EVALUATION AND ASSESSMENT FOR FUNCTIONAL and COMMUNITY MOBILITY

FUNCTIONAL MOBILITY

MOBILITY
• Most people would not consider this as a complex activity
o Clients with LE weakness
o Clients with cardiopulmonary conditions
• OT helps persons with mobility restrictions to achieve maximum access to environments and objects of
interest to them
• OT must analyze the activities most valued and environments most used by their clients and must
consider any future changes that can be predicted from an individual’s medical history, prognosis, and
developmental status

FUNCTIONAL MOBILITY COMMUNITY MOBILITY

• Moving from one position or place another • Planning and moving around in the community
• in-bed mobility • using public or private transportation
• wheelchair mobility • transportation such as: driving, walking, bicycling
• Transfers • use of public transportation such as: accessing
• functional ambulation and riding in buses, taxi cabs, or other
• transportation of objects transportation systems

BASICS OF AMBULATION

• Normal walking is a method of using two legs, alternately, to provide support and propulsion
• GAIT: accurately describes the style of walking
• EVENTS OF WALKING: loading response, midstance, terminal stance and pre-swing, and midswing and
terminal swing
• CYCLE TIME: duration of the complete cycle
• CADENCE: average step rate
• STRIDE LENGTH: distance between two placements of the same foot
• WALKING BASE: distance between the line of 2 feet

Presentation of step length, step width, and stride length during walking
Retrieved from: https://musculoskeletalkey.com/walking-mechanics-following-surgical-interventions-for-ankle-arthritis/

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FUNCTIONAL AMBULATION

• integrates ambulation into ADLs and IADLs

• using an occupationally based approach, the OT assesses the client’s abilities within the performance context
and with an understanding of client habits, routines, and roles
• Is the purposeful application of the mobility training taught to the client to enable movement from one position
or place to another
• Collaboration between OT and PT:
o PTs providing gait training, exercises, and ambulation aid recommendations;
o OTs apply recommendations during functional activities, reinforcing training and integrating it during
purposeful activities

WHEELCHAIR ASSESSMENT
NOTE: WC mobility and transfers will be covered in Management course

VIDEO: Must watch the World Health Organization (WHO) videos uploaded in Moodle
1 introduction_subtitles (2:35)
2 the benefits of an appropriate wheelchair_subtitles (3:17)

• Wheelchair can be the primary means of mobility for someone with a permanent or progressive disability
• Someone with short-term illness or orthopedic problem may need it as a temporary means of mobility
• Wheelchair can also substantially influence total body positioning, skin integrity, overall function, and the
general well-being of the client.
• OTs must understand the complexity of wheelchair technology, available options and modifications, the
evaluation and measuring process, the use, care, and cost of the wheelchair, and the process by which this
equipment is funded
• When evaluating for a wheelchair, the therapist must know the client and have a broad perspective of the
client’s clinical, functional, and environmental needs.
• Careful assessment of physical status must include the following: the specific diagnosis, the prognosis, and
current and future problems (e.g., age, spasticity, loss of range of motion [ROM], muscle weakness, reduced
endurance) that may affect wheelchair use.
• Additional client factors to be considered in assessment of wheelchair use are sensation, cognitive function, and
visual and perceptual skills. Functional use of the wheelchair in a variety of environments must be considered.

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WHEELCHAIR MEASUREMENT PROCEDURES

VIDEO: Must watch the World Health Organization (WHO) videos uploaded in Moodle
11 measurement demonstration (2:38)

A. SEAT WIDTH
• WHO standards: HIP WIDTH is the term
used by WHO and was used in the video

B. SEAT DEPTH

C. SEAT HEIGHT FROM FLOOR

• WHO standards: CALF LENGTH is
pertinent and is measured from popliteal to
base Sof heel → this will be used to know the
distance from seat to footrest or foot plate

D. FOOTREST CLEARANCE

E. BACKREST HEIGHT
• WHO standards: backrest height levels
varies from: (bottom of rib cage, inferior angle of
scapula—these 2 landmarks are presented inthe
video; however for intermediate or more
intricate WC of which would require
intermediate level training there are 2 more
landmarks for higher back support: top of
shoulders and occiput)

F. ARMREST HEIGHT

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SEAT WIDTH

OBJECTIVES MEASUREMENTS WC CLEARANCE CHECKING CONSIDERATIONS

• To distribute the client’s • across the widest part of • Add ½ to 1 inch on each • Place the flat palm of the • User’s potential weight
weight over the widest the thighs or hips while the side of the hip or thigh hand between the client’s gain or loss (i.e., gender
possible surface. client is sitting in a chair measurement taken. hip or thigh and the tendencies:
• To keep the overall width comparable with the • Consider how an increase wheelchair skirt and male-abdominal weight
of the chair as narrow as anticipated wheelchair in the overall width of the armrest. gain vs. female-hips and
possible. chair will affect • The wheelchair skirt is buttocks)
accessibility attached to the armrests in • Accessibility of varied
many models, and environments
clearance should be • Overall width of
sufficient between the wheelchair. Camber, axle
user’s thigh and the skirt to mounting position, rim
avoid rubbing or pressure. style, and wheel style can
also affect overall
wheelchair width.

SEAT DEPTH

OBJECTIVES MEASUREMENTS CHECKING CONSIDERATIONS

• distribute the body weight along • base of the back (the posterior • Check clearance behind the knees • Braces or back inserts may push the
the sitting surface by bearing buttocks region touching the chair to prevent contact of the client forward.
weight along the entire length of back) to the inside of the bent knee; front edge of the seat upholstery • Postural changes may occur
the thigh to just behind the knee • the seat edge clearance needs to be with the popliteal space. throughout the day from fatigue or
1 to 2 inches less than this spasticity.
NOTE: measurement • Thigh length discrepancy: the depth
This is necessary to help prevent pressure of the seat may be different for
sores on the buttocks and each leg.
the lower back, and to attain optimal • If considering a power recliner,
muscle tone normalization to assist in assume that the client will slide
prevention of pressure sores throughout forward slightly throughout the day,
the body. and make depth adjustments
accordingly.
• Seat depth may need to be
shortened to allow independent
propulsion with the lower
extremities

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OT-EAD313: OT Evaluation and Assessment in Orthopedic, Rheumatologic, and Sports Medicine 5
AY 2022-2023
Updated and revised by MBALABAT from MLSValenzuela, OTRP, MAESpEd
SEAT HEIGHT FROM FLOOR AND FOOT ADJUSTMENT

OBJECTIVES MEASUREMENTS WC CLEARANCE CHECKING CONSIDERATIONS

• To support the client’s • from the top of the • client’s thighs are kept • Slip fingers under the If the knees are too high,
body while maintaining the wheelchair frame parallel to the floor, so the client’s thighs at the front • increased pressure at
thighs parallel to the floor. supporting the seat (the body weight is distributed edge of the seat the ischial tuberosities
• To elevate the foot plates post supporting the seat) evenly along the entire upholstery. puts the client at risk
to provide ground to the floor, and from the depth of the seat. for skin breakdown
clearance over varied client’s popliteal fossa to • The lowest point of the NOTE: and pelvic deformity.
surfaces and curb cuts the bottom of the heel. foot plates must clear the A custom seat height may be • This position also
floor by at least 2 inches needed to obtain footrest impedes the client’s
clearance. An inch of increased ability to maneuver
seat height raises the foot plate the wheelchair using
1 inch the lower extremities.
Posterior pelvic tilt
• makes it difficult to
shift weight forward
as needed to propel
the wheelchair,
especially with uphill
grades.
Sitting too high off the ground
• can impair the client’s
center of gravity, seat
height for transfers,
and visibility if driving
a van from the
wheelchair

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BACKREST HEIGHT

OBJECTIVES MEASUREMENTS CHECKING CONSIDERATIONS

• Back support consistent with Full support height • Ensure that the client is not being • Adjustable-height backs (usually
physical and functional needs must • Measuring from the top of the pushed forward because the back of offer a 4-inch range)
be provided. seat frame on the wheelchair the chair is too high or is not leaning • Adjustable upholstery
• The chair back should be low (seatpost) to the top of the backward over the top of the • Lumbar support or another
enough for maximal function and user’s shoulders. upholstery because the back is too commercially available or custom
high enough for maximal low. back insert to prevent kyphosis,
support Minimum trunk support scoliosis, or other long-term trunk
• top of the back upholstery is deformity
below the inferior angle of the
client’s scapulae; this should
permit free arm movement,
should not irritate the skin or
scapulae, and should provide
good total body alignment

ARMREST HEIGHT

OBJECTIVES MEASUREMENTS WC CLEARANCE CHECKING CONSIDERATIONS

• To maintain posture and • With the client in a • The height of the top of • The client’s posture should • Armrests may have other
balance. comfortable position, the armrest should be 1 look appropriately aligned. uses, such as increasing
• To provide support and measure from the inch higher than the height • The shoulders should not functional reach or holding
alignment for upper wheelchair seat frame from the seat post to the slouch forward or be a cushion in place.
• extremities. (seat post) to the bottom user’s elbow. subluxed or forced into • Certain styles of armrests
• To allow change in position of the user’s bent elbow. elevation when the client is can increase the overall
by pushing down on in a relaxed sitting posture, width of the chair.
armrests. with flexed elbows resting • Are armrests necessary?
slightly forward on • Is the client able to remove
armrests. and replace the armrest
from the chair
independently?
• Review all measurements
against standards for a
particular model of chair.
• Manufacturers have lists of
the standard dimensions
available and the costs of
custom modifications.

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TO CONSIDER IN WHEELCHAIR SUBSCRIPTION/RECOMMENDATION

RENTAL VS PURCHASE

RENTAL PERMANENT
• appropriate for short-term or temporary use, such • indicated for the full-time user and for the client
as when the client’s clinical picture, functional with a progressive need for a wheelchair over a
status, or body size is changing long period.
• maybe necessary when the permanent • may be indicated when custom features are
wheelchair is being repaired required or when body size is changing
• may be useful when prognosis and expected
outcome are unclear, or when the client has
difficulty accepting the idea of using a wheelchair
and needs to experience it initially as a temporary
piece of equipment

MANUAL VS POWER/ELECTRIC WHEELCHAIRS

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MANUAL RECLINE VS POWER RECLINE VS TILT WHEELCHAIRS

FOLDING VS RIGID MANUAL WHEELCHAIRS

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LIGHTWEIGHT (FOLDING / NON-FOLDING) VS STANDARD-WEIGHT (FOLDING) WHEELCHAIRS

STANDARD AVAILABLE FEATURES VS CUSTOM TOP-OF-THE-LINE MODELS

Once a WC is made available for client use, it is of utmost importance to check for weight distribution in prevention
of pressure sores. There are several ways to prevent pressure sores which is not covered in assessment and
evaluation course. The video will present how to assess if client is prone to having pressure sores given wheelchair
use.

VIDEO: Must watch the World Health Organization (WHO) videos uploaded in Moodle
9 pressure test demonstration_subtitles (1:45)

COMMUNITY MOBILITY
Can be accomplished thru:
- Walking
- Using a bicycle or a powered mobility device
- riding as a passenger
- driving oneself
- Using public transportation

It can be considered as:

- Means to an occupation (work, education, social participation)
- Occupation in an of itself (leisurely stroll or scenic drive)
- Basis for personal independence, employment, and aging in place
- Deep social and cultural contexts

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ASSESSMENT OF COMMUNITY MOBILITY

Identify important and meaningful activities and community mobility needs necessary for participation

Analyze the client and the activity demands of the type of travel preferred and available

Assess performance skills necessary for preferred and available travel modes

Assess contextual and environment barriers

Set individual person-centered goals

Environmental Factors Impacting Transportation Usability

Availability Existence of transportation when needed
Accessibility Transportation is reached and used considering riders’ abilities/disabilities
Affordability The costs are within the users means or reimbursable
Acceptability Meets standards of cleanliness, safety, courteous/helpful operators
Adaptability Modification can be made for disabilities and special needs

DRIVING AS AN IADL
In OTPF 4…
Planning and moving around in the community using public or private transportation, such as driving,
walking, bicycling, or accessing and riding in buses, taxi cabs, ride shares, or other transportation systems

Requirements of Driving (Client Factors):

- Visual-Perceptual skills (visual acuity, contrast sensitivity)
- Cognitive skills (executive functioning, working memory)
- Motor functions (ROM, muscle strength, coordination)
- Sensory functions (stereognosis, proprioception)

Driving is:
- Considered a privilege, not a right
- Executed in a coordinated manner within an environment that is:
oComplex
oDynamic
oUnpredictable
- Achievement of control over the vehicle and steer cautiously and safely in the flow of traffic
- Observing rules of the road and traffic regulations

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DRIVER REHABILITATION

SCREENING
Self- Refer to Drivers 65 Plus
Screening A 15-question self-rating driving assessment exercise designed to help examine
driving performance. The driving assessment will list strengths and weaknesses,
along with suggestions for how to improve driving.
Proxy Refer to Fitness-to-Drive Screening Measure
Screening A free web-based screening tool that identifies at-risk older drivers using a proxy
rater (family members, caregivers, friends) who have been passengers for the last
3 months and are able to rate the client. These are rated with critical safety
concerns, some safety concerns, and no safety concerns.
Link: https://ftds.phhp.ufl.edu/us/index.php
Evaluator - Explore how impairments impact driving and should set goals related to their
Screening clients’ driving and community mobility needs.
- OT Generalist: sufficiently understand the skills needed to play a role in initial
decisions about driving
- OT Driving Specialist (DRS): plans, develops, coordinates, and implements driver
rehabilitation services for individuals with disabilities.
- May conduct a Mini-Mental State Examination for general cognitive functioning
o Scoring lower than 24 on MMSE should not be considered for an on-road
assessment
o Clients with visual fields or contrast impairment shall be referred to an
ophthalmologist prior to conducting comprehensive driving evaluation

ASSESSMENTS
Clinical OT Generalists or DRS Assesses the following:
Assessment - Visual-Perceptual skills (visual acuity, contrast sensitivity)
- Cognitive skills (executive functioning, working memory)
- Motor functions (ROM, muscle strength, coordination)
- Sensory functions (stereognosis, proprioception)
Driving Use of a computer-controlled environment that presents selected aspects of
Simulator the driving experience considered representational of real-word driving.
Assessment
May be given for individuals what want to return to driving, but still pose
considerable risk on the road, and not ready for on-road assessments.
On-Road “Behind the Wheel” Assessment, conducted in real-word circumstances.
Assessment Can be conducted in:
- Closed-road or open-road conditions
- Setting and traffic density
- Maneuvers
- Environmental conditions

Conducted by a certified DRS

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Comprehensive Thorough assessment of an individual’s personal, medical, and driving history,
Driving driving knowledge, driving skills and abilities.
Assessment Includes:
- Clinical Assessments (sensory/perceptual, cognitive, psychomotor
functional abilities)
- On-Road assessment
- Outcome summary
- Recommendations for an inclusive community mobility plan

Conducted by a certified DRS

ADDITIONAL READINGS and VIDEOS:

A. VIDEO
1. Instrumented Gait Analysis: https://www.physio-pedia.com/Instrumented_Gait_Analysis
2. Ten-meter Walk Test: https://www.physio-pedia.com/10_Metre_Walk_Test
3. Dynamic Gait Index: https://www.physio-pedia.com/Dynamic_Gait_Index
B. READINGS
1. Functional Gait Analysis: https://geriatrictoolkit.missouri.edu/FGA/Wrisley-2007-FGA_PTJ_84-10-
Appendix.pdf
2. The UK FIM + FAM: https://www.kcl.ac.uk/cicelysaunders/resources/fimfam-manual-v2.2-sept-2012-
print-double-sided.pdf

REFERENCE

• Faota, P. H. P. O. M., & Faota, S. W. P. O. B. S. (2012). Pedretti’s Occupational Therapy: Practice Skills for
Physical Dysfunction (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (7th ed.). Mosby.
• Radomski, Mary Vining’s Occupational Therapy for Physical Dysfunction 6th (sixth) edition by Radomski,
Mary Vining published by Lippincott Williams & Wilkins [Hardcover] (2007) (Sixth ed.). (2007). Lippincott
Williams & Wilkins.
• Randomski, M., & Latham, C.T. (2014). Occupational therapy for physical dysfunction. Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins, [2014].
• Crepeau, Elizabeth Blesedell (2008). Willard and Spackmans Occupational Therapy, 11th Edition
• ONLINE LIN

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