The International Classification of Functioning, Disability, and Health (ICF) has been developed by the World Health Organization (WHO) as a comprehensive framework in which to classify the varying aspects of a person’s disability and health. With the ICF, the focus is turned towards achieving the best possible activity and participation level in society despite the disability.
Recently endorsed by the American Physical Therapy Association (APTA), the ICF continues in world-wide expansion and acceptance, being integrated in the treatment approaches of healthcare workers serving individuals with disabilities.
Previous classification systems such as the ICD-10 have focused on the limitations and causes of disability. The ICF, in contrast, mainstreams the experience of disability, acknowledging that every individual can experience a health problem at some time.
The ideas of the ICF are organized into an assessment tool that describes health and disability on three levels: Body function and structure, activities and participation, and environmental factors. This tool can be used to assess interventions and individual abilities, identify barriers to participation, and create plans to overcome them.
To better understand the model of the ICF, it is necessary to discuss the two prior existing approaches to disability. The first one is the medical model. This model defines disability as an inherent part of the individual, caused by a disease and therefore treated with medical intervention. The second approach is the social model and describes disability as a result of social attitudes and environmental barriers. Either of these two models, standing alone, is limited in effectiveness.
However, when these approaches are combined into the biopsychosocial model, they contribute to a comprehensive assessment of disability. The ICF is based on this model. The point is that disability is not only viewed in the context of body impairment (and intervention for that impairment) but that the framework has expanded, which also means that the intervention should expand. Therapy should look at the person’s ability for activity and participation within their environment! This certainly has relevance when considering physical therapy for the developmentally disabled in the school or habilitation practice setting.
With the ICF, treatment now focuses on enabling an individual to function to their full capacity in any setting despite a disability. When barriers to activity are overcome through interventions in the individual’s environment, this in itself will diminish disability. The ICF approach is more function-oriented and activity-based than the medical model alone.
With the development of the ICF, healthcare around the world is being viewed differently. In the field of physical therapy, therapists are empowered to expand their intervention toward treating the whole individual and not just the body part. The implications of this approach for those with developmental disabilities is both exciting and hope-filled.
World Health Organization. International Classification of Functioning, Disability, and Health (ICF). Available at: http://www.who.int/classifications/icf/en/. Accessed January 27, 2009.
To learn more about the ICF go to: http://www.who.int/classifications/icf/en/