Title: The ICF and communication disability
1The ICF and communication disability
- Professor Linda Worrall
- Communication Disability in Ageing Research
Centre and Division of Speech Pathology - School of Health and Rehabilitation Sciences
- The University of Queensland
2Outline of presentation
- Communication disability what is it
- Why is the ICF attractive to communication
specialists - How has the ICF been applied to communication
disability - Some challenges to the ICF from our discipline
area and research
3What is communication disability
- Health conditions stroke injury cancer
progressive neurological disorders (e.g.
Parkinsons MS muscular dystrophy) - Impairments voice speech fluency language
hearing. - Activity limitations Participation Restrictions
communication disability affects most life
activities but particularly communication and
interpersonal relationships which has an effect
on all areas of participation particularly
social participation
4Our research team at this conference
- A/Prof Louise Hickson hearing impairment
- Dr Brigette Larkins cognitive- communication
impairment from brain injury - Nerina Scarinci hearing impairment
- Tami Howe language impairment
- Elizabeth Savina age-related impairments
- Robyn OHalloran acute hospital patients
5Communication Disability in Ageing Research Centre
- We have always used the ICF (and its previous
versions) as a basis for its research and
education of speech pathologists and audiologists - Research outcomes using the ICF have included
- 3 PhD 1 MPhil thesis
- another current 4 PhD students
- NHMRC and ARC Linkage grants
- 2 books 3 clinical tools 1 book in prep (ICF
and Speech Pathology) - Teaching outcomes all graduating speech
pathologists and audiologists from UQ have a good
working knowledge of the ICF.
6Why is the ICF attractive to speech pathologists
and audiologists
- Communication and communication disability are
not easily understood by non-specialists. The ICF
can help explain it. - Communication is nearly always a two way process
hence the communication partner (an EF) is an
essential part of the performance of the person.
Is this different to physical disability - Most communication disabilities are chronic and
incurable so the role of the speech pathologist
or audiologist is to facilitate functioning. The
ICF provides a framework for this.
7How has the ICF been applied to communication
disability (see Threats Worrall 2004)
- The ICF describes the scope of practice for
speech pathology e.g. Speech Pathology Australia
and American Speech Language Hearing
Association - The ICF is being considered as a basis of
terminology in speech pathology - The ICF is the basis for outcome measurement
e.g. AusTOMs - Each communication disability (e.g. stuttering
dysphonia laryngectomy aphasia) has been
described in ICF terms.
8Some challenges to the ICF from communication
disability
- Terminology not consistent with common usage
- b167 Mental functions of language (not Language
functions) - b1672 Integrative language functions (Executive
language functions) - Level of detail not consistent in ICF and not
consistent with professions requirements - Hearing function b2300 Sound detection b2301
Sound discrimination b2302 Localisation of sound
source b2304 Speech discrimination while only
three codes for language function (a more complex
function)
9Some challenges to the ICF from communication
disability
- Activity and Participation should be viewed
within the same construct (in the diagram as
well) - Capacity assumes that there is evidence for a
standard environment for communication disability - Many communication related EF are not included in
the lower level categories (see Tami Howes
presentation) - Personal factors are important and need some
further explanation and codes
10Results from our research program
Activities/Participation
Body structure and function
Activity limitations Participation restrictions
Impairment
Worrall Yiu 2000
Environmental factors
Personal factors
Barriers facilitators
11-
- This is evidence that intervention effects flow
both ways.
12Results from our research program
Quality of life
Cruice Worrall Hickson Murison 2003
13- This is evidence for the ICF framework that
Participation contributes more strongly to
Quality of Life than Impairment.
14Everyday communicative activities are complex and
highly contextualized (Worrall et al 2002)
- Level 1 (general) context - communication
activities that are likely to occur in most
cultures with most individuals - Level 2 (group) context - communication
activities that are specific to a health
condition such as TBI and/or specific to a
culture such as New Zealand Maori. - Level 3 (individual) context - communication
activities of specific individual their daily
activities interests personal challenges and
plans. Their disorder culture age gender
occupation and environment are also considered.
15- This research supports the concept that Life
roles (that Participation was originally based
on) are simply more complex and contextualized
Activities. Activities and Participation appear
to be one construct and should therefore be
combined.
16How our ICF research challenges rehabilitation
- Rehabilitation at the Activity/Participation
level can improve Impairments (challenges bottom
up linear model) - Targeting Activities/Participation directly may
have a greater effect on quality of life than
targeting Impairments but treatment for the
Impairment is still important - Functional communication cant be measured in a
standardized test it is too contextualised
17Recent ICF relevant references
- Ghidella C. Murray S. Smart M. Worrall L.
and McKenna K. Website accessibility for people
with aphasia. Aphasiology - Knight K. Worrall L. and Rose T. (in press)
The provision of health information to stroke
patients within an acute hospital setting What
actually happens and how do patients feel about
it Topics in Stroke Rehabilitation - Brennan A.D. Worrall L.E. McKenna K.T. (in
press) The relationship between specific features
of aphasia-friendly written material and
comprehension of written material for people with
aphasia. Aphasiology - Worrall L. Rose T. Howe T. Brennan A.
Egan J. Oxenham D. McKenna K. (in press)
Access to written information for people with
aphasia Aphasiology - Egan J. Worrall L. Oxenham. (in press) An
Internet training intervention for people with
traumatic brain injury barriers and outcomes
Brain Injury 1-21 - McCooey-OHalloran R. Worrall L. Hickson L.
(2004) Evaluating the role of speech-language
pathology with patients with communication
disability in the acute hospital setting using
the ICF Journal of Medical Speech Language
Pathology. - Stewart F. Worrall L. Egan. J. Oxenham D.
(2004) Addressing Internet training issues for
people with Parkinsons Disease Advances in
Speech Language Pathology 6 (4) 209-220. - Hoffman T. and Worrall L. (2004) Designing
effective written health education materials
Considerations for rehabilitation professionals
Disability and Rehabilitation - Howe T. Worrall Hickson L (2004) What is an
aphasia-friendly environment Aphasiology - Hoffman T McKenna K. Worrall L. Read S.
(2004) Evaluating current practice in the
provision of written information to stroke
patients and their carers International Journal
of Therapy and Rehabilitation - Threats T.T. Worrall L.E. (2004) Classifying
communication disability using the ICF. Advances
in Speech Language Pathology - Griffin E. McKenna K. Worrall L. (2004)
Stroke education materials on the World Wide Web
An evaluation of their quality and suitability.
Topics in Stroke Rehabilitation - Egan J. Worrall L. and Oxenham D. (2004)
Accessible Internet training package helps people
with aphasia cross the digital divide.
Aphasiology. - Rose T. A. Worrall L.E. McKenna K. (2003) The
effectiveness of aphasia-friendly principles for
printed health education materials for people
with aphasia following stroke. Aphasiology 17
(10) 947-963. - Cruice M. Worrall L. Hickson L. Murison R.
(2003) Finding a Focus for Quality of Life with
Aphasia Social and Emotional health and
Psychological Well-being. Aphasiology17 (4)
333-353. - Eames S. McKenna K. and Worrall L. (2003)
The suitability of written education materials
for stroke survivors and their carers. Topics in
Stroke Rehabilitation. 10 (3) 70-83. - Davidson B. Worrall L. Hickson L. (2003)
Identifying the communication activities of older
people with aphasia Evidence form naturalistic
observation. Aphasiology 17 (3) 243-264. - Email l.worrall_at_uq.edu.au for copies