Chapter 18

Objective assessment (functional assessment)

OBSERVATION OF HOW THE PATIENT MOVES

Patient

Therapist

Functional ability

The quality of performance/movement analysis

ANALYSIS

Observation of how the patient moves

This part of the assessment can be completed while the patient carries out a functional transfer such as rolling, sitting to lying, lying to sitting, sitting to standing, standing to sitting, walking indoors/outdoors, stairs, running. However, it is equally useful to assess the patient’s movement during functional activities, for example, dressing/undressing, reach and grasp, writing their name, etc.

Patient

The function/s chosen to observe will depend on the patient’s ability. For example, if the patient is unable to move out of bed, then start your assessment with bed mobility. On the other hand, if the patient walks into the department, then the assessment will be set at a higher level of function.

Note: If the patient is able to walk, then the therapist will also need to complete a full gait analysis (S3.19).

Therapist

The aim of observing function is to identify any movement abnormalities and as such, the patient must be physically challenged. However, care should be taken not to fatigue the patient. Ultimately, all transfers will need to be assessed for the therapist to gain a full understanding of functional ability.

While the patient performs the function the therapist needs to note:

Functional ability

That is, how successful the patient is and what assistance they require completing the task. For example, the patient is independent sitting to standing or the patient needs minimal assistance of 1 from lying to sitting.

The quality of performance/movement analysis

The therapist also needs to analyse how they perform the function. In essence this is movement analysis. At this point the therapist is trying to identify any deviations from the normal limits of efficient movement and not necessarily the underlying cause of the deviations. This demands the therapist has a good understanding of the requirements of the task and may require the inexperienced therapist to carry out a task analysis prior to observing the patient. The task analysis should be considered in relation to the wide variation of normal presentations possible. A good understanding of basic biomechanical principles will also facilitate the therapist’s reasoning during this process.

Normal requirements of the task

To facilitate this process, the therapist may choose to base their analysis on the following basic structure:

• Start position – in relation to joint angles

• Finish position – in relation to joint angles

• Muscle action – in terms of how the individual moves from start to finish position. Consider:

• Which muscles are required

• The function of the muscle during the task (agonist, antagonist, synergist)

• Type of muscle contraction (eccentric, isometric, concentric)

• Range of the muscle work (inner, middle, outer).

 Caution

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