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Model and Structure of the ICF 18.02.2016
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The integrative bio-psycho-socialmodel of functioning and disability
Health condition
Environmental factors
Personal factors
Body functions/ Body structures
Activities Participation
Understanding Functioning and Disability
• explain what functioning and disabilitymeans in the context of the bio-psycho-social model of the ICF
• identify the components of the ICF and corresponding terminology
After completing this section, you will be able to..
Model and Structure of the ICF 18.02.2016
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• familiarise the participants with the bio-psycho-social model of the ICF
• provide various examples and conductexercises to make the content of the ICF model more understandable and tangible
As a trainer, you will be able to..
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Bio-psycho-social model of functioning and disability
Grandma Anna has been diagnosed with rheumatoid arthritis
The lived experience
Model and Structure of the ICF 18.02.2016
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5
Bio-psycho-social model of functioning and disability
The lived experience
Grandma Anna hasrheumatoid arthritis
International Classification of Diseases
(ICD)
Grandma Anna has rheumatoid arthritis (ICD11: FA20)
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Bio-psycho-social model of functioning and disability
The lived experience
Prevale
nce in
%
Age in yearsMen
Women
Model and Structure of the ICF 18.02.2016
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7
Bio-psycho-social model of functioning and disability
However:
What problems is Grandma
Anna experiencing and what
are her needs in relation to
her experience living with
rheumatoid arthritis?
The lived experience
Grandma Anna has rheumatoid arthritis (ICD11: FA20)
Michael, 20 3 months followingtraumatic paraplegia
„The most difficult thing for me at the moment is that I am not able to simply go to the toilet anymore. And for me, this is the most difficult thing to accept.“
The lived experience (Examples: Spinal Cord Injury)
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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Massimo, 6 years old
Has had Cerebral Palsy since birth
“Before I received my special electric wheelchair 1 year ago, I was very slow in moving around on my own. The streets near my home have an uneven surface and was bumpy and very narrow. Now I can play with my friends in the courtyard near my home. I only have a problem with getting on and off my wheelchair by myself – I need help for this.”
The lived experience (Examples: Cerebral Palsy)
Bio-psycho-social model of functioning and disability
William, 12 years oldDiagnosed with cholesteotoma as a toddler
Has conductive hearing loss
„With other hearing aids, they’re heavier and more noticeable…this one is sort of hidden…its helped me be more social…“
Source: Testimonials ADHEAR (MedEl), http://www.medel.com/int/adhear#testimonials
The lived experience (Examples: Conductive hearing loss)
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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Why “lived experience”? Why different examples?
Tips & Tricks on Training Methodology
Going from a purely bio-medical model of disease…
AB51 Acquired hearing impairment
Evaluation of the disease consequences
Source: MedEl Websites http://www.medel.com/ch/about-med-el/
https://blog.medel.com/quick-list-common-hearing-related-terms/
http://www.medel.com/int/hearing-loss/
Model and Structure of the ICF 18.02.2016
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…to a bio-psycho-social model of functioning and disability
AB51 Acquired hearing impairment
Source: MedEl Image Gallery, http://www.medel.com/int/image-gallery
Functioning and Disability are not the consequence of diseases alone, but are related to a variety of factors
Functioning and disability is reflected at the levels of…
Body Structures Structure of brain
Structure of (external, middle, inner) ear
Activities & ParticipationListening
Conversing with people
Intimate relationships
Body FunctionsEmotional functions
Speech discrimination
Voice functions
…in interaction with the environmentCochlear implant,
Support and relationships,
Provision of health services
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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Functioning may range from…
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FunctioningNo problem Complete problem
Integrity in
Body functionsBody structuresActivities andParticipation
Impairments in
Body functions andBody structures
Limitations inActivities and
Restrictions inParticipation
Bio-psycho-social model of functioning and disability
Using examples and visuals
Good content is not storytelling. It is telling your story well.
Ann Handley, Wall Street Journal best-selling author
Tips & Tricks on Training Methodology
Model and Structure of the ICF 18.02.2016
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The conceptual basis of the ICF provides a multi-dimensional approach to describe human functioning and disability
and serves as a framework for organizing this information.
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Health condition
Environmental factors Personal factors
Body functions/ Body structures
Activities Participation
Bio-psycho-social model of functioning and disability
Health Condition(disease, trauma)
Environmental Factors
Personal Factors
Introduction to the ICF
ActivitiesBody FunctionsBody Structures
Participation
The definitions of the components of the ICF model with the example of Mr. Wun.
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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A health condition is an umbrella term for disease, disorder, injury or trauma.
A health condition may also include other circumstances, such as ageing, stress, pregnancy, congenital anomaly, or genetic predisposition
Health conditions may be coded using the ICD.
Health condition
Environmental factors
Personal factors
Body functions/ Body structures
Activities Participation
Introduction to the ICF
Bio-psycho-social model of functioning and disability
20
Health condition
Environmental factors
Personal factors
Body functions/ Body structures
Activities Participation
„I was driving my car at night somewhere close to Bangkok. I was so tired that I fell asleep while driving. …I didn‘t wear the safety belt…. The next thing I remember is being at the hospital and not being able to move my legs and arms. I was wearing a brace around my neck to stabilize my broken vertebra. This was two years ago. I still can‘t move my legs and parts of my hands.“
Tetraplegia
MB50 (ICD-11)
Introduction to the ICF
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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Body functions are physiological functions of body systems, including psychological functions
Body structures are anatomical parts of the body, such as organs, limbs and their components
Impairments are problems in body functions or structure such as a significant deviation or loss
Health condition
Environmental factors
Personal factors
Body functions/ Body structures
Activities Participation
Tetraplegia
MB50 (ICD-11)
Introduction to the ICF
Bio-psycho-social model of functioning and disability
22
Physical Therapist: Beside Mr. Wun‘s complete problems in the lower extremity, he has partial deficits of muscle power in the arms. Due to his loss of movement in his legs, he demonstrates stiffness in the muscles and reduced mobility in the ankle joints. As a consequence of the loss of muscle power he has also problems with his respiratory functions
Health condition
Environmental factors
Personal factors
Body functions/ Body structures
Activities Participation
Tetraplegia
MB50
Introduction to the ICF
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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Environmental factors
Personal factors
Activities Participation
Activity is the execution of a task or action by an individual
Participation is involvement in a life situation.
Activity limitations are difficulties an individual may have in executing activities
Participation restrictions are problems an individual may experience in involvement in life situation
Tetraplegia
MB50 (ICD-11)
movements in his legs
stiffness in the muscles
muscle power in the arms
mobility in the ankle joints
respiratory functions
Introduction to the ICF
Bio-psycho-social model of functioning and disability
24
„ My problems in daily living are that I need much more time for eating, and I can‘t go to the toilet. Staying in a sitting position is difficult; I always need my arms to prop up. I can‘t go out to meet my friends, but I still communicate with them by phone or email. I also started to work using the computer to do translations from English to Thai ….“
Health condition
Environmental factors
Personal factors
Activities Participation
Tetraplegia
MB50 (ICD-11)
Introduction to the ICF
Bio-psycho-social model of functioning and disability
movements in his legs
stiffness in the muscles
muscle power in the arms
mobility in the ankle joints
respiratory functions
Model and Structure of the ICF 18.02.2016
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Environmental factors
Personal factors
Activities Participation
Environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives.
These factors are external to individuals and can have a positive or negative influence on the individual’s performance as a member of society, on the individual’s capacity to execute actions or tasks, or on individual’s body function or structure
eating
maintain sittinggo to the toilet
meet my friendswork on the computer
Introduction to the ICF
Bio-psycho-social model of functioning and disability
Tetraplegia
MB50 (ICD-11)
movements in his legs
stiffness in the muscles
muscle power in the arms
mobility in the ankle joints
respiratory functions
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„My wheelchair is very heavy, that makes it difficult for me to move it. Most of the buildings outside are not adapted for disabled. The streets are full of obstacles; impossible to overcome.The support of my mother is very important for me. Additionally we have two housekeepers who help me all the time.My health insurance pays for all my hospital stays, that helps also. Environmental
factors
Personal factors
Activities Participation
Tetraplegia
MB50 (ICD-11)
eating
maintain sitting position
go to the toiletmeet my friendswork on the computer
Do translations
Introduction to the ICF
movements in his legs
stiffness in the muscles
muscle power in the arms
mobility in the ankle joints
respiratory functions
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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Health condition
Environmental factors
Personal factors
Activities Participation
Personal factors are the particular background of an individual’s life and living, and comprises features of the individual that are not part of a health condition or health state.
These factors may include gender, race, age, other health conditions, fitness, lifestyle, habits, coping styles, social background, education, profession, past and current experience,…
Tetraplegia
MB50 (ICD-11)
movements in his legs
stiffness in the muscles
muscle power in the arms
mobility in the ancle jointsrespiratory functions
eating
maintain sittinggo to the toilet
meet my friendswork on the computer
housekeepers
wheelchairbuildingsstreets are full of obstaclessupport of my mother
health insurance
Introduction to the ICF
Bio-psycho-social model of functioning and disability
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Medical Doctor:„Mr Wun is 24 years old, he finalized his university degree in engineering last year. Although his disease is severe he is motivated to improve his situation.
Health condition
Environmental factors
Personal factors
Activities Participation
Tetraplegia
MB50 (ICD-11)
movements in his legs
stiffness in the muscles
muscle power in the arms
mobility in the ancle jointsrespiratory functions
housekeepers
wheelchairbuildingsstreets are full of obstaclessupport of my mother
health insurance
Bio-psycho-social model of functioning and disability
eating
maintain sitting position
go to the toilet work on the computer
Do translations
meet my friends
Model and Structure of the ICF 18.02.2016
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Body functions and structures
Activities & Participation
Functioning
Bio-psycho-social model of functioning and disability
ImpairedBody functions and structures
LimitedActivities
& RestrictedParticipation
Disability
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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ImpairedBody functions and structures
LimitedActivities
& RestrictedParticipation
Person‘sexperience of disability in
relation to thebody
Person‘sexperience of disability in
relation to theenvironment
Bio-psycho-social model of functioning and disability
ANY QUESTIONS?
Model and Structure of the ICF 18.02.2016
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Functioning and disability is…
• reflects what the body does, parts of the body, what people do in daily life and their participation in society
• the result of the interaction between a person’s health condition and both personal and environmental factors
• Personal and environmental factors can have either a positive and/or negative influence on the person’s functioning
Take home message (for your workshop participants)
Bio-psycho-social model of functioning and disability
Assign the magnets to the components of the bio-psycho-social model of the ICF
Magnet -Exercise: Getting familiar with the components of the bio-psycho-social model of functioning and disability
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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ADHEAR, Non-surgical bone conduction
system
Hearing functionsSensation of pain (headache)Energy level
35
Health condition
Environmental factors
Personal factors
Body functions/ Body structures Activities Participation
There is a dynamic interaction between the entities: Changes in one entity have the potential to modify one or more of the other entities.
AB51.0 Acquired conductive hearing loss
Bio-psycho-social model of functioning and disability
Ownership of ADHEAR use, Compliance of use, Motivation
Focusing attention, Conversation, School,
Socializing with classmates
Health condition
Environmental factors
Personal factors
Body functions/ Body structures Activities Participation
It is important to collect data on these constructs independently and thereafter explore associations and causal links between them.
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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Bio-psycho-social model of functioning and disability
Understanding interactions between ICF components
Example:
Louis is a fisherman. In recent
years, his worsening rheumatoid
arthritis has made major job tasks
like untangling and repairing
fishing nets difficult. Both his
hands and knees are affected, but
his finger joints are what cause
the most problems; especially with
respect to finger movement.
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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Health condition
Environmental factors
Personal factors
Body functions/ Body structures
Activities Participation
Example:
Energy and drive functionsSleep functionsEmotional functionsExperience of self and timeSensation of painHaematological system functionsExercise tolerance functionsIngestion functionsSexual functionsMobility of joint functionsStability of joint functionsMuscle power functionsMuscle endurance functionsGait pattern functionsEye, ear and related structuresStructures of head and neck regionStructure of upper extremityStructure of lower extremityStructure of trunkStructure of areas of skin
WritingCarrying out daily routineUsing communication devicesChanging basic body positionsMaintaining a sitting positionLifting and carrying objectsFine hand useHand and arm useCarrying, moving and handling objectsWalkingMoving aroundMoving around in different locationsMoving around using eqiupmentUsing transportationDrivingWashing oneselfCaring for body partsToiletingDressingEatingDrinkingLooking after one‘s health
Acquisition of goods and servicesPreparing mealsDoing houseworkAssisting othersFamily relationshipsIntimate relationships
Remunerative employmentCommunity lifeRecreation and leisure
DrugsAssistive devicesAssistive devices for mobilityProducts and technology for employmentDesign and construction of public buildingsClimateImmediate familyHealth professionalsSocietal attitudesSocial security services, systems and policies
AgeGenderMarital statusLifestyleGeneral life goalsExpectationsAcceptance of situationSelf-esteemSelf-discipline
Bio-psycho-social model of functioning and disability
Rheumatoid arthritis, ICD11: FA20
In your group, identify potential interactions between thecomponents of the bio-psycho-social model with respect toremunerative employment for the allocated healthcondition
Designate one person who will present the group result
Supermarket Cashier Exercise :Understanding the interactions between the components of the bio-psycho-social model of functioning and disability
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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Supermarket Cashier Exercise
Hanna, 45 years old, has been working full time in a local supermarket for 8 years.
She is mother of two boys, 12 and 14 years old. They are living in a 3 room flat 10
minutes walking distance from her workplace.
Both children are good in school and support Hanna with household tasks.
Nevertheless mastering the double burden of her job, household and family
management became increasingly difficult since her divorce two years ago.
Since the divorce her mother has provided great practical and emotional support.
The work atmosphere in the supermarket had been good. Her boss had been
understanding and considered her as a hard working and reliable employee.
However as the workload increased in the last year, Hanna started to struggle.
Besides working at the cash register, she had to spontaneously help other colleagues
with their work. This increasing stressed her out. She appeared disorganized and
unfocused, and mistakes accumulated in her work.
Since she also felt increasingly fatigued and experienced pain in her neck and
shoulder girdle, she finally visited her physician.
Supermarket Cashier Exercise
Model and Structure of the ICF 18.02.2016
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Supermarket Cashier Exercise
ANY QUESTIONS?
Model and Structure of the ICF 18.02.2016
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ICF is an universal model and applies to all people
irrespective of their culture, health condition, gender, or age.
ICF describes all the domains of functioning and disability that
are applicable to everyone.
Bio-psycho-social model of functioning and disability
The ICF promotes a neutral etiological perspective of disability
Bio-psycho-social model of functioning and disability
Model and Structure of the ICF 18.02.2016
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Take home message(for your workshop participants)
The bio-psychosocial model of functioning and disability is…
• multidimensional with dynamic interactions among the components
• universal, applying to all people and describes functioning and disability irrespective of cause
Bio-psycho-social model of functioning and disability
1. Does the ICD version matter when applying the ICF?
2. Does a health condition have to be present to use the ICF?
3. How can Activities and Participation be best differentiated?
4. How can some similar Body Functions and Activities and Participation (A&P) categories be differentiated (example, Urination functions and Toileting)?
Frequently Asked Questions in this Module
Model and Structure of the ICF 18.02.2016
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• Adapt the exercises and examples to your audience and context
• Activate participation by asking participants to explain why the participants made a decision
• Encourage discussion and interaction in small groups and during plenary
• Periodically ask if participants have questions and after answering ask if the response was clear
• If questions are asked that refer to the content of other modules, let them know that it will be addressed in a later module
Tips & Tricks on Training Methodology