2012 Annual Conference

de Joya, Anna Lisa

TIRR Memorial Hermann and University of Alabama at Birmingham

Establishing a diagnosis related to the human movement system is an essential element of the physical therapy (PT) patient management model. Existing classification systems categorize patients based on movement related impairments. To date, classification systems that include the activity and participation domains of the International Classification of Functioning, Disability and Health (ICF) are not documented. The purposes of the Mobility and Balance Diagnostic Classification System (MBDCS) are to classify movement dysfunction related to neurologic conditions across the activity and participation domains of the ICF and to guide neurologic PT clinical decision making.

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A literature review of mobility disability, including dimensions of the activity and participation domains of the International Classification of Functioning, Disability and Health (ICF) related to movement dysfucntion was performed to identify a model for which a mobility and balance diagnostic classification system could be based upon.  Associated outcome measures related to each dimension of movement dysfunction were also reviewed based on the clinical utility and psychometric properties for inclusion into the classification system as criteria for diagnostic categories.

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The MBDCS is based on Patla and Shumway-Cook’s conceptual framework for mobility and also self-efficacy, life-space and participation dimensions of the movement function of a patient. Each dimension is related to one or more of the following eleven diagnostic categories: gait distance dysfunction, gait speed dysfunction, sensory organization dysfunction, balance disorder (BD) associated with postural maladjustment, BD associated with abnormal postural responses, functional ambulation dysfunction associated with various terrain surfaces, balance disorder associated with cognitive impairment, BD associated with abnormal postural responses in the presence of obstacles, restricted community integration associated with balance self-efficacy disorder, decreased community/social role functioning and/or decreased satisfaction with life/quality of life associated with limited participation in important social roles, restricted pattern of mobility associated with limited life-space and/or decreased level of independence. Data obtained from tests and measures serve as the criteria to make decisions about the diagnostic categories the patient’s movement dysfunction is assigned to.

Clinicians establish a diagnosis related to movement dysfunction which guides and directs treatment interventions, improves communication among members of an inter-professional team and enhances efficiency of identifying evidence-based treatment interventions. A standard of care through this organized clinical decision making process lessens variability in neurologic PT practice.

The MBDCS guides neurologic PT practice in clinical decision making that goes beyond the impairment level and focuses on the activity and participation domains of the ICF. This provides a holistic framework for identification and management of human movement system dysfunction related to a neurologic condition. The diagnoses made by clinicians grounded in the human movement system establishes the PT professional identity.