Disablement Models

Question 1

Why do we have disablement models

Answer 1

• to have a unified framework to define health & disability
• create an universal language
• help clinicians make decisions throughout the continuum of care
• help agencies make decisions/policies for providing benefits
• allows to provide customized care for individual patients

Question 2

Define a medical model

Answer 2

• attribute of person directly related to disease/condition

Question 3

Define a social model

Answer 3

• problem is created by an unaccommodating/inflexible environment due to attitudes or features of the social & physical environment

Question 4

Define a biopsychosocial model

Answer 4

• disability is viewed as a consequence of biological, personal, & social forces

Question 5

Characteristics of the medical model and disability

Answer 5

• the problem is with the person with the disability
• the disability needs to be fixed
• professionals are the only hope for cure or normality
• goals are to “over-come” or normality

Question 6

Keys points of the medical model

Answer 6

• focus only on curing the disease
• disease manifestations at all levels considered the same
• treatment results in a curing the disease, living with it, or death

Question 7

What are the 4 components of the Nagi social disablement model

Answer 7

• Pathology: disruption/injury to body tissues
• Impairment: loss/disruption of structure or function at system level
• Functional limitations: inability/decreased ability to perform activities in a normal manner
• Disability: restriction of abilities in occupational roles, family roles, recreational roles etc.

Question 8

What are the 4 components of the biopsychosocial model

Answer 8

• Disease: disruptions at the cell or tissue level
• Impairment: disruption of structure/function
• Disability: decreased ability to perform activities at person level
• Handicap: continued limitations at societal level imposed by physical environmental barriers or attitudes

Question 9

Order of a linear interactions between disablement components

Answer 9

• Pathology
• Impairment
• Functional limitation
• Disability
• Handicap

Question 10

What does IFC model stand for

Answer 10

• International classification of functioning, disability, and health

Question 11

Describe the ICF model

Answer 11

• model of enablement
• emphasis on what patient’s can do as an initial basis for devising POC
• describes a patient’s health/functional status in the context of environmental or personal factors
• gives a holistic picture of a person

Question 12

Define model of enablement

Answer 12

• use of positive terms of normal health & functioning instead of negative terms of disease, impairment, etc.

Question 13

Examples of body functions & structures impairments

Answer 13

• bones
• ligaments
• muscles
• sensation
• circulation

Question 14

Examples of activity limitations

Answer 14

• speaking
• walking
• jumping
• bed mobility
• dressing
• bathing
• eating

Question 15

Examples of participation restrictions

Answer 15

• work roles
• social roles
• athletic roles

Question 16

Examples of environmental factors

Answer 16

• Physical aspects: appropriate living/working conditions, transportation
• Social factors: financial situation, access to healthcare, support from community
• Social attitudes: expectations from others, ideas/biases about disabilities/handicap

Question 17

Examples of personal factors

Answer 17

• age
• gender
• comorbidities
• coping styles
• social background
• education
• behaviors

Question 18

Define impairments

Answer 18

• problems with body functions/structures
• deviation from the norm
• temporary or permanent

Question 19

Define activity limitations/functional limitations

Answer 19

• difficulties someone may have in executing activities and/or ADLs

Question 20

Define participation restriction

Answer 20

• problems experienced in the involvement in life situations

Question 21

Order of the patient management model

Answer 21

• Examination
• Evaluation
• Diagnosis
• Prognosis
• Intervention
• Outcomes

Question 22

Common PT diagnoses for neuro patients

Answer 22

• Movement pattern coordination deficit
• Force production deficit (fancy way of saying weakness)
• Fractionated movement deficit
• Postural vertical deficit
• Sensory selection & weighting deficit
• Sensory detection deficit
• Hypokinesia (decreased body movement)
• Dysmetria (under/over shooting movements)
• Cognitive deficit

Question 23

Factors that help determine neuro prognosis

Answer 23

• Progressive nature of pathology (non vs progressive pathology)
• Extent of pathology (focused vs broad area of injury)
• Age (younger vs older)
• Number of systems impaired/comorbidities (single/few systems vs multiple systems)
• Acuity of disorder (<6 mo vs >6 mo)
• Initial level of function (high vs low physical functioning)
• Glasgow coma scale (high vs low score)
• Sensation (intact vs absent)
• Degree or impairment (mild vs severe Sx)
• Prior intellectual (higher vs lower intelligence)
• Prior level of physical function (very active vs difficulty walking)
• Duration of amnesia ( short vs long)
• Current cognitive status (optimal vs decreased arousal, attention, cognition)
• Motivation (highly vs poorly motivated)
• Family/social support (strong vs limited)
• Recent trends of recovery (ongoing vs no recent improvements)

Question 24

What components must every goal have

Answer 24

• Audience (who)
• Behavior (what)
• Conditions (how)
• Degree (how well)
• Expected duration (by when)

Question 25

How does ICF help inform patient management

Answer 25

- diagnosis - prognosis - goal writing - effective interventions - determining D/C requirements, destinations

Question 26

What does HOAC II stand for

Answer 26

- Hypothesis oriented algorithm for clinicians II

Question 27

How does HOAC II help in patient management

Answer 27

- arrive at an appropriate diagnosis/assessment - use current evidence to design/refine POC - during re-evaluation to update/change POC - better clinical justification (supports medical necessity)

Question 28

Define PIPs and NPIPs

Answer 28

- PIPs = patient identified problems (existing problems) - NPIPs = non-patient identified problems (anticipated problems that need preventative intervention)

Question 29

Order of clinical decision making using HOAC II

Answer 29

- Generate hypotheses for each existing & anticipated problem - Select appropriate tests/measures to test hypothesis - Refine hypothesis based on examination outcomes - Generate appropriate goals for each hypothesis - Determine interventions to address hypotheses - After interventions test each hypothesis again to assess changes in status of problem

Question 30

4 conditions in Gentile Taxonomy movement analysis of tasks

Answer 30

- Stable body in stationary environment - Stable body in moving environment - Body transport in stationary environment - Body transport in moving environment

Question 31

Gentile's taxonomy limitation

Answer 31

- it does not analyze quality of movements in terms of its essential components (movement constructs) or their timing (temporal sequence), so does not inform how a task is impaired

Question 32

Core tasks in the movement continuum framework

Answer 32

- Initial conditions - Preparation: did patient understand instructions/task requirements - Initiation - Execution - Termination - Outcome achieved?

Question 33

Words to use to analyze initiation, execution, & termination of a movement

Answer 33

- symmetry - speed - amplitudee - alignment - postural control verticality - stability - coordination smoothness - sequencing - timing - accuracy - symptom production - Stages of motor control: mobility, stability, controlled movement, skill