400871 Tutorial 10

Describing and explaining the

clients 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 persons 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 Janes 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
Juvenile Rheumatoid Arthritis
Fingers, shoulders, elbows, knees,
all joints. They are inflammed and hence
decreased range of motion.
Holding a pen
Everyday limitations
Daily tasks such as carrying
Spots
Part time job
Recreation, parks
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.
Tims 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 Downs 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.