MODEL KETIDAKMAMPUAN Disability model. The Nature of Physical Therapy Physical Therapy is providing services to people and populations to develop, maintain.

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1 MODEL KETIDAKMAMPUAN Disability model

2 The Nature of Physical Therapy Physical Therapy is providing services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. Physical therapy includes the provision of services in circumstances where movement and function are threatened by the process of ageing or that of injury or disease. Full and functional movement are at the heart of what it means to be healthy.  Pelayanan Fisioterapi ditujukan kepada perorangan dan masyarakat  Lingkup pelayanan Fisioterapi adalah Mengembangkan, memelihara, dan memulihkan  Yang menjadi bidang garapan Fisioterapi adalah (maksimilisasi) Gerak dan (kemampuan) Fungsi  Sehat yang dimaksud oleh Fisioterapi adalah keadaan gerakan penuh dan fungsional

3 Apakah yang dikerjakan Fisioterapi Physical therapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. Physical therapy involves the interaction between physical therapist, patients or clients, families and care givers, in a process of assessing movement potential and in establishing agreed upon goals and objectives using knowledge and skills unique to physical therapists. Fisioterapi mengenali dan memaksimalkan potensi gerak yang berhubungan dengan lingkup promosi, prevensi, penyembuhan dan pemulihan. Fisioterapi ikut dalam interaksi antara Fisioterapis, pasien atau klien, famili dan pemberi pelayanan kesehatan dalam proses pemeriksaan potensi gerak dalam upaya penegakan goal dan tujuan pengobatan yang disepakati dengan menggunakan pengetahuan dan ketrampilan Fisioterapi yang unik

4 …...Fisioterapi The physical therapists' distinctive view of the body and its movement needs and potential is central to determining a diagnosis and an intervention strategy and is consistent whatever the setting in which practice is undertaken. These settings will vary in relation to whether physical therapy is concerned with health promotion: prevention, treatment or rehabilitation. Fisioterapis secara khusus memandang tubuh dan kebutuhan potensi gerak merupakan pusat penentuan diagnosis dan strategi intervensi dan konsiten dengan bentuk apapun dimana praktek fisioterapi dilakukan. Bentuk pelayanan Fisioterapi akan sangat bervariasi dalam hubungannya dengan dimana Fisioterapi bekerja maupun berkenaan dengan promosi, pencegahan, penyembuhan dan pemulihan kesehatan

5 KEPMENKES 1363 Fisioterapi adalah bentuk pelayanan kesehatan yang ditujukan kepada individu dan atau kelompok untuk mengembangkan, memelihara dan memulihkan gerak dan fungsi tubuh sepanjang daur kehidupan dengan menggunakan penanganan secara manual, peningkatan gerak, peralatan (fisik, elektroterapeutis dan mekanis), pelatihan fungsi, komunikasi.

6 DEFINISI FISIOTERAPI Pelayanan kepada individu dan masyarakat Mengembangkan, memelihara, memulihkan gerak dan fungsi Sepanjang daur kehidupan Dengan modalitas fisioterapi

7 Nagi Model berdasarkan pada konsep penyakit atau aktif patologi, impairtment, keterbatasan fungsi, dan disability

8 Nagi model penyakit / aktif patologi, impairtment keterbatasan fungsi, (Functional limitation ) Ketidak mampuan ( Disability )

9 Nagi model aktif patologi adalah interruption/ berhentinya atau interference proses normal dan usaha organisme secara simultan untuk memperbaikinya sendiri ke keadaan normal dengan mobilisasi defense tubuh dan mekanisme coping, impairtment adalah hilangnya atau abnormalitas anatomi, fisiologikal, mental atau psikologikal atau fungsi; keterbatasan fungsi atau restriksi kemampuan untuk melakukan tindakan fisik, tugas atau efisiensi aktifitas, harapan khusus, atau kompeten pada tingkat semua organisme dan person; disability adalah ketidakmampuan untuk melakukan atau keterbatasan dalam melakukan tindakan, tugas, aktifitas yang biasanya diharapkan dalam peran social khusus untuk individu atau diharapkan untk status person atau peran dalam konteks sosiokulturan khusus dan lingkungan fisik.

10 WHO Pada tahun 1980, World Health Organization (WHO) dikembangkan suatu model disablement alternative. Dalam WHO International Clasification of Impairtment, Disabilities and Handicaps (ICIDH),

11 World Health Organization Disability model penyakit / disease impairtment Ketidak mampuan HANDICAPED

12 WHO MODEL desease/penyakit didefenisikan sebagai perubahan patologi yang ditunjukkan sebagai suatu kondisi kesehatan yang berubah atau attribute status kesehatan individu yang akan membawa pada suatu distress, interference dengan aktifitas sehari-hari atau kontak dengan pelayanan kesehatan. Impairtment didefenisikan sebagai perubahan abnormal pada tingkat molecular, selular dan jaringan melalui struktur dan fungsi abnormal pada tingkat organ; disability restriction atau kurangnya kemampuan untuk melakukan aktifitas umum dengan cara yang normal; handicap didefenisikan sebagai ketidakmampuan untuk berfungsi pada tingkat person to person atau pada tingkat person to lingkungan. Handicap menunjukkan disadvantage sosial yang berhubungan dengan impairtment atau disability yang membatasi atau mencegah pemenuhan peran normal. WHO merevisi formulasi original model disablement dan pada desembar 2000 mengeluarkan versi pre – final yang berjudul ICIDH 2 : International Classification of Functioning Disability and Health.

13 NCMRR (1992 ) National Center For Medical Rehabilitation and Research (NCMRR) mempublikasikan suatu model disablement yang diambil dari Model Nagi dan WHO yang digunakan pada klasifikasi :

14 NCMRR (1992 ) patofisiologi, impairtment, keterbatasan fungsi, disability dan keterbatasan social.

15 NCMRR Model NCMRR menolak konotasi negative dari bentuk “handicap” dan diusulkan untuk menggantinya dengan bentuk “keterbatasan societal” untuk menghitung keterbatasan – imposed by society - membatasi kemampuan orang untuk berpartisipasi secara independent dalam tugas, aktifitas dan dan peran.

16 (IOM) Pada tahun 1991, Institute Of Medicine (IOM) menempatkan keempat model disablement untuk menekankan prevention, diusulkan bahwa disability mungkin dicegah melalui control resiko fisik dan resiko factor lingkungan social dalam factor resiko gaya hidup dan biological.

17 Health condition Environmental factors Personal factors Body functions/ Body structures Activities Participation The ICF: Conceptual Model

18 Health condition Environmental factors Personal factors Body functions/ Body structures Activities Participation 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example

19 A health condition is an umbrella term for disease, disorder, injury or trauma. A health condition may also include other circumstances, such as ageing, stress, pregnancy, congenital anomaly, or genetic predisposition Health conditions may be coded using the ICD-10. Health condition Environmental factors Personal factors Body functions/ Body structures Activities Participation 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example

20 Body functions are physiological functions of body systems, including psychological functions Body structures are anatomical parts of the body, such as organs, limbs and their components Impairments are problems in body functions or structure such as a significant deviation or loss Health condition Environmental factors Personal factors Body functions/ Body structures Activities Participation Tetraplegia G83.5 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example

21 Physical Therapist: Beside Mr. Wun‘s complete problems in the lower extremity, he has partial deficits of muscle power in the arms. Due to his loss of movement in his legs, he demonstrates stiffness in the muscles and reduced mobility in the ankle joints. As a consequence of the loss of muscle power he has also problems with his respiratory functions Health condition Environmental factors Personal factors Body functions/ Body structures Activities Participation Tetraplegia G83.5 muscle power in the arms movement in his legs stiffness in the muscles mobility in the ankle joints respiratory functions 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example

22 Health condition Environmental factors Personal factors Activities Participatio n Activity is the execution of a task or action by an individual Participation is involvement in a life situation. Activity limitations are difficulties an individual may have in executing activities Participation restrictions are problems an individual may experience in involvement in life situation Tetraplegia G83.5 movements in his legs stiffness in the muscles muscle power in the arms mobility in the ankle joints respiratory functions 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example

23 „ My problems in daily living are that I need much more time for eating, and I can‘t go to the toilet. To maintain sitting is difficult, I always need my arms to prop up. I can‘t go out to meet my friends, but I still communicate to them by phone or E-Mail. I also started to work on the computer, doing translations from English to Thai ….“ Health condition Environmental factors Personal factors Activities Participatio n Tetraplegia G83.5 eating maintain sitting meet my friends work on the computer go to the toilet movements in his legs stiffness in the muscles muscle power in the arms mobility in the ankle joints respiratory functions 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example

24 Health condition Environmental factors Personal factors Activities Participation Environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives. These factors are external to individuals and can have a positive or negative influence on the individual’s performance as a member of society, on the individual’s capacity to execute actions or tasks, or on individual’s body function or structure Tetraplegia G83.5 movements in his legs stiffness in the muscles muscle power in the arms mobility in the ancle joints respiratory functions eating maintain sitting go to the toilet meet my friends work on the computer 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example

25 „My wheelchair is very heavy, that makes it difficult for me to move it. Most of the buildings outside are not adapted for disabled. The streets are full of obstacles; impossible to overcome. The support of my mother is most important for me, additionally we have two housekeepers who help me all the time. My health insurance pays for all my hospital stays, that helps also. Health condition Environmental factors Personal factors Activities Participatio n Tetraplegia G83.5 movements in his legs stiffness in the muscles muscle power in the arms mobility in the ancle joints respiratory functions eating maintain sitting go to the toilet meet my friends work on the computer wheelchair is very heavy buildings streets are full of obstacles support of my mother housekeepers health insurance 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example

26 Health condition Environmental factors Personal factors Activities Participatio n Personal factors are the particular background of an individual’s life and living, and comprises features of the individual that are not part of a health condition or health state. These factors may include gender, race, age, other health conditions, fitness, lifestyle, habits, coping styles, social background, education, profession, past and current experience,… Tetraplegia G83.5 movements in his legs stiffness in the muscles muscle power in the arms mobility in the ancle joints respiratory functions eating maintain sitting go to the toilet meet my friends work on the computer housekeepers wheelchair buildings streets are full of obstacles support of my mother health insurance 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example

27 Medical Doctor: „Mr Wun is 24 years old, he finalized his university degree for engeneering last year. Although his disease is severe he is motivated to improve his situation. Health condition Environmental factors Personal factors Activities Participatio n Tetraplegia G83.5 movements in his legs stiffness in the muscles muscle power in the arms mobility in the ancle joints respiratory functions eating maintain sitting go to the toilet meet my friends work on the computer housekeepers wheelchair buildings streets are full of obstacles support of my mother health insurance motivated engeneering university degree 24 years old 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example