Handbook of Rehabilitation Medicine

Keng He Kong, Samantha Giok Mei Yap;Yong Joo Loh

• Publisher: WSPC
• Year: 2016
• ISBN:
  9789813148734
• Topic: Médecine
• Subtopic: Physiothérapie, médecine physique et réadaptation

Handy companion to common topics in Rehabilitation Medicine, including stroke, spinal cord injury, traumatic brain injury, lower limb amputation, spasticity, cardiopulmonary and geriatrics rehabilitationAlso included are chapters on Management of Medical

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Functional Assessment in Rehabilitation Medicine

CHAN Wai Lim William

Introduction

Rehabilitation medicine is the specialty focusing on the optimisation of functions lost in diseases and injuries.

Functional assessment is an extension of the conventional medical history taking and physical examination. It goes beyond the identification of the foci and the extent of the disease, disorder or injury of the patient, and includes all levels of disability specific to the patient.

The term “disability” as defined by the World Health Organisation (WHO) encompasses all levels of functional losses, which are systematically catalogued in the International Classification of Functioning, Disability and Health (ICF). ICF offers an international, scientific tool shifting from a purely medical model to a bio-psycho-social model of human functioning and disability. The three domains of functioning are defined as:

1.Impairments: any loss or abnormality of body structure or of physiological or psychological function

2.Activity Limitations: the nature and extent of functioning at the level of the person

3.Participation Restrictions: the nature and extent of a person’s involvement in life situations in relationship to impairments, activities, health conditions, and contextual factors

Source: ICF Website: http://www.who.int/classifications/icf/en/

Health Condition

Fig. 1. The ICF Model of Disability.

Rehabilitation medicine functional assessment

Apart from the assessment of the primary impairments caused by the disease or injury, the functional assessment must explore potential secondary impairments in other systems.

For example, for a patient with a pure motor stroke, apart from thorough assessment of the motor impairments, symptoms and signs of common secondary impairments such as shoulder pain and subluxation, venous thrombo-embolism and spasticity must be explored and documented. Furthermore, symptoms and signs of activity limitations and participation restrictions such as ability to perform self-care activities and use of public transport must also be evaluated.

Table 1. The essential elements of the Rehabilitation Medical Functional Assessment.

Component	Examples
History taking
History of present illness	Location, onset, quality, severit...