When I was in a rehab hospital I learned how toileting training is done. OTs evaluate how clients get on and off the toilet, but NOT how clients handle clothing in the bathroom. Aides are the ones who deal with dressing and undressing during toileting. Unfortunately aides have large caseloads so they get everyone to therapy on time by doing everything for their clients. Stroke survivors need training to be safe when toileting.
One challenge is handling clothing. It took me three weeks for my standing balance to improve enough for me to feel safe when I pulled my pants up over my hemiplegic (paralyzed) hip. I had to twist my trunk to let my sound reach the front and back of my hemiplegic hip. Small weight shifts while rotating my trunk were enough to throw me off balance. When my skin was damp after a shower or a vigorous therapy session it took repeated tries to get my pants all the way up.
Toileting is also a balance challenge because it requires repeated turning in small spaces while attention is divided. When I went home I learned that managing a cane, the door, and the toilet interfers with my ability to monitor if I am vertical. After I walk into the bathroom I have to turn 180 degrees to close the door. I want privacy when I use bathrooms in the community (e.g. doctor's office, friend's house, restaurant). I am facing the door I just closed so I have to turn 180 degrees to walk to the toilet. When I get to the toilet I have to turn 180 degrees so I can sit down. I turn again after I stand up to flush the toilet. The last 10 seconds of this video shows why I do not want to be sitting when I flush the toilet.
PTs walk clients in large unobstructed paths in the gym where clients are required to think only about controlling their body. OTs know about divided attention, but they do not evaluate gait or standing balance in the bathroom because ambulation is PT's domain. Requiring 24 hour assistance with toileting often leads to a nursing home. This is a severe consequence. Different disciplines need to stop worrying about stepping on each others toes. Therapists need to stop worrying about embarrassing clients by asking them to uncover a private area of the body.