Ivan is always on the move, always running from here to there. He never walks slowly, never slows down. Moving quickly and never standing still can represent difficulty with static balance.
How does a person move? What is the quality? Do they have habitual postures, asymmetrical positions, particular movement patterns? In this discussion relating to the International Classification of Functioning, Disability & Health- Children & Youth (ICF-CY), we explore an added domain of Posture and Movement (otherwise known as Motor Functions). As discussed in a previous post, this is an addition to the traditional ICF-CY made by the Neuro-Developmental Treatment Association. This domain highlights common postures and movement patterns that run through many activities. The category of posture and movement describes how a child looks in their general every-day movement. Yes, the left lean is present is sitting, standing and gait. The W-sitting is habitual whenever on the floor. The entire right hemiplegic side is retracted in all positions. In my experience, this domain is often useful for justifying equipment components. I need the lateral on the seating system because of the left lean. I need the pelvic control in the support walker because of the hip retraction. Additionally, If you see changes in this domain at reassessment, the system has often had a significant shift.
For Ivan in the case above, the common movement pattern is running around and never standing still. This happens with transitions, with walking and with running. It happens at home, at school and in the park.
- The impairment is most likely decreased balance.
- The activity limitation is most likely 1) lack of ability to stand still on two feet 3 seconds or 2) stand with one foot in front of the other for one second.
- The participation limitation frequent falls while lining up for class
- The Motor Function (Posture and Movement) is constant moving around, never standing still.
Observations added to this category depend on one’s training and experience.
Next in the ICF series: 10 Strategies For Filling In the ICF-CY/ NDTA Enablement Model