World Health Organization (WHO)
International Classification of Functioning, Disability and Health (ICF)
Disablement models
• Interrelationship among
– Disease, impairments, functional limitations, disabilities, handicapps, and the environment
• Nagi
– Active pathology, impairment, functional limitations and disability
• ICF
– Alters the perspective of disability models from framework of causes of disability and health to a framework that describes the impact the changes in health has on person‐ does not focus on cause but captures a descriptive assessment of the disability
– Individual function is complex dynamic relationship between
• Health condition
• Environment and personal factors
– Body Functions and Structures, Activities and Participation
World Health Organization (WHO)
• Family of Classifications‐ describe the health status of an individual at a point in time
• International Classification of Function
– Classify function and disability
• ICD‐9 (ICD 10 coming)‐ classify diagnosis disease and disorders • Combination of 2 is meant to describe a patient in combining the diagnosis with the corresponding disability
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ICF
• Health Condition
– Disorder, disease, injury, trauma , aging or congenital abnormality (ICD‐9 and 10 codes)
• Body function‐ physiological and neuromuscular function • Body Structure‐ anatomical parts of body • Impairments – problems in body function or structure that are perm or temporary
• Activity‐ execution of a task or action
• Activity limitation‐ difficulty executing activities
• Participation‐ involvement with life situations
• Participation restriction‐ problems in involvement with life situations
• Environmental Factors‐ physical, social and attitudinal environment in which people live and conduct life
ICF
• Personal
– Background of Life – age, gender , race, habits , lifestyle and social background
• Environmental Factors
– Physical, social, attitudinal environment in which people live and conduct life
• These 2 Interact and Impact Function
ICF Model
Disability and function are
Interactions between health
Conditions and contextual
factors
Health Condition
(disorder/disease)
Body functions and
structure
Environmental
Factors
Activity
Participation
Personal
Factors
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ICF Model: Body Functions
• Impairments of:
– Mental functions
– Sensory functions
– Functions of the cardiovascular, and respiratory systems
– Neuromusculoskeletal and movement related functions
• Mobility of joint, muscle power, muscle tone, involuntary movements
ICF Model: Body Structures
• Impairments of:
– Structure of the nervous system
– Structure of the cardiovascular and respiratory system
– Skin and related structures
– Structure related to movement
• Head and neck, shoulder, UE, pelvis, LE, trunk
ICF Model: Body Structures and Function
• Both use qualifiers to describe extent
– No impairment
– Mild impairment
– Moderate impairment
– Severe impairment
– Complete Impairment
– Not specified
– Not applicable
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ICF: Activity Limitations and Participation Restrictions
 Learning and 
applying 
knowledge
General tasks and demands

– Communication 
– Mobility
– Self care
Domestic life
Interpersonal interactions and relationships
Major life areas
Community social and civic life
Qualifiers
• ICF becomes a classification when qualifiers are used
• Performance qualifier
– What individual does in current environment
– Involvement in life situation‐ includes assistive devices
• Capacity qualifier
– Ability to execute a task or action
– Highest probable level of functioning in a standard environment
• If capacity >performance than environment is barrier to performance • If performance > capacity than environment has facilitated performance
ICF: Environmental Factors
• Products and technology
• Natural environment and human made changes (climate, light, sound, terrain)
• Support and relationships
• Legal and social structures
• Attitudes
• Services, systems and policies
• Described in barriers or facilitators
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ICF: Personal Factors
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•
•
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Lifestyle
Habits
Social background
Education
Life events
Race/ethnicity
Sexual orientation
Why the ICF model over others?
1. Accepted/endorsed by APTA, international community, and across health professions
2. Interaction between areas/non‐causal relationships
3. Inclusion of contextual factors
4. Uses neutral language to allow us to talk about enabling and disabling factors.
ICF Definitions
• Function= Non‐problematic or neutral aspects of health
• Disability=
– Body function and structures
– Activity Limitation
– Participation Limitation
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ICF
• Validated cross culturally in over 40 countries
• Describes components of functioning impacted by a health condition
• Unifies the medical and social models of disablement – Function is associated with and not just a consequence of a health condition
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What ICF is Not
• NOT Classify People ‐
– Unit of Classification is function of person in relation to health
• Not Clinical Assessment or Measurement Tool
– Framework and set of classifications on which assessments and measurements may be based
– Professionals develop the tools to measure the function
• Not just for people with disability
– Health related state for all people
• Not Describes the Patient
– Describes the function at one point in time or over time 7