There are hundreds of medical reports in Kiyoshi’s file. In addition to oligoarticular juvenile idiopathic arthritis (JIA) he has uveitis and a seizure disorder. Kiyoshi has severe pain, joint contractures and difficulty moving around. Medications are not controlling the inflammation, there have been more seizures lately and his foot orthotics are too small. How do you begin physical therapy decision-making with a child this complex?
The International Classification of Functioning (ICF) conceptual framework allows you to apply your knowledge and skills to challenging situations. It will take a while to sort information into proper categories and edit. However, once this is complete, connections become clear and sound clinical decision-making will follow. The question I get asked most often about the ICF is , “where do you start?”. This post will guide you as you fill in the ICF/NDTA Enablement Model categories for the first time. Continue reading “14. Strategies For Filling In the ICF/ NDTA Enablement Model”
Ivan is always on the move, always running from here to there. He never walks slowly, never slows down. Moving quickly and never standing still can represent difficulty with static balance.
How does a person move? What is the quality? Do they have habitual postures, asymmetrical positions, or particular movement patterns? In this discussion about the ICF, we explore the domain of Posture and Movement (otherwise known as Motor Functions). As discussed in a previous posting, this is an addition to the traditional ICF made by the Neuro-Developmental Treatment Association. This domain highlights common threads running through many activities. Continue reading “12. HOW does she move? Pulling the ICF Together by Describing Motor Function.”
Continuing on with the ICF, this post looks at what makes up personal factors. Personal factors are independent of the health condition but can often influence how a person functions. These factors are specific to social and cultural customs of each country. While all the other categories have codes, this one does not yet have specific codes. Continue reading “11. ICF- What are Personal Factors?”
This post is the tenth in the ICF series and explores what constitutes an environmental factor. Environmental factors have an impact on all components of functioning in the ICF. They affect the experience of participation and can be either facilitators or barriers to an individual’s participation. Continue reading “10. ICF-Environmental Factors”
In my opinion, participation is the most fun part of the ICF. Participation is using an activity to interact with others or with the environment. When the activity is walking, participation is walking on the beach with friends, or walking in the grocery store to help with the shopping. Participation is one of the most motivating and satisfying levels of functioning. New activities should be put into participation as soon as possible to build motor control. These happen in many different environments: Home, friends’ homes, schools, libraries and parks. Continue reading “9. ICF-Participation”
Here we start another category of the ICF….activity! This is the heart and soul of physical therapy, at least in the clinic or during a home visit. The activity section of the ICF describes what a person can do in a standard environment or their regular environment. Activity is defined as the execution of a task or action. The activity section includes the following:
- developmental skills that babies learn in the first year of life,
- gross motor skills at any age
- fine motor skills at any age
- activities of daily living/self-care
Continue reading “8. ICF- Activity”
I often begin in the impairment section of the ICF. Impairment describes problems that are happening at the structural level. Impairments are stated in medical reports and can be listed in preparation for the initial evaluation. Impairment would include any changes in the following body structures or body functions: Continue reading “7. ICF-Impairment”