Definition
Disablement is a term that refers to the impact(s) and functional consequences of acute or chronic conditions, such as disease, injury, and congenital or developmental abnormalities, on specific body systems that compromise basic human performance and an individual’s ability to meet necessary, customary, expected, and desired societal functions and roles.60,86,143 Physical therapists most commonly provide care and services to people with physical disability. Social, emotional, and cognitive disablement can affect physical function and vice versa and, therefore, should not be disregarded or dismissed.58,60
Implications in Health Care
Knowledge of the process of disablement provides a foundation for health-care professionals to develop an preciation of the complex relationships among function, disability, and health.62,132
This knowledge, in turn, provides a theoretical framework upon which practice can be organized and research can be based, thus facilitating effective management and care of patients that is reflected by meaningful functional outcomes.
Inherent in the integration and application of knowledge of the disablement process in health-care delivery is an understanding that the process is not unidirectional; that is, it is not necessarily unpreventable or irreversible.14 Furthermore, it is assumed that in most instances, depending on factors such as the severity and duration of the pathological condition, a patient’s access to quality health care as well as the motivation and desires of the patient, the progression of the process can indeed be altered and the patient’s function improved.
An understanding and application of the disablement process shifts the focus of patient management from strict treatment of a disease or injury to treatment of the impact that a disease, injury, or disorder has on a patient’s function as well as the identification of the underlying causes of the patient’s dysfunction. This perspective puts the person, not solely the disease or disorder, at the center of efforts to prevent or halt the progression of disablement by employing interventions that improve a patient’s functional abilities while simultaneously reducing or eliminating the causes of disability.
Models of Disablement
Several models that depict the process of disablement have been proposed over the past 40 years. The first two schema developed were the Nagi model and the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) model for the World Health Organization (WHO). The ICIDH model was revised after its original publication, with adjustments made in the descriptions of the classification criteria of the model based on input from health-care practitioners as they became familiar with the original model. The National Center for Medical Rehabilitation Research (NCMRR) integrated components of the Nagi model with the original ICIDH model to develop its own model. The NCMRR model added interactions of individual risk factors, including physical and social factors, to the disablement process. Although each of these models uses slightly different terminology, each reflects a spectrum of disablement. Several sources in the literature have discussed or com[1]pared and contrasted the terminology and descriptors used in these and other models. Despite the variations in these models, each taxonomy reflects the complex interrelationships among the following.
- Acute or chronic pathology
- Impairments
- Functional limitations
- Disabilities, handicaps, or societal limitations.
The conceptual frameworks of the Nagi, ICIDH, and NCMRR models of disablement, although applied widely in clinical practice and research in many health-care professions, have been criticized for their perceived focus on disease and a medical-biological view of disability as well as their lack of attention to the person with a disability.21 In response to these criticisms, the WHO undertook a broad revision of its conceptual framework and system for classifying disability described in its ICIDH model. Through a
comprehensive consensus process over a number of years, the WHO developed the International Classification of Functioning, Disability, and Health (ICF). This new conceptual model integrates functioning and disability and is characterized as a bio-psycho-social model of disablement that provides a coherent perspective of various aspects of health. The revised model was also designed to place less emphasis on disease and greater emphasis on how people affected by health conditions live.
The ICF model consists of the following components of health and health-related influences.
- Impairment of body structure (anatomical) and function (physiological)
- Activity limitation
- Participation restriction
- Impact of contextual factors (environmental and personal) on functioning, disability, and health
