1. Rehabilitation – What is it? Defining the Dimensions and Scope of Rehabilitation Dr Clive Thursfield Consultant Clinical Scientist

21. Cooperation Strategy Tools How am I going to get out of this situation ? Call the RAC ? Use the car jack ?

22. Assistive Technology Inherent ability / skills Cooperation Strategy Tools needed Personal assistance services Disabled

23. Classification systems (taken from David B Gray, Washington University, School of Medicine) ICF

26. ICF Components Body Functions & Structures Activities & Participation Environmental Factors Barriers Facilitators Functions Structures Capacity Performance

28. In the context of health: Body functions are the 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 function or structure such as a significant deviation or loss. Activity is the execution of a task or action by an individual. Participation is involvement in a life situation.

29. Activity limitations are difficulties an individual may have in executing activities. Participation restrictions are problems an individual may experience in involvement in life situations. Environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives.

30. qualifiers qualifiers qualifiers qualifiers ICF Functioning and Disability Contextual Factors Body Functions and Body Structures Activities and Participation Environmental Factors Personal Factors

31. Body Functions Body Structures Functioning and Disability ICF Functioning and Disability Contextual Factors Body Functions and Body Structures Activities and Participation Environmental Factors Personal Factors Skin and related structures Functions of the skin and related structures Structures related to movement Neuromusculoskeletal and movement-related functions Structures related to the genitourinary and reproductive systems Genitourinary and reproductive functions Structures related to the digestive, metabolic and endocrine systems Functions of the digestive, metabolic and endocrine systems Structures of the cardiovascular, immunological and respiratory systems Functions of the cardiovascular, haematological, immunological and respiratory systems Structures involved in voice and speech Voice and speech functions The eye, ear and related structures Sensory functions and pain Structures of the nervous system Mental functions

32. Domains d1 Learning and applying knowledge d2 General tasks and demands d3 Communication d4 Mobility d5 Self-care d6 Domestic life d7 Interpersonal interactions and relationships d8 Major life areas d9 Community, social and civic life Activities and Participation Functioning and Disability ICF Functioning and Disability Contextual Factors Body Functions and Body Structures Activities and Participation Environmental Factors Personal Factors

33. 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 the individual’s body function or structure. Contextual Factors ICF Functioning and Disability Contextual Factors Body Functions and Body Structures Activities and Participation Environmental Factors Personal Factors Individual Societal

34. Environmental factors are organized in the classification to focus on two different levels: (a) Individual – in the immediate environment of the individual, including settings such as home, workplace and school. Included at this level are the physical and material features of the environment that an individual comes face to face with, as well as direct contact with others such as family, acquaintances, peers and strangers. Contextual Factors ICF Functioning and Disability Contextual Factors Body Functions and Body Structures Activities and Participation Environmental Factors Personal Factors Individual Societal

35. (b) Societal – formal and informal social structures, services and overarching approaches or systems in the community or society that have an impact on individuals. This level includes organizations and services related to the work environment, community activities, government agencies, communication and transportation services, and informal social networks as well as laws, regulations, formal and informal rules, attitudes and ideologies. ICF Functioning and Disability Contextual Factors Body Functions and Body Structures Activities and Participation Environmental Factors Personal Factors Individual Societal Contextual Factors

36. Personal factors are the particular background of an individual’s life and living, and comprise features of the individual that are not part of a health condition or health states. These factors may include gender, race, age, other health conditions, fitness, lifestyle, habits, upbringing, coping styles, social background, education, profession, past and current experience (past life events and concurrent events), overall behaviour pattern and character style, individual psychological assets and other characteristics, all or any of which may play a role in disability at any level. Personal factors are not classified in ICF. However, they are included to show their contribution, which may have an impact on the outcome of various interventions. Contextual Factors ICF Functioning and Disability Contextual Factors Activities and Participation Environmental Factors Personal Factors Individual Societal Body Functions and Body Structures

40. + BODY FUNCTIONS + BODY STRUCTURES + ACTIVITIES AND PARTICIPATION + ENVIRONMENTAL FACTORS ICL

41. + BODY FUNCTIONS + CHAPTER 1 MENTAL FUNCTIONS + CHAPTER 2 SENSORY FUNCTIONS AND PAIN + CHAPTER 3 VOICE AND SPEECH FUNCTIONS + CHAPTER 4 FUNCTIONS OF THE CARDIOVASCULAR, HAEMATOLOGICAL, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS + CHAPTER 5 FUNCTIONS OF THE DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS + CHAPTER 6 GENITOURINARY AND REPRODUCTIVE FUNCTIONS + CHAPTER 7 NEUROMUSCULOSKELETAL AND MOVEMENT-RELATED FUNCTIONS + CHAPTER 8 FUNCTIONS OF THE SKIN AND RELATED STRUCTURES

42. + BODY STRUCTURES + CHAPTER 1 STRUCTURES OF THE NERVOUS SYSTEM + CHAPTER 2 THE EYE, EAR AND RELATED STRUCTURES + CHAPTER 3 STRUCTURES INVOLVED IN VOICE AND SPEECH + CHAPTER 4 STRUCTURES OF THE CARDIOVASCULAR, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS + CHAPTER 5 STRUCTURES RELATED TO THE DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS + CHAPTER 6 STRUCTURES RELATED TO THE GENITOURINARY AND REPRODUCTIVE SYSTEMS + CHAPTER 7 STRUCTURES RELATED TO MOVEMENT + CHAPTER 8 SKIN AND RELATED STRUCTURES

43. ACTIVITIES AND PARTICIPATION + CHAPTER 1 LEARNING AND APPLYING KNOWLEDGE + CHAPTER 2 GENERAL TASKS AND DEMANDS + CHAPTER 3 COMMUNICATION + CHAPTER 4 MOBILITY + CHAPTER 5 SELF-CARE + CHAPTER 6 DOMESTIC LIFE + CHAPTER 7 INTERPERSONAL INTERACTIONS AND RELATIONSHIPS + CHAPTER 8 MAJOR LIFE AREAS + CHAPTER 9 COMMUNITY, SOCIAL AND CIVIC LIFE

44. ENVIRONMENTAL FACTORS + CHAPTER 1 PRODUCTS AND TECHNOLOGY + CHAPTER 2 NATURAL ENVIRONMENT AND HUMAN-MADE CHANGES TO ENVIRONMENT + CHAPTER 3 SUPPORT AND RELATIONSHIPS + CHAPTER 4 ATTITUDES + CHAPTER 5 SERVICES, SYSTEMS AND POLICIES

45. CHAPTER 7 NEUROMUSCULOSKELETAL AND MOVEMENT-RELATED FUNCTIONS + Functions of the joints and bones (b710-b729) + Muscle functions (b730-b749) + Movement functions (b750-b789) > b798 Neuromusculoskeletal and movement-related functions, other specified > b799 Neuromusculoskeletal and movement-related functions, unspecified

46. + Movement functions (b750-b789) + b750 Motor reflex functions > b755 Involuntary movement reaction functions + b760 Control of voluntary movement functions + b765 Involuntary movement functions > b770 Gait pattern functions + b780 Sensations related to muscles and movement functions > b789 Movement functions, other specified and unspecified

47. b765 Involuntary movement functions Functions of unintentional, non- or semi-purposive involuntary contractions of a muscle or group of muscles. Inclusions: involuntary contractions of muscles; impairments such as tremors, tics, mannerisms, stereotypies, motor perseveration, chorea, athetosis, vocal tics, dystonic movements and dyskinesia Exclusions: control of voluntary movement functions ( b760 ); gait pattern functions ( b770 )

48. + BODY FUNCTIONS + BODY STRUCTURES + ACTIVITIES AND PARTICIPATION + ENVIRONMENTAL FACTORS ICL

49. ACTIVITIES AND PARTICIPATION + CHAPTER 1 LEARNING AND APPLYING KNOWLEDGE + CHAPTER 2 GENERAL TASKS AND DEMANDS + CHAPTER 3 COMMUNICATION + CHAPTER 4 MOBILITY + CHAPTER 5 SELF-CARE + CHAPTER 6 DOMESTIC LIFE + CHAPTER 7 INTERPERSONAL INTERACTIONS AND RELATIONSHIPS + CHAPTER 8 MAJOR LIFE AREAS + CHAPTER 9 COMMUNITY, SOCIAL AND CIVIC LIFE

50. + CHAPTER 1 LEARNING AND APPLYING KNOWLEDGE + CHAPTER 2 GENERAL TASKS AND DEMANDS + CHAPTER 3 COMMUNICATION + Communicating - receiving (d310-d329) + Communicating - producing (d330-d349) + Conversation and use of communication devices and techniques (d350-d369) > d398 Communication, other specified > d399 Communication, unspecified + CHAPTER 4 MOBILITY + CHAPTER 5 SELF-CARE + CHAPTER 6 DOMESTIC LIFE + CHAPTER 7 INTERPERSONAL INTERACTIONS AND RELATIONSHIPS + CHAPTER 8 MAJOR LIFE AREAS + CHAPTER 9 COMMUNITY, SOCIAL AND CIVIC LIFE

51. + Communicating - receiving (d310-d329) + Communicating - producing (d330-d349) + Conversation and use of communication devices and techniques (d350-d369) + d350 Conversation + d355 Discussion + d360 Using communication devices and techniques > d369 Conversation and use of communication devices and techniques, other specified and unspecified > d398 Communication, other specified > d399 Communication, unspecified

52. d360 Using communication devices and techniques Using devices, techniques and other means for the purposes of communicating, such as calling a friend on the telephone. Inclusions: using telecommunication devices, using writing machines and communication techniques

53. xxx.0 NO problem (none, absent, negligible,… ) 0-4 % xxx.1 MILD problem (slight, low,…) 5-24 % xxx.2 MODERATE problem (medium, fair,...) 25-49 % xxx.3 SEVERE problem (high, extreme, …) 50-95 % xxx.4 COMPLETE problem (total,…) 96-100 % xxx.8 not specified xxx.9 not applicable Illustration of Code with Qualifiers

61. The dimensions and components of Rehabilitation Technicians Biomedical engineers Psychologists Social workers Occupational therapists Physical therapists Nurses Medical doctors The People Special teachers (seeing and hearing) Speech therapists Clinical Scientists Audio physicist Opticians Rehabilitation engineer Housing and building Work School sector (all levels) Preschool sector Social sector Health (all levels) The places

62. Rehabilitation 5 divisions – “ professional ” 23 divisions - “specialism” 21 Knowledge and Skill requirements

80. Mental Capacity Act (April 2005)