ndt enablement classification model of health and disability mary rose franjoine, pt, dpt, ms, pcs...
Post on 26-Dec-2015
222 Views
Preview:
TRANSCRIPT
NDT Enablement Classification Model of Health and Disability
Mary Rose Franjoine, PT, DPT, MS, PCS
Margo Prim Haynes, PT, DPT, MA, PCS
2009 M R Franjoine & M P Haynes 2
Readings & ReferencesRequired Reading:• Neuro-Developmental Treatment Approach Theoretical
Foundations and Principles of Clinical PracticeChapter 2
References:• www.who.org• Neuro-Developmental Treatment Approach Theoretical
Foundations and Principles of Clinical Practice Assignment:• Study Guide:
– Learning Activity 2.1.1 (pg 83-85)– Learning Activity 1.1.5 (pg 91)
2009 3
Evolutionary Process Disablement Models• WHO & Nagi Disablement frameworks• NCMRR Disablement Model
– Pathophysiology– Impairments – Functional Limitations– Disability– Societal Limitations
Enablement Models• International Classification of Function, Disability, and
Health • NDT Enablement Classification Model of Health and
Disability
2009 M R Franjoine & M P Haynes 4
Enablement Frameworks, WHY?
• Universal, all inclusive model
• Multi-dimensional
• Cross Cultural
• Social and Medical
2009 M R Franjoine & M P Haynes 5
NDT Enablement Classification Model of Health and Disability
Dimension Functional Domain Disability Domain
A. Body structure & functions
Structural & functional integrity
Impairments
A.Primary
B.Secondary
B. Motor functions Effective posture & movement
Ineffective posture & movement
C. Individual functions
Functional activities Functional activity limitations
D. Social functions Participation Participation restriction
+ Domains -
Dim
ensi
ons
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
2009 M R Franjoine & M P Haynes 6
Participation
• Nature and extent of a person’s involvement in life situations
• Example:
Going to the mall on Saturday afternoon with your friends to “hang”
2009 M R Franjoine & M P Haynes 7
Participation Restrictions
• Problem an individual may have in the manner or extent of involvement in life
• Example:Can’t “hang” at the mall on Saturday afternoon, because:• Can’t walk fast enough• Can’t walk safe enough• Can’t walk and talk
2009 M R Franjoine & M P Haynes 8
Functional Activities
• Directly observable functions• Performance of a task or action by
the individual.• Example:
Able to get the toy
2009 M R Franjoine & M P Haynes 9
Functional Limitations• Difficulties or inability an individual
may have in performing a task or function.
• Example:Unable to get the toy• Can’t roll over to get toy• Can’t belly crawl to get the toy• Can’t reach to get the toy
2009 M R Franjoine & M P Haynes 10
Posture & Movement Behaviors• Directly observable
• Interaction of the systems & the environment
• Examples:• Sitting with PPT• Reaching overhead with IR in shoulder, pronated
forearm, and fisted hand • Toe walking• Rib cage elevation during expiration
2009 M R Franjoine & M P Haynes 11
Is the Posture and Movement Behavior Effective or Ineffective?Consider:• Alignment• Weight bearing• Postural Control• Balance• Coordination• Motor planning
– Temporal– Spatial
• Tone• Movement combinations
2009 M R Franjoine & M P Haynes 12
Single Systems
• Body Functions– The physiological or psychological
functions of the body system
• Body Structure– The anatomical parts of the body such
as organs, limbs and their components
2009 M R Franjoine & M P Haynes 13
Body Functions• Mental function• Sensory function and pain• Voice and Speech functions• Functions of Cardiovascular, Hematological,
Immunological and Respiratory systems • Functions of the Digestive, Metabolic and
Endocrine systems• Genitounitary and Reproductive functions• Neuromusculoskeletal and Movement-related
functions • Functions of the Skin and related structures
2009 M R Franjoine & M P Haynes 14
Body Structures• Structures of the nervous system• The eye, ear and related structures• Structures involved in voice and speech• Structures related to the Cardiovascular, Hematological,
Immunological and Respiratory systems• Structures related to the Digestive, Metabolic and
Endocrine systems• Structures related to the Genitounitary and Reproductive
systems • Structures related to Movement• Skin and related structures
2009 M R Franjoine & M P Haynes 15
Impairments
Problems in a body function or structure
• Single system impairments • Multi-system impairments • Can be temporary or permanent• Can change over time
ProgressionRegression
2009 M R Franjoine & M P Haynes 16
Primary Impairments• Can be single or multi-system• Are a direct result of the Body
Function or Body Structure injury, dysfunction, or absence.
• Positive Behaviors that are present
• Negative Behaviors that are absent
2009 M R Franjoine & M P Haynes 17
Secondary Impairments
• Can be single or multi-system
• Are an indirect result of the Body Function or
• Body Structure injury, dysfunction, or absence.
2009 M R Franjoine & M P Haynes 18
ExamplesNeuromuscular System
Primary Positive Impairments• Spasticity• Impaired muscle activation• Excessive co-activation• Stereotypic, atypical movement synergies• Impaired motor execution• Incorrect scaling of muscle force• Inter-limb and Intra-limb dyscoordination
2009 M R Franjoine & M P Haynes 19
ExamplesNeuromuscular System
Primary Negative Impairments
• Insufficient force generation (weakness)
• Impaired anticipatory balance
• Hypokinesia
• No fractionated movements
2009 M R Franjoine & M P Haynes 20
ExamplesSensory - Perceptual SystemPrimary Positive Impairments
• Inaccurate Registration
• Inaccurate Modulation
• Inaccurate Response
2009 M R Franjoine & M P Haynes 21
Contextual Factors
Environmental Physical, social, and
attitudinal environment in which people live and function.
Examples:• Facilitators
• Excellent medical coverage for AT
• Barriers• A home
environment where children are to be quiet and well behaved at all times
Personal Features of the individual
that are not part of a health condition or functional state.
Examples:• Facilitators
• Outgoing personality
• Barriers• Shy, quiet
2009 M R Franjoine & M P Haynes 22
Contextual Factors
• Can interact at any level within the model
• Can come from within the person
• From the family
• Can be cultural
• Can be environmental
top related