Functional Evaluation
The pediatric rehabilitation examination is meaningless if the physiatrist does not construct from it a coherent picture of the child's functional achievements. This evaluation both complements and integrates the variety of information derived from all phases of the examination.
The developmental diagnostic evaluation is a convenient, functionally oriented assessment tool for infants and preschool children (19,52). Language, fine motor and adaptive skills, gross motor abilities, and personal-social behavior are the four major areas of function in the organizational framework of developmental testing. The same functional domains are considered in the evaluation of older children and adolescents. However, in these age groups, the examination includes a wider range of developmental expectations and abilities to function in school and society. ADLs and gross mobility skills need to be assessed in this context. In addition to speech, testing of language function includes other modes of communication: reading, writing, spelling, and, if indicated, augmentative communication. Drawing, design construction, arithmetic problems, and questions about handling hypothetical situations in daily life offer a brief, preliminary insight into cognitive and learning abilities. A number of specific assessment instruments were designed for various childhood disabilities (53-56). These instruments are useful functional assessment tools for their designated conditions and appropriately complement the customary developmental evaluation.