Activities of daily living (ADLs) are the most basic, common body movements that people must perform repeatedly every day in order to live independently, i.e., the basic movements and skills to perform clothing, food, housing, transportation, and personal hygiene. The ability to perform the activities of daily living is essential for everyone. For the average person, this ability is extremely common, while in people with disabilities, it is often a highly advanced skill that is difficult to perform. The greater the degree of disability, the more severe the impact on the ability to perform activities of daily living. The basic purpose of rehabilitation training is to improve the ability of the disabled person to perform activities of daily living. For this purpose, it is necessary to first understand the functional status of the patient, i.e., to perform the determination of the ability to perform activities of daily living. Wang Bo of the Rehabilitation Department of Songwon City Hospital of Traditional Chinese Medicine The determination of activities of daily living is to understand and summarize as accurately as possible the basic functional status of the disabled person in daily life by scientific methods, i.e. to clarify how they perform their daily activities, how many daily activities they can do, which items are difficult to complete, and what is the degree of dysfunction. Therefore, the determination of activities of daily living is an important part of the rehabilitation diagnosis of functional assessment, and is the basis for establishing rehabilitation goals, formulating rehabilitation plans, and evaluating rehabilitation efficacy, which is an essential and important step in rehabilitation medical treatment. According to the opinions of most scholars, the following major aspects should be measured: (1) Bed activities, including postural changes, movement and sitting balance in bed. (1) Changing position (1) lying down ←→ sitting up. (2) Turn over to the left and right. (3) supine ←→ prone 2. Body movement (1) move up and down. (2) move to the left and right. (3) Sitting balance (1) balance when the trunk moves and turns in all directions forward, backward, left and right – keep sitting stable. (2) Sitting balance when the arms are extended to either side – to maintain a stable sitting position. (2) Wheelchair activities including wheelchair riding and mastery of wheelchair: 1. wheelchair ↔ bed 2. wheelchair ↔ toilet 3. wheelchair ↔ bathroom (including shower and tub) 4. mastery of wheelchair (1) mastery of various parts of wheelchair. (2) How to push or drive the wheelchair. (3) Self-care activities including toileting, grooming, dressing, and eating: 1. Toileting and personal hygiene (1) Turning on and off the faucet. (2) Washing: including face washing, hand washing, hair washing and tooth brushing. (3) Bathing, showering or tub bathing. (4) Handling of bowels and urine, including the use of urinals, potties and toilets. (2) Grooming – personal grooming (1) Combing hair. (2) Shave your face. (3) The use of cosmetics. (4) Trimming nails. (3) Dressing (1) Putting on and taking off underwear and underwear. (2) Put on and take off pullover. (3) Putting on and taking off a pair of shirts. (4) Buttoning and zipping. (5) Knot the belt and tie. (6) Put on shoes, socks and lace up shoes. (4) Eating includes the use of tableware and the ability to eat: (1) Hold chopsticks and take food. (2) Scoop food with a spoon. (3) Cut food with a knife and pick up food with a fork. (4) Use straws, cups or bowls to drink water and soup. (5) Holding of bowls and plates, including carrying bowls and holding plates. (4) Reading and writing 1. reading books and newspapers 2. writing names and addresses (5) using lights and telephones 1. turning lights on and off 2. making phone calls (1) dropping coins. (2) Dial the phone. (3) answer the phone. (F) use of money 1. the use of wallet (money clip). (2) The use of coins and banknotes (7) Walking including the use of assistive devices and walking outside and inside: 1) the use of assistive devices (1) the use of walking sticks. (2) Use of crutches. (3) Wearing a brace, brace or prosthesis. 2. Indoor walking (1) Walking on concrete or dirt pavement. (2) Walking on carpet. 3. Outdoor walking (1) Walking on concrete or dirt pavement. (2) Walking on gravel pavement. (3) Walking up and down the stone steps of the road. (8) Going up and down stairs 1. going up stairs (with or without handrails) 2. going down stairs (with or without handrails) (9) taking a bus or a car 1. getting on a bus 2. getting off a bus 2. grading of activities of daily living The grading of activities of daily living is a measure of the patient’s independent living ability and functional disability, which is a quantitative and qualitative indicator to assess the patient’s basic functions of daily living. It is a quantitative and qualitative indicator to assess the basic functions of daily living. Different levels can reliably indicate different levels of function and disability, and changes in level can sensitively reflect improvement or deterioration of function. There are many ways to organize and design the grading of activities of daily living, and three grading methods are introduced: (a) Five-grade grading method This is based on the two-grade grading method developed by the Institute of Rehabilitation Medicine of New York University Medical Center, which is divided into five grades according to the independent procedures of daily living. Grading and its symbols (1) Grade I: Able to move independently without help or guidance, indicated by “√”. (2) Level II: Can do activities but needs guidance, indicated by “S” (supervision). (3) Level III: specific help is needed to complete the activity, indicated by “A” (assistance). (4) Level Ⅳ: no mobility, must rely on others to lift or manipulate the work, with “L” (lifting). (5) Level V: that is, the activity is not suitable for the patient, indicated by “×”. In the above levels, if the patient is in the condition of assistive devices (wheelchair, orthopedic support or crutches, etc.), the name of the assistive device must be indicated. 2. The recording method records the results of daily living ability measurement and functional progress by means of a form. (1) See Table 2-2-1 for the report form for the determination of activities of daily living. (2) See Table 2-2-2 for the record form for the test and progress of activities of daily living. Table 2-2-1 Report form for the determination of activities of daily living Name Gender Age Ward Record number Occupation Address Admission date Physician in charge Date of initial test Date of onset Type of impairment Flaccid Spasticity Disability Cause of onset Bed sores Surgery Table 2-2-2 Measurement of activities of daily living and progress record Bed activity G/1 G/2 Date Determiner Lying down Sitting up Turning left Right Supine Prone Making the bed Using the bedside table Using the signal lamp List the items of measurement of activities of daily living in order in the table, and record the measured level (fill in the level symbol), the date of measurement and the name of the person who made the measurement. The first measurement was recorded in blue pen, and the grade symbol was filled in the G/1 column, and a “√” indicated that the patient could complete the activity independently; a “×” indicated that the patient was not suitable for the activity, and if the patient could not complete the activity, a space was left in the column for the activity If the patient could not complete the activity, a space was left in the activity column without any marking. The progress is recorded with a red pen, and the grade symbol thing is filled in the G/2 column. Table 2-2-2 shows the recording section for bed activities, and so on for wheelchair activities, self-care activities, reading and writing, use of lights, telephone and money, walking, going up and down stairs and riding in a car. The five-level grading method and its recording method are simple and clear, and it is easy to understand at a glance whether the patient has the ability to move independently and what kind of assistance he needs, so it is convenient for clinical application. (2) Barthel index grading The Barthel index grading is a method of grading the independence of 10 daily activities: eating, bathing, grooming, dressing, stool control, urine control, toileting, bed and chair transfer, level walking and stairs. A score of 0 to 100 indicates that the patient is able to perform basic activities of daily living without assistance, control bowel movements, eat, dress, transfer to bed and chair, bathe, walk at least one block, and walk up and down stairs. 0 indicates poor functioning and no independence, requiring assistance in all activities of daily living. According to the Barthel Index score, the ability to perform activities of daily living was classified as good, moderate or poor; >60 was good, with mild functional impairment, able to perform some daily activities independently, requiring partial assistance; 60-41 was moderate. The score of 60-41 is moderate, requiring great help to complete activities of daily living; ≤40 is poor, with severe functional impairment, unable to complete most of the activities of daily living or requiring the service of others. The Barthel Index score is an effective method to determine the ability to perform activities of daily living. Table 2-2-3 Barthel Index Score Activities of Daily Living Independent Partially independent 10 5 0 Bathing 5 0 Grooming (washing, brushing, shaving, combing) 5 0 Dressing (including tying shoes) 10 5 0 Control of bowel movements 10 5 Occasional loss of control 0 (loss of control) Control of urination 10 5 Occasional loss of control 0 (loss of control) Toilet use (including swabbing, dressing, flushing) 10 5 0 Bed and chair transfer 15 10 5 0 Walking on level ground 45m 15 10 5 (wheelchair required) 0 Going up and down stairs 10 5 0 (C) Five levels of 20 activities of daily living grading method This is the grading method introduced in our “Rehabilitation Medicine” trial textbook. Grade Ⅰ: Can’t complete it, all rely on others to do it for you. Grade II: Can do part of it by himself, but can only do it with the specific help of others. Grade III: Can be completed with the guidance of others from the side. Grade IV: Can do it independently, but slowly, or need to use aids and supports. Level V: Normal, can complete independently. The content and scoring criteria of the five levels of 20 activities of daily living are shown in Table 2-2-4. III. Methods of measuring activities of daily living The methods of measuring activities of daily living include objective observation and recording during the test. （The direct observation method is to assess the actual activity ability of the patient by observing the patient’s activities of daily living in person. During the measurement, the assessor gives instructions to the patient for the patient to actually do it. For example, “Please sit up”, “Please wash your face”, “Let me see how you comb your hair”, etc. The patient’s ability to perform each action should be observed item by item and assessed and recorded. Observe the patient’s ability to perform each movement, assess and record. For the actions that can be directly observed, do not just take the approach of asking about what can be done, what can be done and the degree of completion, but make every effort to be objective and avoid being subjective in order to prevent patients from exaggerating or narrowing their abilities. 2, indirect assessment method Indirect assessment refers to the method of understanding and assessing some movements that cannot be directly observed by asking questions. For example, to find out whether the patient is able to control bowel movement or urination through questioning. Table 2-2-4 Measurement of the ability to perform activities of daily living and the scoring standard No. Item Time required to complete Completion Unable to complete 0 points Completed with help 25 points Completed with instructions 50 points Completed independently but slowly 75 points Completed independently at a normal speed 100 points 1 Put on the blouse, button the coat 2 Put on the pants, knot the belt 3 Put on shoes and socks 4 Use the spoon 5 Lift the bowl 6 Use chopsticks 7 Lift the thermos and pour water 8 Put away the bed 9 Switching on and off lights 10 Switching on and off taps 11 Unlocking locks with keys 12 Walking on level ground 13 Going up and down stairs 14 Getting in and out of wheelchairs 15 Using wheelchairs to move around 16 Getting on and off buses 17 Brushing teeth 18 Washing face 19 Bathing 20 Using toilets Total assessment: 2000 points normal, 1500 points mildly impaired, 1000 points mildly disabled, 500 points disabled, 0 points severely disabled 3. Activities of daily living ability measurement room The activity of daily living test room is a place to measure the ability to perform activities of daily living, and it is also a unit for functional training. It provides patients with basic conditions for activities of daily living and enables rehabilitation medical staff to directly observe patients’ specific activities. The setting of the daily living activity measurement room must be as close as possible to the actual living environment conditions. It should have the necessary equipment such as bedrooms, washrooms, bathrooms, toilets, kitchens, etc. and the corresponding daily living supplies. For example, beds, chairs, faucets, lights, aids, etc. Also, all equipment and supplies should be placed in a home-friendly location like the actual situation at home so that the patient can operate them. In rehabilitation centers or rehabilitation departments or rehabilitation wards of general hospitals, there should be a room for testing the ability to perform activities of daily living. The China Rehabilitation Research Center in Beijing has a modern ADL testing room with a bedroom, bathroom (shower and tub), lavatory, toilet and kitchen, including a bed, chair, famous faucet, various door and cabinet handles, knobs and fasteners, various light switches, kitchen stove and aids such as canes, crutches, wheelchairs and other daily living necessities. Some settings in the room are equipped with electric switches, which can be adjusted according to the need for high and low and left and right positions. This kind of test room is advanced and easy to use, and is conducive to the determination of daily living activities and functional training. High-level rehabilitation medical institutions can refer to it. General rehabilitation medical units can set up a test room for activities of daily living that meets the basic requirements according to their specific conditions. (ii) Test records Objective records must be made of the results of the determination of activities of daily living, i.e., the assessment of the patient’s basic functions of daily living, and the records should be concise and reliable. In order to assess the effectiveness of rehabilitation and functional progress, the date of measurement and the name of the person who made the measurement must be indicated in the record for comparison. It is easy and practical to record in a tabular format. You can design your own recording form based on the established ADL grading method. In this section, “Grading of Activities of Daily Living”, in the section on the five-level grading system, the New York University Medical Center Rehabilitation Medicine Institute’s recording forms (Tables 2-2-1 and 2-2-2) have been described. It is worthwhile to refer to these forms, especially Table 2-2-2, “Activity of Daily Living Measurements and Progression Records,” because they show both the current level of functioning and changes in functioning, and they combine the initial test and progression records in one form.