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Introduction

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"I always thought my increased difficulty in walking and doing my daily activities was just due to aging but after my assessments and discussion from my physiotherapists and occupational therapists, I came to realize there are issues I can seek help for and changes I can make to improve my performance!"

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—Comment from a client involved in a study titled "Detecting and Addressing Pre-Clinical Disability"

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LEARNING OUTCOMES

By the end of this chapter, readers will be able to:

  1. Define functional performance.

  2. Differentiate among the various purposes and types of assessments and evaluations.

  3. Describe the need for a conceptual framework to guide the assessment of functional performance.

  4. Compare and contrast among the International Classification of Functioning, Disability and Health, the Glass Model, and the Person-Environment-Occupation Model.

  5. Identify important areas of functional performance that should be assessed in older adults.

  6. Describe factors, specifically related to older adults, that affect functional performance and need to be considered in assessment.

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Clinical Vignette

Ms. Annette Altman is a 68-year-old woman with a medical history of hypertension, obesity, and osteoarthritis in her cervical spine, hands, and left knee. She has had a cortisone injection in her left knee that provided temporary relief of her symptoms. Ms. Altman has four children and lives alone in a townhouse. She is recently retired, having worked as a personal support worker for 25 years and, more recently, as an educational assistant in an elementary school. When asked about her current level of physical function, she reports she is having difficulty going up and down the stairs and has trouble crouching and kneeling due to her knee pain. She is experiencing shortness of breath with exertion, which makes walking distances difficult for her. She also describes pain in her hands that affects her ability to do many of her daily chores and activities. Ms. Altman was asked by the therapist working with her to identify important activities that she is unable to do or is having difficulty with due to her health. She listed five activities: (1) walking in the park or on local trails with her family, (2) using her hands to perform fine motor activities for dressing herself or for hobbies (knitting and crocheting), (3) bowling, (4) water exercise, and (5) gardening.

  1. When you have been confronted with short- or long-term health concerns, which activities in your daily life do you give up first?

  2. Why was it important for the therapist working with Ms. Altman to ask about activities that were challenging for her?

  3. How would you proceed to conduct a functional assessment with Ms. Altman based on the information you have so far?

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In this chapter, issues related to the meaning of functional performance and why it needs to be assessed, conceptual frameworks to guide assessment of functional performance, and priority areas of functional performance that often require evaluation by occupational therapists and physical therapists ...

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