Due to a disability or after sustaining an injury, one may find it difficult to perform activities of daily living (ADLs).

Bathing, dressing, grooming, toileting, and feeding are self-care activities that are including in the spectrum of activities of daily living (ADLs).

Occupational therapists will help you develop skills needed to complete your ADLs as independently as possible.

It may also be necessary to use adaptive equipment (AE) to perform your ADLs. Adaptive equipment are devices that are used to assist with completing activities of daily living.

Some of the most common activities of daily living are:

* Feeding The amount of assistance needed to perform ADLs varies from person to person depending current strength and range of motion, functional abilities, health status and medical diagnosis and precautions.

Activities of Daily Living

Adaptive equipment for dressing

Upper Body Dressing

Upper body dressing (UBD) includes putting on and taking off any clothing items from the waist up. For the individual with paraplegia, the upper extremities (arms) are usually functioning properly, and UBD is usually completed without difficulty. However, sitting balance and safety precautions should be addressed before attempting UBD from the edge of the bed or while sitting without support on any surface. If balance is impaired, it may be easier to sit in a wheelchair or standard chair for additional back support. If a brace is worn around the torso, loose garments with front closures are suggested. Additionally, comfortable, wrinkle-resistant clothes allow for easier application and neat appearance.

Upper body dressing techniques depend on several factors including:

* Amount of movement in the arms
* Strength of active arm muscles
* Sitting balance and endurance
* Fine motor coordination/hand strength

A person may be able to use adapted techniques/adapted clothing, adaptive equipment and/or splints to increase independence when doing UBD.

Lower body dressing

Lower body dressing (LBD) includes putting on and taking off any clothing item from the waist down. When dressing the lower body, persons with a paraplegic level of injury might find it helpful to use a combination of alternative techniques and adaptive equipment. The most common position for performing LBD is circle sitting or long sitting in bed. This allows the person to reach his/her feet from a large base of support, which increases balance.

Some of the most commonly used pieces of adaptive equipment (AE) used during dressing include:

* Dressing sticks
* Reachers
* Long-handled shoe horns
* Button hooks
* Velcro®
* Elastic shoe laces
* Sock aids
* Legs straps

In the first few days or weeks following injury, you will most likely sponge bathe from bed. This process may seem complicated if a brace must be worn or if other medical complications are present. Once you are medically stable and cleared for showering by the doctor, your occupational therapist will help you learn to shower safely. You may use some of the following to assist with safety and completion of your bath:

* Tub chair/tub bench with a back
* Transfer board
* Hand held shower
* Long handled sponge
* Grab bars
* Thermometer

You may use some of the following to assist with safety and completion of your bath:

* Shower chair (with tilt/recline feature)
* Transfer board or mechanical lift
* Hand held shower
* Universal-cuffs or other splints to assist with holding items
* Wash mitt
* Thermometer

This is just a small sampling of the equipment that may be used to increase independence with bathing. Your occupational therapist will help you develop a bathing program appropriate for your discharge environment.

Toileting includes the ability to pull down clothing in preparation for elimination, cleaning of the perineal area and pulling clothing up after completion. A person is often able to independently complete the process with the correct technique and needed equipment.

Examples include:

* Leaning on one elbow to raise a hip and pull down clothing from side to side
* Drop-arm bedside commode for safe transfers
* Toilet aid to reach perineal area
* Leg straps to assist lifting legs

Toileting for an individual with a tetraplegic level of injury is usually difficult and unique for each person. Your occupational therapist will develop a specialized toileting program for patients/caregivers for the discharge environment.

Grooming tasks include brushing teeth, washing face, combing hair, shaving and applying make-up. As with UBD, a person with aparaplegic level of injury usually has full use of their arms and grooming is completed without difficulty from a wheelchair as long as items are in reach. For a person with a tetraplegic level of injury, grooming becomes more difficult and is usually completed in a supported seated position in bed or in a wheelchair.

Necessary AE and orthotics may include:

* Universal-cuff to hold toothbrush, razor, make-up, etc.
* ADL wrist splint to stabilize wrist
* Wash mitt
* Long handled brush
* Lap tray
* Built-up handles

Once you can tolerate a sitting position, your occupational therapist will help you practice techniques to complete these activities as independently as possible.

Feeding, like upper body dressing and grooming, is usually not difficult for a person with a paraplegic level of injury. This activity, however, can be difficult for a person with a tetraplegic level of injury. Feeding is usually done in a supported seated position in bed with a bedside table or from wheelchair level with a lap tray. There are several splints and pieces of adaptive equipment available to assist with this process.

These items include:
* Universal-cuff to hold utensils
* ADL wrist splint to stabilize wrist
* Non-skid bowl
* Plate guard
* Scoop dish
* Adaptive utensils
* Long straw
* Mobile arm supports

As soon as you are medically stable and able to swallow safely, your occupational therapist will begin working with you to promote self-feeding. This may include strengthening/positioning regimens to increase tolerance for ADLs.

Common types of adaptive equipment

ADAPTED UTENSILS - Forks, spoons, and knives that are modified to assist with feeding. These may include utensils with built-up handles, weighted handles, and angled utensils.

ADL SPLINT - Allows user to hold utensils without grasp or wrist control.

BED LADDER - Series of connected loops attached to end of bed to assist with bed mobility.

BED MOBILITY - Movement of the body in the bed. Includes rolling and transitioning from sitting edge of bed to lying down.

BEDSIDE COMMODE (BSC): Portable commode with armrests that can be used beside the bed or over the toilet.

BUILT-UP HANDLES - Larger handles used to assist user with weak grasp to perform ADLs.

BUTTON HOOKS - Assist user who has poor hand control to fasten buttons.

CIRCLE SITTING - Sitting position in which legs are supported on bed, mat, or floor with knees bent and out to the side with bottom of feet touching each other.

DRESSING STICKS - Assist user to reach legs without bending for putting on pants.

DROP-ARM BEDSIDE COMMODE - Portable commode with removable armrests that can be used beside the bed or over the toilet.

ELASTIC SHOE LACES - Shoe laces made out of elastic material, which are laced into shoes and permanently tied to allow shoes to slip on/off.

ENVIRONMENTAL CONTROL UNITS (ECU): Electronic system that allows user to control aspects of his/her environment.

GRAB BARS - Mounted onto wall to assist with balance and transfers.

HAND HELD SHOWER (HHS): Showerhead with a hose that allows user to hold shower in his/her hand to direct the spray. A HHS with the controls on the handle is recommended.

LAP TRAY - Wooded or plastic tray attached to wheelchair to provide support for arms.

LEG STRAPS - Attach to users legs at thigh, knee, and ankle to assist with moving legs during activity.

LONG-HANDLED BRUSH – Hairbrush placed at the end of flexible, extended handle to allow user to reach hair.

LONG-HANDLED SHOE HORNS (LHSH) - Extra-long shoehorn to allow user to keep heel of shoe up without bending over while putting on shoes.

LONG-HANDLED SPONGE (LHS): Bath sponge placed at the end of extended handle to allow user to reach legs and feet without bending.

LONG SITTING- Sitting position in which legs are supported on bed, mat, or floor with knees straight.

LONG STRAW - Extended, reusable straw to allow user independently drink from a cup.

MOBILE ARM SUPPORTS (MAS) - Mounted arm supports that assist user with feeding and other ADLs.

MOUTHSTICK - Allows person with limited arm function to use mouth to access switches.

NON-SKID BOWL - Dish with non-skid material on bottom to provide stability during feeding.

PLATE GUARD - Attaches to rim of plate to allow user to scoop items onto fork/spoon.

RAISED TOILET SEAT (RTS): Attaches to existing toilet to increase the height for easier transfers.

REACHERS - Allows user to retrieve items out of reach.

SCOOP DISH - Dish with one side sloped upward to allow user to scoop items onto fork/spoon.

SHOWER CHAIR (WITH TILT/RECLINE FEATURE) - Rolling chair with tall back that will recline to assist with balance/safety in a roll-in shower.

SKIN INSPECTION MIRROR - Dual sided mirror attached to extended, flexible handle to assist with inspecting skin for pressure sores.

SOCK AIDS - Allows user to put sock on without bending.

SWIVEL UTENSILS - Utensils attached to moving handle to assist user with getting food into mouth.

TOILET AID - Toilet tissue aid designed to assist user in cleaning perineal area when reaching is difficult.

TRANSFER BOARD (Also known as a sliding board) – Plastic or wooden board used to bridge the gap between two surfaces to make a transfer safer and easier.

TUB CHAIR/TUB BENCH WITH A BACK - Placed into tub or shower to provide a seated surface while bathing.

TUB/SHOWER CHAIR: Fits into tub or shower to provide surface for bathing. A shower chair with a back and seatbelt is recommended for increased stability and balance.

TUB TRANSFER BENCH: Base of bench extends outside tub to make transfers easier. A tub transfer bench with back and seatbelt is recommended for increased balance and stability.

UNIVERSAL-CUFF (U-cuff) – Splint that allows user to hold ADL items without grasp.

WASH MITT - Large mitt that can be used by a person with limited hand function to bathe.