An activities of daily living (ADL) evaluation is an assessment of an individual's physical and sometimes
mental skills. In the area of physical or occupational therapy, it reflects how well a disabled patient or someone recovering from disease or accident can function in daily life. It is also used to determine how well patients relate to and participate in their environment.
ADL evaluations help practitioners determine how independent patients are and what skills they can accomplish on their own, as well as to gauge how independent each individual can become after intervention by a health professional. The goal of practitioners performing ADL evaluations is to help patients become as independent as possible, using appropriate adaptations if needed.
Many ADL indexes exist, such as the Katz Index, Revised Kenny Self-Care Evaluation, and the Barthel Index. These indexes typically evaluate patients on their self-care skills and rate each individual according to how functional they are. Scoring is based on how independently a task can be performed and whether supervision or assistance is needed in performing the task.
Basic ADL versus Instrumental ADL
Basic activities of daily living are those skills needed in typical daily self care. An evaluation would, in part, consist of bathing, dressing, feeding, and toileting. The evaluator would examine various activities in each category to determine the patient's skill. Afterward it can be determined what, if any, changes will be necessary to allow the patient to function as independently as possible.
Instrumental activities of daily living refer to skills beyond basic self care that evaluate how individuals function within their homes, workplaces, and social environments. Instrumental ADLs may include typical domestic tasks, such as driving, cleaning, cooking, and shopping, as well as other less physically demanding tasks such as operating electronic appliances and handling budgets. In the work environment, an ADL evaluation assesses the qualities necessary to perform a job, such as strength, endurance, manual dexterity, and pain management.
If a person is being treated following an injury or disorder diagnosis, whether an intervention is needed depends upon how severe his or her functional ability has been affected. If an individual's ADL function is not restored, a health care professional will perform an intervention, which entails helping the individual adapt to permanent dysfunction or regain meaningful function. How well an individual must be able to perform these tasks depends upon the living setting he or she is returning to, whether it is a full custodial facility, assisted living community, or living at home on his or her own.
Returning a client to full meaningful function can be problematic for individuals who do not have the motivation to do so. A holistic approach to treatment is most important in cases such as these, and physical and occupation therapists are trained to evaluate not only the physical disability or dysfunction of an individual, but also the person's mental health and well-being. Occupational therapists can address mental health issues resulting from injury or disorder diagnosis, such as depression. However, in cases where a patient has sustained a permanent cognitive disability and is learning-impaired, it is more effective and appropriate for the occupational therapist to teach family members or a caretaker how to perform daily tasks for the patient.
Interventions implemented to increase function include adaptations and home modification. Adaptations are devices that can enhance the usability of everyday items for individuals who have a limited range of motion. Home modification involves the process of making one's living environment more functional for ADL.
There are several ways that adaptations can be used to make common household items more functional. For example, patients commonly have a weakened grasp that is insufficient to hold heavy or small objects, so enhancements such as easily gripped handles could be added to small objects, such as eating utensils or personal grooming items. Other adaptations may involve the use of unique tools to facilitate tasks, such as using a long rod with a hook at one end, known as a dressing stick, to pull on pants or socks. Adaptations may involve altering the environment to aid in other tasks, such as providing adequate lighting or magnifying lenses to compensate for a vision impairment.
Home modification has become a major area for occupational therapists to practice. In order for patients to return home or go to a group setting, the physical environment of the house or facility may have to be altered to make ADL function better. Common examples of home modifications include the installation of grab bars in the shower, toilet area and hallways; lower kitchen counters for easier access to wheelchair-bound individuals; and the elimination of potential trip points, such as loose throw rugs and slight changes in floor elevation.
Health care team roles
Occupational therapists and physical therapists are the two primary disciplines most qualified to assess ADL function and recommend the appropriate intervention and modifications in one's home and work environment. Physical therapists might focus primarily on a patient's mobility and ambulation, while the occupational therapist might focus on more specific tasks described above.
Adaptationltering a tool used in performing a task so that the patient is better able to function independently or with minimal assistance.
Dressing stick long rod with a hook attached to the end that a patient uses in place of the hands. Typically a dressing rod would be used to pull on a pair of pants or socks.
Home modificationltering the physical environment of the home so as to remove hazards and provide an environment that is more functional for the patient. Examples of home modification include installing grab bars and no-slip foot mats in the bathroom to prevent falls.
Eisenberg, Myron G. Dictionary of Rehabilitation. New York: Springer Publishing Company, Inc., 1995.
Neistadt, Maureen E. and Elizabeth Blesedell Crepeau. Williard & Spackman's Occupational Therapy. Philadelphia: Lippincott-Raven Publishers, 1998.
Reed, Kathlyn L. and Sharon Nelson Sanderson. Concepts of Occupational Therapy Practice Baltimore: Lippincott Williams & Wilkins, 1999.
Trombly, Catherine A., ed. Occupational Therapy for Physical Dysfunction Baltimore: Williams & Wilkins, 1995.
The American Occupational Therapy Association. 4720 Montgomery Lane, Bethesda, MD 20824-1220. (301) 652-2682. <<a href="http://www.aota.org">http://www.aota.org>.
The American Physical Therapy Association. 1111 North Fairfax Street, Alexandria, VA 22314-1488. (703) 684-2782. <<a href="http://www.apta.org">http://www.apta.org>.
Meghan M. Gourley
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