ICF: International Classification of Functioning, Disability and Health

International Classification of Functioning, Disability and Health (ICF)

• ICF is a bio-psycho-social model that integrates abilities and disabilities, providing a coherent perspective of human functioning and disability as they relate to health.
• It provides a common language for all health professionals for documentation and communication.
• ICF emphasizes function (activity) in daily lives over disease.

ICF Model

• Consists of two parts:
  • Part 1: Functioning and Disability
    • Body Functions and Structures
    • Activities and Participation
  • Part 2: Contextual Factors
    • Environmental Factors
    • Personal Factors

Impairments

• Impairment of Body Function: Any loss or abnormality of psychological, physiological function of body systems (e.g., musculoskeletal, neuromuscular, cardiovascular/pulmonary, or integumentary).
• Examples: ROM, strength, coordination, balance, etc.
• Impairment of Body Structure: Readily apparent during observation.
  • Examples: swelling, scarring, open wound, amputation, muscle spasm, ligament laxity.
• Primary impairments: Arise directly from a health condition.
• Secondary impairments: Result from pre-existing impairments.
• Composite impairments: Result from multiple underlying causes and arise from a combination of primary and secondary impairments.

Activity Limitations and Participation Restrictions

• Activity Limitations: When a person has difficulty executing or is unable to perform tasks or actions of daily life (functional limitations).
  • May be physical, social, or psychological.
  • Examples: ADLs or IADLs.
• Participation Restrictions: Problems a person may experience in their involvement in life situations as measured against social standards.
  • Examples: unable to work, take care of children, participate in recreational activities, socializing with family and friends.

Quality of Life

• Influenced by body health, activity limitations, and participation restrictions.

Results of Disease: Cognitive Disability

• Executive functions: Deficit in cortical function involved in goal setting, planning, and maintaining behavior.
• Complex problem-solving: Deficit in handling new information to problem-solve.
• Information processing: Deficit in the speed of information traveling in the brain.
• Memory deficits: Failure to restore or retrieve information.
• Learning disability: Problems acquiring information.

Categories of Disease

• Congenital diseases: Present at birth.
  • Caused by gene mutation, chromosomal abnormalities, or multifactorial causes.
• Acquired diseases:
  • Caused by infection, injury, degeneration, dietary deficiencies/excesses, idiopathic (unknown cause), or iatrogenic (treatment effect) causes.

Diagnostic Procedures

• Blood Chemistry:
  • CBC (complete blood count): Includes 7 tests.
  • Glucose: 70-110 mg (fasting); high = diabetes, low = hypoglycemia.
• Arterial Blood Gases (ABG): Assess gas exchanges of oxygen and carbon dioxide in the lungs.
  • PO2: 75-100 mm Hg.
  • PCO2: 35-45 mm Hg.
• Urinalysis: Calcium, protein, steroids, and drug testing.
• Radiology:
  • Conventional radiography: Radiographic density related to size and atomic number (z).
  • Computerized Tomography (CT scan): More sensitive than conventional x-ray.
  • Bone Scan: Uses ionizing radiation to visualize musculoskeletal absorption of injected chemical isotopes.
  • Magnetic Resonance Imaging (MRI): Excellent for detecting soft tissue; can take images in any plane.
  • Myelogram: X-ray of spinal cord after injection of a contrast medium into the subarachnoid space.
  • Position Emission Tomography (PET): Produces 3D cross-section images of the brain after injection of nuclide positrons.

Heart and Electrical

• Echocardiogram: Non-invasive test using ultrasound to visualize the function of internal cardiac structures.
• Electrocardiogram (ECG/EKG): Recording of electrical currents coming from the heart muscle.
  • Diagnoses location, extent, and acuteness of MI.
  • Halter monitoring: 24-hour ECG analysis.
• Cardiac catheterization: Catheter passed into the right or left side of the heart.
  • Determines intracardiac pressures and blood flow.
  • Blood gas pressures to determine cardiac output and shunting.
• Angiogram/arteriogram/arthrogram: X-ray visualization of joints and/or blood vessels after injection of radiopaque material.
  • Used to assess aneurysm, AVM, leaking of vessels, arteriosclerosis, and tumors.
• “Doppler” ultrasonography: Non-invasive test evaluating blood flow velocity in major veins and arteries.
• Electroencephalography (EEG): Recording of electrical current.
  • Used for seizure, sleep, metabolic, and dementia diagnoses.
• Electromyography (EMG): Recording of changes in electrical potential of muscles.
  • Used to assess peripheral nerve injury and neuroma disorders.

Other Tests

• Pulmonary function tests (PFT): Number of tests to determine the ability of lungs to exchange oxygen and carbon dioxide.
  • Measures lung volumes, capacities, and flow rates.
• Stress Tests: Graded Exercise Test (GXT) - observation and recording of an individual's cardiovascular response during a maximal or submaximal exercise challenge.
  • Determines capacity to adapt to physical stress.
• Lumbar Puncture: Puncture between 3rd and 4th lumbar vertebra to remove CSF for analysis.
  • Used to assess autoimmune disease and infectious disease.
• Bronchoscopy: Flexible fiberoptic tube inserted into the nose or tracheal tube to visualize or aspirate fluids.
• Laparoscopy: Nitric oxide or carbon dioxide gas infused into the abdominal cavity through an incision near the umbilicus.
• Oximetry: Oxygen saturation.