1. Measuring Functional Skills
Chapter 11

2. Functional Skills
Abilities or tasks demonstrated by the client that can be observed and measured
The purpose of functional assessment is to
Make a measurement of the level of skill in specific tasks before therapy begins, during the intervention process, and before discharge
Identify the underlying causes of suboptimal performance
Identify possible actions to address for need

3. Standard Domains for Measurement of Function
The use of four primary domains in health care dates back to the 1920s
Because the division of function into the four domains is interdisciplinary and has been accepted by various professions, Rec. Therapists may benefit from also adopting the primary four.

4. The Four Domains of Function
Physical Domain
Cognitive Domain
Social Domain
Emotional Domain

5. Physical Domain
Other disciplines may provide the specific measure of the physical domain, but RTs need to be able to identify whether a patient’s functional ability falls within normal or not

6. Physical Domain Grasps and Grips
Grasp – used to describe the positions of a client’s thumbs and fingers when holding an object
Developmental Levels of Hand Grasps - Table 11.1 pg. 306
Grip – The measurement of the amount of pressure exerted by the hand and fingers.
Endurance of grip measured by dynameters
RTs do not generally use dynameters, however grip abilities are worked on during activities and therapy sessions.

7. Physical Domain Coordination
The client’s ability to move through space and manipulate his/her environment in a synchronized manner
Involves a wide variety of skills
Upper left, page 307
Coordination Extremity Test (AKA Finger to Nose Test)
Body mechanics refer to the muscle’s ability to maintain balance and muscle effectiveness against the pull of gravity to carry out the desired task. Key elements of body mechanics to look for during activities:
Alignment
Balance
Base of Support
Gravity

8. Physical Domain Gait Refers to the client’s style of walking
When assessing gait, therapist will want to observe the motor patterns, rhythm, cadence, and speed
Types of gaits to familiarize yourself with
Pages

9. Physical Domain Endurance/Activity Tolerance
Relate to the client’s ability to tend to a task, maintain the energy that is necessary to work on a task for an appropriate length of time, and produce an adequate output.
Endurance
Fatigue
Activity Intolerance
OPQRST – pg. 309

10. Cognitive Domain Broken down into many different subcategories
Zoltan (2007) Manual
Outcome based programs could measure changes in any of the following areas described below to determine the effect of treatment:
Attention/Concentration
Mental Flexibility
Awareness
Orientation
Generalization and Transfer
Planning and Organization
Initiation
Problem Solving
Memory

11. Social Domain
The areas of social domain function that the treatment team is usually interested in relate to the client’s social roles, social patterns, social skills, and social support.
Psychometrically, the ability to measure functional skills in the social domain is the least developed area of measurement.
Some tools measuring the social domain
CERT – Psych/R
School Social Behavior Scales
Home and Community Social Behavioral Scales
SOFAS (page 313)
Other scales include social items

12. Social Domain Social Roles Social Patterns
To act in a manner that represents what would be expected of the character for which one is playing
Social Patterns
Patterns of interactions between people
Intra-Individual
Extra-Individual
Aggregate
Inter-individual
Unilateral
Multilateral
Intra-group
Inter-group

13. Social Domain Social Skills Social Support
Refer to the actual techniques used by an individual to interact with others
Three areas where clients often demonstrate a suboptimal level of functional social skills are:
Boundaries
Coping
Conflict management
Social Support
Family, friends, and community support a client has available

14. Emotional Domain AKA Affective
Umbrella term that includes feelings, moods, other things related to affect
Measuring a client’s emotional domain is always a two part assessment.
First, the therapist asks the client to describe his/her emotions, feelings, or mood
Second, the therapist observes the client’s behaviors and body movements.

15. Emotional Domain
Sadock & Kaplan (2007) describe seven different categories of observed affect
Appropriate Affect
Broad Affect
Inappropriate Affect
Restricted Affect
Blunted Affect
Flat Affect
Labile Affect