RHS 332 Clinical Neurology Ahmad Alghadir M S

RHS 332: Clinical Neurology Ahmad Alghadir, M. S. Ph. D. P. T. Room: 2071 aalghadir@hotmail. com alghadir@ksu. edu. sa Ahmad Alghadir M. S. Ph. D. P. T.

Recommended texts • S. B. O’sullivan, T. J. Schmitz, Physical Rehabilitation: Assessment and Treatment, F. A. Davis Company. 3 rd ed. 1994. • R. L. Braddom, Physical Medicine & Rehabilitation, W. B. Saunders Company. 1 st ed. 1996. Ahmad Alghadir M. S. Ph. D. P. T.

Functional Assessment Ahmad Alghadir M. S. Ph. D. P. T.

Purposes • To describe the patient’s problem in functional terms. • To plan treatment to eliminate or reduce the problems identified. • To measure the progress of these treatments towards the desired functional outcome. Ahmad Alghadir M. S. Ph. D. P. T.

Health • Definition by WHO: “a state of complete physical, mental, and social well-being, and not merely the absence of diseases. ” • Factors used to define health: 1. Physical signs. 2. Symptoms. 3. Functional disability. • See figure 11 -1. Ahmad Alghadir M. S. Ph. D. P. T.

Disease • Definition: “pathologic condition of the body that presents a group of characteristic signs and symptoms that sets the condition apart as abnormal. ” Ahmad Alghadir M. S. Ph. D. P. T.

Physical signs and symptoms • Physical signs: directly observable or measurable changes in an individual’s organs or systems as a result of pathology or disease (e. g. elevated blood pressure). • Symptoms: “subjective reactions to the changes experienced by an individual as a result of pathology or disease” (e. g. dizziness). Ahmad Alghadir M. S. Ph. D. P. T.

Syndromes • Definition: medical conditions that are not labels for a single pathologic entity, but clusters of signs and symptoms (e. g. AIDS). Ahmad Alghadir M. S. Ph. D. P. T.

Impairments • Definition: “any loss or abnormality of anatomic, physiologic, or psychologic structure or function; the natural consequence of pathology or disease” (e. g. loss of ROM). • Manifestation of pathology or disease. • Temporary or permanent. Ahmad Alghadir M. S. Ph. D. P. T.

Functional limitations • Definition: “deviation from normal in the way an individual performs a task or activity, usually as the result of impairment” (e. g. inability to bath independently). Ahmad Alghadir M. S. Ph. D. P. T.

Categories of function 1. Physical function: “sensory-motor skills necessary for the performance of usual daily activities. ” Ahmad Alghadir M. S. Ph. D. P. T.

a) Basic ADL: “tasks concerned with daily self-care, such as feeding, dressing, hygiene, and physical mobility. ” b) Instrumental ADL: “advanced skills considered vital to an individual’s independent living in the community, including managing personal affairs, cooking and shopping, and home chores. ” Ahmad Alghadir M. S. Ph. D. P. T.

2. Psychological function: “ability to use mental and affective resources effectively in response to the requirements of a particular situation. ” Ahmad Alghadir M. S. Ph. D. P. T.

a) Mental function: “intellectual or cognitive abilities of an individual, including initiative, attention, concentration, memory, problem solving, and judgment. ” Ahmad Alghadir M. S. Ph. D. P. T.

b) Affective function: “mental and emotional skills and coping strategies needed to perform everyday tasks and stresses, as well as the more traumatic events each person encounters over the course of a lifetime; includes such factors as selfesteem, body image, anxiety, depression, and the ability to cope with change. ” Ahmad Alghadir M. S. Ph. D. P. T.

3. Social function: “ability to interact successfully with others in the performance of social roles and obligations; includes social interactions, roles, and networks. ” Ahmad Alghadir M. S. Ph. D. P. T.

• To be clinically meaningful, impairments must be linked to functional limitations in a cause-and-effect relationship. Ahmad Alghadir M. S. Ph. D. P. T.

Disability • Definition: “inability to perform social roles typical of independent adults, taking into account age, sex, social, and cultural factors. ” Ahmad Alghadir M. S. Ph. D. P. T.

• “Disability is characterized by a discordance between the actual performance of an individual in a particular role and the expectations of the community regarding what is “normal” for an adult. ” Ahmad Alghadir M. S. Ph. D. P. T.

Handicap • Definition: “social disadvantage for a given individual of impairment, functional limitation, or disability. ” • “The negative value placed by others on an impairment, functional limitation, or disability makes a person handicapped. ” Ahmad Alghadir M. S. Ph. D. P. T.

• • Independence. Social stigma. Environmental restrictions. Same disease and impairments, but different functional limitations. • Functioning differently, but not handicapped. Ahmad Alghadir M. S. Ph. D. P. T.

Types of instruments 1. Performance-based assessment: “assessment of a particular skill based on observation of an actual attempt, as opposed to acceptance of a self-report of skill level. ” • Setting should be similar to the actual environment. • Assessment may be biased by fatigue. • Take appropriate safety precautions. Ahmad Alghadir M. S. Ph. D. P. T.

2. Self-administered assessment: “survey or series of questions constructed to be answered directly by the respondent without additional input or direction. ” • Distinguish between person’s habitual performance and capacity to perform a task (NO vs. N/A). • Specify a time-frame reference (short- vs. long-term objectives). Ahmad Alghadir M. S. Ph. D. P. T.

Instrument parameters 1. Descriptive parameters: • e. g. dependence, difficulty, and endurance. - Dependence: “state requiring some level of human assistance. ” - Difficulty: “hybrid term that suggests that an activity poses an extra burden for an individual, regardless of dependence level. ” Ahmad Alghadir M. S. Ph. D. P. T.

- Endurance: “energy consumption required to complete a functional task. ” • “Meanings of descriptive terms should be clear to all others using the medical record. ” • See table 11 -1. Ahmad Alghadir M. S. Ph. D. P. T.

2. Quantitative parameters: • e. g. timed assessments. • Speed vs. quality. Ahmad Alghadir M. S. Ph. D. P. T.

Instrument formats 1. Checklist scale (dichotomous or categorical scale): see table 11 -5. • “Assessment tool format in which a description of various tasks is simply scored dichotomously (e. g. , present or absent; completed or not completed). ” Ahmad Alghadir M. S. Ph. D. P. T.

2. Numeric or letter-grade scale (ordinal scale): MMT. • “Classification scheme that rates observations in terms of the relationship between items (e. g. , less than, equal to, or greater than). ” Ahmad Alghadir M. S. Ph. D. P. T.

3. Summary or additive scale: see table 112. • “Approach to grading a specific series of skills by awarding points for each task or activity; totals the score as a percentage of 100 or as a fraction. ” Ahmad Alghadir M. S. Ph. D. P. T.

4. Visual or linear analog scale (continues scale): pain. • “Linear rating designed to capture a subject’s judgment of his or her position on a continuum. A line is presented horizontally or vertically on paper, with the endpoints anchored with descriptive words representing the extremes in terms of the parameter of interest. ” Ahmad Alghadir M. S. Ph. D. P. T.