NDT Enablement Classification Model of Health and Disability Mary Rose Franjoine, PT, DPT, MS, PCS Margo Prim Haynes, PT, DPT, MA, PCS

2009M R Franjoine & M P Haynes2 Readings & References Required Reading: Neuro-Developmental Treatment Approach Theoretical Foundations and Principles of Clinical Practice Chapter 2 References: Neuro-Developmental Treatment Approach Theoretical Foundations and Principles of Clinical Practice Assignment: Study Guide: –Learning Activity (pg 83-85) –Learning Activity (pg 91)

3 Evolutionary Process Disablement Models WHO & Nagi Disablement frameworks NCMRR Disablement Model –Pathophysiology –Impairments –Functional Limitations – Disability –Societal Limitations Enablement Models International Classification of Function, Disability, and Health NDT Enablement Classification Model of Health and Disability

2009M R Franjoine & M P Haynes4 Enablement Frameworks, WHY? Universal, all inclusive model Multi-dimensional Cross Cultural Social and Medical

2009M R Franjoine & M P Haynes5 NDT Enablement Classification Model of Health and Disability DimensionFunctional DomainDisability Domain A. Body structure & functions Structural & functional integrity Impairments A.Primary B.Secondary B. Motor functionsEffective posture & movement Ineffective posture & movement C. Individual functions Functional activitiesFunctional activity limitations D. Social functionsParticipationParticipation restriction + Domains - Dimensions From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82

2009M R Franjoine & M P Haynes6 Participation Nature and extent of a person’s involvement in life situations Example: Going to the mall on Saturday afternoon with your friends to “hang”

2009M R Franjoine & M P Haynes7 Participation Restrictions Problem an individual may have in the manner or extent of involvement in life Example: Can’t “hang” at the mall on Saturday afternoon, because: Can’t walk fast enough Can’t walk safe enough Can’t walk and talk

2009M R Franjoine & M P Haynes8 Functional Activities Directly observable functions Performance of a task or action by the individual. Example: Able to get the toy

2009M R Franjoine & M P Haynes9 Functional Limitations Difficulties or inability an individual may have in performing a task or function. Example: Unable to get the toy Can’t roll over to get toy Can’t belly crawl to get the toy Can’t reach to get the toy

2009M R Franjoine & M P Haynes10 Posture & Movement Behaviors Directly observable Interaction of the systems & the environment Examples: Sitting with PPT Reaching overhead with IR in shoulder, pronated forearm, and fisted hand Toe walking Rib cage elevation during expiration

2009M R Franjoine & M P Haynes11 Is the Posture and Movement Behavior Effective or Ineffective? Consider: Alignment Weight bearing Postural Control Balance Coordination Motor planning –Temporal –Spatial Tone Movement combinations

2009M R Franjoine & M P Haynes12 Single Systems Body Functions –The physiological or psychological functions of the body system Body Structure –The anatomical parts of the body such as organs, limbs and their components

2009M R Franjoine & M P Haynes13 Body Functions Mental function Sensory function and pain Voice and Speech functions Functions of Cardiovascular, Hematological, Immunological and Respiratory systems Functions of the Digestive, Metabolic and Endocrine systems Genitounitary and Reproductive functions Neuromusculoskeletal and Movement-related functions Functions of the Skin and related structures

2009M R Franjoine & M P Haynes14 Body Structures Structures of the nervous system The eye, ear and related structures Structures involved in voice and speech Structures related to the Cardiovascular, Hematological, Immunological and Respiratory systems Structures related to the Digestive, Metabolic and Endocrine systems Structures related to the Genitounitary and Reproductive systems Structures related to Movement Skin and related structures

2009M R Franjoine & M P Haynes15 Impairments Problems in a body function or structure Single system impairments Multi-system impairments Can be temporary or permanent Can change over time Progression Regression

2009M R Franjoine & M P Haynes16 Primary Impairments Can be single or multi-system Are a direct result of the Body Function or Body Structure injury, dysfunction, or absence. Positive Behaviors that are present Negative Behaviors that are absent

2009M R Franjoine & M P Haynes17 Secondary Impairments Can be single or multi-system Are an indirect result of the Body Function or Body Structure injury, dysfunction, or absence.

2009M R Franjoine & M P Haynes18 Examples Neuromuscular System Primary Positive Impairments Spasticity Impaired muscle activation Excessive co-activation Stereotypic, atypical movement synergies Impaired motor execution Incorrect scaling of muscle force Inter-limb and Intra-limb dyscoordination

2009M R Franjoine & M P Haynes19 Examples Neuromuscular System Primary Negative Impairments Insufficient force generation (weakness) Impaired anticipatory balance Hypokinesia No fractionated movements

2009M R Franjoine & M P Haynes20 Examples Sensory - Perceptual System Primary Positive Impairments Inaccurate Registration Inaccurate Modulation Inaccurate Response

2009M R Franjoine & M P Haynes21 Contextual Factors Environmental  Physical, social, and attitudinal environment in which people live and function.  Examples: Facilitators Excellent medical coverage for AT Barriers A home environment where children are to be quiet and well behaved at all times Personal  Features of the individual that are not part of a health condition or functional state.  Examples: Facilitators Outgoing personality Barriers Shy, quiet

2009M R Franjoine & M P Haynes22 Contextual Factors Can interact at any level within the model Can come from within the person From the family Can be cultural Can be environmental

NDT Enablement Classification Model of Health and Disability Mary Rose Franjoine, PT, DPT, MS, PCS Margo Prim Haynes, PT, DPT, MA, PCS