Measuring Functional Skills Chapter 11

Functional Skills Abilities or tasks demonstrated by the client that can be observed and measured The purpose of functional assessment is to Make a measurement of the level of skill in specific tasks before therapy begins, during the intervention process, and before discharge Identify the underlying causes of suboptimal performance Identify possible actions to address for need

Standard Domains for Measurement of Function The use of four primary domains in health care dates back to the 1920s Because the division of function into the four domains is interdisciplinary and has been accepted by various professions, Rec. Therapists may benefit from also adopting the primary four.

The Four Domains of Function Physical Domain Cognitive Domain Social Domain Emotional Domain

Physical Domain Other disciplines may provide the specific measure of the physical domain, but RTs need to be able to identify whether a patient’s functional ability falls within normal or not

Physical Domain Grasps and Grips Grasp – used to describe the positions of a client’s thumbs and fingers when holding an object Developmental Levels of Hand Grasps - Table 11.1 pg. 306 Grip – The measurement of the amount of pressure exerted by the hand and fingers. Endurance of grip measured by dynameters RTs do not generally use dynameters, however grip abilities are worked on during activities and therapy sessions.

Physical Domain Coordination The client’s ability to move through space and manipulate his/her environment in a synchronized manner Involves a wide variety of skills Upper left, page 307 Coordination Extremity Test (AKA Finger to Nose Test) Body mechanics refer to the muscle’s ability to maintain balance and muscle effectiveness against the pull of gravity to carry out the desired task. Key elements of body mechanics to look for during activities: Alignment Balance Base of Support Gravity

Physical Domain Gait Refers to the client’s style of walking When assessing gait, therapist will want to observe the motor patterns, rhythm, cadence, and speed Types of gaits to familiarize yourself with Pages 307-309

Physical Domain Endurance/Activity Tolerance Relate to the client’s ability to tend to a task, maintain the energy that is necessary to work on a task for an appropriate length of time, and produce an adequate output. Endurance Fatigue Activity Intolerance OPQRST – pg. 309

Cognitive Domain Broken down into many different subcategories Zoltan (2007) Manual Outcome based programs could measure changes in any of the following areas described below to determine the effect of treatment: Attention/Concentration Mental Flexibility Awareness Orientation Generalization and Transfer Planning and Organization Initiation Problem Solving Memory

Social Domain The areas of social domain function that the treatment team is usually interested in relate to the client’s social roles, social patterns, social skills, and social support. Psychometrically, the ability to measure functional skills in the social domain is the least developed area of measurement. Some tools measuring the social domain CERT – Psych/R School Social Behavior Scales Home and Community Social Behavioral Scales SOFAS (page 313) Other scales include social items

Social Domain Social Roles Social Patterns To act in a manner that represents what would be expected of the character for which one is playing Social Patterns Patterns of interactions between people Intra-Individual Extra-Individual Aggregate Inter-individual Unilateral Multilateral Intra-group Inter-group

Social Domain Social Skills Social Support Refer to the actual techniques used by an individual to interact with others Three areas where clients often demonstrate a suboptimal level of functional social skills are: Boundaries Coping Conflict management Social Support Family, friends, and community support a client has available

Emotional Domain AKA Affective Umbrella term that includes feelings, moods, other things related to affect Measuring a client’s emotional domain is always a two part assessment. First, the therapist asks the client to describe his/her emotions, feelings, or mood Second, the therapist observes the client’s behaviors and body movements.

Emotional Domain Sadock & Kaplan (2007) describe seven different categories of observed affect Appropriate Affect Broad Affect Inappropriate Affect Restricted Affect Blunted Affect Flat Affect Labile Affect