NDT Enablement Classification Model of Health and Disability Mary Rose Franjoine, PT, DPT, MS, PCS...

NDT Enablement Classification Model of Health and Disability

Mary Rose Franjoine, PT, DPT, MS, PCS

Margo Prim Haynes, PT, DPT, MA, PCS

2009 M R Franjoine & M P Haynes 2

Readings & ReferencesRequired Reading:• Neuro-Developmental Treatment Approach Theoretical

Foundations and Principles of Clinical PracticeChapter 2

References:• www.who.org• Neuro-Developmental Treatment Approach Theoretical

Foundations and Principles of Clinical Practice Assignment:• Study Guide:

– Learning Activity 2.1.1 (pg 83-85)– Learning Activity 1.1.5 (pg 91)

http://www.who.org/

2009 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


Enablement Frameworks, WHY?

• Universal, all inclusive model

• Multi-dimensional

• Cross Cultural

• Social and Medical



Dimension Functional Domain Disability Domain

A. Body structure & functions

Structural & functional integrity

Impairments

A.Primary

B.Secondary

B. Motor functions Effective posture & movement

Ineffective posture & movement

C. Individual functions

Functional activities Functional activity limitations

D. Social functions Participation Participation restriction

+ Domains -

Dim

ensi

ons

From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82


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”


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


Functional Activities

• Directly observable functions• Performance of a task or action by

the individual.• Example:

Able to get the toy


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


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


Is the Posture and Movement Behavior Effective or Ineffective?Consider:• Alignment• Weight bearing• Postural Control• Balance• Coordination• Motor planning

– Temporal– Spatial

• Tone• Movement combinations


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


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


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


Impairments

Problems in a body function or structure

• Single system impairments • Multi-system impairments • Can be temporary or permanent• Can change over time

ProgressionRegression


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


Secondary Impairments

• Can be single or multi-system

• Are an indirect result of the Body Function or

• Body Structure injury, dysfunction, or absence.


ExamplesNeuromuscular 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


ExamplesNeuromuscular System

Primary Negative Impairments

• Insufficient force generation (weakness)

• Impaired anticipatory balance

• Hypokinesia

• No fractionated movements


ExamplesSensory - Perceptual SystemPrimary Positive Impairments

• Inaccurate Registration

• Inaccurate Modulation

• Inaccurate Response


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


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


Mary Rose Franjoine, PT, DPT, MS, PCS

Margo Prim Haynes, PT, DPT, MA, PCS

NDT Enablement Classification Model of Health and Disability Mary Rose Franjoine, PT, DPT, MS, PCS...

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