the integrative bio-psycho-social modelof functioningand ...€¦ · the integrative...

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..


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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


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Grandma Anna hasrheumatoid arthritis

International Classification of Diseases

(ICD)

Grandma Anna has rheumatoid arthritis (ICD11: FA20)

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Prevale

nce in

%

Age in yearsMen

Women


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However:

What problems is Grandma

Anna experiencing and what

are her needs in relation to

her experience living with

rheumatoid arthritis?


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)



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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)


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)



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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/


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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



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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


Using examples and visuals

Good content is not storytelling. It is telling your story well.

Ann Handley, Wall Street Journal best-selling author



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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




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.



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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


Personal factors





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Health condition


Personal factors



„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)




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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


Personal factors



Tetraplegia

MB50 (ICD-11)



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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


Personal factors



Tetraplegia

MB50




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Personal factors


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



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„ 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


Personal factors


Tetraplegia

MB50 (ICD-11)









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Personal factors


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



Tetraplegia

MB50 (ICD-11)






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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


Tetraplegia

MB50 (ICD-11)

eating

maintain sitting position

go to the toiletmeet my friendswork on the computer

Do translations









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Health condition


Personal factors


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)




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



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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


Personal factors


Tetraplegia

MB50 (ICD-11)




mobility in the ancle jointsrespiratory functions

housekeepers

wheelchairbuildingsstreets are full of obstaclessupport of my mother

health insurance


eating

maintain sitting position

go to the toilet work on the computer

Do translations

meet my friends


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Body functions and structures

Activities & Participation

Functioning


ImpairedBody functions and structures

LimitedActivities

& RestrictedParticipation

Disability



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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


ANY QUESTIONS?


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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)


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



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ADHEAR, Non-surgical bone conduction

system

Hearing functionsSensation of pain (headache)Energy level

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Health condition


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


Ownership of ADHEAR use, Compliance of use, Motivation

Focusing attention, Conversation, School,

Socializing with classmates

Health condition


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.



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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.



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Health condition


Personal factors



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


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



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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.



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ANY QUESTIONS?


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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.


The ICF promotes a neutral etiological perspective of disability



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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


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


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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


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