Chapter 10: Activities of Daily Living (Pedretti) – Flashcards

- Bathing/showering - Toileting and toilet hygiene (bowel and bladder management) - Swallowing/eating - Feeding - Functional Mobility (transfers and bed mobility) - Personal device care (hearing aids, orthotics, splints) -Personal hygiene and grooming

- Care of others - Care of pets - Child rearing - Communication management (telephone and computer use) - Driving and community mobility (public transportation use) - Financial management - Health management and maintenance - Home establishment and management - Meal preparation and cleanup - Religious and spiritual activities and expression - Safety and emergency maintenance - Shopping

It is done for the client and family to learn to adapt to the life changes or situations and to participate as fully as possible in occupations that are meaningful

- Who is the "Client"? - Client Factors - Performance Skills - Performance Patterns - Environment - Cultural, Personal, Temporal, and Virtual Contexts - Finances - Occupational Justice

1. Person (and their Family) 2. Organization - Businesses, industries, agencies - Consultation or referral for accessibility 3. Population - Refugees or survivors of a natural disaster

- Values, beliefs, and spirituality - Body functions - Body structures

- ROM - Strength - Coordination - Sensation - Balance - Cognition: memory, attention, problem solving - Emotional functioning: coping strategies and behavior management - Sleep quality - Belief that one has the potential to improve

Important to client functioning and assessed to determine the potential for remediation, restoration or need for adaptive equipment or other modifications.

- Motor Skills - Process Skills - Social Interaction Skills *Observable and Demonstrable

Motor Skills - REACH and BEND down to retrieve a pot from a low cupboard Process Skills - Difficulty SEQUENCING during showering; Begins to dry off first instead of turning on the water

- Habits - Routines - Roles - Rituals

Habits - Automatically placing a napkin on one's lap before staring to eat Routines - Waking up at the same time every day and completing the sequence of toileting, showering, dressing, hygiene and grooming Roles - Husband of a wife with severe RA Rituals - Praying or saying grace before every meal

An understanding of these allows the OT to: - Identify performance deficits - Set priorities with goal setting - Help the client reestablish continuity in daily living.

- Physical Environment (home, work, church) - Social Environment (spouse, coworkers, friends)

Strongly influences treatment priorities - Support system? - Home?

Cultural - Differ in terms of ADL's/IADL's - Important in understanding differences in how independence is defined and valued Personal - ADL's/IADL's may differ based on age, gender, educational level, etc. Temporal - Time of year, time of day, or stages of life determine when certain tasks occur during the day Virtual - Recognition of its significance to a client connecting socially

Culture - Bathing viewed as a private event vs. bathing as a communal event - A client who does not value Independence in ADL's seen as unmotivated Personal - A young adult female may consider it important to regain the ability to shave her legs where as an elderly female may not Temporal - When a person dresses or eats a meal Virtual - Ability to contact friends using a computer or cellphone

Financial resources available for potential expenses such as assistant care, special equipment, and home modifications are important considerations for ADL and IADL performance. - Making recommendations based on the clients finances: bathroom remodel vs. less costly modifications (obtaining a bath bench or removing a shower door)

The ability of all people to be given the opportunity to engage in occupations, including ADLs and IADLs that are important to them. Example: A client is unable obtain a piece of adaptive equipment such as a transfer bath bench that is not covered by insurance or available for a client to purchase. OT's creativity, compassion, and resourcefulness can be used to bridge this disparity to help this clients perform bathing that is important to them.

Involves collaborating with the client to determine what needs to be done to support health and participation in life through engagement in occupation.

1. Checklists - Can be used as a guide for questioning and the selection of specific activities to perform as identified during the interview for the occupational profile. 2. Standardized tests - Objective assessment - Can be used for Reevaluation

- After gathering client data, the feasibility of ADL assessment or ADL training should be determined with the client, physician, and rehab team - The interview may serve as a screening device to help determine the need for further assessment - Performance of activities should be assessed in the environment and context whee they usually take place - Simple and safe tasks from the ADL, IADL checklist should be selected and progress to more difficult complex items. - During the performance analysis, the therapist should observe the methods the client is using or attempting to use to accomplish the task and try to determine causes of performance problems; if problems and their causes can be identified, the therapist has a good foundation for establishing training objectives, priorities, methods, and the need for assistive devices - Do not overlook the client's need for respect and privacy and the ongoing interaction between the client and the therapist.

Independent - Client can perform task independently ans safely Modified Independent - Client can perform the task independently with the use of assistive devices or at slower than customary speed Supervised - Client requires general supervision and may require verbal cue for safety; OT can be greater than arms length away at all times Standby assistance/contact guard assistance - Client requires caregiver or someone to provide Hands-On guarding to perform task safely Minimal assistance -Client requires 25% physical or verbal assistance (client performs 75% or more of the task) Moderate assistance -Client requires 50% physical or verbal assistance (client performs 50% - 74% or more of the task) Maximum assistance - Client requires 51% - 75% physical or verbal assistance (client performs 25% - 49% or more of the task) Dependent - Client requires more than 75% physical or verbal assistance (client performs less than 25% or more of the task)

ADL - Functional mobility (transfers/ambulation) - Self feeding/Eating (swallowing) - Undressing - Dressing - Clothing Fasteners - Hygiene and Grooming/Bathing/Toileting - Sexual Activity IADL - Health Management and Maintenance - Communication Management - Care of Others - Financial Management - Religious Observance - Safety and Emergency Maintenance - Rest and Sleep - Operate Objects in External Environment - Community Mobility Client Factors - Perceptual/Cognitive/Emotional Regulation - Functional ROM - Sensation - Vision (Sensory and Perceptual) - Strength (indicate muscle grade) - Coordination/Endurance - Functional Balance

1. Interview Client - Description of Home - Former and present Responsibilities - Significance of Role 2. Assessment - Complete in ADL Kitchen/Apartment of Treatment Facility or Clients Home (Environment/Context) - Select tasks - Exercise safety precautions consistent with the clients capabilities and limitations - Start simple and progress to grading task in complexity and including safety precautions Examples - Executive Function Performance Test - Home Management Checklist

- Description of Home (Own/Rent, Type of Home, # Rooms, # Floors, Stairs, Elevator, Bathroom Description) - Meal Prep - Serving - Washing dishes - Shopping - Laundry - Child care - Housekeeping

- Safety - Accessibility - Client functioning in their home (modifications or medical equipment needed?) - Helps OT understand physical, cultural, and social environment

- Exterior entrances and exits - Interior doors, halls, stairs - Bathroom - Kitchen - Living, dining, bedroom - Laundry - Telephone and door - Storage space - Windows - Electrical outlets and controls - Heat, air, light, security, water temp, carbon monoxide controls *Can be completed by the client and their famil if a home evaluation is not possible, prior to discharge

Review pgs 184-191

- OT writes a report summarizing the information on the home evaluation checklist and describes the clients performance in the home; including environmental barriers and functional limitations the client encountered Recommendations (review w/ client and family) - Safety equipment and assistive devices - Modifications (Detailed: size, building specifications, costs, and sources) - Feasibility of the client's discharge to the home environment or remaining in or managing the home alone

- Lack of reach and joint movement - Lack of muscle strength

- Dressing sticks (pushing/pulling garments on/off) - Sock Aid - Elastic shoelaces/Adapted shoe fasteners eliminate lacing (Velcro-fastened shoes or Secure slip-on shoes) - Reachers (pick up socks and shoes, arrange clothes, remove clothes from hangers, pick up object off the floor, donning pants)

- Garments: front-opening, one size larger, stretchy fabric - Dressing sticks (push shirt over head) - Larger buttons or looped zippers with pull-tabs - Replace buttons, snaps, hook and eyes with Velcro or zippers - Buttonhooks

- Built-up handles on eating utensils - Elongated or specially curved handles - Swivel spoon/fork for limited supination - Long plastic straws and straw clips on cups (limited neck, elbow, shoulder ROM or inadequate grasp) - Universal cuff/Utensil holders - Plate guards/Scoop dishes

- Handheld flexible shower hose for bathing/shampooing; handle can be built up (Can sit and control direction of spray) - Long-handled bath brush/Sponge with a soap holder/Long cloth scrubber to reach LE - Wash mitt for limited grasp - Soft rubber brush with extended handle to shampoo hair - Wall-mounted hair dryer - Long handled comb, brush, toothbrush, lipstick, mascara brush, and safety or electric razor - Spray deodorant, hair spray, and spray powder or perfume can extend reach - Electric toothbrushes and a Water-pik for dental care -Short reacher for toilet paper use - Dressing sticks to pull garments up after toilet use - Use of a long piece of elastic/webbing with clips on each end that can be hung around the neck and fastened to pants or underwear to prevent them from slipping to the floor during toilet use - Safety rails for bathtub transfers - Safety mats/strips in bathtub - Transfer tub bench or shower stall - Grab bars to prevent falls and ease transfers - Pump Dispenser for shampoo, conditioner, lotion - Use smaller containers to eliminate lifting/pouring out of larger containers

- Extended built-up/Lever Handles on faucets - Place telephones within reach or use portable telephones that can be kept with the client - Use of a speakerphone or headset - Dialing stick or use of phone w/ large push buttons - Built-up writing utensils - Personal computers, word processors, voice recognition software, book holders, and electronic books can facilitate communication - Lever-type doorknob extensions, car door openers, and adapted key holders

- Glider chair operated by feet - Platform crutches - Enlarged grips on crutches, canes, and walkers - Raised toilet seat - Walker w/ padded grips and forearm troughs - Walker or crutch bag, tray, or basket to carry objects

- Store frequently used items on the 1st cabinet shelf, just above/below counters or on the counter - High, stable stool to work comfortably at counter height with feet firmly placed on the ground - Utility cart of comfortable height to transport several items at once - Reacher to retrieve lightweight items from high shelves - Nonslip mats to stabilize mixing bowls and dishes - Lightweight utensils (plastic or aluminum), bowls, pots, plates, cups, and other serving containers - Electric can opener/mixer - Electric scissors or adapted loop scissors to pen packages - Extended and flexible plastic handles on dust mops, brooms, and dustpans - Adapted knives for cutting or use pre-cut food items - Pull-out shelves or lazy Susans to organize cupboards/refrigerator - Wall oven, counter top broiler, microwave oven, convection oven - Elevate dishwasher to a convenient height for w/c - Pump dispensers for dish soap or single-use pre-measured dishwasher detergent - Dycem or nonslip puffy shelf liner or thick rubber band around jar lid or jar openers to open containers - Top-loading automatic washer and elevated dryer to eliminate bending - Front loading machines for w/c users - Use of a reacher to obtain clothes in washer/dryer - Adjustable height ironing board or eliminate ironing with use of permanent press clothing - Elevate the playpen and diaper table - Use a bathinette (portable folding baby bath tub) or a plastic tub on the kitchen counter for bathing - Raise crib mattress (until child reaches 3 or 4 months) - Use slightly larger/loose-fitting garments with Velcro fastenings on children - Reacher to pick up items off the floor - Comforter instead of a top sheet and blanket to increase the ease of making the bed

- Tremors, ataxia, athetosis (writhing), and chorea (jerky) can reduce safety and stability of gait, body parts, and objects to complete the tasks. Fatigue, stress, emotional factors, and fear influence severity of symptoms. Arm stabilization can reduce incoordination and allow for gross and fine motor movements without assistive devices. When muscle weakness is absent a Velcro-fastened weight can be attached to the client's arm,the back of their hand, or the device. * Conditions: Parkinson's, MS, CP, Freidrich's ataxia, and head injuries

In a seated posiiton: - Front-opening/Loose fitting clothing - Large buttons, Velcro, or Zippers with looped tabs - Button hook w/ large-weighted handle - Elastic shoelaces, Velcro closures, slip-on shoes - Slacks w/ elastic waistbands or Velcro closures - Bras w/ front openings or Velcro replacements - Slip-over elastic bra or bra-slip combination - Fastening regular bras at waist level, slipping around back, put arms in straps, and work over shoulders - Clip-on Ties

- Plate stabilizers (nonskid mats-Dycem, suction bases, damp dishtowels) - Plate guard or scoop dish - Weighted/Swivel utensils - Weighted cuffs or gloves with weights to decrease involuntary movement - Long plastic straws with a straw clip - Cup with a weighted bottom - Plastic cups with covers and spouts - Resistance or friction feeder - Mechanical self-feeding device

- Attach razor, lipstick, toothbrush to a cord if frequently dropped - Electric toothbrush - Weighted wrist cuffs during hair care, shaving, applying makeup - Wall-mounted (or stand-mounted) hair dryer - Electric razor rather than blade razor with a strap around the razor and hand to prevent dropping - Suction brush attached to the sink or counter for nail and denture care - Soap on a rope; can be worn around neck or hung over a shower fixture within easy reach - Bath mitt that holds soap - Liquid soap and a soft nylon scrubber or bath glove - Emery board or stabilized sandpaper or nail clipper for nail care - Large roll-on deodorants instead of sprays or creams - Sanitary pads that stick to undergarments are easier to manage than tampons - Nonskid mats inside/outside the bathtub. - Safety grab bars installed on the wall next to the bathtub or on the edge of the bathtub - Bathtub seat or shower chair