the disablement process clinical reasoning what is physical therapy disablement process nagi model...

The DisablementThe DisablementProcessProcess

ClinicalReasoning

What is Physical TherapyDisablement

Process

Nagi Model

ClinicalApplication

Map of Map of Essential ConceptsEssential Concepts

What do Physical Therapists doWhat do Physical Therapists do

ICF Model

Patient Cases

Healthcare Professionals

Who Model

Model Comparison

Intervention Strategies

Healthcare Domain

Disablement processWhat is Physical TherapyWhat do Physical Therapists doNagi model of disablementWHO model of disablementICF model of disablementComparison of modelsPatient casesIntervention strategies Healthcare domainHealthcare professionalsClinical applicationClinical reasoning

Last ViewedLast Viewed DisablementDisablement ExitExitConcept MapConcept Map

Disablement ProcessDisablement Process

Disablement ModelDisablement Model A conceptual explanation of the A conceptual explanation of the processprocess and and

underlying underlying mechanismsmechanisms by which disease, by which disease, injury or birth defect impacts a person’s ability injury or birth defect impacts a person’s ability to function (perform their expected role in to function (perform their expected role in society).society).


What is Physical Therapy?What is Physical Therapy? Physical Therapy is a group of health care Physical Therapy is a group of health care

professionals dedicated to:professionals dedicated to: Alleviating painAlleviating pain Preventing the onset and progression of Preventing the onset and progression of

impairment, functional limitation, disability, or impairment, functional limitation, disability, or changes in physical function and health status changes in physical function and health status resulting from injury, disease, of other causesresulting from injury, disease, of other causes

Restoring, maintaining, and promoting overall Restoring, maintaining, and promoting overall fitness, health, and optimal quality of lifefitness, health, and optimal quality of life

(Guide to Physical Therapists Practice)(Guide to Physical Therapists Practice)


What do Physical Therapists What do Physical Therapists Do?Do?

Relieve / resolve disability or functional Relieve / resolve disability or functional limitation bylimitation by

Changing the underlying impairmentsChanging the underlying impairments(Guide to Physical Therapists (Guide to Physical Therapists

Practice) Practice)

The Goal of Therapeutic InterventionThe Goal of Therapeutic Intervention Maximize function and thereby minimize Maximize function and thereby minimize

disability.disability.


Nagi Model 1/8Nagi Model 1/8 A conceptual explanation of the A conceptual explanation of the processprocess and and

underlying underlying mechanismsmechanisms by which disease, by which disease, injury or birth defect impacts a person’s ability injury or birth defect impacts a person’s ability to function (perform their expected role in to function (perform their expected role in society).society).

Nagi experimental hypothesisNagi experimental hypothesis DiseaseDisease Causes Causes Impairment Impairment

ImpairmentImpairment Causes Causes Functional Functional limitationlimitation

Functional limitationFunctional limitation Causes Causes Disability Disability


Nagi Model 2/8Nagi Model 2/8

Functional Limitations

Disability

Primary Impairment

Primary Pathology


Primary Pathology 3/8Primary Pathology 3/8

Pathophysiology due toPathophysiology due toDisease, Injury, or Congenital AbnormalityDisease, Injury, or Congenital Abnormality


Primary ImpairmentPrimary Impairment(Signs & Symptoms ) (Signs & Symptoms )

4/84/8 Result of primary pathology - physiological Result of primary pathology - physiological

or psychological consequences (e.g. in or psychological consequences (e.g. in stroke: hemiplegia, loss of selective stroke: hemiplegia, loss of selective movement control, sensory loss, movement control, sensory loss, perceptual problems, aphasia)perceptual problems, aphasia)

NotNot usually amenable to intervention by PT usually amenable to intervention by PT


Secondary Impairments 5/8Secondary Impairments 5/8

Due to lack of treatment of primary Due to lack of treatment of primary impairments (e.g. dicubiti, contractures, impairments (e.g. dicubiti, contractures, disuse atrophy)disuse atrophy)

Usually what PTs treatUsually what PTs treat


Functional LimitationsFunctional Limitations(Abilities Lost) 6/8 (Abilities Lost) 6/8

Due to impairments (inability to perform ADLs)Due to impairments (inability to perform ADLs) Basic ADLs (BADLs): self care: dressing, Basic ADLs (BADLs): self care: dressing,

grooming, hygiene, toileting, grooming, hygiene, toileting, bed mobility, bed mobility, transfers, locomotion, transfers, locomotion, speech, reading, writingspeech, reading, writing

Instrumental ADLs (IADLS): higher order skills Instrumental ADLs (IADLS): higher order skills requiring more psychological processing in requiring more psychological processing in addition to motoric functioning (e.g. shopping, addition to motoric functioning (e.g. shopping, paying bills, meal preparation, going to the paying bills, meal preparation, going to the movies)movies)


Disability (Handicap) 7/8 Disability (Handicap) 7/8

Social and psychological consequences Social and psychological consequences of functional limitations (inability to of functional limitations (inability to fulfill expected social roles, e.g. hold a fulfill expected social roles, e.g. hold a job) - may be heavily influenced by job) - may be heavily influenced by external factors like: support system or external factors like: support system or funding funding


Limitations of Nagi Model 8/8Limitations of Nagi Model 8/8

Nagi is a unidimensional (pathology-Nagi is a unidimensional (pathology-based) and unidirectional model of based) and unidirectional model of disability onlydisability only

Does not account for impairments and Does not account for impairments and functional limitations functional limitations notnot due to pathology due to pathology Functional limitations due to obesity or due to Functional limitations due to obesity or due to

sedentary lifestylesedentary lifestyle Dose not consider societal barriers: Dose not consider societal barriers:

architectural, attitudinalarchitectural, attitudinal


World Health Organization World Health Organization Model (WHO) 1/3Model (WHO) 1/3

Primary Impairment

Disability

Disease

Handicap


WHOWHO

Primary Impairment

Handicap

Disability

DiseasePrimary Pathology

Primary Impairment

Functional Limitations

Disability

NagiNagiLevel of Analysis

Cell / Organ

System

Personal

Society

2/32/3


ACTIVEACTIVEPATHOLOGY PATHOLOGY IMPAIRMENT IMPAIRMENT

FUNCTIONALFUNCTIONALLIMITATION LIMITATION

DISABILITYDISABILITY

Interruption or Interruption or interference with interference with normal processes, normal processes, and efforts of the and efforts of the organism to regain organism to regain normal statenormal state

Anatomical, Anatomical, physiological, physiological, mental, mental, or emotional or emotional abnormalities or abnormalities or lossloss

Limitations in Limitations in performance performance at the level of at the level of the whole the whole organism or organism or personperson

Limitations in Limitations in performance of performance of socially defined roles and socially defined roles and tasks within a tasks within a sociocultural and physical sociocultural and physical environmentenvironment

DISEASE DISEASE IMPAIRMENT IMPAIRMENT DISABILITY DISABILITY HANDICAPHANDICAP

The intrinsic The intrinsic pathologypathologyor disorderor disorder

Loss or Loss or abnormality of abnormality of psychological, psychological, physiological, or physiological, or anatomical anatomical structure or structure or function at organ function at organ levellevel

Restriction or Restriction or lack of ability lack of ability to perform an to perform an activity in activity in normal normal mannermanner

Disadvantage due to Disadvantage due to impairment or impairment or disability that limits or disability that limits or prevents fulfillment of prevents fulfillment of a normal role [depends a normal role [depends on age, sex, sociocultural on age, sex, sociocultural factors] for the personfactors] for the person

Nagi Model

WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)

3/33/3


Patient CasesPatient Cases

Inversion ankle sprain Myelomeningocele


An example of using the model to An example of using the model to determine the level of determine the level of disability/handicapdisability/handicap 1/6 1/6

Following a severe inversion ankle sprain, this 35 year Following a severe inversion ankle sprain, this 35 year old, male, Fed Ex driver is unable to walk or work.old, male, Fed Ex driver is unable to walk or work.


PathologyPathology

ImpairmentImpairment

Functional Functional limitationlimitation

DisabilityDisability


An example of using the model to An example of using the model to determine the level of determine the level of disability/handicap 2/6disability/handicap 2/6


PathologyPathology Grade II, inversion sprain of the Grade II, inversion sprain of the ankleankle Partial rupture of the anterior Partial rupture of the anterior

talofibular and calcanofibular talofibular and calcanofibular ligamentsligaments









ImpairmentImpairment Impaired AROMImpaired AROMImpaired strengthImpaired strengthPainPain










Non-weight bearingNon-weight bearingAmbulates with crutchesAmbulates with crutches









Non-weight bearingNon-weight bearingAmbulates with crutchesAmbulates with crutches

DisabilityDisability Unable to workUnable to work





A 40 year old woman born with spinal bifida, transports A 40 year old woman born with spinal bifida, transports via a wheel chair, practicing lawyer, married with two via a wheel chair, practicing lawyer, married with two children.children.



A 40 year old woman born with spinal bifida, ambulates A 40 year old woman born with spinal bifida, ambulates via a wheel chair, practicing lawyer, married with two via a wheel chair, practicing lawyer, married with two children.children.PathologyPathology Failure of neural tube to closure Failure of neural tube to closure

(meningomyelocele) with (meningomyelocele) with resultant spinal cord transection resultant spinal cord transection (L4-5)(L4-5)





An example of using the model to An example of using the model to determine the level of determine the level of disability/handicapdisability/handicap 3/6 3/6 A 40 year old woman born with spinal bifida, ambulates A 40 year old woman born with spinal bifida, ambulates via a wheel chair, practicing lawyer, married with two via a wheel chair, practicing lawyer, married with two children.children.

PathologyPathology Failure of neural tube to closure Failure of neural tube to closure (meningomyelocele) with (meningomyelocele) with resultant spinal cord transection resultant spinal cord transection (L4-5)(L4-5)

ImpairmentImpairment Bilateral lower extremity Bilateral lower extremity paralysis (paraplegia) paralysis (paraplegia) IncontinenceIncontinence


DisabilityDisabilityLast ViewedLast Viewed DisablementDisablement ExitExitConcept MapConcept Map

An example of using the model to An example of using the model to determine the level of determine the level of disability/handicapdisability/handicap 5/6 5/6 A 40 year old woman born with spinal bifida, ambulates A 40 year old woman born with spinal bifida, ambulates via a wheel chair, practicing lawyer, married with two via a wheel chair, practicing lawyer, married with two children.children.

PathologyPathology Failure of neural tube to closure Failure of neural tube to closure (meningomyelocele) with (meningomyelocele) with resultant spinal cord transection resultant spinal cord transection (L4-5)(L4-5)

ImpairmentImpairment Bilateral lower extremity Bilateral lower extremity paralysis (paraplegia) paralysis (paraplegia) IncontinenceIncontinence


NonambulatoryNonambulatoryIndependent in w/c for transportIndependent in w/c for transport

DisabilityDisabilityLast ViewedLast Viewed DisablementDisablement ExitExitConcept MapConcept Map

An example of using the model to An example of using the model to determine the level of determine the level of disability/handicap disability/handicap 6/66/6 A 40 year old woman born with spinal bifida, ambulates A 40 year old woman born with spinal bifida, ambulates via a wheel chair, practicing lawyer, married with two via a wheel chair, practicing lawyer, married with two children.children.

Primary Primary pathologypathology

Failure of neural tube to closure Failure of neural tube to closure (meningomyelocele) with (meningomyelocele) with resultant spinal cord transection resultant spinal cord transection (L4-5)(L4-5)

Primary Primary impairmentimpairment

Bilateral lower extremity Bilateral lower extremity paralysis (paraplegia) paralysis (paraplegia) IncontinenceIncontinence


NonambulatoryNonambulatoryIndependent in w/c for transportIndependent in w/c for transport

DisabilityDisability NoneNoneLast ViewedLast Viewed DisablementDisablement ExitExitConcept MapConcept Map

Medical Aspects Social Aspects

Domain of Physical Therapists Practice

CardiopulmonaryIntegumentaryMusculoskeletalNeuromuscular

PhysicalPsychologicalSocial

DisabilityFunctionalLimitation

ImpairmentPathologyPathophysiology

Health Care

Healthcare DomainHealthcare Domain


Levels at Which Health Levels at Which Health Professionals Function 1/2Professionals Function 1/2

Pathology

Impairment

Functional Limitation

Disability

Physician

Physical Therapist

Occupational Therapist


Activity Emphasis of Activity Emphasis of Health Professionals Health Professionals 2/22/2 Functional

ActivityHealth

Professional

Mobility

Transfers

Positioning

Toileting and Hygiene

Dressing

Feeding

Communication

PhysicalTherapist

OccupationalTherapist

SpeechTherapist


Clinical Application 1/2Clinical Application 1/2

What is the patient’s functional limitation?What is the patient’s functional limitation? How do you know?How do you know?

Patient told you during historyPatient told you during history Performance on normalized functional assessment, Performance on normalized functional assessment,

reliable test was > reliable test was > ± ± 2 SD from mean2 SD from mean

What is causing the functional limitation? What is causing the functional limitation? (What are the impairments?)(What are the impairments?) How do you know?How do you know?

Performance on valid and reliable impairment testPerformance on valid and reliable impairment test


Clinical Application 2/2Clinical Application 2/2

What practice pattern(s) is most What practice pattern(s) is most appropriate?appropriate? What is you prognosis?What is you prognosis?

How are you treating the impairments?How are you treating the impairments?

How are you documenting progress: How are you documenting progress: (Outcome measures)(Outcome measures) ImpairmentsImpairments Functional limitationsFunctional limitations DisabilityDisability


Intervention Strategies 1/2Intervention Strategies 1/2

Requires understanding of the Requires understanding of the underlying process.underlying process.

Efforts to prevent or modify disability can Efforts to prevent or modify disability can be aimed at:be aimed at: Preventing/ modifying diseasePreventing/ modifying disease Preventing/ modifying impairmentsPreventing/ modifying impairments Preventing/ modifying functional limitationsPreventing/ modifying functional limitations Preventing/ modifying disabilityPreventing/ modifying disability


Intervention Strategies 2/2 Intervention Strategies 2/2 Impairment interventionsImpairment interventions: medical : medical

interventions to deal with the impairment, and interventions to deal with the impairment, and preventive interventions to avoid activity limitation preventive interventions to avoid activity limitation

Activity limitation interventionsActivity limitation interventions: rehabilitative : rehabilitative interventions and provision of assistive devices interventions and provision of assistive devices and personal assistance to mitigate the activity and personal assistance to mitigate the activity limitation, and preventive interventions to avoid limitation, and preventive interventions to avoid participation restrictionsparticipation restrictions

Participation restriction interventionsParticipation restriction interventions: public : public education, equalization of opportunities, social education, equalization of opportunities, social reform and legislation, architectural “universal reform and legislation, architectural “universal design” applications and other ways of design” applications and other ways of accommodating activity limitations in major life accommodating activity limitations in major life areasareas


Model ComparisonModel Comparison

AnalysiAnalysis Levels Level NAGINAGI WHO WHO ICFICF

CellCell PathologyPathology DiseaseDisease Health Health ConditionCondition

System System (Body)(Body)

ImpairmentImpairment ImpairmentImpairment Body Body structure & structure & functionfunction

PersonPerson Functional Functional LimitationLimitation

DisabilityDisability Activity Activity (Limitation)(Limitation)

SocialSocial DisabilityDisability HandicapHandicap Participation Participation (Restriction)(Restriction)


Clinical ReasoningClinical Reasoning

Use of the Nagi Model Use of the Nagi Model

In Clinical Decision MakingIn Clinical Decision Making

1/11


How do you decide what to treat? How do you decide what to treat? 2/112/11

What is the functional limitation?What is the functional limitation? How do you know?How do you know?

What is causing the functional limitation? What is causing the functional limitation? (What are the impairments?)(What are the impairments?) How do you know?How do you know?

How should I treat the impairments?How should I treat the impairments? How should I set S/LTGs?How should I set S/LTGs? How should I documenting progress?How should I documenting progress?



What is the functional limitation?What is the functional limitation? How do you know?How do you know? Subjective CC from the evaluation.Subjective CC from the evaluation. Performance ofPerformance of ≤ 2SD below the mean on ≤ 2SD below the mean on valid valid

& reliable functional & reliable functional test.test.



What is causing the functional limitation? What is causing the functional limitation? (What are the impairments?)(What are the impairments?) How do you know?How do you know? Given the subjective history (and your Given the subjective history (and your

knowledge of anatomy and physiology), you knowledge of anatomy and physiology), you hypothesizehypothesize what impairments, in this case, what impairments, in this case, might be causing the functional limitation.might be causing the functional limitation.

Test your hypothesis: performance of Test your hypothesis: performance of ≤ 2SD ≤ 2SD below the mean on below the mean on valid & reliable impairment valid & reliable impairment test.test.



How should I treat the impairments?How should I treat the impairments? Evidence based practice (EBP)Evidence based practice (EBP)

How should I documenting progress?How should I documenting progress? By showing progress on function / impairment By showing progress on function / impairment

measures greater than expected by chance.measures greater than expected by chance. ≥ ≥ 2 SD in the standard error of the measure (SEM). 2 SD in the standard error of the measure (SEM). 2 SD in a population equals the 95% confidence level.2 SD in a population equals the 95% confidence level.


How to select and measure a LTG How to select and measure a LTG 6/116/11

Use the patient’s LTG (Listen to the pt Use the patient’s LTG (Listen to the pt during Hx)during Hx)

LTGs are set at the disability or functional LTGs are set at the disability or functional levellevel

Disability data is collected at the “quality Disability data is collected at the “quality of life” level (SF 36)of life” level (SF 36)

Functional limitations are Functional limitations are objectivelyobjectively determined by performance of determined by performance of ≤≤ 2 SD 2 SD belowbelow the mean on a the mean on a valid, reliable, valid, reliable, normalized normalized functional testfunctional test


How to select and measure a LTG How to select and measure a LTG

7/117/11 ObjectiveObjective goal assessment is set at of ≥ 2 goal assessment is set at of ≥ 2

SD in the standard error of the measure SD in the standard error of the measure (SEM). (SEM).

2 SD in a population equals the 95% 2 SD in a population equals the 95% confidence level.confidence level.

In reality, we guess at a realistic In reality, we guess at a realistic estimation of an expected % improvement estimation of an expected % improvement (usually 10-20%) based on experience (usually 10-20%) based on experience (previous performance of pts with similar (previous performance of pts with similar S&S).S&S).


How to select and measure a STG How to select and measure a STG 8/118/11

After the LTG has been identified, hypothesize After the LTG has been identified, hypothesize what impairments are causing the functional what impairments are causing the functional limitation.limitation.

Test your hypothesis by performing a valid, Test your hypothesis by performing a valid, reliable, normalized impairment test.reliable, normalized impairment test.

Performance of Performance of ≤≤ 2 SD 2 SD belowbelow the mean rules in the mean rules in that variable as an impairment.that variable as an impairment.

STG are STG are objectivelyobjectively assessed by improvement of assessed by improvement of ≥ 2 SD (change > chance – ≥ 2 SD (change > chance – “clinically meaningful”“clinically meaningful”).).


Clinical Example 9/11Clinical Example 9/11

For the UPS driver:For the UPS driver: LTG: return to work following 1 week (Disability LTG: return to work following 1 week (Disability

level)level) The objective measure of goal accomplishment is The objective measure of goal accomplishment is

YesYes or or NoNo on returning to work in one week. on returning to work in one week. One week duration was selected on the basis One week duration was selected on the basis

of known tissue repair ratesof known tissue repair rates PT interventions (cryotherapy and ROM PT interventions (cryotherapy and ROM

exercises) may be able to change the natural exercises) may be able to change the natural rate of tissue recovery (evidence remains rate of tissue recovery (evidence remains unknown)unknown)

Orthosis (Air splint) will help support the ankle Orthosis (Air splint) will help support the ankle in a shoe and assist return to workin a shoe and assist return to workLast ViewedLast Viewed DisablementDisablement ExitExitConcept MapConcept Map


For the UPS driver:For the UPS driver: One functional limitation is the inability to walk, One functional limitation is the inability to walk,

effectivelyeffectively, on the injured ankle., on the injured ankle. A valid and reliable measure of A valid and reliable measure of effectiveeffective

ambulation is the 10 meter walk test.ambulation is the 10 meter walk test. Gait velocity of 1-1.8 mph, 236 feet/min is Gait velocity of 1-1.8 mph, 236 feet/min is

required to cross a street during a red light required to cross a street during a red light (Podsiodlo ’91)(Podsiodlo ’91)

STG: On a 10 meter walk test, walk faster than STG: On a 10 meter walk test, walk faster than 236 feet/min carrying a 5 pound box, without an 236 feet/min carrying a 5 pound box, without an assistive device.assistive device.



For the UPS driver:For the UPS driver: Impairments causing his functional limitationImpairments causing his functional limitation

Pain: 8/10Pain: 8/10 Impaired strength: DF/EV 3-/5 2Impaired strength: DF/EV 3-/5 200 pain pain Impaired ROM: EV 0Impaired ROM: EV 000-15-1500 (0 (000-35-3500))

STG: EV AROM STG: EV AROM ≥ ≥ 0000-20-2000

SEM for goniometry is SEM for goniometry is ± 2.5± 2.500

2 SD 2 SD ±± 5500


International Classification of International Classification of Functioning, Disability and Health Functioning, Disability and Health

1/91/9 The World Health Organization (WHO) authorized The World Health Organization (WHO) authorized

the International Classification of Functioning, the International Classification of Functioning, Disability and Health (ICF) in 2001. Disability and Health (ICF) in 2001.

It is accepted by 191 countries as the It is accepted by 191 countries as the international standard to describe and measure international standard to describe and measure health and disability. The ICF classifies the health health and disability. The ICF classifies the health and disability using approximately 1500 items of and disability using approximately 1500 items of "body function", "body structure", "activity and "body function", "body structure", "activity and participation "and "environmental factors".participation "and "environmental factors".


International Classification of International Classification of Functioning, Disability and Health Functioning, Disability and Health (ICF) 2/9(ICF) 2/9


Functioning and disability ("Body Functions and Structures," Functioning and disability ("Body Functions and Structures," "Activities," and "Participation") are seen as an interaction "Activities," and "Participation") are seen as an interaction between the "Health Condition" ("disorder/disease") and the between the "Health Condition" ("disorder/disease") and the contextual factors ("Personal Factors" and "Environmental contextual factors ("Personal Factors" and "Environmental Factors"). Factors").

ICF is multidimensional (bio-psycho-social) and ICF is multidimensional (bio-psycho-social) and multidirectional model of human health.multidirectional model of human health.

ContextualFactors

3/9


Body Functions 4/9Body Functions 4/9

MENTAL FUNCTIONS MENTAL FUNCTIONS SENSORY FUNCTIONS AND PAIN SENSORY FUNCTIONS AND PAIN VOICE AND SPEECH FUNCTIONS VOICE AND SPEECH FUNCTIONS FUNCTIONS OF THE CARDIOVASCULAR, FUNCTIONS OF THE CARDIOVASCULAR,

HAEMATOLOGICAL, IMMUNOLOGICAL AND RESPIRATORY HAEMATOLOGICAL, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS SYSTEMS

FUNCTIONS OF THE DIGESTIVE, METABOLIC AND FUNCTIONS OF THE DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS ENDOCRINE SYSTEMS

GENITOURINARY AND REPRODUCTIVE FUNCTIONS GENITOURINARY AND REPRODUCTIVE FUNCTIONS NEUROMUSCULO-SKELETAL AND MOVEMENT-RELATED NEUROMUSCULO-SKELETAL AND MOVEMENT-RELATED

FUNCTIONS FUNCTIONS FUNCTIONS OF THE SKIN AND RELATED STRUCTURESFUNCTIONS OF THE SKIN AND RELATED STRUCTURES


Body Structures 5/9Body Structures 5/9 STRUCTURES OF THE NERVOUS SYSTEM STRUCTURES OF THE NERVOUS SYSTEM THE EYE, EAR AND RELATED STRUCTURES THE EYE, EAR AND RELATED STRUCTURES STRUCTURES INVOLVED IN VOICE AND SPEECH STRUCTURES INVOLVED IN VOICE AND SPEECH STRUCTURES OF THE CARDIOVASCULAR, IMMUNOLOGICAL STRUCTURES OF THE CARDIOVASCULAR, IMMUNOLOGICAL

AND RESPIRATORY SYSTEMS AND RESPIRATORY SYSTEMS STRUCTURES RELATED TO THE DIGESTIVE, METABOLIC AND STRUCTURES RELATED TO THE DIGESTIVE, METABOLIC AND

ENDOCRINE SYSTEMS ENDOCRINE SYSTEMS STRUCTURES RELATED TO THE GENITOURINARY AND STRUCTURES RELATED TO THE GENITOURINARY AND

REPRODUCTIVE SYSTEMS REPRODUCTIVE SYSTEMS STRUCTURES RELATED TO MOVEMENT STRUCTURES RELATED TO MOVEMENT SKIN AND RELATED STRUCTURES SKIN AND RELATED STRUCTURES


Activities and Participation 6/9Activities and Participation 6/9 LEARNING AND APPLYING KNOWLEDG LEARNING AND APPLYING KNOWLEDG GENERAL TASKS AND DEMANDS GENERAL TASKS AND DEMANDS COMMUNICATION COMMUNICATION MOBILITYMOBILITY SELF-CARESELF-CARE DOMESTIC LIFEDOMESTIC LIFE INTERPERSONAL INTERACTIONS AND INTERPERSONAL INTERACTIONS AND

RELATIONSHIPSRELATIONSHIPS MAJOR LIFE AREASMAJOR LIFE AREAS COMMUNITY, SOCIAL AND CIVIC LIFECOMMUNITY, SOCIAL AND CIVIC LIFE


Environmental Factors 7/9Environmental Factors 7/9

PRODUCTS AND TECHNOLOGYPRODUCTS AND TECHNOLOGY NATURAL ENVIRONMENT AND HUMAN-MADE NATURAL ENVIRONMENT AND HUMAN-MADE

CHANGES TO ENVIRONMENTCHANGES TO ENVIRONMENT SUPPORT AND RELATIONSHIPSSUPPORT AND RELATIONSHIPS ATTITUDESATTITUDES SERVICES, SYSTEMS AND POLICIESSERVICES, SYSTEMS AND POLICIES


ICF Model 8/9ICF Model 8/9

Multidimensional, bi-directional model (Bio-Multidimensional, bi-directional model (Bio-Psycho-Social) of human healthPsycho-Social) of human health

Positive terminologyPositive terminology Includes non-pathological causes of Includes non-pathological causes of

impairments and functional limitationsimpairments and functional limitations Context: potentially has an effect on all Context: potentially has an effect on all

levels of modellevels of model External environmental factorsExternal environmental factors Personal characteristicsPersonal characteristics

Participation goes beyond performance of Participation goes beyond performance of roles and deals with barriers and facilitators roles and deals with barriers and facilitators to participation in societyto participation in society


Overview of Dimensions of ICF Overview of Dimensions of ICF 9/9 9/9

ImpairmentsImpairments ActivitiesActivities ParticipationParticipation Contextual Contextual FactorsFactors

FunctioningFunctioning At body level At body level At person At person level level

At social level At social level Interaction Interaction with with environmental environmental factors and factors and personal personal factors factors

CharacteristiCharacteristicscs

Body function Body function Body Body structure structure

Person's daily Person's daily activities activities

Involvement in Involvement in the situation the situation

Features of Features of the physical, the physical, social social attitudinal attitudinal world world

Positive Positive AspectAspect

Functional Functional and structural and structural integrity integrity

Activity Activity Participation Participation Facilitators Facilitators

Negative Negative AspectAspect

Impairment Impairment Activity Activity limitation limitation

Participation Participation restriction restriction

Barriers Barriers


the disablement process clinical reasoning what is physical therapy disablement process nagi model...

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