Deliver care


Four step process to providing rehabilitation care - Deliver care


Delivering Activities of Daily Living interventions to address personal and environmental factors

Delivery of rehabilitation interventions for ADLs follows the planning phase. These interventions should be linked to the assessment findings and the plan. A person may or may not therefore need all the suggested interventions listed below. Only the appropriate interventions should be provided.

 

Bathing and Personal Hygiene

Personal factors

  1. Provide the person with training on how to practise the sequence of bathing and personal hygiene such as brushing teeth, combing hair, wiping after using the toilet.
  2. Educate and advise the person to modify certain bathing and personal hygiene activities such as:

  • Sit to shower or perform personal hygiene tasks 
  • Lean body or affected limb against a wall for stability when brushing teeth, such as when the person has upper limb weakness or tremor 
  • Rest between tasks 

Environmental factors

  1. Advising the person on how they may adapt their environment, such as:

  • Insert grab bars in the shower/bath 
  • Ensure ventilation to assist breathing
  • Move items in the bathroom/bedroom for easy access, e.g., all items located between hip and shoulder height 
  • Clearly label items, such as hot/cold water, soap, shampoo, etc. when the person has visual or cognitive impairment 
  • Use a mat to keep the floor dry and remove trip hazards 
  • Ensure space for safe transfer onto a shower chair or bath board 
  • Place a stool by the sink to rest when performing grooming tasks 
  • Ensure adequate light
  • Insert ramps where there are steps or raises

  1. Facilitate the provision and installation of assistive products, and provide training in their use. Common assistive products for bathing and grooming may include:

  • A shower chair or bath board 
  • A grab bar
  • Long handled washing aids
  • Adapted handles and grips to assist with gripping items such as a toothbrush or hairbrush 

 

Dressing

Personal factors

  1. Train the person on repetitive task practice for components of the task, e.g., doing buttons, managing zippers as well as sequencing of tasks 
  2. Educate and advise the person to modify certain dressing activities such as:

  • Sit to dress 
  • Practice one-handed dressing technique (when person has upper limb amputation or hemiplegia)- dress the affected limb first 
  • Rest between tasks 
  • Select clothing or adapt clothing to avoid need for doing buttons, tying laces, etc.  

 

Environmental factors

  1. Educate and advice the person to adapt the environment through activities such as:

  • Place a chair with armrests in the bedroom for dressing 
  • Use tags to identify specific items of clothing if a person has visual impairment 
  • Remove trip hazards from the area 
  • Display visual cue cards (e.g. pictures) to prompt each step in the task sequence 

  1. Facilitate the provision and installation of assistive products, and provide training in their use. Common assistive products for dressing include:

  • dressing aids (eg. a sock donner, shoehorn, or long-handled reacher to assist lower-limb dressing )


Feeding

Personal factors

  1. Provide the person with training on repetitive task practice for components of the task, e.g., grasp and release, hand to mouth 
  2. Educate and advice the person and the caregiver to modify certain feeding activities such as:

  • Use a bowl instead of plate to enable the person to use the sides to collect food on the spoon/fork, especially when doing it one-handed 
  • Provide verbal description of where the food is on the plate at each meal, when the person has a visual impairment 
  • Time feeding around a person’s optimal level of arousal (avoid feeding when an individual is typically drowsy or has taken medication that affects their level of alertness) 
  • Change the consistency of food or liquids to avoid the person choking or taking food or liquid into their lungs when eating 
  • Pre-cut the food for easy chewing and swallowing

 

Environmental factors

  1. Educate and advice the person to adapt the environment through activities such as:

  • Position the plate or bowl on a non-slip surface 
  • Minimize auditory or visual distractions in the environment to enhance attention 
  • Use a footrest and a chair with armrests to promote balance and positioning 

  1. Facilitate the provision and installation of assistive products, and provide training in their use. Common assistive products for feeding include:

  • Adapted eating and drinking products, such as built- up cutlery and two-handed cups 
  • Use supportive seating such as a chair with armrests and footrest to improve core stability when eating, as this may improve overall balance and positioning as well as control and coordination of the upper limbs 

 


Toileting including bladder and bowel management

Personal factors

  1. Provide the person with training on :

  • safe transfers on and off the toilet 
  • how to practice correct techniques for inserting and cleaning catheters and using suppositories 
  • how to establish a toileting routine to minimize incontinence  

  1. Educate and advice the person on:

  • bladder functions and management including the implications of continence dysfunction
  • timing for eating and drinking to minimize incontinence
  • what foods to choose or avoid 
  • the selection of clothing that is easy to pull down and up for toileting (e.g. loose clothes with elasticated waists) 

  1. Provide pharmacological agents (if within your scope of work) including the following:
    1. Anticholinergics eg. Oxybutynin (Ditropan XL, Oxytrol); Tolterodine (Detrol); Darifenacin (Enablex)

      Indications – urine urge incontinence (where a person regularly gets a sudden need or desire to pass urine which is difficult to control and results in wetting oneself)

      Common side effects – dry mouth, constipation

  1. Laxatives eg. Bisacodyl (Dulcolax, Correctol); Docusate (Colace, Sulfolax); Polyethylene glycol (MiraLax)

    Indications – constipation

    Common side effects – diarrhoea, bloating, gas, nausea

 

Environmental factors

  1. Educate and advice the person to adapt the environment through activities such as:
  • Ensure space for safe transfer onto the toilet or commode

  1. Facilitate the provision and installation of assistive products, and provide training in their use. Common assistive products for toileting including bowel and bladder management include:
  • Use a commode, raised toilet seat or an over toilet frame 
  • Continence products (absorbent)  
  • Continence products (catheters, suppositories and bags) 

 

Remember to follow the three steps of

    1. Explaining the intervention to the person
    2. Demonstrating the intervention and
    3. Letting the person practice the intervention in your presence to ensure safe home implementation


Note: 

Use the BORG scale to determine whether the practice is at an appropriate intensity



 Discussion

Ama using a shower chair and grab bars

Ama eating with a spoon with foam wrapped around it


Remember Ama?

Ama who lives with her daughter was recovering from a fracture with difficulty walking and poor balance when she fell in the bathroom. She has recovered from the fall but the knee fracture has not healed completely and her functioning difficulties exist. Ama’s primary health care provider is currently taking care of her in the small town she lives. A plan has been developed and the next step will be to deliver care.

 

What are some of the rehabilitation interventions that Ama’s primary care provider can deliver to assist her engage adequately in activities of daily living?


Last modified: Monday, 28 March 2022, 9:12 AM