Conceptual Models of Disability and Functioning

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Introduction

Historically approaches towards health and disease has been very much focused on the medical or biological model where a person’s ill-health was exclusively thought to be related to pathology and treated purely by medical means. In more recent times thinking has moved towards a more functional model.

Biomedical Model

The biomedical model of disability is focused on pathology and impairment. It assumes several unhelpful notions about the nature of disability.The philosophy of Western medicine has traditionally been to treat and to cure, but in rehabilitation these outcomes are unlikely and the aim has often been to ‘normalise’. This philosophy was reinforced by the initial WhO classification that produced a distinction between impairment, dis- ability, and handicap. The biomedical model of disability usually implies that the physician takes a leading role in the entire rehabilitation process—being team leader, organising programmes of care, and generally directing the delivery of services for the person with disabilities. The doctor/patient relationship was the senior relationship in the medical model. Rehabilitation was born around the time of the First World War when there was a strong philosophy of the doctor telling injured servicemen how to behave, how to get better, and how to get back as quickly as possible to active duty. Such a model may have been appropriate in that cultural context but not in wider society today.

Social Model

The social model of disability views disability not as an underlying medical condition or pathology but rather as secondary to the social, legislative, and attitudinal environment in which the person lives. Although a person’s abilities may be different, the disability is because society either actively discriminates against the person with a disability or it fails to account for their different needs. The key features of the social model include;

Biopsychosocial Model

The biopsychosocial model of disability is an attempt to account for both the social and biomedical models of disability. First conceptualised by George Engel in 1977, it suggests that to understand a person's medical condition it is not simply the biological factors that need to be considered, but also the psychological and social factors .

• Bio (physiological pathology)
• Psycho (thoughts emotions and behaviours such as psychological distress, fear/avoidance beliefs, current coping methods and attribution)
• Social (socio-economical, socio-environmental, and cultural factors such as; work issues, family circumstances and benefits/economics)

The WHO International Classification of Functioning, Disability and Health is underpinned by the Biopsychosocial Model. There has been some controversy around incorporating aspects of health within a model of disability from those that use the social model of disability, as they would define disability as being solely due to a lack of response of society to change the environment to accommodate the needs of the individual. The full ICF is a detailed and lengthy document, which recognises the importance not only of describing the functioning of an individual but also placing such functioning into its social context.

Human Development Model – Disability Creation Process (HDM-DCP)

The Human Development-Disability Creation Process is a conceptual model which aims to document and explain the causes and consequences of diseases, trauma, and other effects on integrity and the development of the person, the HDM-DCP is designed to be used by ethos concerned with the adaptation, rehabilitation, social participation and exercise of human rights of people with disabilities and their families.

The HDM-DCP shows that the accomplishment of life habits can be influenced by reinforcing our abilities and compensating for our disabilities through rehabilitation, but also by reducing environmental obstacles stemming. An obstacles coud be, for example, a prejudice, the lack of assistance or resources, the lack of accessibility at home and at school, a problem in obtaining adapted printed information or moving around with the help of accessible signage.

Thus, measuring the accomplishment of life habits means that we identify the result of the interaction between the person and his/her environment. Here we are referring to an indicator of the quality of social participation: It is measured over a continuum or scale ranging from an optimal situation of social participation to a complete disabling situation.

References