Pathway to Disability: The Nagi Model Courtney Hall, PT, PhD Atlanta VAMC Emory University

Please Note : Jane Gain is referred to as Joyce throughout this lecture.

Pathway to Disability: Nagi Model Disease/ Pathology Functional Limitation DisabilityImpairment

The Nagi Model Revised Disease/ Pathology Functional Limitation Disability Lifestyle/ Inactivity Impairment

Disease/Pathology  Underlying pathologic condition that interferes with normal bodily function or structure  e.g., stroke, osteoarthritis

Impairment  Loss or abnormality at the tissue, organ, or body system level  The physiological or psychological consequences  Impairment can be primary or secondary to pathology  e.g., sensory deficit or abnormal muscle tone after a stroke

Functional Limitation  Restrictions in performance at the level of the whole person  e.g., limitations in gait following stroke

Disability  Limitations in performance of socially defined roles and tasks within a sociocultural and physical environment  Includes work, school, recreation, personal care

Disability  Not all impairments or functional limitations result in disability  Similar patterns of disability may result from different impairments and functional limitations

Measuring Disease and Lifestyle Disease/ Pathology Functional Limitation Disability Lifestyle/ Inactivity Impairment Health/Activity Questionnaire

Gender: Male Female Age: 71 Have you ever been diagnosed as having any of the following conditions? Heart attack Respiratory disease Neuropathies Arthritis Inner ear problems Depression FALL PROOF TM PROGRAM Health/Activity Information Jane (Case Study 1)

List all medications that you currently take: AlbuterolAllopurinol Asthma CortK-Dur LasixBeconase Synthroid How many times have you fallen within the past year? 2 FALL PROOF TM PROGRAM Health/Activity Information Jane (Case Study 1)

In a typical week, how often do you leave your house? less than once/week 3-4 times/week 1-2 times/week most every day Do you currently participate in regular physical exercise that causes an increase in breathing, heart rate, or perspiration? Yes No If yes, how many days per week? FALL PROOF TM PROGRAM Health/Activity Information Jane (Case Study 1)

When you go for walks, which of the following best describes your walking pace: Strolling (easy pace) Average or normal Fairly brisk (fast pace) Do not go for walks on a regular basis FALL PROOF TM PROGRAM Health/Activity Information Jane (Case Study 1)

Measuring Impairment Disease/ Pathology Functional Limitation Disability Lifestyle/ Inactivity Impairment Senior Fitness Test M-CTSIB Health Activity Questionnaire

Do you currently suffer any of the following symptoms in your legs or feet? Numbness Tingling Arthritis Swelling FALL PROOF TM PROGRAM Health/Activity Information Jane (Case Study 1)

Disease/ Pathology Functional Limitation Disability Lifestyle/ Inactivity Impairment BBS or FAB scale 50’ walk/ walkie- talkie Measuring Functional Limitation

Do you use an assistive device for walking? No Yes Type? FALL PROOF TM PROGRAM Health/Activity Information Jane (Case Study 1)

Disease/ Pathology Functional Limitation Disability Lifestyle/ Inactivity Impairment CPF Scale Measuring Disability

Disability - Composite Physical Function Scale Jane (Case Study 1) Take care of personal needs Bathe yourself Climb a flight of stairs Walk outside 1-2 blocks Do light household activities Please indicate your ability to do each of the following: Can Can do with Cannot do difficulty or help do

Disability - Composite Physical Function Scale Jane (Case Study 1) Do own shopping Walk 1/2 mile Walk 1 mile Lift and carry 10 pounds Lift and carry 25 pounds Please indicate your ability to do each of the following: Can Can do with Cannot do difficulty or help do

Disability - Composite Physical Function Scale Jane (Case Study 1) Do most heavy household chores Do strenuous activities CPF Score = 7/24 indicating low-functioning Please indicate your ability to do each of the following: Can Can do with Cannot do difficulty or help do

Disability- Composite Physical Function Scale- Jan (Case Study 1) Do you currently require household or nursing assistance to carry out daily activities? No Yes If yes, please check the reason (s)? a. Health problems b. Chronic pain c. Lack of strength or endurance d. Lack of flexibility or balance