Activities of Daily Living Performed by People with Spinal Cord Injury: Difference between revisions

Activities of daily living (ADLs) include the basic skills needed to manage physical needs, comprising grooming and personal hygiene, dressing, toileting and continence, transferring and ambulating, and eating.[1] Instrumental Activities of Daily Living (IADLs) include complex tasks related to the ability to live independently in the community, and they comprise domestic tasks, leisure, parenting, shopping, managing finances and medications. [2]

Understanding the ability of patients with spinal cord injury to perform daily activities is important to plan their rehabilitation and manage their long-term care. Functional impairments vary significantly among people with spinal cord injury, and they could have a different impact on their quality of life. [2]Some studies suggest that spinal cord injury is responsible for a significant decrease in quality of life and functional limitations, in addition to pain intensity, level of injury, and education status are factors in quality of life. [2][3]

This article includes additional notes that complete the presentation on Activities of Daily Living and Self-Care for People with Spinal Cord Injury.

Activities of Daily Living (ADL)[edit | edit source]

Level of Injury and Selected ADL[edit | edit source]

Hands-free hydration system

Eating and Drinking[edit | edit source]


  • Full assistance in eating
  • Independent in drinking with assistive technology
    • Example: Hands-free drinking system


  • Set up assistive technology for eating
    • Example: U-cuff and wrist extension splint
  • Independent with assistive technology in drinking
    • Examples: Add hooks to drinking bottles or cups, add straw if bottle or cup cannot be lifted high enough

C6 and C7:

  • Independent with assistive technology in eating:
    • Examples include tenodesis grasp, use u-cuff, can also use ringed cutlery, might be able to weave cutlery through fingers
  • Independent in drinking:
    • Examples include tenodesis grasp or can use hooks. DO NOT burn when holding a hot beverage


  • Independent in eating and drinking
  • Can manage with standard cutlery or might need build-up handles

Grooming[edit | edit source]


  • Full assistance in grooming tasks


  • Moderate assistance for some grooming tasks with universal cuff and wrist extension splint due to no active wrist extension


  • Independent in most grooming tasks with u-cuff or intertwining utensil between fingers.
  • Wrist extension present; therefore, use of tenodesis grasp to hold small objects. Seldom use of tenodesis grasp to hold heavier objects as it would be too weak.


  • Independent in all tasks. It may require built-up handles for some tasks

Dressing[edit | edit source]


  • Assistance with all aspects of dressing, but they can DIRECT their caregiver independently about what clothes they would like to wear.


  • Can place arms into sleeves but generally needs assistance for all other aspects of dressing


  • Can become independent in all aspects of dressing but requires extensive practice and modifications to some of their clothing


  • Independent with practice

Showering[edit | edit source]


  • Assistance with all aspects of washing – can independently direct the washing


  • Can wash parts of the body with assistive technology and can hold an adapted hand-held shower head to rinse body, but generally needs assistance for all other aspects of washing


  • Can become independent in all aspects of washing with extensive practice, with appropriate assistive technology and an environment that facilitates independence


  • Independent with practice

Toileting[edit | edit source]

C1 -C5:


  • Intermittent self-catheterisation

Bladder management:

The following problems need to be overcome:

  1. Urinary retention -cannot control the bladder sphincter muscle – thus cannot void on command and experiences leakage
  2. Unable to feel when want to void/when the bladder is full

Solution: Routinely empty the bladder using an appropriate and safe method.

Bowel management:

This article presents the guidelines for the management of neurogenic bowel dysfunction in spinal cord injury.[4]

Watch this video to learn about adaptive tools to help patients with hand weakness successfully manage their bowel program.


Pressure Care[edit | edit source]


  • Requires assistance to relieve pressure using the forward lean technique.
  • A person can be independent in pressure relief by tilting their power wheelchair, but the wheelchair should be able to tilt at least 50 degrees.
  • When ordering a power wheelchair for a patient with high tetraplegia, consider the tilt range.
  • A caregiver can manually tilt a wheelchair backwards to relieve pressure.

Communication[edit | edit source]


  • Use preserved function in head, neck, mouth and voice with assistive technology
    • Examples include mouth or head stick, speakerphone, headset, touch screen, mounting system on wheelchair and hospital bed
  • Can sign document holding a pen in mouth, turn pages if document or book is placed on an appropriate reading stand and use a mouth stick


  • Use assistive technology and available function
    • Examples include universal cuff and writing splint (person with C6/7 SCI), speakerphone, large buttons on the phone, touchscreen, headset, lanyard (prevent phone from being dropped); stylus or finger extension splint to use with touch screen, hook on a phone to help lift it to the ear (not as common as technology has improved greatly)


  • Can generally manage without aids, night requires building up writing device
  • Using a computer
  • Typing splints, mouth or headsticks can be used (no adaptation to the computer), consider mouse and keyboard alternatives.
  • Voice dictation software

Instrumental Activities of Daily Living[edit | edit source]

Domestic Tasks[edit | edit source]


  • May independently perform light housekeeping duties.[6]


  • Able to perform household duties with fewer adaptive aids to manage independent living.[6]

Teach the person with spinal cord injury the following adaptations to assist with housekeeping tasks:[1]

  • When using a duster/sweeper/mop with limited hand function, use one with a hook eye on the handle. You can hook your thumb through to help grip.
  • Use your palm to press the spray bottle if you have limited hand function.
  • Use a scouring pad and stick to wash the bath.
  • Store cleaning supplies together in a basket that can be put on your lap.

Parenting[edit | edit source]

To fulfil the parenting duties, the person with spinal cord injury may benefit from the following guidance:

Transporting and Carrying the Child[edit | edit source]

  • Think about balance, posture, pressure changes on cushion, safety and transfers. When using carriers, watch for shoulder and back pain exacerbation.
  • When using carriers, wraps, and lap belts, make sure that you can open and close them
  • Consider alternative methods of carrying
  • When transferring the baby, ensure you are as close to the surface as possible to increase stability and safety and decrease the risk of injury
  • Place the pillow on your lap to carry a child
  • When lowering baby to the ground, use elbows on knees. When putting weight on your elbows and knees, it creates leverage and more proximal stability
  • Use a velcro wheelchair seat belt to help secure the baby when transporting

Car seats: use lightweight, swivel car seats and buckle release tool.

Strollers: Consider lightweight, adaptive wheelchair-compatible strollers.

Feeding[edit | edit source]

Bottle feeding

  • Adaptive bottle holders
  • Nursing/bottle feeding specific pillows
  • Bottle warmers
  • Burping considerations
  • Strap a bottle holder onto a wheelchair

Breastfeeding positioning

  • Reclined, side-lying, seating
  • Use of positioning pillows

Feeding solids

  • High chair considerations
    • Heigh, portability, straps/securement, accessibility to put the child in a high chair
    • Strap a booster seat onto a barstool for feeding         

Changing Diapers and Nappies[edit | edit source]

  • Consider the changing surface and changing pad
  • A dining table can be used for diaper changing

Dressing[edit | edit source]

  • Install loops onto zippers, use velcro or magnetic closures
  • Padded space on the lap can help with tasks that can be done from the wheelchair, such as dressing

Bathing[edit | edit source]

  • Consider using the kitchen sink (if safe)

Sleeping[edit | edit source]

  • Bedside bassinets and co-sleepers eliminate the need to transfer out of bed to feed/comfort the baby
  • Consider a cot that opens sideways
  • Adjustable/lower height crib

Play[edit | edit source]

  • A bed can be a level play area
  • Toys with loops, handles or hooks

Safety[edit | edit source]

  • Provide physical boundaries
  • Baby gates need to be wide enough for a wheelchair to pass through and should ideally not have a threshold
  • Consider magnetic cabinet locks if limited hand function
  1. 1.0 1.1 Oelofse W. ADL, Self-Care, and Home Modifications for People With Spinal Cord Injury. Plus Course 2023
  2. 2.0 2.1 2.2 Tien NLB, Thanh VV, Hanh KTH, Anh PG, Huyen LTM, Tu NT, Mai DTN, Toi PL. Quality of Life and Activities of Daily Living among Patients with Complete Cervical Spinal Cord Injury and Surgical Treatment in Vietnam. Int J Environ Res Public Health. 2021 Sep 15;18(18):9703.
  3. Bhattarai M, Smedema SM, Hoyt WT, Bishop M. The role of mindfulness in quality of life of persons with spinal cord injury: a cross-sectional study. Health Qual Life Outcomes 2022; 20 (148).
  4. Kurze I, Geng V, Böthig R. Guideline for managing neurogenic bowel dysfunction in spinal cord injury/disease. Spinal Cord 2022; 60: 435–443.
  5. Craig Hospital. Bowel Management Tools for People with Spinal Cord Injuries. Available from: [last accessed 18/11/2023]
  6. 6.0 6.1 SPINAL CORD INJURY FUNCTIONAL GOALS. Available from [last access 18.11.2023].

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