ICF and DISABILITY Theoretical Background PART A

DISTINCTION BETWEEN DEFICIT AND HANDICAP This could be “interpreted” through the concept: “accepting deficit and reducing handicap”. This distinction proves essential every time integration processes involving people with deficits or difficulties are activated.

DEFICIT By deficit, we mean an absence, any kind of “malformation”, a lack of or anomaly in an organ, etc. of a mental, psychological or physiological function. Example of a deficit situation: deaf person: their sensory deficit, manifested through a reduced or total inability to perceive sounds and noises, represents a permanent characteristic. It’s an “objective” feature, measurable in the same way as their body type, colour of hair, colour of eyes, etc. The use of a hearing aid which compensates for or amplifies the missing function of the sensory organ can, to some extent, reduce the effects of the deficit: helping increase auditory perception, but without modifying the deficit or malfunction of the auditory system, which remains unchanged.

HANDICAP By handicap, in contrast, we mean the result of a social and cultural process: it is the consequence of the meeting between the individual – with his/her own physical and psychological (including any deficts) characteristics – and his/her personal history and context. Example of a handicap situation: Beginning with the existence of a certain degree of auditory deficit, a subject can develop a personal history of adaptation to the different contexts in which they find themselves growing up and living. This deaf person may be surrounded by an environment which does not consider their deficit a serious impediment and, therefore, does not undervalue them as an individual. Or vice versa.

DIFFERENCE Difference between deficit and disability (handicap): DEFICIT is a “given” element, which cannot be modified and, in contemporary medical terms, is irreversible. It must therefore be considered a permanent part of the structure of the individual. HANDICAP is not innate in a person, but is a “contextual condition”. We speak of a “handicapping situation” (which can occur even when there is no deficit), determined by the meeting between diverse variables, therefore modifiable.

OUR FIELD …what exists is a certain handicap, and it is a process. The disadvantage could be more remarkable in a given context but lessen or even disappear in others. We work on the reduction of handicap. We work on what does exist and functions and organization of limits.

FRAMEWORK Our framework is ICF (International Classification of Functioning Health and Disability). Health is not a limited concept, centred on being or not being healthy, but implies a wider view of the quality of life and the possibility of preserving it even when faced with diseases that require a reorganization of day-to-day life.

ICF provides a standard language and framework for the description of health and health-related states; It is a classification of health and health-related domains. Domains that help us to describe changes in body function and structure, what a person with a health condition can do in a standard environment (their level of capacity), as well as what they actually do in their usual environment (their level of performance).

ICF These domains are classified from body, individual and societal perspectives by means of two lists: a list of body functions and structure, and a list of domains of activity and participation; In ICF, the term functioning refers to all body functions, activities and participation, while disability is similarly an umbrella term for impairments, activity limitations and participation restrictions; ICF also lists environmental factors that interact with all these components.

ICF stress ICF is named as it is because of its stress is on health and functioning,rather than on disability. Previously, disability began where health ended; once you were disabled, you where in a separate category; ICF is a tool for measuring functioning in society, no matter what the reason for one's impairments; ICF acknowledges that every human being can experience a decrement in health and thereby experience some disability.

ICF application individual level (assessment of individuals; individual treatment planning; evaluation of treatment and other interventions; communication among physicans, nurses, physiotherapists, occupational therapists and other health works, social service works and commmunity agencies; self-evaluation by consumers); institutional level (educational and training purposes; resource planning and development; quality improvement; management and outcome evaluation; managed care models of health care delivery); social level (eligibility criteria for state entitlements such as social security benefits, disability pensions, workers’ compensation and insurance; social policy development, including legislative reviews, model legislation, regulations and guidelines, and definitions for anti-discrimination legislation; needs assessments; environmental assessment for universal design, implementation of mandated accessibility, identification of environmental facilitators and barriers, and changes to social policy).

FUNCTIONING and DISABILITY

FUNCTIONING and DISABILITY in ICF disability and functioning are viewed as outcomes of interactions between health conditions (diseases, disorders and injuries) and contextual factors; contextual factors are external environmental factors (for example,social attitudes, architectural characteristics, legal and social structures, as well as climate, terrain and so forth); and internal personal factors, which include gender, age, coping styles, social background, education, profession, past and current experience, overall behaviour pattern, character and other factors that influence how disability is experienced by the individual.

LEVELS OF HUMAN FUNCTIONING Body Functions are physiological functions of body systems (including psychological functions) and Body Structures are anatomical parts of the body such as organs, limbs and their components; Activity is the execution of a task or action by an individual; Participation is involvement in a life situation.

QUALIFIERS Qualifiers record the presence and severity of a problem in functioning at the body, person and societal levels. For the classifications of body function and structure, the primary qualifier indicates the presence of an impairment and, on a five point scale, the degree of the impairment of function or structure (no impairment, mild, moderate, severe and complete); In the case of the Activity and Participation list of domains, two important qualifiers are provided: Performance qualifier and Capacity qualifier.

QUALIFIERS The Performance qualifier describes what an individual does in his or her current environment. Since the current environment always includes the overall societal context, performance can also be understood as "involvement in a life situation" or "the lived experience" of people in their actual context. (The 'current environment' will be understood to include assistive devices or personal assistance, whenever the individual actually uses them to perform actions or tasks.); The Capacity qualifier describes an individual’s ability to execute a task or an action. This construct indicates the highest probable level of functioning of a person in a given domain at a given moment.