THE WORLD REPORT ON DISABILITY: IMPLICATIONS FOR ASIA AND THE PACIFIC
5-7 December 2011
Sydney, Australia
Using the ICF for assessing assistive products and
enabling environmental needs in persons with disabilities
Saichon Kloyiam, Theeraporn Chaimala, Articha Naravorawat, Wachara Riewpaiboon
Abstract
Purpose: To examine whether the assistive products and enabling environmental modification services mentioned in the current relevant Thailand’s national and local laws would be well covered
by the ICF codes in Chapter e1 (products and technology) and to develop a need assessment questionnaire based on the ICF selected for care plan, service management and resource allocation.
Method: the ICF codes in Chapter 1 were scrutinized and selected based on its relevance for developing a need assessment questionnaire. The developed questionnaire was then tested by pilot
need surveys in communities of eight provinces within three regions. Individual care and service management plans were conducted for resource allocation. The functional performances and
social participation of related PWDs were monitored. Results: Twelve ICF codes in Chapter 1 were identified. Eight ICF codes corresponded to the national Act while five codes to those provided
by the local fund. Only nine codes were selected for the need assessment questionnaire. The service provision process has been running from September through December 2011. The outcome
monitoring has been done in parallel. CONCLUSIONS: Needs for assistive products and enabling environmental modifications could be determined by the developed ICF-based questionnaire. The
functional outcome of the services could also be monitored. It would be better if the need assessment questionnaire for assistive devices and enabling environmental modifications is used
together with other dimensions of need surveys particularly participation in specific meaningful life areas of each PWD.
Introduction
Results
Twelve ICF codes in Chapter 1 were identified. Eight ICF
codes corresponded to the Thai Act, 2007 while five codes to
those provided by the Provincial Authority Office (PAO) in
one pilot province. Only nine codes were selected for the
need assessment questionnaire. The unit of assessment was
performed with persons with disability living in their houses
and household contexts. General demographic data, number
of family members especially children and elderly,
functioning information, availability of assistive device,
individual utilizing spaces, barriers in everyday life, adjusted
home modifications, needs for modifications with reasons
and affordability were also asked. Some of the data are
shown in table 2.
The United Nation Convention on Right of Persons
with Disabilities (UNCRPD), 2008 has addressed the
importance
of
assistive
products
and
environmental
modifications in article 4, 9, 20, 21, 24, 26, 29, and 32.
Measures relevant are stated in additional 17 articles. It
entitles beneficiaries with rights to assistive product and
environmental modification services to full and enjoyment of
all human rights (Borg, Lindstrom, & Larsson, 2009).
Although Thailand has the Person with Disability’s
Quality of Life Promotion Act 2007 (replacing the
Rehabilitation for Persons with Disability Act 1991) which
conforms well to the UNCRPD, issues of inappropriate assistive
products and environmental barriers that limit independent
living and social participation have been evident. In order to
make the right a reality, the question of how to deliver the
services
of
appropriate
devices
and
environmental
modifications is crucial. Linking national to local implementing
mechanism needs to be developed.
To enhance independent living and increase the
opportunity for social participation of persons with disability,
enabling environments are required. Assistive devices would
fill the gap between individual’s personal capability and
environmental demand. So, only devices might be useless in
many places for everyday living if the surrounding
environments are still inaccessible. The major constraints of
making enabling environments include affordability, competing
priority, availability of appropriate technology and knowledge,
and cultural differences (WHO. The World Report on Disability.
2011).
The International Classification of Functioning,
Disability and Health (ICF) is considered conceptually
consistent with the UNCRPD. It could serve as a conceptual
framework for developing a need assessment tool. The
obtained information would address personal context-related
needs in assistive products and environmental modifications.
Personal care plan and service delivery, as well as community
development plan to make environments more enabling could
be formed by utilizing such the information.
Objective
 To examine whether the assistive products and the
enabling environmental modification services stated in
Thailand’s laws and relevant ministerial regulations could
be covered by the ICF codes in Chapter 1 Products and
Technology (e1)
 To develop a need assessment questionnaire for care
plans, service management and resource allocation
Methods & Materials
The Person with Disability’s Quality of Life Promotion
Act 2007 and the Provincial Medical Rehabilitation Fund in
Thailand (PMRF) related to provision of assistive products and
environmental modification services were reviewed. ICF codes
in Chapter 1 (e1: Products and Technology) were linked to the
content with relevant laws.
ICF
codes
covering
assistive
products
and
environmental modification services supported by the laws were
selected and used to develop a need assessment questionnaire
for assistive products and environmental modifications
Table 1: Correspondences among ICF, Act, PMRF and
questionnaire
ICF Codes
1
2
3
4
5
Act
e110: Products or substances for personal
consumption
e115: Products and technology for personal
use in daily living
√
√
√
√
e120: Products and technology for personal
indoor
and
outdoor
mobility
and
transportation
e125: Products and technology for
communication
e130: Products and technology for education
√
√
√
√
√
√
√
√
√
√
√
√
6
e135: Products
employments
7
e140: Products and technology for culture,
recreation and sport
e145: Products and technology for the practice
of religion and spirituality
e150: Design, construction and building
products and technology of buildings for
public use
e155: Design, construction and building
products and technology of buildings for
private use
e160: Products and technology of land
development
e165: Assets
8
9
10
11
12
Questionnaire
PMRF
and
technology
for
√
√
√
Male : Female
√
52+23
No. of family members
3-5
Functioning profiles
(d510: Washing oneself)
Needs (e155: constructs
for private use)
Reasons of no
modification
Mobility
Visual
47
4
80%
7%
Mental
4
7%
Intellectual
4
7%
Able
Unable
Helped by
others
30
20
51%
34%
9
15%
Toilet
Ramp
Door
27
13
11
46%
22%
19%
No budget
59
100%
A service delivery mechanism in eight provinces within Figure 1: Pilot sites in three regions and no. of study
three regions of Thailand was collaboratively developed. A 50 cases
case pilot work using the developed questionnaire has been
being conducted (Figure 1). Pre-environmental modification
assessment data was analyzed.
Local household design and construct to enable PWD
Pictures of standards for urban settings and local
adjusted designs focused on toilets
32:27
Age (yr) (Mean + SD)
Types of Disability ( #, %)
self designed toilet chair
Three national level leading agencies including the
National Office for Empowerment of Persons with Disability
(NEP), the Association of Siamese Architects under the Royal
Patronage of His Majesty the King, and the Institute of Health
Promotion for Persons with Disability have been collaborating,
regionally joined by faculties of Architecture of local
universities, and provincially by at least four alternatives of
service managers including the Provincial Authority Office,
non-government organizations working for persons with
disability, Disable People Organizations and Provincial Office
for Empowerment Persons with Disability. Major functions of
local service management mechanism included case finding
and screening, consultation for need assessment and design,
resource mobilization, and reconstruction management.
Further outcome monitoring would be done after finishing the
constructions and a short period of living in new enabling
environment will be examined.
Table 2: General demographic data
Gender
Standard toilet chair
Regarding the Act 2007, needs for assistive devices
could be assessed and provided personally by many providers
including physicians, special educators, and social workers.
Additionally mass delivery by charitable organizations or
politicians could also be often observed. Standard wheelchairs
and mobility aids e.g. cane and walker were most common
since persons with mobility difficulties were most prevalent.
While campaigns and movements on accessibility in public
buildings, transportation, and information access have long
been conducted, the right of household modifications to
enhance independent living has just been realized and piloted
in 10 provinces with limited budget of 20,000 THB / person in
2011.
√
√
Self modified handrail
Standard handrail
Why? & How is the enabling environment
for person with mental disability?
Conclusions
The ICF codes in Chapter 1: Products and Technology
relevant
to
assistive
products
and
environmental
modifications were practically applied to the corresponding
categories stated in Thailand’s national and local laws.
Individual’s needs for assistive products and environmental
modifications could be determined by the developed ICFbased questionnaire. The functioning and participation
profile could be revealed for later outcome monitoring.
It was found that poverty causing un-affordability
came to the first rank among the constraints of making
enabling
environment
of
individuals.
Standard
environmental modifications were not always appropriate
for local PWD’s lifestyles. Cultural differences in house
constructions and ways of everyday living reflected needs
for context-based or contemporary standards for each
particular community. Additionally, disability attitude might
make PWD unaware of their rights. For an effective and
efficient implementation process, local leading agencies
played important roles to ensure sustainability of service
delivery system.
Further research is needed to evaluate the effects of
assistive products and environmental modifications on
participation in specific meaningful life areas of each PWD
and cost-effectiveness analysis is required to inform
policymakers and funders.
Collaborative Agencies