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Foundations II > COMPS:Functional Exam: Exam 1 > Flashcards

COMPS:Functional Exam: Exam 1 Flashcards

1
Q

What is the functional exam?

A

HOW person accomplishes routine based and meaningful tasks

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2
Q

Functional Tasks

A

Dimensions of ICF encompassing:

tasks

activities

roles that ID person as indep. in society

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3
Q

Generally…

Functional Exam looks @

A

routine based tasks that are meaningful to pt & family

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4
Q

2 Functional Task classes

A
  1. ADLs –> activities one must complete each day to sustain themselves–> ESSENTIAL!!!
    ex. shower, toilet/hygiene, cooking, stairs, make bed, bathroom
  2. IADLs–> req’d to maintain independent lifestyle–keep you indep.
    ex. driving, shopping, house maint, work, hobbies, groceries, bills/finances
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5
Q

Purpose of Functional Exam:

A
  • obtain baseline pt status
    • ID problematic areas—set GOALS to improve overall indep.
  • indic’s for pts initial abilities for progress to more diff tasks
  • clin. dec. making for discharge
  • screens for safety and injury risk
  • outcomes assess.
    • did tx work?
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6
Q

Elements of functional exam:

A
  • Pt interview/med. hx
  • systems rev.
    • pt interview and quick screen UEs/LEs
  • tests/measures–objective
    • observation funct. tasks
    • standardized measures funct.
  • analysis + POC dev.
    • HOAC/problem list
    • interventions/goals
  • chart review & pt interview
    • rev. chart BEFORE interview unless outpatient
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7
Q

What kinds of questions should you include in pt interview?

A
  • Open ended—more than one word response
    • “what brings you in?
  • Closed ended–Yes/No
    • “does pain wake you up?”
  • Funnel/Guiding–open to closed, questions relate, lead from one to another
  • Follow-up
    • paraphrase/sum up info learned
    • be RESPECTFUL
    • engage w/ pt
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8
Q

Systems Review

A

chart/interview

add. manual screening conducted PRIOR to mobilizing every pt

  • Goal of exam== functional mobility
    • ​Screen:
      • ​neuro–cognition
      • CV–vitals!
      • MSK
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9
Q

Tests and Measures + Rehab Team

A

Who are the mbrs of team?

PTs are responsible for bed mobility, transfers, locomotion

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10
Q

Tests & Measures: Functional Mobility

A
  • descriptive parameters
    • quantify functional abilities based on lvl of assist req’d
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11
Q

Universally Recognized Definitions of Functional Ability

Independence

A

pt consist. able to perform task safely w/out anyone else present

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12
Q

Universally Recognized Definitions of Functional Ability

Supervision

A

req’s someone w/in arms reach OR verbal cueing

*LOW prob. of req’ing assist*

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13
Q

Universally Recognized Definitions of Functional Ability

Close Guarding

A

PT pos’d w/ hands ready to assist for pt

hands OFF

*FAIR risk of req’ing assist*

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14
Q

Universally Recognized Definitions of Functional Ability

Contact Guarding

A

PT pos’d in close guarding

Hands ON but NO assist provided

*stabilizing hand*

HIGH prob of req’ing assist

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15
Q

Universally Recognized Definitions of Functional Ability

Min. Assist

A

Pt completes MAJORITY of task w/out assist

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16
Q

Universally Recognized Definitions of Functional Ability

Mod. Assist

A

pt completes only PART of task w/out assist

17
Q

Universally Recognized Definitions of Functional Ability

Max. Assist

A

Pt is UNABLE to complete ANY part of act. w/out assist

18
Q

Descriptive Parameters: Functional Balance Grades

Normal

A
  • Static–> pt able to maint. steady balance w/out hand-held support
  • Dynamic–> accepts MAX challenges and can wt. shift w/in full ranges in all dir’s
    • ex. EOB tying shoes
19
Q

Descriptive Parameters: Functional Balance Grades

Good

A
  • Static–> maint balance w/out hand-held support, limited postural sway
  • Dynamic–> accepts MOD challenges and can maint balance while picking up obj from floor
20
Q

Descriptive Parameters: Functional Balance Grades

Fair

A
  • Static–> req’s handheld assist to maint balance, may req. OCCASIONAL assist
  • Dynamic–> accepts MIN challenges and maints balance while turning head
21
Q

Descriptive Parameters: Functional Balance Grades

Poor

A
  • Static–> req’s handheld support AND mod-max assist to maint balance
  • Dynamic–> UNABLE to accept challenges OR move w/out LOB

**always say “EVIDENCED BY” in your doc. **

22
Q

performance based functional measures

A

What can pt do under a specific set of cirumstances?

ex. six-min. walk test, TUG test, Functional Reach test

23
Q

Limitations of Self Reported Measures???

A

pts can LIE!!!

24
Q

Standardized Measures

Single Dimension

A

Measure includes specific construct of function

ex. balance—Berg, Functional Reach

25
Q

Standardized Measures

Multidimensional

A

Measure includes Combo of constructs

incorps aspects of impairs & activity/part. restrictions

26
Q

3 Commonly used multidimensional standardized measures used in Rehab settings:

A
  • Functional Indep Measure (FIM)
    • phys, psycho, social
    • total indep to total dep.
    • Valid and Reliable
  • Barthel Index
    • degree of assist. on 10 items of mobility and self-care ADLs
    • Valid and Reliable
  • Outcome and Assessment Information Set (OASIS)
    • 13 cats of ADLs/IADLs
    • Reliable and validity uncertain
  • SF-36
    • 8 diff scales of function
      • phys, mental, pain, gen health perception
27
Q

Reliability

A

How well the test is able to be repeated giving the same results

28
Q

Validity

A

Does the test measure what it is supposed to?

29
Q

Sensitivity

A
  • Refers to how well a test IDs persons who should have POSITIVE findings on test OR those who have limits in function
  • POSITIVE FINDING HELPS TO RULE IN
    • ​Remember SNnOUT (exact opp.)
30
Q

Specificity

A
  • Refers to those who do NOT have a limit of function or negative findings
  • NEGATIVE FINDING HELPS TO RULE OUT CONDITION
    • ​Remember SpIN (exact opp.)
31
Q

Meaningful Change

A
  • Measure of functional status should be suff. to reflect meaningful changes in pt’s status
    • Minimal Clinical Importance Difference–MCID
      • ​smallest diff in measured variable that signifies an important rather than trivial diff in pts cond.
32
Q

Choosing an instrument

A
  • practical considerations
  • time/resources
  • what function or aspect of function being measured?
  • type of scoring system
33
Q

Analysis and POC Dev.

A

*synthesize info gathered to eval pt and dev. POC

*Use HOAC II to guide clin dec. making

34
Q

HOAC II

A
  • framework to utilize science based clinical practice to examine relationship b/w clinical impairs and functional deficits
    • ​Problem list development
      • ​link causes for pt presentation TO functional limits
      • used to prioritize and guide POC
35
Q

PTA able to implement mobility interventions and produce assoc’d doc.

A

Under direct supervision of licensed PT

36
Q

Some Final Considerations

A

* choose setting conducive to type of test

  • dec distractions
  • exams NOT biased by pt fatigue
  • eval results in context of other data
    • problem lists guide clin dec making and POC
  • retest/re-eval @ reg intervals
  • incorporate pt into planning/goal setting
    • consider “real world” when testing
  • choose best instrument and what is appropriate/available
37
Q
A

Foundations II (13 decks)

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