National Academies Press: OpenBook
« Previous: B Summary of Information Sources on Disability and Rehabilitation Research
Suggested Citation:"C Taxonomy." Institute of Medicine. 1997. Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Washington, DC: The National Academies Press. doi: 10.17226/5799.
×

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

  1. IMPAIRMENTS—Abnormality or absence of structure or function at the organ level.

A. Musculoskeletal

  1. 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.

Suggested Citation:"C Taxonomy." Institute of Medicine. 1997. Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Washington, DC: The National Academies Press. doi: 10.17226/5799.
×
  1. for differentiating cause as well as describing extent of the impairment)
  1. muscle performance (sometimes incorrectly called ''strength")
    1. force (ability to generate peak acceleration of a mass, or peak torque)
    2. power (ability to develop power in a contraction, usually torque velocity)
    3. endurance (ability to sustain or repeat a contraction)
  2. postural alignment (includes spinal deviations such as scoliosis)
  1. Sensory/perceptual
    1. pain
    2. superficial sensation (touch, temperature, etc.)
    3. deep sensation (includes vestibular, position sense and stereognosis)
    4. body schema (body image or percept)
  2. Neuromuscular
    1. muscle innervation (includes root, spinal and peripheral nerve)
    2. central nervous system
      1. spasm (associated with pain or tension)
      2. spasticity
      3. rigidity
      4. tremor
      5. clonus
    3. coordination
      1. ataxia
      2. athetosis
      3. standing stability and postural reactions
      4. associated movements (i.e., inability to individuate muscle action)
  3. Developmental
    1. perceptual-motor
    2. musculoskeletal
    3. cognitive
    4. social
  4. Psychological
    1. cognitive (includes memory, thinking, consciousness, attention)
    2. 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)
  5. Cardiovascular
    1. cardiac function
    2. peripheral vascular function (includes autonomic)
    3. lymphatic (includes edema)
Suggested Citation:"C Taxonomy." Institute of Medicine. 1997. Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Washington, DC: The National Academies Press. doi: 10.17226/5799.
×
  1. Pulmonary
    1. ventilation (rate, volume, and pattern)
    2. respiration (blood-gas exchange)
    3. secretion clearance
  2. Skin and superficial soft tissues
    1. tissue breakdown and wound healing
    2. scarring and contracture
    3. 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.

  1. locomotor
    1. ambulation (including stairs, rough terrain, etc.)
    2. transfer (lying, sitting, standing, to and from floor, etc.)
    3. transport (use of automobile, bus, etc.)
  2. personal care
    1. hygiene
    2. feeding
    3. dressing and grooming
  3. dexterity (holding, manipulating, adjusting, etc.)
  4. object transport (lifting, carrying, pushing, reaching, balancing, etc.)2
  5. work/stress tolerance
    1. physical (includes cardiac stress and metabolic costs of activity)
    2. psychological (includes ability to tolerate such stress as change, criticism, uncertainty, need to cooperate, etc.)
  6. environmental tolerance (includes ability to tolerate temperature variations, noise, allergens, smoke, etc.)
  7. psychological
    1. cognitive—ability to learn new ideas and techniques, to plan tasks, solve problems, etc.
    2. 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."

Suggested Citation:"C Taxonomy." Institute of Medicine. 1997. Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Washington, DC: The National Academies Press. doi: 10.17226/5799.
×

A.  

productivity: independence and integration

  1. physical independence—ability to meet personal needs in an unmodified environment without use of special aids or assistance from others
  2. social integration—ability to establish and maintain social relationships customary for his/her age, sex, and culture
  3. occupational capacity—ability to carry out the employment, schooling, domestic, or recreational activities customary for his/ her age, sex, and culture
  4. 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.

Suggested Citation:"C Taxonomy." Institute of Medicine. 1997. Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Washington, DC: The National Academies Press. doi: 10.17226/5799.
×
Page 378
Suggested Citation:"C Taxonomy." Institute of Medicine. 1997. Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Washington, DC: The National Academies Press. doi: 10.17226/5799.
×
Page 379
Suggested Citation:"C Taxonomy." Institute of Medicine. 1997. Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Washington, DC: The National Academies Press. doi: 10.17226/5799.
×
Page 380
Suggested Citation:"C Taxonomy." Institute of Medicine. 1997. Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Washington, DC: The National Academies Press. doi: 10.17226/5799.
×
Page 381
Next: D Committee and Staff Biographies »
Enabling America: Assessing the Role of Rehabilitation Science and Engineering Get This Book
×
Buy Paperback | $67.95 Buy Ebook | $54.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The most recent high-profile advocate for Americans with disabilities, actor Christopher Reeve, has highlighted for the public the economic and social costs of disability and the importance of rehabilitation. Enabling America is a major analysis of the field of rehabilitation science and engineering. The book explains how to achieve recognition for this evolving field of study, how to set priorities, and how to improve the organization and administration of the numerous federal research programs in this area.

The committee introduces the "enabling-disability process" model, which enhances the concepts of disability and rehabilitation, and reviews what is known and what research priorities are emerging in the areas of:

  • Pathology and impairment, including differences between children and adults.
  • Functional limitations—in a person's ability to eat or walk, for example.
  • Disability as the interaction between a person's pathologies, impairments, and functional limitations and the surrounding physical and social environments.

This landmark volume will be of special interest to anyone involved in rehabilitation science and engineering: federal policymakers, rehabilitation practitioners and administrators, researchers, and advocates for persons with disabilities.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!