Defining Disability in Policy and in Practice in México

Incorporating a Client-Centered Approach to Audiologic Rehabilitation

This study aims to compare the long-term results of continuous intrathecal baclofen therapy rehabilitation against those of conventional treatment for intractable spasticity in children with cerebral palsy using the International Classification of Functioning, Disability and Health of Children and Youth. This is a 5-yr single-center retrospective cohort study. The International Classification of Functioning, Disability and Health of Children and Youth data from 24 patients with cerebral palsy of Gross Motor Function Classification System levels IV-V (aged between 8 and 18 yrs) were retrospectively analyzed for 5 yrs. The results show different trends between the 12 patients who received continuous intrathecal baclofen therapy and the 12 who were excluded because of contraindications.The continuous intrathecal baclofen therapy group improved spasticity, pain, and body mass index z-scores over 12 mos and during the 5-yr follow-up with a continuous simple Baclofen administration at a maximum of 140 μg/d at a concentration of 2000 μg/mL. Continuous intrathecal baclofen therapy improves structure and function, autonomy, and participation in both short and long term. Overall, the continuous intrathecal baclofen therapy group, with its characteristics of initially greater pain and hypertonia, benefited significantly from the efficacy of intrathecal Baclofen treatment compared with the control group, which continued to receive conventional treatment.The International Classification of Functioning, Disability and Health of Children and Youth outcome measures demonstrated an interrelationship between spasticity and weakness and disease progression over childhood to adolescence.Follow-up will be vital for effective personalized treatment, quality of life, and research.Long-term International Classification of Functioning, Disability and Health of Children and Youth data collection is key to comparing treatment outcomes.

Objective: To identify the categories of the International Classification of Functioning, Disability and Health most suitable as outcome indicators in the transitional care for people with spinal cord injury in China.Methods: A three-round Delphi survey was conducted surveying 37 experts selected through purposive sampling. In the first round, each expert was required to suggest the most useful indicators in the transitional care for spinal cord injury patients. Categories of the International Classification of Functioning, Disability and Health were linked with the concepts extracted from the responses. In the second round, the experts were asked to make a yes/no judgment about the utility of those categories as outcome indicators and to rate their importance from 1 to 10. In the third round, the experts were asked to re-judge and re-rate the importance considering the second-round results.Results: Forty-one categories, seven personal factors, and three concepts not covered in the International Classification of Functioning, Disability and Health were identified. They generated agreement percentages over 80% in the third round. The means of the importance ratings ranged from 5.15 to 9.52.Conclusions: A set of categories and concepts was identified in the Delphi survey based on the International Classification of Functioning, Disability and Health. They provided a reference and a basis for establishing a system of outcome indicators in the transitional care for patients with spinal cord injury in China.Implications for rehabilitationIn China, the people with spinal cord injury who live at home after discharge urgently need professional transitional care which can be extended from medical institutions to families.The categories and concepts identified by the Delphi survey based on the International Classification of Functioning, Disability and Health reflect the focuses in the transitional care of people with spinal cord injury in China.Those categories and concepts provide a reference and a basis for establishing a system of outcome indicators in the transitional care for patients with spinal cord injury in China.

Purpose: We comprehensively evaluated cognitive and social functioning in patients requiring long-term inpatient psychiatric care using the International Classification of Functioning, Disability, and Health.Method: We surveyed 1967 patients receiving long-term inpatient psychiatric care. Patients were further categorized into an old long-stay group (n = 892, >5 years in hospitals) and a new long-stay group (n = 1075, 1–5 years in hospitals). We obtained responses for all the International Classification of Functioning, Disability, and Health items in domain b (Body Functions) and domain d (Activities and Participation). We estimated weighted means for each item using the propensity score to adjust for confounding factors.Results: Responses were received from 307 hospitals (response rate of hospitals: 25.5%). Cognitive and social functioning in the old long-stay group was more severely impaired than in the new long-stay group. No statistically significant differences were observed regarding the International Classification of Functioning, Disability, and Health items associated with basic activities of daily living between the two groups.Conclusion: Combined therapy consisting of cognitive remediation and rehabilitation on social functioning for this patient population should be started from the early stage of hospitalization. Non-restrictive, independent environments may also be optimal for this patient population.Implications for rehabilitationRehabilitation of cognitive and social functioning for patients requiring long-term inpatient psychiatric care should be started in the early stages of hospitalization.In psychiatric fields, the International Classification of Functioning, Disability, and Health checklist could facilitate individualized rehabilitation planning by allowing healthcare professionals to visually assess the comprehensive functioning of each patient using graphics such as radar charts.

International Classification of Function, Health and Disability provides a common framework and universal language for rehabilitation professionals across the globe. To identify problems in functioning and mobility relevant to persons with lower-limb amputation from an expert's point of view and quantify these problems using the International Classification of Function, Health and Disability. Qualitative study using electronic and paper surveys. Electronic or paper survey was done across six countries targeting clinicians involved in pre- and post-amputation care. Meaningful concepts were extracted from the responses and linked to suitable second-level and where applicable third-level International Classification of Function, Health and Disability categories. Categorical frequency analysis was completed for the combined data and for each location. A total of 183 experts from 6 different countries responded to the survey. A total of 2171 concepts were identified, 82% of which could be linked to a second-level International Classification of Function, Health and Disability category. The categorical frequency analysis revealed that the categories of walking, design and construction of buildings for public and private use and sensation of pain were the most frequently occurring concepts and was similar across the six countries. The International Classification of Function, Health and Disability can be utilised as a common framework for communication among clinicians involved in rehabilitation of persons with lower-limb amputation across the globe. The most important factors that were identified by experts in amputee rehabilitation working in different international locations were similar. The challenges faced by the clinicians involved in care of persons with lower extremity amputation vary across different parts of the world. The overarching goal for the clinician irrespective of the location is to improve mobility and quality of life of their clients. The International Classification of Function, Health and Disability provides a common language between the various stakeholders in amputee rehabilitation across the globe.

Introduction: International Classification of Functioning, Disability and Health is an evaluation prepared by the World Health Organization (WHO). In 2001 EU membership states adopted this classification as the basic pillar of the rehabilitation policy for people with health disadvantages. The presented paper shows the possibility of using the International classification of functioning, disability and health (ICF) in research, more specifically using the classification for the evaluation of patients with ankylosing spondylitis.Aim: The aim was to establish in which areas of the respondents' lives (for which codes) people with ankylosing spondylitis, based on the ICF classification, experience limitation of their functioning, and to analyze the subject codes based on their potential statistically important correlation with selected demographic data (sex, age, address, level of impairment caused by ankylosing spondylitis).Methodology: The research pool comprised 181 respondents who underwent a full spa treatment in Bertiny lzn spa in Tebo in 2008. The two-level ICF classification was used for the evaluation, i.e. the basic component code and the basic code of a given chapter were used (e.g. b710, s430, d540...). An interview was held with each respondent, to be more precise specific functional tests were taken in order to establish qualifier values for all two-level classification codes.Results: 121 out of all analyzed codes (265) had other than zero qualifier value. 26 in physical function components (b), 12 in physical structure components (s), 23 in activity and participation components (d), 24 in environment facilitating factor components (eI) and 11 in environment barrier factor components (eII). A significantly important dependence of monitored values from the areas of activity and participation components (d) and environment factors (e) was established for twenty codes.Conclusion: The International classification of functioning, disability and health (ICF) can be regarded as an ideal conceptual framework for the definition and evaluation of positive, or negative impacts of various environmental aspects on the life of a given individual within the holistic context (bio-psycho-social) of understanding health and social issues. This paper can also help to "popularize" the ICF classification amongst the wider professional public as the practical knowledge of the classification is still fairly limited in this country and it has not been really applied in practice.

Capturing functional information is crucial in childhood disability. The International Classification of Functioning, Disability and Health (ICF) Core Sets promote assessments of functional abilities and disabilities in clinical practice regarding circumscribed diagnoses. However, the specificity of ICF Core Sets for childhood-onset disabilities has been doubted. This study aimed to identify content commonalities and differences among the ICF Core Sets for cerebral palsy (CP), and the newly developed Core Sets for autism spectrum disorder (ASD) and attention-deficit-hyperactivity disorder (ADHD). The categories within each Core Set were aggregated at the ICF component and chapter levels. Content comparison was conducted using descriptive analyses. The activities and participation component of the ICF was the most covered across all Core Sets. Main differences included representation of ICF components and coverage of ICF chapters within each component. CP included all ICF components, while ADHD and ASD predominantly focused on activities and participation. Environmental factors were highly represented in the ADHD Core Sets (40.5%) compared to the ASD (28%) and CP (27%) Core Sets. International Classification of Functioning, Disability and Health Core Sets for CP, ASD, and ADHD capture both common but also unique functional information, showing the importance of creating condition-specific, ICF-based tools to build functional profiles of individuals with childhood-onset disabilities. The International Classification of Functioning, Disability and Health (ICF) Core Sets for cerebral palsy (CP), autism spectrum disorder (ASD), and attention-deficit-hyperactivity disorder (ADHD) include unique functional information. The ICF-based tools for CP, ASD, and ADHD differ in terms of representation and coverage of ICF components and ICF chapters. Representation of environmental factors uniquely influences functioning and disability across ICF Core Sets for CP, ASD and ADHD.

Purpose: Evaluating the influence of person-environment interactions on students’ performance is a fundamental requirement for planning individualized educational interventions. Such understanding grounded the use of the International Classification of Functioning, Disability and Health as a reference framework to support special needs assessment in the Portuguese educational system. This study sought to investigate the extent to which special education teams reported relationships between Body Functions, Activities and Participation, and Environmental Factors in Individualized Education Programmes for students with additional support needs and what types of relations were mostly described.Materials and methods: Using content analysis, 176 Individualized Education Programmes were examined. A coding scheme based on the International Classification of Functioning, Disability and Health was developed to categorize and quantify code-relations.Results and conclusions: Code-relations consisted in 6.1% out of the total of meaning units found in textual segments concerning assessment and intervention processes. Code-relations were chiefly focused on mental functions, learning and applying knowledge, and products and technology. Intervention plans were predominantly presented as separate lists of goals and strategies, focusing Activities and Participation (67.8%), Body Functions (16.1%) and Environmental Factors (16.2%). Within the reduced amount of contents in which there was a match between goals and strategies, only 8.2% were directly connected with assessment data. Recommendations are made for the implementation of an interactive approach when using the International Classification of Functioning, Disability and Health in educational contexts.Implications for rehabilitationThe adoption of the International Classification of Functioning, Disability and Health in the educational context goes beyond the use of a universal language including, as well, the potential to foster a multidimensional and comprehensive approach to students’ needs.Professionals’ approach in special needs assessment is often partial and segmented, suggesting a narrow understanding of the relationships between body functions, activities and participation, and environmental factors.Our findings support the need for an expanded focus on person–environment interactions, considering students’ participation in different domains of life – besides learning – as well as the impact of environmental barriers over students’ participation;Training programmes centred on a biopsychosocial understanding of human functioning, the establishment of a transdisciplinary collaborative culture and the use of dynamic assessment tools may equip professionals with appropriate conditions to use the International Classification of Functioning, Disability and Health within an interactive perspective.

For many people assistive products are important to perform daily activities and to participate in society. In the process of selecting the proper assistive product for a person, it is important to describe in a uniform and transparent way his/her present functioning and wishes with respect to functioning. To indicate how the ICF (the International Classification of Functioning, Disability and Health) can be used during the supply process, we have taken as a framework a general guideline describing this process. The guideline distinguishes seven steps in the supply process and for each step an inventory is made of the actions of the client, the actions of the care professional, the instruments used, the decisions made, the data generated, relevant classifications (including the ICF) to code these data, and the results for the client. It is the aim of this discussion paper to describe the role of the ICF in the prescription and supply of assistive products and to discuss the specific data in this process that can be classified using the ICF. Although the ICF is not perfect, it is a useful tool to code important data in the process of supplying assistive products. Clinical relevance Assistive products - used worldwide by millions of people - are used to maintain or enhance functioning, rather than to cure a disease.( 1 ) As functioning can be classified with the International Classification of Functioning, Disability and Health (ICF), it can be expected that the use of ICF terminology in the supply process of assistive products will result in a better match between the characteristics of the person and the characteristics of the assistive product.

The Capability Approach and Disability

Stuttering and the International Classification of Functioning, Disability, and Health (ICF): An update

Stroke is the leading cause of long term disability in the United States. Most poststroke individuals experience difficulty in moving the contralesional limbs to perform daily activities. Studies were systematically reviewed to identify the best predictors of arm-specific motor recovery and further analyzed using the International Classification of Functioning, Disability, and Health to distinguish outcome measures that best reflected participation in life situations. We used PubMed, CINAHL, the Cochrane Library, and EMBASE with the keywords stroke, upper extremity, recovery of function, and predictor. Inclusion and exclusion criteria were developed and applied to further refine the search. Finally, methodological quality was assessed. Fifty-six studies published between 1979 and 2008 met the criteria. There was a 317% increase in the frequency of articles on predictors of arm recovery over a nearly 30-year period. Thirty-six percent were of high methodological quality (score, >or=10 of 15). Early neurophysiologic and sensorimotor measures were the best predictors at follow-up of arm-specific outcomes. There was no outcome measure classified at the International Classification of Functioning, Disability, and Health participation level. Only one study provided information about an outcome-related minimal clinically important difference. Initial measures of the integrity of neural connectivity and voluntary motor behavior were the best predictors of arm-specific functional recovery. The paucity of valid and reliable instruments to capture the more distal outcomes associated with activities and participation has likely limited the breadth of available evidence in this field. This suggests an urgent need for the development of direct measures of arm use in real-life environments.

This systematic review aimed to confirm the effectiveness of hand therapy programmes using the International Classification of Functioning, Disability and Health framework for each of the three phases of the wound healing process in adults with burns. A systematic review was conducted to determine the efficacy of different hand therapy programmes in the management of burnt hands. Two independent reviewers conducted a literature search using the PubMed and Cumulative Index to Nursing and Allied Health Literature databases for original articles reporting effectiveness of hand therapy programmes for adults with burns. Only randomized and non-randomized controlled trials were selected using the Mixed Methods Appraisal Tool. Demographic and clinical data including medical history, burn depth, and hand therapy programme were extracted. Outcome measures were reviewed based on the International Classification of Functioning, Disability and Health framework for acute, convalescence, and chronic phases of rehabilitation. Sixteen articles and 15 hand therapy programmes were identified, which included studies showing improvements in different parameters in the framework. In the acute and convalescence phases, improvements were found in health condition, body functions and structures, activities, and participation. In the chronic phase, improvements were shown only in body functions and structures. Environmental factors in the framework were not reported for all the phases. This review demonstrated the efficacy of hand therapy programmes in adults with burns in terms of the health condition, body function, activities, and participation during acute and convalescence phases but only the body function in the chronic phase.

ObjectiveTo explore the potential use of artificial intelligence language models in formulating rehabilitation prescriptions and International Classification of Functioning, Disability and Health (ICF) codes.DesignComparative study based on a single case report compared to standard answers from a textbook.SubjectsA stroke case from textbook.MethodsChat Generative Pre-Trained Transformer-4 (ChatGPT-4)was used to generate comprehensive medical and rehabilitation prescription information and ICF codes pertaining to the stroke case. This information was compared with standard answers from textbook, and 2 licensed Physical Medicine and Rehabilitation (PMR) clinicians reviewed the artificial intelligence recommendations for further discussion.ResultsChatGPT-4 effectively formulated rehabilitation prescriptions and ICF codes for a typical stroke case, together with a rationale to support its recommendations. This information was generated in seconds. Compared with standard answers, the large language model generated broader and more general prescriptions in terms of medical problems and management plans, rehabilitation problems and management plans, as well as rehabilitation goals. It also demonstrated the ability to propose specified approaches for each rehabilitation therapy. The language model made an error regarding the ICF category for the stroke case, but no mistakes were identified in the ICF codes assigned.ConclusionThis test case suggests that artificial intelligence language models have potential use in facilitating clinical practice and education in the field of rehabilitation medicine.LAY ABSTRACTThis comparative single case report study aims to explore the potential application of ChatGPT, a novel artificial intelligence language model, in the clinical practice of rehabilitation medicine. ChatGPT-4 was used to generate rehabilitation prescriptions and International Classification of Functioning, Disability and Health codes for a representative stroke case. The outcomes were evaluated by 2 licensed PMR clinicians. ChatGPT-4 rapidly formulated rehabilitation prescriptions and International Classification of Functioning, Disability and Health codes for the stroke case, and provided logical explanations for its recommendations. The majority of the rehabilitation treatment plan and codes were accurately generated, although there were a few discrepancies. These findings highlight the potential use of artificial intelligence large language models as tools in clinical rehabilitation practice.

Purpose: The present study was conducted with the aim of examining the indicators of barriers and challenges of virtual education at macro, meso, and micro levels. Methods and Materials: The method employed in this research is a mixed-methods approach. In the qualitative section, documents from the Ministry of Education of the Islamic Republic of Iran, including the "Fundamental Theoretical Foundations for Formal and Public Education Transformation," the "Fundamental Transformation Document of Education," and the "National Curriculum Document," were analyzed. In the quantitative section, two non-random sampling methods were used: non-probability sampling and snowball sampling, which is a non-probability sampling method commonly used in sociology and statistical research. The research population consisted of 150 students from Farhangian University and 10 faculty members from the same institution. Interviews were conducted based on a competency model, and the appropriate tool was developed and implemented after determining its validity and reliability using Cronbach's alpha (α = 0.92). Findings: Based on the findings, 150 digital teacher competencies were categorized into 9 sections, which were further divided into three main areas: curriculum design, barriers to virtual education, and the quality of virtual teaching. The challenges identified in the study were categorized at macro, meso, and micro levels, and the results are applicable for identifying the indicators of barriers and challenges in virtual education. Conclusion: The results of the study indicate that, at the macro level, poor policy-making is the primary issue, at the meso level, budget disruptions are prominent, and at the micro level, students, more than parents, teachers, and professors, believe that the barriers and challenges of virtual education are greater than those of in-person education.