Emil is a seven-year-old boy with cerebral palsy and medical complexity. He has lived in a rural region overseas until coming to see you for a physical therapy evaluation. Thinking of Emil functioning, in the context of his life, what areas should you focus on? When thinking about the whole child, physical therapy decision-making can become a bit overwhelming. Is there a list that can help you concentrate on the most relevant areas of body structures/function, activity, and participation for a seven-year-old boy with CP?
I am reading an interesting book that discusses the power of checklists. It’s called the Checklist Manifesto: How to Get Things Right and it is written by Atul Gawande. In this he discusses how checklists are most effectively used to assist people as they deal with complex situations. After reading this, I began to view the ICF core-sets as essential checklists to reduce error and foster team communication.
The ICF-CY can be used in two ways: With or without core-set codes.
Increasingly, the ICF is used with specific categories and codes.To get a sense of this type of use, I am including the several core sets that the ICF research branch has created:
- COMPREHENSIVE SET: Birth – 18 years (form)
- Brief set: Birth -18 years (form)
- Brief set: Below 6 years of age (form)
- Brief set: 6 years – day before 14th birthday (form)
- Brief set: 14 years-18 years of age (form)
Alternatively, I use the ICF as a conceptual model where descriptive information is filled in for each domain and no codes are used. This includes tests and measures in each domain as well as experienced PT observations. Judgement and structure is required to decide what to include in each domain and it is a bit open-ended for most clinicians. It is easy to overlook an entire area of functioning due to the scope of looking at the whole child. For this reason, I do use the core sets as a checklist to avoid overlooking relevant areas.
The comprehensive set for birth to 18 has green areas highlighting the areas that were covered in the brief set. For instance in the relatively simple body structure category, brain structure is the only structure listed on the brief set. However the comprehensive set cues thought about lower extremity, upper extremity, mouth structure, bone structure as well as trunk structural changes. The first time I followed the comprehensive core-set for CP, I regret to say, I had never thought a great deal about the structures of the mouth! It opened a deep conversation with the occupational therapist of the child I was evaluating.
Update: After I posted this, I saw an interesting commentary on ICF core sets. Apparently only 1 in 5 professionals use the core-sets and this discusses some of the controversy.