Understanding the relationships among pathology, impairments, functional limitations, and perceived disability is fundamental to the prevention or reduction of disability. The presence of functional limitations may or may not lead to loss of independence and result in disability. Take, for example, a relatively inactive person with long-standing osteoarthritis of the knees. The inability to get up from the floor or from a low seat (functional limitation) because of limited flexion of the knees and reduced strength of the quadriceps (impairments) could indeed lead to disability in several areas of everyday function. Disability could be expressed by problems in self-care (inability to get in and out of a tub or stand up from a standard height toilet seat), home management (inability to perform selected housekeeping, gardening, or yard maintenance tasks), or community mobility (inability to get into or out of a car or van independently). The perception of disability can be minimized if the patient’s functional ROM and strength can be improved with an exercise program and the increased ROM and strength are incorporated into progressively more challenging functional activities or if the physical environment can be altered sufficiently with the use of adaptive equipment and assistive devices.

Adjusting expected roles or tasks within the family may also have a positive impact on the prevention or reduction of disability. Factors within the individual also can have an impact on the prevention, reduction, or progression of disablement. Those factors include level of motivation or willingness to make lifestyle changes and accommodations as well as the ability to understand and cope with an adjusted lifestyle. This example highlights that inherent in any discussion of disability is the assumption that it can be prevented or remediated.

Prevention falls into three categories.
• Primary prevention: Activities such as health promotion designed to prevent disease in an at-risk population
• Secondary prevention: Early diagnosis and reduction of the severity or duration of existing disease and sequelae
• Tertiary prevention: Use of rehabilitation to reduce the degree or limit the progression of existing disability and improve multiple aspects of function in persons with chronic, irreversible disease

Therapeutic exercise, the most frequently implemented physical therapy intervention, has value at all three levels of prevention. For example,

the use of resistance exercises and aerobic conditioning exercises in weight-bearing postures is often advocated for the primary and secondary prevention of age-related osteoporosis. However, therapists who work with patients with chronic musculoskeletal or neuromuscular diseases or disorders routinely are involved with tertiary prevention of disability.

Buy the Book that holds this excerpt: Therapeutic Exercise: Foundations and Techniques (Therapeutic Exercise: Foundations & Techniques)

Related Articles