A Clinical Framework for Assessing Function

1. A Clinical Framework for Assessing Function Dan Parkinson, PT, MBA Director of Clinical Services

2. The International Classification of Function, Disability and Health (ICF) • The ICF is structured around the following components: • Body Functions and Structure (impairment) • Activities and Participation (related to a specific task and actions by an individual) International Classification of Functioning, Disability and Health, World Health Organization, May 22, 2001, (http://www.who.int/classification/icf)

3. Diagnosis alone does not predict: Service needs Level of care Functional outcomes Clinical Assessment

4. Medical Model Views disability as a feature of the person, directly caused by disease which requires medical care. Calls for an intervention to correct the problem with the individual. Social Model Views the disability as a socially created problem and not an attribute of an individual. Calls for a political response since the problem is created by an unaccommodating physical environment. Models of Disability

5. Biopsychosocial Model • Views disability as an interaction between features of the person and features of the overall context in which the person lives. • ICF is based on this model.

6. Function (Task Specific) Function

7. Definition of Impairment • Body Functions: physiological functions of body systems • Body Structures: anatomical parts of the body such as organs and limbs • Impairments: problems in body function or structure leading to a significant deviation or loss

8. Definition of Function • Activity: the execution of a task or action by an individual • Participation: involvement in a life situation • Activity Limitations: difficulties and individual may have in executing activities • Participation Restrictions: problems an individual may experience in involvement in life situations • Environmental Factors make up the physical, social and attitudinal environment in which people live and conduct their lives.

9. Example

10. Suggested Framework for Assistive Technology Assessment • Identify Functional Limitation • Identify Impairments that cause functional limitation • Work with rehabilitation specialists to address impairment level issues. • Maximize function by collaborating with rehabilitation specialist to create assistive technology solutions which take into account individual impairments.

11. Physical Impairments • Abnormal Tone • Muscle Weakness • Decreased Range of Motion • Decreased Sensation • Decrease Skin Integrity • Pain

12. Diagnosis • Often present in the following neurologic diagnoses: • CVA • ABI • Progressive Neurologic Diseases: MS, PD, ALS • Cerebral Palsy • Spinal Cord Injury

13. Impairments Post-Stroke Hemiplegia Soft Tissue/ROM Trunk Control Balance Abnormal Tone Visual Language Cognitive Swallowing Functional Limitations Post-Stroke Decreased bed mobility Decreased ability to obtain/maintain upright posture Decreased ability to transfer and/or ambulate Decreased ability to perform ADLs Impairment and Function

14. Function/Task Analysis • Assessment: • Start with identifying loss of function/task specific movement and then determine what impairments are causing the loss of function. • Treatment: • Address impairment level limitations and functional loss at the same time. • Modify the environment to allow for successful completion of specific task (functional).

15. Discussion Potential Functional Impact (Task Specific) Related to impairments below: • Abnormal Tone • Muscle Weakness • Decreased Range of Motion • Decreased Sensation • Decrease Skin Integrity • Pain