1. Linking to the ICF One of the aims of this work is to link this representation scheme to the WHO ICF

2. 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.

3. Components of the ICF

4. Body Functions and Structures ActivitiesParticipation Health Condition ( Disorder or Disease) Environmental Factors Personal Factors

5. 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-Environment Need to Link this to ICF ICF PersonEnvironmentATActivity

6. Person Personal Attributes Body Structures Anthropometric Data Body Functions Activities and Participation Psycho- Social Other Remembering our Person representation

7. 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……

8. 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

9. 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

10. Functioning and Disability Contextual Factors Body Functions and Structures Activities and Participation Environmental Personal Non- ICF ICF Components 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

11. 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:

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

13. 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.

14. Crosswalking Process Profile Through Instruments Crosswalk/ Link to ICF Conceptualization Of System

15. 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

16. Here the concern is linking AT system Conceptsto ICF using Cieza’s et al Rules NL Description Link to ICF Using Cieza rules Formal Description AT System Concept 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

17. 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.

18. 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

19. 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.

20. 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.

21. Documenting this additional information According to Cieza’s 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.

22. Natural Language Description of Action 1 Natural Language Description of Action 2 Natural Language Description of Action 3 As a first Stage then Action descriptions are provided using Natural Language

23. Proposed Approach to extending Rule 3 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. Formalise Documentation Using Cases Lift Sugar Bowl Lift Kettle Pour Kettle using Tipper ACT(LIFT-D4300) OBJECT (Sugar Bowl) ACT(LIFT-D4300) OBJECT( Kettle) ACT (Pour D560) OBJECT( Kettle) Instrument (Tipper) Examples

24. In other Words These Natural Language descriptions are re- written using the case structure approach outlined above

25. 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

26. 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

27. 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.

28. 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

29. 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

30. 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 Token Identifier Token Type i.e. whether it is Activity, object or Environment Linked Token to the token representing Activity, Object or Environment under consideration 0 – No Problem 4 Extreme Difficulty ICF code representing Instance of ACT

31. 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 Example

32. 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.