Pathway to Disability:
The Nagi Model
Courtney Hall, PT, PhD
Atlanta VAMC
Emory University
Please Note:
Jane Gain is referred to as
Joyce throughout this
lecture.
Pathway to Disability:
Nagi Model
Disease/
Pathology
Impairment
Functional
Limitation
Disability
The Nagi Model Revised
Disease/
Pathology
Impairment
Lifestyle/
Inactivity
Functional
Limitation
Disability
Disease/Pathology
 Underlying
pathologic
condition that interferes with
normal bodily function or
structure
 e.g., stroke, osteoarthritis
Impairment
 Loss
or abnormality at the tissue,
organ, or body system level
 The physiological or psychological
consequences
 Impairment can be primary or
secondary to pathology
 e.g., sensory deficit or abnormal
muscle tone after a stroke
Functional Limitation
 Restrictions
in performance at
the level of the whole person

e.g., limitations in gait
following stroke
Disability
 Limitations
in performance of
socially defined roles and
tasks within a sociocultural
and physical environment
 Includes
work, school,
recreation, personal care
Disability
 Not
all impairments or
functional limitations result in
disability
 Similar
patterns of disability
may result from different
impairments and functional
limitations
Measuring Disease and
Lifestyle
Disease/
Pathology
Impairment
Functional
Limitation
Lifestyle/
Inactivity
Health/Activity
Questionnaire
Disability
FALL PROOFTM PROGRAM
Health/Activity Information
Jane (Case Study 1)
Gender: Male
Female 
Age: 71
Have you ever been diagnosed as having any of the
following conditions?
Heart attack 
Respiratory disease 
Neuropathies 
Arthritis 
Inner ear problems 
Depression 
FALL PROOFTM PROGRAM
Health/Activity Information
Jane (Case Study 1)
List all medications that you currently take:
Albuterol
Allopurinol
Asthma Cort
K-Dur
Lasix
Beconase
Synthroid
How many times have you fallen within the past
year?
2
FALL PROOFTM PROGRAM
Health/Activity Information
Jane (Case Study 1)
In a typical week, how often do you leave your house?
less than once/week
1-2 times/week

3-4 times/week
most every day
Do you currently participate in regular physical
exercise that causes an increase in breathing,
heart rate, or perspiration?
Yes
No  If yes, how many days per week?
FALL PROOFTM PROGRAM
Health/Activity Information
Jane (Case Study 1)
When you go for walks, which of the following best
describes your walking pace:

Strolling (easy pace)
Average or normal
Fairly brisk (fast pace)
Do not go for walks on a regular basis
Measuring Impairment
Disease/
Pathology
Health Activity
Questionnaire
Impairment
Functional
Limitation
Lifestyle/
Inactivity
M-CTSIB
Senior
Fitness Test
Disability
FALL PROOFTM PROGRAM
Health/Activity Information
Jane (Case Study 1)
Do you currently suffer any of the following
symptoms in your legs or feet?
Numbness
Tingling
Arthritis
Swelling




Measuring Functional
Limitation
Disease/
Pathology
Impairment
Functional
Limitation
Disability
Lifestyle/
Inactivity
50’ walk/
walkietalkie
BBS or
FAB scale
FALL PROOFTM PROGRAM
Health/Activity Information
Jane (Case Study 1)
Do you use an assistive device for walking?
No  Yes
Type?
Measuring Disability
Disease/
Pathology
Impairment
Functional
Limitation
Disability
Lifestyle/
Inactivity
CPF
Scale
Disability - Composite Physical Function Scale
Jane (Case Study 1)
Please indicate your ability to do each of the following:
Can
Can do with
do
difficulty or help
Cannot
do
Take care of personal needs
2
1
0
Bathe yourself
2
1
0
Climb a flight of stairs
2
1
0
Walk outside 1-2 blocks
2
1
0
Do light household activities
2
1
0
Disability - Composite Physical Function Scale
Jane (Case Study 1)
Please indicate your ability to do each of the following:
Can
Can do with
do
difficulty or help
Cannot
do
Do own shopping
2
1
0
Walk 1/2 mile
2
1
0
Walk 1 mile
2
1
0
Lift and carry 10 pounds
2
1
0
Lift and carry 25 pounds
2
1
0
Disability - Composite Physical Function Scale
Jane (Case Study 1)
Please indicate your ability to do each of the following:
Can
Can do with
do
difficulty or help
Cannot
do
Do most heavy household chores
2
1
0
Do strenuous activities
2
1
0
CPF Score = 7/24 indicating low-functioning
Disability- Composite Physical Function Scale-
Jan (Case Study 1)
Do you currently require household or nursing
assistance to carry out daily activities?
No
Yes  If yes, please check the reason (s)?
a.
b.
c.
d.
Health problems
Chronic pain 
Lack of strength or endurance 
Lack of flexibility or balance 