Frameworkgoal of assessment and treatment

Nagi's (1965) disablement scheme (Fig. 8.5) is a helpful model to use in approaching balance assessment, the first step in balance rehabilitation. Assessment may identify the underlying pathology causing the balance problem (such as PD, vestibular loss, etc.),

Figure 8.5. Nagi's disablement model (adapted from Nagi, 1965).

but the clinician should be aware that diagnosis of pathology itself is not sufficient. The same pathology may affect individuals quite differently, so an assessment must also identify specific impairments and functional limitations that stem from the pathology. The ultimate goal of assessment is to make a differential diagnosis of a postural disorder that allows for development of an intervention that is patient-specific and targets the particular impairments and functional limitations identified. Nagi's disablement scheme does not include another level that therapists should consider in their assessment and treatment of balance and movement disorders, the strategies by which individuals accomplish a functional task given their impairments. The strategy level is located between the impairment and functional levels and represents the tactics or methods by which a subject accomplishes a task. A therapist must decide if the individual is using the most effective and efficient strategy possible given their particular impairments and pathology.

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