International Classification of Functioning
- 1. OVERVIEW OF ICF with respect to UG and PG CURRRICULUM Suvarna Ganvir Prof &HOD Dept of Neurophysiotherapy, DVVPF’s College of Physiotherapy, Ahmednagar.
- 3. Why ??? • From diff systems patient as a whole • From ROM & MMT Daily activity • Scientific Language Patient’s language
- 4. Without ICF • Systems assessment • Functions in scientific terms • Traditional goals With ICF • Patient as whole • Day to day activity • task or function oriented goals with patient as a primary focus
- 5. What is ICF unified and standard language framework for the description of health and health-related states. Domains - individual - body functions and structure - societal perspectives- activity and participation - Physical rehabilitation, fifth edition; Susan B. O’Sullivan, Thomas J. Schimtz; page no:375
- 7. 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 Restrictions • Problems an individual may experience in involvement in life situations • Facilitators & Barriers • Environmental factors may be a facilitator for one person & barrier for another
- 10. Activities (a or d codes) and Participation (p or d codes) • Learning & Applying Knowledge • General Tasks and Demands • Communication • Movement • Self Care • Domestic Life Areas • Interpersonal Interactions • Major Life Areas • Community, Social & Civic Life
- 11. Environmental Factors (e codes) • Products and technology • Natural environment and human-made changes to the environment • Support and relationships • Attitudes • Services, systems and policies
- 13. • A 60 yrs. old male patient with diagnosis as CVA with right hemiparesis since 1 month is referred to Physiotherapy department for treatment. Patient is able to sit independently but cannot stand and walk. Tone of muscles in normal with MMT of grade 2 in Upper Limb & grade 3 in Lower limb. Patient is disoriented and has pain in his shoulder and hand.
- 14. • A 60 yrs. old male patient with diagnosis as CVA with right hemiparesis since 1 month is referred to Physiotherapy department for treatment. Patient is able to sit independently but cannot stand and walk. Tone of muscles in normal with MMT of grade 2 in Upper Limb & grade 3 in Lower limb. Patient is disoriented and has pain in his shoulder and hand.
- 15. Body structure Code Structure s1 STRUCTURE OF THE NERVOUS SYSTEM s2 THE EYE, EAR AND RELATED STRUCTURES s3 STRUCTURES INVOLVED IN VOICE AND SPEECH s4 STRUCTURE OF THE CARDIOVASCULAR, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS s5 STRUCTURES RELATED TO THE DIGESTIVE, METABOLISM AND ENDOCRINE SYSTEMS s6 STRUCTURE RELATED TO GENITOURINARY AND REPRODUCTIVE SYSTEM s7. STRUCTURE RELATED TO MOVEMENT s8 SKIN AND RELATED STRUCTURES ANY OTHER BODY STRUCTURES
- 16. Structural Integrity Code Structure s1 STRUCTURE OF THE NERVOUS SYSTEM s2 THE EYE, EAR AND RELATED STRUCTURES s3 STRUCTURES INVOLVED IN VOICE AND SPEECH s4 STRUCTURE OF THE CARDIOVASCULAR, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS s5 STRUCTURES RELATED TO THE DIGESTIVE, METABOLISM AND ENDOCRINE SYSTEMS s6 STRUCTURE RELATED TO GENITOURINARY AND REPRODUCTIVE SYSTEM s7. STRUCTURE RELATED TO MOVEMENT s8 SKIN AND RELATED STRUCTURES ANY OTHER BODY STRUCTURES
- 17. Structural Integrity Code Structure s2 THE EYE, EAR AND RELATED STRUCTURES s3 STRUCTURES INVOLVED IN VOICE AND SPEECH s4 STRUCTURE OF THE CARDIOVASCULAR, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS s5 STRUCTURES RELATED TO THE DIGESTIVE, METABOLISM AND ENDOCRINE SYSTEMS s6 STRUCTURE RELATED TO GENITOURINARY AND REPRODUCTIVE SYSTEM s7. STRUCTURE RELATED TO MOVEMENT s8 SKIN AND RELATED STRUCTURES ANY OTHER BODY STRUCTURES
- 18. Structural Integrity Code Structure s2 THE EYE, EAR AND RELATED STRUCTURES s3 STRUCTURES INVOLVED IN VOICE AND SPEECH s4 STRUCTURE OF THE CARDIOVASCULAR, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS s5 STRUCTURES RELATED TO THE DIGESTIVE, METABOLISM AND ENDOCRINE SYSTEMS s6 STRUCTURE RELATED TO GENITOURINARY AND REPRODUCTIVE SYSTEM s8 SKIN AND RELATED STRUCTURES ANY OTHER BODY STRUCTURES
- 19. Structural Integrity Code Structure s2 THE EYE, EAR AND RELATED STRUCTURES s3 STRUCTURES INVOLVED IN VOICE AND SPEECH s4 STRUCTURE OF THE CARDIOVASCULAR, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS s5 STRUCTURES RELATED TO THE DIGESTIVE, METABOLISM AND ENDOCRINE SYSTEMS s6 STRUCTURE RELATED TO GENITOURINARY AND REPRODUCTIVE SYSTEM s8 SKIN AND RELATED STRUCTURES ANY OTHER BODY STRUCTURES
- 20. Structural Impairment Source of Information Lobes – Frontal lobe, parietal lobe Technical investigation (CT scan, MRI Brain) VII & VIII C.N involvement Clinical investigation (C.N test , Weber’s test) Primary motor cortex Technical investigation (MRI) Primary sensory cortex Technical investigation (MRI) Structure of Upper limb/ Lower limb - Primary motor cortex & internal capsule Technical investigation (MRI) Tightness of Tendoachiliis or Wrist flexors Muscle Length test
- 21. Functional integrity Code Body function b1 Mental Functions b2 Sensory Functions And Pain b3 Voice And Speech Functions b4 Functions Of The Cardiovascular, Haematological, Immunological And Respiratory Systems b5 Functions Of The Digestive, Metabolic And Endocrine Systems b6 Genitourinary And Reproductive Functions b7 Neuromusculoskeletal And Movement Related Functions b710 Mobility of joint b730 Muscle power b735 Muscle tone b765 Involuntary movements
- 22. Functional integrity Code Functional integrity B1 Mental Functions B2 Sensory Functions And Pain B3 Voice And Speech Functions B4 Functions Of The Cardiovascular, Haematological, Immunological And Respiratory Systems B5 Functions Of The Digestive, Metabolic And Endocrine Systems B6 Genitourinary And Reproductive Functions B7 Neuromusculoskeletal And Movement Related Functions B710 Mobility of joint b730 Muscle power B735 Muscle tone B765 Involuntary movements
- 23. Functional integrity Code Functional integrity B2 Sensory Functions And Pain B3 Voice And Speech Functions B4 Functions Of The Cardiovascular, Haematological, Immunological And Respiratory Systems B5 Functions Of The Digestive, Metabolic And Endocrine Systems B6 Genitourinary And Reproductive Functions B7 Neuromusculoskeletal And Movement Related Functions B710 Mobility of joint b730 Muscle power B735 Muscle tone B765 Involuntary movements
- 24. Functional integrity Code Functional integrity B3 Voice And Speech Functions B4 Functions Of The Cardiovascular, Haematological, Immunological And Respiratory Systems B5 Functions Of The Digestive, Metabolic And Endocrine Systems B6 Genitourinary And Reproductive Functions B7 Neuromusculoskeletal And Movement Related Functions B710 Mobility of joint b730 Muscle power B735 Muscle tone B765 Involuntary movements
- 25. Functional integrity Code Functional integrity B3 Voice And Speech Functions B4 Functions Of The Cardiovascular, Haematological, Immunological And Respiratory Systems B5 Functions Of The Digestive, Metabolic And Endocrine Systems B6 Genitourinary And Reproductive Functions
- 26. Functional integrity Code Functional integrity B3 Voice And Speech Functions B4 Functions Of The Cardiovascular, Haematological, Immunological And Respiratory Systems B5 Functions Of The Digestive, Metabolic And Endocrine Systems B6 Genitourinary And Reproductive Functions
- 27. Functional Impairment Functional Impairment Source of Information Decreased mental fn – attention , orientation Patient reported questionnaire & clinical investigation Loss of Memory Clinical investigation Loss of Sensation over Lt. UL & LL Clinical investigation (sensory assessment) Pain Patient history, Pain assessment Difficulty to perform activity on Lt. Side Range of motion and MMT Difficulty to maintain Balance Patient reported questionnaire & clinical investigation (BBS)
- 28. Functional Impairment Source of information Difficulty to do transition Patient reported questionnaire & clinical investigation (BBS) Unable to stand Unable to walk without support clinical investigation of standing balance and gait assessment
- 29. Activities and Participation Learning and applying knowledge General Tasks and Demands Communication Mobility Self care Domestic Life Interpersonal interaction and relationships Community Social and civic life
- 30. Activity Limitation Impairments Source of Information Clinical reasoning Learning and applying Knowledge MMSE Affection of higher mental function General tasks and demands Clinical examination Higher function affection Communication Higher function examination Affection of speech
- 31. Activity Limitation Impairments Source of Information Clinical reasoning Changing body position 1. lying down 2. squatting 3. Kneeling 4. sitting 5. Standing 6. bending Patient reported questionnaire (BBS), Clinical investigation Weakness UL & LL along with trunk muscles , Spasticity Maintaining body position 1.Maintaining a lying 2.Squatting 3.Kneeling 4. sitting 5. standing position Clinical investigation (Asses ment ) Weakness UL & LL muscles
- 32. Impairments Source of Information Clinical Reasoning Walking 1.walking short or long distances 2. Walking on different surfaces 3. Walking around obstacles Clinical investigation, Patient reported questionnair e (DGI) Weakness – HIP, Knee & Ankle Muscles
- 33. Activity Capacity Performance Mobility- Patient can roll to either side with mild difficulty to move on affected side. Patient finds it difficult to roll on bed due to less space and has fear of fall. Patient can stand with minimum support Patient can stand confidently with the help of a cane held on left side.
- 34. Activity Capacity Performance Moving around different location Patient can move only inside the house (one room to other, room to bathroom) has difficulty in moving outside the house. performance decreased on sloping and uneven surface.
- 35. Environmental Factors Source of Information Barrier - Design, construction and building products and technology of buildings for public use- 1.Design 2.construction and building products technology of entrances and exits 3. Facilities and routing Clinical Investigation, case history Facilitator - Personal care providers and personal assistants 1. ImmediateFamily/ Extended family 2. Friends Case history Facilitator - Health professionals 1. Doctors, nurses, physiotherapists, occupational therapists, Clinical investigation & Case history
- 37. • b for Body Functions and • s for Body Structures • d for Activities and Participation • e for Environmental Factors • 34 – chapters • 362- second level • 1424 - codes, third and fourth level 41
- 38. ICF Core Sets • Clinicians and researchers have identified that more than 1,400 ICF categories is not practical in daily use. • To facilitate a systematic and comprehensive description of functioning and the use of the ICF in clinical practice and research, ICF Core Sets have been developed. - PT, OT, and SLP Services and the International Classification of Functioning, Disability, and Health (ICF) Mapping Therapy Goals to the ICF - www.icf-research-branch.org/publications/publications 42
- 40. • ..Downloadspk june 2020.pdf • ..DownloadsVk 16.06.2020.pdf
- 41. Who • Undergraduate • Postgraduate • Teachers • Researchers
- 42. UG curriculum • Included in third and final year – theory and practical • Description and its clinical application
- 43. Do’s for students • Don’t panic !!!! • Gain knowledge about the basic things • Understand importance and relevance of ICF • Short and Long term Goal - Functional implications. • Efficacy of interventions – measured by functional improvement
- 44. Expectations from teachers • Provide a concise list of components of ICF to students • Explain the interdependent relationship • Supplement with simple examples • Describe the application on real patients as cases. • Practice with well descriptive simulated cases
- 45. PG curriculum • Added upon the knowledge gained in UG • Condition specific • Follow up of patient showing quantitative improvement in function in simulated and real environment. • ICF coresets serves the purpose
- 46. A piece of advice • ICF can be practiced only after thorough examination and assessment of patient.
- 47. Let us check • Find codes for following- 1. Walking short distances 2. Orientation to time 3. Squatting 4. Health professionals attitude
- 48. Create ICFCoreset • A 35 year old male patient diagnosed as a case of fracture of T6 2 months back treated with surgery. • There are no sensations below T6 level. • Patient is able to go to side lying with assistance but cannot come to sitting position on his own. • Lower limb muscle power is grade 0 and upper limb is grade5. Patient is a tailor by occupation and wants to resume his job at the earliest.
- 49. • Mail me for any queries – suvarna.ganvir@gmail.com • Thank you !