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NDT Ch 11

Ch 11 Exam of Functional Status

QuestionAnswer
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
Created by: 1190550002