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, (

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

4. 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.

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)

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. 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

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