Fine Tuning

if a pt does not have 3/5 strength, can you sit them up?

yes

what tests that measure tone

modified ashworth, tardieu, feugel-meyer

if a pt has no spasticity at fingers, do you need to assess proximal?

yes

for person with known neuro diagnosis (like CVA) should you test reflexes?

testing more babinski/clonus - easy to implement and impacts gait but also early sign for another CVA

is it helpful to assess coordination if pt has gross 1/5 strength in left UE and LE extremities?

no

can you walk a pt who has absent sensation

yes

performance based assessments

scoring is based on what pt can actually perform

therapist observes performance of function

ex. FIM, 6MWT, modified functional reach, TUG

body function vs activity limitation based

body function: fugl-meyer, modified ashworth scale

activity based: FIM, CARE tool, Peabody, TUG, Berg, OASIS, SF-36

self assessment

Pt or family verbally describes what they can or can not do

ex. SF-36, ABC scale

FIM

18 item test - physical, psychological, social

asses transfers + locomotion, was widely used in IP

ceiling affect

FIM levels

0 = no activity

1-2 = helper complete dependence

3-5 = modified dependence

6-7 - no helper

CARE tool

required as payment reform for post-acute care reimbursement

items that are required for all pts across settings, specific to diagnosis or setting → GG codes

IRF-PAI

compiled by case manager or team leader → CARE tool included

benefits: interdisciplinary goal setting, compare outcomes across facilities and across diagnosis

IRF-PAI - coding

6 = independent

5 = set-up or clean-up assistance

4 = supervision or touching assistance

3 = partial/mod assist

2 = substantial/max assist

1 = dependent

IRF-PAI coding if not attempted

7 = pt refused

9 = not attempted

10 = not attempted due to environment

88 = not attempted due to safety concerns

CARE tool scoring

6 = ind

5 = set up A

4 = supervision A

3 = mod A

2 = max A

1 = dependent