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ICF in Rehab

Invited talk at "Physical and Rehabilitation Medicine in Pediatrics: Tradition and Innovation" - III National Interdisciplinary Congress with International Participation - August 20th 2020, Moscow, Russia

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ICF in Rehab

  1. 1. ICF in Rehab Olaf Kraus de Camargo, krausdc@mcmaster.ca Twitter: @DevPeds
  2. 2. Outline 1. The ICF 2. The Rehab Team 3. The “F-Words” 4. Video
  3. 3. The ICF - Health § Health is ‘the ability to adapt and self-manage in the face of social, physical and emotional challenges’ (Huber et al. 2011). § In other words, functioning (however it is done, regardless of ability/disability) can be understood as the evidence of health. Huber M, Knottnerus JA, Green L, et al. How should we define health? BMJ 2011; 343: d4163.
  4. 4. The ICF - Disability § We are increasingly aware that developmental conditions are not ‘diseases’ requiring a ‘disease-care’ system § We use an ‘alphabet soup’ of so-called ‘diagnoses’ – CP, ASD, DCD, ID, ODD and so on – for what are really descriptive labels.
  5. 5. The ICF - Disability § The ‘non-categorical’ way of thinking and talking reminds us that many issues are common across ‘developmental disabilities’ § It is also essential to take a life-course approach to these life-long ‘child-onset’ conditions. § And, to accept/celebrate diversity & variation.
  6. 6. 21st Century Thinking: Health Condition (e.g., CP,ASD) Body Structures and Functions Activities Participation Environmental Factors Personal Factors The ICF
  7. 7. ICF Framework Body Structure & Function Activities Participation Environment Personal Factors Body Functions: The physiological functions of body systems (including psychological functions) Body Structures: Anatomical parts of the body such as organs, limbs, and their components Activities: The execution of a task or action by an individual. Participation: Involvement in a life situation Environmental factors: The physical, social and attitudinal environment in which people live and conduct their lives; these are either barriers to or facilitators of the person’s functioning Personal Factors: Internal personal factors which can include gender, age, education, profession, past and current experience, character and other factors that influence how disability is experienced by the individual
  8. 8. What do we like about the ICF? • This is a ‘dynamic system’ of inter-connected parts, and where we start our interventions may be less important than we used to think • ICF reminds us to look at/focus on what people CAN do • This is a focus on strengths! Health Issue BS&F Activity Partn Environt Personal
  9. 9. • It is a framework for health for everyone • The words are ‘neutral’ • Everything is connected to everything else Health Issue BS&F Activity Partn Environt Personal What do we like about the ICF?
  10. 10. Perspectives Health Condition (e.g., CP,ASD) Body Structures and Functions Activities Participation Environmental Factors Personal Factors The ICF
  11. 11. Look again! What Do We See? It may depend on what we are looking for… ...and what we have been told to look for. For example, look at this picture of a beautiful young woman with a feather hat, looking wistfully over her right shoulder! 11
  12. 12. 12
  13. 13. 13 Can anyone see the old woman?
  14. 14. Perspectives Health Condition (e.g., CP,ASD) Body Structures and Functions ActivitiesParticipation Environmental Factors Personal Factors The ICF
  15. 15. Rehab Teams Acute Care Rehab Strategy Patients Physician/Clinician
  16. 16. Rehab Teams Acute Care Strategy curative, cause oriented optimizing, bio-psycho-social Patients Physician/Clinician Rehab
  17. 17. Rehab Teams Acute Care Strategy curative, cause oriented optimizing, bio-psycho-social Patients passive, enduring,“patient” active, responsible Physician/Clinician Rehab
  18. 18. Rehab Teams Acute Care Strategy curative, cause oriented optimizing, bio-psycho-social Patients passive, enduring,“patient” active, responsible Physician/Clinician Giving orders, prescribing,“in charge” counseling, accompanying, member of a team Rehab
  19. 19. Therapists (SLT, PT, OT) Paediatrician Social Worker Psychologist Child & Family Rehab Teams
  20. 20. F-Words Downloaded >16,000 times (September 2011 – Dec 2017) (> 4600 times in 2017 alone) Presented > 100 times locally & internationally Shared around the world and being translated into > 25 languages Rosenbaum P, Gorter JW.The “F-words” in childhood disability: I swear this is how we should think! Child Care Heal Dev 2012; 38: 457–63.
  21. 21. F-Words Health Condition (e.g., CP,ASD) Function Fitness Friends Family Fun The ICF Future
  22. 22. https://canchild.ca/en/res earch-in-practice/f- words-in-childhood- disability/f-words- translations Русский?
  23. 23. F-Words in Goal Setting § Reframing what is important and why § Support shared decision making § Create a common understanding of the journey ahead
  24. 24. Parent’s Perspectives § Sets the stage for a collaborative approach § The child/parent is in the driver’s seat § Promotes family-centredness developed. By Diane Kay @DianeMKay
  25. 25. “Great Rehab” Science: Biomedical Research & Evidence-based Medicine The Patient’sVoice: Narrative Medicine & Patient-reported outcomes Physician’s Tools: ICF Framework & Ethics principles ICF & Ethics: What can we do to improve participation? Evidence: What will work to achieve the patient's goals? The Patient’sVoice: What matters to them? Ronen GM, Kraus de Camargo O, Rosenbaum PL. How Can We Create Osler’s “Great Physician”? Fundamentals for Physicians’ Competency in the Twenty-first Century. Med Sci Educ 2020. DOI:10.1007/s40670-020-01003-1.
  26. 26. Example: Communication https://canchild.ca/en/research-in-practice/current-studies/c-billt
  27. 27. Q & A Session Q A& Спасибо! http://www.mackeith.co.uk/shop/icf-a-hands-on-approach-for-clinicians-and-families-ebook/

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