The common functions of everyday life and tasks of daily routine. Clinicians use ADLs as a key measure of independence, treatment effectiveness (particularly as it relates to the fluctuating phenomenon), and, conversely, decline and care needs. Activities of daily living typically include such functions as bathing, toileting, dressing, cooking, eating, cleaning house, and performing other chores. ADLs, particularly those that require coordination and balance, become more difficult and eventually very limited as Parkinson’s disease progresses. tremors and dyskinesias interfere with the ability to manage tasks that require fine motor skills. sometimes cognitive impairment becomes a factor as well. There are numerous scales that measure ADLs. The two most commonly used are the Unified Parkinson’s Disease Rating Scale (UPDRS) and the schwab and England scale.
Unified Parkinson’s Disease Rating Scale (UPDRS)
The Unified Parkinson’s Disease Rating Scale (uPDRs) was developed to provide a consistent and objective measurement tool for assessing the progress of Parkinson’s disease symptoms and the effectiveness of treatment approaches. it consists of a series of questions divided into six sections. Section II assesses ADLs and measures self-reported assessment, on a 0 through 4 point scale, of
• Speech
• Salivation
• swallowing
• Handwriting
• Cutting of food/handling of utensils
• Dressing, hygiene
• Turning in bed/adjusting of bedclothes
• Falling unrelated to freezing
• Freezing when walking
• Walking
• Tremor
• sensory complaints related to Parkinson’s
The UPDRS integrates ADL scores with clinician assessment of motor function and other scales of measurement. Because of its comprehensiveness, UPDRS is a common tool for measuring and comparing the effectiveness of treatments and the results of clinical studies. Each of its six sections contains subsections with multiple questions or measures. The rating scale is the same as that used in the Common ADL Scale for Parkinson’s Disease, 0 to 4, on which a smaller number indicates greater independence.
Schwab and England Scale of Capacity for Daily Living
The schwab and England scale of capacity for Daily Living assesses functional capacity by percentage. Developed by R. S. Schwab and A. C. England Jr., this scale uses a percentage system to assign levels of independence and dependence, in which 100 percent represents complete independence and 0 percent complete dependence (bedridden). A presentation of the schwab and England Scale would be similar to the following:
|
Level of |
|
|
Independence |
ADL Capacity |
|
100% |
Able to do all chores without difficulty or impairment |
|
90% |
Able to do all chores but with some slowness (up to twice as long) or difficulty. Beginning to be |
|
|
aware of difficulty |
|
80% |
Able to do most chores but with some slowness (takes twice as long) and conscious of difficulty |
|
70% |
Difficulty and slowness doing chores, which take up to three or four times as long |
|
60% |
Can do most but not all chores, but with effort and very slowly; makes some mistakes |
|
50% |
Can do some chores but needs help with most; has difficulty with all and makes many mistakes |
|
40% |
Can help with a few chores but cannot do very many alone |
|
30% |
Can sometimes begin a few chores alone but cannot finish; needs much help |
|
20% |
Cannot do any chores alone (invalid) |
|
10% |
Helpless; total dependence |
|
0% |
Vegetative; bedridden; loss of swallowing, bladder or bowel functions |
ADLs and Independent/Assisted Living Decisions
As a measure of a person’s ability to live and function independently, ADLs factor into decisions regarding living arrangements. Most people with Parkinson’s disease do not need to make significant changes in their living arrangements for years or decades after diagnosis. Awareness of changes in ADL measurements can help the person with Parkinson’s disease and his or her caregivers to make minor adjustments as changes occur, helping to mitigate the effects of these changes. Adjustments range from simple accommodations such as removing throw rugs to prevent falls and arranging kitchen cabinets so that used items are within reach without the need to bend or stretch to exploring adaptive equipment and assist devices that can help maintain independence longer. Keeping pace with the changes as they occur helps reduce frustration with the progression of symptoms. Many people who have Parkinson’s disease ultimately reach the point where it is necessary to consider assisted living arrangements. Consideration of ADLs helps make this decision process more objective and factors in the person’s unique and specific needs.
