Pedretti Ch. 10 -- ADLs

Question 1

Home Management Assessment

Answer 1

• Interview client to find description of the home and of former/present home management responsibilities and the significance of those roles
• Assessment will be more meaningful if after interview, a performance assessment is done in an ADL kitchen, facility apartment, or in the client’s home

Question 2

Executive Function Performance Test

Answer 2

• A standardized assessment to evaluate the executive skills needed to perform IADLs
• Can be used to determine if someone is safe to live at home independently or how much assistance is required for some IADL tasks
• Assessment tasks should exercise safety precautions consistent with the client’s abilities (Initial tasks should be 1 or 2 step tasks
  Ex: wiping a dish, sponging a table, turning water on/off

Question 3

Most basic IADL skills required for clients who live independently are

Answer 3

• Preparing or retrieving a simple meal
• Employing safety precautions and exhibit good judgement
• Taking medication
• Get emergency aid
• Have a system for managing toiling
• Have a method to allow for rest periods

Question 4

Home evaluations

Answer 4

Home evaluations: evaluates the transition from a treatment facility to the home
Assesses a home for safety and accessibility
Offers a way for an OT to assess client functioning at home
Determines a time when caregiver training can occur

From initial client/caregiver meeting, OT must have an idea about the client’s home environment

When discharge from the facility is imminent, home assessment may be carried out to facilitate the client’s max independence in the living environment

Question 5

Home assessment provides the family with…

Answer 5

Home assessment provides the family with modifications and medical equipment needed to maximize safety and independence in the home

Question 6

Home assessment helps OT…

Answer 6

Home assessment helps OTs understand the physical, cultural, and social environment the client will be returning to -> this helps OT establish realistic treatment and goals related to mobility, ADL/IADLs

Question 7

When should home assessment be completed?

Answer 7

Home eval should be performed when the client’s mobility status is stabilized with status close to discharge

Question 8

Why is working with PT important?

Answer 8

Working with PT to figure out client’s ambulatory status and potential is essential to determine timing and necessity of the evaluation

Example: if PT reports client will be walking at discharge, the home modifications OT will recommend will be different if PT reported mobility will be a wheelchair

Ideally OT and PT should perform home assessments together with client and caregivers/family present

Question 9

What if home eval is not possible before discharge?

Answer 9

If home eval is not possible before discharge, the rehab team, client, and family should ID the most serious concerns and develop a plan to address them

Home assessment may also be referred to the home health agency that will provide home care services to the client

Question 10

Before a home eval

Answer 10

Before performing home eval, OT should know if the home is new for the client or if drastic home changes have already been made

Question 11

During a home eval

Answer 11

During assessment, client should use the mobility aid and any assistive devices they are used to using
- Ex: asking client to use the wheelchair in the home environment

OT should bring a tape measure to record width of doorways, height of stairs, height of bed, etc.

During performance assessment, OT should observe safety factors, ease of mobility and performance, and limitations imposed by the environment

• Caregiver should be instructed appropriately if client needs assistance for transfers
• Also instruct client on how to improve maneuverability and simplify tasks in small spaces

Question 12

Recommendations and the ADA

Answer 12

Not all recommendations will be necessarily met by the Americans with Disability ACT (ADA) guidelines b/c homes will be modified to suit the individual and to compensate for that specific disability

• ADA is meant to apply to public areas and to meet the needs of people with a variety of disabilities
• OT should have some familiarity with ADA city guidelines when making recommendations

Question 13

After home eval

Answer 13

After home assessment, OT should write a report describing client’s performance

• Should conclude report with summary of environmental barriers and the functional limitations that the client encountered
• Recommendations should include additional safety equipment and assistive devices needed
• Modification recommendations include specific details on size, building specifications, costs, and sources
• Recommendations can also include further functional goals to improve independence in the client’s home environment

Question 14

Financial Management

Answer 14

• Cognitive and perceptual assessments should be implemented if client is to resume management of money/financial matters independently
• OT evaluates the methods/routines the client implements for financial management
• Caregivers may require training if the role of financial manager is new
• If physical limitation is involved, OT can introduce adaptive writing devices for client to handle paperwork

Question 15

Community mobility

Answer 15

OT also evaluates client’s potential to participate in the community where some community mobility is required
- Evaluates client’s physical, perceptual, cognitive, functional, social capabilities to be independent and safe

Question 16

Community mobility includes:

Answer 16

• Walking w/wo the use of an ambulation aid (cane, walker)
• Using wheeled mobility devices (bike, motorcycle)
• Using a powered device (power wheelchair, scooter)
• Riding as a passenger as primary transport
• Driving oneself in a vehicle (that may/may not be adapted)
• Using public transportation (bus, taxi, subway, airplane)

Question 17

Physical capabilities to be considered in community mobility

Answer 17

• If client has the endurance to be mobile in the community w/o fatigue
• If client is sufficiently independent w/ walker, cane, crutch, wheelchair skills & transfers beyond the home environment
• Examples: managing uneven pavement, curbs, inclines, crossing the street

Question 18

Functional skills to be considered in community mobility

Answer 18

• Handling money
• Carrying objects in wheelchair or w/ walker
• Managing toileting in public restrooms

Question 19

Cognitive skills to be considered in community mobility

Answer 19

• Geographical, topographical orientation
• Getting, understanding directions
• Problem-solving skills

Question 20

Social skills and community mobility

Answer 20

• If the disability is new, client may need to learn new social skills
• Example: being assertive to get an accessible table at a restaurant, comfortable with new body image

Question 21

Armstrong and Lauzen’s Community Integration Program

Answer 21

resource for providing practical treatment protocols to establish a community-living skills program

Question 22

Health Management and Maintenance

Answer 22

Includes the client’s ability to understand the medical condition and make decisions to maintain good health and avoid behaviors that compromise health
- Ex: Client’s ability to handle medications, know when to call physician, make a medical appointment

Evaluating the client’s ability to manage their own health can be completed solely by the OT, but usually includes the entire healthcare team

• Important for OTs to be involved with health management b/c ADL/IADL assessments may ID and help resolve problems related to health maintenance
• Ex: OT and nurse can collaborate to ensure client w/ hemiplegia and diabetes can manage insulin shots