Activities of Daily Living

Back in April I wrote about a volunteer opportunity in the outpatient physical therapy department at Hennepin County Medical Center (HCMC). Shortly after that I was able to move over to the occupational therapy department. This has given me more work to do as well as many opportunities to observe the therapists working with patients. I have learned a lot about what is involved in occupational therapy. There is more than I can write in one post (since I want to keep these short) so I'll focus on the activities of daily living (ADLs) since they come first in the day.

One day Theresa, my supervisor (at least she's the person who gives me work to do), told me to take a break from the computer where I was redoing some patient handouts and come talk with one of her patients while he used the arm bicycle. This man had spent an extended period in the rehab part of HCMC and was now coming in from time to time for outpatient therapy. As a result of an accident he was paralyzed from the waist down. Theresa asked him to tell me what OT had done for him. "It got me out of bed, taught me how to get dressed so I could get to PT and begin to get better." That's what ADL's are all about: getting dressed, bathing and grooming so you can get on with life. This man said the first time he put on his own pants it took him 45 minutes. "My mom thought Theresa was so mean to just watch me struggle and giving only verbal cues and encouragement." Theresa piped in that for the first several years that she worked as a therapist she had to literally sit on her hands so she wouldn't do for her patients what they could do for themselves.

I have had only one opportunity to observe a therapist helping with ADLs. Theresa took me to the room of a gentleman who was recovering from a stroke which had affected both his ability to speak and to understand what others were saying. The only way to communicate with him was through gestures. Yet he knew what needed to be done to get ready in the morning. Because he had some weakness on the right side Theresa placed the items he would need to get ready on the right side of the sink. It was obvious that it was important to him that his hair be well combed. He had no problem using his left hand on the left side of his head but the right side was another matter. The comb kept falling out of his hand. Theresa had tested his grip strength the day before and she knew he had enough to hold on to that comb. The brain just needed to figure that out. Once he got his hair combed right, he took off the t-shirt he had slept in which, of course, messed up his hair. You could see the frustration in his face.

His daughter had come with some clean clothes including some shorts with a drawstring figuring it would be easier for him to not have to deal with buttons and zippers. From the look on his face it was obvious that he didn't usually wear that kind of shorts but he didn't put up a fuss as he put them on. Getting on his button-down shirt was another matter. He put the left arm in first and got that situated and then he was done. This is common for stroke victims. Half of their field of vision is gone and they don't realize it because the brain fills in what it thinks is there. At that point Theresa stepped in and helped him get the shirt all the way on. Teaching him to put his weaker arm in first would be a lesson for another day.