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Monday, September 04, 2006

The Assessment Team

The assessment team:

C is like many adults with age related disabilities. She does not have a caseworker or rehabilitation counselor as she is not eligible for services related to work preparation. C would benefit from the assistance of an occupational therapist if insurance would cover the expense. An assistive technology specialist and supportive life-skills personnel would further enhance C's ability to remain functionally independent.

The main problem

· C's physical limitations are threatening her ability to live independently.
· C is having difficulty maintaining a quality of life due to the loss of physical functioning.
· C lacks reliable transportation and is experiencing increased social isolation.

Goals

Goal #1: C will maintain independent living.

Objective: Adapt C's home environment to miminize the risk of injury. Specific attention will be given to C's concern over falling.
Areas of concern include:
· The bathroom
· The kitchen
· Other

Objective: Adapt C's home to maximize the use of existing physical functioning. Specific areas include:
· Door handles
· Light fixtures/lamps
· Locks
· Faucets
· Appliances
· Entry/Exits
· Other

Goal #2: C will maintain/improve her current ability to engage in meaningful hobbies and activities

Objective: Assist C in reading, writing, sewing, and gardening independently and without risk of pain or injury.




Goal #3: To allow C to shop, attend medical appointments, socializing, church and other business.

Objective: Assist C in locating reliable accessible transportation at least 2 times per week.


Method: Using a standardized Activity Analysis (act.ana.PDF) it is possible to identify activities in need of intervention given C's current level of functioning. The use of an activity analysis tool will provide baseline data to compare C's level of progress, future needs, and potential decline in functioning. First a low technology alternative will be explored and then a higher level technological intervention. It is assumed the least expensive alternative will be employed.

Measuring capacity and performance of functional activities will target
1. Mobility
2. Self-care
3. Social functioning/Quality of life
A modification scale may be administered in addition to the activity analysis to determine the needed level of adaptation.

Mobility
· Walking/standing
· Opening and closing doors
· In and out of car
· In and out of bed
· Stand/sit in shower/tub
· Ability to lift/carry objects
· Method of locomotion in and out of home
· Speed of movement
· Endurance

Self Care
· Food preparation
· Grooming and hygiene
· Laundry
· Bookkeeping
· Cleaning house
· Shopping/Appointments

Social Functioning/Quality of Life
· Social Interaction
· Problem solving
· Household chores
· Self protection
· Self-information
· Community functions
· Hobbies and other interests

Other considerations:
According to research by Technology and Disability (1997), acceptance of assistive devices by the elderly is related to device appearance and stigma as well as the perceived enhancement of individual functioning. In order to maximize potential use and acceptance, the use of "normalized" devices will be considered as possible.

General Fall Risk Factors (CsiA, 1998)

Age-related:
1. Sensory systems:
reduced visual acuity
reduced contrast sensitivity
reduced depth perception
reduced dark adaptation
reduced vestibular functioning
reduced cutaneous sensation
2. Musculoskeletal system:
reduced muscle strength
increased muscle fatigue
reduced flexibility
reduced range of motion
3. Nervous system:
slowing of reflex/response

Changes in balance:
1. Lateral instability
2. Variability in control of gait
3. Fear of falling

Environmental Risk Factors:
1. Doors/latching/swinging doors
2. Floors:
slippery surfaces
edges and obstacles
transitions between tile and carpet
thick/loose carpets
3. Lighting:
brightness
uniformity
glare
low-lit areas
4. Seating: lack of armrest/handrails

Interventions:
1. Floor coverings
non-skid wax on floors
non-skid strips in bathtub
avoid area rugs, tape edges of carpet/runners etctera
avoid transitions or clearly indicate variatios
eliminate trip hazards
2. Lighting
non-glare, uniform and bright
use night lights throughout house
3. Handrails and grab-bars
high visible
install in bathrooms, stairs, other high-risk areas
install for correct positioning (see Proper Handrail Design Parameters)
use vertial poles near chairs, bed, toilet, bath, other high risk areas (see Sturdy Grip example)
4. Toilets and bathtub:
raise height of toilet base and add armrests (see Toilevator example)
install low-wall bathtub (see Access Bathtub example)
5. Stairs/transitions in/out of house
remove visual distractions
remove all obstacles
ensure adequate lighting
clearly mark transition with high contrast/tactile paint or tape

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