Disablement Process and Pathology Quiz

Disablement Process

• Disablement refers to the effects of health conditions, injuries, or developmental abnormalities on a person's ability to function in society.
• Physical therapists primarily work with individuals experiencing physical disabilities but social, emotional, and cognitive disabilities significantly influence physical function.
• The disablement process is understood through models that illustrate the interconnectedness of pathology, impairments, functional limitations, and disability.

Pathology/Pathophysiology

• Pathology is the initial disruption of the body's equilibrium, often caused by diseases, disorders, or conditions.
• It is characterized by abnormal signs and symptoms reflecting alterations in the structure or function of the body at the cellular level.
• Medical intervention typically follows the identification and classification of these abnormalities, leading to a medical diagnosis.

Impairments

• Impairments represent the consequences of pathology manifested as signs and symptoms affecting body systems, organs, or tissues.
• They can be classified based on anatomical, physiological, or psychological alterations, including losses or abnormalities in structure or function.
• Physical therapists primarily treat impairments affecting the musculoskeletal, neuromuscular, cardiovascular/pulmonary, and integumentary systems.

Common Physical Impairments

• Musculoskeletal Impairments:
  • Pain
  • Muscle weakness
  • Decreased muscular endurance
  • Limited range of motion due to various factors like joint capsule restriction, periarticular connective tissue restriction, decreased muscle length, joint hypermobility, and postural problems.
  • Muscle length/strength imbalances.
• Neuromuscular Impairments:
  • Pain
  • Impaired balance, postural stability, or control
  • Incoordination and faulty timing
  • Delayed motor development
  • Abnormal tone (hypotonia, hypertonia, dystonia)
  • Ineffective/inefficient functional movement strategies.
• Cardiovascular/Pulmonary Impairments:
  • Decreased aerobic capacity
  • Impaired circulation
  • Pain with sustained physical activity.
• Integumentary Impairments:
  • Skin hypomobility (e.g., immobile or adherent scarring).

Functional Limitations

• Functional limitations occur at the level of the whole person, resulting from impairments and impacting a person's ability to perform actions or motor skills efficiently.
• For example, restricted shoulder range of motion (impairment) due to pain can limit a person's ability to reach overhead (functional limitation).
• Functional limitations in the physical domain relate to sensorimotor tasks, encompassing activities of daily living (ADL) like bathing, dressing, feeding, and more complex instrumental activities of daily living (IADL) like occupational tasks, housekeeping, and recreational activities, including community mobility.

Evidence-Based Practice

• Evidence-based practice emphasizes the conscientious use of the best available evidence to make informed decisions about patient care.
• It combines knowledge from research with the expertise of the clinician and the patient's values, goals, and circumstances.
• The process involves:
  • Identifying a patient problem and formulating a specific question.
  • Conducting a literature search to collect relevant scientific studies.
  • Critically analyzing the evidence to assess its quality and applicability.
  • Integrating the evidence with clinical expertise and patient values to make decisions.
  • Implementing findings into patient management.
  • Evaluating the outcomes of interventions and revising strategies as needed.

Patient Management Model

• The patient management model is a comprehensive approach guiding physical therapists through systematic steps for optimizing patient outcomes.
• It involves five components:
  • A comprehensive examination to gather information about the patient's problem.
  • Evaluation of collected data.
  • Diagnosis based on impairments, functional limitations, and disability.
  • Prognosis and plan of care based on patient-oriented goals.
  • Implementation of appropriate interventions.

Examination

• The examination process involves obtaining information through:
  • Patient health history (subjective and objective information).
  • Systems review (screening of body systems, including cardiovascular/pulmonary, integumentary, musculoskeletal, neuromuscular, and potentially gastrointestinal and genitourinary systems).
  • Specific tests and measures to provide in-depth information about impairments, functional limitations, and disabilities.

Intervention

• Interventions are purposeful interactions between a therapist and a patient, and they include:
  • Coordination, communication, and documentation (written reports, home exercise programs, communication with other healthcare professionals).
  • Procedural interventions (therapeutic exercise, functional training, and adjunctive modalities).
  • Patient-related instruction (education and guidance).

Procedural Interventions

• Procedural interventions focus on specific treatment procedures.
• Traditionally, these interventions aimed at reducing or correcting impairments.
  • Focus on the improvement of physical performance measures like strength, mobility, and balance.
• Current practice emphasizes task-specific exercises that mimic the patient's intended functional activities.

Overall Goal: Reduce functional limitations, enhance a patient's health-related quality of life, and promote participation in desired activities.