Linking to the ICF

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Linking to the ICF

• One of the aims of this work is to link this
  representation scheme to the WHO ICF

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WHO ICF

• The World Health Organization Introduced its
  International Classification of Functioning in
  2002
• It marked a major shift away from its earlier
  medical viewpoint articulated in its 1980
• International Classification of Impairment
  Disability and Handicap ICIDH 1980
• ICF components are summarised in the following
  diagram.

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Components of the ICF
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Health Condition ( Disorder or Disease)
Body Functions and Structures
Activities
Participation
Personal Factors
Environmental Factors
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Focus of work

• This work concerns itself with the possible use
  of the World Health Organization International
  Classification of Functioning (ICF) as a basis
  for representing a conceptual model of Assistive
  Technology Systems.
• Typical AT systems consist of Person-Activity-AT-
  EnvironmentNeed to Link this to ICF

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Person
Remembering our Person representation
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Person

• We see that many elements of our representation
  map directly to the ICF
• These include Body Structures , Body Functions
  Activity and Participation and so on.
• Similarly

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Environment

• There were two aspects to environmental
  representation
• Objects and other factors based on ICF
  subcategories.
• These other factors include
• Attitudes
• Services Policy and Legislation
• Physical Environment
• Relationship and Associations

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Other Factors

• These are taken Directly from the ICF
• So there is a direct mapping for these
  environmental attributes
• The links between Person and Environment and the
  ICF is summarised in the following

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ICF Components
Functioning and Disability Contextual Factors
Body Functions and Structures Activities and Participation Environmental Personal Non- ICF
Can Describe Persons Body Components and
Functioning Capacity
Can Describe Persons capacity to Perform various
activities such as lifting, moving etc
Can Describe Some environmental Factors such as
home, work etc
Will play role but not yet part of ICF
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ICF and Tokens

• We can see from this that the ICF can serve as a
  significant base for AT system representation
  using CPNS.
• This is summarised in the following

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ICF Components
ICF can serve as basis for TOKENS representing
Person and Environment
Functioning and Disability Contextual Factors
Body Functions and Structures Activities and Participation Environmental Personal Non- ICF
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However

• There are limitations
• There is knowledge involved other than ICF
  categories
• This includes important factors such as prior AT
  use.
• Links to ICF of this knowledge typically made
  through Crosswalking from Profiling Instruments
  such as Scherers MPT
• While acknowledging that substantial linkage
  between the ICF and these instruments has been
  made, it cannot be said that it is a complete
  match.

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Crosswalking Process
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Cross-walking of Profiling Instruments

• Difficult Process
• Issues with incomplete matches, loose matches ,
  and so on
• Reed et al present a thorough review of these
  difficulties
• Recommendations for using the ICF in this way
  were made by Cieza et al , who suggested rules
  for this in 2002
• Upgraded these in 2005

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Here the concern is linking AT system Conceptsto
ICF using Ciezas et al Rules

• The rules of Cieza et al
• dictate that for example,
• Each meaningful concept is linked to the most
  precise ICF category.
• Not to use other specified or unspecified
• They introduce new codes such as nd and pf to
  cover gaps in ICF classification
• Here we link to the ICF using these rules from a
  Natural Language description of AT system
  Concepts such as Activity and Environment, etc
• From there move to a formal description of these

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Of Particular Interest is Rule 3

• Rule 3. Do not use the so-called other
  specified ICF categories, which are uniquely
  identified by the final code 8.If the content of
  a meaningful concept is not explicitly named in
  the corresponding ICF category, the additional
  information not explicitly named in the ICF is
  documented.

• Example
• Concept Pain in left foot
• The meaningful concept pain in left foot is
  linked to b28015 Pain in a lower limb and the
  additional information left foot not contained
  in that category is documented.

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Example

• To illustrate this
• Consider an every day activity such as making
  tea.
• In order to highlight the difficulties the ICF
  has as a means to represent the concepts involved
  in this consider the issues involved in
  representing this activity using ICF activity D
  codes

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Challenges to the use of ICF Activity Codes

• There are many stages involved in making Tea
• Different Instances of the same act occur across
  different stages
• For example, the person making tea will have to
  lift a number of different objects including the
  kettle, teapot, tea caddy sugar bowl and so on.
• This challenges the use of the ICF.

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ICF codes

• The ICF code D4300 (Lifting and carrying objects)
  is not explicitly bound to specific objects and
  hence does not distinguish between different
  instances of lifting.
• This distinction is not possible without
  documenting this additional non- ICF information
  as specified in rule 3 of Cieza et al.
• In rule 3 no formal way of documenting this is
  specified.
• It is presumed that informal natural language is
  used.

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Documenting this additional information

• According to Ciezas rule 3 this additional
  information should be provided.
• As a first step it is proposed to provide a
  natural language description of each act.
• From this description it is proposed to generate
  a formal description of the sentence using the
  ICF code and other syntactic elements.

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As a first Stage then

• Action descriptions are provided using Natural
  Language

Natural Language Description of Action 1
Natural Language Description of Action 2
Natural Language Description of Action 3
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Proposed Approach to extending Rule 3
Formalise Documentation Using Cases

• The work described here proposes to document this
  additional information through a process of
  semantic role labelling around the action, which
  is based on case structure grammar 4
• This will provide information on the action such
  as the agent of the action, the object of the
  action , for example the kettle, the duration of
  the action and instruments used in the
  performance of the action including assistive
  technology.
• These components can change as we move through
  different instances of the action to lift.

Examples
Lift Sugar Bowl
ACT(LIFT-D4300) OBJECT (Sugar Bowl)
ACT(LIFT-D4300) OBJECT( Kettle)
Lift Kettle
Pour Kettle using Tipper
ACT (Pour D560) OBJECT( Kettle) Instrument
(Tipper)
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In other Words

• These Natural Language descriptions are
  re-written using the case structure approach
  outlined above

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Natural Language Description of Action 1
Natural Language Description of Action 2
Natural Language Description of Action 3
Representation of Action1
Representation of Action2
Representation of Action3
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Benefits and References

• Documentation will include cases of activity in a
  formal way
• These include agent, objects, location, duration
  and much more.
• These can change as objects of action change.
• Assistive technology can be linked to an act via
  the instrument case
• Much richer representation of action which
  includes ICF
• Representation rooted in classic representation
  scheme of Artificial Intelligence

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Another consequence of ICF codes as they
currently stand

• Clearly there are different instances of the same
  act.
• Lifting a spoon implies different capability
  demands to lifting a bag of cement.
• Currently a persons capability is presented as a
  qualifier to an ICF code without any reference to
  any of this contextual information that
  distinguishes between instances of the same act.
• It seems that there is case to contextualise
  these capabilities in any proposed representation.

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There are at least three contextualised
capabilities identified.

• Activity Capabilities where the parameters of the
  intended action imply different capability
  demands, For example walk 10 yards V walk 10
  miles
• Object capabilities where the attributes of the
  object and the interaction required determine
  capability e.g. the difference between handling a
  spoon and handling a shovel
• Environmental capabilities Reading in well lit
  room V Reading in poor light

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Proposed Structure

• The proposed structure for Contextualised
  Capabilities Tokens

Contextualised Capability ID Contextualised Capability Type ICF Activity or Body Function Code Intended Activity/ Object / Environment Linked Token Capability Value 0-4
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Proposed Structure

• The proposed structure for Contextualised
  Capabilities Tokens

Contextualised Capability ID Contextualised Capability Type ICF Activity or Body Function Code Intended Activity/ Object / Environment Linked Token Capability Value 0-4
Linked Token to the token representing Activity ,
Object or Environment under consideration
0 No Problem 4 Extreme Difficulty
Token Identifier
Token Type i.e. whether it is Activity , object
or Environment
ICF code representing Instance of ACT
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Example
Contextualised Capability ID CC004 Contextualised Capability Type ACTIVITY ICF Activity or Body Function Code D4600 Intended Activity/ Object / Environment Linked Token A4445 Capability Value 0-4 2
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Contextualised Capabilities

• Can be used to record individual capabilities for
  the person across a range of different instances
  of the same act for example the same act with
  different objects , the same act in different
  environments and also with different variations
  of the same act such as doing the activitty for
  varying durations.