ICD HISTORY

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ICD HISTORY• 1853 FIRST INTERNATIONAL STATISTICAL

CONGRESS– FIRST UNIFORM CLASSIFICATION OF CAUSES OF

DEATH-INTERNATIONAL CAUSES OF DEATH (ICD)– TWO COMPETING APPROACHES

• 1855 CONGRESS ENTERTAINED BOTH SETS– WILLIAM FARR USED ANATOMICAL SITES AS BASIS– MARC d’ESPINE USED NATURE OF DISEASE (GOUTY,

HERPETIC, HEMATIC) – INITIAL COMPROMISE--186 RUBRICS– 20 YEARS TO RECONCILE THE DIFFERENCES—FARR

WON– NOW ICD REVISED ABOUT EVERY DECADE—HENCE

ICD-10

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ICD/ICF HISTORY• 1979 NINTH REVISION OF ICD/ICD-9

– RECOMMENDED “PROVISIONAL PROCEDURES CLASSIFICATIONS” BE PUBLISHED TO NINTH REVISION--CPT CODES BEGIN

1980 RECOMMENDED IMPAIRMENTS AND HANDICAPS CLASSIFICATIONS AS SUPPLEMENT Provisional acceptance--INTERNATIONAL CLASSIFICATION OF IMPAIRMENTS, DISABILITIES, AND HANDICAPS (ICIDH)

1993 REVISION OF ICIDH BEGUN2001 International Classification of Functioning,

Disability, and Health (ICF) APPROVED BY THE WORLD HEALTH ASSEMBLY

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ICF AIM AND PRINCIPLES• AIM—PROVIDE A UNIFIED AND STANDARD

LANGUAGE AND FRAMEWORK FOR THE DESCRIPTION OF HEALTH STATES

»PRINCIPLES• UNIVERSAL NATURE OF DISABILITY

EXPERIENCE• CROSSES THE LIFE SPAN— BIRTH TO DEATH• ETIOLOGY NEUTRAL— PHYSICAL,

EMOTIONAL,etc.• NEUTRAL LANGUAGE— FUNCTION,

ACTIVITY, PARTICIPATION, ENVIRONMENT

Health Condition Health Condition ((disorder/diseasedisorder/disease))

ICF Conceptual FrameworkICF Conceptual Framework

Environmental Environmental FactorsFactors

Personal Personal FactorsFactors

Body Body function&structurefunction&structure

(Impairment(Impairment))

ActivitiesActivities(Limitation)(Limitation)

ParticipationParticipation(Restriction)(Restriction)

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ICIDH - ICF

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Body Functions & Structures/Impairments

BODY FUNCTIONS• Mental• Sensory• Voice, speech• Cardiovascular,

haematological,immunological & respiratory

• Digestive, metabolic, endocrine• Genitourinary & reproductive• Neuromusculoskeletal, &

movement related functions• Skin & related structures

BODY STRUCTURESNervous systemEye, ear & related structures

Voice & speech structuresCardiovascular, immunological & respiratory structures

Digestive, metabolism & endocrineGenitourinary structures

Movement related structures

Skin & related structures

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Activities and Participation:Limitations/Restrictions

1 Learning & Applying Knowledge2 General Tasks and Demands3 Communication4 Movement5 Self Care6 Domestic Life Areas7 Interpersonal Interactions8 Major Life Areas9 Community, Social & Civic Life

Health Condition Health Condition ((disorder/diseasedisorder/disease))

ICF Conceptual FrameworkICF Conceptual Framework

Environmental Environmental FactorsFactors

Personal Personal FactorsFactors

Body Body function&structurefunction&structure

(Impairment(Impairment))

ActivitiesActivities(Limitation)(Limitation)

ParticipationParticipation(Restriction)(Restriction)

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Environmental Factors:Barriers/Facilitators

1. Products and technology 2. Natural environment and human-

made changes to the environment3. Support and relationships4. Attitudes 5. Services, systems and policies

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Example: Polio• May have caused paralysis of legs (Body

Function)• Affects ability to walk or climb stairs

(Activity)• Impedes ability to attend school or find

employment within the current environment (Participation)

BUT….

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Example, continued• Mobility related activities, such as getting

around the house or community can be improved with accessible environment and assistive devices

• Participation can be increased with reduced stigma, accessible environments and flexible job design

• Disability is NOT independent of the environment, and therefore is not static

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Need for version of ICF for children & youth

• Nature and form of functioning in children different from that of adults—children are not small adults

• Child is a “moving target” in classification of function—changes every 6-12 months throughout developing years, esp. activities

• Primary environments and participation areas differ for children

• ICF version for children and youth facilitates continuity of documentation e.g. transitions from child to adult services and communication among professionals and with parents

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Developing child as “moving target”

Need for ICF-CY

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Need for ICF-CY

Activities differ from those of adults

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Need for ICF-CY

Precursors of participation and life roles

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Need for ICF-CY

Emerging habitual, frequent and occasional environments

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Development of the ICF-CY• Structure ICF main volume maintained• Inclusion/exclusion criteria for codes

were expanded• New content added to unused codes at

4, 5 and 6 character level to address needs outlined before

• 2nd draft prepared for review on WHO website fall of 2005

• Publication expected 2006

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Development of the ICF-CY

Expan-sions-I, E

New codes- 4

New codes- 5

New codes- 6

New codes- Total

B F 14 4 13 2 33

B S 0 1 2 4 7

A & P 66 21 77 4 168

E F 19 2 8 0 29

Total 99 28 100 10 237

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ICF-CY: Example of new code for Body Functions

• b120 General cognitive functions• General mental functions required to represent,

and constructively integrate knowledge of objects, events and experiences and apply that knowledge in tasks requiring mental rather than physical activity.

• Exclusion: higher level cognitive functions (b164)

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ICF-CY: representative new A/P codes

• d1200-03 mouthing, touching, smelling, tasting • d133 Acquiring language

– d1330 acquiring single words or meaningful symbols– d1331 combining words into phrases– d1332 acquiring syntax

• d2300 Following routines• d2304 Adapting to changes in daily routine • d2305 Adapting to changes in time demands • d2306 Managing one’s time

• d5205 Caring for the nose• d53000-10/ Indicating need for urination, defecation

• d880 Engagement in play—solitary, onlooker, parallel, shared

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Framework for use of ICF-CY in documentation

Health Conditions- Syndrome, diagnosis,

category

Body Structures& Functions:(Assessment)

Activities(assessment)

Participation(assessment)

Environmental PersonalFactors: (Assessment) Factors

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ACTIVITIES and PARTICIPATION

1. Learning & applying knowledge

2. General tasks & demands

3. Communication4. Mobility

5. Self-care6. Domestic life7. Interpersonal

interactions & relationships

8. Major life areas9. Community,

social & civic life

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LEARNING & APPLYING KNOWLEDGE

• BASIC LEARNING– Copying– Rehearsing– Learning to read– Learning to write– Learning to

calculate– Acquiring skills

• APPLYING KNOWLEDGE– Focusing attention– Thinking– Reading– Writing– Calculating– Solving problems– Making decisions

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INTERPERSONAL RELATIONSHIPS• General interpersonal

interactions– Basic interpersonal

interactions• Social cues• Physical contact

– Complex interpersonal interactions

• Forming relationships• Interacting according to

social rules

• Particular interpersonal relationships– Relating with strangers– Formal relationships

• Persons in authority– Informal relationships

• Other students– Family relationships– Intimate relationships

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Disabilities Associated with ADHD

• d160 Focusing attention–Intentionally focusing on

specific stimuli, such as by filtering out distracting noises

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Disabilities Associated with ADHD• d7202 Regulating behaviors within

interactions–Regulating emotions and impulses,

verbal aggression and physical aggression in interactions with others, in a contextually and socially appropriate manner

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Disabilities Associated with ADHD

• d820 School education– Gaining admission to school, engaging in all school-

related responsibilities and privileges, and learning the course material, subjects and other curriculum requirements in a primary or secondary education program, including attending school regularly, working cooperatively with other students, taking direction from teachers, organizing, studying and completing assigned tasks and projects, and advancing to other stages of education

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Documenting Disabilities: QUALIFIERS

• How much difficulty, do you have– Focusing attention?

0 NO difficulty1 MILD difficulty2 MODERATE difficulty3 SEVERE difficulty4 COMPLETE difficulty

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Disabilities Associated with ADHD

Item # Domain/Item Name

Qualifiers:Level of Difficulty

PERFORMANCE CAPACITYd160 Focusing

attention 3 2d7203 Interacting

according to social rules

3 1

d820 School education 4 2

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Disabilities Associated with ADHDItem # Domain/

Item NameQualifiers:

Level of DifficultyPERFORMANCE

as usualPERFORMANCE

with assistanced160 Focusing

attention 3 1d7203 Interacting

according to social rules

3 2

d820 School education 4 2

ADHD

Body functions: Impairments

Attention, impulse regulation, higher

cognitive functions

Activities Limitations:

focused attention

Participation Restriction:

Problems moving across education

levels, succeeding in program; school life

Environmental Factors

special education

Personal Factors

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• Activity limitations are not unique to any disorder, either physical or mental

• Activity limitations can be characteristic of certain disorders

• ICF is developed to encompass lifespan• ICF is dynamic, captures change• ICF includes effects of health condition

and environment on functioning and disabilities

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Framework for use of ICF-CY in documentation

Health Conditions- Syndrome, diagnosis,

category

Body Structures& Functions:(Assessment/Intervention)

Activities(Intervention/

Outcome)

Participation(Intervention/

Outcome)

Environmental PersonalFactors: (Assessment/ FactorsIntervention)

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Framework for use of ICF-CY in documentation

Health Conditions- Syndrome, diagnosis,

category

Body Structures& Functions:(Assessment)

Activities(assessment)

Participation(assessment)

Environmental PersonalFactors: (Assessment) Factors