Impairment, Disability and Handicap

1. Impairment, Disability and
Handicap
Dr. Sumeet Kumar
MPhil. (OPT), ADPT, BPT
United College of Physical Therapy

2. 2

3. IMPAIRMENT: any loss or abnormality of
psychological, physiological or anatomical structure or
function.
DISABILITY: any restriction or lack (resulting from an
impairment) of ability to perform an activity in the
manner or within the range considered normal for a
human being.
HANDICAP: a disadvantage for a given individual that
limits or prevents the fulfilment of a role that is normal
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4. • Impairment-- leads to functional loss at
organ level
• Disability-- leads to activity limitation at
personal level
• Handicap-- leads to social disadvantage
at social level
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5. THE DISABLEMENT PROCESS
• Disablement is a term that refers to the
impact 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.
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6. MODELS OF DISABLEMENT
 Disablement models are conceptual schemes or
scientific models that form the basic architecture for
clinical practice and research as well as health care
policy.
 Disablement models have become standard components
of clinical practice in most health care professions ,
including medicine, nursing, speech pathology,
occupational therapy and physical therapy
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7. MODELS OF
DISABLEMENT
NAGI MODEL
OF
DISABLEMENT
NATIONAL CENTER
FOR MEDICAL
REHABILITATION
RESEARCH
DISABLEMENT
MODEL (NCMRR)
INTERNATIONAL
CLASSIFICATION
OF
FUNCTIONING,
DISABILITY &
HEALTH (ICF
MODEL)
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8. TERMS RELATED TO DISABLEMENT
 PATHOLOGY
• A diseased condition of body or abnormal entity with a
characteristic group of signs and symptoms that affect
the body, might be of known or unknown etiology &
occurs at the cellular level.
 IMPAIRMENT
• Loss or abnormality at the tissue, organ, or body system
level and include clinical signs and symptoms.
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9. TYPES OF IMPAIRMENT
IMPAIRMENT
DIRECT
(from pathology)
INDIRECT
(pre existing
impairments)
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10. Example
A patient who has been referred to physical
therapy with a medical diagnosis of
impingement syndrome or tendinitis of the
rotator cuff (pathology) may exhibit primary
impairments, such as pain, limited ROM of the
shoulder, and weakness of specific shoulder
girdle and glenohumeral musculature during
the physical therapy examination. The patient
may subsequently develop secondary postural
asymmetry because of altered use of the upper
extremity.
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11. Common Physical Impairments Managed with
Physical Rehabilitation
Musculoskeletal
• Pain
• Muscle weakness
• Decreased muscular endurance
• Limited range of motion due to
• Restriction of the joint capsule
• Decreased muscle length
• Joint hyper mobility
• Faulty posture
• Muscle length
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12. Neuromuscular
•Pain
•Impaired balance, postural stability, or
control
•Inco-ordination
•Delayed motor development
•Abnormal tone (hypotonia, hypertonia,
dystonia)
•Ineffective/inefficient functional movement
strategies
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13. Cardiovascular/Pulmonary
• Decreased aerobic capacity (cardiopulmonary endurance)
• Impaired circulation (lymphatic, venous, arterial)
• Pain with sustained physical activity (intermittent
claudication)
Integumentary
• Skin hypo mobility (e.g., immobile or adherent scarring)
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14. FUNCTIONAL LIMITATION
&
DISABILITY??????
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15.  FUNCTIONAL LIMITATION
• Restrictions in performance at the level of the whole
person or a physical task or activity in an efficient and
expected way
 DISABILITY
• Inability of a person to fulfill his or her desired or
necessary social or personal roles or role in a specific
socio cultural context or environment
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16. NAGI MODEL
• Introduced in 1965 by Saad Nagi, a sociologist.
• He noticed conceptual confusion in the disability
literature regarding disability and its associated
concepts.
• Nagi recognized the importance of the environment
and that family, society, and community factors could
all influence disability.
• Based on this assumption, the consequences of
disease and injury for an individual should be
described at both the level of the person and at the
level of society.
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17. THE NAGI DISABLEMENT MODEL
PATHOLOGY IMPAIRMENT
FUNCTIONAL
LIMITATION
DISABILITY
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18. Case example
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19. Case example
Dimensions
Of the model
Level of
Disablement
Patient
Scenario
pathology impairment
Functional
limitations disability
cellular Body
systems
Whole
person
Person
related
to
society
Supraspina
tus tear
Decreas
e
strength
Inability
to throw
at > 75%
maximal
effort
Inability
to fill role
as a
starting
pitcher
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20. National Center for Medical Rehabilitation
Research Disablement Model (NCMRR)
The NCMRR, is a center within the National
Institutes of Health.
The purpose is to enhance the quality of life of
people with disabilities through the development
of scientific knowledge.
The NCMRR develop a model in 1993 that
encompassed the dimensions of disablement
and adapted the Nagi model by including a
specific component related to societal influences
as contributors to disability.
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21. Continue..
 Focus was placed on how a person with a disability
adapts to functional limitations in the family, work, and
local community.
 The major difference between the Nagi and NCMRR
disablement models is that the NCMRR includes the
concept of societal limitations as a distinct dimension
of the disablement process.
 Societal limitations: refer to the restrictions resulting
from social policy or barriers, which limit fulfillment of
roles or deny access to services and opportunities
associated with full participation in society
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22. 22

23. Case example
Pathology Impairment
Functional
limitations Disability
Cellular Body
Systems
Whole
persons
Person’s
relation to
society
Barriers
Supraspinat
us tear
Decrease
strength
Inability to
throw at >
75%
maximal
effort
Inability
to fill role
as a
starting
pitcher
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Dimensions
Of the
model
Level of
Disablement
Patient
Scenario
Societal
limitations
Loss of
athletic
scholarship

24. INTERNATIONAL CLASSIFICATION OF FUNCTIONING,
DISABILITY AND HEALTH: ICF MODEL
 The most recent model
 A bio- psycho- social model of disablement
 A classification system
 The ICF model is quite different from the Nagi & NCMRR
disablement models, both conceptually & in structure
 One major emphasis in the latest ICF revision was to
remove the negative connotations associated with
disability by using more positive terms to describe its
characteristics
 Approved by the World Health Assembly in 2001 with the
goal of creating a common international language for
disability
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25. 25

26. HEALTH CONDITION
BODY STRUCTURE
AND FUNCTION
ACTIVITIES
PARTICIPATIO
N
CONTEXTUAL FACTORS
ENVIRONMENTAL FACTORS PERSONAL FACTORS
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28. 28

29. ICF BASED ON:
 FUNCTION AND DISABILITY
1. Body structure and functions
2. Activities
3. Participation
 CONTEXTUAL FACTORS
1. Environmental factors
2. Personal factors
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30. BODY STRUCTURE AND FUNCTION
 The functions of the body affected due to involvement
of specific structures. Can be easily identified through
knowledge of disease. Both physiological and
psychological functions of the body.
 Abilities as well as impairments, both are recorded
within this domain
 Example: balance impairment (function) due to
vestibular involvement ( structure)
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31. ACTIVITIES AND PARTICIPATION
 ACTIVITIES
• The functions an individual performs regularly as a
whole person rather than breakdown into functioning
of structure or system. They range from easy to hard.
 Example: Due to balance problems depending upon
the extent, the patient may not be able to walk or
stand for long, transfers might be difficult
 PARTICIPATION
• Relates to activities of a person at the level of society.
 Example: The patient will limit going outdoors. It might
make job requirements impossible to accomplish.
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32. BENEFITS OF ICF MODEL
 A unifying framework for defining rehabilitation
science and clinical rehabilitation
 It provides a framework for the assessment and
evaluation of a patient. The main factors that would
affect the prognosis are clustered in a single place for
easy reference.
 It is also a good tool in selecting subjects for research
studies. Can help in reporting rehabilitation study
results.
 Comparisons of data across countries and other
health care team.
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33. Health Condition
Spinal Cord Injury
Good trunk control,
maintain sitting
position Body
structure & function
T12
level, paraplegia,
sensory & motor
impairment, muscle
atrophy contractures,
urinary incontinence
Bed mobility like rolling,
can change position
Activity
ADLs-
Assisted bathing,
Lower body dressing &
toileting
ADLs- house
keeping, shopping,
unable to walk, balance
difficulty
Likes to involve
in house hold
activities
Participation
Avoid social
gathering
Environmental
Factors Live with her
family, uses wheel chair
for moving around
Personal Factors
45 yrs,
female, married,
house wife
ICF MODEL
(CASE
EXAMPLE)
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34. Comparison of Terminology of Three
Disablement Models
MODEL TISSUE ORGAN
LEVEL
PERSONAL
LEVEL
SOCIETAL
LEVEL
Nagi Active
pathology
Impairment Functional
limitation
Disability
ICIDH Disease Impairment Disability Handicap
ICF Impairment
of
body/struct
ure
Activity
limitation
Participation
restriction
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35. REFERENCE
• THERAPEUTIC EXERCISE 6TH
EDITION
CAROLYN KISNER LYNN ALLEN COLBY