and ICF again

Because of the wider interest in the subject of the use of ICF in Conductive Education I felt to make a short report about a research seminar was held in June 2010, in Newcastle upon Tyne, UK where an ‘international working party’ has been set up to look at core sets for ICF in CE.
A group of people came together who were interested in, or conducting research on CE at present to discuss their research activities, to share ideas on CE’s current measurement ideas. As part of this exercise, ICF was a main focus to look at and find the core sets for ICF in CE. However, this is very early stages and therefore a great deal of work is still needed....

CE use of ICF (?) Second part

Hypotheses of study:

1. We presume that the adapted version of ICF-CY will be suitable for following the functional condition of children with CP.
2. We presume that in many cases it is the environment rather than their condition that make dysfunctioning persons disabled.
3. We presume that the new tool (ICF-CY) will be suitable to measure improvement in the quality of life which is immeasurable by existing instruments.

Current stage of research:

I made a general ICF-CY-based survey for CP child to show how we can fit the codes
into CE practical work. ( You can see an example in the annexes, annex I.)

I made an ICF-CY-based Assesment Form for CP child what belongs to 292 codes in 8
different areas:

1.Muscle tone 7 codes

2.Sensory organs
- seeing 5 codes
- hearing 5 codes
- swallowing, chewing 5 codes
- other purposeful sensing 4 codes


3.Mobility
- changing and maintaining body position 11 codes
- sitting 3 codes
- standing-walking 16 codes
- manipulation 13 codes
~ writing 3 codes
- communication 25 codes


4. Mentality
- global mental function 15 codes
- temperament and personality functions 8 codes
- energy and drive functions 3 codes
- attention functions 4 codes
- memory functions 3 codes
- psychomotor functions 5 codes
- emotional functions 3 codes
- thought functions 5 codes
- general tasks and demands 8 codes
- interpersonal interactions 19 codes


5. Self-care
- washing oneself 9 codes
- toileting 5 codes
- dressing 6 codes
- eating 6 codes
- household tasks 4 codes


6. Recreation and leisure 15 codes


7. Enviromental factors
- products and technology 15 codes
- air qality 2 codes
- support and relationships 8 codes
- attitudes 9 codes
- services, systems and policies 7 codes

+ 8. Learning and applying knowledge (for school ages children)
Basic learning
- copying 10 codes
- rehearsing 2 codes
- learning to read 2 codes
- learning to write 2 codes
- learning to calculate 2 codes
Applying knowledge
- focusing attention 2 codes
- thinking 2 codes
- reading 2 codes
- writing 2 codes
- calculating 2 codes
- solving simple problems 1 code
- solving complex problems 1 code
- making decisions 1 code
Education 5 codes
(You can see a short example in the annexes, annex II.)


Budapest, 15.06.2010.



ANNEXES

Annex I.

General ICF-CY-based survey for CP child


Personal factors

 Name: Ch. E. Personal
 Sexuality: female factors
 DOB:12.11.1996.
 To ethnic: black
 Bringing up: adopted
 Mother’s name: J. E. (Kenya)
 Father’s name: W. E. (Switzerland)
 Live: Switzerland
 Diagnosis: DPL, more effected on the left side
 Weight at birth: 1500g
 Weeks of gestation : 28
 Family anamnesis (life history): no information
 Inclination to fits: -
 Medication: -
 Allergy: -
 Operation (surgery): tracheotomia in 1998.
 Previous treatment: fisikoth.,ergoth.,hypoth., swimming, CE


General description

 Generally age-appropriate body size, her lower body is overweight a bit. Her feet are shorts and showed deformity, that is why she can not walk barefoot.
 She dribble.
 She is a friendly and happy girl, but a real teenager, who has sometimes wavering mood.
 She attends a special school, grade 5. in her home.

Body functions

b1263.1 Psychic stabiliy
b1266.1 Confidence (because of dribble)
b1302.2 Appetite
b1600.1 Form of thought

b1644.1 Insight (fatness)
b1646.1 Problem-solving
b1721.1 Complex calculation
b28015.1 Pain in lower limb (barefoot)
b5104.2 Salivation
b7203.3 Mobility of tarsal bones
b7304.2 Power of muscles of all limbs
b770.2 Gait pattern functions (spastic gait)

b830.1 Other functions of the skin
(sweating, resulting body odour)

Activities and participation

d2402.1 Handling responsibilities
d4101.2 Squatting (standing up from this p.)
d4152.2 Maintaining a kneeling position
d4154.3 Maintaining a standing position
d4301.4 Carrying in the hands (without stick)
d4303.0 Carrying on shoulders, hip and back (backpack)
d4351.2 Kicking
d465.2 Moving around using equipment (stick)
Self-care
d5203.3 Caring for fingernails
d5204.4 Caring for toenails
d5402.2 Putting on footwear

Enviromental factors

e1201.+3 Assistive products and technology for personal indoor and outdoor
mobility and transportation (stick)
e1401.+3 Assistive products and technology for culture, recreation and sport
(trycykle for long distance)
e1500.+4 Design, construction and building products and technology for
entering and exiting buildings for public use (Switzerland)
e1501.+4 Indoor (lifts)
e1550.+4 Buildings for private use (home for handicapped)
e310.+4 Immediate family (adoptive parents)
e320.+3 Friends
e325.+3 Acquaintances, peers, colleagues, neighbours and community
members (special school)
e345.0 Strangers
e445.1 Individual attitudes of strangers (handicapped)
e460.1 Societal attitudes (black skin)
e5551.+4 Association and organizational services (summer camp for
handicapped)
e5750.+4 General social support services (financing conductive education)

Annex II.

ICF-CY-based Assesment Form for CP child (first part of it)



CODE NUMBER DESIGNATION COMMENT
Muscle tone:
b7350.
Isolated muscles
b7351. One limb
b7352. One side of body (hemi)
b7353. Lower half of body
b7354. All limbs
b7355. Trunk (back)
b7356. Whole body
Others:
Sensory organs:

Seeings:
b21000. Binocular acuity of distant
b21001. Monocular …
b21002. Binocular acuity of near
b21003. Monocular …
d110. Watching
Others:
Hearing:
b2300. Sound detection
b2301. Sound discrimination
b2302. Localisation of soundsource
b2303. Lateralization of sound
d115. Listening
Others:
Swalloing, chewing:
b5101. Biting
b5102. Chewing
b5103. Mani. of food in the mouth
b51050. Oral swalloing
b5106. Vomiting
Others:
Other purposeful sensing
d1200. Mouthing
d1201. Touching
d1202. Smelling
d1203. Tasting
Others:




MOBILITY


CODE NUMBER DESIGNATION COMMENT
Changing and maintaining body position:
d4100. Lying down
d4101. Squatting
d4102. Kneeling
d4107. Rolling over
d4150. Maintaining a lying positio
d4151. Maint. a squatting position
d4152. Maint. a kneeling position
d4155. Maint. a head position
d4201. Transferring os. while lying
d4550. Crawling
d4551. Climbing
Others:
Sitting:
d4103. Sitting
d4153. Maint. a sitting position
d4200. Transferring os. while sit.
Others:
Standing-walking: Equipment needed
d4104. Standing
d4105. Bending
d4106. Weight shifting
d4154. Maint. a standing position
d4301. Carrying in the hands
d4302. Carrying in the arms
d4303. Carrying on back, shoulder
d4500. Walking short distances
d4501. Walking long distances
d4502. Walking on diff. surfaces
d4503. Walking around obstacles
d4552. Running
d4553. Jumping
d4600. Mov. around within home
d4601. Mov. other than home
d4602. Mov. around outside
Others:



CODE NUMBER DESIGNATION COMMENT
Manipulation:
d4300. Lifting
d4305. Putting down objects
d4400. Picking up
d4401. Grasping
d4402. Manipulating
d4403. Releasing
d4450. Pulling
d4451. Pushing
d4452. Reaching
d4453. Turning or twisting hands
d4454. Throwing
d4455. Catching
d446. Fine foot use
Writing
d1450. Acquiring writ. implements
d1451. Acqu. symbols, char., alph.
d1452. Acqu. words and phrases
Others:
Communication:
b3100. Production of voice
b3101. Quality of voice
b320. Articulation functions
b3300. Fluency of speech
b3301. Rhythm of speech
b3302. Speed of speech
b3303. Melody of speech
b3400. Production of notes
d1330. Acqu. single words, symbol
d1331. Combining words into phr.
d1332. Acquiring syntax
d3100. Responding to human voice
d3101. Simple spoken messages
d3102. Complex spoken messages
d330. Speaking
d331. Pre-talking
d332. Singing
d3350. Producing body language
d3351. Prod. signs and symbols
d3352. Prod. drawings, photogr.
d3503. Conversing with 1 person
d3504. Con. with many people
d3600. Using telecommuni. devices phone, computer, telex m.
d3601. Using writing machines typewriter, computer
d3602. Using communic. technique reading lips
Others:

CE use of ICF (?)

The use of ICF is getting more common in the 'medical world' all over the world by now. Strangely, the Britons are not very much keen using it anywhere. ICF can be a useful measurement basis system since it views human in its complexity (just like CE) the person as a whole (just like Peto).

The possibility of reasonable use of ICF for the documentation of CE has been considered for a while by different CE service providers mostly in Europe and has been discussed at a research seminar in UK too.

Zsuzsanna Olexa one of the Hungarian trained conductors who has been working at the Peto Institute, Budapest and currently is a PhD student has chosen ICF as thesis subject:

Development of a common language to serve as a scientific basis in conductive education, with the help of the International Classification of Functioning (ICF)
and its Children and Youth Version (ICF-CY)

I am glad to announce that I have the permission from Zsuzsa to publish her work for the very first time here on my blog.

You will be able to read the whole work here in parts.

Development of a common language to serve as a scientific basis in conductive education, with the help of the International Classification of Functioning (ICF)
and its Children and Youth Version (ICF-CY)

by Zsuzsanna Olexa Józsefné



(The Andras Pető Institute of Conductive Education and Conductor Training College; Doctoral School of Educational Sciences, Faculty of Education and Sciences, Eötvös Loránd University, Budapest, Hungary)

The mission of the Pető Institute is to show individuals suffering from injuries to the central nervous system and their families the way to a full life and to make society aware of the opportunities to help.
Physician and educator Andras Pető developed his conductive education system in the 1940s. His method opened up a new path for the rehabilitation of children and adults whose motor impairments originate from damage to the central nervous system. His approach was first taught and practised in the predecessor of the institute now named after him. Conductive education (CE) is based on the idea that despite the damage, the nervous system still possesses the capacity to form new neural connections and this ability can be mobilised with the help of a properly guided teaching and learning process. That is the reason why Professor Peto called his education system „conductive”.
Conductive education (CE), a suitable method for habilitating/rehabilitating individuals in any age-group with motor disorders due to central nervous system damage has by now become known all over the world. Practice has proved its effectiveness and thus it has been established outside Hungary as well.
The conductive educators are trained multidisciplinary and therefore they are able to deal with all damaged functions of brain damaged persons. The work in group with group of clients and educate or conduct them how to perform everyday activities.
Several international studies have examined the effectiveness of CE (Rochel and Weber, 1992.; Bairstow, 1993; Reddihough, 1998; Blank and von Voss, 1996-2001). According to these international studies, to our comparative study and to our practical experiences it may be stated that CE is at least as effective as the traditional rehabilitation team (using the Bobath or Vojta method), or in some aspect more effective, achieving higher satisfaction of clients and their carers.
Research into the matter has made it clear that for measuring accurately the performance of individuals with central nervous disorders a very complex, comprehensive measurement tool is essential.

Studying the various methods of measuring and comparing them with the ICF-CY (International Classification of Functioning Children and Youth Version) prepared by the WHO in 2006 I have come to the idea that I should consider adapting a unified international measurement method.


Conductive Education has remained largely untouched by the International Classification of Functioning, concerning the adult population. Internally at least, Conductive Education has not needed this, as it has already implicitly moved on to the next stage, which involves mechanisms for change not just classification. But International Classification of Functioning Children and Youth Version changes in the developing child’ s functioning and performance and the role of enviromental factors are taken into account; applicable in varying health conditions.

The topic of my PhD research on the application of the ICF-CY in Hungary can be regarded as a pioneering effort for to the best of my knowledge the subject is not dealt with on academic level in this country.
The relevance of the International Classification of Functioning Children and Youth Version to conductive education is that the method developed by the WHO makes an all-round assessment of the disabled individual and the supportive or impediment factors of the environment possible. The classification aims to meet the demands of medical, pedagogical and social-occupational rehabilitation and to provide the different rehabilitation professionals with a common language.
Creating an internationally accepted measurement instrument like the ICF-CY, suitable for the objective measuring of the efficiency of conductive education would be of great importance to both the Pető Institute and conductive pedagogy.

ICF - Towards a common language?

THE MODEL OF ICF
Two major conceptual models of disability have been proposed. 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. Disability, on this model, calls for
medical or other treatment or intervention, to 'correct' the problem with the
individual.

The social model of disability, on the other hand, sees disability as a sociallycreated
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.
On their own, neither model is adequate, although both are partially valid.
Disability is a complex phenomena that is both a problem at the level of a
person's body, and a complex and primarily social phenomena. Disability is
always an interaction between features of the person and features of the overall
context in which the person lives, but some aspects of disability are almost
entirely internal to the person, while another aspect is almost entirely external. In
other words, both medical and social responses are appropriate to the problems
associated with disability; we cannot wholly reject either kind of intervention.
A better model of disability, in short, is one that synthesizes what is true in the
medical and social models, without making the mistake each makes in reducing
the whole, complex notion of disability to one of its aspects.
This more useful model of disability might be called the biopsychosocial model.
ICF is based on this model, an integration of medical and social. ICF provides,
by this synthesis, a coherent view of different perspectives of health: biological,
individual and social.

How can ICF be used?

Because of its flexible framework, the detail and completeness of its
classifications and the fact that each domain is operationally defined, with
inclusions and exclusions, it is expected that ICF, like its predecessor, will be
used for a myriad of uses to answer a wide range of questions involving clinical,
research and policy development issues. (For specific examples of the uses of
ICF in the area of service provision, and the kinds of practical issues that can be
addressed, see the box below.)
ICF Applications
Service Provision
At the individual level
• For the assessment of individuals: What is the person's level of functioning?
• For individual treatment planning: What treatments or interventions can maximize
functioning?
• For the evaluation of treatment and other interventions: What are the outcomes of the
treatment? How useful were the interventions?
• For communication among physicans, nurses, physiotherapists, occupational therapists and
other health works, social service works and commmunity agencies
• For self-evaluation by consumers: How would I rate my capacity in mobility or
communication?
At the institutional level…
• For educational and training purposes
• For resource planning and development: What health care and other services will be needed?
• For quality improvement: How well do we serve our clients? What basic indicators for
quality assurance are valid and reliable?
• For management and outcome evaluation: How useful are the services we are providing?
• For managed care models of health care delivery: How cost-effective are the services we
provide? How can the service be improved for better outcomes at a lower cost?
At the social level…
• For eligibility criteria for state entitlements such as social security benefits, disability
pensions, workers’ compensation and insurance: Are the criteria for eligibility for disability
benefits evidence based, appropriate to social goals and justifiable?
• For social policy development, including legislative reviews, model legislation, regulations
and guidelines, and definitions for anti-discrimination legislation: Will guaranteeing rights
improve functioning at the societal level? Can we measure this improvement and adjust our
policy and law accordingly?
• For needs assessments: What are the needs of persons with various levels of disability -
impairments, activity limitations and participation restrictions?
• For environmental assessment for universal design, implementation of mandated accessibility,
identification of environmental facilitators and barriers, and changes to social policy: How
can we make the social and built environment more accessible for all person, those with and
those without disabilities? Can we assess and measure improvement?

Source:

http://www.who.int/classifications/icf/training/icfbeginnersguide.pdf

17/06/2010

Did you hear about ICF?

International Classification of Functioning, Disability and Health (ICF)

The International Classification of Functioning, Disability and Health, known more commonly as ICF, is a classification of health and health-related domains. These domains are classified from body, individual and societal perspectives by means of two lists: a list of body functions and structure, and a list of domains of activity and participation. Since an The ICF puts the notions of ‘health’ and ‘disability’ in a new light. It acknowledges that every human being can experience a decrement in health and thereby experience some degree of disability. Disability is not something that only happens to a minority of humanity. The ICF thus ‘mainstreams’ the experience of disability and recognises it as a universal human experience. By shifting the focus from cause to impact it places all health conditions on an equal footing allowing them to be compared using a common metric – the ruler of health and disability. Furthermore ICF takes into account the social aspects of disability and does not see disability only as a 'medical' or 'biological' dysfunction. By including Contextual Factors, in which environmental factors are listed ICF allows to records the impact of the environment on the person's functioning.individual’s functioning and disability occurs in a context, the ICF also includes a list of environmental factors.

The ICF is WHO's framework for measuring health and disability at both individual and population levels. The ICF was officially endorsed by all 191 WHO Member States in the Fifty-fourth World Health Assembly on 22 May 2001(resolution WHA 54.21). Unlike its predecessor, which was endorsed for field trail purposes only, the ICF was endorsed for use in Member States as the international standard to describe and measure health and disability.

Source:
http://www.who.int/classifications/icf/en/
17/06/2010


Implementation of the ICF started in 2001 with the unanimous endorsement of the classification by the 54th World Health Assembly as the framework for describing and measuring health and disability. Since then, ICF has been applied in a variety of settings at national and international level.

International and national health and disability reporting
ICF based health and disability surveys have been conducted at national and international level. In WHO the ICF framework has been used in the Multi-Country Survey Study in 2000/2001 and the World Health Survey Program in 2002/2003 to measure health status of the general population in 71 countries. From this data WHO and selected Members States are currently generating population norms for selected ICF domains and disability prevalence rates. At regional level UNSD, UNESCWA and UNESCAP in collaboration with WHO implemented a series of workshops for African, Middle Eastern and Asian countries to improve disability statistics using the ICF framework. At national level ICF based data sets and questionnaires are currently used in a number of countries including Australia, Irland, Mexico, Zimbabwe, Malawi.

Several countries started the process of streamlining ICF in their health & social information standards and legislation. Development and piloting of ICF based indicators and reporting systems for use in rehabilitation, home-care, age-care, disability evaluation are ongoing in Australia, Canada, Italy, India, Japan, Mexico.

Clinical and epidemiological use
In clinical settings ICF is used for functional status assessment, goal setting & treatment planning and monitoring, as well as outcome measurement. Countries, which already use ICF in a variety of clinical settings include Australia, Italy, The Netherlands….. At international level WHO is exploring the use of ICF to measure health outcomes and guide disability management in infectious disease programs such as LF and

Source:
http://www.who.int/classifications/icf/appareas/en/index.html
17/06/2010

Special figures

As part of my research study on Conductive Education I conducted a dialogue with a very unique married couple today. The husband, who is over 80, has been participating in CE for twenty years at one of the NICE’s Parkinson’s group and of course his wife socialized herself with the CE environment throughout those many years there. They are living history, legends, but most importantly, they are still very motivated figures of our pedagogy and an extraordinary example of how CE is able to long (ever) last. What the very best of the today’s encounter was that this couple actually energised me and made stronger my faith in CE.
Thank you.

No Title

Most of the time Conductive Education (CE) is taken to be a rehabilitation method, an intensive therapy for children with Cerebral Palsy. This is a popular misconception because of the lack of understanding of the work of early practitioners and the dearth of appropriate research methodologies to approach the system as a whole since. Although that numerous papers were published in order to introduce and explain CE, the “scientific” acknowledgement was not forthcoming.
In the early 1970’s, the first interpreters of Conductive Education in the UK, such as Ester Cotton, Karel and Bertha Bobath and James Loring, viewed it as a therapeutic treatment method. Griffits (1988) also described conductive education as a therapy which helped people to overcome different dysfunctions and achieve orthofunction, i.e. functioning normally in society without the use of aids or wheelchairs. This was not a true representation of Conductive Education. Brown and Mikula-Toth (1997) disagree with his description and take the view that it would be impossible to set out with this aim as the large majority of people would never achieve it. They expressed that Conductive Education is based on setting realistic goals, not idealistic ones. Despite of Andrew Sutton’s et al numerous papers, presentations on CE Sophie Levitt (2004) still refers to Conductive Education as a treatment, therapy or group therapy in her fourth book ‘Treatment of CP and Motor Delay’.

“Lack of an articulate account of conductive pedagogy from an original Hungarian source has been a major problem in the spread of Conductive Education across the world. Those involved in professional training have lacked an authoritative basic text and those who advocate Conductive Education, struggle to establish conductive centres and defend them, or simply look in from outside and try to understand this new approach to special education and rehabilitation, have all had their jobs made the harder for lack of a simple brief overview." (Maguire, Sutton, A. 2004 p.13).
As a result the ‘principles of Conductive Education’ continue to be misunderstood and misrepresented by proponents and opponents alike and gaining apparent legitimacy in the twenty-first century as they spread across the Internet.
"Over the years Conductive Education has generated a considerable literature written by mostly outsiders. The problem for those less than fully aware of the nature of conductive pedagogy is how to distinguish the nub of relevant, even excellent material within this ever-expanding corpus from the wrong, the ignorant and even the anti-conductive. Astonishingly, even after forty years of professional writing on Conductive Education – not least by those trying to practise it and to train others to do so – there are swathes of published materials, not just in English, which make no mention at all of conductive pedagogy as the vital factor in implementing an education that is conductive. Indeed, there remain many who appear altogether unaware that in seeking to implement an education without its pedagogy but, as one author noted, this is like attempting Hamlet without the Prince." (Maguire, Sutton, A. 2004 p.14).

References:
Griffits, M. and Clegg, M. (1988) Cerebral Palsy: Problems and Practice, Human Horizon Services. Souvenir Press, London
Brown, M. and Mikula-Toth, A. (1997) Adult Conductive Education A practical Guide. Stanley Thornes (Publishers) Ltd
Levitt, S. (2004) Treatment of Cerebral Palsy and Motor Delay. Blackwell Publishing, Oxford
Maguire, G. and Sutton, A. (2004) Maria Hari on Conductive Pedagogy. The Foundation for Conductive education, Birmingham


The facts are:

• Conductive Education is continued to be an attractive option for the habilitation, rehabilitation of central nervous system damaged people and the service mostly used by the private sector in the world
• CE generally thought to be a sort of intensive physiotherapy-kind approach
• Conductive Education Teachers, Conductors are working mostly alongside with different trained professionals or not trained assistants
• In several cases CE is combined with different therapies, ideas, methods
• In some cases CE is integrated to local education services (!) – where Conductive Education Teachers are part of the teacher team however, they are mostly in teacher assistance or “therapist” status
• It is rear to find “conductor teams” functioning as it was thought by the originator of CE in and out of Hungary: each member of the team trained as CE professional
• The scientifically recognised world is hardly interested to explore CE
• The Alma Mater Peto Institute, Budapest had no plan and structure ( and maybe interest) to introduce and sell CE constructively to the rest of the World
• Conductive Education is in an agony of selling itself to the scientifically recognised world
• There are not enough CE training places
• There are not enough CE professionals and there are not enough Conductive Education Teachers

Well, I could continue it but I believe we should openly continue it together… what would you put next?
What are we up to?