The International Classification of Functioning, Disability and Health

Selected slides of the Presentation for the UMINDS class September 14, 2006

Els R. Nieuwenhuijsen, PhD, MPH, OTR

elsni@comcast.net

Foundations of ICFFoundations of ICFHuman Functioning Human Functioning - - notnot merely disability merely disability

Universal Model Universal Model - - notnot a minority model a minority model

Integrative Model Integrative Model - - notnot merely medical or social merely medical or social

Interactive Model Interactive Model - - notnot linear progressive linear progressive

Parity Parity - - notnot etiological causality etiological causality

Context - inclusive Context - inclusive - - notnot person aloneperson alone

Cultural applicability Cultural applicability - - notnot western concepts western concepts

Operational Operational - - notnot theory driven alone theory driven alone

Life span coverage Life span coverage - - notnot adult driven adult driven

Medical Medical versusversus Social Model Social Model

• PERSONAL problem PERSONAL problem vs vs SOCIAL problemSOCIAL problem

• medical care medical care vs vs social integration social integration

• individual treatment individual treatment vs vs social actionsocial action

• professional help professional help vsvs individual & collective individual & collective responsibilityresponsibility

• personal personal vs vs environmental adjustment environmental adjustment manipulation manipulation

• behaviour behaviour vsvs attitude attitude

• care care vs vs human rightshuman rights

• health care policy health care policy vsvs politicspolitics

• individual adaptation individual adaptation vs vs social changesocial change

Health Condition Health Condition ((disorder/diseasedisorder/disease))

Interaction of ConceptsInteraction of ConceptsICF 2001ICF 2001

Environmental Environmental FactorsFactors

Personal Personal FactorsFactors

Body Body function&structurefunction&structure

(Impairment(Impairment))

ActivitiesActivities(Limitation)(Limitation)

ParticipationParticipation(Restriction)(Restriction)

Definition of the term DisabilityDefinition of the term Disability

DisabilityDisability is an umbrella term for impairments, activity is an umbrella term for impairments, activity limitations or participation restrictions. It denontes the limitations or participation restrictions. It denontes the negative aspects of the interaction between an individual negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual (with a health condition) and that individual’s contextual factors (environmental and personal factors).factors (environmental and personal factors).

(Slide inserted by Els Nieuwenhuijsen)

ICF ComponentsICF Components

Body FunctionsBody Functions&&

StructuresStructures

Activities Activities & &

ParticipationParticipation

Environmental Environmental FactorsFactors

BarriersBarriers

FacilitatorsFacilitators

Functions Functions

Structures Structures

CapacityCapacity

PerformancePerformance

Body Functions and StructuresBody Functions and Structures

Skin and related structuresSkin and related structuresFunctions of the skin and related Functions of the skin and related structuresstructures

Structures related to movementStructures related to movementNeuromusculoskeletal and Neuromusculoskeletal and movement-related functionsmovement-related functions

Structures related to the genitourinary Structures related to the genitourinary and reproductive systemsand reproductive systems

Genitourinary and reproductive Genitourinary and reproductive functionsfunctions

Structures related to the digestive, Structures related to the digestive, metabolic and endocrine systemsmetabolic and endocrine systems

Functions of the digestive, metabolic Functions of the digestive, metabolic and endocrine systemsand endocrine systems

Structures of the cardiovascular, Structures of the cardiovascular, immunological and respiratory immunological and respiratory systemssystems

Functions of the cardiovascular, Functions of the cardiovascular, haematological, immunological and haematological, immunological and respiratory systemsrespiratory systems

Structures involved in voice and Structures involved in voice and speechspeech

Voice and speech functionsVoice and speech functions

The eye, ear and related structuresThe eye, ear and related structuresSensory functions and painSensory functions and pain

Structures of the nervous systemStructures of the nervous systemMental functionsMental functions

Activities and ParticipationActivities and Participation

11 Learning &Applying KnowledgeLearning &Applying Knowledge22 General Tasks and DemandsGeneral Tasks and Demands33 CommunicationCommunication44 MovementMovement55 Self CareSelf Care66 Domestic Life AreasDomestic Life Areas77 Interpersonal InteractionsInterpersonal Interactions88 Major Life AreasMajor Life Areas99 Community, Social & Civic LifeCommunity, Social & Civic Life

Environmental FactorsEnvironmental Factors

1. Products and technology 1. Products and technology

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

3. Support and relationships3. Support and relationships

4. Attitudes 4. Attitudes

5. Services, systems and policies 5. Services, systems and policies

Contextual FactorsContextual Factors

PersonPerson gendergenderageageother health other health

conditionsconditionscoping stylecoping stylesocial backgroundsocial backgroundeducationeducationprofessionprofessionpast experiencepast experiencecharacter stylecharacter style

EnvironmentEnvironmentProductsProductsClose milieuClose milieuInstitutionsInstitutionsSocial NormsSocial NormsCultureCultureBuilt-environmentBuilt-environmentPolitical factorsPolitical factorsNatureNature

The ICFThe ICF

1. ICF is the only classification that deals with functioning, disability and health

2. ICF is used world wide 3. ICF is founded on the bio-psycho-

social model

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References• Disability and Rehabilitation, 2005, Vol 27, No 7/8; and

Disability and Rehabilitation, 2003, Vol 25, No 11/12• Measuring health : a guide to rating scales and

questionnaires. Ian McDowell. Oxford: Oxford University Press, 1996

• American Journal of Public Health: November 2005• Surgeon General's Call to Action to Improve the Health

and Wellness of Persons with Disabilities http://www.surgeongeneral.gov/library/disabilities

• Healthy People 2010, focus area 6 http://www.healthypeople.gov/Publications/

• http://vancouver.ca/getinvolved/documents/MeasuringUpWorkbookSept26.pdf

• http://www3.who.int/icf/icftemplate.cfm