Application of “International Classification of Functioning, Disability, and Health” (ICF) to Infants and Toddlers with Motor Delay
Date Issued
2008
Date
2008
Author(s)
Hwang, Ai-Wen
Abstract
The International Classification of Functioning, Disability and Health (ICF) has been officially published in 2001, and the ICF for Children and Youths (ICF-CY) was also published in 2007. The framework of ICF and ICF-CY contains five components: Health Condition, Body Functions and Structures (b, s), Activities and Participation (d), Environmental Factors (e), and Personal Factors. The Environmental Factors and Personal Factors are grouped into the part of Contextual Factors. At conceptual level, the framework emphasized that the Body Functions (b) and Structures (s) and Activities and Participation (d) are the results of the interactions between Health Condition and Environmental Factors (e). At programmatic level, to facilitate the use of ICF in clinical practice, the whole ICF version has been condensed into several different ICF Core Sets for different adult diseases. Only a few ICF categories in the ICF Core Set are needed to describe the health –related status of one person with a specific disease. However, the literature about the application of ICF-CY for both conceptual level and programmatic level were limited in infants and toddlers with or risk for motor delay (WMD). The purposes of this study were: (1) To establish and test the hypothetical ICF-CY based models for explaining motor development (Activities and Participation) in infants and toddlers WMD younger than 2 years (conceptual level). (2) To finding the potential categories for ICF-CY Core Set for infants and toddlers WMD (programmatic level).ethods: the present research was divided into two parts: Study I (conceptual level research) and Study II (programmatic level research). For Study I, firstly, 6 relevant topics in ICF components were systematically reviewed, and related variables and measures were selected. Secondly, reliability of the selected measures was examined in part of children enrolled in present study. Thirdly, to construct three hypothetical ICF-CY based models based on three motor outcomes (Stationary, Locomotion, and Visual-motor integration). A convenient sample of children WMD (n=70) aged 6-24 months was collected. All the enrolled children and their families received measures to have variables related to 5 components of ICF-CY: (1) Motor severity (Health Condition); (2) Body Functions ((b117) Intellectual Functions, (b130) Mastery Motivation, (b210) Seeing Functions, (b730) Muscle Power Functions, (b735) Muscle Tone Functions, (b740) Muscle Endurance Functions, (b755) Balance)); (3) Activities (Stationary (d410, d415), Locomotion (d450, d455), and Visual-motor integration subtests (d440) in Peabody Developmental Motor Scales 2nd Edition (PDMS-II)); and (4) Environmental Factors (learning material or equipment at home (e115), physical home environment arrangement (e155), relationships and support of immediate family (e310), family coping strategies (e410), needs or social support (e5)); and (5) Personal Factors (age and sex). MacArthur moderator-mediator approach was used to analyze the data and verify the three ICF-CY based hypothetical models while the alpha level was set at 0.05. In study II, 11 experts from multi-disciplinary backgrounds in early intervention were invited to attain the consensus on potential 2nd level categories of ICF-CY Core Set for infants and toddlers WMD. The problem rates of the categories in study I and the questionnaire were sent to the experts to obtain their consensus of potential categories of ICF-CY Core Set. The categories in the ICF Core Sets were determined when both of the following criteria were met: of >80% consensus from experts and of >30% of the sample in study I presenting problems on specific categories. esults: for study I (conceptual level), we proposed three ICF-CY models for 3 motor outcomes. Among the three models, social Environmental Factor (“Involvement” (e310)) could be the mediators between the Health Condition (Motor severity) and (b117and b755)) in Body Functions; another social Environmental Factor (“Responsivity” of parents (e310)) could be the mediators between the Health Condition (Motor severity) and one Body Functions variable (b117); one physical Environmental Factor (“Inside space” (e155)) together with Motor severity could predict Locomotion DA (d450, d455); another physical Environmental Factor (“Fine motor Toys”, and “Learning material” (e115)) together with Motor severity could predict Visual-motor integration DA (d440); Health Condition (Motor severity) could predict Activities and Participation (three types of motor outcomes) and Body Functions; some Body Functions variables (b117, b130, b730, b735, b755, b740) could be the mediators between the Health Condition (Motor severity) and Activities (Stationary DA (d410, d415), Locomotion DA (d450, d455), or Visual-motor integration DA (d440)). One more complex mediating path may exist: Motor severity would affect “Involvement” (e310), and then “Cognitive DQ” (b117) and “Balance” (b755), and then three motor outcomes (Stationary DA (d410, d415), Locomotion DA (d450, d455) and Visual-motor integration DA (d440)). Distal Environmental Factors (“Family coping strategies” (e410), and “Met needs index” of family (e575, e580, e585)) were not correlated with three motor outcomes in all three derived models.or study II (programmatic level), according to the results of survey, 20 of the 25 selected ICF-CY categories have reached >80% consensus from experts; 21 have reached >30% problem rates. 17 of the 25 selected ICF-CY categories had met both criteria to be potential ICF-CY Core Set categories. Those categories were: (b117) Intellectual Functions, (b130) Energy and Drive Functions, (b755) Involuntary Movement Reaction Functions, (d310) Communication with-receiving-spoken message, (d330) Speaking, (d410) Changing Basic Body Position, (d415) Maintaining a Body Position, (d430) Lifting and Carrying Objects, (d440) Fine Hand Use, (d450) Walking, (d455) Moving Around, (d550) Eating, (d560) Drinking, (d710) Basic interpersonal interaction, (e115) Product and Technology for Personal Use in Daily Living, (e310) Immediate Family, (e5) Services, Systems, and Policies.onclusions: At the conceptual level, specific 1 to 2 social Environmental variables could mediate the relationship between Health Conditions and Body Functions or between Health Conditions and Activities; specific physical Environmental Factors as well as Health Condition could predict Balance functions in Body Functions, and could also predict Locomotion and Visual-motor integration in Activities; most of the variables in Body Functions could be the mediators between Health Condition and Activities. At programmatic level, there are slight differences of the possible ICF-CY core categories between consensus of experts and evidence from empirical data for infants and toddlers WMD. The potential categories for ICF-CY Core set for Infant and toddlers WMD were also slightly different from the ICF checklist designed for adults.linical implications: The present study indicated the mediating processes of the variables in Body Functions and Environmental Factors would provide the most relevant elements for interventionist to begin with. The potential 17 ICF-CY categories would provide for establishing ICF-CY Core Sets and would help the clinicians to classify and describe the Health Status for infants and toddler with or at risk for motor delay.
Subjects
Motor Delay
ICF
ICF-CY
Child development
ICF-CY Core Set
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