Ahmad Alghadir M.S. Ph.D. P.T. RHS 332: Clinical Neurology Ahmad Alghadir, M.S. Ph.D. P.T. Room: 2071

Ahmad Alghadir M.S. Ph.D. P.T. Recommended texts S.B. O’sullivan, T.J. Schmitz, Physical Rehabilitation: Assessment and Treatment, F.A. Davis Company. 3 rd ed R.L. Braddom, Physical Medicine & Rehabilitation, W.B. Saunders Company. 1 st ed

Ahmad Alghadir M.S. Ph.D. P.T. Functional Assessment

Ahmad Alghadir M.S. Ph.D. P.T. Purposes To describe the patient’s problem in functional terms. To plan treatment to eliminate or reduce the problems identified. To measure the progress of these treatments towards the desired functional outcome.

Ahmad Alghadir M.S. Ph.D. P.T. Health Definition by WHO: “a state of complete physical, mental, and social well-being, and not merely the absence of diseases.” Factors used to define health: 1.Physical signs. 2.Symptoms. 3.Functional disability. See figure 11-1.

Ahmad Alghadir M.S. Ph.D. P.T. Disease Definition: “pathologic condition of the body that presents a group of characteristic signs and symptoms that sets the condition apart as abnormal.”

Ahmad Alghadir M.S. Ph.D. P.T. Physical signs and symptoms Physical signs: directly observable or measurable changes in an individual’s organs or systems as a result of pathology or disease (e.g. elevated blood pressure). Symptoms: “subjective reactions to the changes experienced by an individual as a result of pathology or disease” (e.g. dizziness).

Ahmad Alghadir M.S. Ph.D. P.T. Syndromes Definition: medical conditions that are not labels for a single pathologic entity, but clusters of signs and symptoms (e.g. AIDS).

Ahmad Alghadir M.S. Ph.D. P.T. Impairments Definition: “any loss or abnormality of anatomic, physiologic, or psychologic structure or function; the natural consequence of pathology or disease” (e.g. loss of ROM). Manifestation of pathology or disease. Temporary or permanent.

Ahmad Alghadir M.S. Ph.D. P.T. Functional limitations Definition: “deviation from normal in the way an individual performs a task or activity, usually as the result of impairment” (e.g. inability to bath independently).

Ahmad Alghadir M.S. Ph.D. P.T. Categories of function 1.Physical function: “sensory-motor skills necessary for the performance of usual daily activities.”

Ahmad Alghadir M.S. Ph.D. P.T. a)Basic ADL: “tasks concerned with daily self-care, such as feeding, dressing, hygiene, and physical mobility.” b)Instrumental ADL: “advanced skills considered vital to an individual’s independent living in the community, including managing personal affairs, cooking and shopping, and home chores.”

Ahmad Alghadir M.S. Ph.D. P.T. 2.Psychological function: “ability to use mental and affective resources effectively in response to the requirements of a particular situation.”

Ahmad Alghadir M.S. Ph.D. P.T. a)Mental function: “intellectual or cognitive abilities of an individual, including initiative, attention, concentration, memory, problem solving, and judgment.”

Ahmad Alghadir M.S. Ph.D. P.T. b)Affective function: “mental and emotional skills and coping strategies needed to perform everyday tasks and stresses, as well as the more traumatic events each person encounters over the course of a lifetime; includes such factors as self- esteem, body image, anxiety, depression, and the ability to cope with change.”

Ahmad Alghadir M.S. Ph.D. P.T. 3.Social function: “ability to interact successfully with others in the performance of social roles and obligations; includes social interactions, roles, and networks.”

Ahmad Alghadir M.S. Ph.D. P.T. To be clinically meaningful, impairments must be linked to functional limitations in a cause-and-effect relationship.

Ahmad Alghadir M.S. Ph.D. P.T. Disability Definition: “inability to perform social roles typical of independent adults, taking into account age, sex, social, and cultural factors.”

Ahmad Alghadir M.S. Ph.D. P.T. “Disability is characterized by a discordance between the actual performance of an individual in a particular role and the expectations of the community regarding what is “normal” for an adult.”

Ahmad Alghadir M.S. Ph.D. P.T. Handicap Definition: “social disadvantage for a given individual of impairment, functional limitation, or disability.” “The negative value placed by others on an impairment, functional limitation, or disability makes a person handicapped.”

Ahmad Alghadir M.S. Ph.D. P.T. Independence. Social stigma. Environmental restrictions. Same disease and impairments, but different functional limitations. Functioning differently, but not handicapped.

Ahmad Alghadir M.S. Ph.D. P.T. Types of instruments 1.Performance-based assessment: “assessment of a particular skill based on observation of an actual attempt, as opposed to acceptance of a self-report of skill level.” Setting should be similar to the actual environment. Assessment may be biased by fatigue. Take appropriate safety precautions.

Ahmad Alghadir M.S. Ph.D. P.T. 2.Self-administered assessment: “survey or series of questions constructed to be answered directly by the respondent without additional input or direction.” Distinguish between person’s habitual performance and capacity to perform a task (NO vs. N/A). Specify a time-frame reference (short- vs. long-term objectives).

Ahmad Alghadir M.S. Ph.D. P.T. Instrument parameters 1.Descriptive parameters: e.g. dependence, difficulty, and endurance. -Dependence: “state requiring some level of human assistance.” -Difficulty: “hybrid term that suggests that an activity poses an extra burden for an individual, regardless of dependence level.”

Ahmad Alghadir M.S. Ph.D. P.T. -Endurance: “energy consumption required to complete a functional task.” “Meanings of descriptive terms should be clear to all others using the medical record.” See table 11-1.

Ahmad Alghadir M.S. Ph.D. P.T. 2.Quantitative parameters: e.g. timed assessments. Speed vs. quality.

Ahmad Alghadir M.S. Ph.D. P.T. Instrument formats 1.Checklist scale (dichotomous or categorical scale): see table “Assessment tool format in which a description of various tasks is simply scored dichotomously (e.g., present or absent; completed or not completed).”

Ahmad Alghadir M.S. Ph.D. P.T. 2.Numeric or letter-grade scale (ordinal scale): MMT. “Classification scheme that rates observations in terms of the relationship between items (e.g., less than, equal to, or greater than).”

Ahmad Alghadir M.S. Ph.D. P.T. 3.Summary or additive scale: see table “Approach to grading a specific series of skills by awarding points for each task or activity; totals the score as a percentage of 100 or as a fraction.”

Ahmad Alghadir M.S. Ph.D. P.T. 4.Visual or linear analog scale (continues scale): pain. “Linear rating designed to capture a subject’s judgment of his or her position on a continuum. A line is presented horizontally or vertically on paper, with the endpoints anchored with descriptive words representing the extremes in terms of the parameter of interest.”