The document discusses activities of daily living (ADL) re-education by a physiotherapist. It defines ADLs as basic personal activities, instrumental activities, work activities, and sports/recreational activities that promote independence. The document outlines guidelines for evaluating and training different types of ADLs based on a patient's capabilities and needs, with the goal of maximizing their independence through adaptation and use of assistive devices.
The document discusses activities of daily living (ADL) re-education by a physiotherapist. It defines ADLs as basic personal activities, instrumental activities, work activities, and sports/recreational activities that promote independence. The document outlines guidelines for evaluating and training different types of ADLs based on a patient's capabilities and needs, with the goal of maximizing their independence through adaptation and use of assistive devices.
The document discusses activities of daily living (ADL) re-education by a physiotherapist. It defines ADLs as basic personal activities, instrumental activities, work activities, and sports/recreational activities that promote independence. The document outlines guidelines for evaluating and training different types of ADLs based on a patient's capabilities and needs, with the goal of maximizing their independence through adaptation and use of assistive devices.
• There are many things a physiotherapist needs to know
about patient before he /she starts on a planned schemed of treatment. • Assessment of functional ability needs special attention. • To motivate the patient ,the specific purpose of each activity must be emphasised so that his / her effort is directed towards regaining abilities he/she needs. Re-education of function has importance in achieving the patient’s rehabilitation, and all the methods used in Exercise therapy are directed towards this end. As each patient’s problems differ from those of the others no set routine is possible, but the method used is adapted and modified to meet the needs of the individual. Re-education of function requires the co- operation of all who come in contact with the patient. The physiotherapy plays a part in re-training and also help in achieving other functions in which muscular action is required, e.g. speech, swallowing and feeding by using suitable techniques. Function, in the rehabilitation terms, is what humans do or how humans act. Functional activities encompass all those tasks, activities and roles that makes the individual independent. The ultimate aim of any rehabilitation program is to make the individual independent in all those functions which he used to perform before the trauma /disease. Human functions can broadly be divided into: i. Basic or Personal activities of daily living (BADLs) ii. Instrumental activities of daily living (IADLs) iii. Work activities iv. Sports/recreational activities. i. Basic ADLs
Basic or personal ADLs consists of the fallowing
activities: a. Eating activities (using utensils, cup/glass, taking food/drink to mouth breaking bread etc.) b. Hygiene activities(brushing teeth, bathing, toileting, combing hair,shaving etc.) c. Bed activities(moving in bed, managing pillows and blankets, reaching for objects etc.) d. Dressing activities (putting on /taking off shirts, trousers etc.) e. Transfer activities (bed-to-chair, sit-to- stand from chair and toilet, into car etc.) f. Walking activities (walking on the level surfaces and uneven surfaces, negotiating curbs, ascending and descending stairs) ii. Instrumental ADLs To live independently in a community an individual should be able to perform following functional tasks known as IADLs. a. Meal preparation (cutting vegetables,stirring etc.) b. Household work (dusting,mopping floors,washing dishes etc.) c. Communication (writing,using telephone etc.) d. Shopping e. Driving f. Gardening g. Having sex iii. Work Activities These comprises of physical demands that a worker may need to perform a job: a. Lifting i. Sitting b. Carrying j. Standing c. Stooping k. Walking d. Pushing e. Pulling f. Reaching g. Manipulating h. Climbing iv. Sport and Recreational Activities
These skills are required to perform any sport or game;
a. Walking; Forward, retro and side ways. b. Jogging; Forward,retro,on grass,on a track, on hills,in water etc. c. Jumping; Vertical,forward,retro,side to side, on a level surface,from a height etc. d. Throwing; Underhand,overhand,two handed (with different size and weight of ball) e. Catching; Two handed,one handed(with different size and weight of ball) f. Batting; Cricket bat,tennis and badminton racquet, hockey stick etc. g. Swimming; Back stroke,crawl stroke,breast stroke etc.
h. Sprinting; Forward,retro,on grass,on a track,on a
basket ball court etc. ADL Training is a method to make a particular activity possible for the client to perform with the help of special device,splint,piece of equipment or specific technique.
Factors Influencing ADL Training;
The following factors should be considered before starting ADL training; Physical capability of the client; Muscle strength joint range of motion Co-ordination Sensation Balance Cognitive and perceptual skills Cardiopulmonary endurance
Culture and values of the client
Family support Environment(in which activity has to be performed) Financial assistance Goal of ADL Training ; The ultimate aim of any ADL training for the client is to achieve maximal level of independence is different for every client .For e.g. Walking independently may be the maximal level for a person with lower extremity amputation. But self care ,feeding and communication with assistance or device may be the maximal level for quadriplegic. Evaluation of ADL; Consists of evaluation of those activities which the client was performing before the disability or when he is expected to perform as per his socio-culture context (in case of congenital or early life disability).
Parameters of ADL Evaluation
ADL is evaluated on basis of three (3) parameters; Level of independence-different levels are; Independent Supervision Minimum assistance Maximum assistance Time - Amount of time required to perform an activity. Accuracy- How accurately the client perform the ADL.
Sequence of ADL Training
ADL training has to be given in the following sequence; BADL IADL For self care activities; Feeding Grooming Continence Transfer skills Toileting Undressing Dressing Bathing Basic Principal of ADL Training Make out which ADLs are possible and which are impossible to achieve. Explore the alternate methods of performing the activities. Use any assistive devices that may be helpful. Determine the amount of assistance required(from no assistance to maximal assistance) Progression of training; Dependent-Maximum assistance-Moderate assistance- Minimum assistance-Supervision-Independent Few tasks-More tasks , Simple tasks-Complex tasks Methods of teaching should suit the client’s ability. Each activity should be broken into small tasks and then each task into several small steps, Then step by step teaching should be followed. Demonstration of each activity/task/step should be done by the therapist. Method of “backward” or “forward” chaining may be used while teaching ADL skills. Backward chaining –In this method therapist assists the client in all the steps of the task except the last step (which is independently performed by the client) When the last step is mastered, the therapist withdraws assistance from the second last step and the client performs the second last step independently. The process is continued till the client achieves Independence over all the steps. Forward chaining –The client practice and become independent in the first step of the task and rest steps is assisted by the therapist. Then therapist withdraws his/her assistance from the second step and the client performs the second steps. The process is continued till the client achieves independence over all the steps. Guidelines for ADL training in the client with impaired muscles strength and/or limited range of motion: Dressing Activities Use one size large garment Use front opening garments Use larger buttons or zippers Use Velcro if buttons/zippers are difficult to use Use dressing sticks Use reachers for picking up clothes Use shoe without laces or with elastic or Velcro types fasteners Use button hooks Eating activities Use adapted or built-up handles of utensils. Use straws if is difficult to drink with glass Use universal cuffs Use high table Use cups/glass with bilateral handles Bathing and grooming Use hand held held shower and flexible hose. Use long-handled bath brush or sponge. Use soap on a rope Use long or angulated handled comb/tooth-brush Use reacher Use dressing stick Use bathing stool with grab bar Safety issues;- use non skid tiles in bathroom/toilet - use grab bars. Communication Use holder for hand-piece of telephole Use dialing stick-hand,mouth or head held. Use builts up pen and pencils Use mouth stick or head stick from type-writer or computer.
Mobility and transfers
Use enlarged and padded grips on crutches, canes,canes and walkers. Use walker or crutch,bag or basket to carry objects. Use raised chairs/toilet seats(easy to transfer from) Home management; Use utility cart,reachers,adapted knifes,light weight utensils, etc.
Guidelines ADL training in the client with
incoordination: Weighted devices such as heavy plates or plates with weight attached etc. Suction bases,non skid mats or plate stabilized can also be used. Weighted wrist cuffs can be used while performing ADLs Work height should be high enough to prevent bending ,leaning or reaching.