applying the icf in disability september 5... · icf research branch of the who swiss paraplegic...
TRANSCRIPT
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
www.easierliving.com
• 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)
World Health Organization 2001
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
www.oneidanation.org
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
World Health Organization 2011
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
www.easierliving.com
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
www.psh-rehab.com
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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”
World Health Organization 2011
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
World Health Organization 2011
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
World Health Organization 2011
carecarecarecare
Measures IIMeasures II
Muscle toneMuscle tone
Gait deviationGait deviationParticipation in educationParticipation in education
Measures IIMeasures II
Muscle toneMuscle tone
Gait deviationGait deviationParticipation in educationParticipation in education
Measures IIMeasures II
Communication skillsCommunication skills
Participation in educationParticipation in educationRelationship with familyRelationship with family
Measures IIMeasures II
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!
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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