1

INTERNATIONAL CALSIFICATION
OF FUNCTION- ICF
, - , --
( , ).

ICF Conceptual Framework

Health Condition
(disorder/disease)
Body
function&structure
(Impairment)

Activities
(Limitation)

Environmental
Factors

Participation
(Restriction)

Personal
Factors

INTERNATIONAL CALSIFICATION
OF FUNCTION- ICF
-Body function ( .
) . , ,
'.
- Body structures ( , ).
, CNS ,' . .Impairment = Body function -

-Activity .
-Activity limitation .

Participation - .
-Prticipation restrictions .
.
-Activities & participation ,
, , , , /,
- , , ,
.
-Personal factors ,
. ,
, -
.

-Environmental factors ,
- .
well being - . )[ .Family centered service (FCS
]

Cerebral palsy
Cerebral Palsy is a group of permanent, but not unchanging,
disorders of movement and/or posture and of motor function,
which are due to a non-progressive interference, lesion, or

abnormality of the developing/immature brain. This

definition specifically excludes progressive disorders of
motor function, defined as loss of previously acquired skills in
the first 5 years of life.

:
Cerebral palsy )CP( describes a group of permanent disorders of
the development of movement and posture, causing activity
limitation that are attributed to non-progressive disturbances

that occurred in the developing fetal or infant brain. The motor

disorders of cerebral palsy are often accompanied by
disturbance of sensation, cognition, communication, perception
and/or behavior, by epilepsy, and/or by secondary
musculoskeletal problems
Rosenbaum at el, 2006

10

Cerebral palsy
.
,
, .

, , , ,/ .
2-4/1000 : 2-2.5/1000 , .

, .

Athanasios I et.al Spine 2007

11

:

.

.

(
).

.

/.

/.
.

/-

()

(
)

12

-
quality of tone -

, , ,

distribution -

/ , ,

, ,

GMFCS

13

:
:Monoplegia .
:Diplegia 4 ,
.
:Hemiplegia

( -).

:Triplegia
.

:Quadriplegia 4.
Athanasios I et.al Spine 2007

14

:
Hypotonia /Flaccid
Spastic (hemiplegia;Quadiplegia. Deplegia)
Athetosis

.Mixed type

.C.P - 85% -

Athanasios I et.al 2007 (Spine)

15

16

CP
GMFCS

,
. ( )1
,
. ( )5

17

100
Percentage

80
60
40

20

Learning
disability

II

III
GMFCS level
Epilepsy

IV

Severe visual
impairment

GMFCS , ,

18

( 2,4,5 ) 15,10
( ,)

Small-for-Gestational-Age (SGA( LGA / SGA

)(Hagberg et al 2005

19

20

:


) CMV Cytomegalovirus) ,

IUGR=Intrauterine Growth
))Retardation

( 20-)

21

:
/ /

.
Hypoxia :

Ischemia

Asphyxia ) CO2 (.

22

-CP- :
Post Asphyxia Encephalopathy acute profound hypoxic
/ischemia ( Placental abruption / )
" .
,
- .

:middle cerebral artery- - <

.

23

:
/ Intraventricular/ Peri (.4 /3
) intraventricular hemorrhage .28

, ( )
,

.

24

Flaccid /Hypotonia
,

postural instability
/
=< .

frog position
,
:hypermobility
()

25

:
:
(
, )
:oral motor

- .


=<

=<

26

:
:

( ).

G


Midranges

27

Spastic Diplegia -
: )4(- .
.

( periventricular leucomalacia- PVL -

) , .
.
.

,
.

28

Spastic Diplegia -
: , =< ,
,associated reaction ( ),
.
/
.
, .
.

29

:

, APT- INT ROT ,ADD- -
,Equino-varus -
( )
:





( ' )

30

Quadriplegia-Tetraplegia
: )4(- ," .
, :
.
.
associated Reaction
Co-contraction
/ .
, .
.
: , , .

31

: Quadriplegia-Tetraplegia -
- /
: / ( )

32

:Quadriplegia-
.

.
.
: , ,

.
.

33

Hemiplegia
CP - ,

.
( )
( . ).
70% : 30%-.

34

:
(.
).
:
.
.
.
.

.
.
, ,2-3
.

35

:
- Alignment-
( , ..)

Scoliosis

)(cooper et al., 1995

)(Van Heest et al., 1993

36

(
).
!!!!!!!

.
.

37

Dyskinetic cp
European Classification of CP
DEV MED CHILD NEUROL 2000 42:816-24
Dyskinetic cp is dominated by both:
Abnormal pattern of posture and/or movement
Involuntary, uncontrolled, recurring, occasionally stereotyped
movements

Dyskinetic cp may be either dystonic or choreo-athetotic

38

Dystonic cp is dominated by:

Hypokinesia (reduced activity, ie stiff movement)
Hypertonia (tone usually increased)
Choreo-athetotic cp is dominated by:
Hyperkinesia (increased activity ie stormy movement)
Hypotonia (tone usually decreased)

39

Athetosis
( )BG .

:
.
( ).

( ) BG

40

-
Pure athetosis
Choreo athetosis

Dystonic athetosis spasms- ()ATNR

Athetosis with spasticity

.

41

Pure Athetosis

=< .
,
.
.
.

.
-
.
:

42

Choreo Athetosis

.
:
, ,

:
, "" (:)jerky


, :
, ,
:

,
.

43

Choreo Athetosis
.

.

44

Dystonic Athetosis

.
/
Focal Writers cramp, Hemi hand
Segmental
Generalized .

(
.
" ( ATNR
)

,

45

Dystonic Athetosis
,
.
:
.
- .
Windswept deformity

:

,

46

Dystonic Athetosis

47

Ataxia
.
4-5% CP-

.
:Friedrichs ataxia/ Familial ataxia
, ( CP-

).
4 :.general ataxia ,head-neck ,
- ,over shooting ,
( )

48

Ataxia
:
,
,

"Intention tremor" , .
:
.
,
, ,
.
.
/ , .
.

49

(,
)
.
.

50

51

,37 ( preterm) :
.
AGA appropriate-for-gestational- :
,SGA small-for-gestational-age ,age

.LGA large for gestational age

Low birth weight= 1500-2500 gr
Very low birth weight= 1000-1500 gr
Extremely low birth weight <1000 gr

52

/:
: > 16 < ,40 ( ,
, ) , ( , ,)
: ,

: , ,

53

: .
: .
:' . >
32 .

.
: (
) + .
: .
:' .

54

( )3:
:
: , (
) ,
: .
: ( /) - +.
: .
:
,...

55

: < 32 < 1500' . ,

.

, /
:Defined Ultradian Rhythm -

General movements

,
/
General movements

56

: ,

57

:
) :Respiratory Distress Syndrome (RDS
, . - ,

( . )
:Intraventricular Hemorrhage (IVH) stages I-V
/32 > 1500' .
.CP

) :Necrotizing Enterocolitis (NEC ,

, .

58

:Retinopathy of prematurity

.

: "
( kernicterus
) CP-
).
:Minor handicap , ,DCD ,

. .

59

.211:800 :

60

,

:
( )
V
II-I

61

:
40% -
- ,

:
( 9-30% Atlanto-Axial 3< Atlanto-
5-odontoid" )
( :)Pueschel 1992 " 2-3 ,
8-9
spondylosis "

62

,patello-femoral joint
90%
:
( )2.5-3


" ,"

: ,

63

Spina Bifida
" .
21-28.
: , ,
B12
4:
:S.B Occulta , .
:Closed Neural Tube Defect ,
.
:Meningocele ,"
.
:Myelomeningcele +
,

64

: ( LMN UMN , ;
L4-5- .)LMN .

.

RGO ( )

65

66

67

Torticollis
( Scaleni ,SCM )SternoCleidoMastoid Muscle
=< .
:-

SCM

68

Torticollis:
:

(
)

() , .
- ( )CP

69

:
.
: ,

)....
"
.

70

DDH
, 12

.
CDH congenital dislocation of the ,
hip :

).DDH (developmental dysplasia of the hip

71

72

1-6 - 1000
.
()1:9
.


.
( )2X .

73

:

,

)(acetabulum
DDH .

74

DDH -
( ).
.
.

,F+IR - .
,Abd+ER .

=>

=> THR 30

75

/US ( US 3').

gluteal folds
.
.

,knee flex hip 90 flex Abd+ER :Abd+ER -

; CDH- ""
"" . Ortolani
maneuver

Barlow maneuver

76

B
Tests commonly used to assess hip stability. (A) Ortolani maneuver. A
gentle upward force is applied while the hip is abducted. (B) Barlow
maneuver. A gentle downward force is applied while the hip is adducted.

77

: Abd+ER
/ / , '
.

" ()Pavlik Harness

78

Club foot
- Clubfoot or Talipes equinovarusm
adducted Forefoot
hindfoot varus

ankle equinus
1/1000 :
2
. 50%
+ :

79

Legg-Calve-Perthes
Disease
( )AVN ,
.
)3-12( 3-8 OA-
.
10%-
.
: ( )
.
" MRI

80

: 6-)

12 18 -.
, 2/3 .

:
'
' NWB

81

Toe Walking
:

=<
plantar flexors

CP ,

()

: - , , , ...

82

ADHD
ADHD
Attention Deficit and Hyperactivity Disorder
) (

ADD
Attention Deficit Disorder

.' '

83

" /
( ) , .
.

: , (
) , .low birth weight /

84

" DSM-IV-TR
Diagnostic and Statistical Manual of Mental Disorders

, - , .
/ -
.7

( ," ,).
, .

85

ADHD
.
.

,.
,
- . .

.
/

86

.
.

.
.
.
.

.
" .
.

6
9

87

:
.
.

.
.
.

88

ADHD
:Hyperactive Impulsive , ,
.
.
:Inattentive , ,

, (
) . ' .
. "
","..

89

:
:
- : 10% 6-12. " 12 >: 3-7% . 12 > : 1%. 1:6 :

90

ADHD-

ADHD

-
.

,
.
.

91

. ADHD
:

MRI - ,

.

92

:
SPECT

.

.
:

FMRI - -
.