Tests, Measures, & Classification Systems for Activity

Luca is a 7-year-old boy with Duchenne Muscular Dystrophy.  As his physical therapist, you are wondering about tests and measures that fit into the activity section of the ICF. Thinking of how to quantify his activity, you decide to use the North Star Ambulatory Assessment (NSAA) to measure transitions and mobility, the Timed Floor to Stand-Natural (TFTS-N) to time his rise from the floor, and the Six Minute Walk Test (6MWT) to measure distance walking.

Continue reading “Tests, Measures, & Classification Systems for Activity”

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”

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?”

Exploring the ICF-CY: What is Activity?

ACTIVITY WORDLE

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

In this post we explore another category of the ICF-CY….activity!  This is the heart and soul of physical therapy, at least in the clinic or during a home visit.  The activity section of the ICF-CY describes what a person can do in a standard environment or their regular environment.  Activity is defined as the execution of a task or action.    The activity section includes the following:

  • developmental skills that babies learn in the first year of life,
  • gross motor skills at any age
  • fine motor skills at any age
  • activities of daily living/self-care
  • gait
  • communication

Continue reading “Exploring the ICF-CY: What is Activity?”

Exploring the ICF-CY: Identifying Body Structures & Body Functions

Impairment Wordle

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

icf

This post will be focusing on body structures and body function.  This portion of the ICF-CY describes what is happening at the structural level of a person’s body.   Often when reviewing a chart one sees that hearing and vision have been screened and passed.   This is an example of functioning.  Although the ICF-CY is designed to be as neutral as possible, physical therapists and medical teams must also discuss impairments which often relate to disability.   Impairment is the description of body structures that are diminished, weakened or damaged.  Management often involves a full medical team. For instance, a team consisting of an orthopedist, a physiatrist and a physical therapist  (and parents) will all coordinate different aspects of care for a child with with hip subluxation.

Here is a list of body structures and body functions that are often discussed within the ICF framework. especially as they relate to children and youth:
Continue reading “Exploring the ICF-CY: Identifying Body Structures & Body Functions”

Exploring the ICF: Defining Functioning & Disability

The International Classification of Functioning, Disability and Health (ICF) is a framework for describing and organizing information on functioning and disability.  It works particularly well in the field of pediatric physical therapy, where we are increasingly moving away from the medical model and beginning to think of the whole child in terms of functioning (health) and disability.

In a recent Neuro-Developmental Treatment Association Network article, Danielle Heider, CRC, MRC wrote:

As a certified rehabilitation counselor specializing in working with transitioning youth, it is my job to help young adults begin to think about what they want to do for a job, consider if there are any accommodations needed, and help them understand how to ask an employer for accommodations.  This can seem like a daunting task for some young people, especially if they are accustomed to hearing others talk about everything they can’t do.

Continue reading “Exploring the ICF: Defining Functioning & Disability”

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: Continue reading “Exploring the ICF: The Domains”

Exploring the ICF as a Conceptual Framework

In Isaiah Berlin’s essay on The Hedgehog and the FoxThe fox knows many things, but the hedgehog knows one big thing.  It’s hard to be an organized fox, and being a hedgehog may limit innovation.  The conceptual framework of the ICF organizes all the details of one person’s function and edits that information down to the (few) big things which are vital and specific.

The International Classification of Functioning, Disability and Health (ICF) is an example of a conceptual framework for describing and organizing information on functioning and disability.    A conceptual framework is generally defined as an analytical tool used to organize ideas. 

The ICF gathers details about an individual in order to give a specific understanding of their unique functioning.  The microscopic domain describes the tissues and functions of the body.  In contrast, the most macroscopic domain describes how a person successfully participates or has difficulty participating in their unique world.  The ICF, as a conceptual framework,  gives organization to a diverse array of details and shows relationships between the domains.

RESOURCES:

Next in the ICF series:  Exploring the ICF: The Domains

Exploring the ICF: What is a Biopsychosocial Model?

The International Classification of Functioning, Disability and Health (ICF)is a framework for describing and organizing information on functioning and disability.  The ICF is described as a biopsychosocial model of disability.  Most simply and obviously, this means that it simultaneously considers biological factors, psychological factors and societal factors. By incorporating these three factors,  this model is able to create a unique picture of an individual as they manage a health condition.  In contrast, the biomedical model is limited to the biological aspects only.  The biomedical model often overlooks important individual details, increasing chances that the clinician and child’s family have lack of alignment in their goals. Continue reading “Exploring the ICF: What is a Biopsychosocial Model?”

What is the International Classification of Functioning, Disability and Health (ICF)?

Question: Why use the International Classification of Functioning, Disability & Health in pediatric PT?

Answer:  The framework of the ICF will help you access and organize your knowledge to provide a sound foundation for clinical decision making.

The International Classification of Functioning, Disability and Health (ICF) is a framework for describing and organizing information on functioning, health and disability.  The ICF-CY is specific to children and youth.   In 2001, the World Health Organization adopted the ICF as the basis of standardized scientific data on health and disability for use throughout the world.  It is applicable in health fields from mental health to orthopedics, neurology to cardiology.  The Neuro-Developmental Treatment Association (NDT) immediately recognized its importance as a conceptual framework for applying the NDT concept to pediatric physical therapy and began to use the framework in eight-week pediatric courses.  Moving on in time,  in 2008, The American Physical Therapy Association publicly endorsed the use of the ICF.  This set the expectation that ICF language begin to be used in publications, documents and communication.  Already, participation and environmental factors were becoming common points of discussion in pediatric physical therapy.  In current time, therapists are learning that we must begin to use ICF terminology and the ICF framework in our daily practice and communication, but what is it and how does it work?  That is the tricky part.

I was first introduced to the ICF during a section at the 2001 NDTA Conference.  I immediately began to restructure the way I approached and thought about my more complicated clients.  I was a fairly new PT at that time and goodness knows I needed some help prioritizing.  Continue reading “What is the International Classification of Functioning, Disability and Health (ICF)?”