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.

NPIP Examples:

1. Kinesiophobia (as measured on Kinesiophobia scales)
2. Impaired quadriceps strength/power (55% deficit as measured by hand-held dynamometer)
3. Hypomobile anterior capsule of glenohumeral joint (as assessed through PROM and accessory joint assessment)
4. Abnormal sitting posture (a kyphotic lumbar spine is observed during sitting and confirmed during subjective exam)
5. Nutritional insufficiency impairing appropriate tissue healing (patient mentions that they skip 2 meals per day and are trying to lose weight)
6. Scapular instability (as confirmed by observance of poor scapulo-humeral rhythym testing and confirmed with a positive scapular-assist test)
7. Impaired healing in foot (confirmed with insensate foot with semmes-weinstein monofilament testing and prolonged history of diabetes and foot ulcers)
8. Hypermobile L4-5 segment (confirmed with stress radiographs of lumbar spine to confirm spondylolisthesis, and/or segmental accessory joint assessment)