ADL- Activities of daily living. .ppt

Education

1. Activities of Daily Living
By: Dr Poonam Kadian

2. •Activitiesofdailyliving(ADL)aretasksofself-
maintenance,mobility,communicationandhome
managementthatenablesanindividualtoachieve
personalindependenceinhisorherenvironment.
•ThepurposeofanADLprogramistotrainthepatient
tooptimallyperform,withinthelimitofhisphysical
disabilities,allactivitiesinherenttohisdailylife.

3. •Activitiesofdailylivingareusuallytaughtinthefollowing
manner:
1.Anygivenactivityisbrokendownintoitssimplest
components.
2.Patientperformsthesespecificmotions,intheformof
gradedexercises.
3.Thisactivityitselfispracticedinareallifesituation.
•Forexample,exercisestoimproverangeofmovementof
theshouldercanhelpinreachingoutforobjectsplaced
abovehishead,orwashhimselfduringhistoilet.

4. Barthel’s Index of Activities of Daily Living

5. Modified Barthel score

6. Functional Independence Measures (FIM)

7. ADL GROUPING
•Residualdisability,skillsacquired,job,homeplan,andofficedesignsareall
takenintoconsiderationwhilegroupingADL’s.
•Dailyactivitiesareclassifiedas:
•Bedsideactivities
•Wheelchairactivities
•Selfcareactivities
•Miscellaneoushandactivities
•Ambulation
•Elevation
•Traveling
•Managementofenvironmentcontroldevices
•Communication

8. Bedside Activities
•Theseincludeallgrossbodymotionsnecessarytomove
aboutinbed,likechangingposition,rollingover,movingto
thesittingposition,andsittingup.
•Aftercomingtosit,thepatientmustmaintainsittingbalance
whilemovingtrunkandarmsinalldirections.
•Hemustbeabletocoverhimselfwithbedsheets,reachout
tothesidetableandmanipulateobjects(likeringingabellor
attendingtothetelephone).
•Eatingfoodandtoiletingarealsobedsideactivities,which
needtobetrained.

9. Wheelchair Activities
•Wheelchairtransferstobed,chair,bathtub,ortoilet.
•Wheelchairmanagement—handlingparts,propulsion,
steering,andnegotiatingobstacles,andmaneuveringinand
outofrooms.
•Maintenanceofthewheelchairparts

10. Personal Care
•Selfcareactivities
–Personalhygiene(e.g.bathing,cleaningteeth,combinghairetc)
–Personalimage(careofhairandnails,useofmakeup,shaving)
–Attendingtotoiletneeds(bedpan,urinal)
•Dressingactivities/undressing:variousmodificationstothe
dresses,likeVelcrofasteninginsteadofbuttonsmayalsobe
madetofacilitateeasywearingandremoving.
•Eatingactivities:thepatientisgivenexercisestoimprove
handfunctionssothathecaneatonhisown.Modifications
ofspoonsandforksmayhavetobedone.

11. Miscellaneous Hand Activities
•Handlingthetelephone,signalbuttons,coins,etc.
•Usingspectacles,watch,lights,etc.whilesitting
recliningandotherpositions.
•Finemotorskills,likewriting,cuttingvegetables

12. Ambulation and Elevation
Thepatientisevaluatedon:
•Gaitpatternswithinthehomeoroutofdoorsondifferent
groundsurfaces.
•Helptostandupandsitdownfromvariousheights.
•NeedforLocomotoraids.
•Abilitytonegotiatestaircases.

13. Traveling
•Heshouldbeabletodriveandmaintainatwowheeleror
car,usethegarage,andpracticetogetinandoutofthe
vehicle.
•Thevehicleitselfcanbemodifiedtoaccommodatehis
wheelchair.
•Publictransportinseveralcountriesismodifiedtoenable
seniorcitizenstosteponandoffbusesortrains.
•Theentirebuslevelisloweredsothatthepassengercan
embarkordisembark.

14. Environmental Control System (ECS)
•EnvironmentalControlSystemisdefinedasameansto
controlandinteractwiththeenvironmentbyswitchingon
andoffdevicesthroughswitchesorvoiceactivation,by
remotecontrol.
•ThepurposeoftheECSistomaximizefunctionalability
andindependenceinthehome,school,workandleisure
environment.

15. AnECSbasicallyconsistsofthefollowing:
•Aninputmethodviasingle,dualormultipleswitches.Theselection
maybedirectorthroughamethodofscanningvarioustarget
devices.
•Acontrolorsignalingdevicetochangeinputintoinfraredpulses,
ultrasound,voiceorradiofrequencies.
•Theseinputsignalsarereceivedbyadevicewhichactivatesthe
target,likefanorcomputer.
•Atargetdevicethatrespondstothesignalsrelayed.
•Theconnectionorinterfacebetweenthesignalingdevicesandthe
targetdevice.
•Outputorfeedbackmechanismtoinformtheuseroftheresults
andactions.

16. •Devices that can be Controlled by an ECS
•Telephone TV Electric bed
•Lights VCR Window opener
•Call bell Stereo Drapes/curtains
•Alarm systems Compact disc player Door opener
•Air conditioner Computer Door lock/unlock
•Fan Tape recorder Page turner
•Intercom Tape player Radio

17. Communication
•Theimportanceofcommunicatingtoonesfellowhumanbeings
cannotbeunderscoredenough.
•Everypersonneedstotransmithisorherfeelingsandthoughtsand
today’smoderntechnologycomestoonesaidwhiledoingso.
•Communicationincludestheabilitytowrite,operateapersonal
computer,read,typeorusethetelephone,ataperecorder,ora
specialcommunicationdevice.
•SeveraldevicesareusedbythePersonwithDisabilitytokeepin
touchwiththeoutsideworld.

18. Transfers
•Thepatientisevaluatedasdependent,assisteddependentor
independentinhisabilitytotransferhimselftoandfromtubor
showerstool,bed,toilet,chair,wheelchairandcar.
•Heisalsoevaluatedforbalanceinvariousactivitiesfromwhichhe
canperformhisADL’s.
•Theoccupationaltherapistfillsoutachart,asgivenbelowto
indicatetheADLstatusofthepatientandfollowsthroughwiththe
progress.

19. ADL TRAINING

20. •Theoccupationaltherapistshouldestimatewhich
ADLsarepossibleandwhichareimpossibleforthe
patienttoachieve.
•Heshouldexploretheuseofalternatemethodsof
performingtheactivitiesandtheuseofassistive
devices.

21. In order to motivate the patient the objectives are
framed with a short and long-term perspective :
•Thetrainingprogrammaybegradedbybeginningwitha
fewsimpletasksandgraduallyincreasingtheirnumberand
complexity.
•Themethodsofteachingthepatienttoperformdailyliving
tasksmustbetailoredtosuiteachpatient’slearningstyle
andability.
•Patientswhohaveperceptualproblems,poormemory,and
difficultyfollowinginstructionsofanykindwillrequirea
moreconcrete,stepbystepapproachwhichiseasyto
comprehend.

22. •BeforebeginningtraininginanyADLthetherapistmust
beginbyprovidingadequatespaceandarrangeequipment
andfurnitureforconvenienceandsafety.
•Architecturalbarriersmustberemovedathomeandoffice.
•Performanceismodifiedandcorrectedasneededandthe
processisrepeatedtoensureskilledperformance.

23. Dressing Training
•UpperLimbDressing:
•Theneckhastobestableontheshouldergirdle
•Themusclestrengthintheupperlimbshouldbe3/5to4/5.
•Therangeofmovementattheshouldermustbeatleast0-
90degreeofflexion/abduction,0-30degreeofmedialor
lateralrotation,and15-140degreeelbowflexion.
•Sittingbalancewithoutsupportinbedandwheelchair
•Abilitytousebuttonsorfasteners.Aflexorhingehandsplint
maybeusedifthepatienthasgoodwristextensorpower.

24. •Lower Limb Dressing:
•Thetrainer,usuallyaphysiotherapistenhancesthe
musclestrengthandensurestheextentofmovement
atthekneeandhipthatmustpermitthepersontosit
withlegsfullystretchedandreachouttohiscalf.
•Generallyarangeof0-120degreeswouldbe
adequate.
•Bodycontrol,suchasabilitytotransferfrombedto
wheelchairwithminimumassistancerollingfromside
toside,orbalancewhenlyingonside,mustbe
developed.

25. Clothing Recommendations
•Clothingshouldbelooseandhavefrontfastenings.
•ZippersorVelcrofastenersarepreferredtobuttons.
•Sincepatientsoftenusethethumbtofastenzippers,loops
arerecommended.
•Shoesshouldbecarefullyselectedsoastoprovidefoot
stabilityduringpatienttransfer.
•Personalpreferenceisgivenalotofimportanceandthe
rehabprofessionalmusthavea‘WhatcanIdoforyou’
insteadofa‘Ithinkyoumusthavethis’approach.

26. Hygiene and Grooming
•Adaptations:
•Abrushwithgripisusedforbathingorshampooinghair.
•Abathbrushisprovidedwithalonghandletoreachbehind
theback
•Aposition-adjustablehairdryer.
•Alonghandledtoothbrush,lipstickapplierorrazor.
•Ashortreacher
•Dressingstickstoenablethepersontopullonclothes.
•Thebathtubcanhavesafetyrails,andextendedorbuiltup
handlesonfaucets.

27. Environmental Adaptations (Self Help Aids)
•“Whenyoucannotchangethepatient,changethe
environment”.Ifapatientwithrheumatoidarthritis
repeatedlycomestothedepartmentsayingthatshe
cannotopenthetap,itisfareasiertochangethetap
thantokeepstrengtheninghergrip.

28. Communication Adaptations
•Avastarrayofadaptationsareimprovisedtokeeppacewith
therevolutionincommunication
•Adaptationstothecomputerandkeyboard
•Telephonesshouldbeplacedwithineasyreach.Acliptype
receiver,adialingstickorpushbuttonphonemaymake
usageofthephoneeasier.
•Builtuppensandpencilswithaneasiergrip

29. Some Home Management Tips
•Storefrequentlyuseditemsonthelowershelvesofthe
cabinet.
•Sitonahighstooltoworkcomfortably.
•Useareachertogetitemsbeyondyourreach.
•Stabilizemixingbowlsanddishesorvegetableswithsome
aid.
•Uselightweightutensils,andwherepossibleandsafeuse
poweredcanopenersandmixers.
•Uselonghandledtapsandatoploadingautomaticwasher
andanadjustableironingboard.