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NDT Ch 11
Ch 11 Exam of Functional Status
| Question | Answer |
|---|---|
| Generic functions/activities for everyone | Tasks, activities, & roles the ID a person as an independent adult or as a child progressing toward adulthood Activities require integration of cognitive & affective abilities with motor skills |
| Specific functions/activities to specific people | Work & recreation are functional activities in a social context |
| Traditional biomedical model of disease places emphases on what? | Characteristics of disease (etiology, pathology, & clinical manifestation) Individuals classified according to condition (arthritic, amputee, etc) |
| Traditional biomedical model definition of illness | Personal behaviors that emerge when the reality of having a disease is internalized & experienced by the individual |
| Traditional biomedical model definition of health | State of complete physical, mental, & social well-being; not merely the absence of diseases & infirmity |
| Nagi Model- Direct Impairments | Natural consequences of pathology or disease Alteration/deviation from norm in anatomical, physiological, or psych structures/functions Musculoskeletal, neuro, cardiopulmonary, integumentary (loss ROM, strength, endurance, scar) Temp or permanent |
| Nagi Model- Indirect Impairments | Result of another impairment Ex- impaired muscle strength due to impaired joint mobility |
| Nagi Model- Functional Limitation | Inability of a person to perform an action/activity in the way it's done by most people, usually the result of an impairment |
| Nagi Model- Psychological Function | Mental- intellectual/cognitive abilities of an individual; initiation, attention, cognition, memory, problem solving Affective- affective skills/coping strategies needed to deal with everyday hassles & more stressful events (self-esteem, body image, etc) |
| Nagi Model- Social Function | Individual's performance of social roles/obligations Social activity (recreational), social interaction with other, social roles (place in society) |
| Nagi Model- Disability | Discordance b/t actual performance of an individual in a particular role & the expectations of the community regarding what is "normal" for an adult |
| Nagi- What is "normal"? | Pts with same disease & impairments may not always have the same limitations Although a person may perform functionally not "normal", they may accomplish expected social roles & escape the label of "disabled" |
| Why do you examine function? | Baseline to set goals by Criteria for placement decisions Safety Evidence of treatment effectiveness |
| Testing Perspectives | Are data for descriptive purposes or to ID capacity to perform certain items regardless of whether pt actually does them or not Your goals aren't necessarily the patients'! |
| Preliminary Considerations for Functional Exam | Environment- free of distractions Fatigue Cognition, memory, attention, orientation, strength, ROM, sensation, ADs, home environment, level of assistance, hearing aids |
| Performance Based Tests | Observe- purpose of test? Current level of fxn Might ID max level of fxn possible Standardized instructions, but safety is important Characterize pt's performance limitations as result of impairments & may predict what he can do in "real life" |
| Self Reports | Interview vs. Survey Difference b/t do you cook your meals & if you had to, could you cook your meals Time frame- within past 24 hours have you...; within past week have you... Appropriate reading level & language |
| Descriptive Parameters (Qualitative) | Everyone has to be on same page with terms like independent to max assists, or good to poor in terms of balance Don't use the term "difficulty"; too ambiguous |
| Descriptive parameter (Quantitative) | Might want to add HR, RR before & after activity as measure of energy expenditure (very basic); RPE/exertion |
| What could affect qualitative & quantitative parameters? | Fatigue Meds Environment |
| How can you get ratio data from fxnal tests? | Measure time it takes to complete a series of fxnal activities to help measure improvement in performance |
| Response Formats- Nominal Measures | Checklist of various fxnal tasks on which the patient is simply scored as able to do/not able to do; independent/dependent Results aren't descriptive of exact nature of individual's limitations |
| Response Formats- Ordinal Measures | Descriptive scales that describe range of performance/degree to which a person can perform the task (no difficulty to unable to do; always to never) Categories NOT separated by equal intervals |
| Response Formats- Summary or additive measures (ex. Berg Balance Test) | Grade specific series of skills, award pts for part/full performance, sum the sub-scores as proportion of total possible pts 2 pts may have same score but very different deficits Don't tell you anything as far as what they improved in VAS Videos |
| Patients with different functional limitations | Could score the same on tests, but deficits could be completely different |
| Precise Analysis of Functional Tasks | Subordinate Part- element of a mvmt w/o which the task can't be performed safely/efficiently (rolling in bed mobility) Fxnal loss of ind. bed mobility by result from inability to perform any/all of subordinate parts |
| What is validity? | Does the test measure what it's supposed to |
| Content validity | Does it measure all the important/specified dimensions of fxn? |
| Criterion-Related Validity | Gold standard comparison |
| Concurrent Validity | How well a test compares to the gold standard |
| Predictive validity | Likelihood of a subsequent event |
| Construct validity | abstract concepts such as physical mobility or social interaction |
| Barthel Assessment Instrument | Assesses physical fxn- higher score is better 0-unable, 5-needs help, 10- independent scale Feeding, bathing, toileting, dressing, b/b, all xfers, ambulation, stairs |
| Katz Assessment Instrument | Ambulation, stairs, grooming are missing Looks at bathing, dressing, toileting, xfers, b/b, feeding Get a score for completing each activity independently & it corresponds to an overall letter grade of A-G |
| FIM Assessment (Multi-Dimensional) | Score & observe everything Used as a predictor for whether pt can go to high-end rehab 18 item measurement of physical, psych, & social fxn Rated from dependent to independent on the scale |
| SIP Assessment (Multi-Dimensional) | 136 items in 12 categories Higher scores = greater dysfunction Designed to detect small impacts of illness on perceived fxn May be more suitable for detecting deterioration in status not improvement |
| OASIS Assessment (Multi-Dimensional) | 79 core items covering sociodemographic characteristics, environmental factors, social support, health status, & fxnal status Used by home health agencies to assess quality of care based on outcomes of care |
| SF-36 Assessment (Multi-Dimensional)- also has a functional component | 36 items on physical fxn, social fxn, role fxn, mental health, energy, pain, general health perceptions |
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