarments for ambulatory women with disabilities. The line of undergarments came in standard sizes and included bras, girdles, slips, robes, and pajamas. The business was founded based on the personal needs of Mrs. Odell, who had suffered a cerebral aneurysm, which had paralyzed her left side. She subsequently had difficulty finding suitable underwear products. When she started the business, she could find no marketing research about her target customers, so she concentrated on her own needs, discovering that many others had similar problems. The business was successful and later expanded into a full line of women’s clothing and other items to assist with the activities of daily living, with all products available by mail order.

In the 1970s, continued interest in research on clothing as a rehabilitation tool coincided with passage of the Rehabilitation Act in 1973. More research projects at major universities focused on the specific needs of individuals with varying levels of physical limitations. The subjects of study included handicapped children, elderly people, homemakers with disabilities, and young people with curvature of the spine. A portion of this work following the Rehabilitation Act focused on helping therapists use clothing as a rehabilitation tool. Since the 1970s, research has remained somewhat stagnant in the clothing area; however, more independent retailers, mainly online, are addressing the needs of the disabled, and researchers are investigating smart assistive technologies that might assist people with disabilities.

Thus, initial research focused on the rehabilitation aspects of clothing for the physically disabled, their caregivers, and medical and rehabilitation workers, concentrating on improving skills in dressing and personal appearance. Research efforts moved beyond clothing as a self-help tool to developing functional and stylish specialized garments or adapting ready-to-wear clothing. At the end of the twentieth century, the trend shifted to a reconsideration of the affective aspects of functional clothing and ways to incorporate psychological and expressive needs to assist in fully integrating disabled individuals into society through jobs and activities.

Product Development

The typical model for clothing product development focuses on ready-to-wear mass-produced products where the individual consumer’s needs and preferences are not known beyond a general market segment. Specialization of product development involves creating a product for a market of one end user with unique needs and preferences (customization). A more realistic conceptualization is that specialized products can address the needs of a small group with common specific needs not satisfied by mass production.

A window display at Debenhams’ flagship store on Oxford Street, London, in February 2010, featuring Shannon Murray, the model, in her wheelchair. Getty Images/Ben Stansall/Stringer.

On a broad level, design professionals in many fields have vigorously discussed the inclusion of “unique” populations in the development of consumer products, especially in housing, home products, and transportation. Researchers in academia and industry have argued that development of mainstream consumer products could include consideration of people who have disabilities or are elderly. Some topics for discussion include (a) the definition of individuals who qualify as disabled and elderly and the size of this population, (b) whether their needs should be handled separately as exceptions to the norm, (c) the economic and practical feasibility of including disabled and elderly persons in the design process for mass-produced products, and (d) the benefits of incorporating consideration of disability and aging into mainstream design. These four topics also have relevance to the fashion industry.

The specialization of product development in the clothing industry has been under investigation for some time, as a way of producing clothing that increases consumer satisfaction. Mass-customization technologies have enabled mainstream retailers to partially involve consumers in the design of products, thus allowing them to purchase something in which their input was a significant factor. Involving the consumer at the beginning of the design process has not been a part of mainstream fashion, but designers could benefit from identifying and addressing specific needs to create satisfactory products. In 1985 clothing researcher and ergonomics specialist Elsa Rosenblad-Wallin first proposed user-oriented product development as a method of designing clothing products for people with special needs. Many have suggested that successful mass-produced clothing for people with disabilities should not have functional features as an exclusive focus but should incorporate these features into commercial clothing to make it more accessible. In assessing the state of specialized clothing product development, Marianne Thoren, a researcher in the Department of Consumer Technology at Chalmers University of Technology in Sweden, observed that people with physical impairments were not accommodated in the mass-production system because they need individual clothing adaptations, and that in the design process manufacturers were not taking into account an important dimension of clothing, its symbolic value. Thoren addressed the viewpoint of both manufacturers and final users and suggested a systems approach, necessitating a complete system change in the process. At the time of Thoren’s study, some of the technologies that are being used in the clothing industry in the early twenty-first century (body scanning, 3D virtual prototyping, sensors to monitor body movement mechanics) were not available.

In the design educational process, educator and functional design specialist Susan Watkins explored functional design theory as part of proactive curriculum changes in university apparel courses. Watkins saw no reason for difference between the clothing design processes for ready-to-wear and specialized “functional” clothing, believing that all clothing is functional because clothing must cover the body and ornament it. Certain specialized clothing may include more thermal qualities, for example, or allow greater freedom of movement in certain situations, or provide more protection and safety. Watkins encouraged designers to take an interdisciplinary approach to design and explore the relationships between apparel design and other disciplines. According to Watkins, designers who specialize in functional design must have a thorough background in mechanics, body structures, the properties of materials, basic psychology, and assessment of visual appeal. In this way, the task is different from design for ready-to-wear goods, where most consumers buy a product for its looks rather than for a special function, because specialized knowledge is not considered essential for successful ready-to-wear design.

Product development is an essential part of the ready-to-wear apparel industry and is becoming more specialized as firms struggle to provide their targeted customers with a satisfactory product that not only meets but exceeds expectations. The diversity of the population demands a less homogeneous set of product offerings and more attention to specific needs. Clothing for individuals with disabilities has long been considered under the umbrella term of functional design. However, clothing companies are starting to pay attention to people whose bodies are different from the norm and to embed their needs into mainstream design, such as petite, women’s, and tall size designations. Technologies that enable designers to obtain specific information, such as the 3D body scanner, and then test the appeal of a garment using virtual try-on software are bringing the possibilities of engaging previously fringe consumers into focus.

Aimee Mullins competes in a long jump competition in Sacramento, California, in June 1997. Getty Images/Lynn Johnson/Contributor.

To engage these consumers, the clothing industry can call on data from studies that shed light on the commonalities of clothing problems and needs for people with various types of physical disabilities. However, most of these studies are user specific and result in one garment being designed and/or produced for one person or a small group of users. The following are general conclusions drawn from the existing research by clothing and rehabilitation professionals:

  1. The basic assumption underlying the design of special clothing is that the clothing must solve the problems of the disabled person.

  2. From the point of view of the design and production of clothing, the physical impairment, and not the cause, is the essential factor.

  3. Garments may be designed to include several special features that make them useful for many kinds of physical disabilities (first practiced by Dorothy Behrens in 1962–1963).

  4. Basic adaptive clothing best serves the disabled person if it is further modified for individual needs.

  5. Many ideas and general design features are available, but few patterns or specific detailed instructions exist for making or modifying garments.

  6. Disabled people, particularly adults, should be able to obtain special clothing without having to make or adapt it themselves.

The search for commonalities marks a departure from previous studies that remained narrowly focused on specifics and begins a new stage of investigation to satisfy a larger population. For a study designed to identify commonalities among consumers, clothing researchers Naomi Reich and Patricia Otten chose to focus on arthritis, based on the figures from the Arthritis Foundation stating that 37 million people (one in seven of the total U.S. population) have some form of arthritis, and determined the significance of this handicapping condition. Using a sample of 787 arthritis patients, of whom 77 percent were women, the investigators linked areas of movement difficulty with features in clothing that would address the problem. The principal movement problems were found to be with fingers, hands, knees, shoulders, and wrists. Lack of comfort, unsuitability of designs, improper fit, and fastener manipulation as well as body fatigue, pain, and weakness while handling difficult and unyielding clothing were cited as problems. The features of ready-to-wear clothing that proved most difficult were identified, and the participants suggested improvements, including fabric preferences, placement of additional ease in various garment areas, larger openings (for example, at the neck and armscye), and better fastener and pocket design and placement. The findings were recommended as useful for clothing designers, manufacturers, and marketers. Reich and Otten stated that clothing manufacturers and marketers should pay attention to the requirements of individuals, so that features designed into clothing for this target market actually benefit the customer in some way, and should explore products, including materials and fastenings, that incorporate new technological developments where applicable.

New technologies have been used in assistive devices for a number of years. Examples include computer-based navigational systems for the visually impaired, robotic prostheses controlled by the wearer, and handheld devices to assist in information searches and communications. Some of this technology has found its way into clothing, but it is slow to become mainstream, available, and affordable. Most assistive technology remains handheld and computer-based. However, advances in electronic fibers and smart fabrics have potential to become technologies embedded in ready-to-wear fashions for the physically disabled. For individuals with a condition where constant monitoring of vital signs is necessary, some types of medical garments can measure vital signs, such as heart and respiratory rate, body temperature, and oxygen saturation, and deliver results via telehealth channels to a third party. Falls and mobility issues could also be monitored through such a method.

Aimee Mullins at the launch of Alexander McQueen’s flagship store in Los Angeles, California, in May 2008. Getty Images/Frederick M. Brown/Stringer.

Educational and design programs are encouraging people to think about the disabled in the areas of design, shopping, and accessibility. Higher education curricula are including classes so that in the product design of the future the disabled population is not left out. In London, the Helen Hamlyn Centre for Design at the Royal College of Art commits to teaching and researching inclusive design for society, without barriers of age and physical ability.

Retailers, Media Exposure, and Marketing

For shoppers who are searching for products and services, there are online directories, such as ABLEize and The Disability Resource Directory, which provide a comprehensive resource for the acquisition of products and information related to disability, medical care, and health. In addition, a number of retailers dedicated to disability clothing and accessories have emerged online, selling everything from adaptive clothing to fashion-forward products. These retailers range from the highly functional, such as Rolli-Moden, to the more fashion-oriented designs from Wheelie Chix—Designer Wear for Wheelchair Women. No mainstream retailers have a special area of products and/or services for people with disabilities at this time, although Debenhams, one of the largest department stores in the United Kingdom, has used models with disabilities in some of its advertising. Many consumers with disabilities know which mainstream stores carry comfortable, accessible clothing that is easy to don and doff and remains feasible within their budget. The options for acquisition of clothing remain (a) reuse and adapt, (b) purchase “user-friendly” fashions, and (c) shop from a specialty online retailer.

People with disabilities have been a silent population in terms of media exposure, but actions such as the use of disabled models in fashion shoots and television shows promoting the next top disabled model have become more prevalent. Aimee Mullins, a model, actress, athlete, and motivational speaker who is also a double lower-leg amputee, has appeared in Dazed & Confused magazine, photographed by Nick Knight for an editorial titled “Fashion-Able.” In addition, she modeled runway fashions for Alexander McQueen in 1999, creating a stir with hand-carved wooden prosthetic legs. Recognizing that powerful visual images can shake up established categories and expectations, the disabled community and its supporters have realized that positive visual media can shape public consciousness.

Fashion designer Stella McCartney and Sophie Morgan, a designer, television presenter, artist, and model, joined forces in the early twenty-first century to create the Mannequal, a mannequin in a wheelchair seen in the windows of stores such as adidas and Debenhams on Oxford Street, one of the busiest shopping streets in London. Debenhams also featured a model in a wheelchair, Shannon Murray, in an advertising campaign in 2010. In the United States, the retailer JC Penney used to put out an easy-dressing catalog that focused on their styles offering comfort, ease of dressing, and independence, but the company discontinued all specialty catalogs for economic reasons. Other media outlets providing publicity for people with disabilities include design competitions and fashion shows, such as the Rolling with Style Gala in New York City; organizations such as Fashionmoves.org; discussion groups such as AbledBody; television shows like Push Girls; and stylist websites such as LuvWhatYouWear.

Many people with a disability engage with others through online discussion forums designed for people to ask questions, share information, and provide a sense of community for people with similar needs. These forums contain multiple topics related to clothing and assistive technology. By engaging with communities such as Apparelyzed—Spinal Cord Injury and Support Group, individuals can find a wealth of information ranging from tips on how to adapt clothing to shopping resources, mainstream retailers with empathetic products, and general support and advice. Given the popularity of online shopping as almost the only retail opportunity for people with disabilities, this online community provides valuable support and assistance.

Conclusion

Clothing has traditionally been an area of struggle for people with physical disabilities. Clothing produced in the early-twenty-first-century garment industry makes little concession for the nonconformist body. However, clothing not only is a tool for covering and protecting the body but also functions to enable people to regain independence and develop skills. It is a source of confidence in the workplace, in recreational activities, and at social events. Through social awareness, visionary design thinking, and the thoughtful use of innovative technologies and materials, functional and attractive fashion could become accessible to all people with disabilities.

References and Further Reading

Find in Library Boettke M. Suggestions for Physically Handicapped Mothers on Clothing for Preschool Children. Storrs: University of Connecticut School of Home Economics, 1957.

Find in Library Cardwell V. E. The Cerebral Palsied Child and His Care at Home. New York: Association of the Aid of Crippled Children, 1947.

Find in Library Davis V. Clothing for the Pre-school Child. Leaflet no. 191. Amherst: University of Massachusetts Extension Service, 1955.

Find in Library Dillingham E. ““Feeding and Dressing Techniques for the Cerebral Palsied Child”.” Crippled Child 26, no. 4 (1948): 20–22, 29.

Find in Library Garland-Thomson Rosemarie. “Integrating Disability, Transforming Feminist Theory.” In Gendering Disability, edited by Bonnie G. Smith and Beth Hutchison, 73–106. New Brunswick, NJ: Rutgers University Press, 2004.

Find in Library Hoffman M. Clothing for the Handicapped, the Aged, and Other People with Special Needs. Springfield, IL: Charles C. Thomas, 1979.

Find in Library Katz Sidney, Amasa Ford, R. W. Moskowitz, B. A. Jackson, and M. W. Jaffe. ““Studies of Illness in the Aged: The Index of ADL: A Standardized Measure of Biological and Psychosocial Function”.” Journal of the American Medical Association 185 (1963): 914–919.

Find in Library Lawton Powell, and Elaine M. Brody. ““Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living”.” Gerontologist 9 (1969): 179–186.

Find in Library Longmore K., and Laurie Umansky. “Introduction: Disability History: From the Margins to the Mainstream.” In The New Disability History: American Perspectives, edited by Paul K. Longmore and Laurie Umansky, 1–32. New York: New York University Press, 2001.

Find in Library Reich Naomi, and Patricia Otten. ““Clothing and Dressing Needs of People with Arthritis”.” Clothing and Textiles Research Journal 9, no. 4 (1991): 34–40.

Find in Library Rosenblad-Wallin Elsa. ““User Oriented Product Development Applied to Functional Clothing Design”.” Applied Ergonomics 16, no. 4 (1985): 279–287.

Find in Library Scott L. ““Clothing Needs of Physically Handicapped Homemakers”.” Journal of Home Economics 51, no. 8 (1959): 709–713.

Find in Library Thoren Marianne. ““Systems Approach to Clothing for Disabled Users. Why is it Difficult for Disabled Users to Find Suitable Clothing”.” Applied Ergonomics 27, no. 6 (1996): 389–396.

Find in Library Watkins M. Clothing: The Portable Environment. Ames: Iowa State University Press, 1984.

World Health Organization. “Health Topics: Disabilities.” n.d. http://www.who.int/topics/disabilities/en/ (accessed 3 October 2012).

See also Snapshot: Use of Universal Design Principles for Disability Designs.