Hippotherapy module 13 EN

1. SpecialisedVET training on Hippotherapy for
professionals working with children with
intellectual, emotional, physical and psychomotor
disabilities
2019-1-TR01-KA202-074547

3. 13What is ICF?
13.1. Introduction to ICF-CY
13.2. Assessment according to ICF
13.2.1. Recording of the demographic data
13.2.2.Tone
13.2.3. Strength
13.2.4. Balance
13.2.5.Trunk control
13.2.6. Motor performance
13.2.7. Motor functions
13.2.8. Cognitive functions
13.2.9. Quality of life
13.2.10. Personal factors
13.2.11. Environmental factors
13.3.Social security system for hippotherapy reimbursement

4. • ICF-CY
• International Classification of Functioning, Disability and Health –
Children and Youth
• Published by WHO 2007 (www.who.int/classifications/icf/en)
• Common language for different professionals and lay people to
describe health and impairment.

5. • 19th Century
• Emergence of modern medicine
• Systematic detection of diseases
• 1923: First Health Organization
• 1948:WHO (World Health Organisation)
• 1990: ICD-10
• International Classification of Diseases, 10th revision
• Classified diseases, disorders and health injury
• 2001: ICF
• International classification of functioning, disability and health
• Classifies functioning and disability associated with a health problem
• 2007: ICF-CY
• International Classification of Functioning, Disability and Health – Children andYouth

6. • Bio-medical model
• ICD (International Classification of Diseases)
• Bio-psycho-social model
• ICF (International Classification of Functioning, Disability and Health)

7. • Functional Health (Schuntermann 2009)
• Concept of context factors
• Concept of body function and body structures
• Concept of activities
• Concept of participation
• Disability
• Negative interaction between person and context factors
• Example: child with cerebral palsy
• Contractures  structural damage
• Concept of body functions and body structures
• Not able to walk  loss of function
• Concept of activities
• Can not go to school  disability
• Concept of participation
• School, accessibility, mood, etc.
• Concept of context factors

8. Objectives of the ICF-CY
• Common language
• Description instrument
• Description of health status
• Formulation of treatment
plans
• Comparative data analyzes
• Creation of statistics
Structure of the ICF
• Part 1: Functioning and
disability
• 1.1. body functions and body
structures
• 1.2. Activity and participation
• Part 2: Contextual factors
• 2.1. environmental factors
• 2.2. personal factors

10. 5 categories / classifications
• Body structures (s)
• anatomical parts of the body
• Body functions (b)
• physiological functions of body systems, including psychological features
• Activities and participation (d)
• performed task or action of a human being
• being included in one life situation
• Environmental factors (e)
• the material, social and attitude-related environment
• Personal factors
• personal background of the life of a human

11. • Example:
• Classification of activities and participation
• Chapter communication
Items:
• d330 Speaking
• d335 Produce nonverbal messages use
• d3350 Body language

13. Health Condition
Body Function and
Structures
Environmental
Factors
Personal Factors
Activities
Participation

14. Cerebral Palsy
Participation
Unable to go to school
Limited meetings with the
friends
Unable to go to cinema
Impairment
Spasticity
Lack of muscle strength
Contracture
Limited range of motion
Activity
Unable to walk
Difficulty in climbing stairs
Difficulty in eating
Personal factors
Gender
Age
Education status
Motivation
Environmental factors
Physical
Social
Social security
Economical issues

15. • The affected person is in focus.
• It provides a consistent language.
• The special living environments of children
and adolescents are considered.
• It takes into account the different
developmental processes of children and
adolescents.
• It simplifies the networking work.
• It provides a basis for interdisciplinary
planning and intervention
implementations.
• It allows data comparisons between
countries, health services, etc. and over
time.
• People with disabilities and their relatives
are considered as equal partners.
• Standardized language
• Transparency and traceability
• quality control
• Easier work planning
• networking opportunity
• Standardized documentation
• Comparability of state of development
resource orientation
• Parents are equal partners
15

16.  Patient History
 Family History
 History about the pregnancy
 Information about the delivery
 Prenatal, natal and postnatal history
 Other problems
 Neurodevelopmental history
 Other intervention that are already used
 Information about the daily living activities

17. • Ashworth scale: Tests resistance to passive movement of a joint with varying degrees
of velocity. Scores range from 0-4, with 5 choices.
• Modified Ashworth scale (MAS): Similar to Ashworth’s scale, but it adds an additional
scoring category to indicate resistance through less than half of the movement.
• Tardieu Scale: It measures spasticity that takes into account resistance to passive
movement at both slow and fast speed.
• Modified Tardiue Scale: Describes R1 and R2; R1 is the angle of the muscle reaction,
R2 is the full passive range of motion.

18. Manual Muscle Testing: Strength should be graded.The following scale, originally
developed by The Medical Research Council of the United Kingdom, is now used
universally:
0: No visible muscle contraction
1:Visible muscle contraction with no or trace movement
2: Limb movement, but not against gravity
3: Movement against gravity but no resistance
4: Movement against at least some resistance supplied by the examiner
5: Full strength

19. • Berg Balance Scale: The Berg balance scale is used to objectively
determine a patient's ability (or inability) to safely balance during a series of
predetermined tasks.
• It is a 14 item list with each item consisting of a five-point ordinal scale ranging from 0 to
4, with 0 indicating the lowest level of function and 4 the highest level of function and
takes approximately 20 minutes to complete.
• Paediatric Balance Scale: The Paediatric Balance Scale is a modified
version of the Berg Balance Scale and is used to assess functional balance
skills in school-aged children.
• The scale consists of 14 items that are scored from 0 points (lowest function) to 4 points
(highest function) with a maximum score of 56 points.

20. • Trunk Control Measurement Scale (TCMS): Trunk Control
Measurement Scale with its subscores, in children with neuromotor
disorders.
• TCMS is a reliable and clinically relevant assessment for children aged 5 years and
older with different neurological impairments.
• Trunk Impairment Scale (TIS): This scale aims to evaluate the trunk in
patients who have suffered a stroke.
• TIS assesses static and dynamic sitting balance and trunk coordination in a sitting
position.

21. • Gross Motor Performance Measure: The GMPM is an observational
instrument used to evaluate gross motor performance (i.e. quality of
movement) in children with cerebral palsy.
• The instrument's primary purpose is to evaluate change over time in
specific qualitative features or attributes of gross motor behaviour.
• The measure was found to be responsive to change over time.

22. • Gross Motor Performance Measure (GMFM): The Gross Motor Function Measure is an
assessment tool designed and evaluated to measure changes in gross motor function over
time or with intervention in children with cerebral palsy.
It was first developed in the late 1980s for use in both clinical and research settings and has
evolved through advanced analytic techniques and in response to requests for more efficient
testing.
There are two versions of the GMFM. The GMFM-88 is the original 88-item measure. Items
span the spectrum of gross motor activities in five dimensions.
• A: Lying and rolling,
• B: Sitting,
• C: Crawling and kneeling,
• D: Standing, and
• E: Walking, running and jumping.
The GMFM-66 is a 66 item subset of the original 88 items identified through Rasch analysis to
best describe the gross motor function of children with cerebral palsy of varying abilities.

23. • Bayley Scales of Infant and Toddler Development:This an assessment instrument
designed to measure motor, cognitive, language, social-emotional, and adaptive behaviour
development in babies and young children.
It involves interaction between the child and examiner and observations in a series of tasks.
As with other assessments, the tasks range from basic responses to more complex responses.
The Bayley Scales contain three subtests:
• The Cognitive Scales, which measures a child's ability to, for example, engage in pretend play,
attend to objects, or look for an object that has fallen.
• The Language Scale, which measures a child's ability to understand and use spoken language to
label objects or people, follow instructions, or recognize objects based on spoken description or
labels.
• The Motor Scale, which tests both gross and fine motor abilities.

24. • Cerebral Palsy Quality of Life Measure (CP QOL): The Cerebral Palsy Quality of
Life Questionnaire for Children (CP QOL-Child) and Cerebral Palsy Quality of Life
Questionnaire for Adolescents (CP QOL-Teen) are condition specific quality of life
instruments.
These instruments are useful for evaluating interventions designed to improve the
lives of children and adolescents.
The CP QOL-Child was first designed to assess the quality of life of children with
cerebral palsy aged 4-12 years.
An adolescent version, the CP QOL-Teen, has recently been developed for
adolescents aged 13-18 years.

25. • The Functional Independence Measure for Children (WeeFIM): WeeFIM is an 18-
item, 7-level ordinal scale instrument that measures a child’s consistent performance in
essential daily functional skills.
Three main domains (selfcare, mobility, and cognition) are assessed by interviewing or
by observing a child’s performance of a task, following criterion standards.
WeeFIM is categorized into 2 main functional streams: “Dependent” (i.e. requires helper:
scores 1–5) and “Independent” (i.e. requires no helper: scores 6–7)”.

26. •Pediatric Evaluation of Disability Inventory (PEDI): The
PEDI (Pediatric Evaluation of Disability Inventory), is an interview-
based assessment that can be used to monitor the self-care, mobility
and social abilities of a person with cerebral palsy.
In this assessment, the parent or care giver answers questions about
the person’s performance in these aspects of life.
There are two versions of this assessment widely used in clinical
practice today:
• The original PEDI, suitable for children aged six months to 7.5 years.
• The PEDI-CAT (Computer-Adaptive Test), a version suitable for
newborns till 21-year-olds. This later version incorporates the larger age
range, new items and different computer-based measurement
methodologies.

27. • There is no scale measuring the environment for Hippotherapy. Usually, the
assessment of environmental factors is made in order that in the respective context
and in the conditions of the moment, possible emergency situations can be
managed to ensure the safety of the beneficiary.
• It evaluates the environmental variables (animals that may be present if the activity
takes place in an open environment, weather conditions, etc.) and analyzes the
management method.
• Other details about the environmental conditions see Module 6, section 6.1.2

28. • There is no reimbursement for Hippotherapy in Turkey, Bulgaria and Romania.

29. 1. World Health Organization. (2007). ICF-CY, International Classification of Functioning, Disability, and Health: Children & Youth version. Geneva: World Health
Organization.
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Functioning, Disability and Health and the version for children and youth as a tool in child habilitation/early childhood intervention--feasibility and usefulness as a
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20843264.
3. Granlund, M., & Pless, M. (2012) Implementation of the International Classification of Functioning, Disability and Health (ICF/ICF-CY) and how this relates to
Augmentative and Alternative Communication. Augmentative and Alternative Communication, 28(1):11-20.
4. Russell, D. J. (2002). Gross motor function measure (GMFM-66 & GMFM-88) user's manual. London: Mac Keith.
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7. Saether R, Helbostad JL, Adde L, Jørgensen L, Vik T. Reliability and validity of the Trunk Impairment Scale in children and adolescents with cerebral palsy. Research
in Developmental Disabilities. 2013 Jul;34(7):2075-2084.
8. Gracies JM, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, Matthews D, Tilton A, Delgado MR. Reliability of the Tardieu Scale for assessing spasticity in
children with cerebral palsy. Arch Phys Med Rehabil. 2010 Mar;91(3):421-8. doi: 10.1016/j.apmr.2009.11.017. PMID: 20298834.
9. Mutlu, Akmer & Livanelioglu, Ayse & Kerem Günel, Mintaze. (2008). Reliability of Ashworth and Modified Ashworth Scales in Children with Spastic Cerebral Palsy.
BMC musculoskeletal disorders. 9. 44. 10.1186/1471-2474-9-44.
10. (2011) WeeFIM II®. In: Kreutzer J.S., DeLuca J., Caplan B. (eds) Encyclopedia of Clinical Neuropsychology. Springer, New York, NY. https://doi.org/10.1007/978-0-
387-79948-3_4889.
11. Haley, S. M., & New England Medical Center Hospital. (1992). Pediatric evaluation of disability inventory (PEDI): Development, standardization and administration
manual. Boston, MA: New England Medical Center Hospital, PEDI Research Group.
12. Cutter, N. C., & Kevorkian, C. G. (1999). Handbook of manual muscle testing. New York: McGraw-Hill, Health Professions Division.
13. Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: a modified version of the berg balance scale for the school-age child with mild to moderate motor
impairment. Pediatric Physical Therapy : the Official Publication of the Section on Pediatrics of the American Physical Therapy Association. 2003 ;15(2):114-128.
.

30. The European Commission's support for the production of this publication does not
constitute an endorsement of the contents, which reflect the views only of the
authors, and the Commission cannot be held responsible for any use which may be
made of the information contained therein.
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