Combining the International Classification of Functioning (ICF) with Standardized Testing: An In-Depth Look at Squatting

Devin likes to go fishing; it’s his favorite hobby.  He is a five-year old boy with a diagnosis of bilateral cerebral palsy, GMFCS level 1.  Devin perches at the river’s edge in a deep squat in order to catch a glimpse of the trout beneath him.

Deep squatting is useful for a variety of reasons, like getting close to the floor to see something clearly, or to rest without getting on knees or bottom.  It requires adequate hip flexion range, ankle range, and postural control.  It is a developmental milestone.

When I look at the drawing of Devin, I wonder why:

  • Devin has an inverted foot position on right.
  • His low back position shows excessive lumbar flexion during a deep squat.
  • His pelvis is posteriorly tilted.
  • He is stabilizing, or limiting his degrees of freedom, by bracing his right elbow on his right knee and resting his chin firmly on his left knee.

Continue reading “Combining the International Classification of Functioning (ICF) with Standardized Testing: An In-Depth Look at Squatting”

Using Core Sets With the International Classification of Functioning-Children & Youth (ICF-CY)

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. Continue reading “Using Core Sets With the International Classification of Functioning-Children & Youth (ICF-CY)”

10 Strategies For Filling In the ICF-CY/ NDTA Enablement Model

There are hundreds of medical reports in Kiyoshi’s file.   In addition to oligoarticular juvenile idiopathic arthritis (JIA)  he has uveitis and a seizure disorder.  Kiyoshi has severe pain, joint contractures and difficulty moving around.  Medications are not controlling the inflammation, there have been more seizures lately and his foot orthotics are too small.    How do you begin physical therapy decision-making with a child this complex?

The International Classification of Functioning  (ICF) conceptual framework allows you to apply your knowledge  and skills to challenging situations.  It will take a while to sort information into proper categories and edit. However, once this is complete, connections become clear and sound clinical decision-making will follow.    The question I get asked most often about the ICF is , “where do you start?”.  This post will guide you as you fill in the ICF/NDTA Enablement Model categories for the first time. Continue reading “10 Strategies For Filling In the ICF-CY/ NDTA Enablement Model”

HOW does she move? Pulling the ICF-CY Together by Describing Motor Function.


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.  Continue reading “HOW does she move? Pulling the ICF-CY Together by Describing Motor Function.”

Exploring the ICF-CY: What are Personal Factors?

The International Classification of Functioning, Disability and Health-Children & Youth (ICF-CY) is a framework for describing and organizing information on functioning and disability.  The ICF is a useful tool in the field of pediatric physical therapy, where we are moving toward treating the whole child.

This post will discuss what constitutes personal factors.  Personal factors are independent of the health condition but can often influence how a person functions.  These factors are specific to social and cultural customs of each country.  While all the other categories have codes, this one does not yet have specific codes.  Continue reading “Exploring the ICF-CY: What are Personal Factors?”

Exploring the ICF-CY: What are Environmental Factors?

The International Classification of Functioning, Disability and Health-Children & Youth (ICF-CY) is a framework for describing and organizing information on functioning and disability.

This post is the tenth in the ICF series and explores what constitutes an environmental factor.  Environmental factors have an impact on all components of functioning in the ICF.    They affect the experience of participation and can be either facilitators or barriers to an individual’s participation. Continue reading “Exploring the ICF-CY: What are Environmental Factors?”

Exploring the ICF-CY: What is Participation?

Screen shot 2016-08-26 at 9.56.26 PMThe International Classification of Functioning, Disability and Health-Children & Youth (ICF-CY) is a framework for describing and organizing information on functioning and disability.  The ICF is a useful tool in the field of pediatric physical therapy, where the child defines how they want to use their function within the context of their own life.

In my opinion, the Participation category is the most fun part of the ICF!  This is really where we begin to see the whole child, their likes and their interests and well as what they want to do with their skills.   Participation is using an activity to interact with others or with the environment.  When the activity is walking, participation is walking on the beach with friends, or walking in the grocery store to help with the shopping.  Participation is one of the most motivating and satisfying levels of functioning.  New activities should be put into participation as soon as possible to build motor control.  These happen in many different environments:  Home, friends’ homes, schools, libraries and parks.  Continue reading “Exploring the ICF-CY: What is Participation?”