ICF

Nagi Model berdasarkan pada konsep penyakit atau aktif patologi, impairtment, keterbatasan fungsi, dan disability

(Functional limitation ) Nagi model keterbatasan fungsi, (Functional limitation ) Ketidak mampuan ( Disability ) penyakit / aktif patologi, impairtment

Nagi model aktif patologi adalah interruption/ berhentinya atau interference proses normal dan usaha organisme secara simultan untuk memperbaikinya sendiri ke keadaan normal dengan mobilisasi defense tubuh dan mekanisme coping, impairtment adalah hilangnya atau abnormalitas anatomi, fisiologikal, mental atau psikologikal atau fungsi; keterbatasan fungsi atau restriksi kemampuan untuk melakukan tindakan fisik, tugas atau efisiensi aktifitas, harapan khusus, atau kompeten pada tingkat semua organisme dan person; disability adalah ketidakmampuan untuk melakukan atau keterbatasan dalam melakukan tindakan, tugas, aktifitas yang biasanya diharapkan dalam peran social khusus untuk individu atau diharapkan untk status person atau peran dalam konteks sosiokulturan khusus dan lingkungan fisik.

WHO Pada tahun 1980, World Health Organization (WHO) dikembangkan suatu model disablement alternative. Dalam WHO International Clasification of Impairtment, Disabilities and Handicaps (ICIDH),

World Health Organization Disability model penyakit / disease Ketidak mampuan impairtment HANDICAPED

WHO MODEL desease/penyakit didefenisikan sebagai perubahan patologi yang ditunjukkan sebagai suatu kondisi kesehatan yang berubah atau attribute status kesehatan individu yang akan membawa pada suatu distress, interference dengan aktifitas sehari-hari atau kontak dengan pelayanan kesehatan. Impairtment didefenisikan sebagai perubahan abnormal pada tingkat molecular, selular dan jaringan melalui struktur dan fungsi abnormal pada tingkat organ; disability restriction atau kurangnya kemampuan untuk melakukan aktifitas umum dengan cara yang normal; handicap didefenisikan sebagai ketidakmampuan untuk berfungsi pada tingkat person to person atau pada tingkat person to lingkungan. Handicap menunjukkan disadvantage sosial yang berhubungan dengan impairtment atau disability yang membatasi atau mencegah pemenuhan peran normal. WHO merevisi formulasi original model disablement dan pada desembar 2000 mengeluarkan versi pre – final yang berjudul ICIDH 2 : International Classification of Functioning Disability and Health.

NCMRR (1992 ) National Center For Medical Rehabilitation and Research (NCMRR) mempublikasikan suatu model disablement yang diambil dari Model Nagi dan WHO yang digunakan pada klasifikasi :

NCMRR (1992 ) patofisiologi, impairtment, keterbatasan fungsi, disability dan keterbatasan social.

NCMRR Model NCMRR menolak konotasi negative dari bentuk “handicap” dan diusulkan untuk menggantinya dengan bentuk “keterbatasan societal” untuk menghitung keterbatasan – imposed by society - membatasi kemampuan orang untuk berpartisipasi secara independent dalam tugas, aktifitas dan dan peran.

(IOM) Pada tahun 1991, Institute Of Medicine (IOM) menempatkan keempat model disablement untuk menekankan prevention, diusulkan bahwa disability mungkin dicegah melalui control resiko fisik dan resiko factor lingkungan social dalam factor resiko gaya hidup dan biological.

Is the ICF the pot of gold at the end of the rainbow? Physical Therapy Practice So perhaps indeed the ICF is the pot of gold at the end of the rainbow… ICF

The ICF

Environmental factors Body functions/ Body structures The ICF: Conceptual Model Health condition Environmental factors Personal factors Body functions/ Body structures Activities Participation

ICF endorsement WCPT in 2003 APTA in 2008

“The lived experience” Grandma Smith is suffering from rheumatoid arthritis (ICD: M05) Def.: Rheumatoid arthritis: “Rheumatoid arthritis (RA) is a chronic, systematic inflammatory disorder that may affect many tissues and organs, but principally attacks the joints producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints.”

“The lived experience” 1. The ICF integrative bio-psycho-social model of functioning and disability “The lived experience” Grandma Smith is suffering from rheumatoid arthritis (ICD: M05) However: What are the problems and needs in relation to the experience living with rheumatoid arthritis from the perspective of Grandma Smith?

Environmental factors Body functions/ Body structures 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example Health condition Environmental factors Personal factors Body functions/ Body structures Activities Participation 18

Environmental factors Body functions/ Body structures 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example A health condition is an umbrella term for disease, disorder, injury or trauma. A health condition may also include other circumstances, such as ageing, stress, pregnancy, congenital anomaly, or genetic predisposition Health conditions may be coded using the ICD-10. Health condition Environmental factors Personal factors Body functions/ Body structures Activities Participation 19

Environmental factors Body functions/ Body structures 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example Body functions are 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 functions or structure such as a significant deviation or loss Tetraplegia G83.5 Health condition Environmental factors Personal factors Body functions/ Body structures Activities Participation 20

Environmental factors Body functions/ Body structures 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example Physical Therapist: Beside Mr. Wun‘s complete problems in the lower extremity, he has partial deficits of muscle power in the arms. Due to his loss of movement in his legs, he demonstrates stiffness in the muscles and reduced mobility in the ankle joints. As a consequence of the loss of muscle power he has also problems with his respiratory functions Tetraplegia G83.5 muscle power in the arms movement in his legs stiffness in the muscles mobility in the ankle joints respiratory functions Health condition Environmental factors Personal factors Body functions/ Body structures Activities Participation 21

Environmental factors 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example Activity is the execution of a task or action by an individual Participation is involvement in a life situation. Activity limitations are difficulties an individual may have in executing activities Participation restrictions are problems an individual may experience in involvement in life situation Tetraplegia G83.5 Health condition Environmental factors Personal factors Activities Participation movements in his legs stiffness in the muscles muscle power in the arms mobility in the ankle joints respiratory functions 22

Environmental factors 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example „ My problems in daily living are that I need much more time for eating, and I can‘t go to the toilet. To maintain sitting is difficult, I always need my arms to prop up. I can‘t go out to meet my friends, but I still communicate to them by phone or E-Mail. I also started to work on the computer, doing translations from English to Thai ….“ Tetraplegia G83.5 Health condition Environmental factors Personal factors Activities Participation eating maintain sitting meet my friends work on the computer go to the toilet movements in his legs stiffness in the muscles muscle power in the arms mobility in the ankle joints respiratory functions 23

Environmental factors 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example 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 individual’s body function or structure Tetraplegia G83.5 Health condition Environmental factors Personal factors Activities Participation movements in his legs stiffness in the muscles muscle power in the arms mobility in the ancle joints respiratory functions eating maintain sitting go to the toilet meet my friends work on the computer 24

Environmental factors 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example „My wheelchair is very heavy, that makes it difficult for me to move it. Most of the buildings outside are not adapted for disabled. The streets are full of obstacles; impossible to overcome. The support of my mother is most important for me, additionally we have two housekeepers who help me all the time. My health insurance pays for all my hospital stays, that helps also. wheelchair is very heavy buildings streets are full of obstacles support of my mother housekeepers health insurance Tetraplegia G83.5 Health condition Environmental factors Personal factors Activities Participation movements in his legs stiffness in the muscles muscle power in the arms mobility in the ancle joints respiratory functions eating maintain sitting go to the toilet meet my friends work on the computer 25

Environmental factors 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example Personal factors are the particular background of an individual’s life and living, and comprises features of the individual that are not part of a health condition or health state. These factors may include gender, race, age, other health conditions, fitness, lifestyle, habits, coping styles, social background, education, profession, past and current experience,… Tetraplegia G83.5 Health condition Environmental factors Personal factors Activities Participation movements in his legs stiffness in the muscles muscle power in the arms mobility in the ancle joints respiratory functions eating maintain sitting go to the toilet meet my friends work on the computer housekeepers wheelchair buildings streets are full of obstacles support of my mother health insurance 26

Environmental factors 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example Medical Doctor: „Mr Wun is 24 years old, he finalized his university degree for engeneering last year. Although his disease is severe he is motivated to improve his situation. Tetraplegia G83.5 motivated engeneering university degree 24 years old Health condition Environmental factors Personal factors Activities Participation movements in his legs stiffness in the muscles muscle power in the arms mobility in the ancle joints respiratory functions eating maintain sitting go to the toilet meet my friends work on the computer housekeepers wheelchair buildings streets are full of obstacles support of my mother health insurance 27

Environmental factors 1. The ICF integrative bio-psycho-social model of functioning and disability Case Example Tetraplegia G83.5 Health condition Writing Carrying out daily routine Using communication devices Changing basic body positions Maintaining a sitting position Lifting and carrying objects Fine hand use Hand and arm use Carrying, moving and handling objects Walking Moving around Moving around in different locations Moving around using eqiupment Using transportation Driving Washing oneself Caring for body parts Toileting Dressing Eating Drinking Looking after one‘s health Energy and drive functions Sleep functions Emotional functions Experience of self and time Sensation of pain Haematological system functions Exercise tolerance functions Ingestion functions Sexual functions Mobility of joint functions Stability of joint functions Muscle power functions Muscle endurance functions Gait pattern functions Eye, ear and related structures Structures of head and neck region Structure of upper extremity Structure of lower extremity Structure of trunk Structure of areas of skin Acquisition of goods and services Preparing meals Doing housework Assisting others Family relationships Intimate relationships Remunerative employment Community life Recreation and leisure Functioning Drugs Assistive devices Assistive devices for mobility Products and technology for employment Design and construction of public buildings Climate Immediate family Health professionals Societal attitudes Social security services, systems and policies Environmental factors Personal factors Age Gender Marital status Lifestyle General life goals Expectations Acceptance of situation Self-esteem Self-discipline 28