SWING and the ICF International Classification of Functioning

SWING and the ICF International Classification of Functioning, Disability and Health

Session Learning Outcomes By the end of the session you will have: • A basic knowledge of ICF and definitions related to people and their disabilities • Awareness of the biopsychosocial approach to disability • Insight into the benefits of assistive technology (AT) in improving performance • A basic knowledge of the appropriate use of AT.

Activity (15 min) – Think about the definitions below related to people and their disabilities Disabled people Differently abled People with special needs Invalid Impairment ? Deficit People with disabilities Handicapped

DEFICIT By deficit, is an absence, any kind of “malformation”, a lack of or anomaly in an organ, etc. of a mental, psychological or physiological function. Example of a deficit situation: deaf person: their sensory deficit, manifested through a reduced or total inability to perceive sounds and noises, represents a permanent characteristic. It’s an “objective” feature, measurable in the same way as their body type, colour of hair, colour of eyes, etc. The use of a hearing aid which compensates for or amplifies the missing function of the sensory organ can, to some extent, reduce the effects of the deficit: helping increase auditory perception, but without modifying the deficit or malfunction of the auditory system, which remains unchanged.

HANDICAP A handicap is the result of a social and cultural process: it is the consequence of the meeting between the individual – with her/his own physical and psychological (including any deficits) characteristics – and their personal history and context. Example of a handicap situation: A person with an auditory deficit, can develop a personal history of adaptation to the different contexts in which they find themselves growing up and living. This deaf person may be surrounded by an environment which does not consider their deficit a serious impediment and, therefore, does not undervalue them as an individual. Or vice versa.

DIFFERENCE Difference between deficit and disability (handicap): DEFICIT is a “given” element, which cannot be modified and, in contemporary medical terms, is irreversible and permanent. HANDICAP is not innate in a person, but is a “contextual condition”. We speak of a “handicapping situation” (which can occur even when there is no deficit), determined by the meeting between diverse variables, therefore modifiable.

International Classification of Impairments, Disabilities and Handicaps (1980) IMPAIRMENT (Deficit) any loss or abnormality of psychological, physiological or anatomical structure or function BODY DISABILITY HANDICAP any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. a disadvantage for a given individual that limits or prevents the fulfillment of a role that is normal ACTIVITY SOCIETY

Deficit, Disability, Handicap (10 min) – Identify and discuss a case example that shows the difference between the impairment, disability and handicaps as shown below. DEFICIT Cerebral Palsy - inability to move the legs - inability to bear weight on the feet -Inability to move hands properly Aids: orthotics and surgery Severe dyslexia - inability to associate sounds with symbols DISABILITY -inability to walk. - inability to use a keyboard HANDICAP - Social exclusion (architectural barriers, lack of AT, etc) -Difficulty in using public transport Aids: Walkers, braces, special keyboard - inability to read -Learning difficulties (lack of AT, alternative Reading strategies, visual Learning, etc)

ICF (2001) Maps the basic concepts of a person’s health and functioning and aims to provide a unified and standard language and framework for the description of health and health-related states. The ICF is structured around the components: - Body functions and structure - Activities (related to tasks and actions by an individual) and participation (involvement in a life situation) -Additional information on severity and environmental factors. Functioning and disability are viewed as a complex interaction between personal factors, the health condition and contextual factors of the environment.

ICF (2001)

ICF (2001) One of the major innovations in ICF is the presence of an environmental factor classification that makes it possible for the identification of environmental barriers and facilitators (e. g. ICT, AT) for both capacity and performance of actions and tasks in daily living. Performance describes what an individual does in his or her current environment. Performance can also be understood as "involvement in a life situation" or "the lived experience" of people in their actual context. Capacity describes an individual’s ability to execute a task or an action.

LEVELS OF HUMAN FUNCTIONING • Body Functions are physiological functions of body systems (including psychological functions) and Body Structures are anatomical parts of the body such as organs, limbs and their components; • Activity is the execution of a task or action by an individual; • Participation is involvement in a life situation.

ICF application • individual level (assessment of individuals; individual treatment planning; evaluation of treatment and other interventions; communication among physicans, nurses, physiotherapists, occupational therapists and other health works, social services and commmunity agencies; self-evaluation by consumers); • institutional level (educational and training purposes; resource planning and development; quality improvement; management and outcome evaluation; managed care models of health care delivery); • social level (eligibility criteria for state entitlements such as social security benefits, disability pensions, workers’ compensation and insurance; social policy development, including legislative reviews, model legislation, regulations and guidelines, and definitions for antidiscrimination legislation; needs assessments; environmental assessment for universal design, implementation of mandated accessibility, identification of environmental facilitators and barriers, and changes to social policy).

Assistive Technology A broad range of devices, services, strategies, and practices that are used to solve the problems faced by individuals who have disabilities. Cook, A. M. & Hussey, S. M. (2002) Assistive Technologies: Principles and Practice, 2 nd Edn. St. Louis, USA, Mosby. /RICHES - KICK-OFF MEETING 9 -10 th December 2013

Case Study 1 (15 min) – Read the following case study and idenitify deficit and possible handicaps, barriers and facilitators (included ICT). Description: - Name: Nikolaos Souflakos - Age: 25 - Location: Nicosia, Cyprus - Marital status: Single - Job: Unemployed - Impairment: Traumatic brain injury Nikolaos (31) lives in Nicosia, Cyprus, and was involved in a severe car accident when he was 19 years old. He was in a coma for 5 months and experienced permanent neurobiological damage. He was able to fully recover from his back injury he sustained during the same accident. Nikolaos has difficulty speaking and being understood (expressive aphasia) while also experiencing blurred vision.

Case study 1 Nikolaos Souflakos Possible AT solutions: To communicate with his peers, Nikolaos uses software on his PC that allows him to communicate using symbols which are transferred to sound. In addition, he also uses text to speech software despite the fact that his linguistic skills were severely affected by his brain injury. He therefore uses word prediction software. On his mobile, he also uses such word prediction software and a simplified interface based on symbols. He mainly uses Nokia phones because the menu structure is similar across all newer models. This persona was created for the ACCESSIBLE project which is financially supported by the European Commission (www. accessible-project. eu – Accessible Applications Design and Development). This persona is licensed under a Creative Commons Attribution-Share Alike 3. 0 License.

Case Study 2 (15 min) – Read the following case study and idenitify deficit and possible handicaps, barriers and facilitators (included ICT). Description: Marta Guglielmi was a severly dyslexic student who failed her first year of Medicine. As a result of This failure, her academic tutors advised her that she ought to seek advice from Dyslexia Support Services. Since the identification of her dyslexia, she received academic skills tuition from a specialist tutor. She was taught many strategies to enable her to cope with the rigorous demands of her chosen course of study. Her dyslexic profile is typical of the experiences related by dyslexic students who have not been identified until they reached HE: -Never seemed to obtain results that reflected time and effort - Reflective learner who lacked self-confidence in academic skills -Oral sentence structure lacked sequential fluency - Could not process different types of information simultaneously (multi-tasking)

Case Study 2 Marta Guglielmi Possible AT solutions: - Mind-mapping software: in a creative manner to support her individual cognitive style. - Text-to-speech software: to support her hesitant reading skills and to develop critical reading skills -Talking spelling checker and thesaurus: to by-pass her weak visual memory skills and to tap into her auditory strength and ensure accuracy and efficiency. -Coloured acetates and individualised screen colour backgrounds: to reduce visual stress when reading This persona is coming from Riddick et al. , 1999; Mc. Loughlin, 2001

Case Study 3 (15 min) – Read the following case study and idenitify deficit and possible handicaps, barriers and facilitators (included ICT). Description: Name: Paulina Reyes - Age: 25 - Location: Murcia, Spain - Marital status: Single - Job: Unemployed - Impairment: Blind Paulina (25) was born blind, and lives in Murcia, Spain. Due to her visual impairment, Paulina was unable to find a job after finishing high school. The only job opportunities she had would have required her to move, which Paulina and her family did not want to do. She started taking guitar lessons and can now play it to a good standard It was not easy to learn in the beginning. She cannot read regular music scores so she has to use music Braille.

Case Study 3 Paulina Reyes Possible AT solutions – Part 1: Paulina uses her PC on a daily basis for the text editor to write letters for job applications and to visit Yahoo and check her emails using Internet Explorer. She tried Hotmail and later Gmail, but there just was too much information on the page. Yahoo email works well with her Jaws screenreader. She also uses OCR software, a Braille embosser, and Adobe reader speech output. The combination of all these technologies enables Paulina to use her PC to a satisfactory degree. However, the investments she and her family had to make to acquire this technology put some pressure on the family finances. The internet was also an enormous help in finding information, Braille music scores, and mp 3 music. Paulina bought herself a smartphone which she uses practically all the time. This persona was created for the ACCESSIBLE project which is financially supported by the European Commission (www. accessible-project. eu – Accessible Applications Design and Development). This persona is licensed under a Creative Commons Attribution-Share Alike 3. 0 License.

Case Study 3 Paulina Reyes Possible AT solutions – Part 2: Her choice of smartphone took into account its ease of use and came recommended by a friend who is also blind. The device has large enough keys that provide lots of tactile feedback when pressed. Paulina uses it to call friends and family and to text, maintain her calendar, and listen to audiobooks she downloads from the internet. She uses a VOCA to read her text messages but, unfortunately, the Spanish output often has a faulty pronunciation. This persona was created for the ACCESSIBLE project which is financially supported by the European Commission (www. accessible-project. eu – Accessible Applications Design and Development). This persona is licensed under a Creative Commons Attribution-Share Alike 3. 0 License.