Seeing Beyond the Diagnosis: The ICF in Physiotherapy

Imagine you're putting together a puzzle. You could focus on just one piece, but you wouldn't see the whole picture. That's kind of how traditional healthcare can be – focusing on just the diagnosis or the injury.

The ICF, or International Classification of Functioning, Disability and Health, is a framework that helps physiotherapists (and other healthcare professionals) see the whole person, not just the condition. It's like stepping back to see the complete puzzle.

What Does It Look At?

The ICF looks at these main areas:

1.      Body functions and structures: This is the part that most people associate with healthcare. It's about the body's systems (like muscles, bones, heart, brain) and how they work. Are there any impairments or problems?

2.     Activities: These are the things a person does in their daily life, like walking, dressing, eating, playing, or going to school. Are there any difficulties performing these activities?

3.      Participation: This is about a person's involvement in real-life situations. Are they able to participate in activities at home, at school, in their community, or in social events? Are there any restrictions limiting their participation?

4.     Environmental factors: These are all the things around the person that can affect their functioning. This includes their home, school, community, social support, attitudes of others, and access to services.

5.      Personal factors: These are things about the person that can affect their functioning, like their age, gender, race, lifestyle, habits, past experiences, character, affect, coping styles, social background, education, profession, and so on.

Why is this Important for Physios?

For physiotherapists, the ICF is a game-changer because it helps us:

·        Understand the whole child: We don't just see a diagnosis; we see a child with unique abilities, challenges, and goals.

·        Set meaningful goals: Instead of just focusing on "improving strength," we can work with the family to set goals that improve the child's participation in activities they love (e.g., playing with friends, going to school).

·        Create a plan that works in real life: We consider the child's environment and personal factors to create a therapy plan that's practical, sustainable, and fits into their daily routine.

·        Measure what matters: We track progress not just in terms of strength or range of motion, but also in terms of the child's ability to participate in meaningful activities.

ICF in Action: Helping 4-Year-Old Leo (GMFCS Level III) Thrive with Cerebral Palsy

Leo, a vibrant 4-year-old boy with cerebral palsy (CP) GMFCS III; can walk with assistive devices (like a walker) but has significant difficulty with balance and coordination.

Now, let's use the ICF framework to create the whole picture for Leo:

1.      Body Functions & Structures:

·        Impairments:

·        Increased muscle tone (spasticity) primarily in his legs, particularly his hamstrings and adductors.
·        Muscle weakness, especially in his core and hip muscles.
·        Limited range of motion in his ankles and hips.

·        How We Assess:

·        Using standardised measures for spasticity.
·        Manual muscle testing (MMT) to assess strength
·        Goniometry to measure joint range of motion

2.      Activities:

·        Difficulties:

·        Walking independently, especially on uneven surfaces or for long distances.
·        Climbing stairs, requiring assistance or using a railing.
·        Transitioning between sitting and standing.
·        Playing actively with peers.

·        How We Assess:

·        Observing Leo during functional tasks like walking, climbing, and playing.
·        Using the Gross Motor Function Measure (GMFM) to quantify his gross motor abilities.

3.      Participation:

·        Restrictions:

·        Limited ability to participate in playground activities with his friends.
·        Difficulty keeping up with his peers during playtime.
·        Dependence on his parents for mobility at school and in the community.

·        How We Assess:

·        Talking to Leo and his parents about his interests and what activities he wants to be part of.
·        Using questionnaires like the Paediatric Evaluation of Disability Inventory (PEDI) to assess his participation levels.

4.      Environmental Factors:

·        Facilitators:

·        Supportive family who is actively involved in his care.
·        Access to regular physiotherapy and occupational therapy.
·        School that is willing to make accommodations to support his mobility.

·        Barriers:

·        Uneven playground surfaces at school.
·        Lack of accessible equipment in the community.
·        Attitudes of some peers who may not understand his limitations.

·        How We Assess:

·        Conducting a home visit to assess the environment.
·        Communicating with his teachers and caregivers to understand the challenges he faces in different settings.

5.      Personal Factors:

·        Positive:

·        High motivation to improve his mobility and play with his friends.
·        Positive attitude and strong self-esteem.
·        Enjoys music and movement activities.

·        Negative:

·        Frustration with his physical limitations.
·        Occasional feelings of sadness or isolation.

·        How We Assess:

·        Building rapport with Leo and creating a safe space for him to express his feelings.
·        Using age-appropriate questionnaires to assess his emotional well-being.

With this ICF-Informed Understanding, the Physio (along with his family) can:

Set goals that matter to Leo: Instead of just "improving lower extremity strength," the goals become:

"Leo will be able to walk independently with his walker across the playground to join his friends in a game for 15 minutes."

"Leo will be able to climb three steps with assistance to access the slide at the park."

Develop a comprehensive therapy plan: This might include:

·        Targeted exercises to improve strength, balance, and motor control, incorporated through fun games.
·        A 24-hour positioning plan to manage spasticity.
·        Practice walking with his walker on different surfaces (grass, pavement, ramps).
·        Playground visits to practice climbing and navigating equipment.
·        Consultations with the school to improve playground accessibility.

Measure success in a meaningful way: The physio tracks progress not just in terms of strength or range of motion, but also in terms of:

·        Leo's ability to walk across the playground and play with his friends.
·        His confidence and enjoyment during playground activities.
·        His overall quality of life.

The Result: By using the ICF, the physio is able to create a therapy plan that is truly tailored to Leo's needs and goals. This leads to:

·        Improved motor skills and physical function
·        Increased participation in activities that are important to Leo
·        Enhanced confidence and self-esteem
·        Greater overall well-being

The Takeaway

The ICF isn't just a fancy framework; it's a way of thinking that helps physiotherapists provide more holistic, effective, and patient-centred care. It's about seeing the whole person, not just the diagnosis, and working together to achieve meaningful goals.