Functional Limitations Checklist PDF
Functional Limitations Checklist PDF
Functional Limitations Checklist PDF
Adapted from the Disability Handbook, Department of Rehabilitation Education & Research
University of Arkansas
The vast majority of this work has been adapted from the Disability Handbook, Two
Thousand Twelve Edition (2012) by Jason D. Andrew and M. Jean Andrew. This edition did not
include a robust definition of functional limitations for Autism, so this author referred to the
Center for Disease Control (CDC) to create the Common Functional Limitations Checklist for this
disability.
Sleep Disorders were not given specific functional limitations in the Handbook, resulting
in adaptations from the Job Accommodation Network (JAN) for this disability. Likewise,
Deafness was combined with Hard of Hearing in the Handbook so information for this disability
came from JAN.
References Include:
Accommodation and compliance series: Employees with sleep disorders. (2013, March 26).
Retrieved from http://askjan.org/media/Sleep.html
Accommodation and compliance series: Employees with hearing loss. (2013, March 7).
Retrieved from http://askjan.org/media/hearing.html
Autism Spectrum Disorders: Signs and symptoms. (2013, May 13). Retrieved from
http://www.cdc.gov/ncbddd/autism/signs.html
Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: Important considerations for public health.
American Journal of Public Health, 100(6), 1019-1028. doi:10.2105/AJPH.2009.159491
Table of Contents
Affective Disorders: Bipolar Disorder .......................................................................................................... 1
Affective Disorders: Depression .................................................................................................................. 2
Affective Disorders: Mania .......................................................................................................................... 3
Albinism ........................................................................................................................................................ 4
Alcohol and Other Drug Abuse Disabilities ................................................................................................. 5
Allergies ........................................................................................................................................................ 6
Amputations ................................................................................................................................................. 7
Arthritis ......................................................................................................................................................... 8
Aspergers Syndrome ................................................................................................................................... 9
Asthma ........................................................................................................................................................ 10
Autism ......................................................................................................................................................... 11
Burns ........................................................................................................................................................... 12
Cancer ......................................................................................................................................................... 13
Cardiovascular Disorders ........................................................................................................................... 14
Carpal Tunnel Syndrome ............................................................................................................................ 15
Cerebral Palsy ............................................................................................................................................. 16
Deafness ..................................................................................................................................................... 18
Delusional (Paranoid) Disorders ................................................................................................................ 19
Diabetes Mellitus ....................................................................................................................................... 20
Eating Disorders ......................................................................................................................................... 21
Chronic Fatigue Syndrome ......................................................................................................................... 22
Fibromyalgia ............................................................................................................................................... 23
Hard of Hearing .......................................................................................................................................... 24
Hemophilia ................................................................................................................................................. 25
H.I.V. (AIDS) ................................................................................................................................................ 26
Intellectual Disabilities ............................................................................................................................... 27
Learning Disorders...................................................................................................................................... 28
Chronic Lower Back Pain ............................................................................................................................ 29
Motor Neuron Diseases ............................................................................................................................. 30
Movement Disorders ................................................................................................................................. 31
Multiple Sclerosis ....................................................................................................................................... 33
Obesity ........................................................................................................................................................ 34
Personality Disorders ................................................................................................................................. 36
Post-Polio Syndrome .................................................................................................................................. 37
Post-Traumatic Stress Disorder ................................................................................................................. 38
Renal-Kidney Disease ................................................................................................................................. 39
Respiratory Disorders................................................................................................................................. 40
Schizophrenic Disorders ............................................................................................................................. 41
Seizure Disorder (Epilepsy) ........................................................................................................................ 42
Sickle Cell Anemia ...................................................................................................................................... 43
Sleep Disorders ........................................................................................................................................... 44
Spina Bifida ................................................................................................................................................. 45
Spinal Cord Injury ....................................................................................................................................... 46
Stroke .......................................................................................................................................................... 47
Traumatic Brain Injury ............................................................................................................................... 48
Visual Impairments .................................................................................................................................... 49
1
Memory problems
his information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
2
Memory problems
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
3
Memory problems
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
4
Bowel conditions
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
5
Spiritual Consequences:
Feelings of hopelessness
Feelings of despair
Feeling directionless
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
6
Limited stamina
Fatigue/weakness
Pain
Sleepiness
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
7
Lower Extremity:
Balancing
Climbing
Walking (even and uneven
surfaces)
Stooping
Pushing
Pulling
Carrying large objects
Intolerant of environmental
conditions (heat, cold, humidity,
dirt) with prosthesis wearers
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
8
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
9
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
1
Please note that the diagnosis of Aspergers Syndrome has been removed from the Diagnostic and Statistical
Manual, Fifth Edition (DSM-V) which will begin widespread use January, 2014. It has grouped with Autism
Spectrum Disorders.
10
Climbing
Lifting
Limited stamina
Sensitivity to cold
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
11
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
2
Autism Spectrum Disorders: Signs and symptoms (2013)
12
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
13
Decreased strength
Lifting ability
Climbing ability
Walking endurance
Intolerance to temperature
changes
Pain
Fatigue
Difficulty breathing
Nausea
Diarrhea or constipation
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
14
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
15
Lifting
Strength
Pain
Grasping
Dexterity
Reaching
Endurance
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
16
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
18
Speech clarity
Difficulty responding to sounds
in the environment
Unable to understand the
meaning of sounds
Problems in conceptualization
Safely operating or working
around vehicles
Tendency to take things in very
concrete ways
Difficulty communicating by
telephone
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
3
Accommodation and compliance series: Employees with hearing loss (2013)
19
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
20
Standing
Walking
Motor coordination
Heavy exertion
Finger dexterity
Handling
Grasping
Manual dexterity
Tolerance to extremes in
temperature
Visual acuity
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
21
Strength
Cold
Decisions/judgment (persons
experiencing bulimia are
frequently associated with
impulsive behavior such as
alcohol/ drug abuse,
stealing/shoplifting, and suicidal
behavior)
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
22
Lifestyle restrictions
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
23
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
24
Intelligibility/context meaning of
sounds
Problems in conceptualization
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
25
Lifting
Strength
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
26
Feeling fearful
Feeling isolated
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
27
Problems communicating
Mobility
Self-care issues
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
28
Conceptualization problems
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29
Bending
Twisting
Lifting
Climbing
Carrying
Limited stamina
Pain
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
30
Common Functional Limitations Yes, No, or Dont How will items marked YES be addressed?
Know in My Case
Upper extremity mobility
Strength
Speech
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
31
Common Functional Limitations Yes, No, or Dont Know How will items marked YES be addressed?
in My Case
Physical limitations:
Shaking (tremors), muscular
control and cramping, poor
coordination, and/or balance
problems
Abnormal eye movements or eye
movements so severe as to
functionally cause blindness
Constipation
Sleep disorders such as insomnia
Language and Communication:
Inability to write legibly
Weakness or inability to control
speech
Tics that can involve the voice or
parts of the body and are seen in
Tourettes syndrome
Psychosocial limitations:
Intellectual deterioration
Personality changes
Confusion
Hallucinations
Memory loss
Fainting
Dementia
Complications:
Permanent physical deformities
Affects the ability to perform
day-to-day activities
Depression
Reactions to certain drugs
Anxiety, stress, and tension
Lack of support systems
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
33
Walking
Climbing
Balancing
Stooping
Kneeling
Crouching
Lifting
Twisting
Reaching
Fingering
Motor coordination
Eye-hand-foot coordination
Limited stamina
Strength
Working in cold conditions
Working in heat conditions
Working in conditions where the
temperature changes frequently
Working in wet, humid
conditions
Vehicle operation
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
34
Balancing
Stooping
Kneeling
Crouching
Lifting
Dressing
Grooming
Limited stamina
Strength
Stigma
Other health concerns (high
blood pressure, diabetes, etc.)
Depression
Low self esteem
Body dissatisfaction
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
4
Puhl & Heuer (2010)
35
Climbing
Standing
Walking
Stooping, bending
Lifting
Sitting
Kneeling
Turning, twisting
Carrying
Crawling
Driving
Irritability
Depression
Personality changes
Dependence on pain medication
Cold, sudden changes in
temperature
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
36
Judgment challenges
Inflexibility to change
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
37
Breathing difficulties
Swallowing problems
Fatigue
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
38
PTSD can be a response to a wide range of traumatic events that may or may not involve
physical injury. Thus it is difficult to generalize about the common functional limitations. The limitations
stemming from PTSD (such as the inability to tolerate certain stimuli) will be connected to the traumatic
event experienced. Because of the broad range of stimuli that trigger the reactive symptoms of PTSD,
there is also a broad range of possible functional limitations due to the PTSD. In addition, the reactive
PTSD symptoms causing these limitations may be entirely distinct from the functional limitations caused
by a traditional disability that is also present (Andrew, 2008, p. 102).
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
39
Concentration
Lifting
Climbing
Heavy exertion
Sleeping difficulties
Alertness
Pushing
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
40
Common Functional Limitations Yes, No, or Dont How will items marked YES be addressed?
Know in My Case
Walking
Climbing
Tolerance to temperature
changes/ extremes
Problems being in
fumes/dust/mold/gasses
Pushing/ pulling
Lifting
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
41
Problems understanding
instructions (particularly if these
involve understanding underlying
principles, reasoning, etc.)
Motor coordination
Eye-hand-foot coordination
Form perception
Spatial perception
Memory
Problem solving
Issues with flexibility and
adapting to change
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
42
Motor coordination
Eye/hand coordination
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
43
Strength
Limited stamina
Difficulty working in cold or heat
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
44
Difficulty maintaining
concentration
Memory deficits
Decreased stamina
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
5
Accommodation and compliance series: Employees with sleep disorders (2013)
45
Wheelchair independence
(transfer, propelling wheelchair)
Writing
Vehicle operation
Motor coordination,
eye/hand/foot coordination
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
46
Susceptibility to infections
Pressure sores
Preoccupation with limitation
(adjustment to disability)
Problems with self-image, self-
confidence
May have a lack of initiative,
inflexibility, irritability
Feelings of isolation,
aggressiveness
Anger, depression, anxiety, low
self-esteem
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
47
Mobility
Attention, concentration,
memory
Decision-making
Motor control
Speed
Behavior
Personality changes
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
48
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.
49
Walking
Driving
Space perception
Form perception
Depth perception
Color discrimination
This information is funded by Rehabilitation Services Administration WI Client Assistance Program grant H16A040054.