Vita TU, Occupational Therapist and Project Manager
Sunshine Social Welfare Foundation
After their injury, burn survivors will often say they want “to get better,” or “to go back to what they used to do.” But the hardships of long-term rehabilitation bring with them setbacks, and burn survivors will often want to give up. By helping our patients better understand the correlation between the content of rehabilitation activities and their own goals of "getting better" and "going back to what they used to do," we can enhance their motivation towards rehabilitation. This article discusses how we can make rehabilitation more purposeful and meaningful to our patients by using BADL as training goals post-burns linked to daily life functions.
What is BADL?
BADL stands for Basic Activities of Daily Living, which are the activities to manage one’s basic physical needs (as opposed to Instrumental Activities of Daily Living or IADL, which are more complex activities related to the ability to live independently in the community).
BADL Examples
Feeding: Able to bring food to mouth using utensils by oneself, does not include meal preparation.
Toileting: Able to use the toilet and clean up oneself.
Transferring: Able to move in bed, able to transfer between bed, chair, wheelchair.
Dressing and grooming: Able to choose appropriate clothing and put them on independently, able to maintain a clean appearance.
Bathing: Able to wash face, hair and body.
Why use BADL as training goals for post-burns?
Every activity of daily living is performed through multi-joint composite movements, which in addition to coordination, also require good range of motion. For example, as therapists we know that a combination of components like elbow flexion and MP joint flexion is necessary to hold objects and perform manipulation activities independently, like eating or brushing one’s teeth. We also know that 90° MP flexion and 135° elbow flexion are ideal to perform the above-mentioned activities smoothly. But when we set goals for our patients AND COMMUNICATE these goals, what does 90° MP flexion and 135° elbow flexion actually mean to them? What do these abstract numbers represent concretely to our patients and why is it worth it to strive to attain them despite all the hardships and setbacks?
This is where using BADL as training goals becomes handy. With the example above, if the patient understands that the goal is to be able to hold a spoon and put the food into his mouth to eat, and to achieve this goal, it is necessary to achieve 90° MP flexion and 135° elbow flexion, the abstract range of motion rehabilitation goals will correlate to concrete daily living goals, and become more specific and meaningful. The patient will better understand how rehabilitation correlates to increased daily living independence and a reduction of the burden placed on the caregiver, and thus feel more motivated and more willing to tolerate pain.
The table below illustrates some example of how BADL can be used to “reframe” goals to make them more easily relatable by the patient, and correlates them to our more traditional range of motion rehabilitation goals.
Therefore, the therapist can discuss the training needs and BADL priorities with the patient or the caregiver, and the therapist can then set goals according to the ability of the patient. To achieve independence in execution, a BADL activity may be divided into several goals in different stages, such as being able to wash the torso by oneself first, and then to be able to wash hair by oneself. And for each goal, there will be a corresponding component that should be trained, which may be joint mobility or muscle strength. This must also be determined according to the condition of the patient.
Use BADL progress to allow the patient to see their own progress
When we use BADL activities as rehabilitation goals, and design a rehabilitation plan for the patient that results in progress, it also means that a certain part or component of a certain BADL activity has achieved independence. Rehabilitation will usually last for a long period of time. The therapist can guide the patient into reviewing milestones in the achievement of the goals. Some goals may have been achieved, while others may still need more efforts. Guiding the patient to be aware of the progress of their own functions will help enhance their sense of competence and accomplishment, and help the patient continue to invest in rehabilitation. For example, the therapist can help the patient realize that at the beginning, they came to the rehabilitation room in a wheelchair but after one month, they can walk safely indoors, and after three months, they can go up and down the stairs. By helping the patient notice the progress of their functions, it can also promote their own reflection about next steps: What goals have not been achieved? What goals are expected to be achieved? What new goals would I like to add? By letting the patient use his imagination for the future, he will be more willing to invest in rehabilitation.
Conclusion
Burn rehabilitation needs to be performed day after day, and along the way, patients may experience pain, delayed progress, setbacks, etc. However, being able to return to something close to their previous life is what every burn survivor looks forward to, and the most basic criteria for achieving this is BADL independence. If BADL activities are used as the rehabilitation goal and a rehabilitation plan is designed accordingly for the patient, the patient can be more focused and targeted in the implementation of rehabilitation; and by regularly guiding the patient to perceive the progress and improvement of their functions, it will promote their imagination of future possibilities, and they will be more motivated to recover.
To learn more about activities of daily living and how to design interventions to help our patients recover as much functionality as possible so they can return to a quality independent life, check out ADL Functional Training - Helping Burn Patients Regain Independence for dates of upcoming course.