Transcript Brussels - MedenoSrce

ICF for undergraduate
students in medicine
G.Vanderstraeten
[email protected]
University Hospital Gent Belgium
Department of Physical and Rehabilitation Medicine
Thanks to
Gerold Stucki,Jan Reinhardt,Alexandra Rauch
Nottwil Rehab Centre
World Health Organization
Assessment Classification & Epidemiology
Group
International Classification
of
Functioning ,Disability
and Health
ICIDH-2 to ICF
WHO Family of International Classifications
PRIMARY CARE
. Lay reporting
. Community-based
information schemes
Procedures
Reasons for encounter
ICD
International
Classification
of
Diseases
SPECIALITY-BASED
ADAPTATIONS
IND
Nomenclature of
Diseases
ICIDH
International
Classification
of
Functioning
and Disability
SPECIALITY-BASED
ADAPTATIONS
WHO Family of International Classifications
PRIMARY CARE
. Lay reporting
. Community-based
information schemes
Procedures
Reasons for encounter
ICD
International
Classification
of
Diseases
SPECIALITY-BASED
ADAPTATIONS
IND
Nomenclature of
Diseases
ICF
International
Classification of
Functioning
Disability and Health
SPECIALITY-BASED
ADAPTATIONS
Need for the ICF?
 Change
in the Health Care Scene:
–from acute to chronic disease
 Change
from disease focus to
consequences focus
 Need for an international ‘common
language’ of consequences
 To serve the needs of people with
disability
Sequence of Concepts
ICIDH 1980 first model
Disease
or
disorder
Impairments
Disabilities
Handicaps
Overall Objective of
ICIDH-2 Revision to ICF
To develop an operational classification system on
human functioning and disability

that is applicable to every human being: universality

addresses multiple dimensions regarding the ‘person’
and ‘environment’ (at body, person and society levels)

international practices that are culture sensitive

based on user needs
Significant Changes:
Overall

Focus: Disabilities
Functioning & Disability

Impairments
Body Functions & Structures

Disabilities
Activities

Handicaps
Participation

No environment
Environmental Factors

Causal - linear
Interactive-integrative

No Definitions
Operational Definitions
Interaction of Concepts
1999
Health Condition
(disorder/disease)
Body Function
Structure
Activities
(Impairments)
(Activity Limitation)
Environmental
Factors
Participation
(Participation Restriction)
Personal
Factors
Functioning & Disability
as a multidimensional construct
Body
F+S
Person level (activity)
ICF in simple terms
body doesn’t
function properly
Your
You
are limited in your
activities
You
face barriers in society
Components of ICF

Body Functions

Body Structure

Activity

Participation

Environmental Factors
Dimensions of
Functioning & Disability
Body
ACTIVITIES
PARTICIPATION
BODY
PERSON
Activities
SOCIETY
Participation
Function/
Structure
(impairment)
(limitation)
(restriction)
Schizophrenia
Body
Information
processing
ACTIVITIES
Participation
Deficit in
Occupational
parental functions hindrance,
Work dysfunction Stigmatization
Epilepsy
IMPAIRMENTS
ACTIVITY
LIMITATIONS
PARTICIPATION
RESTRICTION
Transient loss of
Consciousness
none
denial of a
driving licence
Multiple Sclerosis
IMPAIRMENTS
ACTIVITY
LIMITATIONS
PARTICIPATION
RESTRICTION
Fatigue
Speech
Weakness in
muscles
self-care
doing housework
handling objects
Community part.
Employment
lack of special
devices
Implementation of the International
Classification of Functioning, Disability and
Health (ICF) in Rehabilitation Medicine
Gerold Stucki, MD, MS
Professor and Chair, Departement of Health Sciences and
Health Policy, University of Lucerne, Switzerland
Director, Swiss Paraplegic Research, Nottwil, Switzerland
Director, ICF Research Branch, WHO FIC CC Germany
President Elect, International Society of PRM (ISPRM)
Rehabilitation management and ICF
Health condition
Body functions/
Body
structures
Activity
Environmental factors
Participation
Personal factors
Understanding of
Description of
Functioning, Disability and Health
World Health Organization. International Classification of Functioning, Disability and Health: ICF. Geneva:
World Health Organization; 2001.
Rehabilitation management and ICF
Definition Functioning (Stucki G et al)
Functioning is not considered as the
consequence of a disease,
but the human experience of the interaction
between a health condition and
both personal and environmental factors
(contextual factors)
Stucki G, Cieza A, Melvin J. The ICF: A unifying model for the conceptual description of the
rehabilitation strategy. J Rehabil Med 2007; 39: 279-285
The Bio-psycho-social model of functioning
and disability
Health condition
Disease or disorder
Body functions
Activities
Functioning
and
and structures
Environmental
factors
Participation
Disability
Personal factors
Contextual factors
Rehabilitation management and ICF
Definition Rehabilitation
At the core of rehabilitation care provision are the
evolving problems and needs of individuals in relation
to functioning.
Functioning is the starting point of a patient and goal
oriented, evidence-based and iterative rehabilitation
process
Rauch A, Cieza A, Stucki G. How to apply the International Classification of Functioning, Disability
and Health (ICF) for rehabilitation management in clinical practice. Eur J Phys Med Rehabil Med 2008;
44:329-42
Functioning – the individual’s experience
Some examples
Functioning – the individual’s experience
Michael, 20
3 months following
traumatic 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.“
Functioning – the individual’s experience
Ingrid, 37
4 months following
traumatic tetraplegia
„I am really dependent
on others, I am not
even able to open
the purse by myself.
…and maybe this is
the reason not to go
out to meet other
people.“
Functioning – the individual’s experience
Martin, 26
5 months following traumatic
complete paraplegia
“The major problems for
me at the moment are to
find a wheelchair
accessible
accommodation and how
to manage the
wheelchair in locations
with many obstacles.”
Functioning – the individual’s experience
Mr Dee, 41 years
2 months following traumatic
SCI
„To have an income is very
important for me. I am
very much worried about
having enough money in
the future to purchase
goods and to support my
family. But therefore I
need to gain functions to
be able to work in my
occupation as a farmer.“
Functioning – the individual’s experience
Lisa, 36
Four months following
traumatic paraplegia
„My goal for the future is
to practice my former
profession again …and
to exercise any kind of
sport“
Functioning – the individual’s experience
d530Toileting
The ICF integrative bio-psycho-social model of functioning
and disability
In the following section you will:

learn the definition of functioning and disability and
the according components within the integrative biopsycho-social model.
Health condition
Body functions/
Body structures
Environmental factors
30
Activities
Participation
Personal factors
The ICF integrative bio-psycho-social model of functioning and disability
The definitions of the components of the ICF model with
the example of Mr. Wun.
Health condition
Body functions/
Body structures
Environmental
factors
31
Activities
Participation
Personal
factors
The ICF integrative bio-psycho-social model of functioning and disability
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-10.
Health condition
Body functions/
Body structures
Environmental
factors
32
Activities
Participation
Personal
factors
The ICF integrative bio-psycho-social model of functioning and disability
„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 is nearly two years ago. I
still can‘t move my legs and
parts of my hands.“
Tetraplegia
G83.5
Health condition
Body functions/
Body structures
Environmental
factors
33
Activities
Participation
Personal
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
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
Tetraplegia
Health
condition
G83.5
Body functions/
Body structures
Environmental
factors
34
Activities
Participation
Personal
factors
The ICF integrative bio-psycho-social model of functioning and disability
Physical Therapist:
Beside Mr. Wun‘s complete problems
in the lower extremity, he has
partial deficits
of power
musclein
power
muscle
the in
the arms. Due
to his loss
arms
movement
inof
his
movement instiffness
his legs,
hethe
legs in
mobility
in
the in
ankle
demonstrates
stiffness
the joints
muscles
muscles and reduced mobility in the Body functions/
ankle joints. As a consequence of the Body structures
loss
of muscle
power he has also
respiratory
functions
problems with his respiratory
functions
Environmental
factors
35
Tetraplegia
HealthG83.5
condition
Activities
Participation
Personal
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
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
Health condition
G83.5
muscle power in the
movements
arms in his legs
Activities
stiffness in the muscles
mobility in the ankle joints
respiratory functions
Environmental
factors
36
Participation
Personal
factors
The ICF integrative bio-psycho-social model of functioning and disability
„ My problems in daily living
are that I need much more time
for
eating, and I can‘t
eating
gogo
to to
thethe
toilet
toilet.
maintain
sitting
To maintain sitting is difficult, I
always need mymeet
armsmy
to friends
prop
up. I can‘t go out to meet my
friends, but I still communicate
to them by phone or E-Mail.
workI on
the
computer
also
started
to
work on the computer, doing
translations from English to
Thai ….“
37
Tetraplegia
Health
condition
G83.5
muscle power in the
movements
arms in his legs
Activities
stiffness in the muscles
mobility in the ankle joints
respiratory functions
Environmental
factors
Participation
Personal
factors
The ICF integrative bio-psycho-social model of functioning and disability
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
Tetraplegia
Health
condition
G83.5
movements in his legs
stiffness in the muscles
eating
Activities
go to
the toilet
maintain
sitting
muscle power in the
arms
mobility in the ankle joints
meet my friends
Participation
work on the
computer
respiratory functions
Environmental
factors
38
Personal
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
„Mywheelchair
wheelchairisisvery
veryheavy
heavy,
that makes it difficult for me to
buildings
move it. Most
of the buildings
outside are not adapted for
streets are
full of The
obstacles
disabled.
streets are full of obstacles;
support ofto
my
mother
impossible
overcome.
The support of my mother is
mosthousekeepers
important for me,
additionally we have two
health insurance
housekeepers
who help me all
the time.
My health insurance pays for all
my hospital stays, that helps
also.
39
muscle power in
the arms
movements in his legs
Tetraplegia
Health
condition
G83.5
eating
go to the toilet
stiffness in the
muscles
Activities
maintain sitting
mobility in the ancle joints
respiratory
functions
Environmental
factors
meet my friends
Participation
work on the
computer
Personal
factors
1. The ICF integrative bio-psycho-social model of functioning and disability
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
Health
condition
G83.5
muscle power in the arms
movements in his legs
stiffness in the muscles
mobility in the ancle joints
respiratory functions
wheelchair
Environmental
factors
buildings
streets are full of obstacles
support of my mother
40
housekeepers
health insurance
eating
Activities
go
to the toilet
maintain sitting
meet my friends
Participation
work on the
computer
Personal
factors
. The ICF integrative bio-psycho-social model of functioning and disability
Medical Doctor:
„Mr Wun is 24
24 years
years old
old, he
university
degree
finalized his
university
degree
for engeneering last
engeneering
year.
Although
his disease is
motivated
severe he is motivated to
improve his situation.
Tetraplegia
Health
condition
G83.5
muscle power in the
movements
eating
arms in his legs
Activities
stiffness in the muscles
go
to the toilet
mobility in the ancle joints
maintain sitting
respiratory functions
wheelchair
Environmental
buildings
factors
streets are full of
support
of my mother
obstacles
housekeepers
health insurance
41
meet my friends
Participation
work on the
computer
Personal
factors
The ICF integrative bio-psycho-social model of functioning and disability
Keep in mind:
1. A health condition is an umbrella term for disease, disorder,
injury or trauma. Health conditions are coded using the ICD-10
2. Body functions are physiological functions of body systems,
including psychological functions
3. Body structures are anatomical parts of the body, such as
organs, limbs and their components
4. Impairments are problems in body functions or structure as
a significant deviation or loss
42
. The ICF integrative bio-psycho-social model of functioning and disability
5. Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
6. Activity limitations are difficulties an individual may have in
executing activities
Participation restrictions are problems an individual may
experience in involvement in life situation
7. Environmental factors make up the physical, social and
attitudinal environment in which people live and conduct their
lives.
8. Environments may be either facilitate functioning or be a
barrier to functioning.
9. 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.
43
The ICF Classification
ICD
Health condition
493
Body functions/
Body structures
384
Activity
Participation
Body functions
Body structures
310
Environmental factors
253
Activity and
Participation
Environmental
factors
Personal factors
0
1450
World Health Organization. International Classification of Functioning, Disability and Health: ICF. Geneva:
World Health Organization; 2001.
The Classification
ICF
Contextual factors
Functioning and Disability
Body functions
and structures
Body
functions
Activity and
Participation
Environemental
factors
Personal
factors
e1 – e5
Not
classified
yet!
Body
structures
s1 – b8
d1 – d9
b110 b899
s110 s899
d110 d999
b1100 b7809
s1100 s8309
d1550 d9309
b11420 b51059
s11000 s76009
Specivity
b1 – b8
e110 e599
e1100 e5959
The Classification
Body Functions (b)
Body Structures (s)
•Structures of the nervous
system
•The eye, ear and related
•Sensory functions and pain
structures
•Structures involved in voice
•Voice and speech functions
and speech
•Functions of the cardiovascular,
•Structures of the
haematological, immunological and cardiovascular, immunological
and respiratory systems
respiratory systems
•Structures related to the
•Functions of the digestive, metabolic
digestive, metabolic and
and endocrine systems
endocrine systems
•Structures related to the
•Genitourinary and reproductive
genitourinary and reproductive
functions
systems
•Neuromusculoskeletal and movement- •Structures related to movement
related functions
•Mental functions
•Functions of the skin and related
structures
•Skin and related structures
The Classification
Activity and Participation (d)
•Learning & Applying Knowledge
•General Tasks and Demands
•Communication
•Movement
•Self Care
•Domestic Life Areas
•Interpersonal Interactions
•Major Life Areas
•Community, Social & Civic Life
Environmental factors (e)
•Products and technology
•Natural environment and humanmade changes to the environment
•Support and relationships
•Attitudes
•Services, systems and policies
The structure and codes of the ICF
In the following section you will…
• learn the organization of the structure and codes of
the classification
• understand the benefit of describing functioning at
different levels in the hierarchical structure
48
2. The structure and codes of the ICF
Keep in mind:
1. Classification is the placing of similar objects into
groups
2. Objects are often organized in a hierarchical
structure
49
2. The structure and codes of the ICF
The integrative bio-psycho-social model of functioning and
disability is the basis for the ICF classification.
There are large numbers of factors grouped into the components
of the ICF model (except the personal factors).
Health condition
493
Body functions/
Body structures
classified
within ICD
384
Activities
Participation
Body structures
310
Environmental factors
253
50
Body functions
Activites &
participation
Environmental
factors
Personal factors
0
2. The structure and codes of the ICF
The ICF has two parts, each with two components:
Part 1: Functioning and Disability
a) Body Functions and Structures
b) Activities and Participation
Part 2: Contextual Factors
c) Environmental Factors
d) Personal Factors
Each component consists of various chapters and,
within each chapter, categories, which are the unit of
classification.
51
2. The structure and codes of the ICF
ICF
Functioning and Disability
Body functions
and Structures
Body
functions
Parts
Components
Chapters
Second-level classification
Third-level classification
Fourth-level classification
Contextual factors
Activities and
Participation
Environmental
factors
Personal
factors
Not
classified
yet!
Body
structures
b1 – b8
s1 – b8
d1 – d9
e1 – e5
b110 b899
s110 s899
d110 d999
e110 e599
b1100 b7809
s1100 s8309
d1550 d9309
e1100 e5959
b11420 b51059
s11000 s76009
b 110
52ICF
s 54002
d4401
e1101
code = Prefixes + Numeric codes + ICF Qualifiers
2. The structure and codes of the ICF
An ICF code is composed of a prefix, the numeric code
and an ICF Qualifier.
The letter denotes the place in the classification and the
number of digits indicates the level of detail of the
category.
Component
s 7 302 0
Chapter
2nd level 3rd level
53
4th level
2. The structure and codes of the ICF
The classification provides a standard language and a
common framework for the description of health and
health related domains
“ICF does not classify people, but describes the situation
of each person within an array of health or health-related
domains.” (WHO 2001:8) !!!!!!!
54
2. The structure and codes of the ICF
Body functions
ICF
Functioning and Disability
Body functions
and Structures
Body
functions
Activities and
Participation
Chapters
Contextual factors
Environmental
factors
Personal
factors
Body
structures
b1
Mental functions
b2
Sensory functions and pain
b3
Voice and speech functions
b4
Functions of the cardiovascular, haematological,
immunological and respiratory functions
b5
b6
b7
55 b8
Functions of the digestive, metabolic and endocrine system
Genitourinary and reproductive functions
Neuromusculoskeletal and movement-related functions
Functions of the skin and related structures
2. The structure and codes of the ICF
Body structures
ICF
Functioning and
Disability
Body functions
and Structures
Body
functions
Contextual factors
Environmental
factors
Personal
factors
Body
structures
s1
Structures of the nervous system
s2
The eye, ear and related structures
s3
s4
56
Activities and
Participation
Chapters
Structures involved in voice and speech
Structures of the cardiovascular, immunological and respirator
system
s5
Structures related to the digestive, metabolic and endocrine sy
s6
Structures related to the genitourinary and reproductive syste
s7
Structures related to movement
s8
Skin and relates structures
2. The structure and codes of the ICF
Body functions
Mental functions
b1
s1
Structures of the nervous system
Sensory functions and pain
b2
s2
The eye, ear and related structures
Voice and speech functions
b3
s3
b4
s4
b5
s5
Structures involved in voice and
speech
Structures of the cardiovascular,
immunological and respiratory
system
Structures related to the digestive,
metabolic and endocrine syste
b6
s6
b7
s7
b8
s8
Functions of the cardiovascular,
haematolo-gical, immunological and
respiratory functions
Functions of the digestive, metabolic and
endocrine system
Genitourinary and reproductive
functions
Neuromusculoskeletal and movementrelated functions
Functions of the skin and related
structures
57
Body structures
Structures related to the
genitourinary and reproductive
system
Structures related to movement
Skin and related
structures
2. The structure and codes of the ICF
The WHO provides an online ICF Web-Browser where the
classification can be searched for ICF categories:
58
http://www.who.int/classifications/icfbrowser
2. The structure and codes of the ICF
Keep in mind:
1. The classification is organized in two parts, four
components, chapters (1st level) and categories on 2nd, 3rd and
4th level
2. The chapters (1st level) and categories on 2nd, 3rd and 4th
level comprise definitions with inclusion and exclusion criteria
(not for Body structures)
3. The specificity of the definition of an aspect of functioning
increases from the 1st to the 4th level
59
Use of ICF Qualifiers
ICF
Body
Function
b
Body
Structures
s
Activity &
Participation
d
Environmental
Factors
e
Personal
Factors
0 NO problem (none, absent, negligible,…) 0-4 %
1 MILD problem (slight, low,...)
5-24 %
2 MODERATE problem (medium, fair...)
25-49 %
3 SEVERE problem (high, extreme,...)
50-95 %
4 COMPLETE problem (total,...)
96-100 %
8 not specified (the available information does not suffice to specify
the severity of the problem)
9 not applicable (it is inappropriate or not possible to apply the
Use of ICF Qualifiers
ICF
Body
Function
b
Body
Structures
s
0 NO barrier
Activity &
Participation
d
Environmental
Factors
e
Personal
Factors
0 NO facilitator
1 MILD barrier
+1 MILD facilitator
2 MODERATE barrier
+2 MODERATE facilitator
3 SEVERE barrier
+3 SEVERE facilitator
4 COMPLETE barrier
+4 COMPLETE facilitator
8 not specified
9 not applicable
8 not specified
9 not applicable
Development of ICF Core Sets
1450
categories
s110
s120
s130
s140
s210
s230
…
b110
b114
b117
b122
b126
b140
b144
b147
...
d110
d115
d120
d129
D130
D160
d166
…
e110
e115
e120
e125
e130
e150
…
Health conditions specific,
e.g. situation specific
s410
s430
s710
b110
b130
b134
b152
d240
d410
d415
d420
e110
e115
e120
Comprehensive
ICF Core Sets
Brief
ICF Core Sets
Comprehensive ICF Core Set
List of ICF categories that includes as few
categories as possible to be practical, but as
many as necessary to describe the aspects of
functioning relevant to patients with a specific
condition in a comprehensive, multi-disciplinary
assessment
Brief ICF Core Set
List of ICF categories that serves as practical
tool for single encounters, minimum data sets for
the reporting of clinical and epidemiological
studies and health statistics.
Development of ICF Core Sets
Example:
ICF Core Sets for Spinal Cord Injury (SCI)
Early post-acute
situation
Long-term situation
Brief
25 categories
from the 2nd
levels
33 categories from
the 2nd levels
Comprehensive
161 categories
from 2nd und
3nd levels
168 categories
from 2nd und 3nd
levels
Development of ICF Core Sets
Example 2nd and 3rd level
catgories in the ICF Core Sets
Activity and Particiaption (Component)
Brief ICF Core Set for SCI in early
post-acute situation
d4 Mobility
(Chapter)
d440 Fine hand use
(2. Level)
d4400 Picking up
(3. Level)
d4401 Grasping
Comprehensive ICF Core Set for
SCI in early post-acute situation
d4402 Manipulating
d4404 Releasing
Development of ICF Core Sets
Brief ICF Core Set for Spinal Cord Injury in early post-acute
situation
Body
structures
Body functions
Code
Category
b152
Emotional functions
b280
Sensation of pain
b440
Respiration functions
b525
Defecation functions
b620
Urination functions
b730
Muscle power functions
b735
Muscle tone functions
b810
Protective functions of the skin
s120
Spinal cord and related structures
s430
Structure of respiratory system
s610
Structure of urinary system
Development of ICF Core Sets
Brief ICF Core Set for Spinal Cord Injury in early post-acute
situation
Environmental
factors
Activities and
Participation
Code
Category
d410
Changing basic body positions
d420
Transferring oneself
d445
Hand and arm use
d450
Walking
d510
Washing oneself
d530
Toileting
d540
Dressing
d550
Eating
d560
Drinking
e115
Products and technology for personal use in daily living
e120
Products and technology for personal indoor and outdoor
mobility and transportation
e310
Immediate family
e340
Personal care providers and personal assistants
e355
Health professionals
Example: case of low back pain
Work accident 2008
cf. core set for low back pain (10): typical spectrum of problems in functioning
of patients with low back pain,taking in mind comorbidities
Body functions and structures
e.g. b280.3 sensation of pain (low back pain and sciatica)
+
b810.1 protective functions of the skin (contactallergy )
b210.1 seeing functions (former lesion with visual consequences)
s810.1 structure of areas of skin
s2201.1 cornea
Activity limitation and participation restriction
e.g. d430.3 Lifting and carrying objects
d450.1 Walking
d845.3 Acquiring, keeping and terminating a job
…
Environmental factors
e570.+2 social security services, systems and policies
Personal factors
e.g. age 59 years old, former job experience, low education level
Vocational rehabilitation case: below knee
amputee
1. CONSULTATION BY REHABILITATION PHYSICIAN
-
-
Work accident: crush trauma of left lower limb => traumatic amputation
below knee
personal factors: 28 years old, vocational education, job:
- fork lift operator/machine operator,
- strong focus of patient on return to work
Pain complaints: phantom pain
2. JOB ANALYSIS
- Work visit: emphasis on physical task demands e.g.
- Operating fork lift
- working kneeled
- lifting and pulling weights
-…
-
Work conditions: clean working floor, stairs
-
3. JOBSPECIFIC TRAINING PROGRAM
Prosthesis fitting
Walking rehabilitation: tredmill, gait resistance training,
stairs, uneven surfaces, obstacles hydrotherapy
Strengthening exercises lower limbs
Conditional training
Exercise program on BTE and ERGOS work simulator:
working in different positions, carrying weights,…
4. ASSESMENT OF WORK ABILITIES
ERGOS Worksimulator: comparison with job fork-lift operator (DOT category
= medium heavy job)
- No physical deficits
- stumppain while carrying heavy weights and during kneeled work activity
- Several days after test remaining stumppain while walking
5. PROPOSITION OF REINTEGRATION PLAN
- Contact players: company physician, insurance physician, employer
- Adaptation to working environment: adjusted fork-lift: one pedal, low
instep system, hydraulic fork positioner
- Adjustment of job: higher use of fork lift instead of manual work
- Parttime work resumption
6. LONG TERM FOLLOW-UP
- Attempt to increase work resumption to 75% => skinproblems, more pain
complaints
- Further adjustment of job: fork lift operator, other tasks as machine
operator no longer part of job
- Adjustment prosthesis with a thigh corset
VR CASE: BELOW KNEE AMPUTEE
ENVIRONMENTAL FACTORS
BODY FUNCTIONS AND
STRUCTURES
ACTIVITIES AND
PARTICIPATION
s7501.31 structure of
lower leg
d8451.3 keeping job
e1351+2 assistive products and
technology for employment
Major task demand =
operate forklift
Adjustment of forklift: single pedal
system
d4501.2 Walking long
distances
e330+2 people in positions of
authority
b770.2 gait pattern
functions
d4502.2 Walking on
different surfaces
Supportive employer
…
d4551.2 climbing
b7301.2 power of
muscles of one limb
d4102.3 Kneeling
d460.2 Moving around in
different locations
…
e5502+2 legal policies
Federal anti-discrimination law,
diversity plans, compensatory
policies by VDAB
e1201+2 Assistive products and
technology for personal indoor and
outdoor mobility and transportation
Adaptatation to vehicle
PERSONAL FACTORS
…
Highly motivated to return to work
Vocationary education level
High expectations prosthesis
Difficulties with accepting consequences accident and insecure future
…
Rehabilitation management and ICF
www.icf-casestudies.org
Applying the ICF in Rehabilitation management
Health condition
Body functions/
Body structures
Environmental
factors
Activity
Participation
Personal factors
Assessment
Evaluation
Rehab-Cycle
Intervention
Assignment
Functioning is the starting point of
rehabilitation
It requires a common and
Comprehensive
approach of
How to assessunderstanding
functioning???
comprehensive
Multidisciplinary
approach
functioning