Activities of Daily Living (ADL): Targeted Self Care ... · PDF fileActivities of Daily Living (ADL): Targeted Self Care Strategies ... Grooming Oral Hygiene ... Power Tilt-in-space

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Activities of Daily

Living (ADL):

Targeted Self Care

Strategies

Julia Marton, OT, CBIS

Leslie Brady, PT

Objectives

Define Activities of Daily living (ADL)

Review Assessment of ADL

Performance

Compare ADL Teaching Strategies

Identify Population Specific Self-Care

Strategies & Adaptive Equipment

Activities of Daily Living

(ADL)

ADL= Self-Care

or Self-

Maintenance

Tasks

Grooming

Oral Hygiene

Bathing/Showering

Toilet Hygiene

Personal Device Care

Dressing

Feeding & Eating

Medication Routine

Socialization

Functional Mobility

Emergency Response

Functional Communication

Sexual Expression

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Assessing ADL Performance

Functional

Independence

Measure (FIM)

Documents level

of disability based

on burden of care

18 items in 6

categories

• Self-Care

• Communication

• Locomotion

• Mobility

• Sphincter Control

• Cognition

Teaching ADL Strategies

Adaptation:

Compensation for

loss of function

Adaptive

Equipment

Durable Medical

Equipment (DME)

Alternative

Strategies

Recovery:

Remediation of

functional deficits

Targeted

impairment level

interventions

Repetitive

practice of close

to normal

movement

Population Specific Self-

Care Strategies

Stoke

Brain Injury

Spinal Cord Injury

Orthopedic

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Stoke/BI

Compensation vs. Remediation

Adaptive equipment

Only if the patient cannot perform the

task safely or efficiently

Compensatory strategies

Durable medical equipment (DME)

Stoke/BI

Common barriers to ADL

Dysphagia

Cardiac precautions

Shoulder pain/subluxation

G-Tube

Visual deficits

Cognitive/Behavioral deficits

Physical deficits

Cognitive/Visual deficits

after BI/CVA

Strategies: • Distractibility: Frequent redirection may be required. May

implement use of external aides such as a timer to keep focus.

• Initiation: May require use of verbal and/or tactile cueing.

• Visual inattention, field deficits, diplopia: May implement use of visual anchor, compensatory head turn, use of prisms, patching.

• Communication strategies: May require demonstration/ hand over hand assist, may need written cue or use of picture.

• Learning: Complete contextually appropriate activities, simulate actual home environment

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Physical deficits after

BI/CVA

Strategies:

Strength/ROM: strength training,

dominance retraining, one handed

techniques, adaptive equipment

Balance: alter position (seated vs.

standing), alter amount of support

provided

Feeding/Drinking Adaptive

Equipment for Stroke/BI

Eating

Plate Guards Dycem

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Eating

-Adjustable Angle

Spoon

-Angled Utensils

-Built Up Handles

-Rocker Knife

-Curved Knife

Drinking

Cup Holders

Drinking

Straw Holder Long Straw

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Grooming/Bathing Adaptive


Grooming

-Electric Razor Holder

-Extended Comb/Brush

-One Handed Nail Clipper

-Toothbrush Holder

-Toothpaste dispenser

Bathing: Adaptive

Equipment

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Bathing: DME

Dressing Strategies for

Stroke/BI

Upper and Lower Body Dressing:

Allow for immediate success

Start with loose fitting clothing

Limited fasteners

Clothing positioned in reach

Clothing positioned in the intact visual field

Position fasteners on non-affected side

Attempt in a stable (seated) position

Implement one-handed dressing strategies

Dressing Strategies for

Stroke/BI

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Dressing Adaptive


-Sock Aid

-Reacher

-Zipper Pull

-Button Hook

-Dressing Stick

-Long shoehorn

Toileting Strategies for

Stroke/BI

Toilet tissue should be positioned at

the unaffected side for ease of access

Consider use of clothing without

fasteners or modified fasteners

Trial one-handed strategies

Toileting Adaptive

Equipment for Stroke/BI -Pant holder

-Leg spreader

with mirror

- Catheter inserter

-Urinals

-Catheter mirror

-Toilet paper aid

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Toileting DME

Transfer Strategies for the

BI/CVA populations

Transfer types: stand pivot, sit pivot

(lateral), transfer board, ambulatory,

dependent lift

Facilitate anterior weight shifting

Consistent/appropriate guarding

technique

Utilize momentum & head hips

relationship

Head Hips Relationship

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BI/CVA populations

Understand the impact of neglect:

Proper foot placement

Only aware of ½ the body

Promote proper foot placement

Manual contacts

Transfer Equipment for the

BI/CVA populations

Spinal Cord Injury (SCI)

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SCI

Understand AIS

classification Understand

expected

functional

outcomes

SCI

Tetraplegia (C1-C4)

Instruction of others

Tetraplegia (C5-C8)

Set-up

Adaptive equipment

Alternative strategies

SCI

Paraplegia (T1-T6)

Adaptive equipment


Paraplegia (T7-S5)


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Common ADL Strategies for

SCI

Use of alternative strategies for task

completion:

Utilizing postural support from the

wheelchair or hospital bed

Short sitting, long sitting, supine

positioning

Consistent use of adaptive equipment

Need for custom DME

Feeding Strategies for the

SCI population

Feeding

Trials of adaptive equipment

Various food types

• Solids & liquids

• Finger foods

Container management

Setup of adaptive equipment

Cutting food

Alternative techniques for utensil

management

Feeding Strategies for the

SCI population

Consider injury level and need for adaptive equipment

C5 Wrist/forearm support

Plate guard, dycem

Possible MAS

C6 U-cuff

or

Adapted utensil

Wean off of adaptive equipment

C7 Adapted techniques

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Feeding Adaptive

Equipment for the SCI

Population

May utilize with C4/C5/C6 tetraplegia

• Assists with tasks requiring against

gravity planes of movement

•MAS by JAECO Orthopedic

Feeding Adaptive

Equipment

Dining with

Dignity

Utensils

Feeding Adaptive

Equipment

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Utensil Management

Finger Weave Technique (C6,

C7)

Drinking Strategies

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Drinking Strategies

Drinking Strategies

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Grooming Strategies for the SCI

Population

Consider two handed strategies

Use of universal cuff for absent grasp

Avoid use of containers that require fine motor skills

Grooming Strategies for the SCI

Population

Recommendations for the SCI

population

Make Up Application

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Dressing Strategies for the

SCI population

Consider dressing in bed vs. the wheelchair

Evaluate hamstring length

Back extensor muscle length for stability

Promote lower extremity flexibility

Utilize positioning and momentum for lower extremity management

Utilize appropriate postural support

Introduce adaptive equipment

SCI Upper Body Dressing

SCI Upper Body Dressing

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SCI Lower Body Dressing

SCI Lower Body Dressing

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Clothing Management for the

SCI population

Female – Pant

Mgmt in wheelchair

for ICP

Skin Inspection

Activity in bed

Toileting for the SCI population

Clothing management

Wheelchair skills

Catheter management

Catheter clips

Catheter guides

Catheter mirrors

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Toileting for the SCI

Population


SCI population

Transfer types: stand pivot, sit pivot

(lateral), transfer board, ambulatory,

dependent lift (patient lifter)

Facilitate anterior weight shifting

Consistent/appropriate guarding

technique

Utilize momentum & head hips

relationship

Utilize appropriate adaptive equipment

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Wheelchair Considerations

Appropriate fit

Cushion

Type

Manual

Power

Tilt-in-space

Accessories

Environment accessibility

ADL Strategies for the

Orthopedic Population

Total Hip Replacement:

Reinforce total hip precautions during all tasks • Confirm approach: anterolateral vs. posterolateral

Understand weight bearing status • Extended leg for sitting/standing

Utilize long handled adaptive equipment

Utilize elevated height DME

Recommend utilizing chairs with arms

ADL Strategies for the

Orthopedic population

Total Knee Replacement:

Understand weight bearing status • Extended leg for sitting/standing

Utilize long handled adaptive equipment

Utilize elevated height DME

Recommend utilizing chairs with arms Encourage functional movement of affected knee

(ex: squatting motion to reach for clothes from drawers)

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Questions?