Exploring the ICF: The Domains

Ezekiel is a adventurous 10-year old boy who is integrated into regular education and living in a large city.  His diagnosed health condition ICD-10 code is G80.9: Cerebral palsy, unspecified.   The ICF describes his hip migration status, his range of motion, balance and endurance.   We learn of his recreational interests, his home and school environment, his family, and the equipment that supports his movement and communication.  Through the ICF, we can begin to see Ezekiel as a complex and unique person functioning with the health condition of cerebral palsy.

The International Classification of Functioning, Disability and Health (ICF) is a framework for describing and organizing information on functioning and disability.  In this post, we will be looking at the domains that are components of the ICF.   As you can see from the above diagram, the domains of body structure and function, activity, participation, environmental factors and personal factors each interact with one another, creating unique combinations of functioning and disability.  The ICF is composed of the following domains:

  1.  BODY FUNCTIONS AND STRUCTURE: (At the level of the body)
    1. Body functions are physiological and psychological functions of the body.
    2. Body structures are the anatomic parts of the body.
  2. ACTIVITIES: (At the level of the individual) This refers to the execution of tasks or actions by individual.
  3. PARTICIPATION: (At the level of family and society) This is involvement in a life situation.
  4. ENVIRONMENTAL FACTORS: (Facilitators and inhibitors) These are the physical, social and attitudinal situations in which people live.
  5. PERSONAL FACTORS: (Facilitators and inhibitors) These are the particular background of individuals’ life and living situation and comprise features that are not part of a health condition.

From the WHO’s Beginner’s Guide (link below):

 The ICF is named as it is because of its stress is on health and functioning , rather than on disability. Previously, disability began where health ended; once you were disabled, you were in a separate category. We want to get away from this kind of thinking. We want to make ICF a tool for measuring functioning in society, no matter what the reason for one’s impairments. So it becomes a much more versatile tool with a much broader area of use than a traditional classification of health and disability. This is a radical shift. From emphasizing people’s disabilities, we now focus on their level of health.ICF puts the notions of ‘health’ and ‘disability’ in a new light. It acknowledges that every human being can experience a decrease in health and thereby experience some disability. This is not something that happens to only a minority of humanity. ICF thus ‘mainstreams’ the experience of disability and recognizes it as a universal human experience. By shifting the focus from cause to impact it places all health conditions on an equal footing allowing them to be compared using a common metric – the ruler of health and disability.
  • Keep in mind that the ICF classifies functioning not the individual.
  • Each level describes function and also functional limitation (disability) to give a broad picture and a neutral tone.
  • The health condition is the ICD-10 diagnosis and complements the ICF but is not officially part of the ICF.


The ICF: An Overview

ICF Resources from the World Health Organization

CanChild: ICF for Parents (with video)

Author: spritelypt

Pediatric physical therapist

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