(1) THE DEVELOPMENT OF A PERSON TO

THE FULLEST PHYSICAL, PSYCHOLOGICAL,

SOCIAL, VOCASIONAL AND EDUCATIONAL
POTENTIAL CONSISTENT WITH HIS OR HER
PHYSIOLOGICAL OR ANATOMICAL
IMPAIRMENT AND ENVIRONMENTAL
LIMITATION
(2) THE RESTORATION OF FUNCTION SO
THAT THE PERSONS CAN PERFORM TO
THEIR FULLEST PHYSICAL, EMOTIONAL,
SOCIAL AND VOCATIONAL POTENTIAL.
 IMPAIRMENT : ANY LOSS OR ABNORMALITY OF
PSYCHOLOGICAL, PHYSIOLOGICAL, OR ANATOMICAL STRUCTURE
OR FUNCTION

 DISABILITY : ANY RESTRICTION OF LACK RESULTING FROM AN

IMPAIRMENT OF THE ABILITY TO PERFORM AN ACTIVITY IN THE
MANNER OR WITHIN THE RANGE CONSIDERED NORMAL FOR A
HUMAN BEING

 HANDICAP : A DISADVANTAGE FOR A GIVEN INDIVIDUAL,

RESULTING FROM AN IMPAIRMENT OR A DISABILITY, THAT LIMITS
OR PREVENTS THE FULFILLMENT (DEPENDING ON THE AGE, SEX
AND SOCIAL-CULTURE FACTORS) OF A ROLE THAT IS NORMAL FOR
THAT INDIVIDUAL
 IMPAIRMENT : ANY LOSS OR ABNORMALITY OF BODY
STRUCTURE OR OF A PHYSIOLOGICAL OR PSYCHOLOGICAL
FUNCTION (ESSENTIALLY UNCHANGED FROM 1980 DEFINITION)

 ACTIVITY : THE NATURE AND EXTENT OF FUNCTIONING AT THE

LEVEL OF THE PERSON

 PARTICIPATION: THE NATURE AND EXTENT OF A PERSON’S

INVOLVEMENT IN LIFE SITUATIONS IN RELATIONSHIP TO
IMPAIRMENTS, ACTIVITIES, HEALTH CONDITIONS, AND
CONTEXTUAL FACTORS
 THE GENERAL ORIENTATION OF THE MEDICAL
MODEL IS TOWARD DISEASE, WHILE THAT OF
REHABILITATION MEDICINE IS TOWARD
DISABILITY

 DISEASE : INTERACTION OF A
PATHOLOGICAL PROCESS WITH INDIVIDUAL
MOLECULES, CELLS AND ORGANS (BIOLOGICAL
EVENT)
 DISABILITY, HOWEVER , IS ESSENTIALLY A
HUMAN EVENT

  HOW THE DISEASE CAN AFFECT THE HUMAN

LIFE?
 PATIENT ENVIRONMENT

DISEASE SOCIAL

PSYCHOLOGICAL VOCATIONAL
RESPONSE

TOTAL
DISABILITY
 REHABILITATION MODEL :
MEDICAL MODEL : ALSO ENCOMPASS THESE
TENDS TO BE ACTIVE FUNCTION BUT EXTENDS TO
INCLUDE HELPING THE
PATIENTS ADJUST TO THE
DISABILITY AND PROBLEM
SOLVING TO MINIMIZE THE
FUNCTIONAL LOSS FROM A
LONG TERM, CHRONIC
CONDITION
MEDICAL MODEL : REHABILITATION MODEL:
PATIENT OFTEN PATIENTS IS ENCOURAGE
PASSIVE AND TO BE AN ACTIVE,
UNINFORMED, WITH INFORMED PARTICIPANT
DIAGNOSTIC AND
THERAPEUTIC
MEASURES DONE OR
GIVEN TO HIM
MEDICAL MODEL REHABILITATION MODEL
ON TREATMENT ON THE MANAGEMENT *

* MANAGEMENT IS DEFINED AS EFFECTING RELIEF FROM

ILLNESS OR DISABILITY AND ENHANCING FUNCTION,
USING THE FULL RESOURCES OF THE HEALTH CARE
SYSTEM
 IN THE MEDICAL SPECIALTY OF PHYSICAL
MEDICINE AND REHABILITATION, DIAGNOSING
THE DISEASE IS ONLY THE FIRST STEP IN
EVALUATING A PATIENT.

 THIS DIAGNOSIS DOES NOT REVEAL WHAT

FUNCTIONS ARE LOST AS THE RESULT OF THE
DISEASE OR INJURY
 THE SYMPTOMS AND SIGNS REQUIRED FOR
THE DIAGNOSIS OF DISABILITY DIFFER FROM
THOSE REQUIRED FOR THE DIAGNOSIS OF
DISEASE

 THERE IS NOT A ONE TO ONE CORRELATION

BETWEEN A DISEASE AND THE RANGE OF
ASSOCIATED DISABILITY PROBLEMS, THE
DISABILITY IS DEPENDENT ON THE PATIENT’S
TOTAL DAILY NEEDS
 THERE IS NOT A ONE- TO- ONE RELATIONSHIP
BETWEEN A DISEASE AND THE AMOUNT OF
RESIDUAL DISABILITY , DISABILITY CAN BE
REMOVED WITHOUT ALTERING THE COURSE OF
THE DISEASE

 THE ABILITY OF THE PATIENT AND THE

PHYSICIAN TO REMOVE DISABILITY IN THE
FACE OF CHRONIC DISEASE IS DEPENDENT ON
THE RESIDUAL CAPACITY OF THE PATIENT FOR
PHYSIOLOGICAL AND PSYCHOLOGICAL
ADAPTATION
 DISABILITY MEANS LOST OF FUNCTION, NOT
ONLY PHYSICAL BUT ALSO PSYCHOSOCIAL-
VOCATIONAL
 THE DISABILITY IS DEPENDENT ON THE
PATIENTS’S TOTAL REQUIREMENTS.

 THE PATIENT’S RESIDUAL STRENGTH

MUST BE EVALUATED AND BUILT UPON TO
“WORK AROUND” IMPAIRMENT TO
REMOVE DISABILITY
 PHASE 1 : HISTORY, PHYSICAL
EXAMINATION AND THE INITIAL
LABORATORY STUDIES

 PHASE 2 : SPECIFIC PROBLEM LIST

 PHASE 3 : IDENTIFIES A SPECIFIC
TREATMENT PLAN FOR EACH OF THE
PROBLEMS

 PHASE 4 : EFFECTIVENESS OF EACH OF THE

PLANS AND DESCRIBES SUBSEQUENT
ALTERATIONS IN EACH, DEPENDING ON
THE PATIENT’S PROGRESS
 THE FOLLOWING CASE HISTORY WILL
ILLUSTRATES THE APPLICATION OF THE
PROBLEM ORIENTED APPROACH.
 69 YEAR OLD MALE
 SUDDEN RIGHT-SIDED WEAKNESS
 SECONDARY TO OCCLUSION OF THE LEFT
MIDDLE CEREBRAL ARTERY
 HE IS RETIRED
 LIVING WITH HIS WIFE
 BEFORE THE ONSET OF THE DISEASE HE HAD
BEEN INDEPENDENT IN ALL FUNCTIONAL
ACTIVITIES
 HAS MINIMAL TO MODERATE APHASIA
 A SEVENTH CRANIAL NERVE CENTRAL PALSY ON
THE RIGHT
 DEEP TENDON REFLEXES ARE HYPERACTIVE,
POSITIVE BABINSKI AND INCREASED MUSCLE
TONE IN THE RIGHT SIDE AND NORMAL ON THE
LEFT SIDE
 ROM WITHIN NORMAL LIMITS, BUT THERE IS A
WEAKNESS IN THE RIGHT EXTREMITY
 MOBILIZATION
 BALANCE: STATIC AND DYNAMIC; SITTING AND
STANDING
 TRANSFERS :TURNING IN BED, SITTING UP, STANDING
UP, MOVE TO A CHAIR OR MAT
 AMBULATION : PROPEL WHEELCHAIR, WALK USING A
FUNCTIONAL AND EFFICIENT GAIT PATTERN
 ACTIVITIES OF DAILY LIVING (ADL)
 DRESSING, FEEDING, GROOMING, BATHING,
PERSONAL HYGIENE
 COMMUNICATION SKILL
 ECONOMIC ASSET
 FAMILY AND COMMUNITY SUPPORT
 MENTAL / PSYCHOLOGICAL STATUS AND
COPING SKILLS
MEDICAL REHABILITATION
 Mobilization
 Right hemiparesis
 Activities of daily living

 Mobilization
 Spasticity  Activities of daily living

 Social interaction
 A seventh cranial  Psychological status
nerve palsy

 Aphasia  Communication
 INDEPENDENT : PATIENT CAN PERFORM
ACTIVITIES WITHOUT VERBAL OR PHYSICAL
ASSISTANCE

 SUPERVISION NEEDED: PATIENT MAY REQUIRE

VERBAL INSTRUCTION OR STANDBY
ASSISTANCE TO PERFORM FUNCTIONAL
ACTIVITIES
 ASSISTANCE NEEDED; PATIENT REQUIRES
ASSISTANCE OF ANOTHER PERSONS AT
MINIMAL, MODERATE, OR MAXIMAL LEVEL TO
PERFORM THE FUNCTIONAL ACTIVITY

 DEPENDENT; PATIENT CANNOT PERFORM THE

ACTIVITY EVEN WITH THE ASSISTANCE OF
ADAPTIVE EQUIPMENT OR ANOTHER PERSON
AND THE FUNCTIONAL ACTIVITY MUST
PERFORMED TOTALLY BY SOMEONE OTHER
THAN THE PATIENT
 DONE BY THE TEAM OF REHABILITATION
MEDICINE
 THE TEAM CONSIST OF
▪ PHYSICIAN (PHYSIATRIST)
▪ PSYCHOLOGIST
▪ PHYSIOTHERAPIST
▪ OCCUPATIONAL THERAPIST
▪ SPEECH THERAPIST
▪ REHABILITATION NURSE
▪ SOCIAL WORKERS
▪ ORTHOTICS PROSTHETIST