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

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)

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

Models of Disability 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.

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.

Function (Task Specific)

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

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.

Example

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.

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

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

Impairment and Function 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

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).

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