Functional assessment scale.pptx

Functional assessment

1. Functional Assessment Scales Darpan V anvi 1st Year MPT

2. Contents Introduction Berg Balance scale Barthel Index Functional Independence Measure Action Research Arm Test F unctional Reach Test & Multi-directional Reach Test References

3. Introduction Functional assessment measures an individuals level of function and ability to perform functional task. Functional assessments evaluate specific things such as grooming, bathing, dressing or more general aspect such as quality of life.

4. Assessments have to be valid, reliable and reproducible. They can be self-administered questionnaires or clinician administered.

5. Berg Balance Scale The berg balance scale is widely used clinical test of person’s Static and Dynamic balance abilities. Name after Katherine berg. Berg balance scale is generally considered to be Gold Standard.

6. Used to objectively determine a patient’s ability to safely balance during a series of predetermined tasks. 14 items list Each item consisting of a five point 0 to 4

7. 0 indicating the lowest level of function and 4 the highest level of function It takes approximately 20 minutes to complete.

8. Interpretation Cut-off scores for the elderly were reported by Berg et al 1992  as follows : A score of 56 indicates functional balance. A score of < 45 indicates individuals may be at greater risk of falling.

9. (A) Parkinson’s disease Test/Retest reliability: Excellent(ICC=0.94) Interrater reliability: Excellent(ICC=0.95)

10. (B) Stroke Test/retest reliability: (For acute stroke) =Excellent (ICC=0.99)

11. Interrater Reliability: For acute stroke) =Excellent (ICC=0.95) For chronic stroke: =Excellent(ICC=0.98 )

12. Concurrent( For acute stroke): Excellent correlation with Postural Assessment scale (r=0.92 to 0.95) Predictive ( For acute stroke) Excellent correlation with Motor assessment scale (r=0.82 to 0.84)

13. Barthel Index The Barthel Scale/Index (BI) is an ordinal scale used to measure performance in activities of daily living (ADL). The Barthel Index measures the degree of assistance required by an individual on 10 items of mobility and self care ADL

14. Area of assessment : Activities of daily living functional mobility gait Assessment type: Performance measure ICF Domain : Activity Measurement Domain : Activity of daily living motor

15. The Barthel includes 10 personal activities: Feeding, Personal Toileting, Bathing, Dressing And Undressing, Getting On And Off A Toilet,

16. Controlling Bladder, Controlling Bowel, Moving From Wheelchair To Bed And Returning, Walking On Level Surface (Or Propelling A Wheelchair If Unable To Walk) And Ascending And Descending Stairs

17. Proposed guidelines for interpreting Barthel scores are that scores of 0-20 indicate “total” dependency, 21-60 indicate “severe” dependency, 61-90 indicate “moderate” dependency 91-99 indicates “slight” dependency. Note- the Barthel Index should not be used alone for predicting outcomes.

18. STROKE MCID : Acute stroke =1.85 points

19. Interrater/Intrarater Reliability For acute stroke : Excellent (ICC=0.94) For Ischemic Stroke : :Intrarater excellent (ICC=0.98 :Interrater excellent (ICC=0.90)

20. Criterion validity(Predictive/Concurrent): Acute stroke : Excellent agreement between The FIM motor & 10 items BI at both admission & Discharge (ICC>0.83)

21. Functional Independence Measure Measure the level of patient’s disability & Indicates how much assistance is required for individual to carry out activities of daily living Area of Assessment : Activities of daily living Assessment type : Observer

22. It is an 18-item measurement tool that grouped into 2 sub-scales- Motor and Cognition . 1)13 motor tasks 2) 5 cognitive tasks(considered basic activities of daily living)

23. Motor subscales includes: 1)Eating 2)Grooming 3)Bathing 4)Dressing UL 5)Dressing LL 6)Toileting

24. 7)Bladder management 8)Bowel management 9)Transfer -Bed/ Chair/ Wheelchair 10)Toilet transfer 11)Shower transfer 12)Walk/ Wheelchair 13)Stairs

25. Cognition subscales include : 1)Comprehension 2)Expression 3)Social interaction 4)Problem solving 5)Memory

26. No Helper 7 . Complete Independence (Timely, Safety) 6 . Modified Independence (Device) Helper - Modified Dependence 5 . Supervision (Subject = 100%) 4 . Minimal Assistance (Subject = 75% or more) 3 . Moderate Assistance (Subject = 50% or more) Helper - Complete Dependence 2 . Maximal Assistance (Subject = 25% or more) 1 . Total Assistance or not Testable (Subject less than 25%)

27. Interpretation Motor subscale(the sum of the individuals motor subscale item) will be a value between 13 and 91. Cognition subscale(the sum of individual cognition subscale items) will be a value between 5 and 35.

28. The total score for the FIM instrument(the sum of motor and cognition subscale scores) will be a value between 18 and 126.

29. STROKE Criterion Validity(Predictive/Concurrent): A) Predictive validity :FIM total score at admission were found to be the most powerful prediction of Montebello Rehabilitation factor score (beta coefficient=0.42)

30. B) Concurrent :Excellent correlation between FIM motor subscale & Barthel index At admission (r=0.92) At discharge (r=0.94)

31. Action Research Arm Test The Action Research Arm Test (ARAT) is a 19 item observational measure used by physical therapists and other health care professionals to assess upper extremity performance (coordination, dexterity and functioning) in stroke recovery, brain injury and multiple sclerosis populations.

32. Items comprising the ARAT are categorized into four subscales (grasp, grip, pinch and gross movement) and arranged in order of decreasing difficulty, with the most difficult task examined first, followed by the least difficult task.

33. Area of assessment :Activities of daily living :Co-ordination :Dexterity :UE Function Assessment type : Observer

34. The 19 items comprising the ARAT are scored using a 4 point ordinal scale, as follows: = No movement 1 = Movement task is partially performed

35. 2 = Movement task is completed but takes abnormally long 3 = Movement is performed normally

36. Positioning Standard positioning for the ARAT has the subject seated upright in a chair with a firm back and no armrests. The head should be in a neutral position, with feet in contact with the floor.

37. This body posture must be maintained throughout the testing period, with the trunk contacting the back of the chair. Feedback is provided as required, to prevent the subject from standing up, shifting laterally or leaning forward.

38. Stroke MCID :Acute stroke =5.7 :Chronic stroke=12 to 17 points

39. Interrater/Intrarater Reliability: Acute stroke- Excellent interrater (ICC=0.92) Chronic stroke-Excellent interrater (ICC=0.995) -Excellent intrarater (ICC=0.989)

40. Criterion Validity(Predictive/Concurrent): Chronic stroke-Excellent correlation between ARAT & Arm motor score of Fugl meyer (r=0.94<0.001)

41. Functional Reach Test FRT was developed by Pamela Duncan and co-workers in 1990 Defined as “The maximal distance one can reach forward beyond arm’s length, while maintaining a fixed base of support in the standing position.” Used to assess dynamic balance in one simple task.

42. This test measures the distance between the length of an outstretched arm in a maximal forward reach from a standing position, while maintaining a fixed base of support. It was developed to predict fall in elderly people; being unable to reach more than 15 centimeters (6 inches) depicts a high fall risk and frailty.

43. Area of Assessment: 1)Balance : Vestibular 2)Balance : Non-Vestibular 3)Functional Mobility 4)Vestibular Assessment type : Performance measure

44. Measurement Interpretation : 10’’/25cm - Greater low risk of falls 6’’/15cm to 10’’/25cm – Risk of falls is 2x greater than normal 6’’/15cm – Less risk of falling 4x greater than normal Unwilling to reach risk of falling 8x greater than normal

45. Multi-directional reach test Used to determine the limits of stability of individual in 4 directions. It measures how far an individual can voluntarily reach, thereby shifting the COG to the limits of the BOS with the feet stationary.

46. References: Duncan, P. W., D. K. Weiner, et al. (1990). "Functional reach: a new clinical measure of balance." J Gerontol 45(6): M192-197. Wood-Dauphinee S, Berg K, Bravo G, Williams JI: The Balance Scale: Responding to clinically meaningful changes. Canadian Journal of Rehabilitation, 10: 35-50,1997.

47. Susan B. O’Sullivan-Tomas J. Schmitz-George D. Fulk : Sixth Edition Rehabmeasure.com