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.

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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:
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