Chapter 6: Assessment of Function

Objectives

Introduction

Assessing function for individuals with spinal cord injury (SCI) can be challenging, yet it is imperative that clinicians working with researchers standardize the measures by which they assess function. As medical and rehabilitation researchers and/or clinicians discover methods to restore function and quality of life to individuals with a SCI, it is important to develop easily replicated measures for demonstrating the efficiency and effectiveness of services provided in order to facilitate comparisons of outcomes among different clinical trials.¹ In addition to validating neurological or functional recovery, standardized measurements of function can also:

1. Justify cost reimbursement for medical and rehabilitative services.^2,3

2. Predict long-term caregiver needs and estimate the amount of assistance necessary.^3,4,5

3. Facilitate communication among health-care professionals by comparing the efficacy of different rehabilitation treatments.^2,3,4,6

4. Guide management to initiate improvements within the rehabilitative continuum of care.⁴

This chapter will describe and discuss various assessments that have been used in SCI treatment to measure an individual's level of function. The International Classification of Functioning, Disability and Health (ICF) provides a conceptual framework for consequences of disease and injury.⁷ In keeping within this framework, functional assessments will be reviewed in the body functions and structures, activity, and participation domains as described by the ICF.⁷ These three domains address disturbances in terms of functional changes associated with the body, person, and society.⁷

The first domain of body functions and structures is the loss or abnormality of body structure or of a physiological or psychological function.⁷ For individuals with SCI, the loss or abnormality of body structure applies to altered activity of neural structures, such as those measured by muscle weakness and sensory loss.^7,8 The second domain of activity is "the execution of a task or action."⁷ Limitations in activities relate to an individual's difficulty in performing an activity or set of activities such as self care or mobility.^7,8 The third domain of participation addresses a person's involvement in life situations.⁷ This third domain identifies changes in social roles, including vocational, marital, and avocational roles.⁷

The assessments of function described in this chapter will be organized using the above ICF domains. The procedures for the administration of each assessment will be reviewed along with a discussion of how they are to be scored and interpreted. In ...