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1. The Muscular Dystrophy Association (MDA) through a patient care grant provides a one-time OT/PT home evaluation, or 2. Private insurance which may authorize an in-home evaluation due to the home-bound status of the insured. Regardless of the referral source, these professional home evaluations can provide a heightened awareness of in-home environmental possibilities that can affect the patient’s daily activities both now and in the future. Through the professional evaluation performed by the OTs and PTs alternative solutions can be utilized within the framework of the patient’s home that facilitates safety with transfers, energy conservation, and home exercise programs. Many times therapists are utilized for what is presently needed and not for potential issues that may arise in the future within the home environment. Since home visits tend to be a very limited service, it is most important to not only focus on today’s challenges but to consider future needs. During the home evaluation, the therapist will perform an initial evaluation. The purpose of this evaluation will be to maintain maximum independence and energy conservation. The following recommended areas may included : ROM and strength assessments: Range of Motion (ROM) exercises are critical in maintaining joint mobility and muscle nourishment. The assessment gives the therapist a good starting point for proper instruction for the home exercise program. Limitations in range of motion are important to note so proper stretching techniques can be implemented. Strengthening exercises are not recommended for muscles that already show weakness. Joints like the knee require motion to be maintained. Movements like walking or getting up from a chair require the knee to be flexed and extended so it remains "oiled" and used. As weakness sets in, movement is lessened and the joints become stiff and eventually sore due to lack of motion. It is very important that range of motion exercises become established and are followed routinely. The home therapist can help the patient with simple ROM exercises and instruct the family/caregivers to safely assist the patient in moving their arms, hands, fingers, legs, ankles, and feet. Do not rely upon the therapist to be the only person who will assist you in performing these daily activities. Instructions to the family/caregivers as well as assigned home health aides is essential to the daily execution of a prescribed ROM home program. Mobility and transfers observations: Therapists can assess the strength, safety, and efficiency of a patient’s physical ability. Oftentimes muscle weakness can make independent movements rather difficult and therefore transfer assistance may be helpful or even required or even helpful for the moderately independent patient to conserve their energy and always maintain safety. A transfer is defined as "getting from point A to point B." Professional therapists are trained to assess transfers and provide the patient with alternative ways to perform various activities. As an example, if you find it difficult to get up from the toilet, the therapist might recommend an alternative technique that includes hand placements for support or a piece of equipment (a raised toilet seat with arms or a 3 in 1 commode). Activities of daily living and self-care interviews: The therapist can best assess patients’ needs within the home if they are allowed to interview them first-hand and observe them performing the various specific activities of daily living -- getting in and out of the shower, climbing out of the bathtub, getting on and off the toilet, getting in and out of bed, climbing up and down the stairs, and getting in and out of the car. It is vital that a thorough assessment of transfers is made to ensure the safety of each separate task. If the therapist finds that the safety of the patient or caregiver is compromised when performing transfers, they will recommend an alternative solution that fits within the framework of the home and the abilities of the caregivers. Energy conservation evaluations: Many patients report a significant decline in energy level and difficulty performing activities of daily living, including feeding, dressing, bathing, and daily self care regimen. The therapist can help address these difficulties by recommending alternative ways to perform simple daily activities. For example, brushing teeth can be an exhausting ritual when done standing at the sink. An energy-conserving alternative might involve purchasing an electric toothbrush and sitting down to brush the teeth with an elbow resting on the sink lip, and moving the head to get to the back teeth instead of moving the whole arm. So, it is also important to tell the visiting home therapist about the tasks that are challenging to perform. A long-handled sponge to assist with bathing, a button hook device or the use of Velcro to help with dressing, and large-handled utensils for eating may be the key to maintaining independence in these activities over a longer period of time. Be open to recommendations for changes that will help conserve energy, as this is a key factor in maintaining quality of life.
Home dimension measurements: Measurements within the house may be necessary. These can include the width of the front, bedroom, and bathroom doorways as well as bedroom dimensions. Hallway width and corners can be assessed to enable proper equipment recommendations. The measurement of the home by the therapist provides an immediate assessment of adequate or inadequate available space and supplies information that is essential for durable medical equipment recommendations or if a wheelchair is to be used in the future. Throughout the entire home evaluation, on-going communication between the patient and the ALS team is most important. A home evaluation report is prepared by the therapist and is sent to the referring physician. Since the referring doctor may not be an ALS team member, it is highly recommended that a copy of the home evaluation report be communicated to an ALS team member (neurologist, nurse clinician, rehabilitation specialist) in order to provide optimal services and follow through for the patient. Further information please contact your local MDA Office. In NYC:212-689-9040 or www.MDAUSA.org
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Individuals diagnosed with Amyotrophic Lateral Sclerosis (ALS) are often referred to an Occupational Therapist (OT) or a Physical Therapist (PT) for a professional evaluation for home rehabilitation services. The purpose of this article is to provide a checklist of items that can be reviewed during a home rehabilitation evaluation to maximize the benefits to the patient and their families/caregivers. At the Eleanor and Lou Gehrig MDA/ALS Center, most patients utilize two referral sources for professional home evaluations:
Home accessibility appraisals: Appraising home accessibility includes how the patient enters the home, room-to-room mobility, and how the patient could exit normally and in case of an emergency. If a patient lives in a split-level ranch style home and uses a walker, the therapist needs to include the size of the walker as well as patients in accessing space within their home. The home therapists might review techniques for getting a person and their walker up and down stairs, and/or recommend the purchase of additional assistive equipment if indicated. In addition, the therapist should evaluate potential risks that exist within the home (i.e., scatter rugs, floor pillows, poor lighting, shoes) and recommend safe changes of potential problem areas. 
