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OTD 8102: Week 6 Introduction to the ICF.

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Rick Davenport

on 29 June 2015

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Transcript of OTD 8102: Week 6 Introduction to the ICF.

Health Condition
Disease or Disorder

Abnormal findings which show alterations in functioning
Body Functions
Problems with body systems, both physiological and psychological
Limitations may be physical, social, or psychosocial
One's ability to fulfill personal and social responsibilities in relation to societal expectations
Support and Relationships
the amount of physical and emotional support the person provides for another person
can take place at home, work, school, play etc.
Body Structure
Problems with anatomical features of the body such as deviations or loss's
Refers to:
decreased ROM
decreased endurance
restriction of joint capsule
Refers to:
impaired balance
postural stability
ineffective movement
Refers to:
decreased aerobic capacity
impaired circulation
pain with activity
Limitations and difficulties an individual may have in executing actions, tasks and activities
Basic Activities of Daily Living (BADL)
Instrumental Activities of Daily Living (IADL)
Include physical, social and attitudinal environment in which people live and conduct their lives
Factors that are not within a person's control as family, work, government agencies, laws, and cultural beliefs
the natural products or human-made products in a patient's environment that are used to perform personal activities
Refers to observable consequences of:
The particular background of an individual's life.
family life etc.
Age- 35
Gender- female
Race- Caucasian
Family Life- married with kids
ICF, Biomedical Model, Social Model, Biopsychosocial Model, and ICIDH.
Health Condition
Classifying these abnormalities are the basis of a medical diagnosis. Intervention is then based off the diagnosis.
Two patients with the same condition could present it very differently
This is why its so important to pay attention to the impact
Lucy is a 35 year old mother who has been diagnosed with adhesive capsulitis. Two months ago, she began to experience pain in her left shoulder whenever she tried to move it. Now she is pain free but has limited ROM.
Lucy is a CNA at a nursing home in Toronto, but is currently performing light duties on the job.
Impairments are the Consequence of the Condition
They can be primary or secondary
Primary comes from health condition
Secondary is the result of preexisting impairment
Lucy no longer is experiencing pain, but the tightening of her rotator cuff is causing severe decreased ROM.
Lucy's muscle tone in her arm will be mildly affected because of decreased use.
She will have to compensate by using her right arm more. Her bilateral arm use and coordination will be severely affected.
Refers to :
Skin hypo-mobility
A physical limitation while performing a BADL task
e.g. 2 Eating
grasp spoon
bring food to mouth
e.g. 1 Brushing your teeth
Self Care:
reaching for clothing high in closet
reaching to put a shirt over her head
Washing the floor at home
using both arms to control a mop
lifting a heavy pain of water
Reading a book to her children
reaching for a book on the shelf
holding a book open away from her body
A physical limitation while performing an IADL task
E.g. 1 Driving
sitting for a long time
reaching both arms to the wheel
Shifting gears
E.g. 2 Grocery shopping
pushing the buggy
reaching for products
paying the cashier
loading and unloading car
Self Care:
Shaving her legs
controlling razor
grasping objects
choosing ingredients
reaching pots
Coaching Basketball
catching and throwing
teaching drills
The client must be able to deal with fulfilling personal and social obligations/responsibilities.
These are the things that are important to the client, in self care, productivity and leisure
Lucy loves to care for her three children. she enjoys playing with them and bringing them on outings. She coaches their basketball team in her spare time. She also really enjoys to bake.
Caring for Her Children
Lucy will have a hard time picking up her kids to hold them.
Lucy will have to rearrange her kitchen so that she can bake efficiently.
Lucy may need to get an assistant to aid in demonstration.
Products and Technology
Natural Environment and It's Changes
living and non-living elements of physical environment
changes due to natural disaster
changes by populations
factual beliefs
religious beliefs etc.
Services, Systems and Policies
established structured programs and operations that are designed to provide benefits to individuals
General Overview/Background
Use of ICF
Conceptual Model of ICF
Functioning and Disability
Contextual Factors
• Functioning - "integrity of body functions and structures and the ability to participate in life's activities".
• Disability- "the result of impairments in body functions and/or structures, activity limitations and participation restrictions".
• Explains how physical environment, social expectations and internal influences facilitate or hinder functioning
Why is the ICF Important?
•Helps provide structure for knowledge of the complicated relationships between one's health status, functioning and disability.
•Switches the focus from simply treating the health disruption to the all encompassing treatment of the impact which the disruption has on the client's life
•This is a much better client centered approach
•The treatment focus is on the client's functional abilities and, simultaneously, the client's disease or disorder
•A bio-psycho-social model that includes both abilities and disabilities
In order to facilitate dressing, Lucy would use a sock aid, a shoe horn and a reacher.
Lucy has a very supportive family, since they all help her in many ways, which makes dealing with her functional disability a little bit easier. As a result, she is able to maintain a positive outlook on life.
Lucy does not want her disability to get in the way of being a mom and providing for her family. She holds very high expectations of herself and would not feel fulfilled if she could not accomplish these things.
Lucy lives in a bungalow with her family in Pickering.
Refers to:
Refers to:
Refers to:
Refers to:
Unless otherwise stated, the material for this presentation was created from material from:
World Health Organization (2002). Towards a common language for functioning, disability, and health ICF document.
PT, OT, and SLP Services and the ICF. Retrieved from CMS.gov website
WHO, website link http://www.who.int/classifications/icf/en/

OTD 8102: Introduction to the International Classification of Functioning, Disability and Health (ICF)
Week 6

There is a widely held misunderstanding that the International Classification of Functioning, Disability and Health (ICF) is only about people with disabilities; in fact, it is about all people. The health and health-related states associated with all health conditions can be described using ICF. In other words, ICF has universal application.

Is the ICF only for people with disabilities?
The ICF emphasizes function
The ICF provides a biopsychosocial (rather than a biomedical) framework to understand phenomena related to function.
In this Prezi I cover additional models (e.g. Biomedical Model, Social Model, Biopsychosocial Model etc.) as they provide necessary background information for comparison with the ICF. While I have not assigned any textbook readings associated with these additional models you will be responsible for all information presented in this Prezi whether it is on the ICF, Biomedical Model, Social Model etc.)
Biomedical Model
Just as health care practice has evolved over time, so too have general perceptions of human health and disease. Historically, a disability was considered to be the result of a disease, trauma or some other health condition. Individuals with disabilities were therefore often perceived as anomalies, or deviations from a "normal," healthy state. As such, individuals with a disability were commonly described by the pathological condition they bore (e.g., 'an amputee') rather than a person with a medical condition (e.g., 'an individual with an amputation'). This focus on the medical condition does not include elements related to social factors or the individual's perception of their health.

This perspective forms the basis of the biomedical model, which describes health as an absence of disease. Using this model, treatments and interventions are a means to move a disabled individual from a diseased or unhealthy state toward a normal or healthy state. In this way, the biomedical model is considered to be a linear, unidirectional model (Figure 2A).

figure 2A
Material from this section were retrieved from Leimkuehler, P. (2013) Outcome Measures in Upper Limb Prosthetics Module. Website link: http://www.oandp.org/olc/lessons/html/SSC_09/module2.asp?frmCourseSectionId=7CC1D52A-9E9D-4A03-A2F0-78AE7DB64977
Social Model
In contrast to the biomedical model, the social model of disability perceives disability as a socially created problem, not a characteristic of the individual. This perspective purports that the limitations caused by the disease or unhealthy state are due to a rigid physical or social environment that creates disability where one may not otherwise exist. The social model describes that these variations from the "normal state" are in fact, normal and that any disability is the result of societal perceptions rather than barriers to participation in life.

In contrast to the biomedical model, the social model of disability perceives disability as a socially created problem, not a characteristic of the individual. This perspective purports that the limitations caused by the disease or unhealthy state are due to a rigid physical or social environment that creates disability where one may not otherwise exist. The social model describes that these variations from the "normal state" are in fact, normal and that any disability is the result of societal perceptions rather than barriers to participation in life.

The United States Americans with Disabilities Act (ADA) Accessibility Guidelines addresses the physical environmental limitations described by the social model through building requirements that allow for easier access for individuals with disabilities.
The social model advocates equality among individuals, and proposes that everyone can fully and completely participate in life if society's attitudes, information, and physical structures are appropriate for both "normal" and "differently abled" individuals.

The first WHO model, the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) was published in 1980 and is part of the same family of classification systems as the ICD-10 (the International Statistical Classification of Diseases and Related Health Problems). The ICIDH identified three fundamental concepts—impairments, disabilities and handicaps that were suggested to describe disability. This model, like Nagi's original Disablement Model, was a linear model. It showed a directional progression from disease to handicap.

The United States Social Security System currently determines disability by the presence and severity of a medical condition (and its impact on an individual's ability to work). This perspective is consistent with the biomedical model.

Although the biomedical model is still commonly considered to be the dominant health model, proponents of other health models argue that this framework is limited by its view of disability through changes in pathology, physiology, and biochemistry and that it demonstrates a number of limitations, specifically that it ignores the role of the individual and their society in the description of "disability."

The limitations of the biomedical model are particularly relevant to the selection of an outcome measure. Selecting an instrument that measures only the health condition and not the impact of that condition on the individual's ability (or inability) to perform activities or their desire to participate (or not to participate) in life situations may limit the potential of an outcome measure to detect meaningful change in areas of importance to the individual or the caregiver. The influence of external factors can be quite important to the development of a treatment plan, and therefore, other perspectives on health can be quite informative.
Biopsychological Model
The biomedical, social, and psychological models converged under the development of psychiatrist George Engel. In 1977, Engel published a description of the basic biophysical model in the esteemed journal, Science. Engel proposed this framework as an alternative to the predominant biomedical model of health and advocated for its use in research, teaching, and the provision of health care. The biopsychosocial model was unique in that it presents a holistic approach to health and therefore health care. This model, like the rehabilitation sciences and services themselves, examines health from a variety of points of view (including the biomedical, the social, and the psychological), and correspondingly interprets "health" as the interaction of these three perspectives.

The biopsychosocial model also advocates that while the three domains of health (i.e., the biomedical, the social, and the psychological) are all interrelated, they are also independent. Thus, if an individual is healthy (by medical standards) and perceives him or herself to be ill, then that individual may be considered unhealthy. Conversely, someone who has a medical condition (i.e., a disease) and perceives them self to be well, may not be considered healthy under the biopsychosocial model. This model of health as a synthesis of body, social, and perceptive factors is at the core of most contemporary models of health and disease.

The elements of the original ICIDH Model of Disability:

impairment was defined as an abnormality of a body organ, structure or function (including mental functions)
disability was defined as a restriction in activity that resulted from the impairment
handicap was the disadvantage (in the social context) brought on by the impairment or the disability

The ICIDH also included a taxonomy of impairments, disabilities, and handicaps. Like the historical biomedical models, the original ICIDH was predominantly focused on the disease and related conditions and drew criticism for not adequately describing the role of the individual and the environment in disability.
In 2001, the WHO released a major revision to the ICIDH framework named the International Classification of Function and Disability (ICF). The ICF framework describes changes to health as the dynamic interaction between the health condition and contextual factors. It is important to note that this is the first time that "health" is a model element in lieu of disability or disablement, suggesting a radical philosophical change in this model when compared to earlier models.
In the ICF model, as in the underlying biophsychosocial model, health is described according to three levels which include the body, the individual, and society. Within each level, the ICF model identifies three domains of functioning (i.e., body structures and function) and associated levels of disability (i.e., impairments, limitations, and restrictions).

Example: The difference between body function and structure may be subtle. Skeletal muscle is a structure and its function is to contract. Therefore, atrophied muscle tissue and reduced muscle strength would both be considered impairments.
Like differences in body structure and function, differences between activity and participation may be subtle. Activity often refers to an individual's ability to perform a task (irrespective of whether or not they would normally do the selected activity), while participation may reflect whether or not that individual chooses to do the task and how they accomplish it. For example, to measure activity, one might ask the questions "how much difficulty do you have in putting on a shirt?" Likewise, to measure participation, the question might instead be "to what extent do you feel limited in getting dressed for work?"
ICF is Useful for Clinical Purposes
Guide thinking and clinical decision-making
Individual and interdisciplinary care plan development
Assist when communicating with patients, clients, families, students, and colleagues.
Common terminology reduces misunderstandings
Plan research that is consistent with a whole view of the person in his or her environment
Measurement tools and clinical documentation can be mapped to ICF permitting comparison study.
The Goals of the ICF
To provide a scientific basis for the consequences of health conditions
To establish a common language to improve communications.
To permit comparisons of data across:
Health care disciplines,
To provide a systematic coding scheme for health information systems.
Wrap up/Summary
ICF is a classification system
The ICF provides a standard language and framework for the description of health and health-related states.
It is a classification of health and health-related domains, that help describe:
Changes in body function and structure,
What a person can do in a standard environment (level of capacity), and
What a person can do in their usual environment (level of performance).
ICF is the World Health Organization's (WHO) framework for health and disability.
ICF is named to stress health and functioning, rather than disability.
ICF belongs to the WHO family of international classifications (including ICD-10)
ICF is complimentary to ICD-10 and WHO encourages their use together as ICD-10 classifies mortality, and ICF classifies states of health.
ICF is a classification system not a clinical measurement tool.
ICF was endorsed in May 2001 by 191 nations, including the United States.
Superseded the International Classification of Impairment Disability and Handicap (ICIDH)
Large international multidisciplinary participation in development of ICF
ICF endorsed by the AOTA, APTA, and ASHA as well as other American healthcare organizations
What model would this be - IF you only considered the circled components?
Key ICF Definitions:
Body functions are the physiological functions of body systems
Body structures are anatomical parts of the body
Impairments are problems in body function or structure such as a significant deviation or loss
Activity is the execution of a task or action
Participation is involvement in a life situation
Activity limitations are difficulties in executing activities.
Participation restrictions are problems in involvement in life situations
Environmental factors make up the physical, social and attitudinal environment in which people live.
ICF has two parts, each with two components:
Part 1. Functioning and Disability
(a) Body Functions and Structures
(b) Activities and Participation
Part 2. Contextual Factors
(c) Environmental Factors
(d) Personal Factors
ICF Components can be expressed in both positive and negative terms
Disability and function are interactions between health conditions and contextual factors
The following chart gives some possible examples of disabilities that may be associated with the three levels of functioning linked to a health condition.
ICF Beginner's Guide (Provided by WHO)
WHO - ICF Training Beginner's Guide - in next section.
From Physical Therapy Perspective
The End
please note Dr. Davenport will
hold you responsible for the coding section of the ICF...
Full transcript