The ICF and communication disability

1
The 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

2
Outline 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

3
What 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

4
Our 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

5
Communication 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.

6
Why 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.

7
How 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.

8
Some 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)

9
Some 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

10
Results 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.

12
Results 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.

14
Everyday 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.

16
How 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

17
Recent 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