by Anne C. Clark, M.S., P.T. on Tue, 2002-10-01 17:00
People with ALS are often referred to an occupational therapist (OT) or physical therapist (PT) for a professional evaluation for home rehabilitation services. This article provides a checklist of items that a therapist may review to maximize benefits to you and your family or caregivers.
Sometimes private insurance will authorize an in-home evaluation for an insured person who’s considered "homebound." MDA also offers annual PT and OT evaluations as part of its clinic program.
Professional home evaluations can provide a heightened awareness of the home environment and its effects on your daily activities. OTs and PTs can offer alternative ways to perform daily activities safely with a minimum of energy. Since home visits tend to be a very limited service, it’s important that your home evaluation not only focus on today’s challenges but also consider your future needs.
The therapist may assess you and your home environment in these areas:
ROM and strength assessments
Range-of-motion (ROM) exercises are critical in maintaining joint mobility and muscle nourishment. By assessing your abilities, the therapist can instruct you and your caregivers in a home exercise program to help you maintain flexibility in joints such as the knees and exercise your arms, hands, fingers, legs, ankles and feet.
Limitations in ROM are important to note so proper stretching techniques can be implemented. Strengthening exercises aren’t recommended for muscles that already show weakness. (See "Exercise Has Many Benefits.") It’s important that ROM exercises become established and followed routinely, every day if possible.
Don’t rely on the therapist to be the only person to assist you in performing these daily activities.
Mobility and transfer observations
Therapists can assess the strength, safety and efficiency of a patient’s physical ability. Oftentimes muscle weakness can make independent movements rather difficult, and transfer assistance may be helpful. Assistance can help the moderately independent person to conserve energy and maintain safety.
A transfer is defined as "getting from point A to point B." A therapist’s evaluation will provide you with alternative ways to perform various activities.
As an example, if you find it difficult to get up from the toilet, the therapist might recommend a technique that includes hand placements for support or a piece of equipment such as a raised toilet seat with arms or a 3-in-1 commode (a free-standing commode with a safety frame and raised seat).
Activities of daily living and self-care interviews
The therapist can best assess your needs within your home by interviewing you and observing you performing various activities of daily living — getting in and out of the shower, climbing out of the bathtub, getting on and off the toilet, getting in and out of bed, climbing up and down the stairs, and getting in and out of the car.
It’s vital that a thorough assessment of these transfers be made to ensure the safety of each task. If the therapist finds that the safety of the patient or caregiver is compromised when performing transfers, he or she will recommend an alternative feasible solution.
Energy conservation evaluations
Many people with ALS report a significant decline in energy levels, and that leads to difficulty performing activities such as feeding, dressing, bathing and a daily self-care regimen.
For example, brushing teeth can be an exhausting ritual when done standing at the sink. Energy-conserving alternatives might involve using an electric toothbrush; sitting down to brush the teeth with an elbow resting on the sink lip; or moving the head to get to the back teeth instead of moving the whole arm.
It’s important to tell the visiting home therapist about tasks that are challenging to perform. A long-handled sponge to assist with bathing, a button hook device or the use of Velcro to help with dressing, and large-handled utensils for eating may be keys to maintaining independence in these activities over a longer period of time.
Conserving energy in these tasks is a key factor in maintaining quality of life.
Home accessibility appraisals
In appraising your home’s accessibility the therapist will assess how you enter and exit the home, move from room to room, and how you’d get out in case of an emergency.
The home therapist might review techniques for getting you and your walker up and down stairs, and/or recommend the purchase of additional assistive equipment. The therapist should also evaluate potential risks inside your home (i.e., scatter rugs, floor pillows, poor lighting, type of shoes) and recommend safe changes in potential problem areas. (See "Take Falls Seriously.")
Home dimension measurements
Measurements within the house may be necessary. These can include the width of the front, bedroom and bathroom doorways, as well as bedroom dimensions. Hallway width and corners can influence equipment recommendations.
Throughout the home evaluation, ongoing communication between you and your ALS care team is most important. The therapist will send a report to the referring physician. You should also be sure a copy goes to a member of your ALS team (neurologist, nurse clinician, rehabilitation specialist) so they can provide optimal services and follow-through. For further information please contact your local MDA office.
Adapted with permission from the newsletter of the Eleanor and Lou Gehrig MDA/ALS Center at Columbia Presbyterian Medical Center in New York. Anne Clark is a physical therapist at the center.