MOT2212T: THEORETICAL CONCEPTS OF TREATMENT

APPROACHES AND MODELS IN OCCUPATIONAL THERAPY

Presentation Topic
• Discuss contemporary OT practice in relevance to WHO classi cation:
ICF, ICD, ICH
• Relate the connections among ICF - OT practice framework

Prepared by
Alent Cheria Varghese
MOT 1st year
SRMCOT

Guided by
Mr. Anbarasu
Associate Professor
SRMCOT
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 Learning Objectives

1. Basic idea of;

a. Occupational therapy : De nition and Process
b. Language in Occupational therapy: De nition and Importance
c. World Health Organization International Classi cations
- ICD
- ICHI
- ICF
2. Contemporary OT practice in relevance to WHO classi cation

3. Connections among ICF - OT practice framework

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Occupational Therapy: De nition
• Occupational therapy is a client-centered health profession concerned with
promoting health and well-being through occupation.
• The profession’s primary goal is to help people do the day-to-day activities that
are important and meaningful to them and those in their lives
• Occupational therapy uses a variety of interventions designed to prevent
performance problems, promote healthy participation, and reduce the impact of
impairment and disability on daily life

Occupational Therapy Process

• By understanding occupation and carefully analyzing many factors associated
with occupation, practitioners use this knowledge to turn occupation into
therapy.
• Occupational therapists must attend to the person or groups doing the occupation,
the characteristics of the occupation itself, and the physical and social context in
which the occupation occurs.
• Therapists also appreciate how various occupations interweave and how each
support or detract from the other.
• Therefore, the evaluation process involves careful attention to what the person
(or group) wants or needs to do and how both person factors and contextual
factors are affecting actual performance.
• Intervention then involves very carefully selecting those factors that most affect
performance and figuring out ways to tip the balance toward performance.
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Language for Occupational Therapy
Clinical professionals practise in various settings and form interdisciplinary teams
that communicate using the same terminology, standardised classifications and
assessments to address and improve a person's functioning.
• As in any profession, OT uses terminology that has evolved to reflect the specific
concerns of the profession.
• As much of health care is provided in concert with other disciplines, resources
described below play an important role in inter-professional communications by
providing a common language.

These are resources were developed by World Health Organization (WHO)

WHO Family of International Classifications

• The WHO provides several resources for scientists and health care professionals
throughout the world.

• WHO Family of International Classifications is comprised of three core

classifications which are:

- ICD : International Classification of Diseases

- ICHI : International Classification of Health Interventions
- ICF : International Classification of Functioning, Disability and Health

• These classifications go some way to allow standardised assessment, treatment

and management across the world. This is important for a number of clear and
obvious reasons.
I. ICD : International Classification of Diseases
• International Classification of Diseases provides a standard classification of
diseases and health problems
• It gives occupational therapists the freedom to select diagnostic codes that
include a high level of detail about their patient’s condition.
• It provides a common language for healthcare professionals to communicate
about diagnosis. While occupational therapists do not typically diagnose
medical conditions, they collaborate with other healthcare providers and use
the ICD coding system to ensure accurate communication about clients' health
conditions.
• This resource is most commonly seen when used in medical records and on
billing sheets where the diagnosis is listed

Why are ICD codes important for therapy?

• Therapists including physical, speech, and occupational therapists, use ICD
codes to document detailed descriptions of the diseases, health issues, and
complications affecting their patients.
• These practitioners also report ICD codes for treatment, for patient billing and
reimbursement.

• Commonly-Used OT ICD-10 Codes

• R63.3 — Feeding dif culties
• G54.0 – Brachial Plexus disorders
• R62.0 — Delayed milestones in childhood
• M62.81 — Muscle weakness (generalised)
• F81.9 — Developmental disorder of scholastic skills, unspeci ed
• G82.20 — Paraplegia unspeci ed
• R27.0 — Ataxia, unspeci ed
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II. ICHI : International Classification of Health Interventions

• ICHI is a common tool for reporting and analysing health interventions for
clinical and statistical purposes.
• It aims to provide a standardized way to document and communicate the
interventions provided in healthcare settings.
• ICHI covers interventions carried out by a broad range of providers across the
full scope of health systems and includes interventions on: diagnostic, medical,
surgical, mental health, primary care, allied health, functioning support,
rehabilitation, traditional medicine and public health.
• The classification is built around three axes:
I. Target (the entity on which the Action is carried out),
II. Action (a deed done by an actor to a target) and
III. Means (the processes and methods by which the Action is carried out).

• Example:
For ‘Assessment of cleaning living area’ assign: SOD.PH.ZZ
Where: SOD.PH.ZZ is ‘Assessment of doing housework’

III. ICF : International Classification of Functioning, Disability and Health

After the ICD, WHO recognised that the classification of diseases was just not
adequate to reflect the concerns of people with disabilities. After extensive
development, the International Classi cation of Functioning, Disability and
Health (ICF) was developed.

• The ICF provides an organizing framework in which factors related to persons,

their performance, and their performance contexts are clustered.
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• ICF helps to establish a common language for describing health and health-
related states in order to improve communication between different users, such
as health care workers, researchers, policy-makers and the public, including
people with disabilities.

• ICF gives standard operational definitions of the health and health-related

domains as opposed to “vernacular” definitions of health

In the most basic sense, health occurs when the person is able to participate in
activities due to a good “match” between the health status and the context in
which the activities occur.
At the person level, individuals have body structures (such as bones and nerves)
and body functions (such as muscle endurance or the ability to see).
At the whole person level, individuals have the capacity to do activities (ride a
bike, make dinner).
At Contextual level, their actual participation is affected by physical and social
aspects of the performance context (safe space to ride the bike, family member’s
praise for the meal), and thus, “Actual participation is a function of both
personal capacity and the contextual support”

• This WHO document

(ICF), thus provides
language that
occupational therapists
can use to explain their
services to a broad
audience.
Applying the three WHO-FIC classi cations together:

• ICD can be used to record the person’s health conditions.

• ICHI can be used to describe investigative intervention(s)

• ICF can be used to describe the person’s functioning (body functions, body
structures, activities and participation domains and environmental factors)
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Contemporary OT practice in relevance to WHO classi cation
Contemporary occupational therapy practice is relevant to the ICF, ICD, and ICHI
in several ways.

• The ICF classi cation of health and disability in terms of body functions and
structures, activities and participation, and environmental factors.

Occupational therapists use the ICF to understand the impact of a health

condition or injury on an individual's ability to participate in occupations.

• The ICD is a classi cation of diseases and health conditions.

Occupational therapists use the ICD to identify the underlying health condition
that is causing an individual's disability.

• The ICHI is a classi cation of interventions used in occupational therapy.

Occupational therapists use the ICHI to select interventions that are
appropriate for the individual's needs and goals.

By using these classi cations together, occupational therapists can provide

comprehensive and individualized care that is tailored to the speci c needs of each
client.
Example

An occupational therapist working with a child who has cerebral palsy might use
the
- ICF to identify the child's limitations in body functions and structures, such as
muscle weakness and spasticity.
- ICD to identify the underlying health condition, which is cerebral palsy.
- ICHI to select interventions that are appropriate for the child's needs, such as
providing adaptive equipment and teaching the child how to use it.
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An occupational therapist working with an older adult who has had a stroke might
use the
- ICF to identify the adult's limitations in activities and participation, such as
bathing and dressing.
- ICD to identify the underlying health condition, which is stroke.
- ICHI to select interventions that are appropriate for the adult's needs, such as
providing home modi cations and transportation assistance.

The use of these classi cations in occupational therapy practice is essential to

providing high-quality, evidence-based care.
By understanding the individual's health condition, disability, and needs,
occupational therapists can select interventions that are most likely to be effective.

In addition to the ICF, ICD, and ICHI, occupational therapists also use other
classi cations, such as the Occupational Therapy Practice Framework (OTPF) and
the Canadian Occupational Performance Measure (COPM). The OTPF provides a
framework for describing the occupational therapy profession and its processes,
while the COPM is a self-report measure that can be used to assess an individual's
occupational performance and satisfaction
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 Connections among ICF and OTPF
The International Classi cation of Functioning, Disability and Health (ICF) is a
framework that describes health and disability in terms of body functions and
structures, activities and participation, and environmental factors.

The Occupational Therapy Practice Framework (OTPF) is a framework that

describes the occupational therapy profession and its domains of practice.

How ICF in uenced development of OTPF?

OTPF was established by occupational therapists as the ICF framework only

focused on impairment of the person and not included the speci c area of
occupation as well as how the intervention can be done in the therapy sessions.
Therefore, the OTPF acts as the reference and is being used by all the occupational
therapy practitioners all over the globe.

How are both related?

The ICF and OTPF are closely related.

• The ICF provides a common language for understanding and describing health
and disability, which can be helpful for occupational therapists in assessing and
planning interventions.

• The OTPF can be used to guide occupational therapists in using the ICF to
understand the impact of health conditions on people's ability to participate in
occupations.
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 The following are some of the speci c connections between the ICF and OTPF:
• The ICF's Body Functions and Structures domain is related to the OTPF's Client
Factors domain, which includes physical, psychological, and cognitive factors
that affect occupational performance.
• The ICF's Activities and Participation domain is related to the OTPF's
Performance Skills and Performance Patterns domains, which describe the
individual's ability to perform occupations.
• The ICF's Environmental Factors domain is related to the OTPF's Context
domain, which includes the physical, social, and cultural factors that affect
occupational performance.

A common focus

In addition to these speci c connections mentioned above, both ICF and OTPF
share a common focus i.e. “Individual’s ability to participate in occupations”

Both frameworks recognize that health and disability are not static, but rather are
in uenced by a variety of factors, including the individual's physical and mental
health, their environment, and their personal resources.

How can we use both together?

The ICF and OTPF can be used together to provide a comprehensive assessment of
the individual's needs and to plan interventions that will help them to improve their
participation in occupations.

Here is one example on how the ICF and OTPF can be used together:
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• An occupational therapist might use the understanding of ICF to assess a client's
ability to walk after a stroke. The therapist would look at the client's body
functions and structures (e.g., strength, range of motion), their activities and
participation (e.g., ability to walk short distances, ability to climb stairs), and the
environmental factors that might affect their ability to walk (e.g., the availability
of ramps and railings).

• The therapist would then use the OTPF to develop interventions that would help
the client to improve their ability to walk. These interventions might include
exercises to improve the client's strength and range of motion, training in how to
use a walker or cane, and environmental modi cations such as installing ramps
and railings.

Conclusion

• The ICF, ICD, ICHI and OTPF provides a common language for documentation
and communication of various factors related to the client

• These are valuable tools that can be used by occupational therapists to assess and
plan interventions for people with a variety of health conditions.

• By using these frameworks together, occupational therapists can provide

comprehensive and individualized care that helps people to improve their
participation in occupations and live their lives to the fullest.
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 References

1. Willard and Spacksman's Occupational Therapy , 13th edition

2. Willard and Spacksman's Occupational Therapy, 12th Edition

3. International Classi cation of Functioning, Disability and Health (ICF). WHO 2001

4. International Classi cation of diseases for mortality and morbidity statistics (ICD).WHO 2022

5. ICHI - International Classi cation of Health Interventions. WHO

6. Occupational Therapy Practice Framework: Domain and Process (3rd ed.). American Journal

of Occupational Therapy. AOTA 2022

7. Haglund L, Henriksson C. Concepts in occupational therapy in relation to the ICF. Occup Ther

Int. 2003;10(4):253-68. doi: 10.1002/oti.189. PMID: 14647539.

8. Cozzi, Silvia & Martinuzzi, Andrea & Della Mea, Vincenzo. (2021). Ontological modeling of
the International Classi cation of Functioning, Disabilities and Health (ICF):
Activities&Participation and Environmental Factors components. BMC Medical Informatics
and Decision Making. 21. 10.1186/s12911-021-01729-x.
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