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Activities of Daily Living

- The performance of the physical

daily living skills and personal care with or without adaptive equipment

ADL activities are

a. Grooming & Hygiene - Bathing, Toileting, Hair Care b. Feeding / Eating - Sequentially feeding oneself, sucking, swallowing, chewing. Use of appropriate utensils. c. Undressing/Dressing - taking off and putting on clothing, learning to unfasten/fasten and adjust clothing. d. Functional Mobility - mobility in bed, on floor, use of apparatus (P.T.), wheelchair mobility, transfer from & to bed, toilet, bath, chair, car. e. Functional Communication writing equipment, use of keyboards, switches.

f. Object Manipulation performance and skill of handling large and small common objects such as utensils, toys, pencils, taps, doorknobs and light switches. g. Play/Leisure performance and skill in choosing, performing and engaging in activities of amusement, relaxation, spontaneous enjoyment & or self expression, recognizing specific needs, interests & adaptation necessary for performance.

Nagis model of the Process of disability

Diseases Impairments functional limitation Disability
Pathology organic dysfunction Altered ability in a task or activity inability to perform or meet an expectation

Physical signs and symptoms

Physical Psychological Social

Chronically ill and disabled person

represents a large segment of population Approximately 35 million individuals suffer from physical and mental impairments that limits their capacity to perform some daily functional activity

Health (WHO). A state of complete physical,mental and social well-being ,and not merely the absents of diseases and infirmity



A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms. A condition or tendency, as of society, regarded as abnormal and harmful.

Impairment any alteration or deviation

from normal in anatomical,physiological ,or psychological structure or function

Partial or complete loss of limb

Functional limitation
The inability of an individual to perform an

action or activity in the way it is done by most people is usually due to impairment.
Physical (bed transfer,walking ) Psychological( mental affective ) Social (social activates )

discordance between the actual

performance of an individual in a particular role and expectations of the community regarding what is normal for an adult.

The effectiveness of any program of medical

intervention is determined by its therapeutic outcome. The rehabilitation outcome measurements are changes in muscular strength and endurance, degrees of change of motion: and levels of independence of physical function.

The principles of rehabilitation involves in making a physically handicapped patient. independent in the performance of those activities of daily living as well as some of the systems utilized to measure ADL rehabilitation outcome. The activities that must me performed to achieve functional dependence may be classified as
mobility activities, hygiene, ambulation, dressing, eating, bowel and bladder control

The activities that must be performed are analyzed

and broken down in to simple component. The activities can be performed with a variety of mechanical aids and assistive devices.

1. Lack of independence with self-feeding, as
evidenced by not opening the mouth in response to stimulation or not eating independentlywith proper utensils. 2. Assistance needed with dressing, as evidenced by not selecting appropriate attire, failure to physically put clothes on, or inability tomanipulate fasteners. 3. Impaired identification of hygienic needs and/or initiation of response to hygienic needs, as evidenced by deficiencies in caring for a runny nose, toileting needs, bathing, washing hands, and brushing teeth, resulting in poor hygiene.

4.Absence of initiating activities of personal interest. 5. Failure to complete required tasks. 6. Failure to seek assistance when needed. 7. Lack of initiative to resolve problems. 8. Difficulties in comprehending requests, emotions, greetings, comments,protests, or rejection due to limitations in receptive and expressive communication. 9. Poor interaction skills characterized by limited eye contact, insufficient attending, and awkward social

Assessment of function
functional assessment measures how an individual does certain task or fulfills certain roles in various dimensions of living


The Klein-Bell ADL Scale is intended to give a numerical score based on the number of ADL skills a patient can perform Independently. Subsequent scores will measure change in performance. Activities of daily living are broken down into essential behavioral components and each component is scored separately. This gives the opportunity to measure progress even when small gains are made.



Mobility activities. Bed mobility. Wheel chair mobility. b.1 Pivot transfer. b.2 Trapeze bar transfer b.3 Sliding board / transfer board Wheel chair mobility requires ability to propel with upper extremity. To prevent pressure sore.


Ambulation 2.a Transfer from sitting to standing and from standing to ambulation. 2.b Walking with ambulation aids. 2.c Walking training in variety of environmental condition. Dressing 3.a Velcro, elastics Hygiene 4.a Holding devices. 4.b A counterbalanced deltoid aid 4.c Motorized equipment such as electric razors / tooth brushes 4.d A stool in the tub or shower, non skid mats, rails




Bowel and bladder control 5.a Indwelling catheter. 5.b Condom catheter. 5.c Intermittent catheter. 5.d Develop regular bowel habits (gastrocolic reflex) 5.e Stimulation of the Anorectal reflex 5.f Dietary management
Eating 6.a 6.b


Holding device Adapted utensils- warm spring feeder, rocker speeder, or balanced forearm orthososis


The ultimate outcome of training for functional

independence is the use of this knowledge and techniques by patients in their home or postdischarge domicile.

Purpose of functional assessment

Base line information for setting functional oriented goals and outcomes of intervention Indicator of a patients initial abilities and progression towards more complex functional level Criteria for placement decision, (need for inpatient rehabilitation,extended care community services Manifestation the individual level of safety in performing a task Evidence of effectiveness of a specific intervention

Types of instrument
Performance based assessment Self assessment

Assessing physical function

BARTHEL INDEXSpecifically measures the degree of assistance required by an individual on 10 items of mobility and self care ADL KATZ INDEX Pts performance and degree of assistance required in six categories of basic ADL

Barthel ADL Index

0 = unable 5 = needs help cutting, spreading butter, etc., or requires modified diet 10 = independent Bathing 0 = dependent 5 = independent (or in shower) Grooming 0 = needs to help with personal care 5 = independent face/hair/teeth/shaving (implements provided) Dressing 0 = dependent 5 = needs help but can do about half unaided 10 = independent (including buttons, zips, laces, etc.) Bowels 0 = incontinent (or needs to be given enemas) 5 = occasional accident 10 = continent Bladder 0 = incontinent, or catheterized and unable to manage alone 5 = occasional accident 10 = continent

Toilet Use 0 = dependent 5 = needs some help, but can do something alone 10 = independent (on and off, dressing, wiping) Transfers (bed to chair, and back)) 0 = unable, no sitting balance 5 = major help (one or two people, physical), can sit 10 = minor help (verbal or physical) 15 = independent Mobility (on level surfaces) 0 = immobile or < 50 yards 5 = wheelchair independent, including corners, > 50 yards 10 = walks with help of one person (verbal or physical) > 50 yards 15 = independent (but may use any aid; for example, stick) > 50 yards Stairs 0 = unable 5 = needs help (verbal, physical, carrying aid) 10 = independent TOTAL (0100):

Visual Analogous Scale-10cm scale

Functional indepence measurement sickness impairment scale

to accurately access each individuals's capabilities and deficits in order to prescribe the correct equipment. To encourage independence in every aspect of the individual's life.
The increased independence that each person gains through the ADL program will rebuild confidence. This confidence will carry over into all areas of an individual's life, including home and work goals.

1. Strengthen existing ADL skills and develop independence with new ADL skills. 2.Develop and maintain skills of dressing self to create greater autonomy from caregivers. 3. Maximize independence in all ADL areas. 4. Use adaptive equipment and training modalities that support independent functioning.

Exercises according to the muscle grades
Bed mobility exercise Balance and coordination training Transfers Gait training

training in ADL with adaptive aids