Activities of Daily Living Performed by People with Spinal Cord Injury

Original Editor - Wendy Oelofse

Top Contributors - Jess Bell, Ewa Jaraczewska and Kim Jackson  

Introduction

Activities of daily living (ADLs) include the basic skills needed to manage physical needs, comprising grooming and personal hygiene, dressing, toileting and continence, transferring and ambulating, and eating. Instrumental Activities of Daily Living (IADLs) include complex tasks related to the ability to live independently in the community, and they comprise domestic tasks, leisure, parenting, shopping, managing finances and medications.

Understanding the ability of patients with spinal cord injury to perform daily activities is important to plan their rehabilitation and manage their long-term care. Functional impairments vary significantly among people with spinal cord injury, and they could have a different impact on their quality of life. Some studies suggest that spinal cord injury is responsible for a significant decrease in quality of life and functional limitations, in addition to pain intensity, level of injury, and education status are factors in quality of life.

This article includes additional notes that complete the presentation on Activities of Daily Living and Self-Care for People with Spinal Cord Injury.

Activities of Daily Living (ADL)

Level of Injury and Selected ADL

File:Hands-free hydration system.png

Hands-free hydration system

Eating and Drinking

C1-4:

• Full assistance in eating

• Independent in drinking with assistive technology
  • Example: Hands-free drinking system

C5:

• Set up assistive technology for eating
  • Example: U-cuff and wrist extension splint
• Independent with assistive technology in drinking
  • Examples: Add hooks to drinking bottles or cups, add straw if bottle or cup cannot be lifted high enough

C6 and C7:

• Independent with assistive technology in eating:
  • Examples include tenodesis grasp, use u-cuff, can also use ringed cutlery, might be able to weave cutlery through fingers

• Independent in drinking:
  • Examples include tenodesis grasp or can use hooks. DO NOT burn when holding a hot beverage

C8-T1:

• Independent in eating and drinking
• Can manage with standard cutlery or might need build-up handles

Grooming

C1-4:

• Full assistance in grooming tasks

C5:

• Moderate assistance for some grooming tasks with universal cuff and wrist extension splint due to no active wrist extension

C6-7:

• Independent in most grooming tasks with u-cuff or intertwining utensil between fingers.
• Wrist extension present; therefore, use of tenodesis grasp to hold small objects. Seldom use of tenodesis grasp to hold heavier objects as it would be too weak.

C8-T1

• Independent in all tasks. It may require built-up handles for some tasks

Dressing

C1-4:

• Assistance with all aspects of dressing, but they can DIRECT their caregiver independently about what clothes they would like to wear.

C5:

• Can place arms into sleeves but generally needs assistance for all other aspects of dressing

C6:

• Can become independent in all aspects of dressing but requires extensive practice and modifications to some of their clothing

C7-C8:

• Independent with practice

Showering

C1-4:

• Assistance with all aspects of washing - can independently direct the washing

C5:

• Can wash parts of the body with assistive technology and can hold an adapted hand-held shower head to rinse body, but generally needs assistance for all other aspects of washing

C6:

• Can become independent in all aspects of washing with extensive practice, with appropriate assistive technology and an environment that facilitates independence

C7-C8:

• Independent with practice

Toileting

Bladder management:

The following problems need to be overcome:

1. Urinary retention -cannot control the bladder sphincter muscle – thus cannot void on command and experiences leakage
2. Unable to feel when want to void/when the bladder is full

Solution: Routinely empty the bladder using an appropriate and safe method.

Bowel management:

This article presents the guidelines for the management of neurogenic bowel dysfunction in spinal cord injury.

Watch this video to learn about adaptive tools to help patients with hand weakness successfully manage their bowel program.

You can find additional information about bladder and bowel management in spinal cord injury in these two articles: Bladder Management in Spinal Cord Injury and Bowel Management in Spinal Cord Injury.

Pressure Care

C1-C5:

• Requires assistance to relieve pressure using the forward lean technique.
• A person can be independent in pressure relief by tilting their power wheelchair, but the wheelchair should be able to tilt at least 50 degrees.
• When ordering a power wheelchair for a patient with high tetraplegia, consider the tilt range.
• A caregiver can manually tilt a wheelchair backwards to relieve pressure.

Communication

C1-4:

• Use preserved function in head, neck, mouth and voice with assistive technology
  • Examples include mouth or head stick, speakerphone, headset, touch screen, mounting system on wheelchair and hospital bed

• Can sign document holding a pen in mouth, turn pages if document or book is placed on an appropriate reading stand and use a mouth stick

C5-7:

• Use assistive technology and available function
  • Examples include universal cuff and writing splint (person with C6/7 SCI), speakerphone, large buttons on the phone, touchscreen, headset, lanyard (prevent phone from being dropped); stylus or finger extension splint to use with touch screen, hook on a phone to help lift it to the ear (not as common as technology has improved greatly)

C8:

• Can generally manage without aids, night requires building up writing device
• Using a computer
• Typing splints, mouth or headsticks can be used (no adaptation to the computer), consider mouse and keyboard alternatives.
• Voice dictation software

Instrumental Activities of Daily Living

Domestic Tasks

C6:

• May independently perform light housekeeping duties.

C7:

• Able to perform household duties with fewer adaptive aids to manage independent living.

Teach the person with spinal cord injury the following adaptations to assist with housekeeping tasks:

• When using a duster/sweeper/mop with limited hand function, use one with a hook eye on the handle. You can hook your thumb through to help grip.
• Use your palm to press the spray bottle if you have limited hand function.
• Use a scouring pad and stick to wash the bath.
• Store cleaning supplies together in a basket that can be put on your lap.

Parenting

To fulfil the parenting duties, the person with spinal cord injury may benefit from the following guidance:

Transporting and Carrying the Child

• Think about balance, posture, pressure changes on cushion, safety and transfers. When using carriers, watch for shoulder and back pain exacerbation.

• When using carriers, wraps, and lap belts, make sure that you can open and close them
• Consider alternative methods of carrying
• When transferring the baby, ensure you are as close to the surface as possible to increase stability and safety and decrease the risk of injury
• Place the pillow on your lap to carry a child
• When lowering baby to the ground, use elbows on knees. When putting weight on your elbows and knees, it creates leverage and more proximal stability
• Use a velcro wheelchair seat belt to help secure the baby when transporting

Car seats: use lightweight, swivel car seats and buckle release tool.

Strollers: Consider lightweight, adaptive wheelchair-compatible strollers.

Feeding

Bottle feeding

• Adaptive bottle holders
• Nursing/bottle feeding specific pillows
• Bottle warmers
• Burping considerations
• Strap a bottle holder onto a wheelchair

Breastfeeding positioning

• Reclined, side-lying, seating
• Use of positioning pillows

Feeding solids

• High chair considerations
  • Heigh, portability, straps/securement, accessibility to put the child in a high chair
  • Strap a booster seat onto a barstool for feeding         

Changing Diapers and Nappies

• Consider the changing surface and changing pad
• A dining table can be used for diaper changing

Dressing

• Install loops onto zippers, use velcro or magnetic closures
• Padded space on the lap can help with tasks that can be done from the wheelchair, such as dressing

Bathing

• Consider using the kitchen sink (if safe)

Sleeping

• Bedside bassinets and co-sleepers eliminate the need to transfer out of bed to feed/comfort the baby
• Consider a cot that opens sideways
• Adjustable/lower height crib

Play

• A bed can be a level play area
• Toys with loops, handles or hooks

Safety

• Provide physical boundaries
• Baby gates need to be wide enough for a wheelchair to pass through and should ideally not have a threshold
• Consider magnetic cabinet locks if limited hand function

Resources

• SCI Parenting- Spinal Cord Injury and Parenting

• Childcare Strategies for SCI – Detailed