Week 8: Assessment of Function Flashcards
Health
Health: state of complete physical, mental, and social well-being, and not merely the absence of diseases and infirmity
Definition of ICF Model
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
2 main components of ICF model
Part one: components of function and disability
Part two: contextual factors that interact with the components of the first part
Function
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.
Disability
Disability: Encompasses impairments in body functions and structures, activity limitations, and participation restrictions.
3 subcomponents of components of function and disability in ICF model
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
2 sub components of contextual factors of ICF model
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
activities of daily living
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
Categories of daily living
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
Functional ability
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)
instrumental activities of daily living
Instrumental activities of daily living (IADL) are those activities that allow an individual to live independently in a community.
Categories of IADLS
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.
cognition
Cognition is the act or process of knowing, including awareness, reasoning, judgment, intuition, and memory
Executive functions can be categorized into the following main areas
Planning, cognitive flexibility, initiation and self-generation, response inhibition, and serial ordering and sequencing.
clinical indicators of cognitive impairment
- 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
List the 4 components of clinical assessment of cognition
- orientation
- attention/level of alertness
- memory
- apraxia
Components of a Clinical Assessment of Cognition: orientation test
Procedure: asked the person, place, and time; test is positive if unable to recall all information
Components of a Clinical Assessment of Cognition: attention/level of alertness
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
Components of a Clinical Assessment of Cognition: memory
Recent memory: Ask patient to recall 3 items after 3-5 minutes
Remote memory: Ask patient about a verifiable historical event
Components of a Clinical Assessment of Cognition: apraxia
Procedure: ask patient to perform complex task (cut paper in half, use a comb); positive sign: unable to follow motor command
Does mild cognitive impairment influence an individual’s ability to complete ADLs?
Individuals with MCI have greater difficulty performing IADLs compared to healthy controls but still have ability to perform BADL
Is there a relationship between the degree of cognitive impairment and functional limitations?
Lower DRS scores were associated with greater difficulty in ADLs, independent of age, education, and gender
short form (36) health survey
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.
Is there a relationship between scores on the SF-36 and hospital readmission rates?
Lower scores on the SF-36 are a risk factor for hospital readmissions and death
What is the Barthel Index?
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
Is the Barthel Index associated with a higher risk of mortality in a geriatric patients?
A lower Barthel Index is associated with a higher risk of mortality
functional independence measure (FIM)
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
Is there a relationship between FIM scores and acute care readmission rates?
Hospital readmission rates are higher in individuals with lower FIM scores at initial visit
gait speed
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
Is there an association with gait speed and physical disabilities?
Slower gait speed is associated with a higher risk of disability
Timed-up and go
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.
Are low TUG scores associated with functional dependency?
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
Is there a relationship between gait speed and the Mini-Mental State Examination?
There is a weak correlation between gait speed and the Mini-Mental State Examination
Is there a relationship between FIM and SF-36 scores with hospital length of stay?
Only the FIM is correlated with length of stay
Is there a relationship between FIM and BI scores with disability and cognition?
Both measures are strongly associated with levels of disability
Is there a relationship between the Barthel Index and the Timed-Up and Go Tests?
There is a moderate negative correlation between the Barthel Index and the Timed-Up and Go Tests
