Non-patient Behaviours in Rehabilitation

The clinician translates what psycho-social factors, patient behaviors, movement patterns, co-morbidities, abnormal forces and structural faults are contributing to the patients dysfunction.

The problem list is heavily focused on impairments. In the NAGI model, the NPIP is generally a list of impairments that are contributing to the patients patho-anatomic hypothesis, functional limitations and disabilities. During movement assesment, this often identified through deficits in QQS & EF (quantity, quality, symptoms and/or end feel). Often, there is a disruption in the osteokinematics or arthrokinematics of a particular joint movement. There is also often a posture deficit that you may observe and include in your NPIP list.

Example: You have a patient with low back pain and radiographic evidence of a grade II spondylolisthesis. The pathoanatomic hypothesis may also be confirmed with segmental testing. You may feel a large neutral zone (laxity) with facet gliding at the L4/5 segment. You may also note a segmental shearing effect in the L4/5 region during spinal AROM that is observable. Therefore the patho-anatomic hypothesis is spondylolisthesis leading to excessive segmental shearing.