Download Proses Fisioterafi Pertemuan 8

ICF
Nagi Model
berdasarkan pada konsep
• penyakit atau aktif patologi,
• impairtment,
• keterbatasan fungsi,
• dan disability
Nagi model
penyakit /
aktif patologi,
impairtment
keterbatasan
fungsi,
(Functional
limitation )
Ketidak
mampuan
( Disability )
Nagi model
•
•
•
•
aktif patologi adalah interruption/ berhentinya atau interference
proses normal dan usaha organisme secara simultan untuk
memperbaikinya sendiri ke keadaan normal dengan mobilisasi
defense tubuh dan mekanisme coping,
impairtment adalah hilangnya atau abnormalitas anatomi, fisiologikal,
mental atau psikologikal atau fungsi;
keterbatasan fungsi atau restriksi kemampuan untuk melakukan
tindakan fisik, tugas atau efisiensi aktifitas, harapan khusus, atau
kompeten pada tingkat semua organisme dan person;
disability adalah ketidakmampuan untuk melakukan atau
keterbatasan dalam melakukan tindakan, tugas, aktifitas yang
biasanya diharapkan dalam peran social khusus untuk individu atau
diharapkan untk status person atau peran dalam konteks
sosiokulturan khusus dan lingkungan fisik.
WHO
• Pada tahun 1980, World Health Organization
(WHO) dikembangkan suatu model disablement
alternative.
• Dalam WHO International Clasification of
Impairtment, Disabilities and Handicaps (ICIDH),
World Health Organization
Disability model
penyakit /
disease
impairtment
Ketidak
mampuan
HANDICAPED
WHO MODEL
•
•
•
•
desease/penyakit didefenisikan sebagai perubahan patologi yang ditunjukkan
sebagai suatu kondisi kesehatan yang berubah atau attribute status kesehatan
individu yang akan membawa pada suatu distress, interference dengan
aktifitas sehari-hari atau kontak dengan pelayanan kesehatan.
Impairtment didefenisikan sebagai perubahan abnormal pada tingkat
molecular, selular dan jaringan melalui struktur dan fungsi abnormal pada
tingkat organ;
disability restriction atau kurangnya kemampuan untuk melakukan aktifitas
umum dengan cara yang normal;
handicap didefenisikan sebagai ketidakmampuan untuk berfungsi pada
tingkat person to person atau pada tingkat person to lingkungan. Handicap
menunjukkan disadvantage sosial yang berhubungan dengan impairtment atau
disability yang membatasi atau mencegah pemenuhan peran normal. WHO
merevisi formulasi original model disablement dan pada desembar 2000
mengeluarkan versi pre – final yang berjudul ICIDH 2 : International
Classification of Functioning Disability and Health.
NCMRR (1992 )
• National Center For Medical Rehabilitation
and Research (NCMRR) mempublikasikan
suatu model disablement yang diambil dari
Model Nagi dan WHO yang digunakan pada
klasifikasi :
NCMRR (1992 )
•
•
•
•
•
patofisiologi,
impairtment,
keterbatasan fungsi,
disability dan
keterbatasan social.
NCMRR
• Model NCMRR menolak konotasi negative dari
bentuk “handicap” dan diusulkan untuk
menggantinya dengan bentuk “keterbatasan
societal” untuk menghitung keterbatasan – imposed
by society - membatasi kemampuan orang untuk
berpartisipasi secara independent dalam tugas,
aktifitas dan dan peran.
(IOM)
• Pada tahun 1991, Institute Of Medicine (IOM)
menempatkan keempat model disablement untuk
menekankan prevention, diusulkan bahwa disability
mungkin dicegah melalui control resiko fisik dan
resiko factor lingkungan social dalam factor resiko
gaya hidup dan biological.
Is the ICF the pot of gold at the end of the
rainbow?
Physical Therapy Practice
ICF
The ICF
The ICF: Conceptual Model
Health condition
Body functions/ Body
structures
Environmental factors
Activities
Participation
Personal factors
ICF endorsement
• WCPT in 2003
• APTA in 2008
“The lived experience”
Grandma Smith is suffering from
rheumatoid arthritis
(ICD: M05)
Def.: Rheumatoid arthritis:
“Rheumatoid arthritis (RA) is a chronic,
systematic inflammatory disorder that may
affect many tissues and organs, but
principally attacks the joints producing an
inflammatory synovitis that often progresses
to destruction of the articular cartilage and
ankylosis of the joints.”
1. The ICFlived
integrative
bio-psycho-social model of functioning and disability
“The
experience”
Grandma Smith is suffering from
rheumatoid arthritis
(ICD: M05)
However:
What are the problems and needs in
relation to the experience living with
rheumatoid arthritis from the
perspective of Grandma Smith?
1. The ICF integrative bio-psycho-social model of functioning and disability
Case Example
Health condition
Body functions/
Body structures
Environmental
factors
Activities
Participation
Personal
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
Case Example
A health condition is an umbrella term for disease, disorder, injury or
trauma.
A health condition may also include other circumstances, such as
ageing, stress, pregnancy, congenital anomaly, or genetic
predisposition
Health conditions may be coded using the ICD-10.
Health condition
Body functions/
Body structures
Environmental
factors
Activities
Participation
Personal
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
Case Example
Body functions are physiological functions of body systems, including
psychological functions
Body structures are anatomical parts of the body, such as organs,
limbs and their components
Impairments are problems in body functions or structure such as a
significant deviation or loss
Tetraplegia
Health
condition
G83.5
Body functions/
Body structures
Environmental
factors
Activities
Participation
Personal
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
Case Example
Physical Therapist:
Beside Mr. Wun‘s complete problems in
the lower extremity, he has partial
deficits of muscle power in the arms
arms.
Due to his loss of movement in his legs
legs,
he demonstrates stiffness in the muscles
joints
and reduced mobility in the ankle joints.
As a consequence of the loss of muscle
Body functions/
power he has also problems with his
Body structures
respiratory functions
Environmental
factors
Tetraplegia
HealthG83.5
condition
Activities
Participation
Personal
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
Case Example
Activity is the execution of a task or action by an individual
Participation is involvement in a life situation.
Activity limitations are difficulties an individual may have in
executing activities
Participation restrictions are problems an individual may experience
in involvement in life situation
Tetraplegia
Health
condition
G83.5
muscle power in the arms
movements in his legs
stiffness in the muscles
mobility in the ankle joints
respiratory functions
Environmental
factors
Activities
Participation
Personal
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
Case Example
„ My problems in daily living are
that I need much more time for
eating, and I can‘t go to the toilet.
eating
toilet
To maintain sitting is difficult, I
always need my arms to prop up.
I can‘t go out to meet
meet my
my friends
friends,
but I still communicate to them by
phone or E-Mail.
I also started to
work on the computer
computer, doing
translations from English to Thai
….“
Tetraplegia
Health
condition
G83.5
muscle power in the arms
movements in his legs
stiffness in the muscles
mobility in the ankle joints
respiratory functions
Environmental
factors
Activities
Participation
Personal
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
Case Example
Environmental factors make up the physical, social and attitudinal
environment in which people live and conduct their lives.
These factors are external to individuals and can have a positive or
negative influence on the individual’s performance as a member of
society, on the individual’s capacity to execute actions or tasks, or on
individual’s body function or structure
Tetraplegia
Health
condition
G83.5
muscle power in the arms
movements in his legs
stiffness in the muscles
mobility in the ancle joints
respiratory functions
eating
goActivities
to the toilet
maintain sitting
Environmental factors
meet my friends
Participation
work
on the computer
Personal
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
Case Example
„My wheelchair is very heavy
heavy, that
makes it difficult for me to move it.
Most of the buildings outside are
not adapted for disabled. The
streets are full of obstacles;
obstacles
impossible to overcome.
The support of my mother is most
important for me, additionally we
have two housekeepers who help
me all the time.
My health insurance pays for all my
hospital stays, that helps also.
Tetraplegia
Health
condition
G83.5
muscle power in the arms
movements in his legs
stiffness in the muscles
mobility in the ancle joints
respiratory functions
Environmental factors
eating
goActivities
to the toilet
maintain sitting
meet my friends
Participation
work on the computer
Personal
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
Case Example
Personal factors are the particular background of an individual’s life
and living, and comprises features of the individual that are not part of
a health condition or health state.
These factors may include gender, race, age, other health conditions,
fitness, lifestyle, habits, coping styles, social background, education,
profession, past and current experience,…
Tetraplegia
Health
condition
G83.5
muscle power in the arms
movements in his legs
stiffness in the muscles
mobility in the ancle joints
respiratory functions
eating
go Activities
to the toilet
maintain sitting
wheelchair
Environmental
factors
buildings
streets are full of obstacles
support of my mother
housekeepers
health insurance
Personal
meet my friends
Participation
work
on the computer
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
Case Example
Medical Doctor:
„Mr Wun is 24 years old
old, he
finalized his university degree
for engeneering last year.
Although his disease is severe
he is motivated to improve his
situation.
Tetraplegia
Health
condition
G83.5
muscle power in the arms
movements in his legs
stiffness in the muscles
mobility in the ancle joints
respiratory functions
wheelchair factors
Environmental
eating
Activities
go
to the toilet
maintain sitting
buildings
streets are full of obstacles
support of my mother
housekeepers
health insurance
Personal
meet
my friends
Participation
work on the computer
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
Case Example
Tetraplegia
Health
condition
G83.5
Energy and drive functions
Sleep functions
Emotional functions
Experience of self and time
Sensation of pain
Haematological system functions
Exercise tolerance functions
Ingestion functions
Sexual functions
Mobility of joint functions
Stability of joint functions
Muscle power functions
Muscle endurance functions
Gait pattern functions
Eye, ear and related structures
Structures of head and neck region
Structure of upper extremity
Structure of lower extremity
Structure of trunk
Structure of areas of skin
Environmental
factors
Writing
Carrying out daily routine
Using communication devices
Changing basic body positions
Maintaining a sitting position
Lifting and carrying objects
Fine hand use
Hand and arm use
Carrying, moving and handling objects
Walking
Moving around
Moving around in different locations
Moving around using eqiupment
Using transportation
Driving
Washing oneself
Caring for body parts
Toileting
Dressing
Eating
Drinking
Looking after one‘s health
Drugs
Assistive devices
Assistive devices for mobility
Products and technology for employment
Design and construction of public buildings
Climate
Immediate family
Health professionals
Societal attitudes
Social security services, systems and policies
Acquisition of goods and services
Preparing meals
Doing housework
Assisting others
Family relationships
Intimate relationships
Remunerative employment
Community life
Recreation and leisure
Age
Gender
Personal
factors
Marital status
Lifestyle
General life goals
Expectations
Acceptance of situation
Self-esteem
Self-discipline