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--> C Taxonomy The following is based in part on the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) proposed by the World Health Organization, as modified by the Institute of Medicine.1 It is an example of the beginning of a taxonomy that identifies the consequences of disease and injury most often of concern to physical therapists, occupational therapists, physicians, and others working with physical disabilities. Measurement of these aspects of a person's status would be essential both for providing the basis for treatment planning, and for permitting objective evaluation of progress toward clearly defined therapeutic goals. This represents, therefore, a classification of both the problems addressed in physical rehabilitation and of the therapeutic outcomes sought through treatment of those problems. A taxonomy of Clinical Measurements IMPAIRMENTS—Abnormality or absence of structure or function at the organ level. A. Musculoskeletal joint mobility (including hyper and hypomobility and methods 1 For a description and discussion of the original WHO taxonomy see: International Classification of Impairments, Disabilities, and Handicaps: a Manual of Classification Relating to the Consequences of Disease. Geneva: World Health Organization, 1980; see also: Pope AM, Tarlov AR (eds): Disability in America: Toward a National Agenda for Prevention, Washington, D.C.: National Academy Press, 1991.
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--> for differentiating cause as well as describing extent of the impairment) muscle performance (sometimes incorrectly called ''strength") force (ability to generate peak acceleration of a mass, or peak torque) power (ability to develop power in a contraction, usually torque velocity) endurance (ability to sustain or repeat a contraction) postural alignment (includes spinal deviations such as scoliosis) Sensory/perceptual pain superficial sensation (touch, temperature, etc.) deep sensation (includes vestibular, position sense and stereognosis) body schema (body image or percept) Neuromuscular muscle innervation (includes root, spinal and peripheral nerve) central nervous system spasm (associated with pain or tension) spasticity rigidity tremor clonus coordination ataxia athetosis standing stability and postural reactions associated movements (i.e., inability to individuate muscle action) Developmental perceptual-motor musculoskeletal cognitive social Psychological cognitive (includes memory, thinking, consciousness, attention) affective (includes motivation, anxiety and other factors which influence readiness to respond to and participate in treatment and to cope with illness and its consequences) Cardiovascular cardiac function peripheral vascular function (includes autonomic) lymphatic (includes edema)
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--> Pulmonary ventilation (rate, volume, and pattern) respiration (blood-gas exchange) secretion clearance Skin and superficial soft tissues tissue breakdown and wound healing scarring and contracture cosmetic problems II. FUNCTIONAL LIMITATIONS [DISABILITIES in ICIDH]—restriction or lack of ability, resulting primarily or secondarily from an impairment, to perform activities that are generally accepted as essential components of everyday life; disturbance of function at the level of the person. locomotor ambulation (including stairs, rough terrain, etc.) transfer (lying, sitting, standing, to and from floor, etc.) transport (use of automobile, bus, etc.) personal care hygiene feeding dressing and grooming dexterity (holding, manipulating, adjusting, etc.) object transport (lifting, carrying, pushing, reaching, balancing, etc.)2 work/stress tolerance physical (includes cardiac stress and metabolic costs of activity) psychological (includes ability to tolerate such stress as change, criticism, uncertainty, need to cooperate, etc.) environmental tolerance (includes ability to tolerate temperature variations, noise, allergens, smoke, etc.) psychological cognitive—ability to learn new ideas and techniques, to plan tasks, solve problems, etc. affective—ability to take initiative, accept limitations, adapt, etc. III. DISABILITIES [HANDICAPS in ICIDH]—person-in-context restriction due to conditions that interfere with one's productivity or quality of life; conditions that place the individual at a disadvantage relative to other members of society. 2Note: B, C, and D are often jointly called "instrumented or instrumental ADL."
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--> A. productivity: independence and integration physical independence—ability to meet personal needs in an unmodified environment without use of special aids or assistance from others social integration—ability to establish and maintain social relationships customary for his/her age, sex, and culture occupational capacity—ability to carry out the employment, schooling, domestic, or recreational activities customary for his/ her age, sex, and culture B. quality of life—ability to find a degree of satisfaction in life equivalent to that of most others of his/her age, sex, and culture.
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