Applying the ICF in disability September 5... · ICF Research Branch of the WHO Swiss Paraplegic Research, Nottwil, Switzerland Dr. Margaret Chan, WHO Robert B. Zoellick, World Bank

Applying the ICF in disability

evaluation in adults: Implications to

children and youth rehabilitation

Dr. Reuben Escorpizo

Assistant ProfessorLouisiana State University, New Orleans USA

Research ScientistICF Research Branch of the WHO

Swiss Paraplegic Research, Nottwil, Switzerland

Dr. Margaret Chan, WHO Robert B. Zoellick, World Bank

Our driving vision is of an

inclusive world in which we

are all able to live a life of

health, comfort, and dignity.

Disability and

Rehabilitation across

the lifespan

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• Part of human condition

•

What is disability?

• Complex, multidimensional, dynamic

• Shift from medical model to

biopsychosocial model

• Results from the interaction between

persons with impairments and

What is disability?

persons with impairments and

attitudinal and environmental barriers

that hinder their full and effective participation in society on an equal

basis with others

World Health Organization 2011

• Umbrella term for impairments, activity

limitation, and participation restrictions

• Negative aspects of the interaction

What is disability?

• Negative aspects of the interaction

between a person with a health

condition and that person’s contextual factors (environment and personal

factors)


Demographics of

Disability• Estimates of disability in children

depend on the definition and measure

of disability

•• 0-14 yrs old with moderate-severe

disability (93 million, 5.1%), severe

disability (13 million, 0.7%) (GBD 2004)

• Varying prevalence 0.4 to 12.7%

(maybe due to that children do not get

services and are not identified)World Health Organization 2011

ICF-Children & Youth

• International Classification of

Functioning, Disability and Health

• World Health Organization 2001• World Health Organization 2001

• Conceptual framework and

classification system

• Impact of health condition on

functioning (disability)

Health Condition

Body Functions

Body StructureActivity Participation

Body Structure

Environment Person

Cerebral Palsy

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Disability and

Environment• Environment

influences the

experience and extent

of disability

• Inaccessible

environment impeded

participation and

inclusion

• E.g. Lack of sign

language intepreter,

no ramp or elevator for

wheelchair user World Health Organization 2011

Disability and

Environment

• Also includes policies

and service delivery

systemssystems

• Attitude of others

• Support and

relationship with

others

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Disability and

Development• Disability is a development issue

• Impacts socioeconomics and impact on education and work / employmenteducation and work / employment

• Children with disabilities are less likely

to attend school

• Households with children with

disabilities are likely to experience

hardship (water, housing, sanitation,

food, and healthcare)

Evaluating Disability

• A challenge because disability is

complex, multidimensional, and

dynamicdynamic

• Different definitions, question design,

reporting sources, data collection

method, and expectations of functioning

• Need to evaluate the ICF components

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Same health condition

Different environment

Different levels of participation

=Different levels of Disability

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Same health condition

Different personal factors

Different levels of participation

=Different levels of Disability

Evaluating Disability• Disability is interpreted based on what

is considered normal functioning

based on context, age group, or even

income groupincome group

• For children, disability evaluation is a

challenge due to varying types of

information source: parents / caregivers, age-inappropriate

questions, methods


Evaluating Disability

• Functioning of a child must be

evaluated within the context of the evaluated within the context of the

family and social environment e.g. in

developing countries exposed to many risks such as poverty, malnutrition, poor

health.

Disability and

Rehabilitation across

the lifespan

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Intra-comparison of Brief ICF Core Sets

for Cerebral Palsy * using selected ICF

categories

Sample ICF

Categories< 6 yrs 6-13 yrs 14-18 yrs

Energy and driveEnergy and drive

Pain x

High cognition x

Daily routine

Walking x x x

Family relation x x x

Immediate family

Health services x x x

* Schiariti et al. 2013

Inter-comparison of Brief ICF

Core Sets using selected ICF

categories

Sample ICF

Categories

Multiple

Sclerosis

Traumatic

Brain Injury

Cerebral

Palsy *

Energy and drive x x

Pain x x xPain x x x

High cognition x x

Daily routine x x

Walking x x x

Family relation x x x

Immediate family x x

Health services x x x

* Schiariti et al. 2013 (all ages)

Intra-comparison of ICF Core Sets for Cerebral Palsy and Traumatic Brain Injury

ICF categories TBI (adults)CP (up to 18 yrs)

PainVisual Analogue

Scale

•Face, Legs, Activity, Crying , Consolability Scale (2 mo-7 yr)•Faces Pain Scale (3 yrs +)•VAS (8 yrs +)

Walking 2-min Walk test•Activities Scale for Kids 5-15 yrs•Gross Motor Function 5 mo-16 yrs

Family relation Patient-reported Family / proxy-reported

Health services Patient-reported Family / proxy-reported

* Major life area Work Education

Take Home Message

• Functioning domains will vary between

adults vs. children

• Measurements will vary between adults • Measurements will vary between adults

vs. children

• ICF-based definitions and national data

standards on the ICF- comparability of measures and outcomes

• Be careful with comparison and

interpretation of data!

Part II

Rehabilitation

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What is

Rehabilitation?

• A set of measures that assist

individuals who experience or are likely

to experience, disability to achieve and to experience, disability to achieve and

maintain optimal functioning in interaction with their environments

• Habilitation -“maximal functioning”


Understanding

Rehabilitation

• Targets body functions and structures,

activities and participation, and activities and participation, and

environmental and personal factors

• Can be single or multiple interventions,

carried out by one person or multiple

people


Rehabilitation: Child

with Cerebral Palsy

Unable to care Unable to care

for selffor self

Intervention IIntervention I

TherapyTherapy

Assistive TechnologyAssistive TechnologyFamily EducationFamily Education

Measures IMeasures I

PosturePosture

Physical PerformancePhysical PerformanceAbility of parents to take Ability of parents to take

carecare

Measures IMeasures I

PosturePosture

Physical PerformancePhysical PerformanceAbility of parents to take Ability of parents to take

carecare

Difficulty walkingDifficulty walking

Communication Communication

difficultiesdifficulties


carecarecarecare

Measures IIMeasures II

Muscle toneMuscle tone

Gait deviationGait deviationParticipation in educationParticipation in education


Muscle toneMuscle tone

Gait deviationGait deviationParticipation in educationParticipation in education


Communication skillsCommunication skills

Participation in educationParticipation in educationRelationship with familyRelationship with family


Communication skillsCommunication skills

Participation in educationParticipation in educationRelationship with familyRelationship with family

Intervention IIIntervention II

TherapyTherapy

OrthoticsOrthoticsExercisesExercises

Intervention IIIIntervention III

AudiologyAudiology

AAC devicesAAC devicesFamily EducationFamily Education

Expanding Research

and Evidence-Based

Practice• Research can inform rehabilitation policies • Research can inform rehabilitation policies

and programs

• Link between rehabilitation needs,

services, health outcomes, cost

• There is no common taxonomy of

rehabilitation (coming soon? Dijkers et al.)

• Heterogeneity of rehabilitation practice

Expanding Research

and Evidence-Based

Practice

• Few valid outcome measures• Few valid outcome measures

• Patient participation in research

• Challenge in conducting controlled-trials

• Clinical practice guidelines e.g. CPG for Congenital Musculoskeletal Torticollis

(Kaplan et al. 2013)

Thank you!

[email protected]

Disclaimer: No part of this presentation can be reproduced or reprinted in any way unless there is written consent and permission of the author (R. Escorpizo). Materials and figures that were

used for academic / scholarship purposes are the property of their developers / creators and were accordingly cited.

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Documents

Applying the ICF in disability September 5... · ICF Research Branch of the WHO Swiss Paraplegic Research, Nottwil, Switzerland Dr. Margaret Chan, WHO Robert B. Zoellick, World Bank