Activities in Daily Life (ADL)
9.9 Measuring Is Knowing: Clinimetry Within the ADL
To check whether the ADL training is effective, measuring instruments can be used. At the start you determine the zero point (the starting level), and during the evaluation you measure on the same scale. For the ADL, various measuring
Table 9.2 ADL training of the CVA patient with reasonable balance
ADL activity Instruction
1 Baseline − active sitting
− (wheel)chair angled in front of wash basin 2 shoulder control − leave affected shoulder low, possibly ‘hanging’
3 getting undressed
− sweater/shirt − over the head
− rolling down sleeves affected arm
− blouse/pyjama coat − unaffected arm out of sleeve first
− rolling down sleeves affected arm
− (under)pants − prepare in seat (opening fasteners)
− toilet hold
− socks/shoes − untying shoes on floor
− cross the legs one by one 4 washing/drying − start on the affected side each time
− buttocks: toilet hold
− legs: cross one for one for washing/drying legs/feet 5 getting dressed
− blouse and sweater/shirt − first sleeve affected arm between legs and rolling up
− releasing shoulder at blouse
− crossing legs
− pants − toilet hold
− tying shoes on the floor
− socks/shoes
E. Franssen et al.
93
Table 9.3 ADL training with the CVA patient with sufficient balance ADL activity Instruction patient Instruction to carer 1 baseline active sitting
2 shoulder control keep affected shoulder low, possibly ‘hanging’
3 getting undressed
− sweater/shirt − over the head
− rolling down sleeves affected arm
− blouse/pyjama
coat − freeing affected shoulder possibly offer help; help with fasteners
− unaffected arm out of sleeve first
− rolling down sleeves affected arm
− (under)pants − prepare in seat (opening fasteners)
− socks/shoes − stand up possibly supervision; Please note:
let patient stand on both legs
− untying shoes on floor help in weight shifting when sitting
− cross the legs one by one 4 washing/drying − head: with unaffected hand
− affected arm: with unaffected hand
− abdomen/chest: with unaffected hand
− genital area/ramp: washing while standing
− legs: cross affected leg 5 getting dressed
− blouse and
sweater/shirt − putting down label
− pants − first sleeve affected arm between legs and rolling up
possibly help with fasteners
− releasing shoulder at blouse
− socks/shoes − crossing legs possibly help with fasteners
− pulling up pants when standing
please note: let patient stand on both legs
− tying shoes on the floor possibly help with laces
instruments (also known as clinimetry) are available. In Table 9.4 is an exam- ple of such an ADL measuring instrument: the Barthel Index (Mahoney and Barthel 1965). This measurement scale is used in many settings and in many studies.
9 Activities in Daily Life (ADL)
94
Table 9.4 Barthel Index for measuring activities in daily life (ADL). The Barthel Index
Bowels
0 = incontinent (or needs to be given enemata) 1 = occasional accident (once/week)
2 = continent Patient’s Score:
Bladder
0 = incontinent, or catheterized and unable to manage 1 = occasional accident (max. once per 24 h) 2 = continent (for over 7 days)
Patient’s Score:
Grooming
0 = needs help with personal care
1 = independent face/hair/teeth/shaving (implements provided) Patient’s Score:
Toilet use 0 = dependent
1 = needs some help, but can do something alone 2 = independent (on and off, dressing, wiping) Patient’s Score:
Feeding 0 = unable
1 = needs help cutting, spreading butter, etc.
2 = independent (food provided within reach) Patient’s Score:
Transfer
0 = unable—no sitting balance
1 = major help (one or two people, physical), can sit 2 = minor help (verbal or physical)
3 = independent Patient’s Score:
Mobility 0 = immobile
1 = wheelchair independent, including corners, etc.
2 = walks with help of one person (verbal or physical) 3 = independent (but may use any aid, e.g., stick) Patient’s Score:
Dressing 0 = dependent
1 = needs help, but can do about half unaided 2 = independent (including buttons, zips, laces, etc.) Patient’s Score:
Stairs 0 = unable
1 = needs help (verbal, physical, carrying aid) 2 = independent up and down
Patient’s Score:
E. Franssen et al.
95
References
Bertolin M, Van Patten R, Greif T, Fucetola R. Predicting cognitive functioning, activities of daily living, and participation 6 months after mild to moderate stroke. Arch Clin Neuropsychol.
2017;25:1–15.
Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988;10(2):61–3.
Gillen, G. Stroke rehabilitation: a function-based approach, Chapter 4. Elsevier Publisher. ISBN 978–0–323-17281-3. Chapter 4: https://books.google.nl/books?id=8vBwCgAAQBAJ&pg=
PA83&lpg=PA83&dq=generalization+phase+stroke&source=bl&ots=8GYQUhR79P&sig=
LBaWYbQR1TgQZ6K2PYVFhp1rVvI&hl=nl&sa=X&ved=0ahUKEwiClvra2frXAhWIA 8AKHTHwDN0Q6AEIVjAF#v=onepage&q=generalization%20phase%20stroke&f=false Consulted on December 5th, 2017. 2016.
Langhammer B, Sunnerhagen KS, Lundgren-Nilsson Å, Sällström S, Becker F, Stanghelle JK. Factors enhancing activities of daily living after stroke in specialized rehabilitation: an observational multicenter study within the Sunnaas International Network. Eur J Phys Rehabil Med. 2017;53(5):725–34.
Mahoney FI, Barthel DW. Functional evaluation: the barthel index. Md State Med J. 1965;14:61–5.
van Peppen R, Beurskens S. Predicting ADL independence in patients with a CVA. Physio Practice.
2010;19(6):18–20.
Bathing 0 = dependent
1 = independent (or in shower) Patient’s Score:
Total Score:
Collin et al. (1988) Table 9.4 (continued)
9 Activities in Daily Life (ADL)
97
© Springer International Publishing AG, part of Springer Nature 2018 B. Buijck, G. Ribbers (eds.), The Challenges of Nursing Stroke Management in Rehabilitation Centres, https://doi.org/10.1007/978-3-319-76391-0_10 B. I. Buijck, Ph.D.
Erasmus MC University Medical Center, Department of Neurology & Rotterdam Stroke Service, Rotterdam, The Netherlands
e-mail: [email protected] D. J. Rowberry, R.N. (*)
College of Human and Health Science, Swansea University, Swansea, UK e-mail: [email protected]