Prosthesis and daily life: the importance of a functional assessment

The activities of daily life (ADL) are the actions that an adult performs independently during the daily life, without necessarily requiring assistance.

Brushing your teeth, combing your hair, wearing a sweater or making your own lunch are all considered activities of daily life and the inability to carry them out by yourself significantly affects the quality of life.

The ADL classification

The ADLs are divided into two main sub-categories: the basic ADLs (bADL) and the instrumental ADLs (iADL).

The first includes the personal care and hygiene activities as well as functional mobility, which implies the ability to carry out a series of activities independently such as walking, sitting or getting up from a chair.

The latter concerns all those activities considered not essential but equally important, because they allow you to live independently within your community. For example, the preparation of meals, housework, money management, the use of the phone are all included in the iADL.

Where does the definition ADL come from?

The ADL concept was born in the 1950s, thanks to the research activity of Dr. Sidney Katz at the Benjamin Rose Hospital in Cleveland.

Originally, his goal was to identify some parameters as indicators of the state of functional autonomy of the elderly, an increasingly pressing need considering the increase in life expectancy and therefore the aging of the average population.

Based on the definition of the degree of autonomy, the possible need for home care or hospitalization of the elderly person would then be assessed.

ADL today

Since then the concept of ADL has evolved and expanded, and today it’s very important to define parameters that attest the functional autonomy not only of the elderly, but also of a person who has disabilities or diseases that can compromise the performance of some daily activities.

Think, for example, of Parkinson’s or other neurodegenerative diseases, as well as motor deficits caused by a stroke, or even by the loss or surgical removal of a limb, following a traumatic event or a pathology.

The relationship between ADL and prosthesis

In the latter case, as well as in the event that the user presents a congenital alteration, the use of a prosthesis for upper or lower limb, must be able to contribute effectively to the autonomous performance of the ADLs.

In the design of a prosthetic device it is therefore essential to guarantee the user the restoration of limb functionality in the highest possible percentage. In this way the user will be able to bring the best out of the device, feeling comfortable in carrying out daily activities.

This is the goal of Adam’s Hand, a light, compact hand prosthesis that the user can control in an extremely simple and intuitive way.

The great challenge that our team wants to achieve is to create a device that gives users the opportunity to independently carry out 90% of daily life actions, essential for the well-being of the person, and to restore independence to the individual.

Functional tests of ADLs

There are specific tests that allow a functional evaluation, both in the case of pathologies involving motor deficits, and in the case in which a prosthesis is used.

Let’s analyze some tests used to evaluate the functionality of the upper limbs and in particular of upper limb prosthetic devices such as Adam’s Hand.

The score obtained in these tests is used in the clinical setting to attest the degree of functionality of the prosthesis and it helps to compare the characteristics of different prosthetic devices.

One of the main clinically validated function tests is the Southampton Hand Assessment Procedure (SHAP), originally developed to assess the effectiveness of upper limb prostheses and that has been applied to assessments of musculoskeletal and neurological diseases.

The test involves 26 tasks, 12 of which consist of grasping some objects (sphere, cylinder, etc.) and 14 are represented by the performance of specific ADLs (buttoning a shirt, opening a zip, pick up coins, food cutting, etc.).

A score in seconds is given for each task, which is timed by the participant. At the end of the test, the overall score is calculated, and it represents the SHAP Index of Function

Everything needed for the test is found in a suitcase supplied by the University of Southampton, the research center where the procedure was developed and which is the reference point for purchasing the test.

Another function assessment test is the Box & Block Test (BBT), used in both prosthetic and rehabilitation fields. The BBT is composed of a wooden box divided in two compartments by a partition and 150 small wooden blocks.

The user has to move, one by one, the maximum number of blocks from one compartment of the box to another, within 60 seconds. In this case the index of function is simply represented by the number of blocks that the user has managed to move in the expected time.

Both these tests, as well as other functionality tests, can also be repeated by the same user some time later, in order to monitor the improvements in the use of the prosthesis or the effectiveness of a rehabilitation therapy.

Among the most used tests to certify the functionality of upper limb prostheses, there are also the Minnesota Dexterity test (MMDT), the Assessment of Capacity for Myoelectric Control (ACMC) and the Clothespin Relocation Test.

There are also other tools, such as the Self-reported / self-administered questionnaires used for upper-limb prosthesis’ users, which allow to understand which activities of daily life are carried out with more or less ease and also what is the degree of user satisfaction in using the prosthesis.

Some examples of questionnaires are: Orthotics & Prosthetics User Survey – Upper Extremity Functional Status (OPUS-UEFS), Disability of the Arm, Shoulder and Hand (DASH) questionnaire, ABILHAND questionnaire.

The functionality tests of Adam’s Hand

In this stage of Adam’s Hand development, we have scheduled some functionality tests with the new version of the device, which will soon be launched on the European market.

The tests will initially be carried out by testers who have already used the alpha and beta prototypes of our prosthesis, and who are very curious  to testing the device in its final version.

We also aim to expand the testing activity with the collaboration of new users who will use Adam’s Hand and who want to contribute to the functional evaluation of our device.

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