Functional assessment and training

Ahmad Osailan

Assessment in Geriatric

• Such assessment like ROM and muscle strength is important BUT

• does not reflect the patient’s function level

• The goal is to make Comprehensive geriatric assessment by Mixing :

• Musculoskeletal parameters • Functional abilities

Functional Evaluation

• What is the importance of functional evaluation?

• * ability to give beginning and end point based on functional outcome

• * relationship of this outcome to patient independence.

Example for functional evaluation

• Barthel index • Helps to rate difficulty in bathing or walking • Every level of function is indicated by number• The total score helps to decide if the patient is

ready to go home or still need assisstance.• Patient is given the index without numbers • Measures ADL

What makes functional assessment so important ?

• Because:• It targets specific behaviours and tasks patient

wishes to accomplish.

• The ultimate goal of rehabilitation is to assist people in achieving their highest level of function.

aMistake most of us fall into it

• While assessing patient we focus in signs and symptoms.

• we still need to consider level of function • We need to understand the four component

of function:• 1- physical function, walking, stairs• 2- mental function, cognitive ability, memory • 3- emotional function, anxieties, stress• 4- social function, person interaction with

family

Geriatric Assessment

Involves a multi-dimensional diagnostic process designed to qualify an elderly individual in

terms of:

• Functional capabilities• Disabilities

• Medical & Psychological characteristics

we will consider particularly: • Activities of Daily Living (ADL)

• Instrumental Activities of Daily Living (IADL)

Assessment Programs include tests that are grouped into three categories

1. Tests examining general physical health

2. Tests measuring ability to perform basic self care (ADLs)

3. Tests measuring ability to perform more complex activities (IADLs), reflecting the ability to live independently in the community

Table 3-4 Categories of Physical Health Index MeasuringPhysical Competence

ACTIVTIES INSTRUMENTAL ACTIVITIESOF DAILY LIVING OF DAILY LIVING

Feeding CookingBathing CleaningTo ileting Using telephoneDressing WritingAmbulation ReadingTr ansfer from toilet LaundryVisual acuity Driving a carOthers Others

How to measure severity of disability

The severity of the disability may be measured in terms of whether a person:

• Does not perform the activity at all• Can only perform the activity with the help of

another person• Can perform the activity with the help of

special equipment

% of persons 70 years & older having difficulty/inability to perform ADLs & IADLs

With advancing age, 1) disability intensity increases in men & women; 2) disability intensity is higher in women than in men at the same age (esp. at later ages); 3) females live a longer average life span but live longer with disability

Aging is associated with increased incidence of:

• Diseases• Accidents• Stress

The increased susceptibility to stress and disease in old age may be related to cell

senescence.

Functional Assesment of ElderlyHISTORY

PHYSICAL EXAMINATION including: neurologic and musculoskeletal evaluation of arm and leg, evaluation of vision, hearing and speech

DEPRESSIONIf Geriatric Depression scale is positive:- check for adverse medications - initiate appropriate treatment

MENTAL STATUSNumber of tests are available

INCONTINENCE (eventually fecal incontinence)presence and degree of severity

HOME ENVIRONMENT AND SOCIAL SUPPORTEvaluation of home safety and family and community resources

Functional Assessment: Goals

• Identify limitations of patient ability to function in daily life.

• Develop strategies/interventions to improve function.

• In other words: What cannot be done, why cannot it, what can be done to fix the limitation (patient-based intervention) or change task (environmental remediation)

comperhensive Rehabilitation

• Disease -> impairment -> disability -> handicap• Example: Degenerative joint disease (DJD) ->

pain -> gait disturbance -> unable to access 2nd-floor apartment

• Interventions: Disease-specific (nonsteroidal anti-inflammatory drugs [NSAIDs], total knee replacement [TKR]) -> impairment management (pain control) -> disability compensation (cane) ->environmental modification (move to 1st-floor apartment)