The document discusses conceptual models of disability, defining disease as a biological disorder that may or may not lead to impairment, which is the loss of body structure or function. Disability is characterized by limitations in activities and participation due to health conditions or impairments and is often variable over time. The biopsychosocial model, introduced by George Engel, emphasizes a holistic approach to understanding medical conditions by considering biological, psychological, and social factors, guiding rehabilitation efforts toward optimizing individual function and participation.

1. CONCEPTUAL MODELS OF
DISABILITY

2. • Disease is a disorder of structure or function of the human organism that deviates
from the biological norm.
• it includes biochemical, physiological or anatomical abnormalities, which can result
from congenital, traumatic, infective, inflammatory, degenerative or other
pathological processes.
• the key features of disease are that it may be evaluated more objectively, at an
organic level, in the individual, and as a matter of medical diagnosis (who 1980,
boyd 2000). disease may or may not lead to impairment, and does not necessarily
cause symptoms, illness, disability or incapacity.

3. • Impairment is significant deviation or loss of body structure or function (i.e.
impairment can be anatomical or physiological) in a person with a health condition
or disease (who 1980, 2001, ama 2007).
• The key feature is that impairment is a matter of objective evidence: ‘detectable ...
by direct observation or by inference from observation’ (who 2001).
• The us social security administration operationalizes this as ‘demonstrable by
medically acceptable, clinical and laboratory diagnostic techniques’ (ssa 2001).
• Note that impairment is not the same as the underlying disease, but is the
manifestation(s) of the disease.

4. • Disability is limitation of activities and/or restriction of participation in
life situations in a person with a health condition or impairment (boyd
2000, who 2001, ama 2007).
• Disability is often assumed to be permanent, but in reality is often
dynamic and fluctuates over time (burchardt 2000, howard 2003).

5. • Models of disability and functioning are tools that are used to define
impairment and more recently functioning, which are utilised by
governments and society to devise strategies and policies for meeting
the needs of those who have a loss in function as a result of health
conditions, disease or injury.
• These models reveal or reflect how society provides or limits access to
work, goods, services, economic influence and political power for
people with a disability or loss of function, and provide some insight
into the attitudes, conceptions and prejudices in society.

6. BIOPSYCHOSOCIAL MODEL
• The biopsychosocial model was first conceptualised by george engel in
1977, suggesting that to understand a person's medical condition it is
not simply the biological factors to consider, but also the psychological
and social factors.
• Bio (physiological pathology)
• Psycho (thoughts emotions and behaviours such as psychological
distress, fear/avoidance beliefs, current coping methods and
attribution)
• Social (socio-economical, socio-environmental, and cultural factors suchs
as work issues, family circumstances and benefits/economics)

8. • Traditionally within a medical model the primary skills of a doctor are
most often in the area of pathology and impairment, whereas those of
the health and social care professionals are more based on activity
and participation, while within this biopsychosocial model the
rehabilitation team should to be able to take an informed overview
considering the whole person, and ensure a holistic approach to
rehabilitation that is person centred.

9. • The World Health Organisation’s International Classification of Functioning,
disability and health is underpinned by the biopsychosocial model.
• Rehabilitation psychology should focus on function, which is considered an umbrella
term for body functions, body structures, activities and participation. it denotes the
positive aspects of the interaction between an individual (with a health condition)
and that individual’s contextual factors (environmental and personal factors) and
focuses on activity and participation, attempting to optimise these according to
what is felt to be most important by the individual involved, determined through
goal setting. while elements of pathology and impairment may need to be
addressed, the overall aim or goal should be based at the level of activity or
participation in order to "optimise function"