INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY, AND HEALTH Examination and treatment of individuals with health problems are based on the World Health Organization (WHO) International
condition, the body functions and structure, and participation. Therefore, becoming independent in transfers can improve strength and ROM through repetition of transfers and allows a return to golfing as a result of regaining the ability to get in and out of the golf cart independently. The sections of this course on examination and treatment are based on the ICF classification system (see Figure 4.) Figure 4: Who ICF Classification System
Classification of Functioning, Disability and Health (ICF), shown in Figure 4. This system was created to better define terminology across healthcare providers and to guide care and reimbursement. In this classification system, function and disability are viewed as a complex interaction between the health condition (e.g., PD) and the contextual factors of the individual, the environment, and the personal situation. Body structures are anatomical parts of the body such as organs, limbs, and their components; body functions are physiological functions of body systems (including psychological functions). Activity is the execution of a task or action by an individual and would include walking and transfers. Participation is involvement in a life situation such as work or child care. Environmental factors include the natural environment in which the person lives and functions, as well as the technology used, whereas personal factors include family support and culture. Physical therapy is typically initiated based on the patient receiving a diagnosis of PD (the health condition). Knowing this, the therapist would ask the patient about difficulties he or she is having and what the patient’s goals are for therapy. The patient may report issues such as difficulty walking and rising from chairs (activity level issues) and inability to enjoy recreational activities such as golf (participation level issues). Based on this information, the therapist would conduct an examination of areas such as strength, ROM, reflexes, and balance (body functions and structure). The therapist would also include questions about where the person lives, whether the house has stairs, whether anyone else is in the home to help the individual (environmental factor), and whether the person feels depressed (personal factor). The WHO ICF shows that each of these areas has an impact on all the others. The model makes clear that changing the activity level function impacts the health
WHO = World Health Organization; ICF = International Classification of Functioning, Disability and Health Note . From Towards a Common Language for Functioning, Disability, and Health: ICF , by World Health Organization, 2002, p. 9. Copyright 2002 by World Health Organization. Reprinted with permission. .
EXAMINATION OF THE CLIENT WITH PARKINSON’S DISEASE
The client with PD benefits from examination by a physical therapist at the time of diagnosis with ongoing periodic re- examination throughout the course of disease. This process ensures early detection of declines in function and allows therapy to address them before they lead to significant functional loss or Client history In addition to the routine questions for any patient about demographics, medical history, physical therapy history, general activity level, and fall history, there are PD-specific questions that should be reviewed. It is important to screen the patient for many of the nonmotor problems previously discussed, such as cognitive changes, fatigue, sleep problems, apathy, depression, and anxiety, because they will impact the client’s experience with physical therapy. The clinician should also document the client’s medication regimen (including dosage and timing) as well as Outcome measures The use of outcome measures is highly recommended to benefit the individual patient, the community of clients with PD, and providers. Outcome measures establish a baseline status as a means to quantify change in function over time and provide information regarding effectiveness of the care plan as part of periodic re-examination. In addition, they provide the opportunity to collectively compare care across multiple clients with PD to determine an intervention’s effectiveness. Providers benefit as standardized measures provide a common language to evaluate the success of physical therapy interventions, thereby providing a basis for comparing outcomes related to an intervention across clinics. It is important to use the same core measures over the course of the disease for ease in comparison across clinics and in research. The Academy of Neurologic Physical Therapy convened a task force to develop recommendations of outcome measures to be used in the
deterioration in health. Consistent and ongoing use of evidence- based outcome measures optimizes management of the client with PD, allowing the therapist to note changes over time and improving outcomes for clients with PD.
any unwanted medication side effects, such as hallucinations, dyskinesias, or dystonias. Determining the medication schedule is particularly important for individuals who use carbidopa- levodopa because their ability to participate in therapy is best at peak dose, and some functional deficits are more likely to be evident at the end of their dose cycle. Depending on their goals, clients might come to physical therapy at different times during their medication cycle to address functional limitations during both “on” and “off” times. care of clients with PD. The PD Evidence Database to Guide Effectiveness (EDGE) taskforce recommended nine measures as core measures based on the ICF (Table 3). In addition, the task force made recommendations for measures by disease stage, for entry-level education, and for research. The use of these outcome measures also makes it possible to comply with Medicare guidelines for the use of G Codes. The Academy of Neurologic Physical Therapy also underwent an analysis of EDGE task force recommendations across neurologic diagnoses and produced a list of five highly recommended or core outcome measures: 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), BBS, Functional Gait Assessment (FGA), and the Activities-Specific Balance Confidence Scale (ABC). Studies demonstrate that better outcomes of neurologic rehabilitation correlate with use of outcome measures to perform a comprehensive assessment of medical problems, body structure/
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