Applying the International Classification

of Functioning, Disability and Health

(ICF) to Clinical Practice and Research
in Acquired Brain Impairment
Robyn L. Tate1,2 and Michael Perdices3
1 Rehabilitation Studies Unit, Northern Clinical School, Faculty of Medicine, University of Sydney, Australia
2 Royal Rehabilitation Centre Sydney, Australia
3 Department of Neurology, Royal North Shore Hospital, Sydney, Australia

he International Classification of Functioning, Disability and Health (ICF) is a

T taxonomy that classifies health states and health conditions. It is a complex
and detailed taxonomy, with 1,424 categories, covering body structures and func-
tions, activities and participation, and environmental factors. The complexity and
detail, however, can serve as a barrier in its everyday application. A number of
strategies have been developed to facilitate use of the ICF in clinical and research
practice, including the development of ‘core sets’. In this article, we present
another method which will assist both the newcomer and those more familiar with
the ICF. Along with a description of the ICF structure and contents, the article pre-
sents a graphical representation of ‘ICF trees’ as a vehicle to more readily grasp
the detail of the ICF structure and contents and facilitate its use in the area of
acquired brain impairment.

Keywords: ICF, classification, brain injuries, rehabilitation

Background Bruyère, Van Looy, & Peterson, 2005; Cieza et al.,

The International Classification of Functioning,
Disability and Health (ICF; WHO, 2001) aims ‘to
provide a unified and standard language and
framework for the description of health and
health-related states’ (p. 3). It addresses function-
ing from a ‘whole-of-person’ perspective and is a
taxonomy in which the person can be described in
terms of body system, functional activity, social
role and participation, and environmental milieu.
The ICF is thus a biopsychosocial model of func-
tioning in its continuum, encompassing both
health and health conditions.
Stineman, Lollar and Üstün (2005) report that
the ICF has been accepted by 191 counties, and ‘is
fast becoming the world standard for describing
health and disabilities’ (p.1109). A rapidly
expanding literature is available on the ICF1
(Australian Institute of Health and Welfare, 2003;
2002; de Kleijn-deVrankrijker, 2003; Reed et al.
2005; Stucki & Melvin, 2007; Üstün, Chatterji,
Bickenbach, Kostanjsek, & Schneider, 2003;
Wade, 2005), including critical reviews of its
strengths and weaknesses (Wade & Halligan,
2003). In addition to its use for research, auditing,
social policy and education, the ICF manual
(WHO, 2001) enumerates its potential application
in clinical practice: for vocational and needs
assessment, matching treatments with specific
conditions, rehabilitation and outcome evaluation.
To the newcomer, however, the ICF can be a
taxonomy of overwhelming detail and complexity.
It adopts a nested structure, containing 2 Parts, 4
Components, 30 Domains, and 362 second-level
Categories (which can be further subdivided to a
total of 1,424 Categories at the fourth level of sub-
division). Previous papers describing the ICF have

Address for correspondence: Robyn Tate, Associate Professor, Rehabilitation Studies Unit, PO Box 6, Ryde NSW 1680,
Australia. E-mail: rtate@med.usyd.edu.au

BRAIN IMPAIRMENT
282 VOLUME 9 NUMBER 3 DECEMBER 2008 pp. 282–292

provided general overviews of the ICF structure,
but to date there has been no report that has
bridged the gap between general description of the
ICF and the minutae of the 1,424 ICF categories.
The present article aims to meet the need for an
intermediate level of detail. A graphical represen-
tation of the ICF (‘ICF trees’) is presented as a
vehicle to more readily grasp the detail of the ICF
structure and contents and facilitate its use in the
area of acquired brain impairment.
Structure of the ICF
Parts and Components
The structure of the ICF is described in the manual
as being hierarchical and nested in a stem–branch–
leaf arrangement. The ICF is divided into two parts:
(1) Functioning and Disability, and (2) Contextual
Factors. These parts are further subdivided into
components. Functioning and Disability contains
two components: Body Systems (Function and
Structure) and Activities/Participation. Contextual
Factors also contains two components (Environ-
mental and Personal). These components are
defined as follows (WHO, 2001, p. 10):
• Body functions: Physiological functions of
body systems (including psychological func-
tions)
• Body structure: Anatomical parts of the body,
such as organs, limbs and their components
• Activity: The execution of a task or action by
an individual
• Participation: Involvement in a life situation
• Environmental factors: Physical, social and
attitudinal environments in which people live
and conduct their lives
• Personal factors: ‘The particular background
of an individual’s life and living, and comprise
features of the individual that are not part of a
health condition or health state’ (p.17).
The ubiquitous figure describing the ICF is pre-
sented below. It is intended to illustrate the inter-
action among the components. For example,
Environmental Factors (e.g., distracting stimuli or
ground texture) can interact with Body Functions
(attention or balance respectively).
The ICF thus contrasts with its original ver-
sion, the International Classification of Impair-
ments, Disabilities and Handicaps (ICIDH; WHO,
1980), which was predominantly a medical model
of diseases and disabilities. Yet, the ICF repre-
sents more than an update of the ICIDH. In addi-
tion to the shift of the conceptual model
THE ICF IN ACQUIRED BRAIN IMPAIRMENT
underpinning the taxonomy (including the intro-
duction of Contextual Factors), two major differ-
ences from the ICIDH comprise (1) the use of
neutral language, and (2) the combining of
Disabilities and Handicaps into a single compo-
nent (Activities/Participation).
In terms of nomenclature, the ICF adopts neu-
tral language, in contrast to the ICIDH in which
only the negative experience was described. Thus,
Body Function replaces Impairments, Activities
replaces Disabilities, Participation replaces Handi-
caps. Moreover, the ICF allows both ends of the
health continuum to be described. The positive
poles are as labeled above (Body Function,
Activities, Participation); the negative corollaries
are Impairments, Activity Limitations, Participa-
tion Restrictions respectively. Similarly, Contextual
Factors can be described from both positive and
negative perspectives, by use of the terms ‘facilita-
tors’ and ‘barriers/hindrances’ respectively.
Domains and Categories
It is at the domain and category levels that clini-
cians and researchers need to have a good working
knowledge of the ICF. Domains are described as
the first level of classification, whereas categories,
which represent the most detailed level of the ICF
taxonomy, have second, third, and/or a fourth level
of classification (NB: there is some variability in
the degree of detail and not all domains have a
fourth-level category classification).
The component, Body, has eight domains for
each of Body Functions and Body Structures,
which are organized according to the body system
(e.g., nervous system, cardiovascular system).
Each domain of Function corresponds to one of
Structure (e.g., respectively, Mental Functions
versus Structures of the Nervous System; Neuro-
muscular and Movement-related Functions versus
Structures related to Movement etc.). The compo-
nent Activities/Participation contains a single set
of nine domains, addressing both individual and
social aspects of functioning (e.g., mobility, inter-
personal interactions and relationships).
Within the Contextual Factors part of the ICF,
the Environmental Factors component contains
five domains, referring to physical, social and atti-
tudinal environments. The second component,
Personal Factors, is not yet classified within the
ICF ‘because of the large social and cultural vari-
ance associated with them’ (WHO, 2001, p.8) and
is designated as an area of future development of
the ICF. Figure 2 presents a graphical representa-
tion of the ‘ICF tree’, which depicts the structure
of the parts, components and domains of the ICF.
283
 ROBYN L. TATE AND MICHAEL PERDICES
Health Condition
(disorder or disease)
Body Function
and Structure
Environmental Factors
FIGURE 1
Overview of the International Classification of Functioning, Disability and Health
In comparing Figures 1 and 2, it will be appar-
ent that there is some discrepancy. Figure 1 sug-
gests that there is a demarcation between
Activities/Participation. In the ICIDH such a
demarcation did occur between the predecessors
of Activities and Participation (viz. Disabilities
and Handicaps respectively), but in the main text
the ICF presents the Activities/Participation com-
ponent as a single listing of nine domains, as
depicted in Figure 2. In an annex to the manual,
the ICF does suggest four separate ways in which
Activities and Participation can be differentiated,
which ‘if users so wish [they can apply] in their
own operational ways’ (WHO, 2001, p. 16):
• Option 1: The domains are considered distinct
with no overlap; the first four domains
(Learning and applying knowledge; General
tasks and demands; Communication; Mobility)
classified as Activities and the second five
domains (Self-care; Domestic life; Inter-
personal interactions; Major life areas;
Community, social and civic life) classified as
Participation.
• Option 2: There is partial overlap with some
domains. The first two domains are consid-
ered exclusively Activities, and the last three
284
Activities Participation
Personal Factors
domains exclusively Participation. The middle
four domains (Communication; Mobility;
Self-care; Domestic life) are considered ‘to be
open to an individual (i.e., as a task or action
that an individual does) and a societal (i.e.,
involvement in a life situation) interpretation’
(WHO, 2001, p.235) and hence are considered
both Activities and Participation.
• Option 3: Within each domain, the more
detailed categories (third and fourth-level cat-
egories; e.g., starting a conversation, prepar-
ing simple meals) are considered Activities
and the broad level of classification (first
[domain] or second-level category; e.g., com-
munication, domestic life) are considered
Participation.
• Option 4: Total overlap, with each domain
interpreted as having both Activity (‘individ-
ual functioning’) and Participation (‘societal
functioning’) aspects.
This recommendation suggesting that the
Activities/Participation domains can be parti-
tioned in (four) various ways has served to create
confusion among users. Some authors suggest that
the Activities/Participation component should be
retained as a single set of domains; others have
 THE ICF IN ACQUIRED BRAIN IMPAIRMENT

PART COMPONENT DOMAIN

ST
1 LEVEL

Mental Functions
FUNCTION & Body
Function Sensory & pain
DISABILITY
Voice & speech
Functions of the cardiovascular,
haematological, immunological
& respiratory systems

Functions of the digestive,

metabolic & endocrine systems

Genitourinary & reproductive

functions

Neuromusculoskeletal &
movement-related functions
Functions of the skin & related
structures

Structures of the nervous system

Body
Eye, ear & related structures
Structure
Structures involve in voice &
speech
Structures of the cardiovascular,
immunological & respiratory
systems

Structures related to the

digestive, metabolic & endocrine
systems

Structures related to the

genitourinary & reproductive
systems

Structures related to movement

Skin & related structures

Learning & applying knowledge

Activities / General tasks & demands
Participation
Communication
Mobility
Self-care
Domestic life
Interpersonal interactions &
relationships
Major life areas
Community, social & civic life

Products & technology

CONTEXTUAL Environmental Natural environmental & human-
FACTORS Factors made changes to environment
Support & relationships
Attitudes
Services, systems & policies
Personal
Not yet classified
Factors

FIGURE 2
Parts, Components and Domains of the International Classification of the Functioning, Disability and Health

285
 ROBYN L. TATE AND MICHAEL PERDICES

provided empirical support regarding the underly-
ing structure differentiating Activities and
Participation. Jette, Haley and Kooyoomjian
(2003), for example, collected data from 150 older
people on the Late Life Function and Disability
Instrument, which contains items similar to those
found in three domains of the Activities/
Participation component. Using principal compo-
nents analysis, three components were extracted:
mobility activities, daily activities and social/
participation. Further study of this fundamental
issue is obviously required.
The ICF manual also advises that for surveys
and health outcome evaluation classification at the
second-level category is appropriate, but for spe-
cialist services, such as rehabilitation, geriatrics
and mental health, classification should be con-
ducted at the more detailed fourth-level category.
The ICF manual provides a listing of the 1,424
fourth-level categories over approximately 200
pages. This also encompasses inclusion and
exclusion criteria.
Additionally, each of the ICF categories is
assigned a code, using alphanumeric notation:
commencing with ‘b’ for body functions, ‘s’ for
structure, ‘d’ for domain (referring to domains of
the Activities/Participation component, which
alternatively can be referred to as ‘a’ and ‘p’
respectively if the user so desires) and ‘e’ for envi-
ronment. The first digit represents the domain
number, the next two digits represent the (second-
level) category number. Two additional digits are
applied for category subdivision at the third and
fourth levels. Figure 3 presents category codes to
the second-level category subdivision for compo-
nents and domains of Body Function and
Activities/Participation that are of most relevance
to the area of acquired brain impairment. The cat-
egory codes are fully enumerated in the 2001
WHO publication.
As is apparent from Figure 3, located between
Domains and Categories are Blocks. According
to the ICF, Blocks are ‘provided as a convenience
to the user and, strictly speaking, are not part of
the structure of the classification and normally
will not be used for coding purposes’ (WHO,
2001, p. 220).
In addition to category codes, the ICF uses
qualifiers, without which ‘the codes have no
inherent meaning’ (WHO, 2001, p. 222). The
qualifiers are numeric descriptors which appear
following a point after the code, and there can be
more than one qualifier. As shown in Table 1, the
first qualifier is generic, referring to the extent of
the problem (viz. degree of severity). Second and
third qualifiers can be used for body structures to
designate the nature of the impairment (e.g., par-
tial absence) and location of impairment (e.g., left
side) respectively. Two qualifiers are used for
Activity Limitation and Participation Restriction,
which refer to the environments in which the mea-
surements occur. The first qualifier refers to per-
formance (i.e., what a person actually does in the
current or usual environment, including perfor-
mance with the use of assistive devices or per-
sonal help); the second capacity qualifier is rated
‘without assistance in order to describe the indi-
vidual’s true ability which is not enhanced by an
assistive device or personal assistance’ (WHO,
2001, p. 230). Both of these qualifiers use the
generic listing. Environmental Factors also uses
the same set of generic qualifiers to describe the

TABLE 1
Qualifiers for ICF codes

First (generic) qualifier Second qualifier Third qualifier

(nature) for body (location) for body
Code Percentage structure structure
.0 — no problems 0–4 0 —
no change 0 — more than one region
.1 — mild problem 5–24 1 —
total absence 1 — right
.2 — moderate problem 25–49 2 —
partial absence 2 — left
.3 — severe problem 50–95 3 —
additional part 3 — both sides
.4 — complete problem 96–100 4 —
aberrant dimensions 4 — front
.8 — not specified 5 —
discontinuity 5 — back
.9 — not applicable 6 —
deviating position 6 — proximal
7 —
qualitative changes 7 — distal
in structure, including
accumulation of fluid
8 — not specified 8 — not specified
9 — not applicable 9 — not applicable

286
 THE ICF IN ACQUIRED BRAIN IMPAIRMENT

COMPONENT DOMAIN
ST
BLOCK CATEGORY
ND
1 LEVEL 2 LEVEL

Global Mental Consciousness functions (b110)

Body Function Mental Functions Functions Orientation functions (b114)
Intellectual functions (b117)
Global psychosocial functions (b122)
Temperament & personality (b126)
Energy & drive functions (b130)
Sleep functions (b134)
Other (b139)

Specific Mental Attention functions (b140)

Functions Memory functions (b144)
Psychomotor functions (b147)
Emotional functions (b152)
Perceptual functions (b156)
Thought functions (b160)
Higher level cognitive functions (b164)
Language functions (b167)
Calculation functions (b172)
Sequencing complex movement (b176)
Self & time functions (b180)
Other (b189)(b198)(b199)

Seeing and Seeing (b210)

Sensory & Pain related Structures adjoining eye (b215)
Sensation associated with the eye &
adjoining structures (b220)
Other (b229)

Hearing and Hearing (b230)

vestibular Vestibular (b235)
Sensations associated with hearing
& vestibular (b240)
Other (b249)

Additional Taste (b250)

sensory Smell (b255)
Proprioception (b260)
Touch (b265)
Sensory functions related to
temperature and other stimuli (b270)
Other (b299)

Pain Sensation of pain (b280)

Other (b289) (b298) (b299)

Voice (b310)
Voice & Speech Articulation (b320)
Fluency & rhythm (b330)
Alternative vocalisation (b340)
Other (b398) (b399)

Functions Of Functions related Ingestive functions (b510)

Digestive Metabolism to the digestive Digestive functions (b515)
& Endocrine System system Assimilation functions (b520)
Defecation functions (b525)
Weight & maintenance functions (b530)
Functions related Sensations associated with the
to metabolism & digestive system (b535)
the endocrine Others (b539)
system

Stability of joint functions (b715)

Musculoskeletal Joints &
Mobility of joint functions (b710)
& Movement bones
Mobility of bone functions (b720)
Other (b729)

Power (b730)
Muscle Tone (b735)
Endurance (b740)
Other (b749)

Motor reflex (b750)

Movement Involuntary movement reaction
functions (b755)
Control of voluntary movement (b760)
Involuntary movement functions (b765)
Gait pattern functions (b770)
Sensations related to muscle &
movement functions (b780)
Other (b789) (b798) (b799)

FIGURE 3
Listing of ICF categories and codes in sections pertinent to acquired brain impairment.

287
 ROBYN L. TATE AND MICHAEL PERDICES

COMPONENT DOMAIN
ST
BLOCK CATEGORY
ND
1 LEVEL 2 LEVEL

Watching (d110)
Activities & Learning & Purposeful
Applying sensory Listening (d115)
Participation experience
Knowledge Other (d120)(d129)

Copying (d130)
Basic Rehearsing (d135)
learning
Learning to read (d140)
Learning to write (d145)
Learning to calculate (d150)
Acquiring skills (d155)
Other (d159)

Focusing attention (d160)

Applying
knowledge Thinking (d163)
Reading (d166)
Writing (d170)
Calculating (d172)
Solving problems (d175)
Making decisions (d177)
Other (d179)(d198)(d199)

Undertaking a single task (d210)

General Tasks &
Undertaking multiple tasks (d220)
Demands
Carrying out daily routine (d230)
Handling stress & other psychological
demands (d240)
Other (d298)(d299)

Receiving spoken messages (d310)

Communication Communication Receiving non-verbal messages (d315)
Receiving
Receiving formal sign language
messages (d320)
Receiving written messages (d325)
Other (d329)

Speaking (d330)
Communication Producing nonverbal messages (d335)
Producing
Producing messages in formal sign
language (d340)
Writing messages (d345)
Other (d349)

Conversation (d350)
Use of devices Discussion (d355)
& techniques
Using devices & techniques (d360)
Other (d369)(d398)(d399)

FIGURE 3 (continued)
Listing of ICF categories and codes in sections pertinent to acquired brain impairment.

288
 THE ICF IN ACQUIRED BRAIN IMPAIRMENT

Changing basic body position (d410)

Changing &
Activities & Mobility maintaining Maintaining a body position (d415)
Participation body position
Transferring oneself (d420)
Other (d429)

Lifting & carrying objects (d430)

Carrying, moving
Moving objects with lower extremities
and handling
(d435)
objects
Fine hand use (d440)
Hand & arm use (d445)
Other (d449)

Walking (d450)
Walking & Moving around (d455)
moving
Moving around in different locations
(d460)
Moving around using equipment (d465)
Other (d469)

Using transportation (d470)

Moving around
using Driving (d475)
transportation
Riding animals for transportation (d480)
Other (d489)(d498)(d499)

Washing one self (d510)

Self-care Caring for body parts (d520)
Toileting (d530)
Dressing (d540)
Eating (d550)
Drinking (d560)
Looking after one’s health (d570)
Other (d598)(d599)

Acquiring a place to live (d610)

Domestic Life Acquisition of Acquisition of goods & services (d620)
necessities
Other (d629)

Preparing meals (d630)

Household Doing housework (d640)
tasks
Other (d649)

Caring for household objects (d650)

Caring for
household objects Assisting others (d660)
& assisting others
Caring for household objects &
assisting others, other specified (d669)
Other (d698)(d699)

FIGURE 3 (continued)
Listing of ICF categories and codes in sections pertinent to acquired brain impairment.

289
 ROBYN L. TATE AND MICHAEL PERDICES

Basic interpersonal interactions (d710)

Interpersonal General
Activities & interpersonal
Complex interpersonal interactions
Interactions & (d720)
Participation interactions
Relationships
Other (d729)

Relating with strangers (d730)

Particular
interpersonal Formal relationships (d740)
relationships
Informal social relationships (d750)

Family relationships (d760)

Intimate relationships (d770)
Particular interpersonal relationships,
other (d779)

Interpersonal interactions and

relationships, other (d798)(d799)

Informal education (d810)

Major Life Areas Education Preschool education (d815)
School education (d820)

Vocational training (d825)

Higher education (d830)

Other (d839)

Apprenticeship (work preparation)

(d840)

Work and Acquiring, keeping and terminating a

employment job (d845)

Remunerative employment (d850)

Non-remunerative employment (d855)

Other (d859)

Basic economic transactions (d860)

Economic life Complex economic transactions (d865)
Economic self-sufficiency (d870)
Economic life, other (d879)

Major life areas, other (d898)(d899)

Community life (d910)

Community,
Social & Civic Recreation and leisure (d920)
Life Religion and spirituality (d930)
Human rights (d940)

Political life and citizenship (d950)

Community, social and civic life, other

(d998) (d999)

FIGURE 3 (continued)
Listing of ICF categories and codes in sections pertinent to acquired brain impairment.

290

extent of the barriers; facilitators use the same set
of codes with a + sign preceding the qualifier.
Applying the ICF in Clinical Practice
and Research
Use of the ICF in clinical practice allows precise
description of patient status and characteristics,
which allows comparison among different services
and centres, both local and worldwide. To illus-
trate, a hypothetical patient, John, with traumatic
brain injury, returned to the community brain
injury clinic for follow-up. In spite of his overall
good recovery, investigations revealed selected
areas of dysfunction. Computerised tomography
scan showed atrophy in the frontal lobes
(s11000.223). The lesions were moderately exten-
sive (cf. first qualifier), caused partial absence in
brain structure (cf. second qualifier), and were
bilateral (cf. third qualifier). As a consequence,
John experiences mild difficulties with impulse
control (b1304.1) and has a mild hemiparesis
(b7302.1). His most pronounced area of difficulty
is a moderate impairment of planning and organi-
sation ability (b1641.2). In everyday terms, John
shows some disruption of informal relationships
with friends (d7500.1), but he gets along well with
his family (d760.0). He successfully returned to his
work as a grain and stock salesman (d8451.03),
and avoids organisational difficulties by keeping a
diary of his clients and their orders (cf. first per-
formance qualifier), although without his notebook
he frequently makes mistakes (cf. second capacity
qualifier). John experiences mild difficulty walk-
ing over uneven ground (d4502.12), even with the
use of a walking stick (cf. first performance quali-
fier), without which he has moderate difficulty (cf.
second capacity qualifier). Although his hemipare-
sis does not cause any physical access problems in
his home (e1550.0), it is a mild barrier in the com-
munity (e1500.-1). His immediate family is very
supportive (e310.+3), but he lives in a remote rural
location, which restricts his ability to access health
services (e5800.-2).
As will be evident from the foregoing exam-
ple, the codes alone are sufficient to describe this
patient’s status. Stineman et al. (2005) also pro-
vide a worked example of the application of the
ICF and their codes in clinical practice.
Considerable work has been conducted in
developing so-called ICF ‘core sets’, which
comprise a selected number of codes that are
adequate to describe specific health conditions.
A detailed methodology is undertaken to identify
the codes relevant to different health conditions
(see Supplement 44, Journal of Rehabilitation
THE ICF IN ACQUIRED BRAIN IMPAIRMENT
Medicine, 2004). Core sets have been published
for patients with neurological conditions in the
acute stages of recovery (Ewert et al., 2005) and
post-acute rehabilitation facilities (Stier-Jarmer
et al., 2005). Development of core sets for trau-
matic brain injury is currently in progress. Core
sets for stroke were published in 2004 (Geyh et
al., 2004), comprising 41 categories from the
Body Functions component, 5 from Body
Structures, 51 categories from the Activities/
Participation component, and 33 from Environ-
mental Factors. Thus, taken together, these 130
second-level categories provide a comprehensive
listing of ICF categories pertinent to stroke and
represent a considerable savings from the com-
plete listing of categories. A ‘Brief ICF Core Set’
for stroke reduced the number of categories even
further to 18 (6 Body Functions, 2 Body Struc-
tures, 7 Activities/Participation, and 3 Environ-
mental Factors).
In theory, use of the ICF extends to an analy-
sis of the instruments clinicians and researchers
use to document functioning. As yet, limited
research literature is available in this arena, and
Tate (in press) describes difficulties that are
encountered in mapping instruments used in the
area of acquired brain impairment to the ICF.
There will always be difficulty in mapping instru-
ments that were developed prior to introduction of
the ICF in 2001. For example, in their comparative
review, Perenboom and Chorus (2003) identified
only two instruments that exclusively addressed the
Participation construct of the ICF. It is expected
that newly developed instruments that use the ICF
as their conceptual structure, such as the World
Health Organization — Disability Assessment
Schedule 2 (WHODAS II; http://www.who.int),
will provide conceptually based procedures to
assess functioning after acquired brain impairment
and other health conditions.
In conclusion, the ICF has singular advan-
tages. It draws upon a comprehensive biopsy-
chosocial model of functioning and health and it is
universally endorsed. Additionally, it has many
potential applications. It is therefore surprising
that there is so little evidence that the ICF is in
widespread use in an integrated and informed way
in the area of acquired brain impairment for either
research or clinical practice. We suggest that part
of the difficulty may be the inherent detail in the
ICF codes, making the ICF overwhelming and
inaccessible. It is anticipated that strategies to
streamline the ICF without jeopardising its com-
plexity, such as the use of the ‘ICF trees’
described in this paper and core sets, will serve to
facilitate use of the ICF.
291
 ROBYN L. TATE AND MICHAEL PERDICES
Endnote
1 For more information on the ICF see Larkins,
Worrall and Hickson, this issue.
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