The International Classification of Functioning, Disability and Health: Contemporary Literature Overview

This article reviews the literature from the 3 years since the International Classification of Functioning, Disability and Health\u27s (ICF\u27s) endorsement, focusing on those articles that discuss (a) what the ICF means and how it can be used; (b) the general utility of the ICF for specific fields, such as nursing, occupational therapy, speech-language pathology, and audiology; (c) examples of applications for classification in particular disorders, such as chronic health conditions, neuromusculoskeletal conditions, cognitive disorders, mental disorders, sensory disorders, and primary and secondary conditions in children; (d) uses of the ICF to recode prior work across multiple surveys and across country coding schemes on disability-related national survey items; and (e) governmental uses of the ICF in the United States and selected countries abroad. Future directions needed to effectively implement the ICF across rehabilitation policy, research, and practice are discussed. Our review suggests that the actual application of the ICF is as yet somewhat limited because the World Health Organization (WHO) endorsement is so recent; the earliest references using the ICF correspond with the WHO\u27s 2001 endorsement. Standardized application of the ICF in North America has yet to be realized in anticipation of the release of the clinical implementation manual (see Reed et al., 2005); thus, it is not surprising to find limited research on clinical implementation of the ICF. From our review of the literature and of unpublished reports, it seems clear that the ICF is being used in a preliminary fashion to inform conceptual frameworks in research and for recoding data from other health classifications. Recently completed and ongoing research has undoubtedly not yet been published

Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework

Pediatric feeding disorders (PFDs) lack a universally accepted definition. Feeding disorders require comprehensive assessment and treatment of 4 closely related, complementary domains (medical, psychosocial, and feeding skill-based systems and associated nutritional complications). Previous diagnostic paradigms have, however, typically defined feeding disorders using the lens of a single professional discipline and fail to characterize associated functional limitations that are critical to plan appropriate interventions and improve quality of life. Using the framework of the World Health Organization International Classification of Functioning, Disability, and Health, a unifying diagnostic term is proposed: “Pediatric Feeding Disorder” (PFD), defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. By incorporating associated functional limitations, the proposed diagnostic criteria for PFD should enable practitioners and researchers to better characterize the needs of heterogeneous patient populations, facilitate inclusion of all relevant disciplines in treatment planning, and promote the use of common, precise, terminology necessary to advance clinical practice, research, and health-care policy

Agent-Based Emergency Evacuation Simulation with Individuals with Disabilities in the Population

Catastrophic events have raised numerous issues concerning how effectively the built environment accommodates the evacuation needs of individuals with disabilities. Individuals with disabilities represent a significant, yet often overlooked, portion of the population disproportionately affected in emergency situations. Incorporating disability considerations into emergency evacuation planning, preparation, and other activities is critical. The most widely applied method used to evaluate how effectively the built environment accommodates emergency evacuations is agent-based or microsimulation modeling. However, current evacuation models do not adequately address individuals with disabilities in their simulated populations. This manuscript describes the BUMMPEE model, an agent-based simulation capable of classifying the built environment according to environmental characteristics and simulating a heterogeneous population according to variation in individual criteria. The method allows for simulated behaviors which more aptly represent the diversity and prevalence of disabilities in the population and their interaction with the built environment. Comparison of the results of an evacuation simulated using the BUMMPEE model is comparable to a physical evacuation with a similar population and setting. The results of the comparison indicate that the BUMMPEE model is a reasonable approach for simulating evacuations representing the diversity and prevalence of disability in the populationAgent-Based Simulation, Individual-Based Simulation, Disability, Emergency Egress, Evacuation, Reinforcement Learning

Effects of alteplase for acute stroke on the distribution of functional outcomes: a pooled analysis of 9 trials

Background—Thrombolytic therapy with intravenous alteplase within 4.5 hours of ischemic stroke onset increases the overall likelihood of an excellent outcome (no, or nondisabling, symptoms). Any improvement in functional outcome distribution has value, and herein we provide an assessment of the effect of alteplase on the distribution of the functional level by treatment delay, age, and stroke severity. Methods—Prespecified pooled analysis of 6756 patients from 9 randomized trials comparing alteplase versus placebo/open control. Ordinal logistic regression models assessed treatment differences after adjustment for treatment delay, age, stroke severity, and relevant interaction term(s). Results—Treatment with alteplase was beneficial for a delay in treatment extending to 4.5 hours after stroke onset, with a greater benefit with earlier treatment. Neither age nor stroke severity significantly influenced the slope of the relationship between benefit and time to treatment initiation. For the observed case mix of patients treated within 4.5 hours of stroke onset (mean 3 hours and 20 minutes), the net absolute benefit from alteplase (ie, the difference between those who would do better if given alteplase and those who would do worse) was 55 patients per 1000 treated (95% confidence interval, 13–91; P=0.004). Conclusions—Treatment with intravenous alteplase initiated within 4.5 hours of stroke onset increases the chance of achieving an improved level of function for all patients across the age spectrum, including the over 80s and across all severities of stroke studied (top versus bottom fifth means: 22 versus 4); the earlier that treatment is initiated, the greater the benefit

Blaming the victim, all over again: Waddell and Aylward's biopsychosocial (BPS) model of disability

The biopsychosocial (BPS) model of mental distress, originally conceived by the American psychiatrist George Engel in the 1970s and commonly used in psychiatry and psychology, has been adapted by Gordon Waddell and Mansell Aylward to form the theoretical basis for current UK Government thinking on disability. Most importantly, the Waddell and Aylward version of the BPS has played a key role as the Government has sought to reform spending on out-of- work disability benefits. This paper presents a critique of Waddell and Aylward’s model, examining its origins, its claims and the evidence it employs. We will argue that its potential for genuine inter-disciplinary cooperation and the holistic and humanistic benefits for disabled people as envisaged by Engel are not now, if they ever have been, fully realized. Any potential benefit it may have offered has been eclipsed by its role in Coalition/Conservative government social welfare policies that have blamed the victim and justified restriction of entitlements

Interdependence as a Frame for Assistive Technology Research and Design

In this paper, we describe interdependence for assistive technology design, a frame developed to complement the traditional focus on independence in the Assistive Technology field. Interdependence emphasizes collaborative access and people with disabilities' important and often understated contribution in these efforts. We lay the foundation of this frame with literature from the academic discipline of Disability Studies and popular media contributed by contemporary disability justice activists. Then, drawing on cases from our own work, we show how the interdependence frame (1) synthesizes findings from a growing body of research in the Assistive Technology field and (2) helps us orient to additional technology design opportunities. We position interdependence as one possible orientation to, not a prescription for, research and design practice--one that opens new design possibilities and affirms our commitment to equal access for people with disabilities

Engulfed by the Spectrum: The Impact of Autism Spectrum Disorders on Law and Policy

The recent increased awareness of Autism Spectral Disorders (“ASD”) has led to rapid development in laws meant to ensure disabled children receive adequate treatment and education. This development is due in large part to the proliferation of litigation initiated by individual ASD advocates, especially parents. Leaving the development of disability laws up to litigation, however, has resulted in often uneven and inconsistent interpretations of federal disability legislation. Moreover, the push to interpret these laws as they relate to children with ASD and their families has engulfed the development of disability law in general, especially where special education is concerned. This Article calls for replacing the current model of isolated parties advocating for their own individual interests with a more targeted, planned, and cohesive advocacy effort that includes parents, doctors, attorneys, and other professionals working together toward a common goal. To reach this conclusion, this Article first provides an introduction to ASD and its treatment and then examines the history of special education law in the United States, with particular attention paid to the Individuals with Disabilities Education Act. The Article then traces the evolution of ASD litigation in the courts, analyzing the major trends that have emerged involving diagnosis, treatment, placement of children within the education system, and funding of services. Finally, the Article surveys the various recent developments in federal and state legislation, focusing specially on insurance coverage requirements, federal health care reform, funding, education practices, and oversight mechanisms in legislation at the state level. In doing so, the Article reveals the need for a more cohesive and comprehensive approach to ensuring that law and policy related to ASD reflect the true needs of children and adults with ASD

Representing the family: how does the state 'think family'?

Over the last decade the family and family-centred policies and practices have received increasing attention within the public service agenda, culminating in the emphatic instruction to ‘think family’ individually, collectively and institutionally. This has occurred at a time when the sociology of the family has increasingly emphasised the difficulties of thinking family in a coherent way. In this article we explore this agenda through an examination of the representational tools with which public service professionals and managers have been recently equipped. We conclude by questioning the adequacy of these tools for effectively representing family relations

Neurocognitive profiles in autism spectrum disorder

textThe current research project examines the performance of a group of high functioning young adult males with autism spectrum disorders on standardized measures of neurocognitive functioning to determine whether distinct cognitive profiles of strengths and weaknesses emerge. Neuropsychological test data across various domains: general cognitive ability, visuospatial processing, verbal learning and memory, visual learning and memory, working memory, reasoning, cognitive flexibility, attention, receptive language, expressive language, social and emotional processing, and fine motor skills was examined. Data were analyzed using cluster analysis to assess for the presence and nature of unique clusters/subgroups based on neuropsychological test performance. Three unique clusters were derived from the analyses. This study highlights the well-documented heterogeneity across the spectrum of autism and suggests a method for parsing a heterogeneous sample of ASD subjects into smaller and more meaningful homogeneous groups using standardized neuropsychological assessments.Educational Psycholog