Occupational Performance and the Performance Areas: Evaluation and
Moderate Assistance (50-74%)
Intervention Part 1
- Overall Goal: want the clients to learn to adapt to the life
changes and to fully participate in the occupations that are
meaningful.
Considerations in ADL and IADL Occupational Analysis and Training
1. Comprehensuve Evaluation
- Client Factors
- Performance Skills
- Performance Patterns
- Contexts
2. Client Centered Approach
3. ADL & IADL Performance
- Checklist
4. General Procedures
- Feasibility is determined by the OT together with the client,
supervising physician, and other members of the rehabilitation
team
“ADL training may be delayed due to client’s limitations or in favor of
more immediate intervention objectives that require the client’s energy
and participation.”
REMEMBER
- A partial or incomplete performance analysis is invaluable in
assessing performance.The interview alone can lead to
inaccurate assumptions.Time your OPA at the usual schedule
the client performs their occupations.
- Requiring the client to perform routine self-maintenance tasks
at irregular times in an artificial environment may conribute to
a lack of CARRYOVER, especially for clients who have difficulty
generalizing learning.
Evaluation of Areas of Occupation
1. During Occupational Performance Analysis, observe methods
the client uses pr attempts to finish the task.
- Determine the cause of performance patterns.
- BEST to observe.
2. Client’s needs for respect and privacy.
- Also ge the client’s attitudes and feelings about the
occupations, priorities in training, dependence and
independence, values and customs.
Evaluation of Areas of Occupation: HOME ASSESSMENT
1. Helps with transition from treatment facility to home
2. Assesses the home for safety and accessibility
3. Assesses client’s functioning at home
4. Determines the time when caregiver training can occur
5. It gives the OT an idea about the home environment the client
will return to
6. Not every client needs home assessment
7. Performed when the client nearing their discharge
8. Collaborate with the PT (OTs and PTs assess home together)
9. If it’s not possible to perform a home evaluation, identify most
serious concerns and develop a plan around it
- Ask the family to take photos of their home/draw floor plans
- Interview
Most Common Modifications Recommended
1. Installation of Ramp or Railings at entrances of home
2. Removal of scatter rugs, extra furniture and bric-a-brac
3. Removal of door tresholds and the doorjambs
4. Addition of safety grab bars around the toilet and bathtub
5. Rearrangement of furniture to accommodate a WC
6. Rearrangement of kitchen stirage
7. Lowering of the clothes rod in the closet
Supplies to take home on a Home Evaluation
1. Measuring tape (30feet long)
2. Clipboard, notepad and laptop
3. Pen
4. Home Eval checklist
5. Digital cam, video
6. Maps or GPS
7. All important emergency phone numbers
8. Durable medical equipment (the patient needs)
9. Tool kit for quick fixes
10. Cell/Mobile phone
If taking the client on the Home Evaluation:
1. Urinal, as appropriate
2. Blood pressure cuff, steth and gloves
Recording Results of Assessment
1. Levels of Independence
- Maximum, moderate and minimal assistance
- Define or input supporting Statements
General Categories
1. Independent
2. Supervised
3. Standby Assistance/Contact guard Assistance
4. Minimal Assistance (75%)
5.
6. Maximal Assistance (25-49%)
7. Dependent (greater than 25%)
ADL and IADL Training
1. Establish appropriate STGs and LTGs.
- Based on client’s priorities and potential for independence)
2. Based on normal development of self-care independence of
children.
- Feeling> Grooming> Continence Management> Transfer Skills>
Toileting> Undressing> Dressing> Bathing.
- Start from the easiest for the client’s to feel satisfied.
3. Estimate which occupations are possible and which aren’t
within the client’s potential to achieve.
- Use of alternative Methods
- Environmental Modifications
- Assistive Devices
4. Determine which occupations require assistance
- Begin with a few simple tasks, progressively grading up
- Dependent > assisted > supervised > independent
(with/without assistive devices)
IADLS
- Requires more advanced skills than seen in ADLs
- Use of executive functions, social skills, and more complex
environmental interactions than IADLs.
1. Care of others (includes selection and supervision of caregivers)
2. Care of pets and animals
3. Child rearing
4. Communication management
5. Driving and community mobility
6. Financial management
7. Home establishment and management
8. Meal preparation and cleanup
9. Religious and spiritual expression
10. Safety and emergency maintenance
11. Shopping
12. Health management
Recording Results of IADLs Assessment
1. Home Management Assessment
- its more meaningful and accurate if you do OPA after the
interview.
- Applies to women, men, adolescents and achildren.
- Role reversals are possible after a disability.
 2. Financial Management Assessment - To write while using telephone, a stand/shoulder telephone - Clothes carrier on wheels Lightweight electrical hand mixer
- Cognition and Visual Perceptual Skills are targated receiver holder Emersion blender wand
- Evaluate metjods and routines. (Write a cheque or pay bills) - Speakerphone/headsets - Food processor
- Caregiver training is provided if the role of financial manager is - One-touch dialing using pre- programmed phone numbers - Standard dust mop Carpet sweeper Upright vacuum cleaner
new and must be assumed SPECIFIC IADL TECHNIQUES (Home Management, Meal Preparation, and Self-wringing mop
- Money Management (Shopping, balancing a cheque book, Cleanup Activities) ADLs
making a budget plan) 1. Person with Limited ROM & Strength - aka: Personal activities of daily living (PADL) or Basic activities
- For Physical Limitations: Adapttive writing devices - Store frequently-used items on the first shelves (just above or of daily living (BADL)
3. Community Mobility Assessments below) (eliminate unnecessary items) - Requires basic skills and focus on activities to take care of one’s
- Be familiar with where the client lives and access to the - High table stool body
community. - Drop-leaf table/pull-out breadboards 1. Bathing, showering
- Use of an ambulation aid, Wheeled mobility devices, Powered - Utility cart 2. Toileting and toileting hygiene
devices, Riding as a passenger, Driving one’s self, Public - Reachers for lightweight items 3. Dressing
transportation. - Nonslip mats 4. Eating and swallowing
Before considering community mobility, can the client: - Lightweight utensils 5. Feeding
Handle money? Carry objects in a wheelchair or while using ambulation - Electric can opener/mixer 6. Functional mobility
aid? Manage toileting in a public restroom? - Electric/adapted-loop scissors 7. Personal Hygiene and Grooming
Before considering community mobility does the client have? Endurance - Extended/flexible handles on dustpans/mops/ brooms 8. Sexual Activity
and Independence in WC. - Adapted knives/pre-cut ingredients Pull-out shelves Recording Results of ADLs Assessment
4. Health Management Assessment - Wall oven/countertop broiler/microwave oven/ convection 1. Standardized assessments
- How to open meds and measure if liquid oven - Use standard terminology identified for the assessment.
- Evaluate and ztrain client in other skills that affect health - When remodeling, elevate dishwasher 2. Non-standardized assessments
management. - Pump dispensers/single-use pre-measured water- soluble - Separate checklists.
- Use phone, find appropriate numbers and provide needed info dishwasher detergent packets Methods of Teaching ADLs
to make a medical appointment. - Non-slip materials for opening jars 1. Tactile and kinesthetic modes of instruction
SPECIFIC IADL TECHNIQUES (Communication & Environmental Hardware - Cutting board with two stainless steel/aluminum nails - Touch body parts to be moved, dressed, bathed, or positioned
Adaptations) - Raised corner on the board for stabilizing bread Suction cups - Passive movement of the part through the desired pattern to
1. For Persons with Limited ROM and Strength - Rubber mats achieve a step or task
- Telephones within reach/portable phones - Sponge cloths, nonskid mats/pads, wet dishcloths, suction - Gentle manual guidance
- Speakerphones/headsets devices when washing dishes 2. Perform steps or tasks repeatedly to achieve skill and speed
- Dialing stick/phones with large push buttons - Opening a jar (Stabilize between knees, Partially-opened - Leads to declarative learning, ultimately leading to procedural
- Built-up pens/pencils or Wanchik Writer drawer while leaning against the drawer, Break air seal by learning
- Personal computers, word processors, voice recognition sliding a pop bottle opener under the lid, Use Zim jar opener) 3. May be repeated during one session
computer software, book holders, or electronic books - Open boxes/sealed paper/plastic bags by stabilizing between 4. Be familiar with the task, special methods, or assistive devices
2. For persons using only one UE knees or in drawer, and cut open with scissors 5. Ensure appropriate environmental set-up
- Writing using clipboard/paperweight/non-skid mat/taping - Cracking an egg: Hold in palm of hand, hit its center on 6. Staff and family training
paper to table/affected arm rests on top of paper bowl/edge of table, push top half open with thumb and index 7. Once client has mastered steps, ask them to perform them
- Dominance shifts to non-dominant hand, practice to improve finger, push bottom half open with ring and little finger (Egg independently
speed and coordination separator/funnel/large slotted spoon) - Check adequacy of performance, progress, and carryover of
- Book holders/pillows/electronic book reader - Grater with suction feet/electric countertop food processor learning
- One-touch dialing - Pan holder with suction feet One-handed electric can opener
Utility carts (weighted*)
 8. Recording Progress in ADL Training - Method 2 Donning:- shirt gets twisted/trouble sliding sleeves - Doffing
- For standardized assessments, look back on them when down stronger arm 1. Slip straps down shoulders, stronger side first
re-evaluating . Objectively reassesses. 1. Steps1-3 from Method1 2. Work straps down over arms and hands
ADL Training (Assistive Technology & Adaptive Equipment) 2. Step4 from Method 1, but doesn’t go above elbow 3. Slip it around to the front
1. Assistive Technology: item, piece of equipment, or product 3. Stronger arm goes into 180 abd 4. Unfasten and remove
system used to increase or improve functional capabilities of 4. Lower stronger arm and work sleeve up the affected arm Necktie
individuals with disabilities 5. Steps 6-9 from Method 1 - Clip-on are convenient
2. Adaptive Equipment: compensates for physical limitation, - Method 2 Doffing (One sleeve at a time) - Donning
promotes safety, and prevents joint injury 1. Unbutton 1. Place collar up and bring necktie around neck; adjust so shorter
3. Electronic Aids to Daily Living (EADLs): a bridge between an 2. Stronger arm pushes shirt off shoulders on affected side then end is at desired length
individual with limited function and electric device stronger side 2. Fasten short end to front of shirt with tie clasp or spring clip
Specific ADLs Techniques 3. Pull cuff offs stronger side using stronger arm clothespin
1. ADLs for the Person with Limited ROM & Strength 4. Alternate shrugging shoulders and pulling cuff down 3. Loop long end around short end (one complete loop) and bring
- Compensating for lack of reach and joint excursion through 5. Lean forward, bring shirt around back, and pull sleeve off up between the “V” at neck; bring tip down, adjust tie using
environmental adaptation and assistive devices affected arm ring and little finger to hold tie end, and thumb and forefingers
2. ADLs for the Person Using Only One UE - Method 3 Donning to slide knot up tightly
- For those with unilateral UE amputations, fractures, burns, and 1. Steps 1-4 from Method 1 - Doffing
peripheral neuropathic conditions 2. Pull sleeve up affected arm up to shoulder 1. Pull knot at front of neck until short end slips up for tie to be
3. ADLs for the Person with Limited ROM & Strength (LBD) 3. Grasp tip of collar on stronger side using stronger arm, lean slipped overhead
- Dressing stick Sock aid forward, and bring arm over and behind head Women’s Underwear
- Elastic shoelaces,Velcro- fastened shoes, or secure slip- ons 4. Put stronger arm into sleeve, directing it up and out - Velcro replaces fasteners
- Reacher 5. Steps 8-9 from Method 1 - Slightly larger than usual with a wide opening at the ankles Put
- Front-opening garments one size larger and stretchable on after socks are worn but before shoes are worn
- Dressing stick - If in a wheelchair, feet flat on the floor (not on footrests)
- Large buttons/zippers with a loop LBD - trousers, shorts, and women’s underwear
- Replace fasteners with Velcro or zippers - Method 1 Donning
- Buttonhooks
- Method 1 (Donning)

- Method 3 Doffing (Method 2 for doffing may be used)

UBD Brassiere
- Best if straps are elastic and fabric is stretchy-
- Donning
1. Fabric loop may be sewn near fastener
- Method 1 (doffing) - Method 1 Doffing
- Affected thumb slips through fabric loop for stabilization while
1. Unbutton 1. Unfasten trousers and work trousers down hips while seated
stronger hand fastens
2. Lean forward 2. Stand and let trousers drop past hips
2. For pre-fastened/without fasteners, follow Method 1 for
3. Stronger hand grasps collar and gathers material 3. Remove from stronger leg first
pullover shirts
4. Leanforward, duckhead, and pull shirt overhead 4. Sit and cross affected leg, remove, and uncross
3. Front-opening bras may be adapted with a fabric loop, too
5. Remove sleeve from stronger arm then affected arm.
 - Method 2 (donning) - Doffing 1. Environmental Hardware Adaptations
- for those in wheelchairs with brakes locked and footrests swung 1. Steps 1-4 of donning socks - Extended built-up/lever handles on faucets
away; those in armchairs with back against wall; and those who 2. Work it up over leg, shifting weight side- to-side to adjust - Lever-type doorknob extensions
can’t stand independently stocking around thigh ADLs for the Person Using Only One UE (Personal Hygiene and
1. Steps1-5fromMethod1 - Doffing Socks/ Stockings Grooming)
2. Elevatehipsbyleaningbackagainstthechairandstrongerlegpushin 1. Work socks/stockings as far down as possible using stronger - Electric razor
gdown.Work trousers over hips with stronger hand arm - Suction brush for fingernail care Suction denture brush
3. Lowerhipsbackandfastentrousers 2. Cross affected leg over stronger leg (dressing stick may be used) Limited ROM & Strength (Bathing)
- Method 2 (doffing) 3. Lift stronger leg to comfortable height/seat level and remove - Handheld shower (handle can be built-up)
- for those in wheelchairs with brakes locked and footrests swung sock/stocking from foot - Long-handled sponge/wash mitt/soap on a rope/soft rubber
away; those in armchairs with back against wall; and those who Shoes brush with extended handle
can’t stand independently - Elastic shoelaces - Wall-mounted hairdryer
1. Unfasten trousers and work trousers down hips while seated - Velcro-fastened shoes - Safety rails/safety mats
2. Elevate hips by leaning back against the chair and stronger leg - Secure slip-ons - Transfer tub bench/shower stool/regular chair Grab bars
pushing down. Work trousers down the hips with stronger hand - One-handed shoe-tying techniques - Pump dispensers/small containers
3. Steps 3-4 of Method 1 Using Only One UE (Bathing)
- Method 3 (donning) - Shower seat
- for those in recumbent position (more difficult method than - Transfer tub bench Bath mat
the rest) Bed is semi-reclined for partial sitting - Wash mitt Long-handled sponge Safety rails
1. Stronger hand places affected leg in crossed position over - Soap on a rope
stronger leg - Suction soap holder Sponge bathing in sitting
2. Put affected leg through trousers up to knee, then uncross leg - Wall-mounted hairdryer
3. Insert stronger leg and work trousers up to hips (as far as they Limited ROM & Strength (Toileting and toilet hygiene)
can) - Dressing stick
4. Stronger leg bent and foot pushes down to elevate hips. Pull Limited ROM & Strength (Feeding) - Raised toilet seat
trousers up hips by rolling side-to-side - Built-up handles Using Only One UE (Toileting and Toilet Hygiene)
5. Fasten trousers - Curved handles on utensils/swivel spoon/spork - Bedside commode
- Method 3 (doffing) - Long plastic straws/straw clips - Urinals
- for those in recumbent position (more difficult method than - Universal cuff - Grab bars
the rest) - Plate guards/scoop dishes - Toilet paper on unaffected side
- Bed is semi-reclined for partial sitting - Difficulty performing bilateral coordination Rocker knife Limited ROM & Strength (Functional Mobility)
1. Step 4 from Method 3 - Non-slip mats - Glider chair
2. Work trousers down hips by rolling side-to-side; remove pants - Plate guard - Platform crutches
from stronger leg then affected leg. - Opening jars/containers/milk cartons - incorporate affected - Enlarged grips on ambulation aids
Sock hand if deemed appropriate - Walker with padded grips/forearm troughs
- Donning Limited ROM & Strength (Personal Hygiene and Grooming) - Walker/crutch bag, tray, or basket
1. Sit on an armchair/wheelchair - Combs, brushes, toothbrushes, lipstick, mascara brushes, and ADLs for those with Cardiac and Pulmonary Conditions
2. Stronger leg in midline, cross affected leg over stronger leg safety/electric razors with long handles (can be built- up) - Take into consideration the following:
3. Open top of sock by inserting thumb and first two fingers near - Sprays (deodorant, hair spray, and perfume) 1. Endurance
cuff - Electric toothbrush/Water-Pik 2. Fatigue
4. Work it on to foot before pulling overheel - Short reacher 3. Aerobic capacity
5. Work it up over ankle
MOBILITY ● Caused by disorders of the complex interaction between - FA platforms
Cardiopulmonary conditions may limit the following: neuromuscular and structural elements of the body Functional Ambulation: Kitchen
● Aerobic capacity ● Results from weakness, loss of sensation, and inability to WB ● Involves transporting items from table within the kitchen
● Endurance through limb or pelvis ● Help clients engage in problem-solving strategies
Attention is given to proper body mechanics ● Deficits include decreased velocity and WB, increased leg swing ● Assess safety
Requires close coordination with PTs and providers of durable medical of affected leg, abnormal BOS, and balance problems ● If a client had a total hip replacement with posterolateral hip
equipment. ● Functional deficits include loss of mobility, decreased safety, precautions, what can they do when they drop something on
Functional Ambulation: and insufficient endurance the floor?
● Term used to describe how a person walks while achieving a Orthotics: Teach clients how to wear LE orthotics Functional Ambulation: Bathroom (Sink, toilet, bathtub, shower)
goal Uses: ● Very risky
● Applicable for those with LE amputation, orthopedic injury, and ● Provide support and stability of a joint Prevent deformity 1. Toileting
total hip/knee replacement ● Replace lost function - Practice toileting in a variety of settings with and without
We work closely with PTs, who do the following: ● Comfortable, easy to apply, and lightweight equipment
● Gait training ● The more joints of LE require bracing, the higher the energy - Post-operative precautions may pose as a limiting factor
● Ambulation evaluation cost for ambulation - PTs provide LE strengthening exercises
● Recommendations for bracing and ambulation aids Walking/Ambulation Aids (Canes, crutches, walkers) 2. Bathing
As OTs, we reinforce gait training by following PT’s recommendations - Support body weight and act as sensory cues - When using bathtub/shower, make sure everything is already in
“Normal” walking - Compensates for deficits in strength and balance Decreases position
● Method of using two legs alternately to provide support and pain - Tub bench
propulsion - Decreases WB for those with fractures or LE amputations - Grab bars
Gait 1. Canes - Sponge baths
● used interchangeably with walking - Clients with painful hip/knee - canes are provided on Functional Ambulation: Home Management
● Accurately describes the style of walking contralateral side to reduce loading on painful joint ● Balance with one hand on sturdy piece of furniture or
- Advanced during swing phase of leg it’s protecting countertop
- Single-point cane - used for those with minor balance problems ● Lightweight equipment
to widen BOS Quad canes and hemi-walkers (heavier and ● Making the bed
bulkier) ● Fanny pack/shoulder bag
2. Crutches ● Rolling carts
- Transmit forces in horizontal plane because of its two ● Baskets/bags attached to ambulation aids
attachments Requires good UE strength
- Don’t lean on crutches at axilla Wheelchairs
Cycle Time - Suitable for short-term use ● Primary/temporary means of mobility
● Duration of the complete cycle of walking - FA/Lofstrand/Canadian crutches - point of contact are hand and ● OTs and PTs are responsible for the following:
Cadence FA Mobility is easier 1. Evaluation
● Average step rate - Useful for active people with severe leg weakness 2. Measurement
Stride length 3. Walkers 3. Selection of wheelchair
● Distance between two placements of the same foot - Most stable 4. Teach safety and mobility skills
● May be shortened in those with disabilities - “Pick-up” style walker - walker moved first, client takes short 5. Ensures wheelchair is appropriate for the patient (wheelchair
Walking base step with each foot, move walker again “Front-wheeled walker” assessment)
● Distance between the line of the two feet and ‘“four-wheeled walker” with a braking system
● Wider than normal for those with balance deficits - Some have seats
Abnormal gait - Requires use of BUE but doesn’t require that much UE strength
Wheelchair Considerations ● Decrease or make use of efficient time of CG? Wheelchair Measurement Procedures
● Prevention of deformity ● Reduces need for transfers to bed for catheterization and rest
● Tone normalization periods?
● Pressure management ● Needs quick position changes?
● Promotion of function ● Reimbursement source?
● Maximum sitting tolerance Wheelchair Selection (Folding vs. Rigid Manual Wheelchairs)
● Optimal respiratory function ● Needed for transport, storage, or home accessibility? Elevating
● Provision for proper body alignment footrests?
Wheelchair Safety ● Can CG lift, load, and fit chair into vehicle?
● Brakes locked during all transfers ● UE function and balance?
● Never WB/stand on footrests ● Benefit from improved energy efficiency and performance?
● Footrests removed or swung away Wheelchair Selection (Lightweight (Folding/Non-folding) vs.
● Elbows not protruding while being propelled by CG Standard-Weight (Folding) WCs)
● Goin up a ramp ● Under 35 lbs
● Going down a ramp, tilt WC backwards (~30o) and in a forward ● Trunk balance and equilibrium?
motion (push gloves may be used, too) ● Enhances mobility?
● Going up a curb ● Ability to propel the WC with the use of this WC? Custom
● Going down a curb features necessary?
Wheelchair Selection (Manual vs. Electric/Power WCs) Wheelchair Selection (Lightweight (Folding/Non-folding) vs.
● Sufficient strength and endurance? Standard-Weight (Folding) WCs)
● Manual mobility enhances functional independence and makes ● More than 35 lbs.
the client tired? Caregiver is the one propelling? ● Stability?
● What are long-term effects of propulsion choice? ● Ability to propel it? Parts of a Wheelchair
● Insufficient endurance and functional,ability to propel ● CG manage increased weight?
independently? ● Increased weight unimportant?
● Progressive functional loss? Wheelchair Selection (Standard Available Features vs.
● Powered mobility enhances functional independence? Custom,Top-of-the-Line WCs)
● Cognitive and perceptual ability? ● Part-time use only?
● Responsibility to take care and maintain equipment? ● Limited life expectancy for WC? Used only 10-20% OTT?
● Van available? ● Indoor and sedentary use?
● Is the home accessible? Educated in how to use it? ● Dependent on CG for propulsion? Propelled only by them?
Wheelchair Selection (Manual Recline vs. Power Recline vs.Tilt WCs) ● Durability unimportant?
● Unable to sit upright? ● Custom features unnecessary?
● Can caregiver assist? Wheelchair Selection (Standard Available Features vs.
● Relative ease a main cause for concern? Custom,Top-of-the-Line WCs)
● Cost? ● Full-time user?
● Potential to use it independently? ● Long-term use of WC?
● Independently WS and changes position? ● Primary WC?
● Demonstrates independent and safe use? ● Active indoors and outdoors?
● Resources available for taking care of and maintaining it? ● Improve prognosis for independent mobility? Wheelchair Measurement Procedures: Seat Width
● Spasticity facilitates? ● Growing adolescent, or progressive disorder? 1. OBJECTIVES
● Contractures inhibit? ● Custom features required? ● Distribute client’s weight over even surface
● Overall width of chair as narrow as possible
 2. MEASUREMENTS ● If knees too low: Impair COG, seat height for transfers, and ● Meets client’s safety needs to accommodate their weight
● Widest part of client’s hips/thighs while sitting on a chair visibility COMMUNITY MOBILITY
3. WC CLEARANCE Wheelchair Measurement Procedures: Back Height ● Walking, using a bicycle/motorcycle, riding as a passenger,
● + 1/2 to 1 in. on each side 1. OBJECTIVES driving oneself, or using public transportation
4. CHECKING ● Low enough for maximal function OTs roles in Community Mobility
● Flat palm of OT’s hand between hip/thigh and WC skirt and ● High enough for maximal support 1. Public Transportation
armrest 2. MEASUREMENTS ● Fixed Transit Paratransit
5. CONSIDERATIONS ● Full Trunk Support:Top of seat frame to shoulders ● PrivateTransportation
● Potential weight gain/loss ● Minimum Trunk Support: Top of back upholstery is below 2. Driving
● Accessibility of varied environments inferior angle of scapula ● On-road evaluation
● Overall WC width 3. CHECKING ● Driving routes
Wheelchair Measurement Procedures: Seat Depth ● If back is too high, could be pushed forward ● Standard of competence
1. OBJECTIVES ● If back is too low, could lean forward 3. Driving from a WC
● Distribute client’s weight over even surface along entire thigh 4. CONSIDERATIONS 4. Driving with Arthritis
to just behind knee ● Adjustable height backs (4 in. range) or upholstery 5. Driving Assessment (Motor Skills Strength)
● Prevent pressure sores ● Lumbar support ● ROM
2. MEASUREMENTS Wheelchair Measurement Procedures:Armrest Height ● Grip Reaction time
● Posterior buttocks to inside of bent knee WC 1. OBJECTIVES Driving Recommendations & Interventions (Possible outcomes)
3. CLEARANCE ● Maintain posture and balance 1. Driving competence
● Seat edge clearance 1-2 inches less ● Provide support and alignment for UE ○ no assistive devices/driver training needed
4. CHECKING ● Allow changes in position by pushing down on armrests 2. Requires changes to achieve competence
● Check clearance behind knees 2. MEASUREMENTS ○ assistive devices/driver training needed
5. CONSIDERATIONS ● Seat post to bottom of elbow 3. Performance skills are borderline
● Braces/back inserts 3. WC CLEARANCE ○ extensive assistive devices/driver training needed
● Postural changes ● Top of armrest is + 1 inch higher 4. Not safe to drive at the time
● Thigh length discrepancy 4. CHECKING ○ re-evaluate 6-12 months after
● For power recliners, may slide forward occasionally ● Posture is aligned 5. Unsafe, no potential for improvement
● Shortened due to LE propulsion ● No slouching forward/subluxed/forced into elevation in relaxed
Wheelchair Measurement Procedures: Seat Height from Floor and Foot position
Adjustment 5. CONSIDERATIONS
1. OBJECTIVES ● Necessary?
● Support client’s body with thighs parallel ● Remove and replace armrests independently?
● Elevate foot plates ● Increases functional reach or holds a cushion in place
2. MEASUREMENTS Pediatrics
● Top of WC frame to floor AND popliteal fossa to bottom of heal ● GOAL: obtain proper fit and facilitate WC functioning, and
3. WC CLEARANCE accommodates child’s growth
● At least 2 inches ● Younger than 5
4. CHECKING ● Stroller base or standard WC base Ability to propel
● Slip fingers under thighs ● Parents’ preferences
5. CONSIDERATIONS Bariatrics
● If knees too high: Pressure sores and posterior pelvic tilt ● WC Average weight it can carry: 250 lbs.
● Most bariatric WCs carry 500 lbs.