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 ICIDH – 2 / ICF
To provide a unified and standard language and
framework for the description of health and health-
related states.
Describe effect of disability towards participation in
activities
ICIDH-2 domains - health domains and health-
related
domains are described from body, individual and
societal perspectives by two basic lists:
(1) Body Functions and Structures;
(2) Activities and Participation
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 Before ICF
Classification started in 1960’ – to better
understanding outcome of disease.
Early model of disability
e.g Nagi model (Nagi, 1976) and the
International classification of Impairments, Disabilities
and Handicaps (ICIDH) (WHO, 1980)
Strongly criticised by International Disability Right

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 Disability
Right
Movement,
1960s.

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 Before ICF
Very medical focus – concentrating on consequences
of disease in hierarchical way (Hurst, 2000, 2003)

Imposing negative attitude towards people with

disability.

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Where did the ICF come from?
Developed by the World Health
Organization (WHO)
Large international and
multidisciplinary participation
Extensive field testing

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 The Aims of the ICF
To provide a scientific basis for the
consequences of health conditions
To establish a common language to
improve communications
To permit comparisons of data across:
Countries
Health care disciplines
Services
Time
To provide a systematic coding scheme
for health information systems
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Definitions
Impairment Loss or abnormality in body structure or
function (including mental function)

Activity Limitations Difficulties individual may have in

executing activities in terms of quantity
or quality

Participation Problems an individual may experience

Restrictions in involvement in life situations

Facilitators & Barriers Environmental factors may be a

facilitator for one person & barrier
for another

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 ICF Components
Body functions Physiological functions of body
systems
Body Structures Structural or anatomical parts of the
body
Activities Execution of a task or action by an
individual (individual perspective)
Participation Persons involvement in a life
situation (societal perspective)
Environmental Factors
All aspects of the external world that
impact on the person’s functioning

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 ICF Structure
Two parts:
1. Functioning and Disability
a) Body functions and structures
b) Activities and Participation
2. Contextual Factors
a) Environmental factor
b) Personal factors

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 Sequence of Concepts
ICIDH 1980
Disease or
disorder
Impairments

Disabilities
-The sequence is medical
model base. Handicaps
-Imposed negative attitude
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(2001)

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Chapters in ICF :

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 Structure
ICF Classification

Part 1: Part 2:
Functioning Contextual Parts
and Disability Factors

Body Functions Activities and Environmental Personal

Components
and Structures Participation Factors Factors

Change in Change in Facilitator/ Constructs/

Body Body Capacity Performance Barrier qualifiers
Functions Structures

Functioning and Facilitators Positive Aspect

Functioning
Structural integrity

Impairment Restrictions

Disability Negative Aspect

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 ICF relate to OT

Practice framework in OT
(Occupational Therapy
Practice Framework
(OTPF)) is
base on ICF
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Define Disability
Webster’s New Universal Unabridged Dictionary
defines:

 Lack of power, strength or physical or mental ability

 A physical or mental handicap, esp. one that prevents a
person from living a full, normal life or from holding a
gainful job.
 Anything that disables or puts one at a disadvantage.
 The state or condition of being disabled.
 Legal incapacity, legal disqualification.

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Definitions and Models
The International Classification of Functioning, Disability
and Health (ICF), produced by the World Health
Organization, distinguishes between:
- body functions (physiological or psychological,
e.g. vision) and
-body structures (anatomical parts, e.g. the eye and
related structures).
Impairment in bodily structure or function is defined as
involving an anomaly, defect, loss or other significant
deviation from certain generally accepted population
standards, which may fluctuate over time.
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 Activity is defined as the execution of a task or action. The
ICF lists 9 broad domains of functioning which can be
affected:

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

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 Developmental disability
Developmental disability is a term used to describe life-long
disabilities attributable to mental and/or physical or
combination of mental and physical impairments, manifested
prior to age twenty-two.
The term is used most commonly to refer to disabilities
affecting daily functioning in three or more of the following
areas:
 capacity for independent living
 economic self-sufficiency
 learning
 mobility
 receptive and expressive language
 self-care
 self-direction
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How The Process of Disability
ACTIVE PATHOPHYSIOLOGY
(DIAGNOSIS)

IMPAIRMENT Response to Treatment

(SIGN AND SYMPTOM) (Medical care & preventive rehabilitation)
CURE
Residual Impairment
(Weakness, restricted motion, pain, etc.)

FUNCTIONAL LIMITATION Response to Treatment

CURE
DISABILITY Need Human Assistance

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 IMPAIRMENT

FUNCTIONAL LIMITATION
(fungsi terhad)

DISABILITY (kelainan upaya)

HANDICAP (Cacat)
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PHATOPHYSIOLOGY
Cells and tissues
 Neurological deficit
 Physiological deficit
Interruption of normal  Immunological deficit
physiological and  Nutritional deficit
developmental processes  Occupational exposure
of structure  Behavioral risk
 Genetic abnormality

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 Organs and Organ System
 Hearing
IMPAIRMENT  Vision
 Speech articulation
 Problem solving
Loss and/or abnormality of  Attention
mental, emotional, or  Memory
anatomical structure or  Mood
function including  Motivation
secondary losses and pain  Pattern recognition

Question:
Is blind an impairment ?
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FUNCTIONAL LIMITATION
Performance of Action
Restriction or lack of
ability to perform an  Initiate, organize, sequence,
action or activity in the judge, attend, select
manner or range  Sit, roll, lift, squat, stand climb,
considered normal that ambulance, walk
results from impairment  Reach, pinch, grip, grasp, hold,
release
 Relate, interact, cope, manage,
control, adapt
 Read, write, learn understand

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 Task performance in
Physical and Social
DISABILITY Context
Inability or limitation in Task performance
performing socially defined  Basic self-care
occupation and roles within a  Worker tasks
social and physical environment
as a result of internal or external  Leisure/Play
factors and their interplay  Education

Context
 Physical environment
 Social & cognitive
environment
“Kelainan Upaya”  Culture
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SOCIETAL LIMITATION
(HANDICAPED)
Roles
 Worker
Restriction attributable to  Student
social policy or barriers  Parent
(structural or attitudinal)  Spouse/partner
that limits fulfillment of  Recreation
roles or denies access to
service or opportunities Context
 Attitudes, beliefs, norms
 Accessibility
 Accommodation
 Inclusion

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Occupational Therapy and Disability
 Occupational therapist practicing in both physical
disabilities and mental handicap
 Treatment goals concern primarily on disabilities
compared to impairments
 The performance areas or components such as motor,
sensory, cognitive or emotion were considered
impairment
 The occupational areas such as self-care, leisure and
productivity were considered as disabilities
 Physical therapist focus primarily on impairment with less
emphasize on disabilities
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 CLASSIFICATIONS OF DISABILITY
 NO DISABILITY
 TEMPORARY PARTIAL DISABILITY
 PERMANENT PARTIAL DISABILITY
 TEMPORARY TOTAL DISABILITY
 PERMANENT TOTAL DISABILITY

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 IMPAIRMENT

FUNCTIONAL LIMITATION
(fungsi terhad)

DISABILITY (kelainan upaya)

HANDICAP (Cacat)
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References
 Hurst, R. (2000). To Revise or Not to Revise? Disability & Society,
15(7), 1083-1087.
 Hurst, R. (2003). The International Disability Rights Movement and
the ICF. Disability & Rehabilitation, 25(11/12), 572.
 Nagi, S.Z. (1976). An epidemiology of disability in the United States.
Milbank Memorial Fund Quarterly Health and Society. 54(4) 439-467
 World Health Organisation (1980). International classification of
impairments, disabilities and handicaps: a manual of classification
relating to the consequences of disease. Geneva, WHO.
 World Health Organisation (2001). International classification of
functioning, disability and health. Geneva, WHO.

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