Process and models of disablement

FOR PHYSICAL THERAPY STUDENTS

1. PROCESS AND MODELS OF DISABLEMENT Dr. QURATULAIN MUGHAL DPT (2019) ISRA UNIVERSITY Dr. QURATULAIN MUGHAL 1

2. CONTENTS Disablement Definition The Disablement Process Models Of Disablement Comparison Of Terminology Of Three Disablement Models Use Of Disablement Models And Classifications In Physical Therapy Impact Of Therapeutic Exercise On The Disablement Process Common Physical Impairments Managed With Therapeutic Exercise Common Functional Limitations Related To Physical Tasks General Categories Of Activities Relevant To Disability Disablement Risk Factors Dr. QURATULAIN MUGHAL 2

3. 1. DISABLEMENT Definition: “ It is a term that refers to the impact(s) and functional consequences of acute or chronic conditions, such as disease, injury, and congenital or developmental abnormalities, on specific body systems that compromise basic human performance and an individual’s ability to meet necessary, customary, expected, and desired societal functions and roles.” Dr. QURATULAIN MUGHAL 3

4. 2. THE DISABLEMENT PROCESS The process is not unidirectional (it is not necessarily unpreventable or irreversible). It is assumed that in most instances, it depends on factors such as the severity and duration of the pathological condition. Also depends on the motivation and desires of the patient. Dr. QURATULAIN MUGHAL 4

5. 3. MODELS OF DISABLEMENT NAGI MODEL THE INTERNATIONAL CLASSIFICATION OF IMPAIRMENTS, DISABILITIES, AND HANDICAPS (ICIDH) MODEL THE NATIONAL CENTER FOR MEDICAL REHABILITATION RESEARCH (NCMRR) MODEL INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY, AND HEALTH (ICF) MODEL Dr. QURATULAIN MUGHAL 5

6. NAGI MODEL Tissue/Cellular Level Active pathology Organ/System Level Impairment Personal Level Functional limitation Societal Level Disability Dr. QURATULAIN MUGHAL 6

7. THE INTERNATIONAL CLASSIFICATION OF IMPAIRMENTS, DISABILITIES, AND HANDICAPS (ICIDH) MODEL Tissue/Cellular Level Disease Organ/System Level Impairment Personal Level Disability Societal Level Handicap Dr. QURATULAIN MUGHAL 7

8. INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY, AND HEALTH (ICF) MODEL Tissue/Cellular Level - - - - - - - - - Organ/System Level Impairment of body structure/function Personal Level Activity limitation Societal Level Participation restriction Dr. QURATULAIN MUGHAL 8

9. 4. Comparison of Terminology of Three Disablement Models Dr. QURATULAIN MUGHAL 9

10. INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY, AND HEALTH (ICF) MODEL The ICF model consists of the following components of health and health-related influences: Impairment of body structure (anatomical) and function (physiological). Activity limitation. Participation restriction. Impact of contextual factors (environmental and personal) on functioning, disability, and health Dr. QURATULAIN MUGHAL 10

11. 5. Use of disablement models and classifications in physical therapy Provided an appropriate framework for clinical decision making in practice and research. To standardize terminology for documentation and communication. Can help to prevented, eliminated, or reduced the risk of occurrence or severity of pathology, impairment, or functional limitation. Shows the effective interventions, in particular therapeutic exercise. Dr. QURATULAIN MUGHAL 11

12. 6. Impact of therapeutic exercise on the disablement process Dr. QURATULAIN MUGHAL 12

13. Pathology/Pathophysiology: refers to disruptions of the body’s homeostasis as the result of acute or chronic diseases, disorders, or conditions characterized by a set of abnormal findings (clusters of signs and symptoms). Impairments : they are the consequences of pathological conditions; that is, they are the signs and symptoms that reflect abnormalities at the body system, organ, or tissue level. They can be (direct/primary impairments)or(indirect/secondary impairments). The combination of primary or secondary impairments, the term composite impairment is sometimes used. Functional Limitations: occur at the level of the whole person. The term now used by the WHO to denote functional limitation is “ability limitation,” as defined in the ICF model of functioning and disability. Disability: is the inability to perform or participate in activities or tasks. Prevention: reduction of the severity or duration of existing disease. Risk Factors: related to disablement are influences or characteristics that predispose a person to the process of disablement. Dr. QURATULAIN MUGHAL 13

14. 7. Common physical impairments managed with therapeutic exercise Musculoskeletal Neuromuscular Dr. QURATULAIN MUGHAL 14 Pain Muscle weakness/reduced torque production Decreased muscular endurance Limited range of motion due to •Restriction of the joint capsule • Restriction of periarticular connective tissue • Decreased muscle length Joint hypermobility Faulty posture Muscle length/strength imbalances Pain Impaired balance, postural stability, or control Incoordination, faulty timing Delayed motor development Abnormal tone (hypotonia, hypertonia, dystonia) Ineffective/inefficient functional movement strategies

15. Cardiovascular/Pulmonary Integumentary Dr. QURATULAIN MUGHAL 15 Decreased aerobic capacity (cardiopulmonary endurance) Impaired circulation (lymphatic, venous, arterial) Pain with sustained physical activity (intermittent claudication) Skin hypomobility (e.g., immobile or adherent scarring)

16. 8. Common Functional Limitations Related To Physical Tasks Dr. QURATULAIN MUGHAL 16

17. 9. General Categories Of Activities Relevant To Disability Dr. QURATULAIN MUGHAL 17

18. 10. Disablement Risk Factors Dr. QURATULAIN MUGHAL 18

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20. ASSIGNMENT ACUTE OR CHRONIC CONDITIONS SIGNS AND SYMPTOMS PERIARTICULAR CONNECTIVE TISSUE ADL IADL TYPES OF PREVENTION DELAYED MOTOR DEVELOPMENT HYPOTONIA HYPERTONIA DYSTONIA AEROBIC CAPACITY Dr. QURATULAIN MUGHAL 20

21. REFERENCE Dr. QURATULAIN MUGHAL 21