daily living skills and personal care with or without adaptive equipment
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.
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
Disease
1.
2.
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.
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 )
Disability
discordance between the actual
performance of an individual in a particular role and expectations of the community regarding what is normal for an adult.
REHABILITATION
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.
PRINCIPLES OF REHABILITATION
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
and broken down in to simple component. The activities can be performed with a variety of mechanical aids and assistive devices.
INDICATIONS
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
TRAINING
1.
a)
b)
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.
2.
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
3.
4.
5.
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
6.
Holding device Adapted utensils- warm spring feeder, rocker speeder, or balanced forearm orthososis
OUTCOME MEASURES
independence is the use of this knowledge and techniques by patients in their home or postdischarge domicile.
Types of instrument
Performance based assessment Self assessment
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):
GOALS
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.
Interventions
Exercises according to the muscle grades
Bed mobility exercise Balance and coordination training Transfers Gait training