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 of Daily Living ADL Teaching Strategies Impact of Seating and Positioning Population Specific Strategies
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: Transfers Bed Mobility Ambulation
WHAT ARE ACTIVITIES OF DAILY LIVING (ADL)? Self Care or Self-Maintenance Tasks Oral Hygiene Personal Device Care Functional Mobility Sexuality and Intimacy
WHAT ARE IADLS? (INSTRUMENTAL ADLS) Functional Communication Using the phone & computer Caregiving Children, family, loved ones, pets Health Management Medication Routine Exercise Housework & basic home maintenance Finances Preparing meals Shopping Religious & Spirituality Transportation Driving or navigating public transit
TEACHING ADL STRATEGIES ALL 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
AND THE DIAGNOSIS Stroke Spinal Cord Injury Cardiac Traumatic Brain Injury Orthopedic Cancer Amputee
FOR EXAMPLE STROKE/TRAUMATIC BRAIN INJURY Strength/ROM Strength training Encouraged or forced use Dominance retraining One handed techniques Adaptive equipment Balance Positioning Supine or Seated Seated or Standing Change amount of support provided
VIDEO OF THERAPY SESSION: IN PRONE
SEATING AND POSITIONING Promoting Engagement in Functional Mobility and ADLs
IMPACT OF SEATING AND POSITIONING ON FUNCTION Safety Prevention Accessibility
SEATING AND POSITIONING: CUSHIONS AND PRESSURE MAPPING
POSTURAL SUPPORT
WHAT DOES PROPER SEATING & POSITIONING DO FOR YOUR PATIENTS? Prevention Pressure Ulcers Postural abnormalities Flexible and Fixed Contractures Joint Injury Intervention Tool Pain Agitation Functional mobility
STROKE/TRAUMATIC BRAIN INJURY: POSITIONING NEEDS FOR THE UPPER BODY Giv-Mohr Sling Splints Arm Trough/Board
STROKE/TRAUMATIC BRAIN INJURY: POSITIONING NEEDS FOR THE LOWER BODY Dorsiflexion wrap (with ace wrap) to protect ankle Braces or Orthotics
LIMB LOSS: POSITIONING NEEDS FOR THE LOWER BODY
STRETCHING FOR POSITIONING: INSTRUCTING A FAMILY MEMBER Consult MD, PT, or OT prior to stretching Be aware of precautions THR precautions Shoulder elevation above 90 degrees Spinal ROM contraindications Preserving tenodesis pattern Verify the physical health of the family member 1) Isolate the movement at the desired joint 2) Stretch the muscle into the desired range 3) Stretch until mild resistance is felt 4) Hold for 30 seconds 5) Have family member return demonstration Contracture Tip: Stretch 1 minute after positioning of 1 hour
ACTIVITIES OF DAILY LIVING Feeding Grooming Bathing Toileting Dressing
FEEDING/DRINKING ADAPTIVE EQUIPMENT Plate Guards Rocker Knife Dycem
STROKE/TRAUMATIC BRAIN INJURY: FEEDING/DRINKING ADAPTIVE EQUIPMENT Angled Utensils Provale Cup Built-up Utensils
SPINAL CORD INJURY: FEEDING STRATEGIES BASED UPON INJURY LEVEL C5 Wrist/forearm support C6 U-cuff C7 Adapted techniques Plate guard, dycem Adapted utensil Finger Weave Possible Mobile Arm Support (MAS) Wean off adaptive equipment
SPINAL CORD INJURY: FEEDING STRATEGIES May utilize with C4/C5/C6 tetraplegia Assists with tasks requiring against gravity planes of movement Mobile Arm Support (MAS) by JAECO Orthopedic
SPINAL CORD INJURY: FEEDING STRATEGIES Trial adaptive equipment Container management Alternative techniques for utensil management Cutting food Various food types Solids & liquids Finger foods
SPINAL CORD INJURY: UTENSIL MANAGEMENT STRATEGIES 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 Finger Weave Technique (C6, C7)
BATHING: DURABLE MEDICAL EQUIPMENT Shower Seats With &without backs Tub Benches Padded & plastic Roll-in Shower Chairs Support (seatbelts, headrest, leg rests) Tilt & non-tilt feature
DECREASED MOBILITY: ADAPTIVE EQUIPMENT FOR BATHING Long Handled Sponge Hand Held Shower Head & Grab Bars
STROKE/TRAUMATIC BRAIN INJURY: ADAPTIVE EQUIPMENT FOR BATHING Hand Mitts Long Handled Sponges
ADAPTIVE EQUIPMENT FOR DRESSING Elastic Laces Button Hooks Dressing Sticks
DECREASED MOBILITY: ADAPTIVE EQUIPMENT FOR DRESSING Long Handled Shoe Horn Reacher Sock Aid
STROKE/TRAUMATIC BRAIN INJURY: DRESSING STRATEGIES Allow for immediate success Loose fitting clothing Fasteners: Limit or position on non-affected side Clothing in physical reach and intact visual field Stable (seated or supine) position One-handed dressing strategies
DRESSING VIDEO
SPINAL CORD INJURY: DRESSING STRATEGIES Stable (seated or supine) position: bed, wheelchair Evaluate hamstring flexibility Back extensor muscle length for stability Promote lower extremity flexibility Positioning & momentum for lower extremity management Introduce adaptive equipment
TOILETING: DURABLE MEDICAL EQUIPMENT 3-in-1 Commode Stand pivot Transfers Drop Arm Commode Lateral Transfers
STROKE/TRAUMATIC BRAIN INJURY: TOILETING STRATEGIES Toilet tissue positioned on the unaffected side for ease of access Use modified fasteners or limit use of fasteners Snaps Elastic Bands Trial onehanded strategies Toileting Schedules Reduce urgency/ emergency situations
SPINAL CORD INJURY: TOILETING ADAPTIVE EQUIPMENT Clothing management Pants Clips Wheelchair skills Catheter management Clips Guides Mirrors Urinals
ORTHOPEDIC: JOINT REPLACEMENT AND ADLS Weight bearing status Adaptive Equipment Durable Medical Equipment Safety Extended leg for sitting/standing Long handled equipment Elevated height DME Chairs with arms Proper Footwear Total Hip Replacement Reinforce hip precautions during all tasks Anterolateral vs. Posterolateral Total Knee Replacement Encourage functional movement of affected knee Squatting motion to reach for clothes from drawers)
POSITIONING, TRANSFERS & MOBILITY
Transfer types Stand pivot Lateral With and without transfer board Ambulatory Dependent lift
BODY MECHANICS DURING TRANSFERS: PROTECT YOUR BACK
STROKE/TRAUMATIC BRAIN INJURY: TRANSFER STRATEGIES Facilitate anterior weight shifting Guarding technique/body mechanics Foot Placement Understand Neglect s Impact Cognitive visual perceptual deficit Only aware of ½ the body, environment Impulsivity Proper foot placement Manual contacts Proper Footwear
TRANSFERS VIDEO
SPINAL CORD INJURY: TRANSFER STRATEGIES Facilitate anterior weight shifting Consistent/appropriate guarding technique Appropriate adaptive equipment Proper body mechanics Understand Key Concepts ASIA Classification Expected functional outcomes
Pressure ulcer prevention & treatment RESOURCES Spinal Cord Injury Clinical Practice Guidelines (CPGs) created by the Paralyzed Veterans of America www.pva.org Stroke National Stroke Association www.stroke.org Traumatic Brain Injury Brain Injury Alliance of New Jersey www.bianj.org Amputee www. Sexuality Acute Management Bladder Management Respiratory Management Preservation of Upper Limb Function Autonomic Dysreflexia Functional Outcomes Depression Neurogenic Bowel
STROKE/TRAUMATIC BRAIN INJURY: OTHER CHALLENGES TO ADDRESS Dysphagia Precautions Shoulder pain/subluxation G-Tube Visual perceptual deficits Cognitive impairments Behavioral challenges