A Clinical Framework for Assessing Function

Dan Parkinson, PT, MBADirector of Clinical Services

The International Classification of Function, Disability and Health (ICF)

The ICF is structured around the following components: Body Functions and Structure (impairment) Activities and Participation (related to a

specific task and actions by an individual)

International Classification of Functioning, Disability and Health, World Health Organization, May 22, 2001, (http://www.who.int/classification/icf)

Clinical Assessment

Diagnosis alone does not predict: Service needs Level of care Functional outcomes

Models of Disability

Medical ModelViews disability as a

feature of the person, directly caused by disease which requires medical care.

Calls for an intervention to correct the problem with the individual.

Social ModelViews the disability as a

socially created problem and not an attribute of an individual.

Calls for a political response since the problem is created by an unaccommodating physical environment.

Biopsychosocial Model

Views disability as an interaction between features of the person and features of the overall context in which the person lives.

ICF is based on this model.

Function (Task Specific)

Disorder or Disease

Activity/Participation

Environmental Factors

Impairments

Function

Definition of Impairment

Body Functions: physiological functions of body systems

Body Structures: anatomical parts of the body such as organs and limbs

Impairments: problems in body function or structure leading to a significant deviation or loss

Definition of Function

Activity: the execution of a task or action by an individual

Participation: involvement in a life situation Activity Limitations: difficulties and individual may

have in executing activities Participation Restrictions: problems an individual may

experience in involvement in life situations Environmental Factors make up the physical, social

and attitudinal environment in which people live and conduct their lives.

Example

Environmental FactorsPhysical Plant

Support

Activities/ParticipationMobility Self Care

Communication

Body Structure

Central Nervous SystemMusculoskeletal System

Body FunctionNeuromusculoskeletal

Functional Task

Suggested Framework for Assistive Technology Assessment

Identify Functional Limitation Identify Impairments that cause functional

limitation Work with rehabilitation specialists to address

impairment level issues. Maximize function by collaborating with

rehabilitation specialist to create assistive technology solutions which take into account individual impairments.

Physical Impairments

Abnormal Tone Muscle Weakness Decreased Range of Motion Decreased Sensation Decrease Skin Integrity Pain

Diagnosis

Often present in the following neurologic diagnoses: CVA ABI Progressive Neurologic Diseases: MS, PD,

ALS Cerebral Palsy Spinal Cord Injury

Impairment and Function

Impairments Post-Stroke Hemiplegia Soft Tissue/ROM Trunk Control Balance Abnormal Tone Visual Language Cognitive Swallowing

Functional Limitations Post-Stroke Decreased bed

mobility Decreased ability to

obtain/maintain upright posture

Decreased ability to transfer and/or ambulate

Decreased ability to perform ADLs

Function/Task Analysis

Assessment: Start with identifying loss of function/task

specific movement and then determine what impairments are causing the loss of function.

Treatment: Address impairment level limitations and

functional loss at the same time. Modify the environment to allow for successful

completion of specific task (functional).

Discussion

Potential Functional Impact (Task Specific) Related to impairments below:

Abnormal Tone Muscle Weakness Decreased Range of Motion Decreased Sensation Decrease Skin Integrity Pain