(I) Activities of Daily Living (ADL) assessment The concept of activities of daily living (ADL) was proposed by SidneyKatz in 1963, which refers to the necessary activities that a person performs on a daily basis in order to satisfy the needs of daily life ADL is divided into basicactivitiesofdailyliving ( ADLs are divided into basic activities of daily living (BADL) and instrumental activities of daily living (IADL)
BADL refers to the daily and repeated activities necessary for a person to maintain the most basic survival life, including self-care activities and functional mobility. BADL refers to repeated daily activities that are necessary to maintain the most basic survival life, including self-care activities and functional mobility. Self-care activities include eating, grooming, washing, bathing, toileting, dressing, etc. Functional mobility includes turning over, getting up from bed, transferring, walking, driving a wheelchair, going up and down stairs, etc.
IADL refers to activities that are necessary to maintain an independent life, including the use of the telephone, shopping, cooking, housework, handling laundry and medication, the use of transportation to deal with emergencies, as well as recreational activities in the community. These activities often require the use of tools to complete
BADLs are assessed for inpatients, while IADLs are used for disabled and elderly people living in the community
The following table lists the items included in the various BADL and IADL scales
Items included in BADL and IADL assessments
The ADLs can be assessed through both direct and indirect assessments. The direct assessment requires the patient to complete each activity one by one by himself/herself, asks the patient why he/she is unable to complete the activity, observes the patient completing the activity, and asks about the effect of the use of the assistive device on the activity. Indirect assessment can be done by obtaining information about the patient's completion of the activity from family members and people close to the patient, obtaining information about the patient's completion of the activity through telephone calls or letters, and obtaining information about the patient's completion of the activity through discussions with a rehabilitation medical team. Obtaining information about the patient's completion of activities
Here are a few commonly used ADL assessment methods:
1. Modified Barthel Index (MBI)
The Barthel Index was first designed and applied to clinical practice in the United States in the mid-1950s by Florence Mahoney and Dorothy Barthel. The Barthel Index is simple to assess, with high reliability and sensitivity, and is currently the most widely used method of ADL evaluation in clinical and research settings. The method was revised in 1987, and the modified Barthel Index (MBI) is now widely used. The scale*** has 10 items, with a total score of 100 points. The higher the score, the greater the independence and the less the dependence. If the score reaches 100, it does not mean that the patient is able to live completely independently; he may not be able to cook and take care of the household or have contact with others, but he does not need to be taken care of and can take care of himself
Contents of the MBI and scoring criteria
2. functionalindependencemeasurement (FIM)FIM is an important part of the unified data system for medical rehabilitation proposed by the American Academy of Physical Medicine and Rehabilitation in 1983, which not only evaluates physical function, but also includes speech, cognition, and social function, and it is a method of evaluating the ability of people with disabilities to perform activities of daily living, which is proposed in recent years to reflect their daily life in a more objective way. FIM is more detailed, precise and sensitive than the Barthel Index in reflecting the level of disability or the amount of help needed, and is a powerful indicator for analyzing and judging the efficacy of rehabilitation. It not only evaluates ADLs due to motor impairment, but also evaluates the impact of cognitive dysfunction on daily life. FIM is the only method of measuring disability in medical rehabilitation that has established the Uniform Data Base System for Rehabilitation Medicine (UDSRM)
3. The FIM assessment consists of 6 aspects, ****18 items, respectively 13 motor ADLs and 5 cognitive ADLs
FIM assessment content
4. The scoring criteria are based on a 7-point scale, i.e., the maximum score for each item is 7, the minimum score is 1 out of 126, and the minimum score is 18. The score is based on the patient's degree of independence, the degree of need for aids or assistive devices, and the amount of help given by others4. The level of the score is based on the patient's degree of independence, the degree of need for aids or assistive devices, and the amount of help given by others
FIM scoring criteria
5.Result Determination:
FIM Scale Result Determination
(ii) Functional Activities Questionnaire (FAMQ). functionalactivitiesquestionnaire,FAQ)
Proposed by Pfeffer in 1982 and revised in 1984, the questionnaire was originally used to study the independence of the elderly and mild dementia scoring scale:
0 points- --Normal or never done, but can do; 1 point --Difficult, but can do alone or never done; 2 points - - needs help; 3 - totally dependent on others
The higher the score, the more severe the impairment Normal criteria is less than 5; ≥5 is abnormal and the patient is unlikely to be independent in the family and community
Functional Activity Questionnaire (FAQ)
(C) quality of life (quality of life, QOL) assessment WHO in 1997 on the definition of QOL: in different cultural backgrounds and value systems, living individuals on their goals and aspirations of the standard and the survival of things related to their own experience of awareness of the state of QOL is divided into objective QOL and subjective QOL Toshimitsu Ueda (Japan) will be QOL is divided into three levels of quality of life, quality of life and quality of life, and with the addition of subjective QOL, QOL*** is divided into four levels
The four levels of Toshi Ueda's QOL
The commonly used methods for assessing QOL include:
1.WHO/QOL-26 World Health Organization Quality of Life Measurement Short Form (WHOQOL-BRIEF)
By the World Health Organization Quality of Life Measurement Short Form (WHOQOL-BRIEF)
Developed by the World Health Organization, 22 countries *** with the participation of the completion of the scale in 1997, the scale applies to different cultural backgrounds with a variety of text rating scale includes 5 areas of 26 items (somato-psycho-social environment and the integrated) is divided into 1-5 levels, 26 items, according to the content or degree of the alternative answer is divided into "very dissatisfied ~ very satisfied" "very satisfied". Satisfaction" "very poor ~ very good" and other criteria 2.ShortForm-36 (ShortForm-36)
This form was developed in 1988 by the Boston Health Research Institute in the U.S., is the international focus on health as a comprehensive rating scale includes 8 areas and 36 items (physical, psychological, social, environmental and comprehensive), which are divided into 1 to 5 levels. The scale consists of 36 items (10 items for physical functioning, 5 items for mental health, 4 items for functioning in daily activities, 3 items for functioning in daily mental activities, 2 items for physical pain, 6 items for general health, 4 items for vitality, and 2 items for functioning in social activities), and is divided into 5 grades, with the maximum possible score for each area being 100 points, and the minimum being 0. The sum of the scores for each of the 8 areas is the composite score, and the higher the score, the lower the impairment of functioning, and the better the QOL. The higher the score, the less functional impairment, and the better the QOL.3. Life Satisfaction Index Scale A (LISA)
LISA is a commonly used subjective method of assessing quality of life, in which the patient is asked to read the 20 items carefully, and then to check "agree" and "disagree" on the right side of each item. "Disagree" and other columns, in line with their own views on the score to make a mark, such as the first question to agree with its right under the column of agreement "2 points" to make a mark, the rest of the same full score of 20 points, the normal is ≥ 12 points, the higher the score the better the quality of life The higher the score, the better the quality of life (d) social ability assessment This chapter introduces the assessment method of Frenchay Activity Index, which has 6 categories of assessment content, each category has its own assessment criteria, the lowest score is 0, the highest score is 47 points according to the scoring results, the ability to make a distinction between the social life as follows: 47 points - - completely normal; 30-44 points; 30-44 points; 30-44 points; 30-44 points; 30-44 points. -completely normal; 30 to 44 points - close to normal; 15 to 29 points - moderate impairment; 1 to 14 points --- severely impaired; 0 points --- totally lost
Frenchay Activity Index Rating Method
(V) Occupational Ability Rating Occupation is an Individuals in the social activities of an important part of people by engaging in various activities in the occupation, not only reflects its status and value in social activities, but also reflects the meaning and purpose of its life occupation involves the individual socio-economic 3 aspects, the unity of roles and positions, which enables individuals to give full play to their individual talents, to fulfill their social roles, and to obtain a reasonable economic remuneration
The selection of occupations should be guided by the following principles ① the principle of individual differences: from the individual's point of view to explore vocational behavior, personal needs, abilities, interests, values, personality and other factors are taken into account; ② emphasis on personal characteristics and occupational characteristics of the match, emphasizing the core of the individual's intrinsic motivation, from the point of view of the development of the study of individual occupational behavior; ③ the principle of sociology of labor: tends to study the role of the individual's occupational choices and occupational development of social and environmental factors, emphasizing the individual's position in the social and environmental factors, and emphasizing the individual's position in the social and economic aspects of occupational choices. Environmental factors, emphasizing the role of the individual's family and social environment and other external factors
The evaluation of vocational ability includes:
1. Preliminary evaluation before employment (1) Selection of occupation according to personality orientation should be done to match the personality needs, interests, attitudes, values and occupations
(2) Selection of occupational activities according to the ability to vocational activities in the ability to say that vocational ability is general. Ability refers to the basic ability to have in a variety of occupational activities, to ensure that people smoothly and effectively grasp the occupational knowledge and skills special ability refers to a certain occupational activities necessary in a particular occupational activity, the ability to show the total combination, expressed in the ability to interact with others work skills intellectual level of behavior at work and other 4 skills such as teachers of verbal expression ability accounting staff of the ability to calculate the driver's operating ability.
(3)Selection of occupations according to the intensity of workThe content of occupational job types determines the workload, and the actual ability of the patient should be selected according to the intensity of the job types when starting the job evaluation
(4)Selection of occupations according to occupational job types
2.Evaluation methods (1)The vocational evaluation adopts the JEVS job types example system established under the auspices of the U.S. Department of Labor. (jewishemploymentandvocationalserviceworksamplesystem), which is designed to integrate a variety of work skills characteristics of the range of 26 types of work***, work characteristics include: manipulation of the distribution of controlled inspection and drawing, etc. The system is evaluated in the actual work environment, and it takes 6 to 7 days to complete. JEVS system requires a high degree of accuracy the system's evaluation of the potential of the client comprehensive and thorough TOWER (testingorientationandworkevaluationinrehabilitation) system, established by the New York Association of the Disabled, *** there are 93 kinds of work examples, can be combined to assess the scope of 14 kinds of vocational training For example: office work drawing production jewelry mailing sewing and assembly it is a comprehensive work evaluation system that provides a real work environment to evaluate and analyze occupational potential to complete the time depending on the number of test items used can be up to 3 weeks
(2) previous ability and work behavior evaluation 1) shelteredworkshop (shelteredworkshop): the The workshop environment is used for "long-term" pre-employment assessment, and can be exempted from the general employment rules. Sheltered workshops have a detailed contract and should be completed within a specific period of time to produce a specific product for a specific customer
2)Workstations: more advanced than sheltered workshops, this type of individualized arrangement is generally for a period of one month, but depending on the work environment and the disability, it is not necessary for a person to be in a sheltered workshop for more than one month. However, depending on the work environment and disability status, it can be extended further. The workstation must have an inspector who is in contact with the evaluator for feedback
(3)Aptitude Tests Measurement and appraisal of the patient's occupational qualities through a variety of validated test instruments
Including:
1)Occupational Physical Qualities:Including Strength and BalanceBending and KneelingSquatting and Crawling Stretching the arms with the hands or skin perception verbal expression vision hearing control coordination and other 8 aspects
2)Occupational aptitude: test the patient to engage in specific occupations must have the ability to, including: intelligence verbal expression ability numerical ability spatial ability physical sense of paperwork ability movement coordination ability finger dexterity manual dexterity hand-eye-foot coordination ability color discrimination ability
3 Occupational personality traits: including occupational interest and personality traits Occupational interest refers to the tendency of a worker to concentrate on a certain type of work or activity due to attention or attraction; personality traits refer to the stable character qualities of a worker's individuality, both of which can be measured by relevant psychological test scales
4) Education and work experience
3. The Functional Assessment Questionnaire (FAQ) was developed by Crewe N.W. and Athelstan G.T. It is a more comprehensive scale for assessing the functional status, which can help to understand the impaired and residual situation of the disabled person's ability to find employment (for details, please refer to Exhibit 4 of P49)
Occupational ability is assessed at the following levels of impairment:
0~5 points: no obvious impairment of occupational ability; 6~31 points: mild impairment of occupational ability; 32~31 points. Mild impairment of vocational ability; 32-62 points: moderate impairment of vocational ability; 63-93 points: severe impairment of vocational ability
It should be noted that all items with a score of "3" must be listed, and based on the characteristics of these items, the occupations that require functional conditions in these areas are indicated
(2) Intelligence Aspect Rating Occupational Decision Making Test WAIS (for senior staff) Special Ability Tests (Motor Skills - Minnesota Operational Speed Test; Mechanical Ability - Bennett Mechanical Comprehension Test Clerical Aptitude Test Art Aptitude Test Music Aptitude Test)Multiple Abilities and Interests Test (Kuder Occupational Interest Survey)Other (Professional Achievement Personality)
(3)Assessment of Physical AbilitiesAssessment of the intensity of the labor that the patient is able to withstand as follows:
Relation of Labor Intensity to Strength
(6)Labor Ability Evaluation
Commonly used method is the microtower method (microtower, MT), mainly on the coordination ability of the fingers precise motor function cognitive ability and other 10 abilities to assess which, the Oriental people of the contents of each sub-test and the parameters of the normal value as shown in the table
Microtower method of assessment
Microtower method of assessment and the normal value of the contents of the