NNDR.dk netværksmøde - SDU – 01.12.2011 ICF, person og kontekst Centerleder Ejgil Jespersen Center for Handicap og Bevægelsesfremme Syddansk Universitet NNDR.dk netværksmøde - SDU – 01.12.2011

Hvad jeg kommer ind på… Institut for Idræt og Biomekanik & Center for Handicap og Bevægelsesfremme WHO klassifikationer ICF: Fra sygdom og konsekvenser af sygdom til funktionsevne Person og kontekst tæller… ICF – supplement eller alternativ til sygeliggørelse?

Center for Idræt, Sundhed og Civilsamfund (CISC) Institut for Idræt og Biomekanik Kerneopgaver Undervisning Forskning (Forskningsenheder) Videndeling og Innovation (Centre) Muskelfysiologi og Biomekanik Forskningsleder, professor Per Aagaard Center for Handicap og Bevægelsesfremme Klinisk Biomekanik Forskningsleder, professor Jan Hartvigsen Clinical Locomotion Science Alle fakultetets uddannelser Exercise Epidemiology Forskningsleder, professor Lars Bo Andersen Research in Childhood Health (RICH) Muskuloskeletal Funktion og Fysioterapi Forskningsleder, professor Ewa Roos Team Danmark Testcenter Fysisk Aktivitet og Sundhed i Arbejdslivet Forskningsleder, professor Gisela Sjøgaard Center for Kunst og Videnskab Bevægelse, Idræt og Samfund Forskningsleder, professor Bjarne Ibsen Center for Idræt, Sundhed og Civilsamfund (CISC)

1.sal: tværfaglig forskningsklinik og genoptræningssal Gang- og bevægelseslaboratorium Lege-/bevægelandskab Fitness-/træningscenter for alle grupper Laboratorium for leg og innovation Handicap og bevægelsesfremme Motorik Rehabilitering Velfærdsteknologi i træning, genoptræning, intteligent motion

Leg, læring og innovation Active Living Park etape Parktema: Fitness og træning Active Living Lab 2. etape Parktema: Leg, læring og innovation 3. etape Parktema: Terapi og sansning Nyt OUH 6

Center for Handicap og Bevægelsesfremme Det generelle formål med centret er - at skabe vidensgrundlag for udvikling af tilpasset idræts- og fysisk aktivitetsdeltagelse for mennesker med handicap, - herunder stimulere politikker og fremme behandlings- og pædagogiske praksisser på området, samt - inddrage tilpasset idræt og fysisk aktivitet i uddannelser under Det Sundhedsvidenskabelige Fakultet

Nøglebegreber Handicap: Disability, relationelt begreb Handicapforskning: Disability research Tilpasset Idræt og Bevægelse: Adapted Physical Activity Funktionsnedsættelse: Impairments, personbunden ICF: International Classification of Functioning, Disability and Health: International klassifikation af Funktionsevne, Funktionsevnenedsættelse og Helbredstilstand Borgerinddragelse: ”… at få sammenhæng mellem borgerens livsverden og selvforståelse og den faglige vurdering af de foreliggende oplysninger og handlemuligheder”

Forskningsprojekter Børn, bevægelse og habilitering – i samarbejde med Børneterapien i Odense kommune, PhD-projekt(er) Bevægelsesbehov for personer med svære handicap mv. – relateret til ordningen om vederlagsfri fysioterapi Tilpasset idræt og bevægelse for unge med sindslidelser – PhD-projekt Bevægelseseksperimentarium i Hou – PhD-projekt(er) Friluftsliv for mennesker med handicap – PhD-projekt Handicapsurvey 2012 – i samarbejde med SFI Desuden diverse udviklings- og evalueringsprojekter samt uddannelsestiltag 9 Juni 2009

Vejledning om kommunal rehabilitering

Rehabilitering af… Håndskade: Håndbevægelser kan rehabiliteres mere effektivt, når patienten udøver den skadede adfærd i en meningsfuld aktivitetskontekst fremfor når øvelsen foregår isoleret Bevægehæmmede neurologiske patienter (ideomotorisk apraksi?): - Patienterne viste betydelige forbedringer i motorisk kontrol, når de udførte meningsfulde handlinger fremfor når adfærden foregik dekontekstualiseret - Yderligere forbedringer fandt sted, når de samme bevægelser foregik i en social situation af personlig og kulturel betydning

Krop Aktivitet Deltagelse Adfærds-situation Abstrakt kontekstu-aliseret Pragmatisk Socialt Meningsfuld handling for subjektet Lav eller ikke-eksisterende Medium Høj Selv og social betydning Compliance/følge forskrift Selv-bestem-melse Social identitet / kompetence

WHO Family of Classifications www.who.int/classifications REFERENCE Classifications DERIVED Classifications International Classification of Diseases for Oncology, Third Edition (ICD-O-3) The ICD-10 Classification of Mental and Behavioural Disorders Application of the International Classification of Diseases to Dentistry and Stomatology, Third Edition (ICD-DA) Application of the International Classification of Diseases to Neurology (ICD-10-NA) ICF, Children & Youth Version (ICF -CY) RELATED Classifications International Classification of Primary Care (ICPC) International Classification of External Causes of Injury (ICECI) The Anatomical, Therapeutic, Chemical (ATC) classification system with Defined Daily Doses (DDD) ISO 9999 Technical aids for persons with disabilities – Classification and Terminology I nternational C lassification of D iseases F unctioning, Disability & Health H ealth I nterventions (under development) The overall vision of the WHO Classifications is to provide a suite of integrated standard tools to capture data at the delivery point with tools that are totally interoperable across systems and countries so that global communication and information exchange in health sector is possible (similar to economic or transport sectors). To get more information you may look at www.who.int/classifications. Juni 2009

WHO Family of International Classifications Primary Aim: International comparability of health information Basic principles: Scientific and transcultural Interrelated use: Coherent, agreed and appropriate Versatility: Responds to current or developing health information needs of different users Foundation classes: Categories of conceptual & metric equivalence Coding Rules: Transparent and reliable Standards: Uniform and meets ISO standards [Keywords] context###[Narration] WHO Family of Classifications wide range of data about health care i.e. diagnosis, disability etc a “common language” for enabling communication ###

Biomedical model DISEASE DEATH Etiology Pathology Manifestations ? Impotent ?, invalid ?, incapable ?, inept ?, crippled ?, infirm ?, deficient ?, limited ?, feeble ?, simple ?, idiot ?, backward ?, retarded ?, degenerated ? (…) Or in need of rehabilitation and subsisting the fragile body (...) Biomedical model Juni 2009

ICF (2001) BIOMEDICAL Model DISEASE DEATH ICIDH 1 (1980 -1993) 1 – Diseases or disorders 2 – Impairments 3 – Disability 4 – Handicap ICF (2001) 1 – Diseases or disorders 2 – Impairments 3 – Activity limitations 4 – Participation restrictions 5 – Barriers, facilitators Juni 2009

From disease and consequences of disease to health-related functioning Level Body Person Society ICD-10 (1990) Disease (Illness) (Sickness) ICIDH 1980 Impair-ment Disability Handicap ICF Body function & structures Activities Participa-tion

Interaction of Concepts ICF 2001 Health Condition (disorder/disease) Body function&structure (Impairment) Activities (Limitation) Participation (Restriction) Environmental Factors Personal Factors Juni 2009

New emphasis on contextual factors Person Gender Age Other health conditions Coping style Social background Education Profession Past experience Character style Environment Products Close milieu Institutions Social Norms Culture Built-environment Political factors Nature [Keywords] structure###[Narration] ###

Functioning and Disability Structure ICF Classification Part 1: Functioning and Disability Part 2: Contextual Factors Parts Body Functions and Structures Activities and Participation Environmental Factors Personal Factors Components Change in Body Functions Change in Body Structures Capacity Performance Facilitator/ Barrier Constructs/ qualifiers ICIDH categories are organized in a "nested" approach Broader Category  detailed subcategory The classification has two parts, each with two components. [An example may help to illustrate the point: The universe of health and disability is being classified (this is the forest). Within that forest we classify the dimensions of Impairments, Activities and Participation (the trees). In the Activities dimension we have several chapters or domains ranging from simple to complex activities - from sensing and recognizing to interpersonal behaviors (the trunks). Within, for example, the chapter on Interpersonal Behaviors are included activities such as general interactive skills (the branch) and included in that broad category are behaviors such as initiating social contact, responding to cues and so on (the leaves).] Item levels: 1st 2nd 3rd 4th Item levels: 1st 2nd 3rd 4th Item levels: 1st 2nd 3rd 4th Item levels: 1st 2nd 3rd 4th Item levels: 1st 2nd 3rd 4th Domains and categories at different levels

ICF Components Body Functions & Structures Activities & Participation Environmental Factors Functions Structures Capacity Performance Barriers Facilitators

Person and context counts… Body functions and structures Activities Participation Disability Impairments Activity limitations Participation restrictions Assess-ment Significant deviation or loss Capacity given a standard background Performance in specified environments Behavioural situation Abstractly contextualized Pragmatically contextualised Socially contextualized Meaningful action for the subject Low or non-existent Medium High Self / social signification Compliance Self-determination Social identity / competence

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