Pathway to Disability

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Pathway to Disability The Nagi Model
Courtney Hall, PT, PhD Atlanta VAMC Emory
University
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Please Note Jane Gain is referred to
as Joyce throughout this
lecture.
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Pathway to DisabilityNagi Model
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The Nagi Model Revised
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Disease/Pathology

• Underlying pathologic condition that interferes
  with normal bodily function or structure
• e.g., stroke, osteoarthritis

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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

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Functional Limitation

• Restrictions in performance at the level of the
  whole person
• e.g., limitations in gait following stroke

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Disability

• Limitations in performance of socially defined
  roles and tasks within a sociocultural and
  physical environment
• Includes work, school, recreation, personal care

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Disability

• Not all impairments or functional limitations
  result in disability
• Similar patterns of disability may result from
  different impairments and functional limitations

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Measuring Disease and Lifestyle
Disease/ Pathology
Functional Limitation
Disability
Impairment
Lifestyle/ Inactivity
Health/Activity Questionnaire
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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 ? Respirator
y disease ? Neuropathies ? Arthritis
? Inner ear problems ? Depression ?
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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
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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 3-4 times/week
• 1-2 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?
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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
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Measuring Impairment
Health Activity Questionnaire
Disease/ Pathology
Functional Limitation
Disability
Impairment
Lifestyle/ Inactivity
Senior Fitness Test
M-CTSIB
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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 ?

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Measuring Functional Limitation
Disease/ Pathology
Functional Limitation
Disability
Impairment
Lifestyle/ Inactivity
BBS or FAB scale
50 walk/ walkie-talkie
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FALL PROOFTM PROGRAM Health/Activity
Information Jane (Case Study 1)
Do you use an assistive device for walking? No
? Yes Type?
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Measuring Disability
Disease/ Pathology
Functional Limitation
Disability
Impairment
Lifestyle/ Inactivity
CPF Scale
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Disability - Composite Physical Function Scale
Jane (Case Study 1)
Please indicate your ability to do each of the
following Can Can do with
Cannot do difficulty or help
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

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Disability - Composite Physical Function Scale
Jane (Case Study 1)
Please indicate your ability to do each of the
following Can Can do with
Cannot do difficulty or help
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

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Disability - Composite Physical Function Scale
Jane (Case Study 1)
Please indicate your ability to do each of the
following Can Can do with
Cannot do difficulty or help
do 

• Do most heavy household chores 2 1 0
• Do strenuous activities 2 1 0
• CPF Score 7/24 indicating low-functioning

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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. Health problems
• b. Chronic pain ?
• c. Lack of strength or endurance ?
• d. Lack of flexibility or balance ?