Week 8: Assessment of Function

Question 1

Health

Answer 1

Health: state of complete physical, mental, and social well-being, and not merely the absence of diseases and infirmity

Question 2

Definition of ICF Model

Answer 2

International Classification of Functioning, Disability, and Health (ICF) Model: attempts to provide a meaningful description of the components of health and its relationship to a person with the health condition

Question 3

2 main components of ICF model

Answer 3

Part one: components of function and disability

Part two: contextual factors that interact with the components of the first part

Question 4

Function

Answer 4

Function: all those tasks, activities, and roles that identify a person as an independent adult or as a child progressing toward adult independence; activities require the integration of both cognitive and affective abilities with motor skills.

Question 5

Disability

Answer 5

Disability: Encompasses impairments in body functions and structures, activity limitations, and participation restrictions.

Question 6

3 subcomponents of components of function and disability in ICF model

Answer 6

Subcomponent one: Body functions and structures: body functions refer to physiological functions of body systems * Body structures are parts of the body such as organs, limbs, and their components. * Examples: joints, muscles, bones

Subcomponent two: Activity: ICF defines activity as the execution of a task or action by an individual * Examples: walking, running, opening a door, studying

Subcomponent three: Participation * Involvement in a life situation * Examples: taking part in a marathon, going to work, having dinner with your family

Question 7

2 sub components of contextual factors of ICF model

Answer 7

Environmental factors * External to the individual and can have positive or negative influence on performance

Personal factors * Features of the individual such as age, gender, and race that are not part of a health condition or health state

Question 8

activities of daily living

Answer 8

Activities of daily living (ADL): Collectively describe fundamental skills that are required to independently care for oneself; used as an indicator of a person’s functional status

• The inability to perform ADLs results in the dependence of other individuals and/or mechanical devices
• The inability to accomplish essential activities of daily living may lead to unsafe conditions and poor quality of life

Question 9

Categories of daily living

Answer 9

Ambulating: The extent of an individual’s ability to move from one position to another and walk independently

Feeding: The ability of a person to feed oneself

Dressing: The ability to select appropriate clothes and to put the clothes on

Personal hygiene: The ability to bathe and groom oneself and to maintaining dental hygiene, nail and hair care

Continence: ability to control bladder and bowel function

Toileting: The ability to get to and from the toilet, using it appropriately, and cleaning oneself

Question 10

Functional ability

Answer 10

Functional ability: capacity to complete everyday tasks necessary to live independently; divided into basic activities of daily living (ADL) and instrumental activities of daily living (IADL)

Question 11

instrumental activities of daily living

Answer 11

Instrumental activities of daily living (IADL) are those activities that allow an individual to live independently in a community.

Question 12

Categories of IADLS

Answer 12

Transportation and shopping: Ability to procure groceries, attend events Managing transportation, either via driving or by organizing other means of transport.
Managing finances: This includes the ability to pay bills and managing financial assets.
Shopping and meal preparation: Everything required to get a meal on the table, shopping for clothing, etc.
House cleaning and home maintenance: Cleaning kitchens after eating, maintaining living areas reasonably clean and tidy, and keeping up with home maintenance.
Managing communication with others: The ability to manage telephone and mail.
Managing medications: Ability to obtain medications and taking them as directed.

Question 13

cognition

Answer 13

Cognition is the act or process of knowing, including awareness, reasoning, judgment, intuition, and memory

Question 14

Executive functions can be categorized into the following main areas

Answer 14

Planning, cognitive flexibility, initiation and self-generation, response inhibition, and serial ordering and sequencing.

Question 15

clinical indicators of cognitive impairment

Answer 15

• Inability to do simple tasks independently or safely
• Difficulty in initiating or completing a task
• Difficulty in switching from one task to the next
• Diminished capacity to locate visually or to identify objects that seem obviously necessary for task completion

Question 16

List the 4 components of clinical assessment of cognition

Answer 16

• orientation
• attention/level of alertness
• memory
• apraxia

Question 17

Components of a Clinical Assessment of Cognition: orientation test

Answer 17

Procedure: asked the person, place, and time; test is positive if unable to recall all information

Question 18

Components of a Clinical Assessment of Cognition: attention/level of alertness

Answer 18

Procedure: spell a simple word forward and backward or repeat a string of integers forward and backward; negative: forward - normal is 6 digits; backward normal is 4 digits

Question 19

Components of a Clinical Assessment of Cognition: memory

Answer 19

Recent memory: Ask patient to recall 3 items after 3-5 minutes
Remote memory: Ask patient about a verifiable historical event

Question 20

Components of a Clinical Assessment of Cognition: apraxia

Answer 20

Procedure: ask patient to perform complex task (cut paper in half, use a comb); positive sign: unable to follow motor command

Question 21

Does mild cognitive impairment influence an individual’s ability to complete ADLs?

Answer 21

Individuals with MCI have greater difficulty performing IADLs compared to healthy controls but still have ability to perform BADL

Question 22

Is there a relationship between the degree of cognitive impairment and functional limitations?

Answer 22

Lower DRS scores were associated with greater difficulty in ADLs, independent of age, education, and gender

Question 23

short form (36) health survey

Answer 23

questionnaire is made up of 36 items that assess the
following 8 HRQL dimensions or subscales: physical functioning, rolephysical, bodily pain, general health, vitality, social functioning, roleemotional, and mental health.

Question 24

Is there a relationship between scores on the SF-36 and hospital readmission rates?

Answer 24

Lower scores on the SF-36 are a risk factor for hospital readmissions and death

Question 25

What is the Barthel Index?

Answer 25

the BI is a sum score across ten domains of ADLs

• A patient or a patient’s caregiver is asked about their ability to complete the tasks on the Barthel Index
• Each domain is scored on a weighted numerical scale with lowest score indicating total dependency and highest score indicating complete independency:
• Feeding, transfer, grooming, toilet use, bathing, mobility, stair climbing, dressing, bowel function, and bladder function

Question 26

Is the Barthel Index associated with a higher risk of mortality in a geriatric patients?

Answer 26

A lower Barthel Index is associated with a higher risk of mortality

Question 27

functional independence measure (FIM)

Answer 27

Functional Independence Measure (FIM): estimates the level of assistance needed for patients to complete basic activities of daily living (ADL)
- The FIM includes 18 basic ADLs, such as self- care, sphincter control, transfers, locomotion, communication, and social cognition
- Clinicians score patients on a 7-point scale ranging from dependent to independent, which reflects the level of assistance needed to complete each ADL
- The FIM items are organized into the motor and cognitive domains, which are further organized into 4 subscales for the motor domain and 2 subscales for the cognitive domain

Question 28

Is there a relationship between FIM scores and acute care readmission rates?

Answer 28

Hospital readmission rates are higher in individuals with lower FIM scores at initial visit

Question 29

gait speed

Answer 29

Gait speed is the time one takes to walk a specified distance on a level surface over a short distance

• Gait speed has been used as a predictor of functional decline
• A distance of 3-10 meters is measured with 2 meters acceleration and 2 meters for deceleration

Question 30

Is there an association with gait speed and physical disabilities?

Answer 30

Slower gait speed is associated with a higher risk of disability

Question 31

Timed-up and go

Answer 31

Timed-Up and Go (TUG): measures (in seconds) the time taken to stand up from a standard arm chair (approximate seat height of 46 cm, arm height of 65 cm), walk a distance of 3 m, turn around, walk back to the chair and sit down

• Regular footwear is worn, a walking aid can be used if required, but no physical assistance is provided
• A practice trial is recommended and the better of the two trials is scored.

Question 32

Are low TUG scores associated with functional dependency?

Answer 32

Slower TUG scores are associated with a higher risk of functional dependency
- Tug test that took 10s or more results in a 65% increase in greater risk of functional dependency

Question 33

Is there a relationship between gait speed and the Mini-Mental State Examination?

Answer 33

There is a weak correlation between gait speed and the Mini-Mental State Examination

Question 34

Is there a relationship between FIM and SF-36 scores with hospital length of stay?

Answer 34

Only the FIM is correlated with length of stay

Question 35

Is there a relationship between FIM and BI scores with disability and cognition?

Answer 35

Both measures are strongly associated with levels of disability

Question 36

Is there a relationship between the Barthel Index and the Timed-Up and Go Tests?

Answer 36

There is a moderate negative correlation between the Barthel Index and the Timed-Up and Go Tests