International Classification of
Functioning, Disability, And Health
International Classification of
Functioning, Disability, and Health (ICF) is a classification method of health
and health related domains classifying health components of functioning and
disability. The ICF model takes into account the body functions, most probably
the psychological functions to establish a rating for the disability in a
patient (Organization. & Santé.,
2001) .
It then reconsiders body structures, these involve the basic components of
body
locomotion including hands and limbs, other body organs together with their
components. By considering the body structures, impairment becomes a great
factor of consideration. Loss of a body part or its functionality is classified
under impairment on a basis of severity of the loss and the impact it has on
the normal functioning of the concerned patient in the normal daily lives.
These factors are then considered on the body structure ability to execute
tasks and participate in a given activity. It classifies the individual capability
to take part in a given physical or psychological activity, and in this
situation his or her ability to perform the task satisfactorily. It goes deeper
to establish the limitation an individual under such impairment will face
limitations in participating in a given task, the difficulties in life
situations and the environmental factors that may concern the physical and
social environment in which he or she interacts with as they carry on with
their daily lives
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The
ICF model creates a more interactive and integrative comprehension of an individual’s
health status incorporating the strengths and weaknesses of individuals and
trying to establish procedures to make them, more participative in the normal
society (Pacific, 2000) . ICF model will
always intervene in enhancing the abilities of the affected so that they strive
to live an almost normal life with satisfaction considering the environmental
factors that are the immediate interaction between the affected and the normal
life.
Impairments
limitations are classified from 0-100% based on the severity of the problem,
the lower qualifier score signaling a patient s ability in body and structure
functionality. Patients with a qualifier score of between 0-4% are considered
as having no problem, patients with a qualifier score of 5-24% are considered
to have a mild problem, patients with a qualifier score of 25-49% are
considered to have a moderate problem, patients with a qualifier score of
50-95% are considered to have a severe problem while a qualifier score of
96-100% is considered a complete problem. In this classification, environmental
factors are quantified in a negative or positive scale in relative to how they
act as a barrier to the normal functioning of the individual (Organization.
& Santé., How to use the ICF : a practical manual for using the
International Classification of Functioning, Disability and Health (ICF) :
exposure draft for comment, 2013) .
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Gary,
a first year university student suffers from
hand injury, a situation
where his hand is completely disabled due to a disconnection in the nerves from
the hand to the spinal cord. With this situation Gary hardly uses his hand to
do any job but rather his hand has been undernourished with little muscle due
to depressed situation since it lacks activity crucial for muscle development.
While many students of his class are considered to have no problem, Gary never
considers this as a problem as he can easily communicate verbally and can use
his right hand to express his idea in words, however Gary cannot use his hand
to handle anything but uses his right hand only, this situation leaves him with
little choices as he can handle light objects only. Gary cannot wash clothes
since he really finds it hard to involve the disabled left hand but rather he
considers his situation temporary as physiotherapy doctors believe that over
time the nerves might develop to guarantee the hand full functionality, however
at the age of twenty six years, the situation is biologically unreliable.
During delivery, Gary encountered a severe case in birth abnormality where his
left hand is delivered in the abnormal situation, doctors effort to undo the
situation was unworkable as the event of delivery was late and no more time
could be compromised, Gary ends up with a hand injury and his hand loses
sensory nerves connectivity and absolute loss of activity.
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Applying
the ICF model Gary’s condition is severe problem with a qualifier score of
50-95% (Powell, 2000) . This situation has
led to a total loss in hand function and a lack of nerves connectivity in the
hand. The hand is disabled with no movement possible and he thus cannot move
fingers or any joint in his hand. This situation a has made Gary lose complete
functionality in the hand, a s a result
the hand has suffered under development and comparison with the normal hand is
a big contrast in size and nourishment. The body function of the hand can’t
function without nerve communication and therefore Gary suffers psychological
torture when he finds that he cannot find jobs in all sectors of his interest
like operating heavy machinery at the end of his career. This situation has
brought denial in Gary, while all doctors promise Gary that the situation will
get better, the situation has not improved since then despite regular
physiotherapy appointments and specialist consultations. This situation has led
to multiple hand injuries by fire and other physical injuries, Gary recalls
having burnt three of his fingers in a kitchen fire, doctors attribute this to
lack of sensitivity a situation which disables any stimuli in case of such an
event. The lack of nerves has disabled sensitivity and thus Gary always gets
injured in many situations without his consent. This situation has left his
hand with scars that are easily visible and thus Gary finds this embarrassing
when he is with his friends. Gary recalls getting his little finger in his left
hand without him noticing as situation that later led to his amputation of the
little finger. He is always optimistic that one day he might regain sensitivity
and thus can avoid such instances in the future. He feels psychologically
stressed when he sees his peers engage in cheerful games like handball when he
really can’t but just be a spectator.
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Gary’s manual ability for his left upper limb (ABILHAND)
pose challenges when managing daily activities with the available strategies (Organization.
& Santé., How to use the ICF : a practical manual for using the
International Classification of Functioning, Disability and Health (ICF) :
exposure draft for comment, 2013) . He finds it hard to
use a single hand to wash his clothes and thus prefers to hire labor, a situation
he considers financially demanding as he cannot however afford a washing
machine.
Considering
the environmental factors in the ICF model (Organization. & Santé., How
to use the ICF : a practical manual for using the International Classification
of Functioning, Disability and Health (ICF) : exposure draft for comment,
2013) ,
Gary finds an unwelcoming social structure as he is the first born in his
family and thus expected to take care of his siblings given the fact that he is
born of a single mother. His culture which demands the firstborns to take care
and become breadwinners of the family forces him to try to accommodate negative
sentiments from the society who consider him lazy, he however feels that given
the hands full functionality he could be his best. His family being a farming
family, he feels rejected in that setting as he cannot help in any farming
chores. At his age he feels that he ought to have accomplished a lot, however
this is not the case as he has not been able to achieve his most goals, he
however finds current experience more accommodating as the society has grown to
understand his situation.
Gary’s
performance is personal assisted as doctors find no other solution can be
offered with her current situation. While doctors believe surgery can be the
last option to correct the situation, Gary feels the idea is unwelcome as it’s
a costly affair beyond his reach, however Gary hasn’t lost hope in life. He
still strives to carry his normal life activities in the given situation
without any medical facility or equipment to aid him.
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Gary’s
impairment can however be diagnosed through medication surgery, in this process
a corrective surgery is carried to connect the barrier between the nerves and
offer full neuron connectivity as the situation heals (Powell, 2000) . This can be a step
towards Prevention of the development of further
activity limitation that may be posed by the impairment. By taking this step,
the impairment may be eradicated or major drawbacks eliminated such that the
patient may be able to carry at least minor activities with his hand.
Gary’s
activity limitation can be aided by providing personal assistance to help him
live a normal life without constraints. Since assistive devices may not be
workable in the given situation, Gary would otherwise be at a better position with
a helper to help him carry physical activities like washing clothes, house
grooming and related activities. In this situation, any improvement in the normal
functioning of his injured hand would be of great advantage, however this may
not serve to improve the injury situation but rather as a way of acceptance of
the current situation hence it’s a measure to alleviate pain and suffering to
the patient.
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In this medical situation Gary feels
socially unwelcome, a situation that makes him suffer psychologically,
therefore this situation can be alleviated by establishing anti-discrimination
law and creating awareness in the society to accept disability as something
within it and therefore treat the disabled with respect and humility. The
society needs to embrace Gary’s situation and still offer him a job after
completing his university education in a field he fits rather than considering
him unproductive in comparison to the physically fit.
References
Organisation, W. H. (1993). The ICD-10
classification of mental and behavioural... by World Health Organisation. .
geneva: World Health Organisation.
Organization., W. H., & Santé., O. M. (2001). International
classification of functioning, disability and health : ICF. geneva: World
Health Organization.
Pacific, W. H. (2000). Implementation of the global
strategy for health for all by the year 2000 : second evaluation: eighth report
on the world health situation / Vol. 7, Western Pacific Region. new york: :
Manila : World Health Organization, Regional Office for the Western Pacific .
Powell, J. (2000). The World Health Organisation.
London: Franklin Watts.
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