therapeutic intervention on activities of daily living : effects ......plan •introduction:...

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Les Amis des Aveugles et Malvoyants

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Therapeutic intervention on Activities of Daily Living : effects on quality of life

Plan

• Introduction: functional reeducation

• The quality of life in ophthalmology

• Evaluation of the quality of life in functional reeducation

• Activities of Daily Living: therapeutic support and fields of intervention

• Case study: functional reeducation program in ADL and evaluation of the quality of life

Introduction

• Functional reeducation:

• For whom? Young children, teenagers, adults and seniors confronted with a change or visual loss

• Why?

• Improvement of the quality of life and the feeling of well-being

• Increase of the autonomy in the private, school or professional spheres

• Handicap adjustment

• How? multidisciplinary therapeutic approach

Quality of life

The concept of quality of life

• Complex concept and plethora of definitions • Attributes in the concept of quality of life :

• Feeling of life satisfaction • State of physical, psychic, social and spiritual well-being • Satisfactory functional state • Feeling of control over its life • Realization of developing activities

Quality of life in ophtalmology

Schematic diagram of the relations between clinical ophthalmology and quality of life (Letzelter 2000)

Quality of life and functional reeducation

• Evaluation: why? • Quantification of the symptoms • Appreciation of their psychological, social, family,

professional echo, on the everyday life • Estimation of the diagnostic and therapeutic

strategies (adaptation of the programs) • Comparison of the therapeutic methods, critical

appraisal of the therapeutic intervention

• Creation of a specific questionnaire in the visual rehabilitation • Understanding the person’s every day life • Adequacy between therapeutic support/functional

and psychological real-life experiences • Estimation of the efficiency of the reeducation

Activities of Daily Living

Therapeutic support

• ADL = Everyday routine or activities • Objective: acquire, recover and/or keep an optimal

functioning in : • personal life, • professional activities • sphere of the leisure activities.

• The therapeutic support materializes by the way of : • concrete activities, • Learnings • Adaptation of the tasks and or the environment.

• Our work also consists in guiding the visual deficient person of a way :

• To identify difficulties / potentialities,

• To get back in a most optimal possible way his capacities,

• Adapting himself to his limits/potential.

• Final goal: moving back the limits and allow the person to act, to find a social role and to live a satisfactory life.

13/11/2013 10 OEUVRE FÉDÉRALE LES AMIS DES AVEUGLES ET MALVOYANTS ASBL

Fields of intervention

• Feeding/cooking

• Hygiene/health

• Mobility


• Communication

• Support for the parenthood


• Adaptation in the professional environment

• Leisures


Means of doing

• Advises (choose a colored dishes, avoid carpets on the ground, etc.)

• Adaptation of the environment (marking of the electrical domestic, improving the lighting, etc.)

• Choice of adapted material (System videos-enlargers, GSM, etc.)

• Learning of new techniques (peeling, pouring a glass, spicing)

Case study

JD : anamnesis

• 47 year-old man

• Maculopathy/ Leber neuropathy

• Visual acuity : 0,03 - 0,05 and < 1/20 to PL +

• Married - 5 children

• Before the announcement of the visual deficit : technician fitter of gas station

• Sudden and rough announcement of the visual deficiency job loss Restructuring of life

Psychological aspects

• Sudden and rough announcement of the handicap Trauma

• Important psychic fragility major anxio-depressive disorder/suicidal ideations

• Identity disruption due to the narcissistic wound modification of the self-image depreciation

• Psychological support defense mechanism Overinvestment of the rehabilitation as attempt of repairing the deficit

• Confrontation to the difficulties by the therapeutic sessions (OM, orthoptie, AVQ) awareness of the possible adjustment

Initial and specific assessment

• Initial assessment : project of global autonomy

• Specific evaluation of the ADL

Functional reeducation program

Reeducation Improvements Money management Management of payments (meals, activities)

in connection with the school of the children

Adapted material and GSM Important helps to the everyday life (use of

telephone, taking medication, reading the

hour, child rearing, etc.)

Dressing and undressing Autonomous management of the preparation

of the children

Marking (measuring cup, spices, cupboards)

Advises for the organization of foodstuffs

Advises for the house cleaning

Autonomy in the daily management of the

meals and the house cleaning.

Cooking and adaptation of the cookbook

(enlarged characters)

Self-confidence and pleasure to cook

Evaluation of the quality of life

Evaluation July 2012 Evaluation November 2012

Mobility Frequent difficulties when

unknown environment Fear,

management of the obstacles

and the distances especially

when the lighting is insufficient

Feels sometimes difficulties in

certain circumstances (too

many people, not enough

servitude in the public

transportation).

Constant embarrassment

when the light is insufficient.

Social life Often disturbed by his visual

problem on the physical and

functional level but also on the

emotional level

Rarely disturbed by his visual

problem at the functional and

emotional level.

Activities of

daily living

Constantly disturbed by his

visual deficiency in the ADL

Rarely disturbed in the ADL

excepted for his leisure

activities where it remains a

constant limitation.

Job Had to stop working because of

his visual deficit

Unchanged

Evaluation of the quality of life Evaluation July 2012 Evaluation November 2012

Reading Constantly disturbed for any tasks

in relation to the reading.

Unchanged

Pain Often feel eye pains or

embarrassment which often

perturb him in his activities.

Feel very often pains or eye

embarrassment which

sometimes perturbs him in his

activities.

Psycho-

affective

aspects

Continual negative thoughts about

the visual problem making him

often sad or depressed and very

often irritable even anxious.

Feel no more negative thoughts,

feeling of sadness or depressive,

irritability or anxiety because of

its visual situation.

Readaptation Total satisfaction about the

helps/learnings and therapeutic

support.

Unchanged

Low global satisfaction of its life

(level of quality of life estimated

at 5/10 ; psychological state

estimated at 6/10).

Average global satisfaction of its

life (level of quality of life

estimated at 8/10 ;

psychological state estimated at

8/10).

23

Centre de Rééducation Fonctionnelle

Stéphanie Demartin, Psychologue Sophie Demoustier, Psychologue Sophie Hamaide, Ergothérapeute Coralie Chevalier, Thérapeute en AVQ

+32 (0) 65 40 31 76 [email protected]
mailto:[email protected]

therapeutic intervention on activities of daily living : effects ......plan •introduction:...

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