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The Disablement Process Clinical Reasoning What is Physical Therapy Disablement Process Nagi Model Clinical Application Map of Essential Concepts What.

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Presentation on theme: "The Disablement Process Clinical Reasoning What is Physical Therapy Disablement Process Nagi Model Clinical Application Map of Essential Concepts What."— Presentation transcript:

1 The Disablement Process Clinical Reasoning What is Physical Therapy Disablement Process Nagi Model Clinical Application Map of Essential Concepts What do Physical Therapists do What do Physical Therapists do ICF Model Patient Cases Healthcare Professionals Who Model Model Comparison Intervention Strategies Healthcare Domain

2 Disablement process Disablement process What is Physical Therapy What is Physical Therapy What do Physical Therapists do What do Physical Therapists do Nagi model of disablement Nagi model of disablement WHO model of disablement WHO model of disablement ICF model of disablement ICF model of disablement Comparison of models Comparison of models Patient cases Patient cases Intervention strategies Intervention strategies Healthcare domain Healthcare domain Healthcare professionals Healthcare professionals Clinical application Clinical application Clinical reasoning Clinical reasoning Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

3 Disablement Process Disablement Model Disablement Model A conceptual explanation of the process and underlying mechanisms by which disease, injury or birth defect impacts a person’s ability to function (perform their expected role in society). A conceptual explanation of the process and underlying mechanisms by which disease, injury or birth defect impacts a person’s ability to function (perform their expected role in society). Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

4 What is Physical Therapy? Physical Therapy is a group of health care professionals dedicated to: Physical Therapy is a group of health care professionals dedicated to: Alleviating pain Alleviating pain Preventing the onset and progression of impairment, functional limitation, disability, or changes in physical function and health status resulting from injury, disease, of other causes Preventing the onset and progression of impairment, functional limitation, disability, or changes in physical function and health status resulting from injury, disease, of other causes Restoring, maintaining, and promoting overall fitness, health, and optimal quality of life Restoring, maintaining, and promoting overall fitness, health, and optimal quality of life (Guide to Physical Therapists Practice) Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

5 What do Physical Therapists Do? Relieve / resolve disability or functional limitation by Relieve / resolve disability or functional limitation by Changing the underlying impairments Changing the underlying impairments (Guide to Physical Therapists Practice) The Goal of Therapeutic Intervention The Goal of Therapeutic Intervention Maximize function and thereby minimize disability. Maximize function and thereby minimize disability. Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

6 Nagi Model 1/8 A conceptual explanation of the process and underlying mechanisms by which disease, injury or birth defect impacts a person’s ability to function (perform their expected role in society). A conceptual explanation of the process and underlying mechanisms by which disease, injury or birth defect impacts a person’s ability to function (perform their expected role in society). Nagi experimental hypothesis Nagi experimental hypothesis Disease Causes Impairment Disease Causes Impairment Impairment Causes Functional limitation Impairment Causes Functional limitation Functional limitation Causes Disability Functional limitation Causes Disability Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

7 Nagi Model 2/8 Functional Limitations Disability Primary Impairment Primary Pathology Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

8 Primary Pathology 3/8 Pathophysiology due to Disease, Injury, or Congenital Abnormality Pathophysiology due to Disease, Injury, or Congenital Abnormality Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

9 Primary Impairment (Signs & Symptoms ) 4/8 Result of primary pathology - physiological or psychological consequences (e.g. in stroke: hemiplegia, loss of selective movement control, sensory loss, perceptual problems, aphasia) Result of primary pathology - physiological or psychological consequences (e.g. in stroke: hemiplegia, loss of selective movement control, sensory loss, perceptual problems, aphasia) Not usually amenable to intervention by PT Not usually amenable to intervention by PT Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

10 Secondary Impairments 5/8 Due to lack of treatment of primary impairments (e.g. dicubiti, contractures, disuse atrophy) Due to lack of treatment of primary impairments (e.g. dicubiti, contractures, disuse atrophy) Usually what PTs treat Usually what PTs treat Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

11 Functional Limitations (Abilities Lost) 6/8 Due to impairments (inability to perform ADLs) Due to impairments (inability to perform ADLs) Basic ADLs (BADLs): self care: dressing, grooming, hygiene, toileting, bed mobility, transfers, locomotion, speech, reading, writing Basic ADLs (BADLs): self care: dressing, grooming, hygiene, toileting, bed mobility, transfers, locomotion, speech, reading, writing Instrumental ADLs (IADLS): higher order skills requiring more psychological processing in addition to motoric functioning (e.g. shopping, paying bills, meal preparation, going to the movies) Instrumental ADLs (IADLS): higher order skills requiring more psychological processing in addition to motoric functioning (e.g. shopping, paying bills, meal preparation, going to the movies) Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

12 Disability (Handicap) 7/8 Social and psychological consequences of functional limitations (inability to fulfill expected social roles, e.g. hold a job) - may be heavily influenced by external factors like: support system or funding Social and psychological consequences of functional limitations (inability to fulfill expected social roles, e.g. hold a job) - may be heavily influenced by external factors like: support system or funding Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

13 Limitations of Nagi Model 8/8 Nagi is a unidimensional (pathology-based) and unidirectional model of disability only Nagi is a unidimensional (pathology-based) and unidirectional model of disability only Does not account for impairments and functional limitations not due to pathology Does not account for impairments and functional limitations not due to pathology Functional limitations due to obesity or due to sedentary lifestyle Functional limitations due to obesity or due to sedentary lifestyle Dose not consider societal barriers: architectural, attitudinal Dose not consider societal barriers: architectural, attitudinal Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

14 World Health Organization Model (WHO) 1/3 Primary Impairment Disability Disease Handicap Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

15 WHO Primary Impairment Handicap Disability DiseasePrimary Pathology Primary Impairment Functional Limitations Disability Nagi Level of Analysis Cell / Organ System Personal Society 2/3 Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

16 ACTIVE PATHOLOGY  IMPAIRMENT  FUNCTIONAL LIMITATION  DISABILITY Interruption or interference with normal processes, and efforts of the organism to regain normal state Anatomical, physiological, mental, or emotional abnormalities or loss Limitations in performance at the level of the whole organism or person Limitations in performance of socially defined roles and tasks within a sociocultural and physical environment DISEASE  IMPAIRMENT  DISABILITY  HANDICAP The intrinsic pathology or disorder Loss or abnormality of psychological, physiological, or anatomical structure or function at organ level Restriction or lack of ability to perform an activity in normal manner Disadvantage due to impairment or disability that limits or prevents fulfillment of a normal role [depends on age, sex, sociocultural factors] for the person Nagi Model WHO Model (International Classification of Impairments, Disabilities, and Handicaps, ICIDH)3/3 Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

17 Patient Cases Inversion ankle sprain Inversion ankle sprain Inversion ankle sprain Inversion ankle sprain Myelomeningocele Myelomeningocele Myelomeningocele Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

18 An example of using the model to determine the level of disability/handicap 1/6 Following a severe inversion ankle sprain, this 35 year old, male, Fed Ex driver is unable to walk or work. Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

19 Pathology Impairment Functional limitation Disability Following a severe inversion ankle sprain, this 35 year old, male, Fed Ex driver is unable to walk or work. An example of using the model to determine the level of disability/handicap 2/6 Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

20 Pathology Grade II, inversion sprain of the ankle Partial rupture of the anterior talofibular and calcanofibular ligaments Partial rupture of the anterior talofibular and calcanofibular ligaments Impairment Functional limitation Disability Following a severe inversion ankle sprain, this 35 year old, male, Fed Ex driver is unable to walk or work. An example of using the model to determine the level of disability/handicap 3/6 Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

21 Pathology Grade II, inversion sprain of the ankle Partial rupture of the anterior talofibular and calcanofibular ligaments Partial rupture of the anterior talofibular and calcanofibular ligaments Impairment Impaired AROM Impaired strength Pain Functional limitation Disability Following a severe inversion ankle sprain, this 35 year old, male, Fed Ex driver is unable to walk or work. An example of using the model to determine the level of disability/handicap 4/6 Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

22 Pathology Grade II, inversion sprain of the ankle Partial rupture of the anterior talofibular and calcanofibular ligaments Partial rupture of the anterior talofibular and calcanofibular ligaments Impairment Impaired AROM Impaired strength Pain Functional limitation Non-weight bearing Ambulates with crutches Disability Following a severe inversion ankle sprain, this 35 year old, male, Fed Ex driver is unable to walk or work. An example of using the model to determine the level of disability/handicap 5/6 Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

23 Pathology Grade II, inversion sprain of the ankle Partial rupture of the anterior talofibular and calcanofibular ligaments Partial rupture of the anterior talofibular and calcanofibular ligaments Impairment Impaired AROM Impaired strength Pain Functional limitation Non-weight bearing Ambulates with crutches Disability Unable to work Following a severe inversion ankle sprain, this 35 year old, male, Fed Ex driver is unable to walk or work. An example of using the model to determine the level of disability/handicap 6/6 Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

24 An example of using the model to determine the level of disability/handicap 1/6 A 40 year old woman born with spinal bifida, transports via a wheel chair, practicing lawyer, married with two children. Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

25 An example of using the model to determine the level of disability/handicap 2/6 A 40 year old woman born with spinal bifida, ambulates via a wheel chair, practicing lawyer, married with two children. Pathology Failure of neural tube to closure (meningomyelocele) with resultant spinal cord transection (L4-5) Impairment Functional limitation Disability Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

26 An example of using the model to determine the level of disability/handicap 3/6 A 40 year old woman born with spinal bifida, ambulates via a wheel chair, practicing lawyer, married with two children. Pathology Failure of neural tube to closure (meningomyelocele) with resultant spinal cord transection (L4-5) Impairment Bilateral lower extremity paralysis (paraplegia) Incontinence Functional limitation Disability Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

27 An example of using the model to determine the level of disability/handicap 5/6 A 40 year old woman born with spinal bifida, ambulates via a wheel chair, practicing lawyer, married with two children. Pathology Failure of neural tube to closure (meningomyelocele) with resultant spinal cord transection (L4-5) Impairment Bilateral lower extremity paralysis (paraplegia) Incontinence Functional limitation Nonambulatory Independent in w/c for transport Disability Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

28 An example of using the model to determine the level of disability/handicap 6/6 A 40 year old woman born with spinal bifida, ambulates via a wheel chair, practicing lawyer, married with two children. Primary pathology Failure of neural tube to closure (meningomyelocele) with resultant spinal cord transection (L4-5) Primary impairment Bilateral lower extremity paralysis (paraplegia) Incontinence Functional limitation Nonambulatory Independent in w/c for transport DisabilityNone Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

29 Medical Aspects Social Aspects Domain of Physical Therapists Practice Cardiopulmonary Integumentary Musculoskeletal Neuromuscular Physical Psychological Social DisabilityFunctional Limitation ImpairmentPathology Pathophysiology Health Care Healthcare Domain Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

30 Levels at Which Health Professionals Function 1/2 Pathology Impairment Functional Limitation Disability Physician Physical Therapist Occupational Therapist Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

31 Activity Emphasis of Health Professionals 2/2 Functional Activity Health Professional Mobility Transfers Positioning Toileting and Hygiene Dressing Feeding Communication Physical Therapist Occupational Therapist Speech Therapist Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

32 Clinical 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 history Patient told you during history Performance on normalized functional assessment, reliable test was > ± 2 SD from mean Performance on normalized functional assessment, reliable test was > ± 2 SD from mean What is causing the functional limitation? (What are the impairments?) What is causing the functional limitation? (What are the impairments?) How do you know? How do you know? Performance on valid and reliable impairment test Performance on valid and reliable impairment test Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

33 Clinical Application 2/2 What practice pattern(s) is most appropriate? What practice pattern(s) is most 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: (Outcome measures) How are you documenting progress: (Outcome measures) Impairments Impairments Functional limitations Functional limitations Disability Disability Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

34 Intervention Strategies 1/2 Requires understanding of the underlying process. Requires understanding of the underlying process. Efforts to prevent or modify disability can be aimed at: Efforts to prevent or modify disability can be aimed at: Preventing/ modifying disease Preventing/ modifying disease Preventing/ modifying impairments Preventing/ modifying impairments Preventing/ modifying functional limitations Preventing/ modifying functional limitations Preventing/ modifying disability Preventing/ modifying disability Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

35 Intervention Strategies 2/2 Impairment interventions: medical interventions to deal with the impairment, and preventive interventions to avoid activity limitation Impairment interventions: medical interventions to deal with the impairment, and preventive interventions to avoid activity limitation Activity limitation interventions: rehabilitative interventions and provision of assistive devices and personal assistance to mitigate the activity limitation, and preventive interventions to avoid participation restrictions Activity limitation interventions: rehabilitative interventions and provision of assistive devices and personal assistance to mitigate the activity limitation, and preventive interventions to avoid participation restrictions Participation restriction interventions: public education, equalization of opportunities, social reform and legislation, architectural “universal design” applications and other ways of accommodating activity limitations in major life areas Participation restriction interventions: public education, equalization of opportunities, social reform and legislation, architectural “universal design” applications and other ways of accommodating activity limitations in major life areas Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

36 Model Comparison Analysis Level NAGIWHOICF CellPathologyDisease Health Condition System (Body) ImpairmentImpairment Body structure & function Person Functional Limitation Disability Activity (Limitation) SocialDisabilityHandicap Participation (Restriction) Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

37 Clinical Reasoning Use of the Nagi Model In Clinical Decision Making 1/11 Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

38 How do you decide what to treat? 2/11 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 are the impairments?) What is causing the functional limitation? (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? Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

39 How do you decide what to treat? 3/11 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 of ≤ 2SD below the mean on valid & reliable functional test. Performance of ≤ 2SD below the mean on valid & reliable functional test. Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

40 How do you decide what to treat? 4/11 What is causing the functional limitation? (What are the impairments?) What is causing the functional limitation? (What are the impairments?) How do you know? How do you know? Given the subjective history (and your knowledge of anatomy and physiology), you hypothesize what impairments, in this case, might be causing the functional limitation. Given the subjective history (and your knowledge of anatomy and physiology), you hypothesize what impairments, in this case, might be causing the functional limitation. Test your hypothesis: performance of ≤ 2SD below the mean on valid & reliable impairment test. Test your hypothesis: performance of ≤ 2SD below the mean on valid & reliable impairment test. Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

41 How do you decide what to treat? 5/11 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 measures greater than expected by chance. By showing progress on function / impairment 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. Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

42 How to select and measure a LTG 6/11 Use the patient’s LTG (Listen to the pt during Hx) Use the patient’s LTG (Listen to the pt during Hx) LTGs are set at the disability or functional level LTGs are set at the disability or functional level Disability data is collected at the “quality of life” level (SF 36) Disability data is collected at the “quality of life” level (SF 36) Functional limitations are objectively determined by performance of ≤ 2 SD below the mean on a valid, reliable, normalized functional test Functional limitations are objectively determined by performance of ≤ 2 SD below the mean on a valid, reliable, normalized functional test Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

43 How to select and measure a LTG 7/11 Objective goal assessment is set at of ≥ 2 SD in the standard error of the measure (SEM). Objective goal assessment is set at of ≥ 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. In reality, we guess at a realistic estimation of an expected % improvement (usually 10-20%) based on experience (previous performance of pts with similar S&S). In reality, we guess at a realistic estimation of an expected % improvement (usually 10-20%) based on experience (previous performance of pts with similar S&S). Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

44 How to select and measure a STG 8/11 After the LTG has been identified, hypothesize what impairments are causing the functional limitation. After the LTG has been identified, hypothesize what impairments are causing the functional limitation. Test your hypothesis by performing a valid, reliable, normalized impairment test. Test your hypothesis by performing a valid, reliable, normalized impairment test. Performance of ≤ 2 SD below the mean rules in that variable as an impairment. Performance of ≤ 2 SD below the mean rules in that variable as an impairment. STG are objectively assessed by improvement of ≥ 2 SD (change > chance – “clinically meaningful” ). STG are objectively assessed by improvement of ≥ 2 SD (change > chance – “clinically meaningful” ). Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

45 Clinical Example 9/11 For the UPS driver: LTG: return to work following 1 week (Disability level) LTG: return to work following 1 week (Disability level) The objective measure of goal accomplishment is Yes or No on returning to work in one week. The objective measure of goal accomplishment is Yes or No on returning to work in one week. One week duration was selected on the basis of known tissue repair rates One week duration was selected on the basis of known tissue repair rates PT interventions (cryotherapy and ROM exercises) may be able to change the natural rate of tissue recovery (evidence remains unknown) PT interventions (cryotherapy and ROM exercises) may be able to change the natural rate of tissue recovery (evidence remains unknown) Orthosis (Air splint) will help support the ankle in a shoe and assist return to work Orthosis (Air splint) will help support the ankle in a shoe and assist return to work Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

46 Clinical Example 10/11 For the UPS driver: One functional limitation is the inability to walk, effectively, on the injured ankle. One functional limitation is the inability to walk, effectively, on the injured ankle. A valid and reliable measure of effective ambulation is the 10 meter walk test. A valid and reliable measure of effective ambulation is the 10 meter walk test. Gait velocity of mph, 236 feet/min is required to cross a street during a red light (Podsiodlo ’91) Gait velocity of mph, 236 feet/min is required to cross a street during a red light (Podsiodlo ’91) STG: On a 10 meter walk test, walk faster than 236 feet/min carrying a 5 pound box, without an assistive device. STG: On a 10 meter walk test, walk faster than 236 feet/min carrying a 5 pound box, without an assistive device. Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

47 Clinical Example 11/11 For the UPS driver: Impairments causing his functional limitation Impairments causing his functional limitation Pain: 8/10 Pain: 8/10 Impaired strength: DF/EV 3-/5 2 0 pain Impaired strength: DF/EV 3-/5 2 0 pain Impaired ROM: EV ( ) Impaired ROM: EV ( ) STG: EV AROM ≥ STG: EV AROM ≥ SEM for goniometry is ± SEM for goniometry is ± SD ± SD ± 5 0 Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

48 International Classification of Functioning, Disability and Health 1/9 The World Health Organization (WHO) authorized the International Classification of Functioning, Disability and Health (ICF) in The World Health Organization (WHO) authorized the International Classification of Functioning, Disability and Health (ICF) in It is accepted by 191 countries as the international standard to describe and measure health and disability. The ICF classifies the health and disability using approximately 1500 items of "body function", "body structure", "activity and participation "and "environmental factors". It is accepted by 191 countries as the international standard to describe and measure health and disability. The ICF classifies the health and disability using approximately 1500 items of "body function", "body structure", "activity and participation "and "environmental factors". Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

49 International Classification of Functioning, Disability and Health (ICF) 2/9 Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

50 Functioning and disability ("Body Functions and Structures," "Activities," and "Participation") are seen as an interaction between the "Health Condition" ("disorder/disease") and the contextual factors ("Personal Factors" and "Environmental Factors"). Functioning and disability ("Body Functions and Structures," "Activities," and "Participation") are seen as an interaction between the "Health Condition" ("disorder/disease") and the contextual factors ("Personal Factors" and "Environmental Factors"). ICF is multidimensional (bio-psycho-social) and multidirectional model of human health. ICF is multidimensional (bio-psycho-social) and multidirectional model of human health. Contextual Factors 3/9 Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

51 Body 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, HAEMATOLOGICAL, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS FUNCTIONS OF THE CARDIOVASCULAR, HAEMATOLOGICAL, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS FUNCTIONS OF THE DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS FUNCTIONS OF THE DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS GENITOURINARY AND REPRODUCTIVE FUNCTIONS GENITOURINARY AND REPRODUCTIVE FUNCTIONS NEUROMUSCULO-SKELETAL AND MOVEMENT-RELATED FUNCTIONS NEUROMUSCULO-SKELETAL AND MOVEMENT-RELATED FUNCTIONS FUNCTIONS OF THE SKIN AND RELATED STRUCTURES FUNCTIONS OF THE SKIN AND RELATED STRUCTURES Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

52 Body 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 AND RESPIRATORY SYSTEMS STRUCTURES OF THE CARDIOVASCULAR, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS STRUCTURES RELATED TO THE DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS STRUCTURES RELATED TO THE DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS STRUCTURES RELATED TO THE GENITOURINARY AND REPRODUCTIVE SYSTEMS STRUCTURES RELATED TO THE GENITOURINARY AND REPRODUCTIVE SYSTEMS STRUCTURES RELATED TO MOVEMENT STRUCTURES RELATED TO MOVEMENT SKIN AND RELATED STRUCTURES SKIN AND RELATED STRUCTURES Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

53 Activities and Participation 6/9 LEARNING AND APPLYING KNOWLEDG LEARNING AND APPLYING KNOWLEDG GENERAL TASKS AND DEMANDS GENERAL TASKS AND DEMANDS COMMUNICATION COMMUNICATION MOBILITY MOBILITY SELF-CARE SELF-CARE DOMESTIC LIFE DOMESTIC LIFE INTERPERSONAL INTERACTIONS AND RELATIONSHIPS INTERPERSONAL INTERACTIONS AND RELATIONSHIPS MAJOR LIFE AREAS MAJOR LIFE AREAS COMMUNITY, SOCIAL AND CIVIC LIFE COMMUNITY, SOCIAL AND CIVIC LIFE Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

54 Environmental Factors 7/9 PRODUCTS AND TECHNOLOGY PRODUCTS AND TECHNOLOGY NATURAL ENVIRONMENT AND HUMAN-MADE CHANGES TO ENVIRONMENT NATURAL ENVIRONMENT AND HUMAN-MADE CHANGES TO ENVIRONMENT SUPPORT AND RELATIONSHIPS SUPPORT AND RELATIONSHIPS ATTITUDES ATTITUDES SERVICES, SYSTEMS AND POLICIES SERVICES, SYSTEMS AND POLICIES Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

55 ICF Model 8/9 Multidimensional, bi-directional model (Bio-Psycho- Social) of human health Multidimensional, bi-directional model (Bio-Psycho- Social) of human health Positive terminology Positive terminology Includes non-pathological causes of impairments and functional limitations Includes non-pathological causes of impairments and functional limitations Context: potentially has an effect on all levels of model Context: potentially has an effect on all levels of model External environmental factors External environmental factors Personal characteristics Personal characteristics Participation goes beyond performance of roles and deals with barriers and facilitators to participation in society Participation goes beyond performance of roles and deals with barriers and facilitators to participation in society Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

56 Overview of Dimensions of ICF 9/9 ImpairmentsActivitiesParticipation Contextual Factors Functioning At body level At person level At social level Interaction with environmental factors and personal factors Characteristics Body function Body structure Person's daily activities Involvement in the situation Features of the physical, social attitudinal world Positive Aspect Functional and structural integrity ActivityParticipationFacilitators Negative Aspect Impairment Activity limitation Participation restriction Barriers Last Viewed Last Viewed Disablement Exit Concept Map Concept Map

57 The End © DM McKeough 2009 Last Viewed Last Viewed Disablement Exit Concept Map Concept Map


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