STANDARD TERMINOLOGY AND CLASSIFICATION OF
DISABLEMENT
WHO GOAL
Concensus on nomenclature in relation to disability and other consequences of disease.
Adoption and widespread use of a consistent & comparable terminology, which is essential to improve the meaning & usefulness of data collection & analysis for various purposes by health organizations.
WORLD HEALTH ORGANIZATION (WHO) (1980) IMPAIRMENTS DISABILITIES HANDICAPS
NAGI (1965)
PATHOLOGY IMPAIRMENTS FUNCTIONAL LIMITATIONS DISABILITIES
NATIONAL CENTER FOR MEDICAL REHABILITATION RESEARCH (NATIONAL ADVISORY BOARD ON MEDICAL REHABILITATION RESEARCH, 1992) NCMRR
PATHOPHYSIOLOGY
IMPAIRMENTS
FUNCTIONAL LIMITATIONS
DISABILITIES
SOCIETAL LIMITATIONS
LOIS BLY 6/94
STANDARD TERMINOLOGY AND CLASSIFICATION OF DISABLEMENT
TRADITIONAL MEDICAL MODEL
ETIOLOGY---> PATHOLOGY---> MANIFESTATIONS
WORLD HEALTH ORGANIZATION (WHO) (1980)
DISEASE (DISORDER)---> IMPAIRMENT---> DISABILITY---> HANDICAPS
NAGI (1965)
PATHOLOGY (DISEASE)-> IMPAIRMENT--> FUNCTIONAL LIMITATIONS> DISABILITIES
IMPAIRMENT: any loss or anatomic, physiologic, or psychologic structure or function.
FUNCTIONAL LIMITATION: Inability to perform a task or obligation of usual roles and typical daily activities as the result of impairment.
DISABILITY: The International Classification of Impairments, Disabilities and Handicaps defines "disability" in terms of the preceding definition of "functional limitation". Nagi limits the term "disability" to overall patterns of behavior in situations of long-term or continued impairments that result in functional limitations.
HANDICAP: The Social disadvantage of a disability.
Lois Bly 6/94
NATIONALCENTER FOR MEDICAL REHABILITATION RESEARCH (NATIONAL ADVISORY BOARD ON MEDICAL REHABILITATION RESEARCH, 1992) NCMRR
PATHOPHYSIOLOGY > IMPAIRMENT-> FUNCTIONAL-> DISABILITIES > SOCIETAL
LIMITATIONSLIMITATIONS
PATHOPHYSIOLOGY the underlying medical or injury processes at the cellular and tissue level.
IMPAIRMENT present at this level are the organ and system disorders that will potentially impair functioning at the organism or person level. Impairments are not necessarily recognized in the lesioned area, but result from it.
Sensorimotor impairments may include:
-lack of sensation
-total or partial denervation of muscles
-muscle atrophy
-decreased force and power output by the neuromuscular system
-poor selective control of movements
-poor anticipatory regulation of postural set of movement
-impaired balance
-impaired efficiency
-impaired endurance
-impaired coordination of movement
-impaired strength and range of motion
SECONDARY IMPAIRMENTS - contractures and deformities
FUNCTIONAL LIMITATIONS - the combination of impairments in one or more systems may lead to functional limitations which involve whole body function.
-slow and inefficient gait
-tendency to lose one's sitting balance while using the arms for dressing
-poor endurance in gait
-poor balance in gait
DISABILITIES - Disabilities result when functional limitation persist over long periods of time and are not remediable or cannot be compensated for by use of assistive devices or orthotics.
-failure to accomplish normal life roles
-e.g. participation in school, play, of family activities
-quality of life may be seriously affected
-lack of independence in dressing or mobility
-learning problems because of perceptual impairments
-inability to participate in sports with able-bodied peers
HANDICAP OR SOCIETAL LIMITATIONS - Handicaps result when societal barriers prevent an
individual from functioning at the highest level of which s/he is capable.y
-architectural barriers to mobility
-inability to attend a day care center because of rules that exclude children who are incontinent
-need for special equipment that is prohibitively expensive or not covered by insurance.
REFERENCES
Duckworth, D: the Need for a Standard Terminology and Classification of Disablement,
World Health Organization: International Classification of Impairments, Disabilities, and Handicaps. Geneva, World Health Organization, 1980.
Nagi SZ: Some Conceptual Issues in Disability and Rehabilitation. In Sussman MB: Sociology and Rehabilitation. Ohio State University Press, Ohio, 1965.
Palisano R, Campbell SK, Harris SR: Clinical decision-Making in Pediatric Physical Therapy. In Campbell SK, Linden DV, Palisano R: Physical Therapy for Children. WB Saunders, Philadelphia, in press.
Guccione AA: Physical Therapy Diagnosis and the Relationship Between Impairments and Function. Physical Therapy, 71: 499-504, 1991.
Guccione AA: Health Status: A Conceptual Framework and Terminology for Assessment. pp102-111.
Schenkman M, Butler RB: A Model for Multisystem Evaluation, Interpretation, and Treatment of Individuals with Neurological Dysfunction. Physical Therapy, 69:538-547, 1989.