ICF pediatric physical therapy

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)”

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?

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?

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

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

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”

What Does the NDTA Enablement Model Add to the ICF?

In this post I will continue to discuss the framework of the ICF. However, hoping not to confuse things, today I am going to briefly talk about NDTA interpretation of the ICF -which is called the NDTA Enablement Model. This model adds one category: POSTURE, ALIGNMENT AND MOVEMENT. This answers the question of how a child moves. If you are passionate about alignment and quality of movement, you are going to love thinking about what to put into this section.

Continue reading “What Does the NDTA Enablement Model Add to the ICF?”

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”