The health care system needs to evolve from a medical to a biopsychosocial model, asserted Robert Palisano, PT, ScD, FAPTA, in the 23rd Maley Lecture, delivered during NEXT 2018. "Healthy living is a societal and systems issue. The focus of the traditional medical model of health care is on the individual and acute conditions." The title of his lecture was "Lifecourse Health Development of Individuals With Chronic Health Conditions: Visualizing a Preferred Future."

Palisano is associate dean for research at the College of Nursing & Health Professions at Drexel University.

Lifecourse health development, a biopsychosocial model, previously had been applied to children and youth with cerebral palsy. Palisano extended the concept of lifecourse health development to adults with acquired chronic conditions such as spinal cord injury, traumatic brain injury, stroke, multiple sclerosis, Parkinson disease, and arthritis.

He noted that APTA's Vision Statement for the Physical Therapy Profession—transforming society by optimizing movement to improve the human experience—served as the springboard for his presentation. Palisano defined "lifecourse" as a progression of socially defined events and roles in which a person engages. Health development, he said, occurs through person-to-environment and environment-to-person transactions that change over time. His preferred future, Palisano said, will be characterized by a person's physical, mental, and emotional well-being; participation in desired social roles throughout life; and achievement of personal goals.

Using 2 case studies—a boy born with cerebral palsy and a woman who contracted polio at 16 months old—Palisano traced their successful transition from childhood to adulthood and identified experiences that contributed to their lifecourse.

He said that the transition to adulthood for youth with disabilities has been described as "falling off a cliff" due to lack of preparation, limited support, lack of skills needed for adult roles, and disjointed adult services. He noted that a successful transition requires that timing "real-life" experiences and interventions coincide with the person's environment and readiness for change. "Unfortunately, implementation of comprehensive and coordinated health transition services and supports has not been widely achieved, and finding adult health care providers is often difficult," Palisano said.

He noted that some laws, such as the Americans with Disabilities Act (ADA), can be of assistance. For example, the ADA defines "disabled but able to work" as an individual with a physical or mental impairment who is able to perform essential functions of a job with or without reasonable accommodations. Employers have a legal obligation to make reasonable worksite and workplace accommodations that are not an undue hardship. However, Palisano cited research that, during the hiring process, employers often have little guidance and are unaware of or do not comply with accommodations required by ADA and other laws.

Further, he said, "Person-workplace transactions often are not timed or adapted to build capacity." Although assistive technologies "offer promise for improving work participation," access to appropriate assistive technologies and qualified providers and teams are "frequently limited."

Addressing community living, Palisano said that key considerations are availability, accessibility, adaptability, and affordability. "Research indicates that young adults in supported living experience more variety in community activities and do preferred activities more frequently than do young adults living in group homes."

Palisano summarized his theme: "The value proposition of lifecourse health development is healthy living. Healthy living involves managing, adjusting, and adapting to changes in health capacities and environments."

To achieve the vision of a preferred future, Palisano said, "A system similar to the pediatric health system is recommended, whereby the health of adults with chronic conditions would be monitored by interprofessional teams, and a care coordinator would be available to coordinate services."

He also called for physical therapy to occur in real life settings, also referred to as "natural environments. Research suggests that rehabilitation services in clinical settings do not optimize participation outcomes….Generalization of learning requires practice in different contexts, including open environments that are not predictable."

Palisano concluded, "A preferred future that embodies lifecourse health development is ambitious, but not beyond the reach of a profession whose vision is to transform society and improve the human experience."