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

2. Readings & References Required Reading: • Neuro-Developmental Treatment Approach Theoretical Foundations and Principles of Clinical Practice Chapter 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) M R Franjoine & M P Haynes

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

4. Enablement Frameworks, WHY? • Universal, all inclusive model • Multi-dimensional • Cross Cultural • Social and Medical M R Franjoine & M P Haynes

5. + Domains - Dimensions NDT Enablement Classification Model of Health and Disability From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82 M R Franjoine & M P Haynes

6. 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” M R Franjoine & M P Haynes

7. 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 M R Franjoine & M P Haynes

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

9. 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 M R Franjoine & M P Haynes

10. 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 M R Franjoine & M P Haynes

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

12. 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 M R Franjoine & M P Haynes

13. 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 M R Franjoine & M P Haynes

14. 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 M R Franjoine & M P Haynes

15. 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 M R Franjoine & M P Haynes

16. 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 M R Franjoine & M P Haynes

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

18. ExamplesNeuromuscular SystemPrimary 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 M R Franjoine & M P Haynes

19. ExamplesNeuromuscular SystemPrimary Negative Impairments • Insufficient force generation (weakness) • Impaired anticipatory balance • Hypokinesia • No fractionated movements M R Franjoine & M P Haynes

20. ExamplesSensory - Perceptual SystemPrimary Positive Impairments • Inaccurate Registration • Inaccurate Modulation • Inaccurate Response M R Franjoine & M P Haynes

21. 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 M R Franjoine & M P Haynes

22. 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 M R Franjoine & M P Haynes

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