RHS 332: Clinical Neurology

1. RHS 332: Clinical Neurology Ahmad Alghadir, M.S. Ph.D. P.T. Room: 2071 aalghadir@hotmail.com alghadir@ksu.edu.sa Ahmad Alghadir M.S. Ph.D. P.T.

2. Recommended texts • S.B. O’sullivan, T.J. Schmitz, Physical Rehabilitation: Assessment and Treatment, F.A. Davis Company. 3rd ed. 1994. • R.L. Braddom, Physical Medicine & Rehabilitation, W.B. Saunders Company. 1st ed. 1996. Ahmad Alghadir M.S. Ph.D. P.T.

3. Functional Assessment Ahmad Alghadir M.S. Ph.D. P.T.

4. Purposes • To describe the patient’s problem in functional terms. • To plan treatment to eliminate or reduce the problems identified. • To measure the progress of these treatments towards the desired functional outcome. Ahmad Alghadir M.S. Ph.D. P.T.

5. Health • Definition by WHO: “a state of complete physical, mental, and social well-being, and not merely the absence of diseases.” • Factors used to define health: • Physical signs. • Symptoms. • Functional disability. • See figure 11-1. Ahmad Alghadir M.S. Ph.D. P.T.

6. Disease • Definition: “pathologic condition of the body that presents a group of characteristic signs and symptoms that sets the condition apart as abnormal.” Ahmad Alghadir M.S. Ph.D. P.T.

7. Physical signs and symptoms • Physical signs: directly observable or measurable changes in an individual’s organs or systems as a result of pathology or disease (e.g. elevated blood pressure). • Symptoms: “subjective reactions to the changes experienced by an individual as a result of pathology or disease” (e.g. dizziness). Ahmad Alghadir M.S. Ph.D. P.T.

8. Syndromes • Definition: medical conditions that are not labels for a single pathologic entity, but clusters of signs and symptoms (e.g. AIDS). Ahmad Alghadir M.S. Ph.D. P.T.

9. Impairments • Definition: “any loss or abnormality of anatomic, physiologic, or psychologic structure or function; the natural consequence of pathology or disease” (e.g. loss of ROM). • Manifestation of pathology or disease. • Temporary or permanent. Ahmad Alghadir M.S. Ph.D. P.T.

10. Functional limitations • Definition: “deviation from normal in the way an individual performs a task or activity, usually as the result of impairment” (e.g. inability to bath independently). Ahmad Alghadir M.S. Ph.D. P.T.

11. Categories of function • Physical function: “sensory-motor skills necessary for the performance of usual daily activities.” Ahmad Alghadir M.S. Ph.D. P.T.

12. Basic ADL: “tasks concerned with daily self-care, such as feeding, dressing, hygiene, and physical mobility.” • Instrumental ADL: “advanced skills considered vital to an individual’s independent living in the community, including managing personal affairs, cooking and shopping, and home chores.” Ahmad Alghadir M.S. Ph.D. P.T.

13. Psychological function: “ability to use mental and affective resources effectively in response to the requirements of a particular situation.” Ahmad Alghadir M.S. Ph.D. P.T.

14. Mental function: “intellectual or cognitive abilities of an individual, including initiative, attention, concentration, memory, problem solving, and judgment.” Ahmad Alghadir M.S. Ph.D. P.T.

15. Affective function: “mental and emotional skills and coping strategies needed to perform everyday tasks and stresses, as well as the more traumatic events each person encounters over the course of a lifetime; includes such factors as self-esteem, body image, anxiety, depression, and the ability to cope with change.” Ahmad Alghadir M.S. Ph.D. P.T.

16. Social function: “ability to interact successfully with others in the performance of social roles and obligations; includes social interactions, roles, and networks.” Ahmad Alghadir M.S. Ph.D. P.T.

17. To be clinically meaningful, impairments must be linked to functional limitations in a cause-and-effect relationship. Ahmad Alghadir M.S. Ph.D. P.T.

18. Disability • Definition: “inability to perform social roles typical of independent adults, taking into account age, sex, social, and cultural factors.” Ahmad Alghadir M.S. Ph.D. P.T.

19. “Disability is characterized by a discordance between the actual performance of an individual in a particular role and the expectations of the community regarding what is “normal” for an adult.” Ahmad Alghadir M.S. Ph.D. P.T.

20. Handicap • Definition: “social disadvantage for a given individual of impairment, functional limitation, or disability.” • “The negative value placed by others on an impairment, functional limitation, or disability makes a person handicapped.” Ahmad Alghadir M.S. Ph.D. P.T.

21. Independence. • Social stigma. • Environmental restrictions. • Same disease and impairments, but different functional limitations. • Functioning differently, but not handicapped. Ahmad Alghadir M.S. Ph.D. P.T.

22. Types of instruments • Performance-based assessment: “assessment of a particular skill based on observation of an actual attempt, as opposed to acceptance of a self-report of skill level.” • Setting should be similar to the actual environment. • Assessment may be biased by fatigue. • Take appropriate safety precautions. Ahmad Alghadir M.S. Ph.D. P.T.

23. Self-administered assessment: “survey or series of questions constructed to be answered directly by the respondent without additional input or direction.” • Distinguish between person’s habitual performance and capacity to perform a task (NO vs. N/A). • Specify a time-frame reference (short- vs. long-term objectives). Ahmad Alghadir M.S. Ph.D. P.T.

24. Instrument parameters • Descriptive parameters: • e.g. dependence, difficulty, and endurance. • Dependence: “state requiring some level of human assistance.” • Difficulty: “hybrid term that suggests that an activity poses an extra burden for an individual, regardless of dependence level.” Ahmad Alghadir M.S. Ph.D. P.T.

25. Endurance: “energy consumption required to complete a functional task.” • “Meanings of descriptive terms should be clear to all others using the medical record.” • See table 11-1. Ahmad Alghadir M.S. Ph.D. P.T.

26. Quantitative parameters: • e.g. timed assessments. • Speed vs. quality. Ahmad Alghadir M.S. Ph.D. P.T.

27. Instrument formats • Checklist scale (dichotomous or categorical scale): see table 11-5. • “Assessment tool format in which a description of various tasks is simply scored dichotomously (e.g., present or absent; completed or not completed).” Ahmad Alghadir M.S. Ph.D. P.T.

28. Numeric or letter-grade scale (ordinal scale): MMT. • “Classification scheme that rates observations in terms of the relationship between items (e.g., less than, equal to, or greater than).” Ahmad Alghadir M.S. Ph.D. P.T.

29. Summary or additive scale: see table 11-2. • “Approach to grading a specific series of skills by awarding points for each task or activity; totals the score as a percentage of 100 or as a fraction.” Ahmad Alghadir M.S. Ph.D. P.T.

30. Visual or linear analog scale (continues scale): pain. • “Linear rating designed to capture a subject’s judgment of his or her position on a continuum. A line is presented horizontally or vertically on paper, with the endpoints anchored with descriptive words representing the extremes in terms of the parameter of interest.” Ahmad Alghadir M.S. Ph.D. P.T.