Disability :Current Concepts

International Classification of Function, Disability and Impairment

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International
Classification of
Disability
Prof. Ahmed-Refat A.G Refat
25/12/2012

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Contents
 Definition of Impairment, Disability and Handicap
 Evolutions of the concepts From ICIDH-1980 to
ICF2001
 Disability Statistics
 Models of Disability
 Current Model of Disability

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Impairment,
Disability
and Handicap
Evolution of the Concepts
From 1980 to 2001

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The most commonly cited definitions are those provided by the World Health
Organization (1980) in The International Classification of Impairments,
Disabilities, and Handicaps:
ICIDH- WHO- 1980

Impairment:

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Impairment:
Any loss or abnormality of
psychological, physiological
or anatomical structure or
function.

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Disability:

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Disability:
Any restriction or lack
(resulting from an impairment) of ability
to perform an activity in the
manner or within the range
considered normal for a
human being.

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Handicap

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Handicap:
a disadvantage for a given
individual that limits or
prevents the fulfillment of a
role that is normal

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As traditionally used, impairment refers to
a problem with a structure or organ of the
body; disability is a functional limitation
with regard to a particular activity; and
handicap refers to a disadvantage in filling
a role in life relative to a peer group.

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Examples to illustrate the differences
among the terms "impairment,"
"disability," and "handicap."

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David is a 4-yr.-old who has a form of
cerebral palsy (CP) called spastic diplegia.
David's CP causes his legs to be stiff, tight,
and difficult to move. He cannot stand or
walk.

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Impairment: The inability to move the legs
easily at the joints and inability to bear
weight on the feet is an impairment.
Without orthotics or surgery, David's level
of impairment may increase as imbalanced
muscle contraction over a period of time
can cause hip dislocation and deformed
bone growth. No treatment may be
currently available to lessen David's
impairment.

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Disability: David's inability to walk is a
disability. His level of disability can be
improved with physical therapy and special
equipment. For example, if he learns to
use a walker, his level of disability will
improve considerably.

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Handicap: David's cerebral palsy is
handicapping to the extent that it prevents
him from fulfilling a normal role at home, in
preschool, and in the community. His level
of handicap has been only very mild in the
early years as he has been well-supported
to be able to play with other children,
interact normally with family members and
participate fully in family and community
activities. As he gets older, his handicap

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will increase where certain sports and physical activities
are considered "normal" activities for children of the
same age. He has little handicap in his preschool
classroom, though he needs some assistance to move
about the classroom and from one activity to another
outside the classroom. Appropriate services and
equipment can reduce the extent to which cerebral
palsy prevents David from fulfilling a normal role in the
home, school and community as he grows.

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Statistics

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Percentage of population estimated to be
disabled in different countries.
Denmark 10,0- 12,0 %
France 5,0- 8,3 %
Norway 12,0 %
Spain 25,0 %
Sweden 12,0 %
U.K. 7,3 %

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In June 2011, World Health
Organization (WHO) and the World
Bank released the first World Report on
Disability.

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(1) Estimates based on the World Health
Survey
The average prevalence rate of disability
in the adult population aged 18 years and
over was 15.6% (some 650 million people of the
estimated 4.2 billion adults aged 18 and older in 2004)
ranging from 11.8% in higher income
countries to 18.0% in lower income
countries.

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If the prevalence figures are extrapolated
to cover adults 15 years and older, around
720 million people have difficulties in
functioning with around 100 million
experiencing very significant difficulties.

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2- Estimates based on the WHO Global
Burden of Disease study
The analysis of the Global Burden of
Disease 2004 data for this Report
estimates that 15.3% of the world
population (some 978 million people of
the estimated 6.4 billion in 2004 (35)) had
“moderate or severe disability”, while
2.9% or about 185 million experienced

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“severe disability” . Among those aged 0–
14 years, the figures were 5.1% and 0.7%,
or 93 million and 13 million children,
respectively. Among those 15 years and
older, the figures were 19.4% and 3.8%,
or 892 million and 175 million,
respectively.

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Models that characterized the history of
disability:
1. The traditional model,
2. the medical/genetic model,
3. the social/human-rights model .

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1- Traditional Model: This model
considers disability as a result of some sin
or as a punishment from God.

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2- Medical Model: This model considers
that persons with disability have a
dysfunction or a problem that needs to be
corrected. Therefore, medical model
promotes activities such as treatment,
surgery, appliances, etc. aimed at reducing
the disability in the person.

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The medical model views disability as a
problem of the person, directly caused by
disease, trauma or other health condition,
which requires medical care provided in the
form of individual treatment by
professionals.

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3- Social Model: This model considers
physical, social, cultural, environmental and
attitudinal barriers that "disable" persons
with impairments and that block their
participation in different life activities.
Therefore, this model promotes a fight
against the different barriers.

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The social model of disability, on the other
hand, sees the issue
mainly as a socially created problem, and
basically as a matter of the full
integration of individuals into society.

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Disability is not an attribute of an
individual, but rather a complex collection
of conditions, many of which are
created by the social environment.

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Hence the management of the problem
requires social action, and it is the collective
responsibility of society at large to make the
environmental modifications necessary for the full
participation of
people with disabilities in all areas of social life. The
issue is therefore an
attitudinal or ideological one requiring social change,
which at the political level
becomes a question of human rights. For this model
disability is a political issue.

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In addition, there is the Human rights
model, that looks at disability as an issue of
human rights.
Community-Based Rehabilitation (CBR ) is
based on human rights model of disability.

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The social model of disability has consider
disability as arising from the interaction
of a person’s functional status with the
physical, cultural, and policy
environments.

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ICF-WHO-2001

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ICF-WHO-2001
International Classification of Functioning,
Disability and Health

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ICF belongs to the WHO family
of international classifications,
Other Member are:

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1- International Classification of Diseases (ICD) Current ICD-10
(2015) ICD-11
22- International Classification of Health Interventions (ICHI)
ICD
The best known member of which is the

ICD-10 (the International Statistical Classification
of Diseases and Related Health Problems).

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ICD-10 gives users an etiological
framework for the classification, by
diagnosis, of diseases, disorders and other
health conditions.

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By contrast, ICF classifies functioning and
disability associated with health conditions.
The ICD-10 and ICF are therefore
complementary, and users are encouraged
to use them together to create more
meaningful picture of the experience of
health of individuals and populations.

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Information on mortality (provided by ICD-10)
and information about health and health-
related outcomes (provided by ICF) can be
combined in summary measures of
population health.

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In short, ICD-10 is mainly used to classify
causes of death, but ICF classifies
health.

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The overall aim of the ICF classification is
to provide a unified and standard language
and framework for the description of health
and
health-related states.

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ICF is based on an integration of the two
opposing models i.e biomedical and social .
In order to capture
the integration of the various perspectives
of functioning, a “bio-psycho-social”
approach is used.

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“bio-psycho-social” approach
in ICF disability and functioning are viewed as outcomes
of interactions between health conditions (diseases,
disorders and injuries) and contextual factors.

The medical model views disability as a feature of the
person, directly caused by disease, trauma or other
health condition, which requires medical care provided
in the form of individual treatment by professionals.

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Disability, on medical model, calls for
medical or other treatment or intervention, to 'correct'
the problem with the
individual.

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The social model of disability, on the other hand, sees
disability as a socially created problem and not at all an
attribute of an individual.

On the social model, disability demands a political
response, since the problem is created by an
unaccommodating physical environment brought about
by attitudes and other features of the social environment

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Components of ICF Model

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I - BODY FUNCTIONS
Body functions are the physiological
functions of body systems
(including psychological functions).
Impairments are problems in body function
or structure as a significant deviation or
loss.

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Body functions
Mental functions
Sensory functions and pain
Voice and speech functions
Functions of the cardiovascular, haematological,
immunological and respiratory systems
Functions of the digestive, metabolic and
endocrine systems
Genitourinary and reproductive functions
Neuromusculoskeletal and movement-related functions
Functions of the skin and related structures

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II- BODY STRUCTURES
Body structures are anatomical parts of
the body such as organs,
limbs and their components.
Impairments are problems in body function
or structure as a
significant deviation or loss.

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Body structures
Structures of the nervous system
The eye, ear and related structures
Structures involved in voice and speech
Structures of the cardiovascular, immunological
and respiratory systems
Structures related to the digestive, metabolic and
endocrine systems
Structures related to the genitourinary and
reproductive systems
Structures related to movement

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III-ACTIVITIES AND
PARTICIPATION
Activity is the execution of a task or action
by an individual.
Participation is involvement in a life
situation.

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Activity limitations
are difficulties an individual may have in
executing activities.
Participation restrictions
are problems an individual may experience
in involvement in life situations.

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Activities and participation
Learning and applying knowledge
General tasks and demands
Communication
Mobility
Self-care
Domestic life
Interpersonal interactions and relationships
Major life areas
Community, social and civic life

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IV- ENVIRONMENTAL
FACTORS
Environmental factors make up the
physical, social and
attitudinal environment in which people live
and conduct their
lives.

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Environmental factors
Products and technology
Natural environment and human-made
changes to
environment
Support and relationships
Attitudes
Services, systems and policies

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Body Functions and Structures; and
Activities and Participation
These terms, which replace the formerly
used terms “impairment”, “disability” and
“handicap” , extend the scope of the
classification to allow positive experiences
to be described.

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“Activity limitation” replaces the term
“disability” used in the 1980 version of
ICIDH.
“Participation restriction” replaces the term
“handicap” used in the 1980 version of
ICIDH

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Functioning

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Functioning
is an umbrella term encompassing all
body functions, activities and participation;
Disability

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Disability
serves as an umbrella term for
impairments, activity limitations or
participation restrictions.

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Functioning is an umbrella term for body
functions, body structures, activities
and participation. It denotes the positive
aspects of the interaction between an
individual (with a health condition) and that
individual's contextual factors
(environmental and personal factors).

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Impairment
is a loss or abnormality in body structure or
physiological function
(including mental functions). Abnormality here is used
strictly to refer to a
significant variation from established statistical norms
(i.e. as a deviation from a
population mean within measured standard norms) and
should be used only in
this sense.

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Disability is an umbrella term for
impairments, activity limitations and
participation restrictions. It denotes the
negative aspects of the interaction
between an individual (with a health
condition) and that individual's contextual
factors (environmental and personal
factors).

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Impairments are problems in body function
or structure such as a significant
deviation or loss.
Activity is the execution of a task or action
by an individual.
Participation is involvement in a life
situation.

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Activity limitations are difficulties an
individual may have in executing
activities.
Participation restrictions are problems an
individual may experience in
involvement in life situations.

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Environmental factors make up the
physical, social and attitudinal
environment in which people live and
conduct their lives.

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Exercises
Identify the Impairment,
Function and Activity Associated with
the following conditions
Leprosy - Panic Disorder-Spinal Injury-
Juvenile diabetes

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Leprosy

Loss of sensation of extremities = ?
Difficulties in grasping objects =?
Stigma of leprosy leads to unemployment =?

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Panic Disorder
Anxiety
Not capable of going out alone
People's reactions leads to
no social relationships

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Spinal Injury Paralysis
Incapable of using public transportation
Lack of accommodations in public
transportation
no participation in religious activities

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Juvenile diabetes
Pancreatic dysfunction
None (impairment controlled by
Medication)
Does not go to school because of
stereotypes about disease

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Vitiligo
Facial disfigurement
None
No participation in social relations owing to
fear of contagion

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Cited References
International Classification of Functioning, Disability and
Health: ICF. World Health Organization 2001.

Towards a Common Language for Functioning, Disability
and Health: ICF The International Classification of
Functioning, Disability and Health. World Health
Organization 2002.

http://www.who.int/classifications/en/

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Exercise #1
( International Classification of Function & Disability)
Dr. Ahmed- Refat 25/12/2012
Your Name
HEALTH
CONDITION
IMPAIRMENT ACTIVITY
LIMITATION
PARTICIPATION
RESTRICTION

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