Multisystem Model for Management of Neurologically Impaired Adults—An Update and Illustrative Case

Physical therapists require focused and efficient clinical reasoning skills to determine effective treatment plans, write appropriate goals, and choose intervention strategies that optimize patients' functional abilities. Disablement models applied to clinical practice assist the clinical reasoning process and the resulting patient management. One such model, developed by Schenkman and Butler and published in 1989, has been used in a variety of settings. The original model focused on interrelationships among impairments and disability resulting from a single pathological process. Models also are needed that take into account impairments and disability resulting from multiple underlying disorders. This article presents an updated version of Schenkman and Butler's model, using the pathway to disablement proposed by Nagi and incorporating risk factors and modifiers as elaborated by several other authors. The clinical reasoning process, based on this model, is then illustrated by a patient who was admitted for rehabilitation following shunt revision for normal pressure hydrocephalus. The patient had several other pathologies, including a prior CVA, plantar fasciitis, and blindness in one eye. The influence of his cognitive status, support system, and home environment are discussed.