Pediatric Physical Therapy, ICF Model

International Classification of Functioning, Disability,

and Health (ICF) of the WHO

Historical background: (1980-2007)

-International classification of impairments, disabilities, and handicaps (ICIDH) 1980 was
published by WHO. ICIDH focused on consequences of the disease rather than health and
functionality.
-It included a conceptual model in which ‘diseases’ and ‘disorders’ were linked to their
possible consequences, specifically ‘impairments’, ‘disabilities’ and ‘handicaps’.

-ICIDH Based on biomedical model

-In the early 1990s, an international effort was begun to revise and reshape the ICIDH.

-WHO published the new classification system: the International Classification of Functioning,
Disability and Health, or ICF (WHO, 2001).

Changes:

✓ Shift in language from negative terms such as ‘impairment’, ‘disability’ and

‘handicap’ to the neutral terms ‘body function and structure’, ‘activity’, and
‘participation’, respectively.

✓ The term ‘disability’ is now an umbrella term to represent the dynamic interaction
between person and environment. In contrast to the traditional view that disability exist
just within the person.

-ICF focused on all health-related experiences of the child

-It uses a bio-psychosocial model which fuses together elements of both the medical and social
models of disability.

-In 2007, ICF version for children and youth (ICF-CY) was developed.

-ICF-CY uses the same framework as the ICF and focuses on the child participation in both
ADL and community.

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 Pediatric Physical Therapy, ICF Model

The ICF, developed and adopted by the WHO in 2001 provides a very useful framework for
structuring intervention services for children with disabilities. It uses a bio-psychosocial model
which fuses together elements of both the medical and social models of disability.
The health condition can be expressed at three different but equally important levels
✓ Body function and structure level
✓ Person or activity level
✓ Participation or societal level
The ICF is not a hierarchical system but there is a dynamic interaction between these three
levels and the context of the individual – which includes personal and environmental factors.

Components of ICF:
❑ Body Functions & Body Structures:
✓ Body functions: physiological functions of body systems (including psychological
functions)
✓ Body Structures: anatomical parts of the body (organs, limbs, and their components).
✓ Impairments: problems in body function or structures such as a significant deviation or
loss

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 Pediatric Physical Therapy, ICF Model

❑ Activity & Participation:

✓ Activity: the execution of a task or action
✓ Participation: involvement in a life situation
✓ Activity limitations: difficulties in executing activities
✓ Participation restrictions: problems in involvement in life situations

❑ Contextual Factors:
• They are external factors: can have a positive or negative influences on all other
components
• Can be qualified as barriers / facilitators
✓ Environmental factors: physical, social & attitudinal environment
✓ Personal factors

-WHO is encouraging application of the ICF internationally not only as a classification tool,
but also as a framework for social policy, research, education, and clinical practice.

-Any health condition that we deal with as physiotherapist impacts body structure &
function causing limitations of our activities that in-turn restricts participation in ADL.
-Knowledge about the concept of ICF and using this model as a framework allow an evidence-
based practice.
Application of ICF on child with CP:
Health condition: Child with bilateral spastic CP level IV
Mother’s concerns and expectations:
- To sit on her own and play
- To eat on her own
Participation Restriction: The child can’t play age appropriately or take part in family mealtime

Activity limitation: The child can’t sit independently and use her hands to play or eat

Impairments: (what is interfering or missing)

- Increased tone in all 4 limbs
- Weakness (poor trunk and head control)
- Asymmetry of posture and function

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 Pediatric Physical Therapy, ICF Model

Environmental factors:
- Facilitators: Supportive, loving family
- Possible barriers: Over sympathy, service delivery occasional and not relevant, attitude of
the community.

Using the ICF as a framework

✓ Assists in organising observation
✓ Planning an activity focused intervention leading to real life participation (goal directed)
✓ Helps us to focus on which impairments restricts a specific activity
✓ Leads to specific preparation for specific functional tasks
✓ Interaction between child, task, and the environment

How is the ICF helping with intervention planning?

✓ Provides the focus on the client and family’s problems – forming the basis of a family
centred approach.
✓ Considers the child’s desire to participate in activities within a chosen environment –
then explore what interferes in participation (in preferred activities)
✓ helps goal setting in collaboration with child and parents or caregivers/teachers

References

• World Health Organization 2007, “International Classification of Functioning, disability

and Health: children & youth version: ICF-CY”.

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