Impairments are the consequences of pathological conditions; that is, they are the signs and symptoms that reflect abnormalities at the body system, organ, or tissue level. Impairments can be categorized as arising from anatomical, physiological, or psychological alterations as well as losses or abnormalities of structure or function of a body system. Physical therapists typically provide care and services to patients with impairments that affect the Musculoskeletal, Neuromuscular, Cardiovascular, Pulmonary and Integumentary System.

Most impairments of these body systems primarily are the result of abnormalities of physiological function or anatomical structure. Some representative examples of physical impairments commonly identified by physical therapists and managed with therapeutic exercise interventions.

Impairments may arise directly from the pathology (direct/primary impairments) or may be the result of preexisting impairments (indirect/secondary impairments). A patient, for example, who has been referred to physical therapy with a medical diagnosis of impingement syndrome or tendinitis of the rotator cuff (pathology) may exhibit primary impairments, such as pain, limited ROM of the shoulder, and weakness of specific shoulder girdle and glenohumeral musculature during the physical therapy examination. The patient may subsequently develop secondary postural asymmetry because of altered use of the upper extremity.

Furthermore, when an impairment is the result of multiple underlying causes and arises from a combination of primary or secondary impairments, the term composite impairment is sometimes used.For example, a patient who sustained a severe inversion sprain of the ankle resulting in a tear of the talofibular ligament and whose ankle was immobilized for several weeks is likely to exhibit a balance impairment of the involved lower extremity after the immobilization order is removed. This composite impairment could be the result of chronic ligamentous laxity and impaired ankle proprioception from the injury or muscle weakness due to immobilization and disuse.

Regardless of the types of impairment exhibited by a patient, a therapist must keep in mind that impairments manifest differently from one patient to another. In addition, not all impairments are necessarily linked to functional limitations or disability. An important key to effective management of a patient’s problems is to recognize functionally relevant impairments, in other words, impairments that directly contribute to current or future functional limitations and disability. Impairments that can predispose a patient to secondary pathologies or impairments must also be identified

Equally crucial for the effective management of a patient’s dysfunction is the need to analyze and determine, or at least infer and certainly not ignore, the underlying causes of the identified physical impairments, particularly those related to impaired movement. For example, are biomechanical abnormalities of soft tissues the source of restricted ROM? If so, which soft tissues are restricted, and why are they restricted? This information assists the therapist in the selection of appropriate, effective therapeutic interventions that target the underlying causes of the impairments, the impairments themselves, and the resulting functional limitations.

Although most physical therapy interventions, including therapeutic exercise, are designed to correct or reduce physical impairments, such as decreased ROM or strength, poor balance, or limited cardiopulmonary endurance, the focus of treatment must still be on restoration of function and prevention of dysfunction. Elimination or reduction of functionally relevant impairments is certainly necessary during treatment; but from a patient’s perspective, successful outcomes of treatment are determined by a reduction or resolution of functional limitations or disabilities and the restoration or improvement of function. A therapist cannot simply assume that intervening at the impairment level (e.g., with strengthening or stretching exercises) and subsequently reducing physical impairments (by increasing strength and ROM) necessarily generalizes to remediation of functional limitations and restoration of functional motor abilities for daily living. Mechanisms for integrating correction of physical impairments and restoration of functional abilities through task-specific training are explored in a model of effective patient management.

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