Nagi Model
berdasarkan pada konsep
•
penyakit atau aktif patologi,
•
impairtment,
•
keterbatasan fungsi,
Nagi model
penyakit /
aktif patologi,
impairtment
keterbatasan
fungsi,
(Functional
limitation )
Nagi model
•
aktif patologi adalah interruption/ berhentinya atau interference
proses normal dan usaha organisme secara simultan untuk
memperbaikinya sendiri ke keadaan normal dengan mobilisasi
defense tubuh dan mekanisme coping,
•
impairtment adalah hilangnya atau abnormalitas anatomi,
fisiologikal, mental atau psikologikal atau fungsi;
•
keterbatasan fungsi atau restriksi kemampuan untuk melakukan
tindakan fisik, tugas atau efisiensi aktifitas, harapan khusus, atau
kompeten pada tingkat semua organisme dan person;
•
disability adalah ketidakmampuan untuk melakukan atau
keterbatasan dalam melakukan tindakan, tugas, aktifitas yang
biasanya diharapkan dalam peran social khusus untuk individu atau
diharapkan untk status person atau peran dalam konteks
WHO
•
Pada tahun 1980, World Health Organization
(WHO) dikembangkan suatu model disablement
alternative.
•
Dalam WHO International Clasification of
World Health Organization
Disability model
penyakit /
WHO MODEL
•
desease/penyakit
didefenisikan sebagai perubahan patologi yang ditunjukkan
sebagai suatu kondisi kesehatan yang berubah atau attribute status kesehatan
individu yang akan membawa pada suatu distress, interference dengan aktifitas
sehari-hari atau kontak dengan pelayanan kesehatan
.
•
Impairtment
didefenisikan sebagai perubahan abnormal pada tingkat
molecular, selular dan jaringan melalui struktur dan fungsi abnormal pada
tingkat organ;
•
disability
restriction atau kurangnya kemampuan untuk melakukan aktifitas
umum dengan cara yang normal;
•
handicap
didefenisikan sebagai ketidakmampuan untuk berfungsi pada tingkat
person to person atau pada tingkat person to lingkungan. Handicap
NCMRR (1992 )
•
National Center For Medical
Rehabilitation and Research (NCMRR)
mempublikasikan suatu model
NCMRR (1992 )
•
patofsiologi,
•
impairtment,
•
keterbatasan fungsi,
•
disability dan
NCMRR
•
Model NCMRR menolak konotasi negative
dari bentuk “handicap” dan diusulkan
untuk menggantinya dengan bentuk
“keterbatasan societal” untuk menghitung
keterbatasan – imposed by society -
membatasi kemampuan orang untuk
(IOM)
•
Pada tahun 1991, Institute Of Medicine
(IOM) menempatkan keempat model
disablement untuk menekankan
prevention, diusulkan bahwa disability
mungkin dicegah melalui control resiko
fsik dan resiko factor lingkungan social
dalam factor resiko gaya hidup dan
Physical Therapy
Practice
ICF
Health condition
Environmental
factors
Personal factors
Body functions/
Body structures
Activities
Participation
The ICF: Conceptual
ICF endorsement
•
WCPT in 2003
Grandma Smith is sufering from
rheumatoid arthritis
Def.:
Rheumatoid arthritis
:
“Rheumatoid arthritis
(
RA
) is a
chronic, systematic infammatory
disorder that may afect many
tissues and organs, but principally
attacks the joints producing an
infammatory synovitis that often
progresses to destruction of the
articular cartilage and ankylosis of
the joints.”
“The lived
experience”
1. The ICF integrative bio-psycho-social model of functioning and
disability
However:
What are the
problems and
needs in relation to the
experience living with
rheumatoid arthritis
from
the perspective of Grandma
Smith?
(ICD: M05)
Grandma Smith is sufering from
rheumatoid arthritis
Health condition
Environmental
factors
Personal
factors
Body functions/
Body structures
Activities
Participation
1. The ICF integrative bio-psycho-social model of functioning and
disability
A
health condition
is an umbrella term for disease, disorder, injury or
trauma.
A health condition may also include other circumstances, such as
ageing, stress, pregnancy, congenital anomaly, or genetic
predisposition
Health conditions may be coded using the ICD-10.
Health condition
Environmental
factors
Personal
factors
Body functions/
Body structures
Activities
Participation
1. The ICF integrative bio-psycho-social model of functioning and
disability
Body functions
are physiological functions of body systems, including
psychological functions
Body structures
are anatomical parts of the body, such as organs,
limbs and their components
Impairments
are problems in body functions or structure such as a
significant deviation or loss
Health condition
Environmental
factors
Personal
factors
Body functions/
Body structures
Activities
Participation
Tetraplegia
G83.5
1. The ICF integrative bio-psycho-social model of functioning and
disability
Physical Therapist:
Beside Mr. Wun‘s complete problems in
the lower extremity, he has partial
deficits of muscle power in the arms.
Due to his loss of movement in his legs,
he demonstrates stiffness in the muscles
and reduced mobility in the ankle joints.
As a consequence of the loss of muscle
power he has also problems with his
respiratory functions
Health condition
Environmental
factors
Personal
factors
Body
functions/
Body
structures
Activities
Participation
Tetraplegia
G83.5
muscle power in the arms
movement in his legs
stiffness in the muscles
mobility in the ankle joints
respiratory functions
1. The ICF integrative bio-psycho-social model of functioning and
disability
Health condition
Environmental
factors
Personal
factors
Activities
Participatio
n
Activity
is the execution of a task or action by an individual
Participation
is involvement in a life situation.
Activity limitations
are difficulties an individual may have in
executing activities
Participation restrictions
are problems an individual may experience
in involvement in life situation
Tetraplegia
G83.5
movements in his legs
stiffness in the muscles
muscle power in the arms
mobility in the ankle joints
respiratory functions
1. The ICF integrative bio-psycho-social model of functioning and
disability
„ My problems in daily living are
that I need much more time for
eating, and I can‘t go to the toilet.
To maintain sitting is difficult, I
always need my arms to prop up.
I can‘t go out to meet my friends,
but I still communicate to them by
phone or E-Mail.
I also started to
work on the computer, doing
translations from English to Thai
….“
Health condition
Environmental
factors
Personal
factors
Activities
Participatio
n
Tetraplegia
G83.5
eating
maintain sitting
meet my friends
work on the computer
go to the toilet
movements in his legs
stiffness in the muscles
muscle power in the arms
mobility in the ankle joints
respiratory functions
1. The ICF integrative bio-psycho-social model of functioning and
disability
Health condition
Environmental
factors
Personal
factors
Activities
Participation
Environmental factors
make up the physical, social and attitudinal
environment in which people live and conduct their lives.
These factors are external to individuals and can have a positive or
negative influence on the individual’s performance as a member of
society, on the individual’s capacity to execute actions or tasks, or on
individual’s body function or structure
Tetraplegia
G83.5
movements in his legs
stiffness in the muscles
muscle power in the arms
mobility in the ancle joints
respiratory functions
eating
maintain sitting
go to the toilet
meet my friends
work on the computer
1. The ICF integrative bio-psycho-social model of functioning and
disability
„My wheelchair is very heavy, that
makes it difficult for me to move it.
Most of the buildings outside are
not adapted for disabled. The
streets are full of obstacles;
impossible to overcome.
The support of my mother is most
important for me, additionally we
have two housekeepers who help
me all the time.
My health insurance pays for all my
hospital stays, that helps also.
Health condition
Environmental
factors
Personal
factors
Activities
Participatio
n
Tetraplegia
G83.5
movements in his legs
stiffness in the muscles
muscle power in the arms
mobility in the ancle joints
respiratory functions
eating
maintain sitting
go to the toilet
meet my friends
work on the computer
wheelchair is very heavy
buildings
streets are full of
obstacles
support of my mother
housekeepers
health insurance
1. The ICF integrative bio-psycho-social model of functioning and
disability
Health condition
Environmental
factors
Personal
factors
Activities
Participatio
n
Personal factors
are the particular background of an individual’s life
and living, and comprises features of the individual that are not part of
a health condition or health state.
These factors may include gender, race, age, other health conditions,
fitness, lifestyle, habits, coping styles, social background, education,
profession, past and current experience,…
Tetraplegia
G83.5
movements in his legs
stiffness in the muscles
muscle power in the arms
mobility in the ancle joints
respiratory functions
eating
maintain sitting
go to the toilet
meet my friends
work on the computer
housekeepers
wheelchair
buildings
streets are full of obstacles
support of my mother
health insurance
1. The ICF integrative bio-psycho-social model of functioning and
disability
Medical Doctor:
„Mr Wun is 24 years old, he
finalized his university degree
for engeneering last year.
Although his disease is severe
he is motivated to improve his
situation.
Health condition
Environmental
factors
Personal
factors
Activities
Participatio
n
Tetraplegia
G83.5
movements in his legs
stiffness in the muscles
muscle power in the arms
mobility in the ancle joints
respiratory functions
eating
maintain sitting
go to the toilet
meet my friends
work on the computer
housekeepers
wheelchair
buildings
streets are full of obstacles
support of my mother
health insurance
motivated
engeneering
university degree
24 years old
1. The ICF integrative bio-psycho-social model of functioning and
disability
Health condition
Environmental
factors
Personal factors
1. The ICF integrative bio-psycho-social model of functioning and
disability
Energy and drive functions Sleep functions
Emotional functions
Experience of self and time Sensation of pain
Haematological system functions Exercise tolerance functions Ingestion functions
Sexual functions
Mobility of joint functions Stability of joint functions Muscle power functions Muscle endurance functions Gait pattern functions
Eye, ear and related structures Structures of head and neck region Structure of upper extremity Structure of lower extremity Structure of trunk
Structure of areas of skin
Writing
Carrying out daily routine Using communication devices Changing basic body positions Maintaining a sitting position Lifting and carrying objects Fine hand use
Hand and arm use
Carrying, moving and handling objects Walking
Moving around
Moving around in different locations Moving around using eqiupment Using transportation
Driving
Washing oneself Caring for body parts Toileting
Dressing Eating Drinking
Looking after one‘s health
Acquisition of goods and services Preparing meals Doing housework Assisting others Family relationships Intimate relationships
Remunerative employment
Community life Recreation and leisureTetraplegia
G83.5
Drugs
Assistive devices
Assistive devices for mobility
Products and technology for employment Design and construction of public buildings Climate
Immediate family Health professionals Societal attitudes
Social security services, systems and policies
Age Gender Marital status Lifestyle
General life goals Expectations
Acceptance of situation Self-esteem
Self-discipline
