Barn i ldersgruppen 3 r Kroppsfunktioner

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International Classification of Functioning,
Disability and Health for Children Youth
ICF-CY Field-trial, 2005 Eva Björck-Åkesson,
PhD, Professor Mats Granlund, PhD, Professor Nina
Ibragimova, doctoral student CHILD research
program, Mälardalen university
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• The importance of ICF in work with children and
  youth (Simeonsson et al., 2003)
• Need for common universal language to describe
  childhood disability
• Documentation of disability and risk factors for
  disability in early childhood is crucial for
  prevention and early intervention efforts
• Possibility of identifying children on the basis
  of functional profiles rather than diagnostic
  labels
• A biopsychosocial model for describing of
  disability thus emphasizing not only medical but
  social, educational and functional needs of
  children
• Emphasis on person-environment interaction

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Field-trial of ICIDH-2 in rehabilitation centers
in Sweden

• Commentaries of the proffessionals
• Material is adult oriented
• Development aspects should be included in
  classification
• Dependence on adult support should be included
• More examples for children are needed
• It is difficult to use qualifiers for children
  and youth
• (Bjorck-Akesson, Eliasson, Folkesson, Holmberg,
  Karlsson, Sanner Westbom, 2002)

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The need for ICF version for children and youth

• Manifestations of disability in early years
  differ from that in adult years
• Accounting for the role of development
• Dependence on the caregiver in activity and
  participation during the early years
• The importance of child-caregiver interaction for
  childs development
• Typical activities in childhood
• Essential role of the immediate environment for
  childs development
• The importance of following transition between
  settings

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WHO work group to develop version of ICF for
children and youth

• Build on work of ICF childrens task force
• Regional meetings 2003-2004 by work group with
  input from country representatives
• 2002-2003 Preparation of 1st draft
• Summer/fall-2004 Field trials
• Winter 2004 Preparation of final draft
• Submission to WHO-2005

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• The work on modification of content in ICF-CY
• (a) modifying or expanding descriptions
• (b) assigning new content to unused codes
• (c) modifying inclusion and exclusion criteria
• (d) expanding generic qualifiers to include
  developmental aspects

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Examples of changes of content

• D3500 Starting a conversation
• ICF
• Starting, sustaining and ending an
  interchange of thoughts and ideas, carried out by
  means of spoken, written, sign or other forms of
  language, with one or more people one knows or
  who are strangers, in formal or casual settings.
• ICF-CY
• Initiating turn-taking activity through
  eye-contact or other means that leads to joint
  attention and dyadic interaction. Beginning a
  dialogue or interchange, such as by introducing
  oneself, expressing customary greetings, and
  introducing a topic or asking questions.

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Example of inclusions
d4402 Manipulating Using fingers and hands to
exert control over, direct or guide something,
such as when handling coins or other small
objects for example strings or blocks Inclusions
Neat pincher grasp to pick up small objects
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Example of adding codes

• Chapter 8- Major Life Areas
• Play (d805-d809)
• d805 Playing- engaging in spontaneous or
  organized activities with objects/toys or others
• d8050 solitary play
• d8051 functional play
• d8052 symbolic/pretend play
• d8053 social play

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• Field trial of ICF-CY, 2005
• Checklists based on ICF-CY contained
• Background information on the participants
• Background information on the child
• Assessment of functioning and environment
  structured as in ICF-CY
• Questions on the feasibility of ICF-CY in the
  assessment

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Field-trial of ICF-CY, 2005
130 checklists
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Field-trial of ICF-CY, 2005 The participants
Special teachers
Physiotherapist
Occupational therapist
Social worker
Psychologist
Lanugage therapist
Physician
Nurse
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Experience of working with ICIDH and ICF
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Sources of information used for assessment
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Field-trial of ICF-CY, 2005
129 children 0 months to 19 years (M9
SD5,05) 83 boys och 38 girls
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DiagnosesPrimary diagnoses as stated by the
respondents
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Comparison between age groupsBody Functions
Complete problem
No problem
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Comparison between age groupsActivity
Participation
Complete problem
No problem
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Comparison between age groupsEnvironment
facilitator
barrier
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Professionals opinions and commentaries
regarding the utility of ICF-CY
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Using ICF-CY and its components
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Using ICF-CY to describe children in specific age
groups
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Using ICF-CY to describe children in different
cultures
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Using the checklist based on ICF-CY to get an
overview of childs problems
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Will you use ICF-CY in your future work?
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Areas of using ICF-CY as suggested by the
respondents
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Necessary changes to the ICF-CY as suggeted by
respondents

• More distinct descriptions and definitions of
  codes
• Clearer instructions
• Revision of translations
• Clearer illustration of interaction between
  individual and environment

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Problems using ICF-CY

• General problems
• Unclear descriptions and definitions of the codes
• Too large groupings and too broad concepts
• Difficulties interpreting the qualifiers

• Environment
• Difficulties using qualifiers barrier and
  facilitator (persons or phenomena that can be
  both facilitator and barrier)
• Difficulties using the scale (when a phenomenon
  is not a barrier or is not present)
• Norm in judgement (comparison with other
  countries)
• Difficulties distinguishing between personal
  support (chapter 3) and attitudes (chapter 4) of
  the persons in the environment

• Activities Participation
• Difficulties distinguishing between capacity and
  performance
• Norm in judgement (comparing with children in the
  same age group)
• Judgement of the highest functional level
• Capacity can be different depending on whether
  the activity is familiar or not

Body Functions
Environment
Body Structures
Activities Participation

• Body Structures
• Difficulties in usage due to complex medical
  terminologi
• Difficulties distinguishing between structure and
  functions
• Difficulties using the scale for the
  localisation of the problem

• Body Functions
• Grading complete and severe difficulties
• Specifying the code when problem
• is located in one of the extremeties (left or
  right)

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Using ICF-CYAdvantages

• gives a comprehensive view of the child
• enables collaboration between professions
• covers considerable areas of childs functions
  and
• Problems
• elucidates activity, participation and
  environmental factors
• - provides more detailed information on younger
  children

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Reliability Validity

• Internal consistency reliability
• Chronbach alpha coefficient
• (a .64-95)

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Reliability Validity

• Construct validity
• Confirmatory factor analysis on domain and
  component level
• Correlations between qualifiers capacity and
  performance
• Correlations within and between the components

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Components Three factor model
Body functions Ch1 Mental functions Ch 2 Sensory
functions pain Ch 3 Voice speech functions Ch
4 Cardiovascular functions Ch 5 Digestive
functions Ch 6 Genitourinary functions Ch 7
Movement-related functions Ch 8 Functions in the
skin
Activity Participation
1 item
3 items
4 items
Activities Participation Ch 1 Learning
applying knowledge Ch 2 General tasks
demands Ch 3 Communication Ch 4 Mobility Ch 5
Self-care Ch 6 Domestic life Ch 7 Interpersonal
relationships Ch 8 Major life areas Ch 9
Community, social civic life
Environment
8 items
Body functions
1 item
Environment Ch 1Products technology Ch 2
Natural environment Ch 3 Support
relationships Ch 4 Attitudes Ch 5 Services,
systems policies
5 items
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Capacity and Performance as counted with Pearson
correlation
The lowest correlation (r.80, p ? .001) d 175
Problem solving The highest correlation (r95, p
? .001) d 415 Maintaining body position
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Activity and Participation as counted with
Pearson correlation
The lowest correlation (r.60, p ? .001) The
highest correlation (r75, p ? .001)
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Correlations between the components as counted
with Pearson correlation coefficient

• Body functions ? Environment no correlations
  above .50
• Body functions ? Activity Participation 9
  correlations above .50
• Activity Participation ? Environment no
  correlations above .50

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Tänan!
Takk!
Tak!
Tack!
Kiitos!
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Body functions Five factor model
Ch1. Mental functions (6 items) alertness,
thinking, sleep, concentration, coordination,
perception
Alertness
2 items
3 items
Concentration
1 item
Ch 2. Sensory functions (3 items) Seeing,
hearing, pain
2 items
1 item
Sensory functions
Ch 4. Cardiovascular systems (3 items) Heart,
allergy, breathing
3 items
1 item
Systems
Ch 5. Digestive systems (4 items) Eating,
digestion, defecation, urination
3 items
1 item
Ch7. Movement-related functions (5
items) mobility of joint functions, muscle
power, muscle tone, movement control involuntary
movements
Movement
4 items
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Activities Participation Five factor model
Ch1. Learning (7 items) Purposeful sensing,
play, using words, using concepts, reading,
writing, calculating
3 items
Reading, writing, Calculating
2 items
Ch 2. Tasks demands (4 items) Following
instructions, daily routines, managing ones own
behavior
1 item
Routines instructions
1 item
3 items
3 items
Ch 3. Communication (5 items) Understanding
speech, gestures drawings, preverbal
communication, speaking, using gestures
Language speech
2 items
1 item
Ch 4. Mobility Changing and maintaining body
position, sponaneous movements, fine hand use,
walking
Movement
3 items
2 items
2 items
Ch5. Self-care Washing oneself,
toileting dressing, eating, avoiding
potentially dangerous situations
Daily life
2 items
1 item
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Environment Five factor model
Ch1. Products technology (9 items) access to
type of food, medicine, aids for every day life,
mobility aids, material for communication, play,
education, public buildings, buildings for
private use
8 items
General support
Ch 2. Natural environment (5 items) population,
climate, natural events, human-caused events, air
quality
Products technology
5 items
1 item
Ch 3. Suppot relationships (7 items) Immediate
family extended family peers, neighbours,
community members people in positions of
authority, personal care providers domesticated
animals health professionals
3 items
1 item
Natural environment
2 items
Support from friends relatives
Ch 4. Attitudes (6 items) immediate family
extended family peers, neighbours, community
members people in positions of authority
personal care providers health professionals
2 items
1 item
3 items
4 items
1 item
Ch5. Services, systems policies (5
items) transportation services social
security services health services general
education special education
1 item
Support from people in positions of authority
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Correlations within the components as counted
with Pearson correlation coefficient

• Body functions 5 correlations .50 between the
  domains
• Activity Participation 14 correlations above
  .50 between domains
• Environment 2 correlations above .50 between the
  domains

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