Reports of Case Series of Institutionalized Adults with Multiple Disabilities: how to Assess Functionality?

ABSTRACT: The objective of this paper is to propose and apply a form of functional neurological classification, based on positioning and transference in institutionalized adults with severe multiple disabilities. The method used was the cross-sectional, descriptive study in a long-stay institution in Curitiba, state of Paraná, Brazil. Participants were filmed at the Gross Motor Function Measure (GMFM), posture transfer and displacement positions. The score from 1 to 5 points was given from the Aquatic Functional Assessment Scale (AFAS), as an adaptation to the floor. The International Classification of Functionality (ICF) was used as a toll to detail the positions regarding qualifiers of facilitators and restrictors for each participant. Five participants with multiple disabilities were evaluated, aged between 21 and 29 years, with a predominance of females (80%). Only one participant had assisted gait and 3 (60%) had stereotyped hands or upper body. Transfers between positions were not performed independently by any participant. The highest score found by AFAS was 14 points and the worst score was 5 points. The results indicate that the ICF was sensitive to perceive the movements or restrictive positions and facilitators for each of the participants and it may be able to help in choosing the best forms of evaluation.

摘要：本研究旨在针对巴西帕拉那州库里提巴市某长期照护机构内的重度多重残疾机构收容成年人，基于体位与转移模式提出并应用一种功能神经分类方法。本研究采用横断面描述性研究设计，研究地点为巴西帕拉那州库里提巴市的一家长期照护机构。研究人员使用粗大运动功能评定量表（Gross Motor Function Measure, GMFM）对参与者进行评估，并拍摄记录其体位转移与移动体位的相关表现；依据适配地面环境的水上功能评定量表（Aquatic Functional Assessment Scale, AFAS），为每位参与者进行1~5分的评分。本研究以国际功能分类（International Classification of Functionality, ICF）作为工具，详细描述每位参与者体位相关的促进因素与限制因素的限定条件。本研究共纳入5名多重残疾参与者，年龄介于21~29岁，其中女性占比80%；仅1名参与者可实现辅助步行，3名（60%）存在手部或上半身刻板动作；所有参与者均无法独立完成体位转移。AFAS评分结果显示，最高得分为14分，最低得分为5分。研究结果表明，国际功能分类（ICF）可有效识别每位参与者的运动或受限体位及相关促进、限制因素，或可为最优评估方案的选择提供参考依据。