FUNCTIONAL OUTCOMES

Functional outcomes
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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
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Personal hygeine Getting on and off toilet Bathing self Walking on a level surface/propelling wheelchair, 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
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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 wheelchair manually or are transported when traveling for long distances or outdoors on uneven terrain.

Gross motor function classification system
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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 wheelchair. 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 (03) 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
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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 flatearly 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

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

varus,valgus,

Berg Balance Scale
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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
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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
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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
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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.

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