ACTIVITIES OF DAILY LIVING

(ADL) RE-EDUCATION

SASMITA SINHA (MPT)

SASASA
INTRODUCTION

• There are many things a physiotherapist needs to know

about patient before he /she starts on a planned
schemed of treatment.
• Assessment of functional ability needs special attention.
• To motivate the patient ,the specific purpose of each
activity must be emphasised so that his / her effort is
directed towards regaining abilities he/she needs.
 Re-education of function has importance in
achieving the patient’s rehabilitation, and all
the methods used in Exercise therapy are
directed towards this end.
 As each patient’s problems differ from those of
the others no set routine is possible, but the
method used is adapted and modified to meet
the needs of the individual.
 Re-education of function requires the co-
operation of all who come in contact with the
patient.
 The physiotherapy plays a part in re-training
and also help in achieving other functions in
which muscular action is required, e.g. speech,
swallowing and feeding by using suitable
techniques.
 Function, in the rehabilitation terms, is what
humans do or how humans act.
 Functional activities encompass all those tasks,
activities and roles that makes the individual
independent.
 The ultimate aim of any rehabilitation program
is to make the individual independent in all
those functions which he used to perform
before the trauma /disease.
 Human functions can broadly be divided into:
i. Basic or Personal activities of daily living
(BADLs)
ii. Instrumental activities of daily living (IADLs)
iii. Work activities
iv. Sports/recreational activities.
i. Basic ADLs

 Basic or personal ADLs consists of the fallowing

activities:
a. Eating activities (using utensils, cup/glass,
taking food/drink to mouth breaking bread
etc.)
b. Hygiene activities(brushing teeth, bathing,
toileting, combing hair,shaving etc.)
c. Bed activities(moving in bed, managing pillows
and blankets, reaching for objects etc.)
d. Dressing activities (putting on /taking off
shirts, trousers etc.)
e. Transfer activities (bed-to-chair, sit-to-
stand from chair and toilet, into car etc.)
f. Walking activities (walking on the level
surfaces and uneven surfaces, negotiating
curbs, ascending and descending stairs)
ii. Instrumental ADLs
 To live independently in a community an individual should
be able to perform following functional tasks known as
IADLs.
a. Meal preparation (cutting vegetables,stirring etc.)
b. Household work (dusting,mopping floors,washing dishes
etc.)
c. Communication (writing,using telephone etc.)
d. Shopping
e. Driving
f. Gardening
g. Having sex
iii. Work Activities
 These comprises of physical demands that a worker
may need to perform a job:
a. Lifting i. Sitting
b. Carrying j. Standing
c. Stooping k. Walking
d. Pushing
e. Pulling
f. Reaching
g. Manipulating
h. Climbing
iv. Sport and Recreational Activities

 These skills are required to perform any sport or game;

a. Walking; Forward, retro and side ways.
b. Jogging; Forward,retro,on grass,on a track,
on hills,in water etc.
c. Jumping; Vertical,forward,retro,side to side,
on a level surface,from a height etc.
d. Throwing; Underhand,overhand,two handed (with
different size and weight of ball)
e. Catching; Two handed,one handed(with different size
and weight of ball)
f. Batting; Cricket bat,tennis and badminton racquet,
hockey stick etc.
g. Swimming; Back stroke,crawl stroke,breast stroke etc.

h. Sprinting; Forward,retro,on grass,on a track,on a

basket ball court etc.
 ADL Training is a method to make a particular activity
possible for the client to perform with the help of
special device,splint,piece of equipment or specific
technique.

 Factors Influencing ADL Training;

 The following factors should be considered before
starting ADL training;
 Physical capability of the client;
 Muscle strength
 joint range of motion
 Co-ordination
 Sensation
 Balance
 Cognitive and perceptual skills
 Cardiopulmonary endurance

 Culture and values of the client

 Family support
 Environment(in which activity has to be performed)
 Financial assistance
 Goal of ADL Training ;
 The ultimate aim of any ADL training for the client is
to achieve maximal level of independence is different
for every client .For e.g. Walking independently may
be the maximal level for a person with lower
extremity amputation. But self care ,feeding and
communication with assistance or device may be the
maximal level for quadriplegic.
 Evaluation of ADL;
Consists of evaluation of those activities which the client
was performing before the disability or when he is
expected to perform as per his socio-culture context (in
case of congenital or early life disability).

Parameters of ADL Evaluation

ADL is evaluated on basis of three (3) parameters;
 Level of independence-different levels are;
 Independent
 Supervision
 Minimum assistance
 Maximum assistance
 Time - Amount of time required to perform an
activity.
 Accuracy- How accurately the client perform
the ADL.

Sequence of ADL Training

ADL training has to be given in the following
sequence;
 BADL IADL
 For self care activities;
 Feeding
 Grooming
 Continence
 Transfer skills
 Toileting
 Undressing
 Dressing
 Bathing
Basic Principal of ADL Training
 Make out which ADLs are possible and which are impossible
to achieve.
 Explore the alternate methods of performing the activities.
 Use any assistive devices that may be helpful.
 Determine the amount of assistance required(from no
assistance to maximal assistance)
 Progression of training;
Dependent-Maximum assistance-Moderate assistance-
Minimum assistance-Supervision-Independent
Few tasks-More tasks , Simple tasks-Complex tasks
 Methods of teaching should suit the client’s
ability.
 Each activity should be broken into small tasks
and then each task into several small steps, Then
step by step teaching should be followed.
 Demonstration of each activity/task/step should
be done by the therapist.
 Method of “backward” or “forward” chaining may
be used while teaching ADL skills.
 Backward chaining –In this method
therapist assists the client in all the steps of
the task except the last step (which is
independently performed by the client)
When the last step is mastered, the therapist
withdraws assistance from the second last step
and the client performs the second last step
independently.
The process is continued till the client achieves
Independence over all the steps.
 Forward chaining –The client practice and
become independent in the first step of the task
and rest steps is assisted by the therapist.
Then therapist withdraws his/her assistance from
the second step and the client performs the second
steps.
The process is continued till the client achieves
independence over all the steps.
 Guidelines for ADL training in the client with
impaired muscles strength and/or limited
range of motion:
 Dressing Activities
 Use one size large garment
 Use front opening garments
 Use larger buttons or zippers
 Use Velcro if buttons/zippers are difficult to use
 Use dressing sticks
 Use reachers for picking up clothes
 Use shoe without laces or with elastic or Velcro types fasteners
 Use button hooks
 Eating activities
 Use adapted or built-up handles of utensils.
 Use straws if is difficult to drink with glass
 Use universal cuffs
 Use high table
 Use cups/glass with bilateral handles
 Bathing and grooming
 Use hand held held shower and flexible hose.
 Use long-handled bath brush or sponge.
 Use soap on a rope
 Use long or angulated handled comb/tooth-brush
 Use reacher
 Use dressing stick
 Use bathing stool with grab bar
 Safety issues;- use non skid tiles in
bathroom/toilet
- use grab bars.
 Communication
 Use holder for hand-piece of telephole
 Use dialing stick-hand,mouth or head held.
 Use builts up pen and pencils
 Use mouth stick or head stick from type-writer or
computer.

 Mobility and transfers

 Use enlarged and padded grips on crutches, canes,canes
and walkers.
 Use walker or crutch,bag or basket to carry objects.
 Use raised chairs/toilet seats(easy to transfer from)
 Home management;
Use utility cart,reachers,adapted knifes,light
weight utensils, etc.

 Guidelines ADL training in the client with

incoordination:
 Weighted devices such as heavy plates or plates
with weight attached etc.
 Suction bases,non skid mats or plate stabilized can
also be used.
 Weighted wrist cuffs can be used while
performing ADLs
 Work height should be high enough to prevent
bending ,leaning or reaching.