Introducing the Nagi Model

Pathway to Disability: The Nagi Model

Courtney Hall, PT, PhD Atlanta VAMC Emory University

Please Note: Jane Gain is referred to as Joyce throughout this lecture.

Pathway to Disability: Nagi Model

Disease/ Pathology

Impairment

Functional Limitation

Disability

The Nagi Model Revised Disease/ Pathology Impairment Lifestyle/ Inactivity

Functional Limitation

Disability

Disease/Pathology  Underlying

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

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

Functional Limitation  Restrictions

in performance at the level of the whole person



e.g., limitations in gait following stroke

Disability  Limitations

in performance of socially defined roles and tasks within a sociocultural and physical environment

 Includes

work, school, recreation, personal care

Disability  Not

all impairments or functional limitations result in disability

 Similar

patterns of disability may result from different impairments and functional limitations

Measuring Disease and Lifestyle Disease/ Pathology Impairment

Functional Limitation

Lifestyle/ Inactivity

Health/Activity Questionnaire

Disability

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 

Respiratory disease 

Neuropathies 

Arthritis 

Inner ear problems 

Depression 

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

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 1-2 times/week



3-4 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?

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

Measuring Impairment Disease/ Pathology

Health Activity Questionnaire Impairment

Functional Limitation

Lifestyle/ Inactivity

M-CTSIB

Senior Fitness Test

Disability

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

   

Measuring Functional Limitation Disease/ Pathology Impairment

Functional Limitation

Disability

Lifestyle/ Inactivity

50’ walk/ walkietalkie

BBS or FAB scale

FALL PROOFTM PROGRAM Health/Activity Information

Jane (Case Study 1) Do you use an assistive device for walking? No  Yes

Type?

Measuring Disability Disease/ Pathology Impairment

Functional Limitation

Disability

Lifestyle/ Inactivity

CPF Scale

Disability - Composite Physical Function Scale

Jane (Case Study 1) Please indicate your ability to do each of the following: Can Can do with do difficulty or help

Cannot 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

Disability - Composite Physical Function Scale

Jane (Case Study 1) Please indicate your ability to do each of the following: Can Can do with do difficulty or help

Cannot 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

Disability - Composite Physical Function Scale

Jane (Case Study 1) Please indicate your ability to do each of the following: Can Can do with do difficulty or help

Cannot do

Do most heavy household chores

2

1

0

Do strenuous activities

2

1

0

CPF Score = 7/24 indicating low-functioning

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. b. c. d.

Health problems Chronic pain  Lack of strength or endurance  Lack of flexibility or balance 