Elizabeth Skarakis-Doyle

Towards a biopsychosocial framework of osteoarthritis of the knee.

Research into the causes of osteoarthritis (OA) of the knee has traditionally followed a biomedical approach whereby the disease development and progression is regarded as an internal physiological process. As a result, treatment has focused on symptom reduction with limited modification of psychosocial variables. In fact, psychosocial factors such as environment and employment play a substantial role in the disease process and are important determinants of the overall level of disability of affected individuals. Thus, by placing greater importance on the biomedical aspects of knee OA, a complete representation of the health condition cannot be achieved thereby limiting treatment effectiveness. The purpose of this clinical commentary is to provide a rationale for the implementation of a biopsychosocial model of knee OA that can aid in more effective research and treatment for the disorder.

Personal perception and personal factors: incorporating health-related quality of life into the International Classification of Functioning, Disability and Health

Purpose. The International Classification of Functioning, Disability and Health (ICF), introduced by the World Health Organisation in 2001, offers a unique perspective from which to view the role of rehabilitation in ones lived experience of a health condition. However, the ICF does not capture the individuals perception of that experience that is key to understanding functioning, disability and quality of life (QOL) and more specifically health-related quality of life (HRQOL). The purpose is to explore expansion of the ICF framework to incorporate personal perception to offer a more complete expression of functioning and disability. Method. We examine the concepts of HRQOL and personal perception, as well as how they have been linked to the ICF in the literature. Through a review of the foundations of the biopsychosocial model, we propose an enhanced version of the ICF that integrates HRQOL within the framework by expanding the personal factors component. Results. Through operationalising aspects of personal perception and situating them among the personal factors, we demonstrate how HRQOL may be integrated within the ICF framework. Conclusion. Using several case examples, we illustrate that if personal perception is housed within the personal factors component all other components may be influenced through mechanisms of the ICFs reciprocal interactions. In doing so, HRQOL becomes part of the experience of a health condition and functioning and disability are completely described.

Young Children's Detection of Violations in Familiar Stories and Emerging Comprehension Monitoring

This study examined young childrens ability to detect violations to script-like story text to investigate the role of detection in the development of comprehension monitoring. An online expectancy violation detection task was used during the reading of familiar stories, and nonverbal as well as verbal responses were measured. Results revealed that children 30 to 47 months of age detected violations to familiar text. However, the youngest children are not as skilled as older children in doing so. Developmentally, solely nonverbal detection responses were the first to emerge for story violations. Around 36 months of age, children not only increased the frequency of their accurate detections of violations but also incorporated their nonverbal expressions of detection into a matrix of a more thorough comprehension monitoring response.

Developmental Language Impairment through the Lens of the ICF: An Integrated Account of Children's Functioning.

UNLABELLED The conceptual framework of the World Health Organizations International Classification of Functioning, Disability and Health (ICF) has the potential to advance understanding of developmental language impairment (LI) and enhance clinical practice. The framework provides a systematic way of unifying numerous lines of research, which have linked a wide array of factors to the functioning of children with LI. The result is an integrated account of LI where childrens functioning emerges from the complex interaction of core linguistic processes, the ability to use them in social interactions, and a variety of environmental and personal factors. This account is well-suited to the clinical context because it focuses clinical attention on how such factors may be interacting to maintain a childs functional limitations, and on how they might work together to facilitate optimal everyday functioning, the ultimate goal of intervention. In this paper, the ICFs conceptual framework is described, and the nature of the relationships among its components explained. We explore how the integrated view of LI inspired by this conceptual framework differs from the prevailing impairment-driven account, provide examples from the literature that are consistent with the former view, and discuss its implications for clinical decision-making. LEARNING OUTCOMES As a result of this activity, the reader will be able to: (1) describe the nature of the relationships that exist among components of the ICF; (2) describe how interactions among components may shape the functioning of children with LI; (3) identify ways in which the integrated account of LI engendered by the ICF may improve clinical service.

Application of Vygotskian developmental theory to language acquisition in a young child with cerebral palsy

Recently, the use of a model of normal language acquisition has been questioned in terms of its application to the study of language acquisition in children with little or no functional speech. These children, particularly those with severe motoric challenges, may exhibit atypical patterns in their language development. The need to examine other developmental theories sensitive to these potential unique patterns is warranted, and the purpose of this study was to conduct such an investigation. Specifically, Vygotskys concept of the “Zone of Proximal Development” (ZPD) was used in conjunction with a normal model to develop methodology appropriate to the longitudinal study of language acquisition in a young child with cerebral palsy. Over a 10-month period, the child was engaged in collaborative interaction with an adult partner providing structured guidance (i.e., prompts) to elicit certain prelinguistic communicative functions. Overall, findings indicated an increase in the frequency of the childs commun...

The ICF as a framework for interdisciplinary doctoral education in rehabilitation: Implications for speech-language pathology

This paper describes the use of the International Classification of Functioning, Disability and Health (ICF) as an educational framework for the development of the Doctoral Programme in Rehabilitation Sciences at the University of Western Ontario in London, Canada. The ICF and the concepts underlying disability and universalism provided the framework from which the programme evolved. As a result, this interdisciplinary programme was facilitated through use of the ICF and efforts to present a common language. We believe that this framework was essential in providing an enriched educational environment for graduate students. Details of the programmes structure, its requirements, and the optimized opportunities for interdisciplinary academic study are described. Additionally, we address coursework and the explicitly designed opportunity for developing a programme of independent research for each student. This includes discussion concerning a new vision for comprehensive examination that provides an ideal opportunity for those interested in communication disorders. Finally, we reflect on both the successes and challenges that have been faced by our programme including student perceptions and the suitability of this educational model for addressing larger and more complex questions specific to functioning and disability in the context of the traditional academic environment.

A critical exploration of the International Classification of Functioning, Disability, and Health (ICF) framework from the perspective of oncology: recommendations for revision

Background: In 2001, the World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) framework in an effort to attend to the multidimensional health-related concerns of individuals. Historically, although the ICF has frequently been used in a rehabilitation-based context, the World Health Organization has positioned it as a universal framework of health and its related states. Consequently, the ICF has been utilized for a diverse array of purposes in the field of oncology, including: evaluating functioning in individuals with cancer, guiding assessment in oncology rehabilitation, assessing the comprehensiveness of outcome measures utilized in oncology research, assisting in health-related quality of life instrument selection, and comparing the primary concerns of health professionals with those of their patients. Discussion: Examination of the ICF through the lens of cancer care highlights the fact that this framework can be a valuable tool to facilitate comprehensive care in oncology, but it currently possesses some areas of limitation that require conceptual revision; to this end, several recommendations have been proposed. Specifically, these proposed recommendations center on the following three areas of the ICF framework: (1) the replacement of the term “health condition” with the more inclusive and dynamic term “health state;” (2) the continuing development and refinement of the personal factors component to ensure issues such as comorbidities can be accounted for appropriately; and (3) the inclusion of a mechanism to account for the subjective dimension of health and functioning (eg, quality of life). Summary: It is through the expansion of these conceptual parameters that the ICF may become more relevant and applicable to the field of oncology. With these important revisions, the ICF has the potential to provide a broader biopsychosocial perspective of care that captures the diverse range of concerns that arise throughout the continuum of care in oncology.

Enhancing the conceptual clarity and utility of the international classification of functioning, disability & health: the potential of a new graphic representation.

Purpose: To present a new graphic representation of the international classification of functioning, disability and health (ICF), entitled the ICF-conceptual revision (ICF-CR). The ICF-CR aims to be clearer and more usable tool than the ICF graphic currently used by starting to address criticisms of the ICF raised in the literature, with a focus on positioning quality of life (QoL) in relation to the ICF’s other components. Method: This is a conceptual paper based on a review of criticisms of the ICF and related literature published on human functioning. Results: In addition to criticisms of the current graphic, four criticisms of the ICF are discussed in relation to the development of the ICF-CR, including: the lack of development of biopsychosocial theory, the lack of clarity between activities and participation, the language used, and the absence of QoL. General systems theory is used to help construct the new graphic in addressing these criticisms and to position QoL. Conclusions: The ICF-CR is designed to be a more responsive graphic of human functioning; one which enhances the clarity of principles integral to the ICF, including biopsychosocial theory and universalism. It is hoped the ICF-CR will promote continued discussion toward the goal of enhancing the ICF, both visually and conceptually. Implications for Rehabilitation The International classification of functioning, disability and health (ICF) is a widely used framework in the disability and rehabilitation domains; however, many criticisms of the framework and its current graphic exist. The ICF-conceptual revision (ICF-CR) is a new graphic representation of the ICF that enhances its biopsychosocial content, positions quality of life (QOL) as an emergent component, and allows for dynamic visualization which is more in line with the actual nature of human functioning and QOL. Users of the ICF may find the ICF-CR useful to incorporate into their own work.

Computer-Based Language Assessment Software: The Effects of Presentation and Response Format.

Nonstandard presentation and response formats are often employed by speech-language pathologists when clients are unable to perform the pointing response required of many standardized tests. However, any adaptation to test administration potentially compromises the norming standards of that test. The present study investigated the effects of computerized presentation of the Peabody Picture Vocabulary Test-Revised (PPVT-R, Dunn & Dunn, 1981) Form M, using two computer-based response formats. Seventy-two normally developing children between the ages of 4:0 (years:months) and 8:11 participated in this study. Subjects were randomly assigned to one of three response conditions: (1) standard presentation -direct pointing, (2) computer presentation-trackball, and (3) computer presentation-automated scanning. Statistical analyses revealed that there were no differences in performance across the response conditions, which is consistent with the hypothesis that computerized testforms are equivalent to standard forms. Age was strongly related to increased accuracy regardless of condition. Thus, the adapted response formats of the computerized version constitute statistically equivalent forms of the PPVT-R and can be used with the published norms for this test.

Exploring use of the ICF in health education

Abstract Purpose: Currently, little is known regarding use of the International Classification of Functioning, Disability and Health (ICF) in health education applications. Therefore, this review sought to examine the scope of work that has been conducted regarding the application of the ICF in health education. Methods: A review of the current literature related to use of the ICF in health education programs was conducted. Twelve electronic databases were searched in accordance with a search protocol developed by a health sciences librarian. In total, 17 878 records were reviewed, and 18 articles met the criteria for inclusion in this review. Results: Current evidence regarding use of the ICF in healthcare education revealed that program and participant properties can be essential facilitators or barriers to successful education programs. In addition, gaps in comprehensive outcome measurement were revealed as areas for future attention. Educational applications of the ICF are very much a work in progress as might be expected given the ICF’s existence for only a little over a decade. Conclusions: To advance use of the ICF in education, it is important to incorporate the measurement of both knowledge acquisition and behavior change related to ICF-based programs. Ultimately, widespread implementation of the ICF represents not only a substantial opportunity but also poses a significant challenge. Implications for Rehabilitation ICF integration in health education is a relatively new, but growing phenomenon that is primarily limited to developed educational and healthcare systems. When incorporating the ICF into health education initiatives, special consideration should be paid to both the intended audience and the method of delivery.