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Dr. Riddle's Measurement and Assessment Class Spring 2009 VCU DPT Class of 2011

Three Main Models of Disablement

Nagi Model, WHO Model (ICF), National Center for Medical Rehabilitation Research

APTA endorses this model of disablement

The WHO's International Classification of Functioning, Disability and Health (ICF)

The Nagi models serves as the basis for...

most other models, including ICF and the Guide for Physical Therapist Practice

in opposition to the MD, who Diagnoses, treats and prevents disease (Pathology), the PT

Diagnoses, Treats and prevents CONSEQUENCES of disease

disease is the same thing as

pathology or condition

The impact of acute and chronic conditions on the functioning of specific body systems , on basic human performance, and on people's functioning in expected roles in society is Verbrugge and Jette's definition of

The disablement process

pathology

interruption of normal cellular processes and the efforts of the affected systems to regain homostasis

impairment

losses or abnormalities in physiologic, psychologic or anatomical structure or function

functional limitation

a restriction in the ability to perform, at the level of the whole person, a physical activity in an efficient, typically expected or competent manner

disability

inability to perform or a limitation in the performance of actions, tasks, activities, usually expected in specific roles that are customary for the individual or expected for a person's status or role in a specific sociocultural context and physical environment

4 parts of the Nagi Model

pathology, impairment, functional limitations, disability

4 parts of the ICF disablement process

Health Condition, Impairment, Activity limitation, Participation restriction

Health Condition, in short, according to the ICF

is the medical diagnosis

___ is more informative than knowing the Health Condition to a PT

The impairment

Examples of impairment include

Reduced PROM/AROM, reduced muscle force, pain, swelling, anatomically short lower limb, excessive anterior glide of gh jt

Impairment means deviation from..

generally accepted population standards and can be temporary or permanent

Activity limitation is (according to V+Jette)

limitation in performing fundamental physical and mental actions typically used in daily life by one's age/gender group

ANother way of phrasing activity limitation

whole body action limitations

Activity limitations include those that would affect

altered gait, sleep, climbing stairs, watching TV... SIMPLE THINGS

Altered ability to sit, stand, or push is an example of a(n)

Activity limitation

Participation restriction is defined as a problem...

an individual may experience in involvement in life situations

A Participation restriction is ___ in comparison to an activity limitation

More complex, i.e. ability to exercise/drive to the grocery store

Basic ADLs fall under...

Activity limitation

Instrumented ADLs fall under this category

Participation restrictions

Altered ability to prepare meals is an example of...

A Participation restriction

Active pathology results in ____

impairment

Not all impairments originate in

Pathology

Limits in social or occupational activities

are Participation Restrictions

in the ICF all arrows

go in both directions

Consider ___ and ___ when understanding why person is disabled

- impairments and activity limitations AND person's social circumstances

Considering disability, reflect on these three things

- person's reaction, - others' perception/sick role expectations, Environment characteristics

The disablement process is not

linear

Most important to considering disability level is...

risk factors that can affect the presence and severity of impairment, functional limitation and disability

Muscle paralysis is an example of a(n)...

impairment

decreased spinal motion is an example of...

an impairment

being unable to reach without pain is an example of

Activity limitation

increased anterior glide (with pain, decreased motion) of GH joint is example of

impairment

Loss of job due to diagnosis?

Participation restriction

unable to stand for prolonged periods of time is example of:

participation restriction

unable to run without pain is example of

activity limit

PT's least common domain in which to intervene:

Participation restriction

MDs most commonly intervene in this domain

health condition

we spend most of the time in examination assessing relevant ____

impairments

Treatment of impairments may not:

carry over to improvements in functional limitations and disabilities

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