COMPS:Functional Exam: Exam 1

Question 1

What is the functional exam?

Answer 1

HOW person accomplishes routine based and meaningful tasks

Question 2

Functional Tasks

Answer 2

Dimensions of ICF encompassing:

tasks

activities

roles that ID person as indep. in society

Question 3

Generally…

Functional Exam looks @

Answer 3

routine based tasks that are meaningful to pt & family

Question 4

2 Functional Task classes

Answer 4

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

Question 5

Purpose of Functional Exam:

Answer 5

• 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?

Question 6

Elements of functional exam:

Answer 6

• 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

Question 7

What kinds of questions should you include in pt interview?

Answer 7

• 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

Question 8

Systems Review

Answer 8

chart/interview

add. manual screening conducted PRIOR to mobilizing every pt

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

Question 9

Tests and Measures + Rehab Team

Answer 9

Who are the mbrs of team?

PTs are responsible for bed mobility, transfers, locomotion

Question 10

Tests & Measures: Functional Mobility

Answer 10

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

Question 11

Universally Recognized Definitions of Functional Ability

Independence

Answer 11

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

Question 12

Universally Recognized Definitions of Functional Ability

Supervision

Answer 12

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

*LOW prob. of req’ing assist*

Question 13

Universally Recognized Definitions of Functional Ability

Close Guarding

Answer 13

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

hands OFF

*FAIR risk of req’ing assist*

Question 14

Universally Recognized Definitions of Functional Ability

Contact Guarding

Answer 14

PT pos’d in close guarding

Hands ON but NO assist provided

*stabilizing hand*

HIGH prob of req’ing assist

Question 15

Universally Recognized Definitions of Functional Ability

Min. Assist

Answer 15

Pt completes MAJORITY of task w/out assist

Question 16

Universally Recognized Definitions of Functional Ability

Mod. Assist

Answer 16

pt completes only PART of task w/out assist

Question 17

Universally Recognized Definitions of Functional Ability

Max. Assist

Answer 17

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

Question 18

Descriptive Parameters: Functional Balance Grades

Normal

Answer 18

• 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

Question 19

Descriptive Parameters: Functional Balance Grades

Good

Answer 19

• 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

Question 20

Descriptive Parameters: Functional Balance Grades

Fair

Answer 20

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

Question 21

Descriptive Parameters: Functional Balance Grades

Poor

Answer 21

• 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. **

Question 22

performance based functional measures

Answer 22

What can pt do under a specific set of cirumstances?

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

Question 23

Limitations of Self Reported Measures???

Answer 23

pts can LIE!!!

Question 24

Standardized Measures

Single Dimension

Answer 24

Measure includes specific construct of function

ex. balance—Berg, Functional Reach

Question 25

Standardized Measures ## Footnote **Multidimensional**

Answer 25

Measure includes Combo of constructs ## Footnote **incorps aspects of impairs & activity/part. restrictions**

Question 26

3 Commonly used multidimensional standardized measures used in Rehab settings:

Answer 26

* 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

Question 27

Reliability

Answer 27

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

Question 28

Validity

Answer 28

Does the test **measure what it is supposed to?**

Question 29

Sensitivity

Answer 29

* 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.)

Question 30

Specificity

Answer 30

* 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.)

Question 31

Meaningful Change

Answer 31

* 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.

Question 32

Choosing an instrument

Answer 32

* practical considerations * time/resources * what function or aspect of function being measured? * type of scoring system

Question 33

Analysis and POC Dev.

Answer 33

\*synthesize info gathered to eval pt and dev. POC \***Use HOAC II to guide clin dec. making**

Question 34

HOAC II

Answer 34

* 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**

Question 35

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

Answer 35

**Under direct supervision of licensed PT**

Question 36

Some Final Considerations

Answer 36

# * 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**