FUNCTIONAL

OUTCOMES
 Functional outcomes
 Gmfcs
 Macs
 Gmfm
 Pedi
 Fim
 Bi
 Bbs
 Pci
 Prs
 Ds
 THE MODIFIED ASHWORTH
SCALE
 0 no increase in muscle tone.
 1 slight increase in tone with a catch and
release or minimal resistance at end of
range.
 2 as 1 but with minimal resistance through
range following catch.
 3 more marked iincrease in tone through
ROM
 THE MODIFIED ASHWORTH
SCALE
 4 considerable increase in tone passive
movement difficult.
 5 affected part rigid.
 PHYSIOLOGICAL COST INDEX
A calculation of energy cost of walking at
childs chosen comfortable speed.
Derived from difference between resting
heart rate and that while walking at a
measured speed.This gives an index with
units of heart beats per metre walked.
Normal values in metres 0.4,in feet 0.12
With shoes,5 rounds of 25 metres,for severe
disability 5 rounds of 6.1 metres.
 PEDI
 It is a judgement-based standardised
structured interview or questionnaire for
parents or clinicians/educators of young
children with variety of disabilities.
 The PEDI measures both the capability
and performance of functional skills of
children ages 6 months to 7.5 years.If
functional skills delayed useful over age of
 7.5 years
 PEDI
PEDI is divided into 3 scales
 Functional skills
 Caregiver assistance
 Modifications.
 Each scale adresses the content domains
of self-care, mobility, and social function.
 Scales can be collectively or
independently administered.
 PEDI
 Scaled scores can be used to provide an
indication of performance along a
continuum from 0 to 100, with higher
scores representing greater functional
performance and less care-giver
assistance.
 BARTHEL INDEX
 The index was developed to measure
functional independence in personal care
and mobility.
 This is a 10 item performance based
instrument that evaluates activities of daily
living.Scores range between 0 and
100,with 100 representing the highest
level of independence.
 BARTHEL INDEX
Each item is assigned a score of 0, 5, 10,
15,each item is weighted differently and
hence reflects the relative importance of
each type of disability in term of
assistance required. The items assessed
are
Feeding
Transfering from wheelchair to bed and
back
 BARTHEL INDEX
 Personal hygeine
 Getting on and off toilet
 Bathing self
 Walking on a level surface/propelling wheel-
chair,
 Ascending/descending surface,
 Dressing,
 Controlling bowels,
 Controlling bladder.
 FUNCTIONAL INDEPENDENCE
MEASURE
It provides an estimate of the burden of
care.
Eighteen items, (13 motor, 5 cognition) are
rated on seven-level ordinal scale that
describes stages of complete dependence
to complete independence in performance
of basic daily living activities.
Total scores range from 18 (lowest) to
126(highest) level of independence.
Gross motor function classification
system
 LEVEL 1
 Children walk indoors and outdoors, and climb stairs
without limitations. Children perform gross motor skills
including running, and jumping but speed, balance and
co-ordination are reduced.
 LEVEL 2
 Children walk indoors and outdoors,and climb stairs
holding onto railing but experience limitations walking on
uneven surfaces, and inclines and walking in crowds and
confined spaces.Children have at best only minimal
ability to perform gross motor skills such as running and
jumping.
Gross motor function classification
system
 LEVEL 3
 Children walk indoors and outdoors ona
level surface with an assistive mobiity
device. Children may climb stairs holding
onto a railing. Depending on upper limb
function, children may propel a wheel-
chair manually or are transported when
traveling for long distances or outdoors on
uneven terrain.
Gross motor function classification
system
 LEVEL 4
 Children may maintain levels of function achieved before age 6 or
rely more on wheeled mobility at home, school, and in the
community. Children may achieve self-mobility using a power wheel-
chair.
 LEVEL 5
 Physical impairments restrict voluntary control of movement and the
ability to maintain anti-gravity head and trunk postures. All areas of
motor function are limited. Functional limitations in sitting and
standing are not fully compensated for through the use of adaptive
equipment and assistive technology .At level 5 ,children have no
means of independent mobility and are transported. Some children
achieve self-mobility using a power wheel-chair with extensive
adaptations.
 Gross motor function measure
 Original 88 item GMFM and newer 66 item
GMFM assess change in gross motor
function for children with C.P.
 The original GMFM is a performance –
based measure arranged into five
dimensions
 1)lying and rolling
 2)sitting
 3)crawling and kneeling
 Gross motor function measure
 4) Standing, and
 5) Walking, running and jumping.
 Each item is scored on a 4-point scale (0-
3) with specific descriptors for scoring
items contained in a manual. Percent
scores are calculated within each
dimension and averaged to obtain a total
score that ranges from 0-100.
 (age group 5months to 16 years)
 Physicians Rating Scale
 Measures gait parametres
 Total perfect score 20 per limb.
 A)knee position whether crouch or recurvatum
 B)initial contact of foot early,
 whether toe, fore-foot, footflat, or heel.
 C)foot contact at mid-stance toe/toe –equinus, foot flat-
early heel rise, foot flat-no early heel rise, occassional
heel-foot flat, heel-toe-normal roo over.
 D)timing of heel rise no heel contact-fixed
equinus,before 25% stance-very, before 25-50%-slightly
early, at terminal stance, no heel rise-after foot flat
crouch.
 Physicians Rating Scale
 E) hind foot at mid stance varus,valgus,
neutral.
 F) base of support frank scissoring,
narrow base,wide base,normal base –
width of shoulders.
 G) gait assistive devices forward/
posterior with assistance, crutch, sticks,
none independent for 10 metres.
 H) change worse, none , better
 Berg Balance Scale
 14 item scale designed to measure balance.
 A five point ordinal scale ranging from0-4,total score 56.
 Interpretation 41-56 low fall risk, 21-40 medium fall risk,
0-20 high fall risk.
 Items studied behind,
 Sitting to standing, standing unsupported, standing to
sitting, transfers, standing with eyes closed, standing
with feet together, reaching forward wiith outsretched
arm, retreiving object from floor, turning to look behind,
turning 360 degrees, placing alternate foot on stool,
standing with one foot in front, standing on one foot.
 Macs
 Macs is a system to classify childrens ability to handle
objects in daily activities.
 Macs intends to report the participation of both hands in
activities. Macs intends to describe which level best
represents the s childs performance in home, school and
community settings.any limitations in manual abilities do
not
 Level 1
 Handles objects easily and successfully.At most,
limitations in the ease of performing manual tasks
requiring speed and accuracy.However, any limitations in
manual abilities do not restrict independence in daily
activities.
 Macs
 Level 2
 Handles most objects but with somewhat reduced quality
of and/or speed of achievement, certain activities may
be avoided or be achieved with some difficulty,
alternative ways of performance might be used but
manual abilities do not usually restrict independence in
daily activities.
 Level 3
 Handles objects with difficulty, needs help to prepare
and /or modify activities. The performance is slow and
achieved with limited success regarding quality and
quantity. Activities are performed independently if they
have been set up or adapted.
 Macs
 Level 4
 Handles a limited selection of easily managed
objects in adapted situations. Performs parts of
activities with effort limited success. Requires
continuous support and assistance and/or
adapted equipment, for even partial
achievement of the activity.
 Level 5
 Does not handle objects and has severely
limited ability to perform even simple actions.
Requires total assistance.