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INTRODUCTION

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LEARNING OBJECTIVES

  1. Discuss the concepts of health status, function, activity, participation, disability, impairment, activity limitations, and participation restrictions.

  2. Define function, and discuss the purposes and components of the examination of function.

  3. Select activities and roles appropriate to an individual's particular characteristics and condition to guide examination of function.

  4. Compare and contrast characteristics of various formal tests of function, including physical function tests and multidimensional functional assessment instruments.

  5. Identify factors to be considered in the selection of formal instruments for testing function.

  6. Compare and contrast various scoring methods used in instruments to measure function.

  7. Discuss the issues of reliability, validity, and meaningful change as they relate to the measurement of function.

  8. Using the case study example, apply clinical decision making skills in evaluating data from the examination of function.

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Aclinician needs to consider the purposes of obtaining the measurement in deciding which measure of function to use. For example, is the measure to describe a specific activity limitation or describe an individual's overall level of function? Will the measure be used to assess outcomes of an episode of care, determine the destination at discharge, obtain reimbursement, meet regulatory requirements, or a combination of all of the above? As function may incorporate performance at the level of body systems, the person, and society, or a combination of these, and the clinician should be cognizant of the ability of the measure to capture the appropriate information.

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The ultimate objective of any rehabilitation program is to return the individual to a lifestyle that is as close to the premorbid level of function as possible or, alternatively, to maximize the current potential for function and maintain it. For an otherwise healthy person with a fractured arm, this may be a reasonably simple process: improving range of motion, strength, and impairments in body function will reestablish skills in the performance of activities, such as dressing and feeding. However, considering the person with a stroke as an example, the task is much more complex because the problems are much more extensive, complicated, and interwoven. The two cases, however, are broadly similar. In both instances, the therapist begins by describing the problem in functional terms obtained from the history, performing a systems review and detailed examination using selected tests and measures, evaluating the data, establishing a diagnosis and prognosis, implementing interventions to reduce or to eliminate the problems identified, and documenting the progress toward the desired functional outcome.1

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Every individual values the ability to live independently. The construct of function encompasses all those tasks, activities, and roles that identify a person as an independent adult or as a child progressing toward adult independence. These activities require the integration of both cognitive and affective abilities with motor skills. Functional activity is a patient-referenced concept and is dependent on what the individual self-identifies as essential to support physical and psychological well-being, as well as to create a personal sense of meaningful living. ...

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