NDT Enablement
Classification Model of
Health and Disability
Mary Rose Franjoine, PT, DPT, MS, PCS
Margo Prim Haynes, PT, DPT, MA, PCS
Readings & References
Required Reading:
• Neuro-Developmental Treatment Approach Theoretical
Foundations and Principles of Clinical Practice
Chapter 2
References:
• www.who.org
• Neuro-Developmental Treatment Approach Theoretical
Foundations and Principles of Clinical Practice
Assignment:
• Study Guide:
– Learning Activity 2.1.1 (pg 83-85)
– Learning Activity 1.1.5 (pg 91)
2009
M R Franjoine & M P Haynes
2
Evolutionary Process
Disablement Models
• WHO & Nagi Disablement frameworks
• NCMRR Disablement Model
–
–
–
–
–
Pathophysiology
Impairments
Functional Limitations
Disability
Societal Limitations
Enablement Models
• International Classification of Function, Disability, and
Health
• NDT Enablement Classification Model of Health and
Disability
3
Enablement Frameworks, WHY?
•
•
•
•
Universal, all inclusive model
Multi-dimensional
Cross Cultural
Social and Medical
2009
M R Franjoine & M P Haynes
4
Dimensions
NDT Enablement Classification
Model of Health and Disability
+
Domains
Dimension
Functional Domain
Disability Domain
A. Body structure &
functions
Structural &
functional integrity
Impairments
A.Primary
B.Secondary
B. Motor functions
Effective posture &
movement
Ineffective posture &
movement
C. Individual
functions
Functional activities Functional activity
limitations
D. Social functions
Participation
Participation
restriction
From: NDT Approach Theoretical Foundations & Principles of Clinical Practice, Table 2.1 pg. 82
2009
M R Franjoine & M P Haynes
5
Participation
• Nature and extent of a person’s
involvement in life situations
• Example:
Going to the mall on Saturday
afternoon with your friends to
“hang”
2009
M R Franjoine & M P Haynes
6
Participation Restrictions
• Problem an individual may have in the
manner or extent of involvement in life
• Example:
Can’t “hang” at the mall on Saturday afternoon,
because:
• Can’t walk fast enough
• Can’t walk safe enough
• Can’t walk and talk
2009
M R Franjoine & M P Haynes
7
Functional Activities
• Directly observable functions
• Performance of a task or action by
the individual.
• Example:
Able to get the toy
2009
M R Franjoine & M P Haynes
8
Functional Limitations
• Difficulties or inability an individual
may have in performing a task or
function.
• Example:
Unable to get the toy
• Can’t roll over to get toy
• Can’t belly crawl to get the toy
• Can’t reach to get the toy
2009
M R Franjoine & M P Haynes
9
Posture & Movement Behaviors
• Directly observable
• Interaction of the systems & the
environment
• Examples:
• Sitting with PPT
• Reaching overhead with IR in shoulder, pronated
forearm, and fisted hand
• Toe walking
• Rib cage elevation during expiration
2009
M R Franjoine & M P Haynes
10
Is the Posture and Movement
Behavior Effective or Ineffective?
Consider:
• Alignment
• Weight bearing
• Postural Control
• Balance
• Coordination
• Motor planning
– Temporal
– Spatial
• Tone
• Movement combinations
2009
M R Franjoine & M P Haynes
11
Single Systems
• Body Functions
– The physiological or psychological
functions of the body system
• Body Structure
– The anatomical parts of the body such
as organs, limbs and their components
2009
M R Franjoine & M P Haynes
12
Body Functions
•
•
•
•
•
•
•
•
Mental function
Sensory function and pain
Voice and Speech functions
Functions of Cardiovascular, Hematological,
Immunological and Respiratory systems
Functions of the Digestive, Metabolic and
Endocrine systems
Genitounitary and Reproductive functions
Neuromusculoskeletal and Movement-related
functions
Functions of the Skin and related structures
2009
M R Franjoine & M P Haynes
13
Body Structures
•
•
•
•
•
•
•
•
Structures of the nervous system
The eye, ear and related structures
Structures involved in voice and speech
Structures related to the Cardiovascular, Hematological,
Immunological and Respiratory systems
Structures related to the Digestive, Metabolic and
Endocrine systems
Structures related to the Genitounitary and Reproductive
systems
Structures related to Movement
Skin and related structures
2009
M R Franjoine & M P Haynes
14
Impairments
Problems in a body function or
structure
• Single system impairments
• Multi-system impairments
• Can be temporary or permanent
• Can change over time
Progression
Regression
2009
M R Franjoine & M P Haynes
15
Primary Impairments
• Can be single or multi-system
• Are a direct result of the Body
Function or Body Structure injury,
dysfunction, or absence.
• Positive
Behaviors that are present
• Negative
Behaviors that are absent
2009
M R Franjoine & M P Haynes
16
Secondary Impairments
• Can be single or multi-system
• Are an indirect result of the Body Function or
• Body Structure injury, dysfunction, or
absence.
2009
M R Franjoine & M P Haynes
17
Examples
Neuromuscular System
Primary Positive Impairments
•
•
•
•
•
•
•
2009
Spasticity
Impaired muscle activation
Excessive co-activation
Stereotypic, atypical movement synergies
Impaired motor execution
Incorrect scaling of muscle force
Inter-limb and Intra-limb dyscoordination
M R Franjoine & M P Haynes
18
Examples
Neuromuscular System
Primary Negative Impairments
•
•
•
•
Insufficient force generation (weakness)
Impaired anticipatory balance
Hypokinesia
No fractionated movements
2009
M R Franjoine & M P Haynes
19
Examples
Sensory - Perceptual System
Primary Positive Impairments
• Inaccurate Registration
• Inaccurate Modulation
• Inaccurate Response
2009
M R Franjoine & M P Haynes
20
Contextual Factors
Environmental
 Physical, social, and
attitudinal environment in
which people live and
function.
 Examples:
• Facilitators
• Excellent medical
coverage for AT
• Barriers
• A home
environment where
children are to be
quiet and well
behaved at all
times
2009
Personal
 Features of the individual
that are not part of a health
condition or functional
state.
 Examples:
• Facilitators
• Outgoing
personality
• Barriers
• Shy, quiet
M R Franjoine & M P Haynes
21
Contextual Factors
•
•
•
•
•
Can interact at any level within the model
Can come from within the person
From the family
Can be cultural
Can be environmental
2009
M R Franjoine & M P Haynes
22
NDT Enablement
Classification Model of
Health and Disability
Mary Rose Franjoine, PT, DPT, MS, PCS
Margo Prim Haynes, PT, DPT, MA, PCS