Functional Abilities/Examinations Flashcards
1
Q
Levels of Assistance
A
- Exam that is a gross measure of function that defines physical assistance required by a patient to do a particular activity
2
Q
Levels of Assistance grading
A
- Maximum assist: Performs 25-49% of task
- Moderate assist: Performs 50-74% of task
- Minimum assist: Performs 75% or more of task
- Contact guard: Required hands-on guarding for balance or safety, not for actual assistance
- Supervision: No hands on contact but requires cuing & supervision for safety
- Independence: No cuing, hands-on assistance
3
Q
Levels of assistance pros
A
- Familiar amongst many healthcare professionals
- Quick and easy
- Objectivity with percentages
4
Q
Levels of assistance cons
A
- Some subjectivity
- Does not care about quality of movement
5
Q
Task analysis pros
A
Breaks down quality of movement
6
Q
Task analysis cons
A
- Not objective - no ordinal data that is used
- Need strong appreciation of normal movement - atypical v typical
7
Q
Get up and go test
A
- Quick screening tool for detecting balance problems in elderly population
- Intra-rater reliability high
- Inter-rater reliability low
8
Q
Get up & go test instructions
A
Stand up from chair with arms –> walk 3 meters/9.8 feet –> turn around –> return to sitting in the chair
- Assistive device can be used
9
Q
Get up & go scoring
A
1 = normal 2 = very slight abnormal 3 = mildly abnormal 4 = moderately abnormal 5 = severely abnormal - Increased risk for falls found in elderly who scores 3 or higher
10
Q
TUG
A
- Designed to detect BOTH functional mobility deficits and predict fall risk
- Examines proactive/anticipatory aspects of postural control
11
Q
TUG Directions
A
- Measures, in seconds, the time that it takes for an individual to stand up from chair with arms, walk 3 meters (~10 feet), turn, walk back to the chair, and sit down - walking at normal pace
- Patient uses customary walking aide and no physical assistance is given
- Instructions: “I want you to stand up and walk to the cone, turn, then walk back to the chair and sit down”
- Timing begins when therapist says go
12
Q
TUG Documentation/Scoring
A
- Time
- Stability/instability with turns
- Assistive device
13
Q
TUG Cut-off scores
A
- Community dwelling frail older adults: > 14 seconds - high fall risk
- Post-op hip fracture at discharge: > 24 seconds - falls within 6 months after hip fracture
- Frail older adults: > 30 seconds - predictive of requiring assistive device for ambulation & being dependent in ADLs
14
Q
TUG Dual-Task
A
- Examines effect of cognition on anticipatory aspects of postural control
- TUG DT cognitive - Complete TUG while counting back by 3 seconds
- TUG DT manual - complete TUG while carrying cup of water
15
Q
Cut-off scores for TUG Dual task
A
- TUG DT cognitive - > 15 seconds - overall correct prediction rate of 87%
- TUG DT manual - > 14.5 seconds - overall correct prediction rate of 90%
16
Q
Pedi TUG
A
- Includes concrete tasks (touch wall), repeated instructions (behave spontaneously), and change in stop/start time (begins when child starts to rise from chair)
- Norm reference studies still needed but it is quick, efficient, and low cost
17
Q
Pedi TUG Population
A
- Reliable in patients without disabilities 3-9 y.o
- Reliable in patients as young as 3 y.o provided ability to follow directions
- Reliable in patients with physical disabilities 3-19 y.o (myelodysplasia (spina bifida) & CP)
18
Q
Timed Functional Movements
A
- Ex. Supine to sit, sit to stand, forward & backward walking
- Important in safety, fire emergency, track regression & progression, and dynamic balance
19
Q
Acute Care of Index of Function (ACIF)
A
- 20 item test developed to standardize functional assessment of patients with acute neurological conditions (excellent reliability)
- Takes 12-15 minutes
- Subgroups: Mental status, bed mobility, transfers, mobility
20
Q
Acute Care of Index of Function (ACIF) pros & cons
A
- Pros: Simple exam, objective, functional
- Cons: No assessment of other factors (home environment, social support, etc.); floor and ceiling effects (not enough numbers/options); narrow approach to functional tasks
21
Q
FIM
A
- ADL assessment instrument of functional status
- Valid only for inpatient rehab settings (other tests are for other settings)
- Tests motor & cognitive aspects: self-care, sphincter control, transfers, locomotion, communication, social cognition
- Measures disability and burden of care
22
Q
FIM Scoring
A
- 7 - Independent - complete (time and safe)
- 6 - Independent - modified (device, safe, extra time)
- 5 - Dependent - modified, requires supervision (cuing, coaxing, set-up
- 4 - Dependent - Modified, requires minimal assistance (>/= 75%)
- 3 - Dependent - Modified, requires moderate assistance (50-74%)
- 2 - Dependent - requires maximal assistance (25-49%)
- 1 - Dependent - requires total assistance (< 25%)
- 0 - Never performed at admission
23
Q
FIM Pros & Cons
A
- Pros: Comprehensive
- Cons: Community mobility not included, household ambulation not included; floor and ceiling effects
24
Q
weeFIM
A
- Modified FIM exam for children 6 months - 7 years
25
Continuous-Scale Physical Functional Performance Test (CS-PFP)
- Comprehensive, in-depth measures of physical function that reflects abilities in several separate physical domains
- Based on ordinary life activities and requires standard conditions, scripted dialogue, and training class
- All tasks quantified by time, distance, or weight
- 16 tasks in three levels: low effort, medium effort, hard effort
- Older adults ages 65-85 validation
26
Continuous-Scale Physical Functional Performance Test (CS-PFP) Scoring
- 0-100 for each task of upper body strength, lower body strength, flexibility, balance, coordination, & endurance
- Each task represented with time, weight carried, distance covered
27
Wheelchair Skills Test (WST)
- Standardized evaluation method that permits a set of representative wheelchair skills to be objective, simple, and inexpensively documented
- Can be used in rehab program for diagnostic measure
- Can be used for program evaluation, to answer research questions, and to assist in wheelchair design
28
Functional Ambulation Category (FAC)
- Categorizes subjects according to basic motor skills necessary for functional ambulation without assessing endurance
- 6 point scale: 0 = non functional ambulation; 1, 2, 3 = dependent ambulator who requires assistance; 4, 5 = independent ambulator
29
Functional Ambulation Category (FAC) Cut-off Scores
- Acute stroke >4 more sensitive in predicting community ambulation at 6 months
30
Observational Gait Assessment (OGA)
- Organized approach to observing joint movements, timing of movements, and quality of movements during walking
- Pros: high intra-rater
- Cons: low inter-rater
- Always measure gait velocity
- In elderly, predictive of hospitalization, requirement of caregiver/nursing home placement, falls & fractures, death in healthy elderly
31
10 Meter Walk Test Population
- Validated in Stroke, SCI, and Parkinson's
32
10 Meter Walk Test
- 0, 2, 12, 14 meter tape marks & individual is timed from 2 meters to 12 meters
- Take vitals at the beginning, have patient walk distance, turn and come back, take vitals at the end
- Documentation: Include time, speed (slow, moderate, fast), vitals, assistive device (keep consistent with repetition of tests)
33
10 Meter Walk Test Instruction
"You are going to walk a distance of about 40 feet. We will repeat this distance 2 times. Both times will be completed at a comfortable pace. Do you have any questions?" :
34
HiMAT
- Population: high level balance TBI
- Multiple high level activities: walking forward, backwards, on toes, over obstacle, run, skip, hop, bounding (affected & unaffected), upstairs, downstairs
