Eliciting a functional history

Function is complicated. If you made a specific list of all the things that you have done, from the moment you woke up until now, you’d find that it encompasses many domains of function. You probably rolled over in bed, got up, walked from the bed to the bathroom or into the kitchen. You got yourself dressed, brushed your teeth, combed your hair.  You take those for granted, but for people who have impairments, the way to accomplish these tasks may not be as self-evident as it is for you.

Because function is complicated, it’s divided into smaller domains: mobility, activities of daily living (ADLs), cognition, communication, vocation (education or employment) and avocation (fun). All of these point towards function, activity, and participation, which is the goal.

In the clinic setting, an initial questionnaire about function may be completed before the visit.  Two tools that are commonly used to assess the ability to perform ADLs the the Katz Index of Independence in ADLs and the Lawton iADL Scale.

When eliciting a functional history, you could start with your patient’s goals – what are they hoping to be able to do? With these goals in mind, you can explore the relevant functional domains in more detail.  You can also start by asking open ended questions about a typical day at home and routine activities.  You could follow up with more specific questions targeting major functions.

If you identify a gap between current and desired function or a significant challenge, you could refer your patient to the appropriate therapist.  Physical therapists specialize in ambulation and mobility (including assistive devices and wheelchairs). Occupational therapists can optimize the ability to perform ADLS and participate in employment and hobbies, and speech and language pathologists specialize in communication and cognition.