Ch. 27: Restoring ADLs
t/f: Bedrails or halos do not provide support for changing bed position
FALSE
ADLs include nine different categories:
(1) bathing and showering, (2) toileting and toilet hygiene, (3) dressing, (4) swallowing and eating, (5) feeding, (6) functional mobility, (7) personal device care, (8) personal hygiene and grooming, and (9) sexual activity.
In these situations, the modification approach is used involving either
(1) modification of the task performance technique (e.g., leaning against a sink when clients fatigue easily while brushing teeth) or (2) using adaptive equipment and altering the environment (e.g., using toothbrushes with built-up handles for clients with decreased grasp strength).
t/f: A person with low endurance and fatigue may not experience difficulty initiating or completing ADLs.
FALSE
A critical component of evaluation is-
ADL observation and analysis.
Describe Use of Adaptive Equipment or Altering the Task Environment for bed mobility.
Adjustable beds assist in bringing patients upright or lowering to supine; Use portable bedrails at home; Use Hoyer lifts.
what do we use to eliminate the need for toilet paper?
Bidet-toilet combos or bidet-toilet seats
Describe bed mobility for side-lying to sitting at the edge of the bed.
Bring their legs over the side of the bed; Use forearms and hands to push up to a sitting position with legs over the side of the bed; To scoot to the edge of the bed, clients should place both hands flat on the bed and weight shift to one side of the body, while moving the opposite buttock forward. Then move the weight to the other side of the body, while moving the opposite buttock forward. Repeat until clients are comfortably seated at the edge of the bed; If clients have weakness on one side of the body, they should roll onto the affected side, reach across the chest with the unaffected UE and use the unaffected hand to push up to a sitting position; For clients who have whole-body weakness, or one-sided weakness but still require help to move to a seated position, therapists should bring the clients' legs to the edge of the bed and stabilize their knees between their legs. Then assist clients to an upright position by guiding the scapula and the hips.
What is Independent?
Clients can perform the activity independently; without modification of technique, assistive devices, or aids; and within a reasonable time frame.
What is Modified independence?
Clients either require an assistive device to complete the activity, the activity takes more than a reasonable time, or safety considerations exist.
What is Supervision (standby assistance)?
Clients require a therapist to stand by for safety in case of balance loss. Therapists may provide verbal cues for safety.
Describe bed mobility for rolling in bed.
Clients should bend both knees by sliding their heels toward their buttocks; Abduct one UE to 90° or less and horizontally adduct the other UE; Lower the knees on the side of the abducted UE and turn the hips and shoulder to roll onto the side; If clients have weakness on one side, have them reach across their body with their unaffected side to grip the bedrail or halo. Lower the knees on the affected side and turn the hips and shoulder to roll onto the affected side; If clients have weakness secondary to spinal disease or injury, and have precautions to avoid twisting the spine, have them hold onto a bedrail and drop the knees while turning their shoulders and hips at the same time like a log (log rolling); If clients require assistance to roll in bed, therapists can assist clients with shoulder protraction, grabbing the bedrail, flexing the knees, and guiding the roll.
Describe bed mobility for bridging in bed.
Clients should lay flat on their back, bend the knees, and bring the feet flat on the bed; Lift the buttocks, upper legs, and lower back on the bed using the back and hip extensors. Move the hips toward the desired position; Therapists can help stabilize the knees and feet if clients have difficulty holding the lower extremities (LEs) in position; Clients can place their hands flat on the bed for stabilization if required.
Describe sitting at the edge of the bed to supine.
Clients should sit close to the head of the bed. They should scoot back further in the bed by placing both hands flat on the bed and weight shifting on one side while pulling their opposite pelvis backward until they are seated with their thighs fully supported in bed; Lift LEs with knees slightly bent onto the bed, while simultaneously leaning down on one forearm or holding the handrail with the hand closest to the head of the bed; Clients should then roll onto their back using their UEs and LEs to guide the roll; For clients with one-sided weakness, therapists should place both hands under the clients' buttocks to scoot them back in the bed, while stabilizing their LEs between their knees. To move to side-lying, have clients lay down on their affected side in the bed by holding onto the handrail with the unaffected UE and placing the forearm of the affected UE on the bed for support. Hook their unaffected LE below the affected LE to simultaneously lift both legs onto the bed; For clients with LE or whole-body weakness, therapists can place both hands under the clients' buttocks to move them back into the bed. When moving to a side-lying position, therapists can guide clients by placing one hand under the scapula of the side closer to the head of the bed to lower clients in bed; the other hand guides the LEs onto the bed.
What does scooting in bed allow?
Clients to be mobile in bed and build strength in trunk and LE muscles
what reduces the amount of effort required to reach perianal areas for toilet hygiene?
Comfort-wipe extended-handle toilet paper holder or tongs
T/F: LE orthotics should not be donned and doffed similarly to donning and doffing socks as described in dressing.
FALSE
T/f: ADL performance should not be assessed in the environments in which they are typically done, or the environment should closely simulate clients' natural environments.
FALSE
T/f: For clients with weakness of the LEs, trunk, and/or UEs, it is often not easier to engage in intercourse while in a wheelchair or while seated and supported by a backrest with the partner positioned on top of them.
FALSE
Describe Modification of Technique for feeding.
Delegate caregivers to precut food and place meals on table;
The following techniques allow clients with impaired or absent sensation to be independent in ADLs:
Develop habits of attending to the affected part to protect against burns, cuts, pressure sores, and bruising during ADLs; Visually inspect the skin for injury and redness regularly during ADLs. Long-handled mirrors can be used to view areas outside the visual field; Protect impaired body parts from sharp items or cold/heat. Avoid placing insensate hands in locations outside the visual field; Use vision to compensate for decreased sensation and limb position awareness/mobility when using the hands for ADLs; Feeding: For loss of sensation in the hands, use built-up handles for feeding to distribute pressure over a greater surface area. Be cautious when holding hot foods right out of the oven or microwave; Reduce the amount of force used to grip objects to prevent breaking them and injuring the hand; Bathing: Always start and end with cold water when running a bath; Dressing: Select clothes that are snug enough to prevent bunching, but loose enough to avoid binding or excessive pressure. Inspect clothes visually or with an area of intact sensation to avoid wrinkles. Dress warmly in cold weather to prevent frostbite. Fine manipulation needed for fasteners may be affected by decreased hand sensation. Clients can learn to compensate visually or may benefit from larger fasteners or adaptive devices described for people with impaired coordination, such as buttonhooks or Velcro closures; Grooming: Use electric razors for safe shaving. Avoid using electric hair curlers, irons, and straighteners
Describe Modification of Technique for toileting and toilet hygiene.
Don't strain during a bowel movement; Set a routine for bowel management;
is the ability to sustain physical activity over time.
Endurance
t/f: Bridging does not enable clients to move their hips to allow independence or assistance with ADLs in bed such as lower body dressing, toileting, and perineal hygiene
FALSE
t/f: Excessively large individuals with a medical condition may have less occupational performance deficits than are typically seen because of preexisting limitations in strength relative to body mass, limited reach, and decreased endurance.
FALSE
t/f: It is not important to identify body type and fat distribution to determine the proper equipment that fits the client and environment.
FALSE
t/f: Low vision does not place people at risk for falls and other injuries and decreases ADL performance.
FALSE
t/f: Occupational profiles do not help therapists understand client abilities, capacities, interests, values, roles, habits, routines, environments, and needs related to occupational engagement.
FALSE
t/f: do not establish routines or use alarms for regular bowel and bladder voiding.
FALSE
t/f: Clients with cognitive-perceptual disorders regarding Loss of Use of One UE or One Side of Body may not have difficulty learning and retaining information.
False
t/f: Individuals who are satisfied with their life roles have the resources and capabilities needed to accomplish everyday tasks, whether they perform tasks themselves or do not seek assistance.
False
what kind of clients use bridging in bed?
For clients with weakness, bridging in bed can assist with strengthening the back, abdominals, quadriceps, and gluteal muscles.
what can move clients out of bed into seated positions; Two people should always assist with Hoyer lift transfers to ensure safety?
Hoyer lifts
is the loss of precise smooth movements and can result from central nervous system disorders.
Incoordination
Why is rolling in bed a critical component of bed mobility?
It allows clients to change position by shifting weight in bed, assists with lower body dressing, and prepares the body to sit up in bed
What is the removal of all or part of the LE on one or both sides?
LE amputation
what assists with lifting clients' legs into or out of bed, one leg at a time?
Leg lifters
OT intervention focuses on compensatory strategies including-
Maximize visual functioning; Modify the task or environment to enhance visual performance; Modify tasks or environments to reduce or eliminate visual performance.
what is one way of avoiding excessive reaching?
Organize and place required supplies in close proximity
Describe Modification of Technique for bathing and showering.
Pace activities and incorporate rest breaks; If sponge bathing bedside, set all items on tray table or nearby within easy reach; It is preferable to take showers instead of baths. Baths require too much energy to get in and out of the tub basin; When showering, preplan: Prepare all items needed for showering (place soap, shampoo, clothing, and towels within reach).Delegate aspects of the task to be completed by caregivers; Use lukewarm water because hot water may increase fatigue level; Cross legs to bathe feet while seated on a tub bench (it takes less energy) or use long-handled equipment.
Describe Modification of Technique for dressing.
Pace dressing activities, and other ADLs completed before and after dressing, so that clients do not perform multiple ADLs in a row without breaks; Incorporate rest breaks; Sit to perform dressing; Preplan and gather needed items: Organize clothes within easy reach in dressers and closets; Crossing the legs to don socks and shoes requires less energy than bending down; Wear light, loose clothing (microfiber stretches); Dressing techniques for weakness apply to clients with low endurance and fatigue.
What are important contextual and environmental factors that might impact client performance?
Physical environmental factors such as clutter, barriers to access, rugs, steps, or stairways should be eliminated or adapted for safe ADL performance; Cultural and social factors also impact ADL performance and should be incorporated in evaluation and intervention when possible and desired by clients; Therapists working in acute or intensive care settings must consider the client's medical complexity.
what do we use to move clients from sitting on a toilet seat to standing or moving to a mobility device?
Use toilet seat lifts to mechanically
Describe Bed Mobility Modification Techniques.
Preplan: Prepare the surface to which the patient will transfer and/or the ambulatory device needed; Perform bed mobility tasks in steps and take breaks; Supine to sit: Log roll independently or, depending on low endurance level, use assistance of one or two persons (see Weakness); Bed mobility techniques for weakness apply to clients with low endurance and fatigue
It is often important to assess client factors and skills such as what?
ROM, strength, sensation, balance, and cognition prior to beginning ADL assessments.
Clients with LE amputations can benefit from many of the adaptations described for people with limited mobility caused by what?
SCI, weakness or limited ROM;
what technique can have arms supported on the surface?
Sit at the sink or vanity for personal hygiene,
Describe Modification of Technique for Personal Hygiene and Grooming.
Sit to perform grooming activities, including brushing teeth, shaving, hair care, and makeup; Rest upper arms/elbows on vanity/counter; Preplan needed items and position them in easy reach; Take rest breaks;
Toileting requires a person to be able to do what?
don and doff clothing, sit on and rise from the toilet, reach and grasp toilet tissue, and clean perianal areas.
Describe a general bathing to shower technique.
Start with sponge bathing in bed (clients may need to begin with the upper body and progress to the whole body as tolerated). Clients should roll on their side to wash their back or allow caregivers to assist. Progress to bedside sponge bathing, then bathing at the bathroom sink, followed by a walk-in shower with a shower chair, and finally showering in a tub with a bath bench.
T/f: Crossing one leg over the other while seated to wash alternate lower limbs is easier than bending down to wash limbs.
TRUE
t/f: Clients should sit at a table with arms supported while using, cleaning, and maintaining personal devices.
TRUE
t/f: Clients who have weakness due to spinal cord injury may have loss of bowel and bladder control.
TRUE
t/f: Electric or adjustable beds with powered head and knee controls assist with moving from supine to sitting and sitting to supine in bed.
TRUE
t/f: Memory deficits can have significant impact on clients' ability to remember ADL steps and sequences.
TRUE
t/f: Most standard DME is manufactured to serve individuals weighing approximately 250 to 300 lb. Individuals weighing more must have specialized equipment ordered.
TRUE
t/f: Regarding chart review, It is important to determine the exact prescription for OT evaluation and intervention.
TRUE
t/f: Sexual activity is often an area of concern for individuals with disabilities.
TRUE
t/f: Teaching bed mobility skills to clients with weakness promotes ADL participation.
TRUE
t/f: Therapists can evaluate ADL performance by asking clients to provide a self-report of their performance or use performance-based ADL assessments.
TRUE
t/f: lower body dressing is unique owing to prosthetic device use.
TRUE
What is Dependent?
Therapist provides more than 75% of assistance (physical or verbal), and clients are able to perform less than 25% of the activity
What is Contact guard?
Therapists place one or two hands on the client's body to maintain balance, dynamic stability, or safety; however, they do not assist in task performance.
What is Minimal assistance?
Therapists provide 25% of assistance (physical or verbal), and clients are able to perform 75% or more of the activity.
What is Moderate assistance?
Therapists provide 50% of assistance (physical or verbal), and clients are able to perform 50% to 74% of the activity.
What is Maximal assistance?
Therapists provide 75% of assistance (physical or verbal), and clients are able to perform 25% to 49% of the activity.
Describe Use of Adaptive Equipment or Altering the Task Environment for bathing and showering.
Use tub benches for clients who do not have the endurance to step in and out of the tub; Use shower chairs for clients who have the endurance to step in and out of the tub, but who fatigue easily; Use long-handled equipment (long-handled bath and toe sponges).Use shower hoses or adjustable mounted shower hoses; Use shower caddies with all needed items within reach; Use soap on a rope placed nearby and bath mitts with soap inserted in pockets to eliminate having to hold soap and washcloths; Use walk-in showers or tubs
Drink-mounting devices for beds or wheelchairs allow clients to what?
drink without holding onto cups.
Describe bed mobility for scooting in bed.
To scoot to the head of the bed, clients should flex the hips and knees with feet flat on the bed. Bring the heels close to the buttocks. Shoulders should be slightly abducted and elbows should be flexed so that hands are flat on the bed next to the waist. Clients should raise their pelvis using bridging techniques and push on the LEs, while depressing and adducting their shoulders simultaneously to move up in bed; To move down in bed, clients should flex their hips and knees with feet flat on the bed. Shoulders should be adducted, and elbows flexed with hands flat on the bed next to the buttocks. Clients should pull on their LEs to push their buttocks closer to their heels while simultaneously pushing up with the shoulders and abducting the shoulders to move down in bed; For clients who need more assistance because of weakness, therapists can assist by stabilizing the knees and feet; Alternatively, to scoot to the head of the bed, lower the head of the bed to make it flat, place a sheet under the client, and use a two-person assist to pull the sheet toward the head
what can help with rolling and moving to the edge of the bed; two people should always assist with transfers for safety?
Transfer sheets or draw sheets
t/f: Absent or impaired sensation affect ADL and IADL performance because of the lack of sensory information provided to the motor system.
True
t/f: Fatigue is not simply low endurance, but a subjective experience of feeling tired or exhausted.
True
t/f: For clients with lost use of one UE or one body side, it is essential to teach bed mobility techniques that are safe and that protect the affected shoulder.
True
t/f: In adults, BMIs between 18.5 and 25 are desirable.
True
what do we use to avoid the need to ambulate to the bathroom?
Use 3-in-1 bedside commodes with pails
what do we use for clients who have difficulty getting to the toilet in time or completing toileting activities?
Use bed pans or adult diapers
What kind of adaptive equipment are used for clients with LE/trunk weakness?
Use bed rope ladders or overhead trapeze bars
personal hygiene and grooming, individuals with reduced grasp can use what?
Use built-up handles on toothbrushes
Describe Use of Adaptive Equipment or Altering the Task Environment for dressing.
Use dressing sticks, reachers, and sock aids; Use slip-on shoes or shoes with elastic laces or Velcro; Use Velcro closure and zipper pulls.
what can we use for clients who need to reach behind for toilet hygiene?
Use drop-arm commodes
Describe Use of Adaptive Equipment or Altering the Task Environment for Personal Hygiene and Grooming.
Use electric razors; Use electric toothbrushes; Use standing or wall-mounted hair dryers.
what do we use to increase safety while transferring?
Use floor-to-ceiling grab bars
Describe Use of Adaptive Equipment or Altering the Task Environment for feeding.
Use long-handled and lightweight utensils; Mobile arm supports and deltoid aids assist with bringing the hand to the mouth; Consider feeding robots (iEat) or electric feeding devices (Mealtime Partner); Use chairs that support the trunk and neck
Strategies that can assist clients with memory deficits in independent ADL performance include:
Use of graded cueing strategies beginning with verbal, then visual, and finally tactile cues; Simplifying activities by breaking them into small steps; Reducing the amount of physical, visual, and auditory clutter in the environment; Developing lists of needed ADL and the order in which they should to be completed; Posting large, visual, step-by-step instructions in the areas where ADLs are performed (such as toileting instructions in front of the commode); Using alarms to remind clients when ADLs need to be completed (such as toileting routines, and eating and medication schedules); Journaling to remember tasks that need to be or have been completed; Using labels on containers, bottles, and cupboards as organizational reminders; Lists, alarms, journals, and reminders can be configured on smartphones and tablets because of programming ease and information portability; Intelligent assistive technologies help clients with memory
what do we use for easier transfer on and off toilets?
Use raised toilet seats and grab bars or arm rests
Describe Use of Adaptive Equipment or Altering the Task Environment for toileting and toilet hygiene.
Use raised toilet seats; Use stools (squatty potty) that raise the feet in a squatting position to promote effortless bowel movements; Use toilet-bidet combos for toilet hygiene.
what are some questions to ask for the occupational profile?
What is the client's current lifestyle? What was the client's ADL status prior to injury, disease, or illness? What are the client's current occupational challenges? What comprises the client's typical day-to-day routines? What occupations are meaningful to the client? In what environments does the client currently navigate to complete occupations?
Occupational profile:
a component of the occupational therapy evaluation that provides information about clients' occupational histories and experiences, daily living patterns, interests, values, needs, reasons for seeking services, and concerns related to occupational performance and disruption.1
Alternatively, clients with hemiparesis can position themselves in what?
a missionary position with their partner on top and supporting some of their weight on the surface on which they are lying.
For clients with paralysis, it is better to be positioned below the partner in what?
a missionary position, with a rolled towel or small pillow to support the lumbar spine.
Evaluation begins with what?
a thorough chart review.
The World Health Organization defines overweight and obesity as what?
abnormal or excessive fat accumulation that may impair health.
the Occupational Therapy Practice Framework, Third Edition (OTPF-3), identifies eight areas of occupation, including-
activities of daily living (ADLs), instrumental activities of daily living (IADLs), rest and sleep, education, work, play, leisure, and social participation.
Activities of daily living (ADLs):
activities oriented toward taking care of one's body and include bathing and showering, toileting and toilet hygiene, dressing, swallowing and eating, functional mobility, personal device care, personal hygiene and grooming, and sexual activity. They are also referred to as personal activities of daily living (PADLs) or basic activities of daily living (BADLs).1
Occupations:
activities that individuals, groups, or populations engage in that are meaningful and include activities of daily living, instrumental activities of daily living, rest and sleep, education, work, play, leisure, and social participation
Occupations are defined as what?
activities that provide a sense of identity and meaning to individuals, groups, and populations.
Eye diseases that cause low vision include, but are not limited to, what?
age-related macular degeneration (ARMD), glaucoma, diabetic retinopathy, and retinitis pigmentosa.
Use wall-mounted hair dryers to-
dry hair.
Client-centered approach:
an approach to service delivery that includes respect for and collaboration with clients (individuals, groups, agencies, governments, or corporations). Therapists involve clients in decision-making, advocate for and with clients to meet needs, and recognize clients' experience and knowledge.2
The chart review will inform therapists about what?
any restrictions or contraindications including other comorbidities, current ambulation or weight-bearing status, and current equipment use; also provide preliminary information about clients' prior ADL status, home environment, and support system.
Many clients who sustained stroke may also have what?
apraxia, a motor perception disorder that affects motor planning and the ability to learn new or perform previously learned motor skills.
Use pump or automatic soap dispensers for clients who-
are unable to lift and squeeze.
How is Low vision defined?
as visual acuity of 20/70 or worse in the better eye that is not correctable through surgery, pharmaceuticals, glasses, or contact lenses.
Incoordination may present as-
ataxia, dysmetria, dyssynergia, dysdiadochokinesis, tremors, and involuntary movements.
Stabilizing the body as much as possible by sitting during ADL activities,
bearing weight on the UEs, holding the UEs close to the body, or using splints to stabilize selected joints can improve clients' extremity control
Depending on the disease or causative factor, vision loss may include-
blurred vision, lost sight in certain visual fields, blind spots called scotomas, tunnel vision, low-contrast sensitivity, or lack of glare modulation.
Swivel utensils reduce the amount of rotation required to what?
bring food from plate to mouth.
How is low vision caused?
by eye diseases, inherited conditions of the eye, aging conditions of the eye, and trauma.
Sporks, which combine spoons and forks, eliminate the need to what?
change utensils while eating.
what does sitting at the edge of the bed allow?
clients to prepare to stand, transfer to a mobility device, and complete ADLs such as grooming, feeding, and hygiene in a seated position.
Use built-up handles on-
combs and brushes
Use universal cuffs to hold-
combs, brushes, toothbrushes, razors, and lipstick.
Rocker knives with or without T-handles allow clients with UE weakness to what?
cut their food with a rocking motion
Adaptive equipment:
devices, tools, or products that are used to assist individuals with disabilities to engage in occupations within their natural contexts and environments; also referred to as assistive technology, assistive devices, or adaptive devices.
Feeding concerns for clients with weakness are caused by what?
difficulty grasping utensils, cutting food, and bringing food from plate to the mouth.
Managing and using personal devices such as contact lenses, glucose monitors, and orthotics may arise because of what?
difficulty grasping, pinching, and positioning devices.
Weakness in the limbs, trunk, or overall body can result in what?
difficulty in dynamic and static balance, posture, transfers, functional mobility, reaching, and grasping.
Use shower wraps to dry body for clients who have what?
difficulty manipulating and using towels.
Obesity can aggravate osteoarthritis, damage joint structures, destroy cartilage, and cause spinal and peripheral nerve compression—which can lead to what?
difficulty moving and reaching, decreased activity tolerance and mobility, and difficulty accessing the environment.
Challenges or difficulties in ADL performance can occur secondary to what?
disability, illness, or injury and lead to activity limitations and participation restrictions.
Place commonly used personal devices in close proximity to what?
each other and at easy-to-reach locations.
Use long, large, or lever shower handles for-
easier grip or touchless faucet adapters.
Use flip-top bottles for-
easier opening and closing.
Plate guards and long-lipped plates allow what?
easier scooping of food
Use waterpiks or dental floss holders for-
easier teeth flossing.
Food can be stored in containers with-
easy-to-open lids for one-handed use.
Use hair removal cream to-
eliminate the need for razors.
If clients have a back brace when showering or bathing,
ensure that there is a second set that can be worn in the shower.
how are bariatric equipment made?
extra wide and with materials to provide stable support for obese and morbidly obese individuals.
When clients have hemiparesis, positioning both partners in a side-lying position with the client lying on the affected side allows what?
free movement of the unaffected side.
For toileting and toilet hygiene, clients with weakness may have difficulty with what?
grasping and holding onto clothes and cleaning supplies, as well as transferring onto and off of toilets.
For personal hygiene and grooming, clients with weakness, especially of the UE, will have difficulty with what?
grasping and holding onto grooming supplies, such as combs, brushes, makeup, and shampoo
Therapists should understand the importance of assessing and monitoring endurance and fatigue during ADL performance such as what?
heart rate (HR)/vitals, metabolic equivalent for task (MET) levels, number or repetitions over a period of time, and scales of perceived exertion.
Built-up utensils allow clients with limited grasp to what?
hold onto utensils
Therapists should also be aware of precautions and contraindications when performing ADLs for persons with low endurance and fatigue such as what?
holding one's breath during ADLs; isometric contractions for clients with active cardiac histories; significant changes in blood pressure, O2 rate, and HR (>20 beats over resting HR); shortness of breath (dyspnea); and angina.
Body mass index (BMI), calculated as body weight in kilograms divided by height in meters squared (kg/m2), is commonly used to what?
identify overweight and obesity in adults.
What does Evaluation information contain?
including interviews, occupational profiles, and assessment instruments—are integrated to develop intervention plans, goals, and outcomes.
ADLs are the focus of evaluation and intervention in most settings in which occupational therapists work including-
intensive care, acute care, acute rehabilitation, subacute rehabilitation, skilled nursing facilities, outpatient facilities, home care, and hand therapy.
Prior to beginning ADL intervention sessions,
it is important to plan therapy sessions, set up the environment, and ensure that chosen activities provide the "just right challenge.
For deodorants, replace fingertip dispensers with long trigger nozzles to allow clients to-
spray themselves using all fingers, palm, or fist.
Rear entry positions may be used with both partners-
kneeling and both sets of forearms on the bed or supporting surface; this reduces both partners' energy expenditure.
Toothpaste dispensers require what?
less strength to dispense toothpaste on a toothbrush
Long or flexible straws reduce the need to what?
lift and tilt cups.
Difficulties in occupational engagement lead to what?
loss of functional independence and reduced quality of life.
Use jar openers for twist-off caps on-
lotions or makeup supplies.
For dressing, clients with weakness or paralysis may have difficulty with what?
obtaining clothing, moving extremities into clothing, and manipulating buttons or zippers because of decreased grip and pinch, and decreased sitting balance.
Suctioned denture brushes and cleaners (in which dentures soak overnight) allow-
one-handed cleaning.
Individuals who have lost use of one UE or one body side (hemiplegia) are taught what?
one-handed techniques to facilitate ADL independence.
For nail care, mount the nail clipper and/or nail file to a friction resistant or emery board to allow-
one-handed use; Nails can be clipped using the palm or fist of the opposite hand
Large flip-top contact lens cases can be what?
opened and closed with fist movements.
BMIs between 25 and 30 are classified as what?
overweight, 30+ are obese, and 40+ are morbidly obese.
Incoordination leads to-
poor dexterity, which is loss of fine and nimble manipulation, and motor coordination skills
For clients with spinal cord injury, it is necessary to complete what?
preparatory activities prior to engaging in sexual activity, such as emptying the bladder and managing catheters.
Preparatory methods can be followed by what?
purposeful activities, such as donning button-down shirts or cooking family meals.
Long-handled sponges, brushes, and toe brushes allow clients to what?
reach all body parts with minimal effort
Mobile arm supports promote client horizontal and vertical arm movements to what?
reach plates and mouth; can be mounted to sinks, wheelchairs, or tables and are portable.
Limited or restricted ROM of the limbs, trunk, or overall body could result in difficulty in what?
reaching body parts to perform self-care, reaching for objects at different heights, transferring or sitting on surfaces with different heights, functional mobility, and grasping items to complete ADLs.
Long- and short-term goals should focus on what?
remediating client skills, modifying performance techniques, altering the environment, or using adaptive equipment, to maximize independent ADL performance
The restoration approach focuses on what?
remediating client skills, which may have been lost due to injury or disease, to promote occupational resumption.
Use pump or automatic dispensers for-
shampoos and lotions.
Glasses or cups with lids prevent-
spillage.
Nonslip mats provide what?
stability in the shower.
Clients who have incoordination disorders or poor dexterity have difficulty with what?
stabilizing body parts and safely coordinating movements and objects to complete ADLs.
An important component of cognition is memory, which includes-
storing and retrieving information for use.
What are some standardized ADL assessments therapists may use?
such as the Functional Independence Measure (FIM); the Klein-Bell Activities of Daily Living Scale; the Katz Index of Independence in Activities of Daily Living; Performance Assessment of Self-Care Skills (PASS); Disabilities of the Arm, Shoulder, and Head (DASH) Assessment; and the Barthel ADL Index; or nonstandardized measures such as ADL checklists
Temperature-control shower valves eliminate what?
sudden water temperatures changes.
Durable medical equipment (DME):
supplies that provide therapeutic benefit to clients experiencing difficulty or functional deficits resulting from medical conditions or illnesses. DME must be prescribed by physicians or health care providers authorized by state law. DME must be reusable and primarily used in the home.
Position the client close to the table and use the table surface to what?
support the arms while eating.
Bed mobility is what?
the ability to bridge in bed, roll from supine to side-lying, scoot up and down in bed, move from supine to sitting and sitting to supine, and sit at the edge of the bed.
Cognition involves what?
the ability to perceive, understand, and make use of information.
Handheld adjustable shower hose or shower slide bars reduce what?
the amount of movement needed in the shower.
Electric toothbrushes reduce what?
the effort required to brush teeth.
Bariatrics is a health care field that relates to or specializes in what?
the investigation, prevention, and treatment of obesity.
Large-handled or two-handled cups reduce-
the need for a strong grasp.
Applying friction material to tool surfaces can reduce-
the need for grasp strength.
Soap on a rope or wash mitts with soap inserted in pocket reduce what?
the need for grip strength.
Universal cuffs with eating utensils reduce what?
the need to grasp
In addition to identifying different positions, it is important to discuss what?
the scope of intimacy (including increasing opportunities to touch, hug, and kiss), to shift the focus from function to pleasure, and to consider the impact of impairment on body image and fears about resuming sex.
For seated clients with one-sided, lower body, or whole-body weakness who require help to move the buttocks toward the bed edge,
therapists can stabilize the clients' legs between their knees, and place both hands under the clients' buttocks or behind their knees to gradually move their body forward.
Regarding bathing and showering, clients with weakness may have difficulty with what?
transferring into the bathtub or shower, standing or sitting in the shower, and grasping and holding onto items such as soap.
The techniques used and the amount of assistance regarding weakness provided to clients will differ based on what?
upper and lower body weakness, trunk weakness, or overall body weakness.
