Slide 1. Slide 2 Disclosure. Slide 3 Objectives. Functional Mobility and Activities of Daily Living: Assessing and Treating Patients in Rehabilitation

Size: px

Start display at page:

Download "Slide 1. Slide 2 Disclosure. Slide 3 Objectives. Functional Mobility and Activities of Daily Living: Assessing and Treating Patients in Rehabilitation"

Angelica West
6 years ago
Views:

1 Slide 1 Functional Mobility and Activities of Daily Living: Assessing and Treating Patients in Rehabilitation Terry Carolan, MSPT, NCS Slide 2 Disclosure Terry Carolan has no industry disclosures to make Slide 3 Objectives Define Functional Mobility Define Activities of Daily living Compare ADL Teaching Strategies Identify Population Specific Strategies & Adaptive Equipment for ADLS and Transfers Review the Impact of Seating and Positioning on Functional Mobility

2 Slide 4 What is Functional Mobility? Due to an injury or illness, muscles of the body may become weak/paralyzed or pain may limit movement. There are 3 main areas of functional mobility: Bed mobility Transfers Ambulation Slide 5 What are Activities of Daily Living (ADL)? ADL= Self-Care or Self- Maintenance Tasks Grooming Oral Hygiene Bathing/Showering Toilet Hygiene Personal Device Care Dressing Feeding & Eating Medication Routine Socialization Functional Mobility Functional Communication Sexual Expression Slide 6 What are IADLs? (Instrumental ADLs) Managing finances Handling transportation (driving or navigating public transit) Shopping Preparing meals Using the phone and computer Managing medications Housework and basic home maintenance

Slide 7 Teaching ADL strategies depends on the individual Adaptation:

Equipment (DME) Alternative Strategies Recovery: Remediation of

practice of close to normal movement Slide 8 And the diagnosis Stroke

3 Slide 7 Teaching ADL strategies depends on the individual Adaptation: Compensation for loss of function Adaptive Equipment Durable Medical Equipment (DME) Alternative Strategies Recovery: Remediation of functional deficits Targeted impairment level interventions Repetitive practice of close to normal movement Slide 8 And the diagnosis Stroke Traumatic Brain Injury Spinal Cord Injury Orthopedic Slide 9 Joint Protection Giv-Mohr Sling

4 Slide 10 UE Support Slide 11 DF wrap to protect ankle Slide 12 Impact of Seating and Positioning on Function

5 Slide 13 Cushions Slide 14 Pressure Mapping Slide 15 Postural Support

6 Slide 16 Potential hazards of poor seating and positioning Pressure Ulcers Flexible and fixed postural abnormalities Pain Limited functional mobility Agitation Joint Injury Contractures (Stretch of 1 minute vs. Positioning of 1 hour) Slide 17 Instructing a family member how to stretch Verify the physical health of the family member Isolate the movement at the desired joint Stretch the muscle into the desired range Stretch until mild resistance is felt Hold for 30 seconds Have family member return demonstration Consult MD, PT, or OT prior to stretching Be aware of precautions (THR precautions, shoulder elevation above 90 degrees in an impaired UE, spinal ROM in SCI patients, preserving tenodesis pattern in SCI) Slide 18 Physical deficits after Stroke/TBI Strategies: Strength/ROM: strength training, dominance retraining, one handed techniques, adaptive equipment, forced use Balance: alter position (seated vs. standing), alter amount of support provided

7 Slide 19 Beyond motor deficits: Dysphagia Cardiac precautions Shoulder pain/subluxation G-Tube Visual deficits Cognitive/Behavioral deficits Stroke/TBI Slide 20 Feeding/Drinking Adaptive Equipment for Stroke/TBI Plate Guards Dycem Slide 21 Feeding/Drinking Adaptive Equipment for Stroke/TBI -Adjustable Angle Spoon -Angled Utensils -Built Up Handles -Rocker Knife -Curved Knife

Slide 22 Feeding Strategies for the SCI population Feeding Trials of adaptive

management Setup of adaptive equipment Cutting food Alternative techniques

Population May utilize with C4/C5/C6 tetraplegia Assists with tasks requiring

8 Slide 22 Feeding Strategies for the SCI population Feeding Trials of adaptive equipment Various food types Solids & liquids Finger foods Container management Setup of adaptive equipment Cutting food Alternative techniques for utensil management Slide 23 Feeding Adaptive Equipment for the SCI Population May utilize with C4/C5/C6 tetraplegia Assists with tasks requiring against gravity planes of movement MAS by JAECO Orthopedic Slide 24 Feeding Adaptive Equipment

Slide 25 Utensil Management Finger Weave Technique (C6, C7) Slide 26 Feeding Strategies for the SCI population Consider injury level and need for adaptive equipment C5 Wrist/forearm support Plate

9 Slide 25 Utensil Management Finger Weave Technique (C6, C7) Slide 26 Feeding Strategies for the SCI population Consider injury level and need for adaptive equipment C5 Wrist/forearm support Plate guard, dycem Possible MAS C6 U-cuff or Adapted utensil Wean off of adaptive equipment C7 Adapted techniques Slide 27 Tenodesis Tenodesis: Flexing of the fingers through tendon action of the extrinsic finger flexor muscles when they are stretched across the wrist joint during wrist extension. Tenodesis splint: Custom splint that assists the hand and wrist in performing tenodesis grasp

10 Slide 28 Slide 29 Slide 30 Grooming/Bathing Adaptive Equipment for Stroke/TBI

11 Slide 31 Bathing: DME Slide 32 Dressing Strategies for Stroke/TBI Upper and Lower Body Dressing: Allow for immediate success Start with loose fitting clothing Limited fasteners Clothing positioned in reach Clothing positioned in the intact visual field Position fasteners on non-affected side Attempt in a stable (seated) position Implement one-handed dressing strategies Slide 33 Dressing Adaptive Equipment for Stroke/TBI -Sock Aid -Reacher -Long shoehorn -Button Hook -Dressing Stick

12 Slide 34 Dressing Strategies for the SCI population Consider dressing in bed vs. the wheelchair Evaluate hamstring flexibility Back extensor muscle length for stability Promote lower extremity flexibility Utilize positioning and momentum for lower extremity management Utilize appropriate postural support (in bed or w/c) Introduce adaptive equipment Slide 35 ADL Strategies for the Orthopedic Population Total Hip Replacement: Reinforce total hip precautions during all tasks Confirm approach: anterolateral vs. posterolateral Understand weight bearing status Extended leg for sitting/standing Utilize long handled adaptive equipment Utilize elevated height DME Recommend utilizing chairs with arms Slide 36 ADL Strategies for the Orthopedic population Total Knee Replacement: Understand weight bearing status Extended leg for sitting/standing Utilize long handled adaptive equipment Utilize elevated height DME Recommend utilizing chairs with arms Encourage functional movement of affected knee (ex: squatting motion to reach for clothes from drawers)

13 Slide 37 Toileting Strategies for Stroke/TBI Toilet tissue should be positioned at the unaffected side for ease of access Consider use of clothing without fasteners or modified fasteners Trial one-handed strategies Slide 38 Toileting DME Slide 39 Toileting Adaptive Equipment Clothing management Wheelchair skills Catheter management Catheter clips Catheter guides Catheter mirrors Urinals

Slide 40 Transfer Strategies for the Stroke/TBI populations Transfer types: stand pivot, sit pivot (lateral), transfer board, ambulatory, dependent lift Facilitate anterior weight shifting

14 Slide 40 Transfer Strategies for the Stroke/TBI populations Transfer types: stand pivot, sit pivot (lateral), transfer board, ambulatory, dependent lift Facilitate anterior weight shifting Consistent/appropriate guarding technique Utilize momentum & head hips relationship Slide 41 Head/Hips Relationship Slide 42 Transfer Strategies for the Stroke/TBI populations Understand the impact of neglect: Proper foot placement Only aware of ½ the body Impulsivity and Transfers Promote proper foot placement Manual contacts

15 Slide 43 Transfer Strategies for the SCI population Transfer types: stand pivot, sit pivot (lateral), transfer board, ambulatory, dependent lift (patient lifter) Facilitate anterior weight shifting Consistent/appropriate guarding technique Utilize momentum & head hips relationship Utilize appropriate adaptive equipment Slide 44 SCI Understand ASIA classification Understand expected functional outcomes Slide 45 Invaluable SCI Resource Clinical Practice Guidelines (CPGs) created by the Paralyzed Veterans of America RK9NJLcJ2E&b= &en=9iLHJUOzF8JQK4OCL7 KNI0OMImJSL0PEIgJTJbOULwH&CategoryID=322146

16 Slide 46 Free CPGs and SCI Pressure ulcer prevention and treatment Sexuality Early Acute Management Bladder Management Respiratory Management Preservation of Upper Limb Function Autonomic Dysreflexia Functional Outcomes Depression Neurogenic Bowel Slide 47 Thank you!

FUNCTIONAL MOBILITY & ACTIVITIES OF DAILY LIVING. Courtney Silviotti, MS, OTR/L

FUNCTIONAL MOBILITY & ACTIVITIES OF DAILY LIVING Courtney Silviotti, MS, OTR/L OBJECTIVES: FUNCTIONAL MOBILITY & ACTIVITIES OF DAILY LIVING Define Compare Review Examine Functional Mobility Activities