What is an Activities of Daily Living Evaluation, and what is its purpose for occupational therapy?

Expert Answers
Jamie Wheeler eNotes educator| Certified Educator

Let’s begin with a definition of an Active Daily Living (or “ADL”) evaluation.  An ADL is assessment of a person’s physical, and, frequently, mental state.  In occupational therapy, (or “OT”) an individual’s ADL provides information to the attending physician or therapist regarding the patient’s progress in recovering from disease or injury as well as how well a patient can perform everyday task.  An ADL may also be used to determine how successfully a patient can relate to, and participate in, their society. 

There are a variety of purposes for conducting an ADL.  The assessment assists doctors and therapists in determining the patient’s present and future abilities in becoming autonomous.  No matter who is working with the patient, the professional’s goal is to help the person become as independent as possible, recommending adaptations when appropriate.

It should be understood that “ADL” refers to a number of indexes, among them the Katz Index, the Barthel Index, and the Revised Kenny Self-Care Evaluation. All of these assessment models measure and evaluate a person’s self-care abilities. A rating system is employed and scored based on these observed functional abilities. Higher scores mean that a person can perform routine tasks with little or no assistance, while lower scores indicate that moderate to intense supervision and assistance is required. 

There are two types of ADLs:  Basic and Instrumental.  Basic ADLs score a patient’s ability to perform self-care tasks such as bathing, dressing, feeding, and using the restroom independently.  After observation, the health care professional can suggest any changes that might be implemented in order for the individual to achieve a greater level of independence.

Instrumental ADLs measure abilities that extend beyond basic self-care.  In an Instrumental ADL, the health care professional assess the patient’s ability to function successfully at home, at work, and in their social circles.  Specifically, the evaluator will rate a patient’s ability to drive a car, cook and clean in their homes, shop for themselves, and balance a checkbook, among other things.    

At work, the Instrumental ADL evaluation rates a patient’s ability to perform necessary job functions, such as endurance, strength, and pain management.

An ADL is typically called for following injury or diagnosis to determine when a how much intervention is necessary for a person to carry on as normal a life as possible.  If an individual’s ADL function cannot be resorted, the next step is an intervention. An intervention is designed to help a person cope an adapt to permanent disability or dysfunction, or a plan is instituted to improve function.  Success for the patient is affected by many things, including where the individual lives whether the patient is returning to his or her previous home, the state of that home, or the quality of his or her assisted living or nursing home. 

There are other factors that affect patient’s success in recovery.  One of those factors is the patient’s own attitude toward his or her recovery.  Motivation to improve is integral to success. The health care professional must approach recovery holistically; that is, they must not only evaluate the physical, but also the mental state of the patient, as both affect well-being.  Depression is one area that can be evaluated by an OT.  However, injuries that have caused permanent cognitive disabilities frequently require family members or caretaker training in how  they must go about performing daily tasks for the patient.

One way to improve life for patients is to make adaptations to the patient’s physical environment.  Such adaptations often include making household items more accessible, and therefore, more functional. Things like grips in the shower, for instance, to aide bathing, or long-handled gripping sticks are typical, small improvements that can ease life for patients in big ways.

Source: Encyclopedia of Nursing & Allied Health, ©2002 Gale Cengage.

mizzwillie eNotes educator| Certified Educator

An Activities of Daily Living Evaluation is just what it says, an evaluation of how well a person can do the activities of daily life on their own.  My son has been through this several times, and the idea is to know if he can dress himself, take care of making himself food, buying food if need be, take a shower and know when he needs to, can use the bathroom independently, and feed himself without help.  Other questions are also considered, but you get the idea.  The purpose for occupational therapy is to consider what treatment options would best help this patient.  For example, my son is autistic, high functioning, and as a student, often needed to either swing on the highest swing available at school or cut off all stimulation in a quiet room.  His occupational therapy was one of the few things which truly helped him when he was at the end of his ability to cope for that day.  One odd thing which helped him was to crash him as hard as possible into a padded wall while on a swing.  The evaluation is an invaluable tool to assess patients and find treatments which work.