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Physical Therapy and Disablement

3

International Classification of Functioning, Disability, and Health (ICF)

Part 1: Functioning and Disability

Part 2: Contextual Factors

Body Structure and Functions

Positive:

Activities and Participation Negative: Impairments, activity limitations, and participation restrictions

Environmental Factors Influencing Disability

Personal Factors Influencing Disability

Individual function and function within society, ie, what the individual is capable of doing

Immediate Environment

Global Environment

Figure 1-2. Parts of the World Health Organization's International Classification of Functioning, Disability, and Health (ICF).6 Note that Part 1 includes pathophysiology as well as function in terms of what the individual can and can not do. Part 2 is divided into both personal and global factors that effect the degree of disability.

Active Pathology

causes

Impairments

contribute to

Functional Limitations

relationship between

Disabilities

definition definition

Patient-specific Socially-defined Roles and Tasks

includes

ADLs and IADLs

includes

Self-Care Home Management Work Community Involvement Leisure

overlapping tasks

Figure 1-3. Nagi's Disablement Model.

may comprise signs and symptoms of a specific pathology. In physical therapy, common impairments include limited range of motion, muscle weakness, impaired balance, decreased sensation, and limited circulation. A functional limitation refers to an abnormality or limitation in an individual's ability to carry out a meaningful action, task, or activity.2,7 The Guide to Physical Therapist Practice describes 2 types of functional abilities. First, there are those associated with basic activities of daily living (ADLs), such as moving in bed, transferring from one surface to another, rising from a chair, ambulating, dressing, bathing, etc. In addition, there are activities associated with more complex independent living and community dwelling skills. These more complex behaviors are known as instrumental activities of daily living (IADLs) and include community ambulation activities, such as going to a grocery store, bank, or restaurant.7 Impairments often lead to functional limitations. For instance, an individual with limited shoulder range of motion (impairment) might be unable to reach into an overhead cabinet or have difficulty donning a shirt (functional limitations). While a patient with decreased quadriceps strength (impairment) might have difficulty ambulating without assistance (functional limitation). Functional limitations are patient-specific. In other words, limitations will vary depending on the individual's lifestyle and functional demands. Read the following scenarios:

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