400871 Tutorial 10 Describing and explaining the

client’s experience using the ICF

At the end of this tutorial students will be able to:

• describe what the ICF is and its main purpose

• understand the different concepts related to the ICF framework

• describe the biopsychosocial model of disability and how this forms the basis of the ICF

• apply the ICF to different case studies to describe their different level of functioning and disability

What does the ICF stand for and what is its purpose?

International Classification of Functioning, Disability and Health

• provides a standard language and framework for the description of health and health-related states/domains

• focuses on level of functioning, rather than on disability

(WHO, 2002)

The ICF……

Helps interprofessional teams work effectively by providing a

common language and framework for practice

(Tempest & McIntyre, 2006, cited in McIntyre, 2009)

The ICF adopts the biopsychosocial model –

the integration of the

medical and social model of disability

This dual focus acknowledges that disability is a complex phenomena that is both a problem at the level of a person’s body and from social/contextual

factors

(World Health Organisation, 2002)

Medical model of disability

Social model of disability

Bio-psycho-social model

ICF Model of Disability

(World Health Organisation, 2002)

In the ICF disability and functioning are viewed as outcomes of interactions

between:

1. health conditions (disease, disorder) and

2. contextual factors (environment and personal)

(World Health Organisation, 2002)

In the ICF human functioning/disability is identified at three levels:

1. body or body part (impairments)

– Function

– Structures

2. whole person (activity limitations)

3. whole person in a social context (participation restrictions)

(WHO, 2002)

Pre-tutorial activity

1. Share your reflections in small groups

2. Discussion with the larger group

Applying ICF to Jane & Alfonzo

In groups of 4 think about Jane or Alfonzo and describe her/his functioning through the three levels: – Impairments

– Activity Limitations

– Participation Restrictions

What Contextual Factors influence Jane’s level of functioning? – Personal

– Environmental

Community Group Activity 1: Jane Jane is a 16 year old with juvenile rheumatoid arthritis. She is currently in year

10 and is hoping to continue on to complete her HSC. She has lived with arthritis since she was six years old. She manages this condition with NSAIDs medication but continues to experience pain, swelling and inflammation in the joints of her fingers, elbows, shoulders, and knees. The pain and swelling limits the range of movement of these joints. These symptoms are more severe in the morning and late evening. She also reports feeling tired and lethargic.

She finds it difficult to participate in all sporting activities at school but would

love to join one of the school sports teams. She is very conscious of her joint swelling when socialising with her friends and tends to sit alone during lunchtimes when this occurs. In the classroom she uses a laptop to help her take notes as she finds holding a pen for long periods of time difficult.

She lives at home with her mother who is very supportive and understanding.

Jane would like to help out more with the chores and is considering finding a part time job to financially assist her mum. She would also like to have more of her own spending money and would like to save up for a holiday at the end of next year.

Applying ICF to Jane

Clinical Group Activity 2: Alfonzo

Alfonzo is an 82 y/o man who lives alone in his home. Since his wife passed away 2 years ago, he has been feeling down and has isolated himself. He does not continue attending lawn bowls and the church group that he and his wife attended together. He has one daughter who visits him regularly. Last week Alfonzo tripped in his garden shed and fell abruptly. When he fell he reached out with his right arm and landed on the concrete floor causing a Colles fracture of the radius.

His daughter found him approximately 5 hours later on the floor in the garden shed disoriented and confused. The fall resulted in bruising and grazing on the hand, forearm and elbow. His R hip and R shoulder were also bruised. He was taken to hospital via ambulance where a cast was placed on his forearm and wrist and then sent back home. He has now developed a fear of going outside and no longer tends to his garden. He is also eating less and has lost a significant amount of weight. His daughter fears that Alfonzo is becoming more frail every day.

Applying ICF to Alfonzo

Homework for week 11

choose one of the following case studies (that most relates to your profession) and prepare the ICF diagram for the week 11 tutorial

Case 1: Tim

Tim is a 25 year old football player who recently sustained an injury to his left knee during a game over the weekend. A MRI of the left knee confirmed that Tim had torn his lateral ligament, meniscus and anterior cruciate ligament. His current symptoms include pain, swelling and reduced range of motion of the left knee. He walks with difficulty but is unable to run due to pain and instability of the left knee joint. He is scheduled to have surgery in 4 weeks time to repair the damage to his knee. Following surgery he will need 6 month rehabilitation before he can return to football playing. He is also concerned about his part time work as a consultant personal instructor. His wife Gemma works full-time and Tim is responsible for dropping off and picking up their 5 year old daughter from school. They live in a 2 story terrace in the city – with bedrooms on the top floor and no allocated parking in the front of their home. Tim’s team mates are very supportive and disappointed that he will be unable to play for the rest of the season. This is the first time Tim has sustained an injury of this kind.

Applying ICF to Case 1 - Tim

Case 2: Hanna Hanna is a 4 year old girl with Down’s syndrome. She has recently

started attending the local child care centre. The service has attained some extra funding to provide Hanna with some one to one carer support. She communicates in 2-3 word sentences to make requests for toys or food. She uses about 50 wds. She is not yet able to go to the toilet independently. She presents with some gross and fine motor delays. In particular she has difficult balancing on the outside climbing equipment and is unable to ride a tricycle. She has generalised low muscle tone and this affects her posture, balance and coordination. She is able to build a tower of blocks (5) and hold a pencil with a basic palmer grasp (hand in the position of a fist) to scribble and colour pictures. She does not yet display appropriate social play behaviours of sharing and turn-taking and will sometimes snatch a toy from another child or hit them so that she can take their toy. For this reason other children do not invited her to play with them and it compromises her opportunities for interaction and friendship with other children.

Applying ICF to Case 2 - Hanna

Case 3: Amira

Amira is a 64 year old woman with malignant adenocarcinoma. She was diagnosed 3 weeks ago and is now unable to walk unaided due to a tumor growth at the colon which is pressing against the base of her spine. She is cared for at home by her husband Tony but he is beginning to worry about his ability to care for her in the home environment. He worries that she may fall when he assists her to the toilet. She is also unable to stand in the shower unaided. She is due to receive a course of chemotherapy in a week's time and Tony is concerned about how he will get her to the Cancer Therapy Centre. They both speak fluent Arabic and English is their second language. They have two children that both live interstate. Extended family members live nearby and have offered to help the couple. The house is level but the shower is over the bathtub. There is one step to the front of the house and two steps at the back. Amira is the homemaker and is worried about her husband Tony, particularly given her prognosis is not good.

Applying ICF to Case 3 - Amira

Reference List

McIntyre, A. (2009). Documentation and the use of the international classification of functioning, disability and health (ICF) in interprofessional working. In A. Atwal & M. Jones (Eds.), Preparing for professional practice in health and social care (pp. 113-129). Oxford, UK: Blackwell Publishing.

World Health Organization. (2002). Towards a common language for functioning, disability and health. Geneva, Switzerland: WHO.