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CTaxonomy
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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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.
