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The vitality, participation and assessment of

environmental factors of children with disabilities aged

2-18

INSTRUCTION MANUAL

Yerevan, 2017

The following Handbook has been developed in the

framework of the “Community Services for Children with

Disabilities” program.

The Community Services for Children with Disabilities regional project is implemented by Save the

Children in five countries: Albania, Armenia, Bosnia and Herzegovina (northwestern Balkans),

Georgia and Kosovo. The goal of the project is to contribute to the development of children’s

capabilities, the development of independence and inclusion into society. It also aims to support

parents and mobilize communities to promote quality services for children with disabilities. In

Armenia, the project partners are “Full Life” and “Armavir Development Center” NGOs. The project

has been implemented between the years 2016-2018 in the regions of Yerevan, Armavir and Ararat.

The basis for the creation of the manual were the methodological guidelines the “Assessment of D

Codes, Individual Activities and Participation Instruments Designed to Identify Disability Based on

the WHO International Classification of Functioning,” written by M. Harutyunyan, L. Grigoryan, A.

Hayrapetyan, L Yesayan and the “Assessment of E Code, Environmental Factors Established for the

Definition of Disability Based on the WHO International Classification of Functioning” written by

M. Harutyunyan and L. Grigoryan, the creation of which was possible thanks to the technical

assistance and expertise of the United Nations Children’s Fund (UNICEF), United Nations

Development Program (UNDP) and USAID Pension Reform Implementation Program

(USAID/PRIP), with the assistance of the Ministry of Labour and Social Affairs of the Republic of

Armenia. The manuals have been developed and tested in the field of disability in the RA within the

framework of reforms being made within the framework of the WHO ICF.

The Opinion of the Ministry of Labour and Social Affairs

The content of the methodological manual is based on the ideology and principles of the WHO

International Classification of Functioning and is consistent with the fundamental and main trends of

the government of the RA’s reforms in the field of disability, simultaneously stemming from the

decision of the RA government on January 12, 2017, of Protocol No. 1 “On the Approval of the

Complex Program of Social Integration of Persons with Disabilities of 2017-2021 and on approving

the list of measures to ensure the implementation of the program.” Based on the above-mentioned,

the Ministry positively assesses the work done and proposes to organize a comprehensive discussion

of the methodological manual, involving representatives of non-governmental organizations and

other stakeholders, in order to ensure their awareness and position.

This methodological manual is designed to evaluate the

difficulties and barriers to the activities and participation of

children and adolescents aged 2-18 years, and for evaluating

the hindering or supporting environmental factors.

Professional Advisor:

Candidate of Pedagogical Sciences, Associate Professor

Marianna Harutyunyan

Editor:

Nune Pepanyan

“Save the Children” expert:

Gohar Galstyan

A questionnaire for children and adolescents aged 2-18 and a methodological manual was created

and developed within the framework of the Community Services for Children With Disabilities

project, based on the WHO ICF principles, the Independent Living Center and Armavir Development

Center professional teams supported by the “Full Life” NGO.

The Authoring Group:

“D” codes: activity and participation (47 code) “Full LIfe” NGO professional team

Candidate of Psychology Ani Avagyan, psychologist Nune Melikyan, ergotherapists Meri Avetisyan

and Tatevik Ghazaryan, speech therapist Anna Malkhasyan, Grigori Mamyan, social worker Lianna

Harutyunyan, assistant to the professional team Anna Nersisyan.

“E” codes: environmental factors (16 code) “Armavir Development Center” NGO professional team

Director Anahit Nahapetyan, Coordinator Margarit Sedrakyan, social workers Armine Stepanyan,

Haykanush Harutyunyan, art therapist Karmen Vardanyan, speech therapist Varditer Hovhannisyan,

special pedagogist Almast Avagyan, psychologist Naira Mkhitaryan, ergotherapist Syuzanna

Torosyan.

Content Introduction....................................................................................................................................... 7

The WHO ICF ideology

……………......................................................................................................... 9

Application procedure of the methodological manual .................................................................... 16

ICF-CY “E” Codes: Environmental Factors.........................................................................................

19

ICF-CY “D” Codes: individuals’ activities in daily life and participation............................................

35

Questionnaire for the assessment of the lifestyle and environmental factors of children with

disabilities between the ages of 2 and 18........................................................................................ 77

Attachments/ Forms .............................................................................................................. 107

Individual summary of assessment results /profile/............................................................. 108

Specialist’s individual intervention plan................................................................................ 110

Revaluation of the individual intervention programme ............................................................

112

Dictionary....................................................................................................................................... 113

References...................................................................................................................................... 118

INTRODUCTION

An important prerequisite for ensuring equitable and affordable conditions for children with

disabilities in Armenia is the introduction of the social model in the process of defining disability.

The definition of disability should not be limited to the disease, which does not provide a

comprehensive assessment of the needs of an individual. Obviously, different people with the same

diagnosis can have different degrees of participation in social life due to individual and environmental

factors. Depending on the individual and the environment, the disability can have a different impact

on the person’s activities. Therefore, as a result of a comprehensive assessment of the individual, it

is necessary to provide adequate social services in order to secure participation and social inclusion,

according to the individual’s capabilities and needs. In order to eliminate subjective approaches in

the process of defining disability, it was necessary to develop appropriate tools and standards that

would take into account the best international practices, while simultaneously being adapted to the

peculiarities of Armenia.

Since 2016, the “Full Life” and “Armavir Development Center” NGOs, with the financial support of

“Save the Children,” have been implementing a three-year project “Community Services for Children

with Disabilities,” which aims to promote the social inclusion of children with disabilities through

multidisciplinary services, participation in social life, as well as creating an environment for children

to live independently. Aside from all this, it was also necessary to develop a unified monitoring and

evaluation system that will enable the monitoring and evaluation of the effectiveness of the services

provided, to effectively manage the process.

Evaluation is the part of information collection, that enables you to identify visitors’ needs, problems

and their current states (Finlay, 2004). A questionnaire for the evaluation of the vitality, participation

and environmental factors for 218 children has been selected and developed as the method for

evaluating the needs of children with disabilities, where detailed degrees of evaluation show the

extent to which a given factor promotes or hinders an individual’s actions, behaviour and participation

in social relations.

WHO ICF METHODOLOGY

The ICF-CY belongs to the “family” of international classifications developed by WHO for the

application to various aspects of health. The WHO Family of International Classifications (WHO-

FIC) provides a framework to code a wide range of information about health (e.g. diagnosis,

functioning and disability, and reasons for contact with health services), and uses a standardized

language permitting communication about health and health care across the world in various

disciplines and sciences. The ICF can be used in a range of areas, such as social security, regulated

health care assessments, as well as for conducting questionnaires among the population at local,

national and international levels. It offers a conceptual framework for information that is applicable

to personal health care, including prevention, health promotion, and the improvement of participation

by removing or mitigating societal hindrances and encouraging the provision of social supports and

facilitators (ICF, 2001). It is also useful for the study of health-care systems, in terms of both

evaluation and policy formulation. The ICF focuses on the strengths of the person, contributing to

their more active participation in public life, including work activities (ICF, 2001).

ICF classifies health and health-related states. The unit of classification is, therefore, categories

within health and health-related domains. It is important to note, therefore, that in ICF persons are

not the units of classification; that is, the ICF does not classify people but describes the situation of

each person within an array of health or health-related domains. Moreover, the description is always

made within the context of environmental and personal factors.

The advantages of the ICF are:

● The ICF emphasizes the strengths of the individual, contributing to their more active

involvement in active life, including work activity.

● The ICF takes into account the role of environmental factors when defining disability.

● The ICF considers the limitations of a person’s activeness and participation, functionality

and vitality as an interaction or complex relationship between the health condition and

contextual factors (i.e. environmental and personal factors).

● The ICF has an extensive list of environmental factors which helps to assess the

environment’s positive or negative impact on the individual’s activities.

Interactions between the components of ICF

The importance and benefits of the application of the ICF

The importance and potential of the ICF are also valued in the development of a common strategy

for the assessment of the needs of children with disabilities in order to promote their rights and

welfare. The ICF presents a common language which helps to develop more targeted policies and

services, responding adequately to the needs of people with disabilities. The ICF takes into account

the role of environmental factors in defining disability. The ICF considers the limitations of a person’s

activeness and participation, functionality and vitality as an interaction or complex relationship

between the health condition and contextual factors (i.e. environmental and personal factors). The

ICF contains an extensive list of environmental factors which helps to evaluate the positive

(supporting) or negative (hindering) impact of the environment on the individual’s activities. The ICF

is a framework that describes human functionality in an ongoing process. It classifies functions, not

people. The ICF classifies health and health-related indicators, and the latter allows for making the

right choice in describing a person in a given situation. Moreover, this description can be made in the

context of environmental and individual factors.

The International Classification of Functioning, Disability and Health for Children and Youth (ICF-

CY) is a derived version of the International Classification of Functioning, Disability and Health

(ICF, WHO, 2001) designed to record characteristics of the developing child and the influence of

environments surrounding the child. The age range covered by the ICF-CY is from birth to 18 years

of age and can be used by all persons dealing with the health, education and well-being of children

and youth. It can be viewed as a common and universal language for clinical, public health and

research applications to facilitate the documentation and measurement of health and disability in

children and youth (ICF, 2001). The classification builds on the ICF conceptual framework and uses

a common language and terminology for recording problems involving functions and structures of

the body, activity limitations and participation restrictions manifested in infancy, childhood and

adolescence and relevant environmental factors.

The ICF uses a coding system

● Body Function: the functions of the body are denoted with the code “b.”

● Body Structure: the anatomical parts of the body (organs, limbs and their components); is

denoted with the code “s,”

● Activities/Participation: the execution of a task or action by an individual and involvement

in a life situation; is denoted with the code “d,”

● Environmental Factors: the physical and social environment; is denoted with the code “e,”

● Assessment involves gathering information as part of trying to understand the needs of

individuals, their problems and their situations (Finlay, 2004). The degrees of the assessment

show the extent that factors support or hinder actions, behaviour and participation in social

relations. The ICF uses four degrees of assessment, these are:

0 – the individual is able to perform the task without difficulty,

1 – mild: the individual is able to perform a given task independently but with difficulty,

2 – moderate: the individual is able to perform the given task with a certain amount of help, in the

case of the presence of a suitable item or with some support from another person,

3 – severe: when the difficulty/issue is severe and the individual can only perform a task with the help

of another person,

4 – extreme: when an individual cannot perform the action altogether or does not participate at all,

even in the case of assistance.

1. The following chapters are on the activities and participation

component: Chapter 1. Learning and applying knowledge

Chapter 2. General tasks and demands

Chapter 3. Communication

Chapter 4. Mobility

Chapter 5. Self-Care

Chapter 6. Domestic life

Chapter 7. Interpersonal interactions and relationships

Chapter 8. Major life areas

Chapter 9. Community, social and civic life

● Activity: the execution of a task or action by an individual.

● Participation: involvement in a life situation.

● Activity limitations: difficulties an individual may have in executing activities.

● Participation restrictions: problems an individual may experience in involvement in life

situations.

2. The following chapters are on the environmental factor. Chapter 1. Products and technology

Chapter 2. Natural environment and human-made changes to the environment

Chapter 3. Support and relationships

Chapter 4. Attitudes

Chapter 5. Services, systems and policies

Environmental factors are those physical and social environments in which people live and conduct

their lives, as well as the attitude that society shows towards them. These factors are external to

individuals and can have a positive or negative influence on the individual’s performance as a

member of society, on the individual’s capacity to execute actions or tasks, or on the individual’s

body function or structure.

APPLICATION PROCEDURE OF THE

METHODOLOGICAL MANUAL

This procedural guideline is a benchmark for evaluators, where the steps are presented in a sequence

and with a purpose.

Before proceeding to the evaluation process, the evaluator should be familiar with the methodology,

in order to have a clearer understanding of each code.

During the evaluation, firstly each specialist has a conversation with a parent regarding the questions

present in the questionnaire, then each specialist (occupational therapist / ergotherapist, psychologist,

speech therapist, social worker) separately evaluates the child through didactic materials and games,

after which the questionnaire is filled out, based on the qualifiers of the methodological manual.

Step 1

Make an assessment by using/filling out the questionnaire on the vitality, participation and

environmental factors for children aged 2-18.

The purpose of this questionnaire is to get information about the current situation of the child. The

questionnaire consists of two parts. The first part contains information on how much the child’s

environment promotes or hinders the individual’s activities and participation and gives an opportunity

to clarify which environmental factors are obstacles to the individual, depending on his or her

situation.

Step 2

Form 1: Fill out the child’s results and personal summary (profile).

The goal of the profile is to find out the child’s basic issues according to the degrees of 2-moderate,

3-severe, 4-extreme, and to find out through the profile what kind of services a child needs, which is

also taken note of in the profile.

Upon filling in the personal summary evaluation (profile) of the evaluation results, the specialist uses

the questionnaires outlined above and completes the objectives set out in the ICF after revealing the

issues and qualifiers. Then, the result indicators are written according to the ICF assessment results,

for example, if the child has a moderate qualification, the programme plans to change it from

moderate to mild.

Step 3

Form 2: Each specialist drafts the child’s professional intervention programme. In order to compile

this form, each specialist can carry out a narrow professional assessment so they can create a more

detailed support programme.

The objective of a professional intervention programme is to provide a conclusion from a specialist

on the current status of the child on the basis of the ICF assessment and to identify and implement

long-term and short-term goals.

The professional intervention programme is completed on the basis of the ICF, however, the specialist

also writes a few qualifiers, if it is determined that it is also necessary to work with the presence of

those qualifiers. After the conclusion is written in the first part of the form, a detailed description of

the child’s participation/activity /d/ and environmental factors /e/ problems is written with the

appropriate code. Then the end result of the intervention /code/, that is, the code specified by the

specialist as a result of the evaluation and the result of the intervention planned on the basis of that

code. A description of the short-term intervention is written in the next column, a detailed description

of the short-term intervention planned by the specialist, which can be 3 small goals through which

the above-mentioned results can be achieved. The specialist will also fill in all those methods,

approaches and steps which will be taken throughout the entire intervention process. The outcome

indicators for the completion of the short-term intervention and a clear timetable for the intervention

programme are also indicated.

Step 4

Form 3: Each specialist reassesses the child’s individual intervention programme. Once each

specialist completes their intervention programme, they also perform a reassessment based on the

goals that were set. The short-term goals of the intervention are written on this form, and the results

of the short-term intervention carried out by the specialist are summarized.

ICF- CY “e” CODES: ENVIRONMENTAL

FACTORS Environmental factors are those physical and social environments in which people live and conduct their

lives, as well as the attitude that society shows towards them. (Katherine A. and Meri V., 2002). These

factors can have varying effects on the individual’s participation, activity, body function and structure. The

physical and social environment surrounding an individual has a unique effect on the functionality of the

former. In the case of a positive impact, the results of the individual’s activity are higher than expected, and

in the case of negative effects, the results of the individual’s activity are lower than expected. When the

environmental factor improves the individual’s activity it is coded as facilitating or supporting, and

hindering when it is an obstacle (WHO, 2007).

The impact of environmental factors should be assessed from the point of view of the person with whom the

interview is being conducted.

The WHO ICF has singled out the following five areas included as environmental factors:

1. Products and technology,

2. Natural environment and human-made changes to the environment,

3. Support and relationships,

4. Attitudes,

5. Services, systems and policies.

Environmental factors have an impact on all components of functioning and disability and are organized in

sequence from the individual’s most immediate environment to the general environment. (ICF, 2001).

e 115. Products and technology for personal use in daily living

General products and technology for personal use in daily living as well as specially designed equipment,

products and technologies adapted for general purpose, which are located within the body, on the body or the

vicinity of, including general purpose intended for personal use and assistive products and technology with

the exception of products and technologies for personal indoor and outdoor mobility and transportation.

● e 115.0. No Obstacles

● e 115.1. Mild obstacles: In terms of acquiring and/or using assistive products and technology for

personal use in daily living, the individual has difficulties which they overcome one their own.

● e 115.2. Moderate obstacles: In terms of acquiring and/or using assistive products and technology

for personal use in daily living, the individual has difficulties, and in order to overcome them,

requires the partial support of others.

● e 115.3. Severe: In terms of acquiring and/or using assistive products and technology for personal

use in daily living, the individual has difficulties which interfere with their vitality and they always

require the help of others.

● e 115.4. Complete obstacles: In terms of acquiring and/or using assistive products and technology

for personal use in daily living, the individual has extreme obstacles that cannot be overcome at all,

either independently or with the help of others.

e 120. Products and technology for personal indoor and outdoor mobility and

transportation.

Equipment, products and technologies used by people in activities of moving inside and outside buildings,

including those adapted or specially designed, located in, on or near the person using them.


● e 120.1. Mild Obstacles: In terms of using equipment, products and technologies used by people in

activities of moving inside and outside buildings, the individual faces some obstacles, but manages

to move independently in the building and outside of the building, overcoming the obstacles on

their own.

● e 120.2. Moderate Obstacles: In terms of using equipment, products and technologies used by

people in activities of moving inside and outside buildings, the individual faces some obstacles,

such as a lack of ramps, a lack of handrails, no adapted elevators, as a result of which there is a

need for partial assistance from other people for moving in and out of the building.

● e 120.3. Severe Obstacles: The use of equipment, products and technologies in activities of

moving inside and outside buildings, allow the individual to move freely in the apartment, but they

cannot leave the house because of the disadvantages of the building conditions and they always

need help from other people.

● e 120.4. Complete Obstacles: Equipment, products and technologies in activities of moving inside

and outside buildings are absent, which makes it impossible for a person to move, even with the

help of another person.

e 125. Products and technology for communication

Equipment, products and technologies used by people in activities of sending and receiving information,

including those adapted or specially designed, located in, on or near the person using them (for example,

orthopedic prosthesis).


● e 125.1. Mild Obstacles: In terms of the use and/or adaptation for products and technologies for

telecommunications, the individual faces difficulties, but is able to overcome the obstacles that they

have to deal with.

● e 125.2. Moderate Obstacles: In terms of the use and/or adaptation for products and technologies

for telecommunications, the individual faces difficulties, which sometimes require the help of other

people to overcome.

● e 125.3. Severe Obstacles: In terms of the use and/or adaptation for products and technologies for

telecommunications, the individual faces difficulties, which can only be overcome with the help of

other people and/or special devices.

● e 125.4. Complete Obstacles: In terms of the use and/or adaptation for products and technologies

for telecommunications, the individual faces obstacles, which cannot be overcome at all.

e 130. Products and technology for education

Equipment, products, processes, methods and technology used for the acquisition of knowledge, expertise or

skill, including those adapted or specially designed.


● e 130.1. Mild Obstacles: In terms of equipment, products, processes, methods and technology used

for the acquisition of knowledge, the individual faces obstacles, but they can overcome them on

their own; for example, in the case of a problem of weak vision, they use larger fonts.

● e 130.2. Moderate Obstacles: In terms of equipment, products, processes, methods and technology

used for the acquisition of knowledge, the individual faces obstacles, and sometimes needs

technical assistance or partial assistance from others.

● e 130.3. Severe Obstacles: In terms of equipment, products, processes, methods and technology

used for the acquisition of knowledge, the individual has a constant need for supervision and

assistance.

● e 130.4. Complete Obstacles: In terms of the use and/ or adaptation of equipment, products,

processes, methods and technology used for the acquisition of knowledge, the individual cannot

overcome the obstacles by neither by themselves nor with the help of others.

e 150. Design, construction and building products and technology of buildings

for public use

Products and technology that constitute an individual’s indoor and outdoor human-made environment that is

planned, designed and constructed for public use, including the design, construction and adaptation of

interior comforts and signage.


● e 150.1. Mild Obstacles: In terms of the formation and adaptation of the environment both inside

and outside of public buildings, the individual faces difficulties, but is able to overcome them

independently.

● e 150.2. Moderate Obstacles: In terms of the use of both inside and outside public buildings, the

individual has a need for an adapted environment or help from another person.

● e 150.3. Severe Obstacles: Both inside and outside public buildings, the individual has a need for

help from another person even in the case of an adapted environment.

● e 150.4. Complete Obstacles: In terms of the formation and adaptation of the environment both

inside and outside of public buildings, the individual faces extreme difficulties which the cannot

overcome neither on their own nor with the help of another.

e 250. Sound

A phenomenon that is or may be heard, such as banging, ringing, thumping, singing, whistling, yelling or

buzzing, in any volume, timbre or tone, and that may provide useful or distracting information about the

world.


● e 250.1. Mild Obstacles: In terms of perceiving the phenomenon of sound and responding to its

effects, in life they encounter a small number of obstacles for example, in the case of hearing very

loud noise, the noise causes discomfort, however the individual can overcome the obstacles on their

own, sometimes the negative response to noise is associated with mood and general health.

● e 250.2. Moderate Obstacles: In terms of perceiving the phenomenon of sound and responding to

its effects, in life they encounter some obstacles, which disrupts their activity and participation.

● e 250.3. Severe Obstacles: In terms of perceiving the phenomenon of sound and responding to its

effects, in life they encounter difficult to overcome obstacles, which disrupts the individual’s neuro-

psychological state, causing health problems (headache, insomnia, irritability, etc.). and their

activity and participation are significantly hindered.

● e 250.4. Complete Obstacles: In terms of perceiving the phenomenon of sound and responding to

its effects, in life they encounter extreme obstacles, which disrupts an individual’s neuro-

psychological state and causes health problems (headache, insomnia, nervous spasms etc.,) which

completely disrupts activity or participation, the individual generally refuses to be involved even in

environments which include insignificant amounts of noise.

e 310. Immediate family

Immediate family members who provide practical physical or emotional support, nurturing and protection.


● e 310.1. Mild Obstacles: The individual sometimes does not receive enough support from

immediate family members, however that does not disrupt the individual’s vitality and social

inclusion.

● e 310.2. Moderate Obstacles: The individual does not receive support from some immediate

family members, as a result of which the individual’s vitality and social inclusion are disrupted,

depending on the situation.

● e 310.3. Severe Obstacles: The individual rarely receives support from their immediate family

members, as a result of which the individual’s vitality and social inclusion are often disrupted.

● e 310.4. Complete Obstacles: The individual never receives support from their immediate family,

which completely disrupts the individual’s vitality and social inclusion.

e 320. Friends

Individuals who are close and ongoing participants in relationships characterized by trust and mutual

support. The code described does not refer to individuals, but the support which they provide.


● e 320.1. Mild Obstacles: The individual experiences some difficulties only when exercising a

small number of activities, and they need support from friends, but it does not result in the

disruption from everyday activities in the social sphere. The individual has friends, often meets

with them, and if necessary asks for and receives the appropriate support from them.

● e 320.2. Moderate Obstacles: In day-to-day social interactions and relationships, an individual

experiences difficulty, needs friends, however, support from the latter is rarely provided or is not

provided at all, they have a small number of friends and neighbors, around 14.

● e 320.3. Severe Obstacles: In day-to-day social interactions and relationships, some individual

experiences difficulties, needs help from friends, however, support from the latter is rarely

provided. As a result, the social sphere of the individual’s life is significantly damaged, leading to

illness and/or passivity.

● e 320.4. Complete Obstacles: In day-to-day social interactions and relationships, an individual

experiences extreme difficulties as a result of not having any friends and/or not receiving any

support from them.

e 410. Individual attitudes of immediate family members

General or specific opinions and beliefs of immediate family members about the person or about other

matters (e.g. social, political and economic issues), that influence individual behaviour and actions.


● e 410.1. Mild Obstacles: Due to the positive and/or negative attitudes of immediate family

members, the individual faces difficulties that affect their behaviour, actions and participation,

which the individual can overcome on their own.

● e 410.2. Moderate Obstacles: Due to the positive and/or negative attitudes of immediate family


limiting the individual’s scope of interaction and activity.

● e 410.3. Severe Obstacles: Due to the positive and/or negative attitudes of immediate family


isolating the individual from the environment.

● e 410.4. Complete Obstacles: Due to the positive and/or negative attitudes of immediate family

members, the individual faces difficulties which completely affect their behaviour, actions and

participation. The individual cannot overcome these difficulties either independently or with the

help of others.

e 420. Individual attitudes of friends

General or specific opinions and beliefs of friends about the person or about other matters (e.g. social,

political and economic issues), that influence individual behaviour and actions.


● e 420.1. Mild Obstacles: Due to personal attitudes of friends, difficulties arise regarding an

individual’s behaviour, actions and participation, but the individual overcomes these obstacles on

their own and it does not result in the disruption of everyday activities in the social sphere.

● e 420.2. Moderate Obstacles: Due to personal attitudes of friends, difficulties arise as a result of

which an individual’s behaviour, actions, participation and social relationships are partially

disrupted, limiting an individual’s range of interaction.

● e 420.3. Severe Obstacles: Due to personal attitudes of friends, difficulties arise as a result of

which an individual’s behaviour, actions, participation and social relationships are significantly

disrupted, isolating the individual from the environment.

● e 420.4. Complete Obstacles: Due to personal attitudes of friends, difficulties arise as a result of

which an individual’s behaviour, actions, participation and social relationships are completely

disrupted, and the individual refuses to establish social relations with other persons.

e 460. Societal attitudes

General or specific opinions and beliefs generally held by people of a culture, society, subcultural or other

social groups about other individuals or about other social, political and economic issues, that influence

group or individual behaviour and actions


● e 460.1. Mild Obstacles: Due to public attitudes, difficulties arise in relation to an individual’s

behaviour, action and participation, but the individual overcomes them independently, and it does

not result in the disruption of everyday activities in the social sphere.

● e 460.2. Mild Obstacles: Due to public attitudes, difficulties arise as a result of which an

individual’s behaviour, actions, participation and social relationships are partially disrupted, for

example, the individual avoids public meetings, parties and events.

● e 460.3. Severe Obstacles: Due to public attitudes, difficulties arise as a result of which an

individual’s behaviour, actions, participation and social relationships are significantly disrupted, the

individual is isolated from the environment, refuses to or does not want to participate in social life

events, and can participate in extreme cases for only short periods of time.

● e 460.4. Complete Obstacles: Due to public attitudes, difficulties arise as a result of which an

individual’s behaviour, actions, participation and social relationships are extremely disrupted, and

in general, the individual refuses to establish social relationships with other people.

e 540. Transportation services, systems and policies

Services and programmes aimed at moving persons or goods by road, paths, rail, air or water, by public or

private transport.


● e 540.1. Mild Obstacles: Due to the inadequate adaptation of a vehicle, the individual faces

difficulties, sometimes there is physical and mental tension, however, the individual overcomes

them independently.

● e 540.2. Moderate Obstacles: When using a vehicle, the individual faces difficulties, depending on

the type of vehicle (non-adapted public buses, etc.,) sometimes the individual needs help from other

people.

● e 540.3. Severe Obstacles: When using a vehicle, the individual always needs help from others

(can only be transported via a private car or taxi).

● e 540.4. Complete Obstacles: The individual is not able to use transportation at all.

e 570. Social security services, systems and policies

Services and programmes aimed at providing income support to people who, because of age, poverty,

unemployment, health condition or disability, require public assistance that is funded either by general tax

revenues or contributory schemes, such as services for determining eligibility, delivering or distributing

assistance payments for the following types of programmes: social assistance programmes (e.g. non-

contributory welfare, poverty or other needs-based compensation), social insurance programmes (e.g.

contributory accident or unemployment insurance), and disability and related pension programmes.


● e 570.1. Mild Obstacles: Social security services are not available, but the individual can overcome

the problems on their own, and it does not lead to the disruption of their everyday activity or other

social issues.

● e 570.2. Moderate Obstacles: Social security services are not available, the individual has a lack of

information and needs the partial help of others to overcome the existing obstacles.

● e 570.3. Severe Obstacles: Social security services are not available and the needs of the individual

are not being met, the individual always needs help from others.

● e 570.4. Complete Obstacles: Social security services and policies are not accessible at all, the

individual is left out of the sphere of these services, they cannot overcome the difficulties either

independently or with the help of others.

e 580. Health services, systems and policies

Services, systems and policies for preventing and treating health problems, providing medical rehabilitation

and promoting a healthy lifestyle, excluding general social support services, systems and policies.


● e 580.1. Mild Obstacles: Health care services are not available when using therapeutic and

preventative measures, the individual experiences minor difficulties, however, they can overcome

them independently, and it does not lead to the deterioration of their health.

● e 580.2. Moderate Obstacles: Health care services are available, however, they do not completely

meet the needs of the individual, they do not provide the necessary therapeutic and preventative

measures for the individual, which leads to the deterioration of the individual’s health. They need

the partial help of others in order to overcome the existing obstacles.

● e 580.3. Severe Obstacles: Health care services are highly unlikely to be available, or are

inadequate for the needs of the individual and for the most part do not provide the necessary

therapeutic and preventative measures for the individual, which leads to the deterioration of the

individual’s health. They always need the help of others to overcome the existing obstacles.

● e 580.4. Complete Obstacles: The aforementioned services, systems and policies in this field are

not available at all, as a result of which the individual's activity and participation in this field are

disrupted.

e 585. Education and training services, systems and policies

Services, systems and policies for the acquisition, maintenance and improvement of knowledge, expertise

and vocational or artistic skills.


● e 585.1. Mild Obstacles: Education and training services are available, but the individual is hardly

able to be involved in them, trying to overcome the existing difficulties on their own.

● e 585.2. Moderate Obstacles: Education and training services are not available, which leads to

difficulties dealing with the partial loss of skills and knowledge related to the education of the

individual. In order to overcome difficulties, the individual needs partial help from others.

● e 585.3. Severe Obstacles: Education and training services are not available, they are strictly

unsatisfactory and do not provide the essential services to the individual, which leads to serious

issues dealing with the loss of skills and knowledge related to the education of the individual. In

order to overcome the obstacles, the individual needs constant help from others.

● e 585.4. Complete Obstacles: Education and training services, systems and policies are not

available at all, the individual is out of the scope of services and cannot overcome the obstacles

either independently or with the help of others.

ICF-CY “d” CODES: INDIVIDUALS’

ACTIVITIES OF DAILY LIVING AND

PARTICIPATION Participation is defined as an individual’s “involvement in different life situations,” introducing the public

aspect of functioning (McIntyre A. and Atwal A., 2005). In the ICF-CY, special attention has been paid to

participation, as the nature and environment of the lives of children and youth are essentially different from

the nature and environment of adult life situations. During development, the number and complexity of life

situations go through dramatic changes, from relationships with the main caregiver and a small child playing

on their own, to at an older age, playing games which develop social skills, relationships with their peers and

attending school. The smaller the child, the more likely it is for parents, guardians or service providers to

determine the possibilities of their participation. The role of the family and other people in the immediate

environment, particularly in early childhood is important to get an idea about the child’s participation.

The activity and participation factors include the following nine areas:

1. Learning and applying knowledge

2. General tasks and demands

3. Communication

4. Mobility

5. Self-care

6. Domestic life

7. Interpersonal interactions and relationships

8. Major life areas

9. Community, social and civic life

Each code is evaluated according to the age of the given child.

d 110. Watching

Using the sense of seeing intentionally to experience visual stimuli, such as following an object, watching

any given person, or children playing.

● d 110.0. No Difficulties

● d 110.1. Mild Difficulties: Visual signals from people, objects, events can be perceived by the

individual from 4 metres away.

● d 110.2. Moderate Difficulties: Visual signals from people, objects, events can be perceived by the

individual from 3-2 metres away. Sometimes they need audio and verbal guidance.

● d 110.3. Severe Difficulties: Visual signals from people, objects, events can be perceived by the

individual from 0-2 metres away. They constantly need audio and verbal guidance.

● d 110.4. Complete Difficulties: The individual cannot see, perceive, analyze visual signals

transmitted from humans, objects and events, (is absolutely blind).

d 115. Listening

Using the sense of hearing intentionally to experience auditory stimuli, such as listening to the sound of

someone's voice (lecture, story, conversation) or listening to the radio, music.


● d 115.1. Mild Difficulties: Auditory signals transmitted from the outside world, such as a human

voice, music and radio can be perceived in a silent, environment with no sound overload from 612

metres away.

● d 115.2. Moderate Difficulties: Auditory signals transmitted from the outside world, such as a

human voice, music and radio can be perceived in a silent, environment from 45 metres away.

● 115.3. Severe Difficulties: The individual is able to perceive the intrinsic tone of the outside world,

such as a human voice, music, radio and is able to perceive it from 24 metres away in the case of

absolute silence.

● d 115.4. Complete Difficulties: The individual cannot listen, perceive, analyze auditory signals

transmitted from people, objects and events (absolute deafness).

d 120. Other purposeful sensing

Using the body’s other basic senses intentionally to experience stimuli, such as touching and feeling

textures, tasting sweets or smelling flowers and perfume.


● d 120.1. Mild Difficulties: Unexpected sound and light signals cause a panic, but it does not affect

the individual’s mood and activity.

● d 120.2. Moderate Difficulties: The individual responds to stimuli from the outside world in an

exaggerated manner, with hypersensitivity. Oral motor deficit is present, in other words, the

individual puts everything in their mouth touches with their mouth. Hunger is not connected with

eating and the individual does not realize how much, when and what they want to eat. In the case of

hypersensitivity, the individual sometimes doesn’t realize what part of their body is being touched

if their eyes are closed. They become aggressive and restless from sudden touch, light, sound and

crowded places.

● d 120.3. Severe Difficulties: The individual cannot keep their balance, especially while moving.

They often slip from a seated position and fall while walking. They avoid touching cold, hot,

slippery objects. They avoid eye contact. They are very sensitive to sounds.

● d 120.4. Complete Difficulties: In general, the individual cannot receive information through any

of the above mentioned senses and/or one of them more purposefully.

d 130. Copying

Imitating or mimicking as a basic component of learning, such as copying a facial expression, gesture, the

letters of an alphabet a sound including directly copying an action or behaviour.


● d 130.1. Mild Difficulties: The individual can copy a facial expression, gesture, sound or the letters

of the alphabet after repeating it 12 times.

● d 130.2. Moderate Difficulties: The individual can copy a facial expression, gesture, sound or the

letters of the alphabet with inaccuracies, without paying attention to the details.

● d 130.3. Severe Difficulties: The individual can copy a facial expression, gesture, sound or the

letters of the alphabet with difficulty, after multiple repetitions and directions. Copying, as a rule, is

done with substantial inaccuracies and distortions, with verbal and non-verbal guidance.

● d 130.4. Complete Difficulties: The individual is completely incapable of copying and duplicating.

d 131. Learning through actions with objects

Learning with two or more objects and through simple symbolic games and role-playing games, such as

hitting objects, knocking blocks, and playing with dolls or cars.


● d 131.1. Mild Difficulties: The individual can do simple actions with one, two or more than two

objects, can learn with verbal guidance through symbolic games and role-playing games, moreover,

they have a need for instructions while learning through games.

● d 131.2. Moderate Difficulties: The individual can do simple actions with one or two objects, and

has difficulty in cases when there are more than two objects. When learning through symbolic

games and role-playing games, the individual needs hints and physical guidance.

● d 131.3. Severe Difficulties: The individual has difficulties carrying out simple actions with one or

two objects, they cannot engage in symbolic or role-playing games.

● d 131.4. Complete Difficulties: The individual cannot carry out actions with any objects.

d 160. Focusing attention

Intentionally focusing on specific stimuli, such as by filtering out distracting noises.


● d 160.1. Mild Difficulties: The individual concentrates attention with a delay, they are inattentive

towards details, but are able to finish the job they started.

● d 160.2. Moderate Difficulties: The individual concentrates attention with a delay, and cannot hear

the what they are being told until the end, or perform the task. They constantly ask additional

questions, are distracted, without a reasonable reason they divert their attention to other factors,

they find it difficult to concentrate on one or two factors at the same time, they complete the

assignment quite later than the allotted time.

● d 160.3. Severe Difficulties: The individual cannot concentrate their attention, they become tired

very quickly, are distracted, has a pathological deviation of concentration, is hyperkinetic, has a

need for help from others as well as hinting.

● d 160.4 Complete Difficulties: The individual cannot concentrate their attention on any factor.

d 161. Directing attention

Intentionally maintaining attention to specific actions or tasks for an appropriate length of time.


● d 161.1. Mild Difficulties: The individual maintains attention, however is inattentive to details and

may allow careless mistakes, but is able to finish the job that they started.

● d 161.2. Moderate Difficulties: The individual is unable to pay attention until the end of the

assignment, they cannot hear the what they are being told until the end, or performs the task. They

constantly ask additional questions, are distracted, without a reasonable reason they divert their

attention to other factors, they find it difficult to concentrate on one or two factors at the same time,

they complete the assignment quite later than the allotted time, they need a little hints and support

in order to finish the job they started.

● d 161.3. Severe Difficulties: The individual has a very short attention span, and can barely

maintain attention, they get tired very quickly, are distracted, has a pathological deviation of

concentration, is hyperkinetic, has a need for help from others as well as hinting.

● d 161.4. Complete Difficulties: The individual cannot maintain attention whatsoever.

d 163. Thinking

Formulating and manipulating ideas, concepts, and images, whether goal-oriented or not, either alone or with

others, and other thinking-related activities.


● d 163.1. Mild Difficulties: The individual is able to carry out analysis and combination, make

simple judgements, understand the relationships of cause and effects, but finds it difficult to come

to a conclusion based on several judgements without guidance. Sometimes it is possible to see their

thoughts stop; they might repeat the same idea several times. They are able to perform simple

purposeful tasks with objects through trial and error with some difficulty. Can put the parts together

to get a complete image, collecting narrative pictures. Considers and maintains the sequence of

operations and cause-and-effect relationships when working. The individual can with some

difficulties, summarize, classify, compare, analyze and combine.

● d 163.2. Moderate Difficulties: The individual’s thinking is superficial, there are no logical links

between thoughts, they are only able to perceive strictly obvious cause-and-effect relationships.

They find it difficult to make judgements, even with guidance. They might not finish one though

before starting with another. With the partial help of another person, the individual can get

complete images from the parts, collecting narrative pictures, they have difficulties comprehending

the meaning of images, they do not pay attention to details, confuses the sequence. They always

need the help of an adult for the implementation of thoughtful processes, comparison, analysis and

combining. From time to time obsessive thoughts can be observed, compulsive thoughts, delusions.

● d 163.3. Severe Difficulties: The individual can only formulate simple thoughts and ideas. The

object needs to be immediately present in order for them to study it. In addition, words are

meaningless, ideas do not correspond to reality. They have difficulties getting a complete image

from parts, they need hints. Even after multiple attempts with the help of another person, it is

difficult for them to get complete images when collecting narrative pictures, and they cannot

comprehend the meaning of the images, do not pay attention to details and confuse the sequence.

They cannot think about processes, compare analyze and combine even with the help of another

person. They can often be observed having obsessive thoughts, compulsive thoughts, delusions.

● d 163.4. Complete Difficulties: The individual does not show any ability to think or express ideas.

d 166. Reading

Performing activities involved in the comprehension and interpretation of written language (e.g. books,

instructions, newspapers in text or Braille), for the purpose of obtaining general knowledge or specific

information.


● d 166.1. Mild Difficulties: The individual doesn’t read very fluently, allowing some errors which

affect the overall speed of reading, quality and sometimes even the ability to perceive, the ability to

interpret what was read, however in the case of reading it again or spending some extra time on it,

the individual is able to overcome the difficulties on their own.

● d 166.2. Moderate Difficulties: The individual reads in syllables, has a difficult time

understanding written material, they interpret the written material through guiding questions and

clue words.

● d 166.3. Severe Difficulties: The individual reads only letter and/or doesn’t know the majority of

the letters, as a result of which they do not understand the meaning of what they are reading and

cannot interpret it.

● d 166.4. Complete Difficulties: The individual cannot read at all; they do not recognize the letters.

d 170. Writing

Using or producing symbols or language to convey information (with typewriters, Braille writers) such as

producing a written record of events or ideas or drafting a letter (with typewriters, Braille writers).


● d 170.1. Mild Difficulties: An individual can write, type with a typewriter, write a diction with a

Braille alphabet, copy, write their own ideas down by writing, using a keyboard or using the Braille

alphabet, however slowly, thinking, with pauses. They have difficulties writing long sentences, and

sometimes allow errors, which they can correct on their own after reviewing.

● d 170.2. Moderate Difficulties: The individual can write (type on a typewriter, write with the

Braille alphabet) only short pieces of information, they copy without difficulty (they copy by hand

or using the Braille alphabet), however when writing dictation (by typing on a typewriter or using a

Braille alphabet) flaws, confusions and substitutions are observed. When writing their handwriting

might be unreadable. Omissions of letters, syllables and words are sometimes observed, which they

cannot find and fix on their own. They can make use of tools for writing or sometimes need the

help of another person (to fix their wrist or elbow), to give directions.

● d 170.3. Severe Difficulties: The individual can write or type (type or copy, write or copy with the

Braille alphabet) only individual letters, words and symbols, only with the help of other people

(fixing their wrist or elbow, provide a comfortable table and so on), or to give directions. They

might need to use writing tools.

● d 170.4. Complete Difficulties: The person cannot typically write, type in the Braille alphabet, due

to a lack of recognizing letters and/or physical or mental disabilities.

d 172. Calculating

Performing computations by applying mathematical principles to solve problems that are described in words

and producing or displaying the results, such as computing the sum of three numbers or finding the result of

dividing one number by another.


● d 172.1. Mild Difficulties: The individual can count, perform calculations, but needs

interpretations and explanations in order to solve problems. In order to solve word problems, the

individual uses simple mathematical principles, expresses the results, writes or types with a

keyboard without difficulty.

● d 172.2. Moderate Difficulties: The individual can count, perform calculations only with the

availability of didactic materials. They find it difficult to make calculations that relate to word

problems. They find it difficult to solve problems even after interpretations and explanations.

● d 172.3. Severe Difficulties: The individual cannot use simple skills to perform calculations and

simple arithmetic operations (for example, to count up to ten). They are capable of counting objects

provided them only in the presence of other people’s hints and help.

● d 172.4. Complete Difficulties: The individual is not able to count/calculate at all.

d 210. Undertaking a single task

Carrying out simple or complex and coordinated activities related to the mental and physical components of

a single task, such as initiating a task, organizing time, space and materials for a task, pacing task

performance, and carrying out, completing and sustaining a task.


● d 210.1. Mild Difficulties: The individual is able to perform simple activities. They face

difficulties when performing complex and coordinated operations, but they are capable of

overcoming those difficulties and completing the task.

● d 210.2. Moderate Difficulties: Out of simple or complex activities the individual can only

perform the activities that they are familiar with, they find it difficult to plan and implement new

actions.

● d 210.3. Severe Difficulties: The individual cannot start and finish simple operations, they select

and use materials and tools for the given task. They need the constant help of another person.

● d 210.4. Complete Difficulties: The individual cannot perform a simple, complex, and coordinated

task at all or take part in them as well as give them an approximate interpretation.

d 230. Carrying out daily routine

Carrying out simple or complex and coordinated activities in order to plan, manage and complete the

requirements of day-to-day procedures or duties, such as budgeting time and making plans for separate

activities throughout the day.


● d 230.1. Mild Difficulties: While performing everyday activities, the individual is able to plan and

implement only the usual activities and has difficulties in planning and implementing new

activities.

● d 230.2. Moderate Difficulties: While performing everyday activities the individual can only

implement a part of the usual activities, they find it difficult to plan a combination of time

activities, as well as a sequence of activities.

● d 230.3. Severe Difficulties: While performing everyday activities the individual is able to perform

just one simple action with hints and under supervision, they find it difficult to plan and perform

simple activities.

● d 230.4. Complete Difficulties: The individual is totally unable to plan and manage everyday

activities.

d 250. Managing one’s own behaviour

Carrying out simple or complex and coordinated actions in a consistent manner in response to new

situations, persons or experiences, such as being quiet in a library.


● d 250.1. Mild Difficulties: The individual independently manages their own behaviour,

consistently performs simple or complementary activities, has difficulties controlling their

behaviour in new situations and in the presence of other people, becomes emotional and tense when

changing role function.

● d 250.2. Moderate Difficulties: The individual independently manages their own behaviour,

consistently performs simple or complementary activities in new situations or in the presence of

new people. From time to time they can become undone and lose self-control, and may have

difficulties with the assessment and perception of the surrounding environment and manifest

themselves inadequately.

● d 250.3. Severe Difficulties: The individual cannot control their behaviour even when under

supervision, or manages with great difficulty in a short period of time. Their behaviour is not

adequate, they need professional help and supervision.

● d 250.4. Complete Difficulties: The individual is unable to control their behaviour independently,

there is a need for constant supervision by another person.

d 310. Communicating with - receiving - spoken messages

Comprehending literal and implied meanings of messages in spoken language, such as understanding that a

statement asserts a fact or is an idiomatic expression, such as responding and comprehending spoken

messages.


● d 310.1. Mild Difficulties: The individual perceives simple and complex messages, but needs

clarification or repetition when perceiving figurative messages.

● d 310.2. Moderate Difficulties: The individual has difficulty responding to actions with simple

verbal messages (two words), such as requests (eg. “give me”) or instructions (for example, “no,”

“come here”). They can only understand simple words, and only when spoken slowly. There is a

need for physical guidance (holding hands and taking a given object and showing where they

should come or go to).

● d 310.3. Severe Difficulties: The individual can only understand instructions made up of one or

two familiar words, they respond to the voice of a person in a very simple way, expressed by

changes in breathing patterns or significant or mild movement in the body.

● d 310.4. Complete Difficulties: In communicating, the individual does not generally perceive

verbal messages.

d 315. Communicating with - receiving - nonverbal messages

Comprehending the literal and implied meanings of messages conveyed by gestures, symbols and drawings,

such as realizing that a child is tired when she rubs her eyes or that a warning bell means that there is a fire.


● d 315.1. Mild Difficulties: The individual perceives messages transmitted by gestures, signs and

pictures without difficulty, but they have difficulties grasping non-verbal messages with figurative

meaning, for example, the fact that shaking the head left to right doesn’t necessarily mean “no” but

can express dissatisfaction, or that nodding the head up and down not only means “yes,” but

gratitude, a smile not only joy, but also consent.

● d 315.2. Moderate Difficulties: The individual may find it difficult to perceive the meaning of a

message transmitted by facial expressions, hand gestures or signs, body posture and other body

movements, but manages to receive messages transmitted by signs, pictures and photos.

● d 315.3. Severe Difficulties: The individual perceives only a few simple gestures and signs (such

as “no,” “yes,” or “come”), they are not able to perceive the meaning of messages with hand

gestures or signs, they find it difficult to grasp the meaning of messages presented through pictures

and photos.

● d 315.4. Complete Difficulties: When communicating, the individual cannot perceive non-verbal

messages at all.

d 330. Speaking

Producing words, phrases and longer passages in spoken simple and complex messages with literal and

implied meaning, such as expressing a fact or telling a story in oral language.


● d 330.1. Mild Difficulties: The individual freely produces words that are straightforward and

figurative, phrases, paragraphs, but the fluency of the speech is disorderly, they stutter, stammer or

speak too fast, and they have difficulties in producing separate sounds and articulations

(replacements, transfers, omissions, confusion), however these issues are not manifested when they

concentrate or in the case of repetition. Their words are understandable to everyone and it does not

constitute an issue when communicating with other people.

● d 330.2. Moderate Difficulties: The individual finds it difficult to produce sentences comprised of

words containing figurative meaning, longer paragraphs, however they have an easier time saying

and pronouncing short verbal messages with a literal meaning. They may have a difficult time

producing sounds and articulations, nasal tone of voice, repetition of sounds, syllables and words.

The fluency of speech is expressly disorderly (stuttering, stammering or speaking too fast), in

general, it is difficult to understand their speech, or only those which are close to them can

understand.

● d 330.3. Severe Difficulties: The individual can produce verbal messages with a literal meaning,

mainly sentences comprising of one word and/or their speech is difficult to understand, even by

those which are close to them.

● d 330.4. Complete Difficulties: Speech is out of the question, the person communicates with

sounds and noises or through gestures.

d 335. Producing nonverbal messages

Using gestures, symbols and drawings to convey messages, such as shaking one’s head to indicate

disagreement or drawing a picture or diagram to convey a fact or complex idea, this includes producing body

gestures, signs, symbols, drawings and photographs.


● d 335.1. Mild Difficulties: The individual is able to produce non-verbal messages using sign

language, pictures and photos, but has difficulties producing messages through diagrams and

symbols.

● d 335.2. Moderate Difficulties: The individual has difficulty producing messages with gestures,

but is able to produce them with the help of signs and pictures, as well as through mimicry, wrist

and hand movements, and body posture (body language).

● d 335.3. Severe Difficulties: The individual has trouble communicating with even a few simple

gestures and signs, is able to compose one simple message through an image.

● d 335.4. Complete Difficulties: The individual cannot produce non-verbal messages whatsoever.

d 350. Conversation

Starting, sustaining and ending an interchange of thoughts and ideas, carried out by means of spoken,

written, sign or other forms of language, with one or more persons one knows or who are strangers, in formal

or casual settings.


● d 350.1. Mild Difficulties: The individual is able to continue and finish a conversation, discussion,

however, finds it difficult to initiate and start a conversation in an unfamiliar environment. It takes

them a long time to answer questions during a conversation.

● d 350.2 Moderate Difficulties: The individual cannot start a conversation, discussion, debate, they

have difficulties in continuing it and sometimes doesn’t make it to the end, they give short answers

to questions. Sometimes they need guidance and assistance.

● d 350.3. Severe Difficulties: The individual cannot start, continue and finish a conversation or

dialogue with one or more people, such as participating in a group exchange of thoughts.

● d 350.4. Complete Difficulties: The individual cannot start, continue and finish a conversation at

all.

d 410. Changing basic body position

Getting into and out of a body position and moving from one location to another, such as rolling from one

side to the other, sitting, standing, getting up out of a chair to lie down on a bed, and getting into and out of

positions of kneeling or squatting including changing body position from lying down, from squatting or

kneeling, from sitting or standing, bending and shifting the body’s centre of gravity.


● d 410.1. Mild Difficulties: The individual is able to change the position of their body (standing,

lying, sitting, squatting) relying on any nearby object to lean on (furniture, walls, etc.), for example,

they are able to get up from a seated position, to lie down, to sit up from a lying down position, to

stand up, to stand up from a squatting position, to sit down or squat from a standing position.

● d 410.2. Moderate Difficulties: The individual finds it difficult to change the position of their body

(standing, lying, sitting, squatting). They need a helper or an assisting device.

● d 410.3. Severe Difficulties: The individual finds it difficult to change the position of their body

(standing, lying, sitting, squatting). They constantly need a helper, an assisting device or help from

other people.

● d 410.4. Complete Difficulties: The individual is not able to change the basic position of their

body at all.

d 415. Maintaining a body position

Staying in the same body position as required, such as remaining seated or remaining standing for work or

school including maintaining a lying, squatting, kneeling, sitting and standing position.


● d 415.1. Mild Difficulties: The individual is able to maintain their body’s position, standing, lying,

sitting, squatting, having difficulty kneeling, sometimes losing their balance but independently

managing and overcoming difficulties.

● d 415.2. Moderate Difficulties: The individual is able to maintain their body’s position by lying,

sitting, standing, squatting, kneeling, with the help of assisting devices (for example adjustable

pillows to reduce bedsores, barriers/covers to prevent the risk of falling from a lying position,

armrests designed to maintain a seated position, canes designed to assist in maintaining a squatting

or kneeling position, crutches that help to maintain balance). Sometimes they need help from

others.

● d 415.3. Severe Difficulties: The individual is able to maintain their body’s position lying, sitting,

standing, squatting only with the help of other people.

● d 415.4. Complete Difficulties: The individual cannot maintain their body’s position at all and are

always in a lying condition.

d 420. Transferring oneself

Moving from one surface to another, such as sliding along a bench or moving from a bed to a chair, without

changing body position.


● d 420.1. Mild Difficulties: The individual is able to move freely from one surface to another with

difficulty, they sometimes need to lean on a nearby object.

● d 420.2. Moderate Difficulties: The individual is able to move from one surface to another only

with the help/support of devices.

● d 420.3. Severe Difficulties: The individual manages to move from one surface to another only

with aiding devices, and has the need for constant assistance from another person.

● d 420.4. Complete Difficulties: The individual is unable to transfer themselves at all.

d 440. Fine hand use

Performing the coordinated actions of handling objects, picking up, manipulating and releasing them using

one’s hand, fingers and thumb, such as required to lift coins off a table or turn a dial or knob.


● d 440.1. Mild Difficulties: The individual can perform fine hand use on their own, they sometimes

have difficulty picking up small objects.

● d 440.2. Moderate Difficulties: The individual is limited in their fine hand use, they have

difficulties picking up small objects, using them and moving them. They have the need for some

supportive/assistive devices.

● d 440.3. Severe Difficulties: During systematic operations, the individual cannot perform fine hand

use, they cannot pick up objects, use them or let go with the help of their hands, fingers or thumb.

They are in constant need of help from another person.

● d 440.4. Complete Difficulties: The individual is unable to perform fine hand use at all.

d 445. Hand and arm use

Performing the coordinated actions required to move objects or to manipulate them by using hands and arms,

such as pulling or pushing objects, reaching, turning or twisting the hands or arms, throwing, catching an

object.


● d 445.1. Mild Difficulties: The individual can make use of their hand and arm independently,

sometimes having difficulties in performing such actions such as styling their hair, lifting objects

above eye level etc., due to shaking or muscle tension in the hand.

● d 445.2. Moderate Difficulties: Hand actions are limited, the individual finds it difficult to pick up

small objects, catch, raise or hold them.

● d 445.3. Severe Difficulties: The individual cannot use their hands and arm when performing the

agreed actions, they cannot pick up, catch or raise small objects, only pulls and pushes them. They

need help from another person.

● d 445.4. Complete Difficulties: The individual cannot use their hand and arm at all.

d 450. Walking

Walking short distances, at home, in the yard, as well as long distances of more than 1 kilometre across a

village or town.


● d 450.1. Mild Difficulties: The individual is able to walk 300-500 metres, slowly, with some

disturbances in the coordination of their walking or with a limp.

● d 450.2. Moderate Difficulties: The individual can walk on their own for 100-200 metres, they

need more time, breaks, rest and assisting devices (walkers, cane, handles and etc.).

● d 450.3. Severe Difficulties: The individual cannot walk on their own up to 10 metres without the

help of other people and the use of devices.

● d 450.4. Complete Difficulties: The individual cannot walk independently, even with the help of

another person. They are unable to get the body into a vertical position.

d 455. Moving around

Moving the whole body from one place to another by means other than walking, such as climbing over a

rock or running down a street, skipping, jumping, or running around obstacles.


● d 455.1. Mild Difficulties: The individual can climb stairs on their own, however with difficulties,

taking breaks they can climb up 45 floors, or 50-60 stairs. They cannot run fast, they find it difficult

to move around obstacles and jump.

● d 455.2. Moderate Difficulties: The individual can only climb stairs with the help of handrails and

with difficulties up to the 2nd floor or 20-40 stairs. They need additional assisting devices. They

have difficulties running, do not jump or move around obstacles.

● d 455.3. Severe Difficulties: The individual can climb up 1-10 stairs only with the help of another,

with assisting devices or by holding a handrail, taking breaks. They cannot run, jump or move

around obstacles.

● d 455.4. Complete Difficulties: The individual cannot move around.

d 465. Moving around using equipment

Moving the whole body from place to place, on any surface or space, by using specific devices designed to

facilitate moving or create other ways of moving around.


● d 465.1. Mild Difficulties: The individual can move freely with the use of wheelchairs, with the

help of a walker or cane, however, there is a need for adaptation, specifically with large doors,

elevators, ramps or tailor-made cars etc.

● d 465.2. Moderate Difficulties: The individual finds it difficult to move using a wheelchair, walker

or cane, and sometimes needs the help of another person.

● d 465.3. Severe Difficulties: The individual can move with the use of a wheelchair, walker or cane

only in the case of getting help from another person.

● d 465.4. Complete Difficulties: The individual cannot move at all using a wheelchair or walker.

d 470. Using transportation

Using transportation to move around as a passenger, such as being driven in a car, bus, private or public taxi.


● d 470.1. Mild Difficulties: The individual uses public transportation on their own but requires

certain environmental adaptation, specifically the availability of handles and ramps for being lifted

into and descending from transports.

● d 470.2. Moderate Difficulties: It is difficult for the individual to use a vehicle independently, they

need assistance from either assisting devices or other people.

● d 470.3. Severe Difficulties: The individual is able to use a car or taxi only with the help of another

person.

● d 470.4. Complete Difficulties: The individual is unable to use any type of vehicle at all.

d 510. Washing oneself

Washing and drying one’s whole body, or body parts, using water and appropriate cleaning and drying

materials or methods, such as bathing, showering, washing hands and feet, face and hair, and drying with a

towel, according to age.


● d 510.1. Mild Difficulties: The individual is able to wash oneself independently, having difficulty

bathing, but overcomes them independently.

● d 510.2. Moderate Difficulties: The individual can hardly wash and bathe oneself. They need

assistance with assisting devices such as a special bath chair, a fixed shower head at an appropriate

height, a non-slip floor surface or another person’s assistance.

● d 510.3 Severe Difficulties: The individual is able to take a shower and bathe only with the help of

other people and with the use of adapted accessories or environments.

● d 510.4. Complete Difficulties: The individual cannot shower or bathe at all.

d 520. Caring for body parts

Looking after those parts of the body, such as skin, face, teeth, scalp, nails and genitals, that require more

than washing and drying.


● d 520.1. Mild Difficulties: The individual is able to take care of their body parts with extra effort.

● d 520.2. Moderate Difficulties: The individual is able to take care of their body parts with

difficulty. Needs assisting devices, such as a customized toothbrush, nail cutter, brush etc., or help

from another person.

● d 520.3. Severe Difficulties: The individual is able to take care of their body parts only with the

help of another person and some help from customized accessories.

● d 520.4. Complete Difficulties: The individual is unable to take care of their body parts at all.

d 530. Toileting

Indicating the need for, planning and carrying out the elimination of human waste (menstruation, urination

and defecation), and cleaning oneself afterwards, according to age.


● d 530.1. Mild Difficulties: The individual feels the need to eliminate human waste, after using the

toilet they take more time in order to maintain rules of hygiene.

● d 530.2. Moderate Difficulties: The individual finds it difficult to control the urge to eliminate

human waste, and has difficulty using the toilet. They feel the need for assisting devices, for

example, they need the height of the toilet to adjusted (adjust the height of the toilet seat to hip-

height), place a handle at hip height etc.

● d 530.3. Severe Difficulties: The individual is able only to report about their urges, however,

cannot control the urge to eliminate human waste. They can only use the toilet and clean their body

with the help of another person, they need hygienic accessories such as diapers etc.

● d 530.4. Complete Difficulties: The individual does not feel the urge to eliminate human waste,

does not control those urges, and cannot use the toilet.

d 540. Dressing

Carrying out the coordinated actions and tasks of putting on and taking off clothes and footwear in sequence

and in keeping with climatic and social conditions, such as by putting on, adjusting and removing shirts,

skirts, blouses, pants, undergarments, saris, kimono, tights, hats, gloves, coats, shoes, boots, sandals and

slippers, according to age.


● d 540.1. Mild Difficulties: The individual is able to get dressed and undressed on their own. They

have difficulties wearing tight clothing, small buttons, back buttons, tying shoelaces etc.

● d 540.2. Moderate Difficulties: The individual is able to get dressed and undressed on their own,

however, they need extra help, for example, they wear only customized clothing which is wide,

have large buttons or zippers etc., they use customized devices for dressing and undressing or they

need help from another person.

● d 540.3. Severe Difficulties: The individual is able to get dressed and undressed only with the help

of another person and/or with customized accessories, having partial participation in the process of

dressing and undressing. They follow the climatic and social conditions only with the direction of

another person.

● d 540.4. Complete Difficulties: The individual does not take part in the process of getting dressed

and undressed.

d 550. Eating

Indicating the need for, and carrying out the coordinated tasks and actions of eating food that has been

served, bringing it to the mouth and consuming it in culturally acceptable ways, cutting or breaking food into

pieces, opening bottles and cans, using eating implements, having meals, feasting or dining, according to

age.


● d 550.1. Mild Difficulties: The individual is able to eat independently, but finds it difficult to bring

food to the mouth, do to muscle spasms, tension or weakness in the wrist.

● d 550.2. Moderate Difficulties: The individual is able to eat independently, however, due to

muscle spasms, tension, or weakness in the wrist they need assisting devices, for example, a

customized spoon, fork, cup, plate or they have the need for the help of another person.

● d 550.3. Severe Difficulties: The individual is able to eat only with the help of another person, they

can chew and swallow food on their own.

● d 550.4. Complete Difficulties: The individual’s ability to swallow is strictly disrupted, they use

specially designed devices to get sustenance.

d 560. Drinking

Indicating the need for, and taking hold of a drink, bringing it to the mouth and consuming the drink in

culturally acceptable ways; mixing, stirring and pouring liquids for drinking, opening bottles and cans,

drinking through a straw or drinking running water, such as from a tap or a spring.


● d 560.1. Mild Difficulties: The individual is able to drink independently, but has difficulty/ies in

bringing the cup to the mouth, due to muscle spasms, tension, weakness in the wrist or another

reason.

● d 560.2. Moderate Difficulties: The individual is able to drink independently with difficulty. They

need assisting devices, for example, customized cups, bottles or they need some help from another

person.

● d 560.3. Severe Difficulties: The individual is able to drink only with the help of another person,

they have difficulties swallowing, they are not able to use their hands to hold a cup.

● d 560.4. Complete Difficulties: The action of drinking is strictly disrupted, and the individual uses

specially designed devices to get sustenance.

d 630. Preparing meals

Planning, organizing, cooking and serving simple and complex meals for oneself and others, such as by

making a menu, selecting edible food and drink, getting together ingredients for preparing meals, cooking

with heat and preparing cold foods and drinks, and serving the food, according to age.


● d 630.1. Mild Difficulties: The individual is able to prepare simple dishes such as salads, soups,

biscuits, etc., they find it difficult to prepare and serve complex meals.

● d 630.2. Moderate Difficulties: The individual finds it difficult to plan simple and complex meal

preparation, serving them, and using electrical appliances. They can do simple actions such as make

a cup of tea, make a bread and cheese sandwich and so on. Sometimes they need partial help and

guidance from others.

● d 630.3. Severe Difficulties: The individual is able to do elementary actions when preparing food,

they have difficulties planning simple and complex meal preparation, serving them, they have the

need for constant help, visual cards, and guidance from other people.

● d 630.4 Complete Difficulties: The individual is unable to prepare meals at all.

d 640. Doing housework

Managing a household by cleaning the house, washing clothes, using household appliances, storing food and

disposing of garbage, washing counters, walls and other surfaces; collecting and disposing of household

garbage; tidying rooms, closets and drawers; cleaning footwear; using brooms, brushes and vacuum

cleaners․


● d 640.1. Mild Difficulties: The individual can do household chores on their own, but easily gets

distracted from various external signals (game, computer, sounds). They return to work with the

direction of another person and continues it again. They can finish the work that they started.

● d 640.2. Moderate Difficulties: The individual can do household chores on their own in part, not

entirely, they mainly carry out the work that they find primarily necessary, they sometimes need

help from other people. They find it difficult to complete the work.

● d 640.3. Severe Difficulties: The individual can do household chores with the use of household

appliances only with the help of others, they can perform only basic elementary actions, such as

wiping the table, shutting off the water, switching off the TV and so on.

● d 640.4. Complete Difficulties: The individual cannot do household chores at all.

d 650. Caring for household objects

Maintaining household objects, including house and contents, clothes, vehicles and assistive devices, and

caring for plants and animals, watering plants.


● d 650.1. Mild Difficulties: The individual can take care of the house, household appliances,

equipment, animals, house plants and yard plants independently, they get distracted from various

external signals (game, computer, sounds). They return to work with the direction of another person

and continues it again.

● d 650.2. Moderate Difficulties: The individual can take care of the house, household appliances,

equipment, animals, house plants and yard plants independently partially, not entirely. They mainly

carry out the work that they find primarily necessary

● d 650.3. Severe Difficulties: The individual can take care of the house, household appliances,

equipment, animals, house plants and yard plants with great difficulty, only with the help of another

person, they can perform only basic elementary actions, such as closing the door, shutting the lights

off etc.

● d 650.4. Complete Difficulties: The individual cannot take care of the house, household

appliances, equipment, animals, house plants and yard plants at all.

d 660. Assisting others

Assisting household members and others with their learning, communicating, self-care, movement, within

the house or outside; being concerned about, or drawing other’s attention to, the well-being of household

members and others.


● d 660.1. Mild Difficulties: The individual can help family members and others with learning,

communicating, self-care, helping them move within the house or outside independently, with some

breaks according to their mood.

● d 660.2. Moderate Difficulties: The individual can help family members and others with learning,

communicating, self-care, helping them move within the house or outside partially independently,

they need the directions of another person.

● d 660.3. Severe Difficulties: The individual is able to perform simple, familiar actions. They have

a need for assisting devices, help from other people and intervention.

● d 660.4. Complete Difficulties: The individual cannot provide any kind of assistance.

d 710. Basic interpersonal interactions

Interacting with people in a contextually and socially appropriate manner, such as by showing consideration

and esteem when appropriate, or responding to the feelings of others as well as showing respect, warmth,

appreciation, and tolerance in relationships; responding to criticism and social cues in relationships, and

using appropriate physical contact in relationships.

● d 710. 0. No Difficulties

● d 710.1. Mild Difficulties: When establishing interpersonal relationships, the individual is able to

approach and communicate with people with simple behaviours (such as greetings, using

affirmative or negative gestures, inviting them inside) in a manner acceptable to the public. Some

actions may be inappropriate or disrespectful towards others.

● d 710.2. Moderate Difficulties: When establishing interpersonal relationships, the individual is

able to interact only with familiar people in a given situation through specific actions. They have

difficulties showing tolerance in relationships, they can demonstrate unpredictability and

inappropriate behaviour.

● d 710.3. Severe Difficulties: The individual finds it difficult to enter into interpersonal

relationships with even familiar people, they are mainly indifferent or aggressive, they have the

need for guidance or supervision of another person.

● d 710.4. Complete Difficulties: The individual cannot enter into interpersonal relationships at all.

d 760. Family relationships

Creating and maintaining kinship relationships, such as with members of the nuclear family, extended

family, foster and adopted family and step-relationships, more distant relationships such as second cousins,

or legal guardians, including parent-child and child-parent relationships, sibling and extended family

relationships


● d 760.1. Mild Difficulties: The individual is able to establish and maintain kinship relationships

with immediate family members and close relatives only with simple behaviours (such as curiosity,

doing an activity together, showing care), and communication. Their actions may be inappropriate

for the situation, they have difficulties initiating, approving and maintaining relationships with

more distant relatives.

● d 760.2. Moderate Difficulties: The individual is able to establish and maintain kinship

relationships with immediate family members and close relatives only with concrete, clear and

simple actions. Their behaviour is unpredictable and does not correspond to the situation. They can

be inappropriate or disrespectful towards family members.

● d 760.3. Severe Difficulties: The individual is able to establish and maintain kinship relationships

with only one-two immediate family member(s), only through physical action that reflect

indifference or aggression, they have the need for supervision and control from others.

● d 760.4. Complete Difficulties: The individual is unable to establish and maintain kinship

relationships at all.

d 810. Informal education

Learning at home or in some other non-institutional setting, such as acquiring non-academic (e.g. crafts) or

academic (e.g. home-schooling) skills from parents or family member in the home or community


● d 810.1. Mild Difficulties: The individual is able to participate in an informal education

programme, according to their personal curriculum, overcoming difficulties on their own.

● d 810.2. Moderate Difficulties: The individual is able to partially participate in an informal

educational programme, they need to be guided by another person to perform the tasks.

● d 810.3. Severe Difficulties: The individual is able to participate in an informal education

programme with difficulty, they perform only simple and short-term assignments with the constant

guidance of another person.

● d 810.4. Complete Difficulties: The individual cannot participate in an informal education

programme at all.

d 815. Preschool education

Learning at an initial level of organized instruction in the home or in the community designed primarily to

introduce a child to a school-type environment and prepare the child for compulsory education, such as by

acquiring skills in a day-care or similar setting in preparation for school (e.g. educational services provided

in the home or in community settings designed to promote health and cognitive, motor, language and social

development and readiness skills for formal education).


● d 815.1. Mild Difficulties: The individual is able to participate in preschool training provided by

the curriculum, overcoming difficulties independently.

● d 815.2. Moderate Difficulties: The individual needs guidance while participating in preschool

education and performing tasks.

● d 815.3. Severe Difficulties: While learning at the preschool level, the individual cannot

independently participate in the learning process, they constantly need help and guidance from

another person.

● d 815.4. Complete Difficulties: The individual is unable to attend preschool at all.

d 820. School education

Gaining admission to school, education; engaging in all school-related responsibilities and privileges;

learning the course material, subjects and other curriculum requirements in a primary or secondary education

programme, including attending school regularly; working cooperatively with other students, taking

direction from teachers, organizing, studying and completing assigned tasks and projects, and advancing to

other stages of education


● d 820.1. Mild Difficulties: The individual is able to participate in the school curriculum, according

to their personal learning plan, having difficulties when performing tasks and collaborating with

other students, but they are able to overcome difficulties independently.

● d 820.2. Moderate Difficulties: The individual participates in a personal learning plan provided by

an educational program, they need guidance and assistance when organizing themselves and

fulfilling tasks.

● d 820.3. Severe Difficulties: The individual fails to participate in elementary or secondary

education programs envisaged by the personal learning plan, they fail to fulfil all responsibilities, to

collaborate with other students, to get tasks from teachers, prepare for other stages of education and

master mandatory components. They need constant help and guidance from another person.

● d 820.4. Complete Difficulties: The individual is unable to participate in school education at all.

860. Basic economic transactions

Engaging in any form of simple economic transaction, such as using money to purchase food.


● d 860.1. Mild Difficulties: The individual can make simple economic transactions, for example, go

to the store by themselves to use the money given them to purchase food and only from the list

provided them.

● d 860.2. Moderate Difficulties: The individual is only able to make simple economic transactions

(go to a shop to purchase goods) with the help of cards, only in a familiar store. They need the

supervision of another person (a seller, someone accompanying them).

● d 860.3. Severe Difficulties: The individual has difficulties making even simple economic

transactions, even with the help of cards, they require the mandatory help of another person, for

example in taking them to the store, accompanying them, finding the store, taking the money out,

counting it, paying and going back home.

● d 860.4. Complete Difficulties: The individual is unable to perform any kind of simple economic

transaction.

d 880. Engagement in play

Purposeful, sustained engagement in activities with objects, toys, materials or games, occupying oneself or

with others.


● d 880.1. Mild Difficulties: The individual is able to play purposefully, both alone and with others,

but shows shyness in a new environment and when playing with strangers.

● d 880.2. Moderate Difficulties: The individual prefers to play only with familiar people and/or

toys, and/or has difficulties participating in a game independently and sometimes feels the need for

assisting devices and/or people.

● d 880.3. Severe Difficulties: In most cases, the individual plays alone and/or not purposefully, they

refuse to cooperate with other people and/or may be involved in game activities only with the help

of supportive means and/or help from other people.

● d 880.4. Complete Difficulties: The individual is completely indifferent and/or incapable of

engaging in playing games even with assisting devices and/or the help of other people.

d 910. Community life

Engaging in aspects of community social life, such as going to various events, concerts, weddings, parks,

cafes and other public venues.


● d 910.1. Mild Difficulties: The individual participates in community social life, but gets very tired

due to physical issues, they generally don’t have the desire or mood to participate.

● d 910.2. Moderate Difficulties: The individual usually participates in community social life for a

short time, gets tired quickly, tenses up, has the need for guidance and assistance or the use of

assisting devices due to physical issues.

● d 910.3. Severe Difficulties: The individual can participate in community social life only in the

case of constant surveillance and assistance.

● d 910.4. Complete Difficulties: The individual cannot participate in community social life, they are

always bedridden.

d 920. Recreation and leisure

Engaging in any form of play, recreational or leisure activity, such as informal or organized play and sports,

programmes of physical fitness, relaxation, amusement or diversion, going to art galleries, museums,

cinemas or theatres; engaging in crafts or hobbies, reading for enjoyment, playing musical instruments;

sightseeing, tourism and travelling for pleasure, including games, sports, arts and culture, crafts, hobbies and

socializing.


● d 920.1. Mild Difficulties: When engaging in recreational and leisure activities, the individual gets

tired due to physical issues, they often have no desire or mood to participate in the given action.

● d 920.2. Moderate Difficulties: The individual will participate in recreational and leisure activities

for a limited time due to physical and/or mental issues, they may have mood disorders, nervous

breakdowns, fear of crowds and so on. Sometimes they need the supervision of another person.

● d 920.3. Severe Difficulties: The individual can only participate in recreational and leisure

activities with the constant supervision and support of another person.

● d 920.4. Complete Difficulties: The individual is unable to organize or participate in recreation or

leisure.

Lifestyle and environmental factors of

children with disabilities between the ages of 2

and 18

ASSESSMENT QUESTIONNAIRE

Personal Information

1 First, last and middle name

2 Birthday, month and year

3 Sex (specify) 1. Male 2. Female

4 Place of registration, actual or temporary residence

5 Telephone number

6 Occupation / educational institution

7 If not studying or attending any educational institution

specify the reason

ENVIRONMENTAL FACTORS

Environmental

factors

Does the

individual have

obstacles in the

following

environment?

0

No

obstacl

es

1

Mild

obstacl

es

2

Moder

ate

obstacl

es

3

Severe

obstacl

es

4

Compl

ete

obstacl

es

Other

notes

e115: Products and

technology for

personal use in

daily living

Need for general

products and

technology for

personal use in

daily living as

well as specially

designed

equipment,

products and

technologies

adapted for

general purposes,

such as

appropriate

clothing,

customized

furniture,

household

appliances.

e120: Products and

technology for

personal indoor

and outdoor

mobility and

transportation

Need for products

and technology

for personal

indoor and

outdoor mobility

and

transportation.

Equipment,

products and

technologies used

by people in

activities of

moving inside and

outside buildings.

e125: Products and

technology for

communication

Need for

equipment,

products and

technologies used

by people in

activities of

sending and

receiving

information.

e 130: Products

and technology for

education

Equipment,

products,

processes,

methods and

technology used

for the acquisition

of

knowledge,

expertise or skill,

including those

adapted or

specially designed

as well as general

and assistive

products and

technology for

education.

e150: Design,

construction and

building products

and technology of

buildings for

public use

Products and

technology that

constitute an

individual’s

indoor and

outdoor human-

made environment

that is planned,

designed and

constructed for

public use,

including those

adapted or

specially

designed.

e250: Sound A phenomenon

that is or may be

heard, such as

banging, ringing,

thumping,

singing, whistling,

yelling or

buzzing, in any

volume, timbre or

tone, including

sound intensity,

sound quality.

e310: Immediate

family

The presence or

absence of

immediate family

members who

provide practical

physical or

emotional

support, nurturing

and protection.

e320: Friends Individuals who

are close and

ongoing

participants in

relationships

characterized by

trust and mutual

support. The code

described does not

refer to

individuals, but

the support which

they provide.

e410: Individual

attitudes of

immediate family

members

General or

specific opinions

and beliefs of

immediate family

members about

the person or

about other

matters (e.g.

social, political

and economic

issues), that

influence

individual

behaviour and

actions.

e420: Individual

attitudes of friends

General or

specific opinions

and beliefs of

friends about the

person or about

other matters (e.g.

social, political

and economic

issues), that

influence

individual

behaviour and

actions.

e460: Societal

attitudes

General or

specific opinions

and beliefs

generally held by

people of a

culture, society,

subcultural or

other social

groups about

other individuals

or about other

social, political

and economic

issues, that

influence group or

individual

behaviour.

e540:

Transportation

services, systems

and policies

The availability

and accessibility

of services and

programmes

aimed at moving

persons or goods

by road, paths,

rail, air or water,

by public or

private transport.

e570: Social

security services,

systems and

policies

The availability

and accessibility

of public support

and social security

services, which

are aimed at

providing support

(eg. benefits).

e580: Health

services, systems

and policies

The availability

and accessibility

of services,

systems and

policies for

preventing and

treating health

problems,

providing medical

rehabilitation and

promoting a

healthy lifestyle,

excluding general

social support

services, systems

and policies.

e585: Education

and training

services, systems

and policies

The accessibility

of services,

systems and

policies for the

acquisition,

maintenance and

improvement of

knowledge,

expertise and

vocational or

artistic skills.

ACTIVITIES AND PARTICIPATION

Activities Does the

individual have

any difficulties?

0

Difficu

lties

1

Mild

difficul

ties

2

Moder

ate

difficul

ties

3

Severe

difficul

ties

4

Compl

ete

difficul

ties

Other

notes

d110: Watching Using the sense of

seeing

intentionally to

experience visual

stimuli, such as

following an

object, watching

any given person,

or children

playing.

d115: Listening Using the sense of

hearing

intentionally to

experience

auditory stimuli,

such as listening

to the sound of

someone's voice

(lecture, story,

conversation) or

listening to the

radio, music.

d120: Other

purposeful sensing

Using the body’s

other basic senses

intentionally to

experience

stimuli, such as

touching and

feeling textures,

tasting sweets or

smelling flowers

and perfume.

d130: Copying Imitating or

mimicking as a

basic component

of learning, such

as copying a facial

expression,

gesture, the letters

of an alphabet a

sound including

directly copying

an action or

behaviour.

d131: Learning

through actions

with objects

Learning with two

or more objects

and through

simple symbolic

games and role-

playing games,

such as hitting

objects, knocking

blocks, and

playing with dolls

or cars.

d160: Focusing

attention

Intentionally

focusing on

specific stimuli,

such as by

filtering out

distracting noises.

d161: Directing

attention

Intentionally

maintaining

attention to

specific actions or

tasks for an

appropriate length

of time.

d163: Thinking Formulating and

manipulating

ideas, concepts,

and images,

whether goal-

oriented or not,

either alone or

with others, and

other thinking-

related activities.

d166: Reading Performing

activities involved

in the

comprehension

and interpretation

of written

language (e.g.

books,

instructions,

newspapers in text

or Braille), for the

purpose of

obtaining general

knowledge or

specific

information.

d170: Writing

Using or

producing

symbols or

language to

convey

information (with

typewriters,

Braille writers)

such as producing

a written record of

events or ideas or

drafting a letter

(with typewriters,

Braille writers).

d172: Calculating Performing

computations by

applying

mathematical

principles to solve

problems that are

described in

words and

producing or

displaying the

results, such as

computing the

sum of three

numbers or

finding the result

of dividing one

number by

another.

d210: Undertaking

a single task

Carrying out

simple or complex

and coordinated

activities related

to the mental and

physical

components of a

single task, such

as initiating a

task, organizing

time, space and

materials for a

task, pacing task

performance, and

carrying out,

completing and

sustaining a task.

d230: Carrying out

daily routine

Carrying out

simple or complex

and coordinated

activities in order

to plan, manage

and complete the

requirements of

day-to-day

procedures or

duties, such as

budgeting time

and making plans

for separate

activities

throughout the

day.

d250: Managing

one’s own

behaviour

Carrying out

simple or complex

and coordinated

actions in a

consistent manner

in response to new

situations, persons

or experiences,

such as being

quiet in a library.

d310:

Communicating

with - receiving -

spoken messages

Comprehending

literal and implied

meanings of

messages in

spoken language,

such as

understanding that

a statement asserts

a fact or is an

idiomatic

expression, such

as responding and

comprehending

spoken messages.

d315:

Communicating

with - receiving -

nonverbal

messages

Comprehending

the literal and

implied meanings

of messages

conveyed by

gestures, symbols

and drawings,

such as realizing

that a child is tired

when she rubs her

eyes or that a

warning bell

means that there is

a fire.

d330: Speaking Producing words,

phrases and

longer passages in

spoken simple and

complex messages

with literal and

implied meaning,

such as expressing

a fact or telling a

story in oral

language.

d335: Producing

nonverbal

messages

Using gestures,

symbols and

drawings to

convey messages,

such as shaking

one’s head to

indicate

disagreement or

drawing a picture

or diagram to

convey a fact or

complex idea, this

includes

producing body

gestures, signs,

symbols,

drawings and

photographs.

d350: Conversation

Starting,

sustaining and

ending an

interchange of

thoughts and

ideas, carried out

by means of

spoken, written,

sign or other

forms of

language, with

one or more

persons one

knows or who are

strangers, in

formal or casual

settings.

d410: Changing

basic body position

Getting into and

out of a body

position and

moving from one

location to

another, such as

rolling from one

side to the other,

sitting, standing,

getting up out of a

chair to lie down

on a bed, and

getting into and

out of positions of

kneeling or

squatting

including

changing body

position from

lying down, from

squatting or

kneeling, from

sitting or standing,

bending and

shifting the

body’s centre of

gravity.

d415: Maintaining

a body position

Staying in the

same body

position as

required, such as

remaining seated

or remaining

standing for work

or school

including

maintaining a

lying, squatting,

kneeling, sitting

and standing

position.

d420: Transferring

oneself

Moving from one

surface to another,

such as sliding

along a bench or

moving from a

bed to a chair,

without changing

body position.

d440: Fine hand

use

Performing the

coordinated

actions of

handling objects,

picking up,

manipulating and

releasing them

using one’s hand,

fingers and

thumb, such as

required to lift

coins off a table

or turn a dial or

knob.

d445: Hand and

arm use

Performing the

coordinated

actions required to

move objects or to

manipulate them

by using hands

and arms, such as

pulling or pushing

objects, reaching,

turning or twisting

the hands or arms,

throwing,

catching an

object.

d450: Walking Walking short

distances, at

home, in the yard,

as well as long

distances of more

than 1 kilometre

across a village or

town.

d455: Moving

around

Moving the whole

body from one

place to another

by means other

than walking,

such as climbing

over a rock or

running down a

street, skipping,

jumping, or

running around

obstacles.

d465: Moving

around using

equipment

Moving the whole

body from place

to place, on any

surface or space,

by using specific

devices designed

to facilitate

moving or create

other ways of

moving around.

d470: Using

transportation

Using

transportation to

move around as a

passenger, such as

being driven in a

car, bus, private or

public taxi.

d510: Washing

oneself

Washing and

drying one’s

whole body, or

body parts.

d520: Caring for

body parts

Looking after

those parts of the

body, such as

skin, face, teeth,

scalp, nails.

d530: Toileting Indicating the

need for, planning

and carrying out

the elimination of

human waste

(menstruation,

urination and

defecation), and

cleaning oneself

afterwards.

d540: Dressing Carrying out the

coordinated

actions and tasks

of putting on and

taking off clothes

and footwear in

sequence and in

keeping with

climatic and

social conditions.

d550: Eating Indicating the

need for, and

carrying out the

coordinated tasks

and actions of

eating food that

has been served,

bringing it to the

mouth, cutting or

breaking food into

pieces, using

eating implements

and dining.

d560: Drinking Indicating the

need for, and

taking hold of a

drink, bringing it

to the mouth and

consuming the

drink, opening

bottles, drinking

through a straw or

drinking running

water.

d630: Preparing

meals

Planning,

organizing,

cooking and

serving simple

and complex

meals for oneself

and others, such

as by making a

menu, selecting

edible food and

drink, getting

together

ingredients for

preparing meals,

cooking with heat

and preparing

cold foods and

drinks, and

serving the food.

d640: Doing

housework

Managing a

household by

cleaning the

house, washing

clothes, using

household

appliances,

storing food and

disposing of

garbage, washing

counters, walls

and other

surfaces;

collecting and

disposing of

household

garbage; tidying

rooms, closets and

drawers; cleaning

footwear; using

brooms, brushes

and vacuum

cleaners․

d650: Caring for

household objects

Maintaining

household objects,

including house

and contents,

clothes, vehicles

and assistive

devices, and

caring for plants

and animals,

watering plants.

d660: Assisting

others

Assisting

household

members and

others with their

learning,

communicating,

self-care,

movement, within

the house or

outside; being

concerned about,

or drawing other’s

attention to, the

well-being of

household

members and

others.

d710: Basic

interpersonal

interactions

Interacting with

people in a

contextually and

socially

appropriate

manner, such as

by showing

consideration and

esteem when

appropriate, or

responding to the

feelings of others

as well as

showing respect,

warmth,

appreciation, and

tolerance in

relationships;

responding to

criticism and

social cues in

relationships, and

using appropriate

physical contact

in relationships.

d760: Family

relationships

Creating and

maintaining

kinship

relationships, such

as with members

of the nuclear

family, extended

family.

d810: Informal

education

Learning at home

or in some other

non-institutional

setting, such as

acquiring non-

academic (e.g.

crafts) or

academic (e.g.

home-schooling)

skills from parents

or family member

in home or

community.

d815: Preschool

education

Learning at an

initial level of

organized

instruction in the

home or in the

community

designed

primarily to

introduce a child

to a school-type

environment and

prepare the child

for compulsory

education, such as

by acquiring skills

in a day-care or

similar setting in

preparation for

school.

d820: School

education

Gaining

admission to

school, education;

engaging in all

school-related

responsibilities

and privileges;

learning the

course material,

subjects and other

curriculum

requirements in a

primary or

secondary

education

programme.

d860: Basic

economic

transactions

Engaging in any

form of simple

economic

transaction, such

as using money to

purchase food

with cash or cards

(exchanges),

exchanging goods

or services or

saving money.

d880: Engagement

in play

Purposeful,

sustained

engagement in

activities with

objects, toys,

materials or

games, occupying

oneself or with

others.

d910: Community

life

Engaging in

aspects of

community social

life, such as going

to various events,

concerts,

weddings, parks,

cafes and other

public venues.

d920: Recreation

and leisure

Engaging in any

form of play,

recreational or

leisure activity,

such as informal

or organized play

and sports,

programmes of

physical fitness,

relaxation,

amusement or

diversion, going

to art galleries,

museums,

cinemas or

theatres; engaging

in crafts or

hobbies, reading

for enjoyment,

playing musical

instruments;

sightseeing,

tourism and

travelling for

pleasure,

including games,

sports, arts and

culture, crafts,

hobbies and

socializing.

The questionnaire was completed by (Name, Last Name)

Ergotherapist-------------------------------------------------------------------------------------------(-----------------------

-------)

Logopedist-----------------------------------------------------------------------------------------------(---------------------

---------)

Psychologist --------------------------------------------------------------------------------------------(----------------------

--------)

Social Worker-------------------------------------------------------------------------------------------(---------------------

---------)

_____________________________ 2017

Attachments/ Forms

1. Personal summary evaluation/profile

2. Professional intervention programme

3. Reassessment form

Form 1

Personal summary evaluation/profile Date of completion: 00/00/0000

Name, Last name, Middle name:

___________________________________________

Diagnosis: ____________________________

Age: ______________________________

day, month, year

Photograph

Provided services ● Logopedist

● Ergotherapist

● Social Worker

● Psychologist

Issues raised by the ICF

assessment

(Here are all the issues that

have been identified with

the help of the

questionnaire)

1 2 3 4 Intervention plan Result indicators according to

the ICF assessment results

Form 2

PROFESSIONAL INDIVIDUAL INTERVENTION

PROGRAMME Professional/ first name/ last name

/Fill out the first and last name of the specialist which created the individual intervention plan/

Date of completion: dd/mm/yyyy/ /Fill out the date, month and year of the creation of the individual intervention plan/

First name, last name, middle name: (Fill out the first, last and middle name of the child receiving rehabilitation services).

Birthday, month, year: (Fill out the date of birth by date, month, and year of the child receiving rehabilitation services).

Diagnos(is/es) 1 (Fill out the child’s medical diagnosis, according to the agency of medical and social expertise)

Conclusions made by a specialist based on the ICF assessment 2 (Fill out the specialist’s conclusions of the individual intervention plan)

Participation/activity (d) environmental (e) issues raised (ICF)

● d 000 - denotation

(Fill out the code with the appropriate characters and name)

description of the issue

(Fill out a detailed description of the relevant issue based on the

code)

1 Diagnosis according to the conclusion of the agency of medical and social expertise.

2 By the professional service provider.

Intervention Outcomes

(Fill this field with the long term-objectives for vitality and participation as defined by the specialist)

Short-term intervention

description

(Fill out a detailed description of

the intervention programme as

planned by the specialist)

Applied methods, approaches,

measures and steps

(Fill out all the methods,

approaches and steps that are

applied during the planned

intervention, which the specialist

will use in the course of the

intervention to achieve the goal)

Result indicators of the

professional individual

intervention plan

(Fill out the results of the

intervention completed by the

specialist and the deadlines of the

intervention)

Form 3

REEVALUATION OF THE INDIVIDUAL INTERVENTION

PROGRAMME (After the completion of their intervention, each specialist also conducts a re-evaluation based on the set goals)

Re-evaluation date dd/mm/yyyy/

(Fill out the day, month and year of the re-evaluation)

Short-term goal of the intervention Short-term goal clearly defined by the specialist

Re-evaluating the child’s individual

intervention programme by a

specialist, according to professional

observation (Fill out the results of the intervention completed by the

specialist and the timing of the intervention)

Other notes (If there are any points subject to explanation, please describe them in detail)

DICTIONARY Adaptation

adjustment, alteration, modification

Adequate

suitable, sufficient, equal, fully compliant

Hyperactive

extremely active

Hyperkinetic

Features a consistently good and happy mood. Active, full of energy. They manifest an aspiration of

leadership. They are friendly, are not stable in their interests.

They have difficulty adapting to being alone. They easily adapt to unfamiliar environments, do not like

monotony, discipline, monotonous work and imposed activity. They are optimistic and tend to overestimate

their own capabilities. They react emotionally to events and are excitable.

Facial Expression

Facial muscle movements, the expression of inner experiences playing on the face.

Sensor

a physical organism that causes senses (visual sensor, auditory sensor, etc.)

Perception

a reflection of the full images of objects in the inner world of a person.

Comprehension

Thoughtful, meaningful, understood perception

Gesture

A gesture is an appropriate movement performed by the body or any part of the body to transmit an

expression of something. The hands, fingers and head are often used to make gestures. The most common

gesture in the head is the movement of nodding, which means yes.

If the head shakes from right to left and left to right then it means no. There is also another gesture that

happens when you move the jaw to the right and to the left, thereby expressing disapproval.

Self-service

The ability to serve oneself without the help of any other person.

Language

a system of symbols and rules for connecting them to each other.

Auditory stimulus

that which is perceived by the auditory analyzer

To reflect

to think, contemplate, consider, ponder

Obsessive thoughts

thoughts that an individual has regularly or at constant intervals

Tardiness

being late, prolongation, delay

Memory

The ability to maintain perceptions in the mind (brain) and replicate them, which is also a group of complex

mental processes.

Reflection

one of the methods that activate thinking and imagination

Thinking

a mental cognitive process, most often a problem-solving process, with which we understand hidden aspects

of occurrences and the patterns of existence.

Remembrance

the original process of memory, the process of keeping that which is perceived in mind.

Trifle

1. small items, objects

2. items and accessories of secondary importance

System of symbols

All the signs that are required to communicate in writing, such as letters, punctuation marks and more.

Non-verbal

not with spoken word

Pathological deviation

development does not have a sustainable deviation

Taciturn

untalkative

Symbolic games

Those games when an object refers to something else who does not exist at the given moment. For example,

when a baby takes a piece of wood and riding it like a horse.

Role-playing game

the collection of behaviour experience and general judgement and a means of forming the main components

of the child’s moral and social aspirations. During the game, an emotional atmosphere is formed that

contributes to the child’s character’s empathy, that is, the formation of attitudes, sensitivity, care, readiness

and fairness.

Verbal

the phenomenon of spoken “word,” the term used to indicate the process of words, signs and actions.

Verbal guidance

Direction, help, which occurs in the form of spoken word or speech, for example, “raise your hand” etc.

Visual cards

Cards designed for visual orientation

Visual stimulus

that which is perceived by the visual analyzer

Distractedness

the inability to focus on anything more or less for a long time. it is the opposite of sustainability.

Attention

the direction of a person’s mental activity towards certain objects and phenomena

Concentration of attention

the concentration of mental activity on one or a few objects, thanks to which they are perceived in clear and

precise details.

Stability of attention

the temporal characteristic of attention: the attention of a person, who has been focusing their attention on a

particular object or activity for a long time, is stable

To interact

to mutually influence, to influence each other or impact each other

Helper/assisting device

customized or special-purpose equipment, products and technologies, with the help of which people can

move around, such as walkers, wheelchairs, crutches as well as with the help of which people are able to

transmit and receive information such as special purpose visual aids, electro-optical devices, special purpose

printers, equipment for painting or writing with the hand, signalling systems and special software, hearing

aids, personal hearing aids, audio prostheses, communication panels, glasses and contact lenses.

Physical activity

any movement of the body that is accompanied by energy expenditure, with the help of muscle power.

Physical guidance

immediate physical assistance from any person, for example, guiding a child by hold their hand and taking it

towards the object or task.

Function

In Armenian: an operation, the role that the subject can perform. Simply put, that which can be done with the

help of a given item. For example, a pen is for writing, a key is for opening and closing a lock, a spade for

digging and so on.

References 1. Anne Mclntyre & Anita Atwal (2005); Occupational Therapy and Older People, Brunel University,

London UK.

2. Catherine A. Trombly & Mary Vining Radomski (2002); Occupational therapy for physical dysfunction

fifth edition.

3. Finlay, L. & Nelson Thornes (2004), The practice of Psychosocial Occupational Therapy.

4. World Health Organization, International Classification of Children and Youth Functionality, Disability

and Health, 2007.

5. Classification of functionality, disability and health, 2001.

6. M. Harutyunyan, L. Grigoryan (2016), ԱՀԿ Ֆունկցիայի միջազգային դասակարգման հիման վրա

հաշմանդամության սահմանման համար մշակված գործիքների e կոդերի՝ միջավայրային

գործոնների գնահատման ուղեցույց [Guidelines for the Assessment of e Code, Environmental Factors

Developed to Identify Disability Based on the WTO Functional Classification]

7. M. Harutyunyan, L. Grigoryan, A. Hayrapetyan, L. Yesayan (2016), ԱՀԿ Ֆունկցիայի միջազգային

դասակարգման հիման վրա հաշմանդամության սահմանման համար մշակված գործիքների d

կոդերի՝ անձի գործունեության և մասնակցության գնահատման ուղեցույց [Guidelines for the

Assessment of d Code an Individual’s Activity and Participation Factors Developed to Identify Disability

Based on the WTO Functional Classification]

the vitality, participation and assessment of environmental … · 2019-07-16 · decision of the...

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