Peripheral neuropathy feels paradoxical at times, as sensory nerve damage can lead both to extreme hypersensitivity on the one hand, as well as sections of complete numbness on … well, that very same injured hand. The impacts of such damage can be felt most persistently in the realm of apparel. Increased sensitivity (hyperesthesia) coupled with unusual pain responses to ordinary stimuli (allodynia) can make ordinary fabrics, seams, and tags feel unusually (and even unbearably abrasive). Partial or complete numbness can make it harder to put on clothes and easier to sustain accidental injuries in the process.
In this third and final article of Broken Plexus, a series about the role of design in long-haul recoveries, we’ll consider clothing and material challenges in light of conflicting sensory nerve inputs. This segment will also serve to close a larger loop on nerve damage more broadly, which started with motor nerves in the preceding mini-series, Single Handed, on adaptive one-handed designs – fully half of that six-article series also revolved around apparel.
Sensory nerve damage may seem secondary to motor impairment – it’s certainly less obvious from the outside – but the effects can be nonetheless pervasive and frustrating. While my own sensory damage hasn’t been as directly observable, reflections of it can be found in my apparel. Over the past year, the interplay of changes in my physical condition and demands of different seasons created ever-evolving clothing requirements, pushing me to radically reshape my wardrobe.
Redressing a Newly Malfunctional Wardrobe
In the weeks and months following a severe brachial plexus injury (BPI) last spring, I slowly began to regain a feeling in parts of my impacted right shoulder, arm, and hand. But the progress was piecemeal and patchwork. In some places, I still couldn’t feel anything on or near the surface of my skin. In other areas, even brushing the cotton of my softest t-shirts felt like the scraping against sandpaper.
My once-comfortable clothing no longer covered my needs. Ultimately, I had to box and shelve most of my upper-body apparel, hoping that I might at some point unpack it if my sensitivity situation improved. Meanwhile, I needed to find new alternatives I could comfortably wear, at first for impending summer needs and later for subsequent seasons.
Springing into Summer with Hypersensitivity
Initially, my entire arm was numb. Then, as parts of it woke up, they did so in pain — and layered on top of that baseline, my skin proved unpredictably sensitive to all kinds of stimuli. Fibrous cotton was a non-starter. Even my softest wool tops, including merino tees, scratched painfully. I was lucky, at least, to have been injured in late spring – so the layered complexities of fall and winter wear were still a ways out.
Through testing, I found myself able to tolerate certain synthetics, such as spandex, nylon, and polyester. So I honed in on hiking outfitters and similar stores in search of options. Trying things on led me to select some “Sahara” tees made by REI, plus similarly outdoorsy Lightweight, Daily, and Trail shirts from Patagonia’s “Capilene Cool” line.
Meanwhile, as some nerves woke with shouts of protest, a large swath of my shoulder and some patches along my arm stayed stubbornly silent. The ulnar (outside) half of my right hand also remained numb – an area including my pinky and ring fingers. Compromised nerves pathways simply weren’t conveying sensory signals to my central nervous system. As autumn rolled around, persistent numbness went from being a curious nuisance to a practical impediment.
Falling Toward Winter, Numbness at Hand
With fall weather came a search for long-sleeved apparel. I looked at extended-arm versions of t-shirts I knew worked already. But I found my injured hand getting hung up inside the elastic tangle of synthetic sleeves. Jammed fingers bent awkwardly as I tried to guide through my motor-impaired arm down thinly clad corridors; the smooth sleeves lacked structure, tending to collapse and bunch up.
Even in more loose-fitting shirts, a lack of tactile feedback (and absence of visual cues) frustrated my attempts to make long-sleeved options work. And I worried about doing additive damage by regularly forcing my hand down uncooperative paths. So I focused on what I could more easily control, working around rather than with my problematic limb.
Feeling (comfortably) out of step with seasonal orders of operation, I started wearing warm winter hats and thick wool scarves before most of my fellow Minnesotans around me. As needed, I also added a zippered puffer jacket for some arm protection (though I to left it perpetually open in front rather than constantly wrangling a zipper with my one functional hand). The sleeves being both structured and smoothed helped accommodate numbness and hypersensitivity, respectively, while the unzipped front made it easier to don and doff in general.
Weathering Minnesota’s “Second Season”
As the saying here in Minnesota goes, “we have two seasons: winter and road repair.” As city repair crews rushed to wrap up projects, I had to face the reality of further cladding myself against even colder weather. The demands of the state’s most punishing season put increased pressure on multiple nerve damage-related fronts.
Mitts & Starts: Handling a Multi-Pronged Paradox
It was clear that my impaired hand would need shelter from the cold, especially with numb nerves unable to gauge temperature or associated damage. Gloves were a no-go as I couldn’t feel half of my hand, making it even more difficult to guide motor-damaged fingers into place. Even mittens presented numbness-related issues. Pairs layered for warmth had gaps between their liners and shells, which presented an unfortunate opportunity to snag an errand finger and thus jam my hand; normally helpful, wrist loops could also hook digits.
Meanwhile, though some parts of my hand were numb, others remained hypersensitive, adding (by now familiar) material considerations to the mix of variables. Strangely enough, these overreactive nerves also had something in common with their numb cousins: their noisy reports made it hard to gauge actual harm.
Despite mixed signals, I did objectively determine that the cold more quickly and thoroughly impacted my injured right hand — thanks to my left hand and its five-digit control group. Comparing the pair after a stint outdoors highlighted a stark difference in temperature. That was perhaps just as well, as I had to keep working left hand more accessible for functional reasons — being non-dominant, it was clumsy enough without a glove or mitten getting in the way. So I focused on the other half of the pair, ensuring the right had protection from the elements.
Strangely, amidst this confluence of complications, the mundane quest for winter mittens also served as a reminder of progress made to date, benchmarked against complete numbness and paralysis at the outset.
- Numbness: Say what you will about proverbial glasses and their relative fullness, but while you could frame the situation in terms of half my hand being numb, that also meant that the other half wasn’t.
- Hypersensitivity: It did take a fair bit of testing, but I was also able to find mittens with wool linings that worked … even on sensitive nerves that had once rejected anything but smooth synthetics.
- Motor Control: And while I couldn’t control much, I was able to pull my impaired fingers a bit closer together to aid my other hand in putting on a mitten – not terrible compared to complete immobility.
Don’t get me wrong — putting a mitten on with one hand was (and is still) a huge pain due to remaining sensory and motor impairments (and I’ve clipped that wrist strap to keep it from catching odd digits). But I’m glad that this wasn’t an apparel problem I had to face at the outset. Of course, gloves aren’t a complete solution. There remains a loose thread … which leads us back to the question of long sleeves.
Long Sleeves: Clothing Up a Last Loose Thread
Like it or not, I couldn’t ignore long sleeves completely – in this state, there are always those sub-zero days with double-digit wind chills. But finding wool-lined mittens that worked suggested that wool sweaters were worth another look, and sure enough: I found a quarter-zip merino from Kuhl that would serve on extreme-weather days.
Once again, this solution had to work on multiple fronts. While still not completely settled, my hypersensitive nerves tolerated the sweater’s fabric. Sturdier than the synthetics, the arms had more structure to limit the risk of snagging stray (numb) fingers. The quarter-length zipper also made the sweater easier to put on while eliminating an concern about two zipped halves coming apart completely.
All the same, my situation resulted in a strange system of outfit priorities. T-shirts underpinned everything, naturally. Hat and scarf came next. Then, instead of a long-sleeved option: a knee-length wool jacket with a smooth silky liner and three large, easy-to-use buttons. Finally, when all above the above were not enough: a sweater and (right) mitten for the coldest of cold days as a last resort.
Nerve Endings: Once More With Feeling
And now, as I write this, the snow has melted and potholes are in bloom around the Twin Cities; road repair has started up again, and I’m relieved at the return of t-shirt season. I’m also pleased to report that I’ve begun to unbox some items I had put away. The softest of my familiar old wool sweaters and cotton shirts have started to feel wearable again, and in some cases even downright comfortable.
My prognosis continues to remain a perpetual unknown — doctors are (perhaps rightly) hesitant to predict future progress. Things may level or or continue to improve over the coming years. I do at least know that I’ve exceeded their recovery expectations (and mine) over this first year. Still, in this as in other aspects of life: I prefer to expect the worst — that way virtually any outcome is an upside surprise.
So the seasons have come full circle … as have two series (containing the first nine articles I’ve written since my injury): Single Handed, on adaptive one-handed designs, and Broken Plexus, on assistive designs for brachial injuries and long-haul recoveries.
I didn’t set out to start and end these arcs on the subject of apparel, but it seems fitting. Hindsight in (my working left) hand, the seasonality of clothing has become one of the ways I recall recovery milestones – thinking back to picture the world around me, and remembering how I have needed to adapt or design ways to fit myself into it along the way.
Adapt or Design (A Project in Three Acts)
Over the course of three articles, Broken Plexus covered designing an organized exercise workbook, optimizing slings and braces, and (in this piece) apparel to accommodate nerve damage. But this set of three articles is also (collectively, if confusingly) the second of three acts.
The preceding mini-series, Single Handed, formed the first act, covering an array of design adaptations for people living with one functional hand. The act following this series, Left to Write, is a three-piece set about adaptive one-handed writing technologies, including specialized keyboards and custom setups.
Broadly, Adapt or Design is about how adaptive designs (and design adaptations) can help address everyday challenges following a debilitating injury and over a long-term recovery. The name references a dilemma I’ve faced repeatedly with respect to post-injury problems: whether I simply need to adapt, or design some fix, or (ideally) find and employ an existing adaptive design solution. The AoD logo design nods to the current condition of my arm, which operates a lot like one of those “claw games” at arcades — you know: the ones that eat fistfuls of quarters as you awkwardly attempt to fish out a chosen prize!
On the Expanse (of AoD) by 99% Invisible’s Kurt Kohlstedt
What started as a single article about adaptive design expanded to become this three-act mega-series, now nearly complete. So thank you, dear readers (and colleagues), for putting up with my puns and supporting this challenging but deeply rewarding process — reflecting, researching, and writing this out for the world to see also helped me gain perspective on this surreal past year.
If someone had told me I would be writing all of these articles in such a short span of time a few months back, I’d have been more than a little skeptical. I’m still relearning the process with new tools — but I’m getting ahead of myself. For more on that, you’ll have to stay tuned for the final act. After that, well, stay tuned as I shift back to more conventionally nerdy 99pi stories!
Leave a Comment
Share