Disability :Current Concepts

International Classification of Disability Ahmed-Refat AG Refat www.SlideShare.net/AhmedRefat

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International Classification of

Disability Prof. Ahmed-Refat A.G Refat

25/12/2012


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Contents

Definition of Impairment, Disability and Handicap

Evolutions of the concepts From ICIDH-1980 to

ICF2001

Disability Statistics

Models of Disability

Current Model of Disability


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Impairment,

Disability

and Handicap Evolution of the Concepts

From 1980 to 2001


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The most commonly cited definitions are those provided by the World Health

Organization (1980) in The International Classification of Impairments,

Disabilities, and Handicaps:

ICIDH- WHO- 1980

Impairment:

AhmedRefat

Sticky Note

Out of date... Presented to illustrate the evolutions of the concepts


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Impairment:

Any loss or abnormality of

psychological, physiological

or anatomical structure or

function.


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Disability:


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Disability:

Any restriction or lack

(resulting from an impairment) of ability

to perform an activity in the

manner or within the range

considered normal for a

human being.


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Handicap


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Handicap:

a disadvantage for a given

individual that limits or

prevents the fulfillment of a

role that is normal


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As traditionally used, impairment refers to

a problem with a structure or organ of the

body; disability is a functional limitation

with regard to a particular activity; and

handicap refers to a disadvantage in filling

a role in life relative to a peer group.


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Examples to illustrate the differences

among the terms "impairment,"

"disability," and "handicap."


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David is a 4-yr.-old who has a form of

cerebral palsy (CP) called spastic diplegia.

David's CP causes his legs to be stiff, tight,

and difficult to move. He cannot stand or

walk.


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Impairment: The inability to move the legs easily at the joints and inability to bear weight on the feet is an impairment.

Without orthotics or surgery, David's level of impairment may increase as imbalanced

muscle contraction over a period of time can cause hip dislocation and deformed

bone growth. No treatment may be currently available to lessen David's

impairment.


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Disability: David's inability to walk is a

disability. His level of disability can be

improved with physical therapy and special

equipment. For example, if he learns to

use a walker, his level of disability will

improve considerably.


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Handicap: David's cerebral palsy is handicapping to the extent that it prevents him from fulfilling a normal role at home, in preschool, and in the community. His level of handicap has been only very mild in the early years as he has been well-supported

to be able to play with other children, interact normally with family members and participate fully in family and community activities. As he gets older, his handicap


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will increase where certain sports and physical activities are considered "normal" activities for children of the same age. He has little handicap in his preschool

classroom, though he needs some assistance to move about the classroom and from one activity to another

outside the classroom. Appropriate services and equipment can reduce the extent to which cerebral

palsy prevents David from fulfilling a normal role in the home, school and community as he grows.


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Statistics


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Percentage of population estimated to be disabled in different countries.

Denmark 10,0- 12,0 %

France 5,0- 8,3 %

Norway 12,0 %

Spain 25,0 %

Sweden 12,0 %

U.K. 7,3 %


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In June 2011, World Health

Organization (WHO) and the World

Bank released the first World Report on

Disability.


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(1) Estimates based on the World Health Survey

The average prevalence rate of disability in the adult population aged 18 years and over was 15.6% (some 650 million people of the

estimated 4.2 billion adults aged 18 and older in 2004)

ranging from 11.8% in higher income countries to 18.0% in lower income

countries.


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If the prevalence figures are extrapolated

to cover adults 15 years and older, around

720 million people have difficulties in

functioning with around 100 million

experiencing very significant difficulties.


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2- Estimates based on the WHO Global Burden of Disease study

The analysis of the Global Burden of Disease 2004 data for this Report estimates that 15.3% of the world

population (some 978 million people of the estimated 6.4 billion in 2004 (35)) had “moderate or severe disability”, while 2.9% or about 185 million experienced


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“severe disability” . Among those aged 0–14 years, the figures were 5.1% and 0.7%,

or 93 million and 13 million children, respectively. Among those 15 years and older, the figures were 19.4% and 3.8%,

or 892 million and 175 million, respectively.


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Models that characterized the history of

disability:

1. The traditional model,

2. the medical/genetic model,

3. the social/human-rights model .


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1- Traditional Model: This model

considers disability as a result of some sin

or as a punishment from God.


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2- Medical Model: This model considers

that persons with disability have a

dysfunction or a problem that needs to be

corrected. Therefore, medical model

promotes activities such as treatment,

surgery, appliances, etc. aimed at reducing

the disability in the person.


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The medical model views disability as a

problem of the person, directly caused by

disease, trauma or other health condition,

which requires medical care provided in the

form of individual treatment by

professionals.


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3- Social Model: This model considers

physical, social, cultural, environmental and

attitudinal barriers that "disable" persons

with impairments and that block their

participation in different life activities.

Therefore, this model promotes a fight

against the different barriers.


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The social model of disability, on the other

hand, sees the issue

mainly as a socially created problem, and

basically as a matter of the full

integration of individuals into society.


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Disability is not an attribute of an

individual, but rather a complex collection

of conditions, many of which are

created by the social environment.


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Hence the management of the problem requires social action, and it is the collective responsibility of society at large to make the

environmental modifications necessary for the full participation of

people with disabilities in all areas of social life. The issue is therefore an

attitudinal or ideological one requiring social change, which at the political level

becomes a question of human rights. For this model

disability is a political issue.


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In addition, there is the Human rights

model, that looks at disability as an issue of

human rights.

Community-Based Rehabilitation (CBR ) is

based on human rights model of disability.


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The social model of disability has consider

disability as arising from the interaction

of a person’s functional status with the

physical, cultural, and policy

environments.


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ICF-WHO-2001


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ICF-WHO-2001

International Classification of Functioning,

Disability and Health


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ICF belongs to the WHO family

of international classifications,

Other Member are:


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1- International Classification of Diseases (ICD) Current ICD-10

(2015) ICD-11

22- International Classification of Health Interventions (ICHI)

ICD

The best known member of which is the

ICD-10 (the International Statistical Classification

of Diseases and Related Health Problems).


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ICD-10 gives users an etiological

framework for the classification, by

diagnosis, of diseases, disorders and other

health conditions.


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By contrast, ICF classifies functioning and

disability associated with health conditions.

The ICD-10 and ICF are therefore

complementary, and users are encouraged

to use them together to create more

meaningful picture of the experience of

health of individuals and populations.


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Information on mortality (provided by ICD-10)

and information about health and health-

related outcomes (provided by ICF) can be

combined in summary measures of

population health.


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In short, ICD-10 is mainly used to classify

causes of death, but ICF classifies

health.


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The overall aim of the ICF classification is to provide a unified and standard language and framework for the description of health

and health-related states.


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ICF is based on an integration of the two

opposing models i.e biomedical and social .

In order to capture

the integration of the various perspectives

of functioning, a “bio-psycho-social”

approach is used.


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“bio-psycho-social” approach

in ICF disability and functioning are viewed as outcomes

of interactions between health conditions (diseases,

disorders and injuries) and contextual factors.

The medical model views disability as a feature of the

person, directly caused by disease, trauma or other

health condition, which requires medical care provided

in the form of individual treatment by professionals.


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Disability, on medical model, calls for

medical or other treatment or intervention, to 'correct'

the problem with the

individual.


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The social model of disability, on the other hand, sees

disability as a socially created problem and not at all an

attribute of an individual.

On the social model, disability demands a political

response, since the problem is created by an

unaccommodating physical environment brought about

by attitudes and other features of the social environment


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Components of ICF Model


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I - BODY FUNCTIONS

Body functions are the physiological

functions of body systems

(including psychological functions).

Impairments are problems in body function

or structure as a significant deviation or

loss.


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Body functions

Mental functions Sensory functions and pain Voice and speech functions

Functions of the cardiovascular, haematological, immunological and respiratory systems

Functions of the digestive, metabolic and endocrine systems

Genitourinary and reproductive functions Neuromusculoskeletal and movement-related functions

Functions of the skin and related structures


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II- BODY STRUCTURES

Body structures are anatomical parts of

the body such as organs,

limbs and their components.


or structure as a

significant deviation or loss.


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Body structures

Structures of the nervous system The eye, ear and related structures

Structures involved in voice and speech Structures of the cardiovascular, immunological

and respiratory systems Structures related to the digestive, metabolic and

endocrine systems Structures related to the genitourinary and

reproductive systems Structures related to movement


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III-ACTIVITIES AND

PARTICIPATION

Activity is the execution of a task or action

by an individual.

Participation is involvement in a life

situation.


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Activity limitations

are difficulties an individual may have in

executing activities.

Participation restrictions

are problems an individual may experience

in involvement in life situations.


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Activities and participation

Learning and applying knowledge General tasks and demands

Communication Mobility

Self-care Domestic life

Interpersonal interactions and relationships Major life areas

Community, social and civic life


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IV- ENVIRONMENTAL

FACTORS

Environmental factors make up the

physical, social and

attitudinal environment in which people live

and conduct their

lives.


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Environmental factors

Products and technology Natural environment and human-made

changes to environment

Support and relationships Attitudes

Services, systems and policies


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Body Functions and Structures; and

Activities and Participation

These terms, which replace the formerly

used terms “impairment”, “disability” and

“handicap” , extend the scope of the

classification to allow positive experiences

to be described.


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“Activity limitation” replaces the term

“disability” used in the 1980 version of

ICIDH.

“Participation restriction” replaces the term

“handicap” used in the 1980 version of

ICIDH


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Functioning


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Functioning

is an umbrella term encompassing all

body functions, activities and participation;

Disability


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Disability

serves as an umbrella term for

impairments, activity limitations or

participation restrictions.


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Functioning is an umbrella term for body

functions, body structures, activities

and participation. It denotes the positive

aspects of the interaction between an

individual (with a health condition) and that

individual's contextual factors

(environmental and personal factors).


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Impairment

is a loss or abnormality in body structure or physiological function

(including mental functions). Abnormality here is used strictly to refer to a

significant variation from established statistical norms (i.e. as a deviation from a

population mean within measured standard norms) and should be used only in

this sense.


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Disability is an umbrella term for

impairments, activity limitations and

participation restrictions. It denotes the

negative aspects of the interaction

between an individual (with a health

condition) and that individual's contextual

factors (environmental and personal

factors).


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or structure such as a significant

deviation or loss.

Activity is the execution of a task or action

by an individual.

Participation is involvement in a life

situation.


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Activity limitations are difficulties an

individual may have in executing

activities.

Participation restrictions are problems an

individual may experience in

involvement in life situations.


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Environmental factors make up the

physical, social and attitudinal

environment in which people live and

conduct their lives.


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Exercises

Identify the Impairment,

Function and Activity Associated with the following conditions

Leprosy - Panic Disorder-Spinal Injury- Juvenile diabetes


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Leprosy

Loss of sensation of extremities = ?

Difficulties in grasping objects =?

Stigma of leprosy leads to unemployment =?


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Panic Disorder

Anxiety

Not capable of going out alone

People's reactions leads to

no social relationships


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Spinal Injury Paralysis

Incapable of using public transportation

Lack of accommodations in public

transportation

no participation in religious activities


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Juvenile diabetes

Pancreatic dysfunction

None (impairment controlled by

Medication)

Does not go to school because of

stereotypes about disease


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Vitiligo

Facial disfigurement

None

No participation in social relations owing to fear of contagion


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Cited References

International Classification of Functioning, Disability and

Health: ICF. World Health Organization 2001.

Towards a Common Language for Functioning, Disability and Health: ICF The International Classification of Functioning, Disability and Health. World Health Organization 2002.

http://www.who.int/classifications/en/


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Exercise #1

( International Classification of Function & Disability)

Dr. Ahmed- Refat 25/12/2012

Your Name

HEALTH

CONDITION

IMPAIRMENT ACTIVITY

LIMITATION

PARTICIPATION

RESTRICTION


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Health & Medicine

Disability :Current Concepts