Chapter 10: Examination and Evaluation of Functional Status and Movement Patterns

Chapter Objectives

Upon completion of this chapter, the learner should be able to:

1. Describe the categories of function and functional measurement using key terms and definitions.

2. Explain the clinical significance of functional measures from the perspective of the patient, therapist, and facility.

3. Describe the process for selecting an appropriate functional measure.

4. Recognize the components of normal movement for rolling, come to sitting, unsupported sitting, transfers, sit-to-stand, stand-to-sit, gait and stair negotiation, wheelchair mobility, and upper extremity function.

5. Analyze movement patterns of patients with neurological deficits and determine missing movement components.

6. Discuss the characteristics of the functional measures presented.

7. Apply concepts in selecting appropriate functional measures based on specific patient problems.

8. Interpret the results of the functional examination.

Introduction

One of the primary goals of physical and occupational therapy is to promote functional independence, the ability to perform daily skills or tasks without depending on help from another person. These tasks, necessary to a person’s daily life, are usually referred to as functional activities. Functional activities are defined by the World Health Organization (WHO, 2002) as “the execution of a task or action by an individual.” Functional activities are required for daily living and are a key component of participation in work or leisure events. Damage to most areas of the central nervous system (CNS) will result in functional activity limitations; therefore, the “Where Is It?” feature with specific anatomical structures highlighted is not included in this chapter. To accomplish the goal of improved performance, the therapist must understand the relationship among existing pathology, impairment, functional limitation, and disability for each patient (Nagi, 1965; Nagi, 1969; Nagi, 1991) as well as interactions between the International Classification of Functioning, Disability, and Health (ICF) levels of function, body structure/ body function, activity, and participation (WHO, 2002) as explained in Chapter 1. A functional examination includes analysis and documentation of a patient’s perfor - mance of the specific activities needed in daily life such as transfers or ambulation, including aspects of balance required in executing each of those activities. Optimal tests and mea - sures in the functional examination are required to accurately document the patient’s initial functional status, document impairments that may contribute to a specific deficit in functional activity, guide development of the specific intervention plan, and document the patient’s progress or lack of progress over time. Additionally, the evaluation of the data from the functional examination guides the selection of appropriate interventions to address deficit areas. Each of these aspects is facilitated through selection of appropriate functional tests and measures as explained in this chapter.

Physical and occupational therapists have long utilized observational skills to determine a person’s ability to perform tasks and to identify missing movement components or abnormal movement patterns contributing to difficulty in performing a particular task. Results of this subjective observational analysis are used to determine appropriate interventions. While this method of ...