During the early 1990s physical therapists began to explore the potential use of disablement models and suggested that disablement schema and related terminology provided an appropriate framework for clinical decision making in practice and research. In addition, practitioners and researchers suggested that consistent use of disablement related language could be a mechanism to standardize terminology for documentation and communication in the clinical and research settings.The American Physical Therapy Association (APTA) subsequently incorporated an extension of the Nagi disablement model and related terminology into its evolving consensus document, the Guide to Physical Therapist Practice (often called the Guide), which was developed to reflect “best practice” from the initial examination to the outcomes of intervention. The Guide also uses the concept of disablement as a framework for organizing and prioritizing clinical decisions made during the continuum of physical therapy care and services.

To be consistent with the language of the Guide, which was configured for this textbook, depicts a model of disablement and the potential impacts of therapeutic exercise interventions on the disablement process. The impact of risk factors has also been included in this depiction of the process. Incorporating risk factors into the model underscores the assumption that disability can be prevented, eliminated, or reduced if the risk of occurrence or severity of pathology, impairment, or functional limitation is reduced. The model also shows that effective interventions, in particular therapeutic exercise, can have a positive impact on every aspect of the disablement process.

By choosing to use a model of disablement as part of the theoretical framework of practice, physical therapists have a responsibility to provide evidence that there are, indeed, links among the elements of the disablement process that can be identified by physical therapy tests and measures. It is also the responsibility of the profession to demonstrate that not only can physical impairments be reduced but functional abilities can be significantly enhanced by physical therapy interventions. This body of evidence has just begun to emerge during the past decade.

An overview of the key components of the process of disablement, using language consistent with that in the Guide, is presented in the following sections of this chapter, with additional discussion of risk factors and their potential impact on disability. The relationship of the disablement model to patient management and physical therapy interventions, specifically therapeutic exercise, is also discussed.Buy the Book that holds this excerpt: Therapeutic Exercise: Foundations and Techniques (Therapeutic Exercise: Foundations & Techniques)

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