Foundations of Therapeutic

Exercise
Chapter 1
Introduction to Therapeutic Exercise
and the Modified Disablement Model

Copyright 2005 Lippincott Williams & Wilkins

 Physical Therapy
Physical therapy includes diagnosis and management of
movement dysfunction and enhancement of physical and
functional abilities: restoration, maintenance, and
promotion of optimal physical function, optimal fitness
and wellness, and optimal quality of life as it relates to
movement and health; and prevention of the onset,
symptoms, and progression of impairments, functional
limitations, and disabilities that may result from
diseases, disorders, conditions, or injuries.

Guide to Physical Therapy

Practice. Phys Ther 2001;81:1

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 Physical Therapy (PT) Includes
 Examining patients with impairments, functional
limitations, and disability or other health-related
conditions to determine a diagnosis, prognosis,
and intervention.
 Alleviating impairments and functional limitations
by designing, implementing, and modifying
therapeutic interventions.
 Preventing injury, impairments, functional
limitations, and disability.
 Engaging in consultation, education, and
research.

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 Impairment Question

“What impairments are related to reduced

function and disability for this patient and which
exercises can improve functional performance
and disability by addressing the appropriate
impairments?”

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 Therapeutic Exercise Intervention

Patients – Persons with diagnosed impairments or

functional limitations.

Clients – Persons who are not necessarily

diagnosed with impairments or functional
limitations, but seek services for prevention or
promotion of health, wellness, and fitness.
Both seek and benefit from Physical Therapy

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Therapeutic Exercise = Core Element
Enables Patient/Client to:

 Remediate or reduce impairments

 Enhance function
 Reduce risk
 Optimize overall health
 Enhance fitness and well-being

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 Therapeutic Exercise
Individual Goal-Oriented Treatment
 Provide comprehensive and personalized patient
management.

 Rely on clinical decision-making skills.

 Implement a variety of therapeutic interventions that

are complimentary.

 Promote patient independence (when possible) through

home treatment, self-management exercise programs,
and patient-related instructions.
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 The Disablement Process

Disablement – “Various impact(s) of chronic and

acute conditions on the functioning of specific
body systems, on basic human performance,
and on people’s functioning in necessary, usual,
expected, and personally desired roles in
society.”

Nagi, SZ, Disability and Rehabilitation. Columbus, Ohio:

Ohio State University Press, 1969.

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 Why Define the Process of
Disablement?
 To understand the complex relationships of
pathology and disease, impairments, functional
limitations and disability and to provide a
conceptual basis for organizing elements of
patient/client management that are produced by
physical therapists.

 To enable the therapist to make sound decisions

regarding therapeutic exercise intervention.

Copyright 2005 Lippincott Williams & Wilkins

 Definitions

Impairment – Loss or abnormality of anatomic,

physiologic, or psychologic structure or function.

Secondary Impairment – An impairment that

originates from other, preexisting impairments.
Primary impairments can create secondary
impairments.

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 Functional Limitation

“A restriction of the ability to perform, at the

level of the whole person, a physical action,
activity, or task in an efficient, typically expected
or competent manner.”

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 Disability

The inability to perform or limitation in the

performance of actions, tasks, and activities
usually expected in specific social roles that are
customary for the individual or expected for the
person’s status or role in a specific sociocultural
context and physical environment.

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 Therapeutic Exercise

Consider the functional loss and disability of

the patient.

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 Evolution of Disablement Model

 World Health Organization (WHO)

 International Classification of Impairments,

Disabilities, and Handicaps (ICIDH)

 Saad Nagi (NAGI)

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 ICIDH

Disease Impairment Disability Handicap

NAGI SCHEME
Active
Impairment Functional
Pathology Disability
Limitation

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 Primary Differences

ICIDH – Functional limitation and disability are not

differentiated.
Handicap – Final element.
Limitation – Lacks consideration of cause of
limitations in performing societal roles.

NAGI – Considers distinction between functional

limitation and disability.

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Modified Disablement Model

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 Impairments

Physiologic – An alteration in any physiologic

function.

Anatomic – An abnormality or loss of structure.

Psychologic – Any abnormality related to the

psychologic system.

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Health-Related Quality of Life (HRQL)

 Added to the final 2 elements of pathway

(Functional Limitations and Disability)

 Definition – Generally corresponding to total well

being, encompassing 3 major components.

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 3 Components of HRQL
 Physical Function Component, which includes Basic
Activities of Daily Living (BADLs) and Instrumental
Activities of Daily Living (IADLs).

 Psychological Component, which includes the

“various cognitive, perceptual, and personality traits
of a person”; and

 Social Component, which involves the interaction of

the person “within a larger social context or
structure.”

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 Risk Factors
 Demographic, social lifestyle, behavioral,
psychologic, and environmental factors
 Comorbidities
 Physiologic impairments
 Anatomic impairments
 Functional performance factors

Risk factors are predisposing in that they exist before

the onset of the disablement process.

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 Prevention and Promotion of Health,
Wellness, and Fitness
Key Preventions in Physical Therapy
Primary – Prevention of disease in a susceptible or potentially
susceptible population through specific measures such as
general health promotion offers.

Secondary – Efforts to decrease duration of illness, severity of

disease, and sequelae through early diagnosis and prompt
intervention.

Tertiary – Efforts to decrease the degree of disability and

promote rehabilitation and restoration of function in patients
with chronic and irreversible diseases.
Promotion of Health, Wellness, and Fitness – Critical
Foundation of Therapeutic Exercise Intervention!!
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Use Of Disablement Model – Empowers
the Physical Therapist to:

 Develop comprehensive and efficient examinations and

evaluations of impairments and functional limitations
relating to the patient’s unique disability profile.

 Reach an accurate diagnosis based on logical

classification of pathology, impairments, and functional
limitations.

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 Disablement Model (cont.)
 Develop a prognosis based on the evaluation
and the patient’s goals.
 Create and implement effective and efficient
interventions.
 Reach a desirable functional outcome for the
patient as quickly as possible.

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 Through understanding the Disablement Model,
practitioners may develop a plan to satisfy the demands of
all involved.

Functionally
Meaningful
Patient Patient
Outcomes + Satisfaction
Clinical Value =
Financial and
Social Costs of
Providing Care

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