International Classification of

Functioning, Disability, and

Health
Solomon Fasika MPT
Lecturer
Physiotherapy department
University of Gondar

April 24, 2024 1

Presentation Overview
What is disability?

Introduction to the ICF

How can the ICF inform disability measurement?

April 24, 2024 2

 Functioning
is an umbrella term for body function, body structures,
activities and participation.

It denotes the positive or neutral aspects of the interaction

between a person’s health condition(s) and that individual’s
contextual factors (environmental and personal factors).

Disability
is an umbrella term for impairments, activity limitations and
participation restrictions.

It denotes the negative aspects of the interaction between a

person’s health condition(s) and that individual’s contextual
factors (environmental and personal factors).
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What is disability?
It is a complex, dynamic, multidimensional and
contested issue

It should be viewed neither as purely medical nor as

purely social issues

It is a ‘bio-psycho-social’ issue

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What is the ICF?
A framework for describing the feature of human
functioning

A classification system – not a measurement tool

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Where did the ICF come from?
Developed by the World Health Organization (WHO)
in May 2001

Large international and multidisciplinary

participation

Extensive field testing

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The Aims of the ICF
To provide a scientific basis for the consequences
of health conditions

To establish a common language to improve

communications

To permit comparisons of data across:

 Countries, Health care disciplines, Services and Time

To provide a systematic coding scheme for

health information systems

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ICF Applications
Health sector
Social security
Education sector
Labour sector
Economics & development sector
Legislation & law
Other ….

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Human Functioning
 ICF does not measure disability
It describes people’s functional abilities in
various domains

Health conditions that affect

functional status are not part of
classification system
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ICF components
Body Function and Structures

Activities

Participation

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ICF components
ICF defines functioning and disability as multi-
dimensional concepts, relating to:

The body functions and structures of people

The activities people do and the life areas in which they

participate; and

The factors in their environment that affect these

experiences

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Definitions of components
Body functions are the physiological functions of body
systems (including psychological functions)

Body structures are anatomical parts of the body, such as

organs, limbs and their components

Impairments are problems in body function and structure,

such as significant deviation or loss.

Activity is the execution of a task or action by any

individual

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Definitions of components
Participation is involvement in a life situation.

Activity limitations are difficulties an individual may have

in performing activities.

Participation restrictions are problems an individual may

experience in involvement in life situations.

Environmental factors make up the physical, social and

attitudinal environment in which people live and conduct
their lives
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 Body Functions and Structures Broken into
Eight Chapters
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
April 24, 2024
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
Skin and related structures
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Activities and Participation
Describes individual’s functioning as a whole
person,
 as opposed to function and structure of his/her body
parts

Range from Basic to Complex

basic would be, for example, dressing, eating,
and bathing
complex include work, schooling, civic activities

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 Classification of Activities and
Participation
1 Learning & Applying Knowledge
2 General Tasks and Demands
3 Communication
4 Movement
5 Self Care
6 Domestic Life Areas
7 Interpersonal Interactions
8 Major Life Areas
9 Community, Social & Civic Life

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Environmental Factors
 Products and technology

 Natural environment and human-made

changes to the environment

 Support and relationships

 Attitudes

 Services, systems and policies

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Interaction of Concepts ICF 2001
Health Condition
(disorder/disease)

Body function
Activities Participation
and structure
(Limitation) (Restriction)
(Impairment)

Environmental Personal
Factors Factors

April 24, 2024 18

Example: Polio
May have caused paralysis of legs (Body
Function)

 Affects ability to walk or climb stairs

(Activity)

Hinders ability to attend school or find

employment within the current
environment (Participation)
BUT….
April 24, 2024 19
Example, continued
Mobility related activities, such as getting around
the house or community can be improved with
accessible environment and assistive devices

Participation can be increased with reduced

stigma, accessible environments and flexible job
design

Disability is NOT independent of the

environment, and therefore is not static

April 24, 2024 20

Case
A family in a rural developing country
is ashamed of having a child with
cerebral palsy who is unable to walk,
speak, and is incontinent. The child
has not been out of the house since he
was 3 years old and the family keeps
him hidden from the community. Local
rehabilitation workers are unaware of
the child’s existence
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Group discussion in five groups
1. Discuss the commonly observed factors which affect the
individuals participation, in Ethiopia

2. Discuss the medical aspect of viewing of disability

3. Discuss the social aspect of viewing disability

4. Discuss the possible reason to maximize individual

functionality

5. Discuss whether disability is viewed as either disability is

a yes or no issue or disability is a less or more issue
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Example 1

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Example 2

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