17&20&21-Feb Activites of daily living-ADL (All Notes Combined)

 Contents

1. Activities of Daily Living
2. Activities of Daily Living Taught in the Following Manners
3. Role of Exercise Therapy:
4. ADL Grouping
5. Daily Activities are Classified as
6. Activity Grading
7. Assessment
8. ADL – Index
9. Activities
10. Functional Independence Measure
11. ADL training
    • Goal setting
    • Dressing training
      1. Upper limb dressing
      2. Lower limb dressing
    • Clothing recommendation
    • Hygiene and grooming
    • Communication adaptation
    • Some management tips
    • problem encountered during ADL training

Activities of Daily Living

• The ADL program aims to enable individuals to achieve personal independence in their environment
• The ADLs are of self-maintenance, morbility, and home treatment
• The purpose is to train the patient to operate optimally within the limits of their physical disabilities
• Reduction in repetitive strains, better family interactions & social acceptance

Activities of Daily Living Taught in the Following Manners

• Any given activity is broken down into its simplest components
• The patient performs this specific motion, in the form of guided exercise
• The activities are practiced in real-life situations

Role of Exercise Therapy:

• To improve patient ADL. Therapy programs are designed to restore & maintain ROM, and to develop coordination and strength.
• Different activities learned are incorporated into useful activities in real-life situations. For e.g., strengthening his grip is later useful for eating food or handling crutches

ADL Grouping

• Activities of Daily Living are grouped according to various areas in the day-to-day life of a patient.
• Residual disability still acquired; Job, home plan, and office design are then taken into consideration while grouping ADL.
• Apart from ADL, there are also the basic ADL (BADL) Groupings which include grooming mobility, and toileting themselves.
• Other important activities are also added under the instrumental activities of Daily Living (IADL) like Money Management and food preparation.

Daily Activities are Classified as

• Bedside activities
• Wheel Chair activities
• Self-Care activities
• Ambulation
• Miscellaneous Household activities
• Hand Elevation
• Traveling
• Most environmental control devices
• Communication

Activity Grading

• Independent in performing the activity
• Need assistance to do so
• Dependent: Activity cannot be performed by the patient
• Activity contraindicated as it may be harmful to the patient & environment like driving a public vehicle

Assessment

• There are several tools available to assess ADL activity & standardize an approach to a patient & help in training and possible evaluation & discharge.
• One of the earliest was the “International Classification on Impairment Disability Handicap (ICIDH)” adopted by WHO.
• Now this is revised & called the ICF i.e. International Classification of Functioning Disability and handicap.
• Apart from that patient must be aware of local safety, urban physical environment motivation mental alertness to be trend, and safety & energy consumption in performing their activities.

ADL – Index

• Barthel Scale / Index B.I is a scale used to measure A.D.L performance this is used to determine the date of discharge.
• The 10 regular activities are scored like bathing, toileting, grooming, etc.

Activities

• The activities are timed and the assistance required to perform each item determines & assigns a value to each item from 0 to 3.
• Examples of activities and their scores:
  • Bowel status (0 to 2)
  • Bladder status (0 to 2)
  • Grooming (0 to 2)
  • Toilet use (0 to 2)
  • Feeding (0 to 2)
  • Mobility (0 to 3)
  • Dressing stairs (0 to 3)
  • Bathing (0 to 3)
• Modified Barthel Score
• There is also a modified Barthel score which further increases the sensitivity & specificity of the test from 0 to the maximum possible 100 without increasing the difficulty of undertaking the test of time involved and with scores from 0 to 5 in individual chart

Function Independence Measure

• This is a global scale that combines ADL and IADL measurements.
• The Functional Independent Measure (FIM) is a broad-based measurement of function used by Various Rehab Centers.
• It consists of 18 categories of function, each scored on a scale from 1. The overall score may range from 18 to 126.
  • Also, there is a FIM score for children, Welfare, and the Pediatric Evaluation of Development Inventory (PEDI).
  • This measures performance in children from 6 months to 7.5 years.

ADL Activities

Bedside Activities:

• This includes gross body motion necessary to move about in bed, like changing position, rolling over, moving to a sitting position, and sitting up.
• Maintaining sitting balance while moving trunk and arms in all directions.
• Eating, toileting, and other activities are bedside activities that need to be trained.
• Patients with Quadriplegia and Muscular Dystrophy are often evaluated for bedside ADL.
• Wheelchair Activities
• The wheelchair-dependent patient has to be taught how to select their wheelchair and then trained in:
  • Wheelchair transfer to bed, chair, bathtub, toilet.
• Wheelchair Management

1. Handling parts
2. Propulsions
3. Steering
4. Negotiating obstacles
5. Maneuvering in and out of rooms

• Maintenance of Wheelchair Parts

Environmental Adaptation (Self-Help Aid)

• If we can't change the patient, environmental adaptation is very important.
• For example, if a patient with Rheumatoid Arthritis repeatedly complains about being unable to open the tap, it is far easier to change the tap than to keep strengthening his grip.

Personal Care

• Self-care Activities

1. Personal hygiene (bathing, cleaning teeth)
2. Personal image (care for hair, nails, makeup, shaving)
3. Attending to toilet needs (bedpan, urinal, dressing activities, or undressing)

• Eating Activities

Miscellaneous Hand Activities

• Handling the telephone, single buttons, coins
• Using spectacles, watches, light
• Fine motor skills, like writing, cutting veggies

Ambulation and Elevation

• The patient is evaluated on:
  • Gait pattern within the home or outdoors on different ground surfaces
  • Assistance to stand up and sit down from various heights
  • Need for locomotor aid

Traveling

• Patients should be able to drive and maintain a two-wheeler or car, use the garage, and practice getting in and out of the vehicle. The vehicle should be modified for wheelchair patients.

Environmental Control System

• ECS leads to controlling and interacting with the environment by switching on and off devices through switches or voice activation by remote control.
• The purpose of ECS is to maximize personal functional abilities in the home, school, work, and leisure environments.

Communication

• It includes the ability to:
  • Write
  • Operate a personal computer
  • Read
  • Type
  • Use the telephone
  • Use a tape recorder
  • Use a special communication device

Transfer

• The patient is evaluated as:
  • Dependent
  • Assisted dependent
  • Independent in his ability to transfer himself to and from:
    • The tub or shower stool
    • Bed
    • Toilet chair
    • Wheelchair
    • Car

ADL Training

• There are some approaches in the training that the person with a disability in ADL:
• Goal setting
• The therapist has to give instructions
• Guide physically
• Guide verbally
• Provide intrinsic and extrinsic feedback as a part of the learning process

Goal Setting:

• Guidance to the patient should involve acquiring skills and practicing them over time until long-term learning occurs.
• The therapist has to give instruction, guide physically, and, provide intrinsic and extrinsic feedback as a part of the learning process
• Considerations for safety, joint protection, and awareness of endurance fatigue should be included in the activities of daily living (ADL) training program.

Dressing Training:

• Upper Limb Dressing
  1. The neck should be stable on the shoulder girdle.
  2. Muscle strength in the upper limb should be rated 3/5 to 4/5.
  3. Range of movement at the shoulder should be at least 0-90 degrees of flexion or abduction, 0-30 degrees of lateral or medial rotation, and 15-190 degrees of elbow flexion.
  4. Sitting balance without support should be achieved in bed and wheelchair.
  5. Ability to use buttons and fastener
• Lower Limb Dressing:

1. Physiotherapists aim to enhance muscle strength and ensure sufficient movement at the knee and hip joints to allow the person to sit with legs fully stretched and reach out to their calves.
2. A range of 0 to 120 degrees is generally considered adequate.
3. Body control skills, such as transferring from bed to wheelchair with minimal assistance, rolling from side to side, and maintaining balance when lying on the side, should be developed.

Clothing Recommendations:

• Clothing should be loose and have front fasteners; zippers and Velcro fasteners are preferred.
• Loose clothing is recommended as patients often use their thumbs to fasten zippers.
• Shoes should be carefully selected to provide foot stability during patient transfers.

Hygiene and Grooming:

• Use a brush with a grip for bathing or shampooing hair.
• A bath brush with a long handle is provided to reach behind the back.
• Position-adjustable hair dryers should be used.
• Provide a long-handled toothbrush, lipstick applier, razor, and a short reacher.
• Use a dressing stick to help the person pull on clothes.
• Install safety rails and extended or built-up handles on faucets in the bathtub.

Communication Adaptation:

• Adapt keyboards and computers for easier use.
• Place the telephone within easy reach.
• Provide pens and pencils with easier grips.

Home Management Tips:

• Store frequently used items on lower shelves in cabinets.
• Sit comfortably on a higher stool.
• Use a reacher to retrieve items beyond your reach.
• Stabilize mixing bowls, dishes, and vegetables with aids.
• Use lightweight utensils.
• Install long-handled taps, tap-loading automatic washers, and adjustable ironing boards.

Problems Encountered During ADL Training:

• Health conditions such as respiratory infections, cardiac problems, or diabetes, which can inhibit ADL training, are regularly monitored.

Exam point of view

10 Marks Question:

Explain the purpose and methodology of the Activities of Daily Living (ADL) program in community-based rehabilitation. How does it contribute to the independence and social integration of individuals with physical disabilities?

Answer Structure:

Introduction: The Activities of Daily Living (ADL) program is a vital component of community-based rehabilitation, designed to empower individuals with physical disabilities to achieve personal independence and social integration. Through a comprehensive approach to skill development, the ADL program addresses various aspects of daily living to enhance the overall well-being of participants.

Purpose of the ADL Program: The ADL program serves multiple purposes aimed at improving the quality of life for individuals with physical disabilities:

1. Skill Development: Its primary objective is to develop essential life skills necessary for self-care, mobility, and home management.
2. Functional Independence: By breaking down complex activities into manageable components, the program helps individuals become functionally independent in performing daily tasks.
3. Enhanced Quality of Life: By enabling individuals to navigate daily challenges independently, the program promotes a sense of empowerment and autonomy, leading to an improved quality of life.
4. Social Integration: Through improved personal hygiene, grooming, and mobility skills, participants are better equipped to engage in social interactions and participate in community activities, fostering social integration and acceptance.

Methodology of the ADL Program: The ADL program employs a structured methodology to facilitate skill development and functional independence:

1. Activity Breakdown: Complex activities are broken down into simpler components to facilitate learning and skill acquisition.
2. Guided Practice: Participants engage in guided exercises to perform specific motions related to daily activities, gradually building competency and confidence.
3. Real-Life Application: Activities are practiced in real-life situations, such as within the home environment or community settings, to ensure practical applicability and skill transfer.
4. Integration of Exercise Therapy: Exercise therapy plays a significant role in the program, focusing on restoring and maintaining range of motion, coordination, and strength, thereby enhancing the ability to perform ADLs.

Contributions to Independence: The ADL program directly contributes to the independence of individuals with physical disabilities by:

1. Equipping with Essential Skills: By mastering activities related to self-care, mobility, and home management, participants gain the necessary skills to navigate daily challenges independently.
2. Reducing Dependency: The program reduces dependency on caregivers and promotes self-reliance, empowering individuals to lead more autonomous lives.
3. Building Confidence: As participants achieve proficiency in performing ADLs, their confidence and self-esteem grow, further enhancing their sense of independence and personal agency.

Contributions to Social Integration: Moreover, the ADL program facilitates social integration by:

1. Improving Social Interaction: Through improved personal hygiene, grooming, and mobility skills, participants are better able to engage in social interactions and participate in community activities.
2. Fostering Acceptance: By reducing repetitive strains, promoting better family interactions, and enhancing overall functionality, the program fosters acceptance and inclusion within the community.

Conclusion: In conclusion, the ADL program is instrumental in promoting the independence and social integration of individuals with physical disabilities. Through its purposeful methodology and holistic approach to skill development, the program empowers participants to lead fulfilling lives and actively participate in their communities, thereby enhancing overall well-being and quality of life.

5 Marks Question:

Discuss the key components and assessment methods of the Activities of Daily Living (ADL) program. How are ADLs classified, and what tools are utilized for evaluating ADL performance?

Key Components and Assessment Methods of the ADL Program:

• Key Components of ADL Program:
  • Tasks related to self-care, mobility, and home management.
  • Activities include grooming, bathing, dressing, eating, toileting, transferring, and ambulation.
• Assessment Methods:
  • Observation, self-report, and standardized assessment tools.
  • Therapists observe tasks, consider self-reported abilities, and use standardized tools for evaluation.
• Classification of ADLs:
  • Basic ADLs (BADLs) focus on essential self-care tasks like grooming and toileting.
  • Instrumental ADLs (IADLs) encompass complex activities such as meal preparation and managing finances.
• Tools for Evaluating ADL Performance:
  • Barthel Index (BI), Katz Index of Independence, and Functional Independence Measure (FIM).
  • These tools assess functional independence across various daily tasks.
• Summary and Outcome:
  • The ADL program aims to enhance individuals' ability to perform daily activities independently.
  • Through systematic assessment and targeted interventions, it promotes functional independence and improve overall quality of life.

2 Marks Question:

Describe two important considerations in ADL training for individuals with disabilities and explain why they are significant for successful rehabilitation outcomes.

1. Individualized Approach: Tailoring ADL training to individual needs and abilities.
2. Customized Interventions: Addressing specific challenges and goals for each individual.
3. Enhanced Engagement: Promoting ownership and empowerment through personalized training.
4. Functional Relevance: Prioritizing tasks essential for daily self-care, mobility, and home management.
5. Improved Independence: Fostering confidence and self-efficacy, leading to greater autonomy in daily activities.