Cookies & Cars

Last week I talked a bit about Activities of Daily Living, or, ADL's. All of those foundational things you do to maintain your health and well-being, and function in daily life. Like brushing your teeth, tying your shoes, all that good stuff. Yes, of course, you remember, you're not stupid, I get it. Just thought a review would make a good segue into the focus of this week...

...Instrumental Activities of Daily Living. IADL's. Yes, I know, it's so completely different from ADL's, because we added an I (for instrumental, if you follow me). Very complex and fancy. And, actually, IADL's can be fairly complex and fancy.

IADL's also happen on a daily basis, like ADL's. However, they are more complex than ADL's, and consequently require more thought. They're difficult to define, but easy to give examples of. Here are a few:

• Cooking & cooking clean-up
• Child rearing
• Caring for a pet
• Talking on the phone, sending emails, anything that involves communication
• Managing finances
• Shopping
• Community mobility (driving, using public transportation, etc.)

So, basically, we're still talking about those necessary activities that keep you successful in your daily life, but we're widening the scope into those areas that require more steps, more resources, and (often) more work (mental and/or physical). You can differentiate them from ADL's by thinking about the amount of thought you put into something like tying your shoes, in contrast to balancing your checkbook. Caring for just yourself, versus caring for your child. Getting around your apartment, versus getting around the city.

And, here's a big surprise: OT's are all over the IADL business. This can take an infinite number of forms, but one of my personal favorites in the IADL biz is community mobility. As alluded to above, this means getting around the community. An OT focusing on community mobility with a client may help them learn how to use the bus system, taking bus trips with them to practice. For someone who uses a wheelchair, an OT might help them map out the wheelchair-accessible spots in town, and devise plans for navigating those that are less-accessible.

Another quickly growing area is driving education and re-education. Currently, I am completely enamored with this last one. I never really thought about how much of a privilege driving is, until I spent time with some people who were waiting to be cleared to drive again after having a stroke. When they were finally able to get back behind the wheel, it was like passing the driving test in high school all over again. Going out to lunch was a big event, because they could drive themselves. If they wanted to make cookies, they could get in the car and drive to the grocery store to get the ingredients. They could go visit their friends and family whenever they wanted. It was huge. 

Of course, this got me thinking about how not being able to drive would be. And I don't mean before taking the driving test in high school, because if you haven't driven before, then you don't really know what you're missing. But being able to drive, and then suddenly not being able to drive. It would mean giving up a huge amount of independence. Relying on other people for errands of any kind. Relying on other people to visit you, instead of you visiting them. Having to stay at home alone because no one's available to drive you to your book club meeting. You get the idea.

So, imagine the thrill of being able to help someone regain that independence! Whether it's helping them re-learn driving, or helping them figure out the public transportation system. Pretty awesome, right?

All IADL information borrowed & adapted from: Occupational Therapy Practice Framework: Domain and Process (3rd Edition). American Journal of Occupational Therapy 2014;68(Supplement_1):S1-S48. doi: 10.5014/ajot.2014.682006.