ADLRehab LectureLab I

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ADL/Rehab Lecture/Lab I

• Veronica Southard PT MS GCS

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What are ADLs/IADLs?

• ADL (self care)
• Drinking
• Dressing
• Washing face,comb hair
• Makeup/shave,Clean teeth
• Indoor mobility/floor to stand
• Eating/bathing
• Bed to chair
• Lavatory

• IADL household
• Cope with money
• Prepare hot drinks
• Car transfers
• Snack prep/Prepare meal/Light cleaning
• Bedmaking
• Ironing/Hangout wash
• Carry shopping

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Definitions

• Mobility- skill required to solve movement
  problems confronted during ADLs

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Gentiles Taxonomy

• Components of a response to a motor problem
• Problem recognition
• Goal selection
• Strategy to meet goal
• Formulation of a motor plan
• Implementation of strategy
• Feedback

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Types of impairments

• Motivational
• Musculoskeletal
• Neurological
• Cardiovascular
• Pulmonary
• Cognitive
• Perceptual

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Task difficulty

• The desired outcome determines how simple or
  complex the action.
• Body stability/body transport.
• Open vs closed environments.

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Performance environment

• Changes in time and space make the environment
  more difficult. Informational processing demands
  will increase performance difficulty

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Task specificity

• Learning and performance are task specific. To
  improve a particular task, practice that task!

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Feedback

• Critical to learning
• Visual, auditory, tactile, mirrors, polaroids

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Progression of learning

• 1. Cognitive learning occurs optimally if the
  goals, outcomes, and processes are explicit..
• 2. Associative learning Start to withdraw
  assistance further, allow time for pt. processing
  of performance outcomes. Pt self corrects as
  errors are detected.
• 3. Autonomous learning Impose a distractor to
  increase automatic tasks. Once the movement has
  been truly learned, the pt. Will be able to
  maintain accurate performance in spite of
  distractors.

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Verbal Cues

• Identify for the patient the elements of the
  intended movement essential for successful
  performance.

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Visual imagery and Mental Practice

• Visually, kinesthetically, both.
• Research has shown Pt.s using mental practice
  move more efficiently when compared to those who
  didnt

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Structuring your session

• Block practice
• Scattering practice
• Cognitive impairment be careful with too many
  intertrial variables.

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Task Analysis

• What is preventing the client from completing the
  activity?
• To turn to the side requires
• Rot and neck flex
• Hip and knee flex
• Flex of shoulder and protraction of sh girdle
• Rot of trunk

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Functional Assessments

• Series of measures that describe the action of a
  part of the body or quantifies a pts individual
  performance as they relate to daily activities.

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Quantification of Function

• Is necessary in order to establish baselines and
  endpoints for measuring pt. outcomes

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Outcome measures

• Standardized tests of functional tools that
  relate pain, strength or ROM to a quantifiable
  scale

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Functional Outcome Tools

• Methods of describing and monitoring patient
  performance.
• Been around since the 1950s
• Performance and self report versions

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Performance vs. Self Report

• Performance
• Better reproducibility, more sensitive to change
• Excellent for showing validity
• Better for cognitively impaired

• Self report
• Influenced by language, culture,education

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The Title of the Tool

• Self Report Questionnaire
• Barthel

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Self Report

• Adults, low level outpatients with RA.
• Measures level of difficulty with 8 ADLs
• Pen and Pencil
• Higher the score the greater the deficits

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The Barthel Index

• Adults, measure of independence able to score
  improvement in rehab.
• Can be used as a pre and post test
• Pen and pencil or performance format
• Self report 5 minutes., performance 20 minutes
• 0,5,10,15scoring, with 0 the most dependent

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Barthel cont

• 100 the pt.can care for himself, but not
  necessarily alone. Scores gt 60 can live
  independently, less than 60 require
  institutionalization or daily assistance.
• Strong content validity
• Only moderate interrater reliability

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Pt. care

• At first meeting the pt.
• 1. Should know who you are
• 2. What the goals of treatment are
• 3. Expected outcomes and risks

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Pt and family education

• Why should every pt get a HEP?

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Goals

• Objective, measurable and include a time frame.
• STG very specific and may be a component of a LTG
• How you modify your goals often lets you know how
  effective you are.

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HEP

• Done prior to D/C
• Reviewed with the assisting caregiver as
  necessary.
• A written copy is always kept in the pt.s chart

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Criteria for Inclusion in HEP

• Pt. Name
• Frequency of performance
• Number of reps
• Precautions/contraindications
• Required supplies/equipment

• Specific instructions/diagrams
• Therapists name and phone number.
• Sometimes it is handy to put next appt.

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Communication

• Necessary for optimal rapport
• Pt.
• Caregiver
• Other team members
• MD

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Types of Communication

• Verbal- actively express terms and concepts in a
  way the pt. can understand.
• Use laymans terms.
• Short and concise commands.
• Vary the volume, tone, inflection of your voice.
• Body language should match what you are saying.
• Eye contact is important

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Non Verbal Communication

• Majority of pt. Interactions
• Made up of facial expressions, posture, gestures,
  body movement, or changes in body responses.
• Planned, spontaneous, uncontrollable or
  voluntary.
• Touch- be careful the proper message is conveyed

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Safety Considerations

• You are responsible for you pt.
• Assure that all the equipment you use and the
  environment is safe in your clinic.
• The pt. is responsible for his health and safety
  within the confines of his abilities.
• Severe medical problems, burns, SCI, DM, CP,
  emotionally disturbed or children require
  constant vigilance