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Introduction

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Optimal functional recovery is the primary goal of all rehabilitation. Although people have traditionally been identified or categorized by their disease or medical condition (e.g., spinal cord injury [SCI]), the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) model1 provides an important framework for examining and treating the patient by clearly defining health condition, impairment, activity limitation, and participation restriction. The American Physical Therapy Association in its Guide to Physical Therapist Practice, Version 3.0, has adopted this framework.2 Thus the patient with SCI presents with paralysis; sensory loss; autonomic dysfunction (impairments); loss of independent function in bed mobility, dressing, bathing, and locomotion (activity limitations); and an inability to work or go to school (participation restrictions). Physical therapist practice intervenes primarily at the level of impairments, activity limitations, and participation restrictions. Effective clinical decision-making is based on an understanding of the ICF model and related contextual factors (environmental and personal factors) to arrive at effective choices for intervention. In addition, clinicians must understand factors that improve quality of life, prevention, wellness, and fitness. An effective plan of care (POC) clarifies risk factors and seeks to fully involve the patient in determining meaningful functional goals. This text focuses on improving motor function (motor control and motor learning) and muscle performance (strength, power, and endurance) through activities and exercises that optimize functional outcomes. Definitions of terminology of functioning, disability, and health are presented in Box 1.1.

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BOX 1.1 Terminology: Functioning, Disability, and Health From World Health Organization's International Classification of Functioning, Disability, and Health

Health condition is an umbrella term for disease, disorder, injury, or trauma and may also include other circumstances, such as aging, stress, congenital anomaly, or genetic predisposition.1 It may also include information about pathogeneses and/or etiology.

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 the problems in body function or structure such as a significant deviation or loss.

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 situations.

Contextual factors represent the entire background of an individual's life and living situation.

  • Environmental factors make up the physical, social, and attitudinal environment in which people live and conduct their lives, including social attitudes, architectural characteristics, and legal and social structures.

  • Personal factors are the particular background of an individual's life, including gender, age, coping styles, social background, education, profession, past and current experience, overall behavior pattern, character, and other factors that influence how disability is experienced by an individual.

Performance describes what an individual does in his or her current environment.

Capacity describes an individual's ability to execute a task or an action (highest probable level of functioning in ...

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