To provide a comprehensive overview of reported effects and scientific robustness of botulinum toxin (BoNT) treatment regarding the main clinical goals related to post-stroke upper limb spasticity, using the ICF classification.
BACKGROUND: Effectiveness in health services is achieved if desired clinical outcomes are reached. In rehabilitation the relevant clinical outcome is functioning, with the International Classification of Functioning, Disability and Health (ICF) as the reference system for the standardized reporting of functioning outcomes. To foster the implementation of the ICF in clinical quality management (CQM) across the rehabilitation services continuum, the UEMS-PRM Section and Board approved an ICF implementation action plan that includes the identification of types of currently provided rehabilitation services in Europe. The objective of this paper is to report on the development of a European framework of rehabilitation service types that can provide the foundation for the standardized reporting of functioning outcomes and CQM programs.
METHODS: A multistage consensus process involving delegates (participants) from the UEMS-PRM Section and Board as well as external experts across European regions comprised the development of an initial framework by an editorial group, two feedback rounds via e-mail and a deliberation by the UEMS-PRM Section and Board in its September 2018 meeting in Stockholm (Sweden). In the first feedback round, participants were asked whether: 1) the initial framework of service types exists in their respective country: 2) the description represents the service type: and 3) an existing service type was missing. Based on the first-round results, the framework proposal was modified by the editorial group. In the second feedback round, participants were asked to confirm or comment on each of the service types in the revised framework. Based on the second-round results, the framework proposal was again modified and presented for discussion, revision and approval at the Stockholm meeting.
RESULTS: In the first feedback round, eight rehabilitation services were added to the framework proposal and two service types that were deemed “missing” were not included. In the second round, all seven initially proposed and six of the added service types were reconfirmed, while two of the added service types were not supported. Based on deliberations at the Stockholm meeting, some modifications were made to the proposed framework, and the UEMS-PRM general assembly approved a European Framework of Rehabilitation Service Types that comprises of: Rehabilitation in acute care, General post-acute rehabilitation, Specialized post-acute rehabilitation, General outpatient rehabilitation, Specialized outpatient rehabilitation, General day rehabilitation, Specialized day rehabilitation, Vocational rehabilitation, Rehabilitation in the community, Rehabilitation services at home (incl. nursing home), Rehabilitation for specific groups of persons with disability, Rehabilitation in social assistance, Specialized lifelong follow-up rehabilitation, and Rehabilitation in medical health resorts.
CONCLUSIONS: The European Framework of Rehabilitation Services Types presented in this paper will be continuously updated according to new and emerging service types. Next steps of the UEMS-PRM effort to implement the ICF in rehabilitation include the specification of clinical assessment schedules for each service type and case studies illustrating service provision across the spectrum of rehabilitation service types. The European Framework will enable the accountable reporting of functioning outcomes at the national level and the continuous improvement of rehabilitation service provision in CQM.
via European Framework of Rehabilitation Services Types: the perspective of the Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists – European Journal of Physical and Rehabilitation Medicine 2019 August;55(4):411-7 – Minerva Medica – Journals
This volume contains the International Classification of Functioning, Disability and Health, known as ICF.1 The overall aim of the ICF classification is to provide a unified and standard language and framework for the description of health and health-related states. It defines components of health and some health-related components of well-being (such as education and labour). The domains contained in ICF can, therefore, be seen as health domains and healthrelated domains. These domains are described from the perspective of the body, the individual and society in two basic lists: (1) Body Functions and Structures; and (2) Activities and Participation. 2 As a classification, ICF systematically groups different domains3 for a person in a given health condition (e.g. what a person with a disease or disorder does do or can do). Functioning is an umbrella term encompassing all body functions, activities and participation; similarly, disability serves as an umbrella term for impairments, activity limitations or participation restrictions. ICF also lists environmental factors that interact with all these constructs. In this way, it enables the user to record useful profiles of individuals’ functioning, disability and health in various domains.
ICF belongs to the “family” of international classifications developed by the World Health Organization (WHO) for application to various aspects of health. The WHO family of international classifications provides a framework to code a wide range of information about health (e.g. diagnosis, functioning and disability, reasons for contact with health services) and uses a standardized common language permitting communication about health and health care across the world in various disciplines and sciences. […]
Cross-sectional research design.
Current assessment of hand function is not focused on evaluating the real abilities required for autonomy.
To quantify the relevance of grasp types for autonomy to guide hand recovery and its assessment.
Representative tasks of the International Classification of Functioning, Disability and Health activities in which the hands are directly involved were recorded. The videos were analyzed to identify the grasps used with each hand, and their relevance for autonomy was determined by weighting time with the frequency of appearance of each activity in disability and dependency scales. Relevance is provided globally and distinguished by hand (right-left) and bimanual function. Significant differences in relevance are also checked.
The most relevant grasps are pad-to-pad pinch (31.9%), lumbrical (15.4%), cylindrical (12%), and special pinch (7.3%) together with the nonprehensile (18.6%) use of the hand. Lumbrical grasp has higher relevance for the left hand (19.9% vs 12%) while cylindrical grasp for the right hand (15.3% vs 7.7%). Relevancies are also different depending on bimanual function.
Different relative importance was obtained when considering dependency vs disability scales. Pad-to-pad pinch and nonprehensile grasp are the most relevant grasps for both hands, whereas lumbrical grasp is more relevant for the left hand and cylindrical grasp for the right one. The most significant difference in bimanual function refers to pad-to-pad pinch (more relevant for unimanual actions of the left hand and bimanual actions of the right).
The relative importance of each grasp type for autonomy and the differences observed between hand and bimanual action should be used in medical and physical decision-making.
Virtual reality is three dimensional, interactive and fun way in rehabilitation. Its first known use in rehabilitation published by Max North named as “Virtual Environments and Psychological Disorders” (1994). Virtual reality uses special programmed computers, visual devices and artificial environments for the clients’ rehabilitation. Throughout technological improvements, virtual reality devices changed from therapeutic gloves to augmented reality environments. Virtual reality was being used in different rehabilitation professions such as occupational therapy, physical therapy, psychology and so on. In spite of common virtual reality approach of different professions, each profession aims different outcomes in rehabilitation. Virtual reality in occupational therapy generally focuses on hand and upper extremity functioning, cognitive rehabilitation, mental disorders, etc. Positive effects of virtual reality were mentioned in different studies, which are higher motivation than non‐simulated environments, active participation of the participants, supporting motor learning, fun environment and risk‐free environment. Additionally, virtual reality was told to be used as assessment. This chapter will focus on usage of virtual reality in occupational therapy, history and recent developments, types of virtual reality technologic equipment, pros and cons, usage for pediatric, adult and geriatric people and recent research and articles.
Enhancement of functional ability and the realization of greater participation in community life are the two major goals of rehabilitation science. Improving sensory, motor, cognitive functions and practice in everyday activities and occupations to increase participation with intensive rehabilitation may define these predefined goals [1, 2]. Intervention is based primarily on the different types of purposeful activities and occupations with active participation [3–5]. For many injuries and disabilities, the rehabilitation process is long, and clinicians face the challenge of identifying a variety of appealing, meaningful and motivating intervention tasks that may be adapted and graded to facilitate this process .
Occupational therapy (OT), which is one of the rehabilitation professions, is a client‐centered profession that helps people who are suffering participation and occupational performance limitations. OT offers a wide range of rehabilitation strategies in different medical and social diagnosis . The common point of all these strategies in rehabilitation is that OT assesses and supports enhancing functional ability and participation throughout participating in meaningful activities in a person’s lifespan. To enhance participation, OT, like the rest of the health professions, uses World Health Organization’s International Classification of Functioning, Disability and Health (ICF) to understand function in a biopsychosocial manner. In ICF framework, function is defined as the interactions between an individual, their health conditions and the social and personal situations in which they thrive. The complex interactions between these variables define function and disability .
ICF classifies health and health‐related fields in two groups. These groups are “body functions” and “body structures” and “activity and participation.” Sub heading of these groups is considered as body function and structures (physical, physiological etc), activities (daily tasks) and participation (life roles) . When these groups taken into account in rehabilitation, occupational therapists focus on all areas to enhance a client’s activity participation, social participation, etc. However, in current literature, there are various rehabilitation approaches that are being used for this aim. Advancements in technology in the twenty‐first century create great opportunities for people working in different areas. In particular, in health practices like rehabilitation, technology supports therapists’ to rehabilitate their clients in too many different ways like robotics, stimulation devices, assessment tools and virtual reality [6–10].
The quality of life in neurological disorders (Neuro-QoL) is a U.S. National Institutes of Health initiative that produced a set of self-report measures of physical, mental, and social health experienced by adults or children who have a neurological condition or disorder.
To describe the content of the Neuro-QoL at the item level using the World Health Organization’s international classification of functioning, disability and health (ICF).
We assessed the Neuro-QoL for its content coverage of functioning and disability relative to each of the four ICF domains (i.e., body functions, body structures, activities and participation, and environment). We used second-level ICF three-digit codes to classify items into categories within each ICF domain and computed the percentage of categories within each ICF domain that were represented in the Neuro-QoL items.
All items of Neuro-QoL could be mapped to the ICF categories at the second-level classification codes. The activities and participation domain and the mental functions category of the body functions domain were the areas most often represented by Neuro-QoL. Neuro-QoL provides limited coverage of the environmental factors and body structure domains.
Neuro-QoL measures map well to the ICF. The Neuro-QoL–ICF-mapped items provide a blueprint for users to select appropriate measures in ICF-based measurement applications.
We investigated intracortical facilitation (ICF) in M1 after unilateral long term hand training.
Motor performance improved for both hands but ICF was only altered for the untrained hand.
The ICF-decrease is associated with a transfer of training-induced improvement of performance.
Repetitive unilateral upper limb motor training does not only affect behavior but also increases excitability of the contralateral primary motor cortex (M1). The behavioral gain is partially transferred to the non-trained side. Changes in M1 intracortical facilitation (ICF) might as well be observed for both hand sides. We measured ICF of both left and right abductor pollicis brevis muscles (APB) before and after a two-week period of arm ability training (AAT) of the left hand in 13 strongly right handed healthy volunteers. Performance with AAT-tasks improved for both the left trained and right untrained hand. ICF for the untrained hand decreased over training while it remained unchanged for the left trained hand. Decrease of ICF for the right hand was moderately associated with an increase of AAT-performance for the untrained right hand. We conclude that ICF-imbalance between dominant and non-dominant hand is sensitive to long-term motor training: training of the non-dominant hand results in a decrease of ICF of the dominant hand. The ICF-decrease is associated with a transfer of training-induced improvement of performance from the non-dominant to the dominant hand.
Objective: This review determines the effects of virtual reality interventions for stroke subjects based on the International Classification of Functioning, Disability,and Health (ICF) framework. Virtual reality is a promising tool for therapy for stroke rehabilitation, but the effects of virtual reality interventions on post-stroke patients based on the specific ICF domains (Body Structures, Body Functions, Activity, and Participation) have not been investigated.
Method: A systematic review was conducted, including trials with adults with a clinical diagnosis of a chronic, subacute, or acute stroke. Eligible trials had to include studies with an intervention protocol and follow-up, with a focus on upper limbs and/or lower limbs and/or balance. The Physiotherapy Evidence Database (PEDro) was used to assess the methodological quality of randomized controlled trials. Each trial was separated according to methodological quality into a high-quality trial (PEDro ≥ 6) and a low-quality trial (PEDro ≤ 6). Only high-quality trials were analyzed specifically based on the outcome of these trials.
Results: In total, 54 trials involving 1811 participants were included. Of the papers included and considered high quality, 14 trials evaluated areas of the Body Structures component, 20 trials of the Body Functions domain, 17 trials of the Activity component, and 8 trials of the Participation domain. In relation to ICF Part 2, four trials evaluated areas of the Personal Factors component and one trial evaluated domains of the Environmental Factors component.
Discussion: The effects of virtual reality on stroke rehabilitation based on the ICF framework are positive in Body Function and Body Structure. However, the results in the domains Activity and Participation are inconclusive. More high-quality clinical trials are needed to confirm the effectiveness of virtual reality in the domains of Activity and Participation.
The effectiveness of “hands-on” physiotherapy for stroke is unclear. The objective here is to analyze the effectiveness of such interventions on movement-related International Classification of Functionality, Disability and Health (ICF) categories. A systematic review was undertaken of randomized controlled trials published since 1980, using the following criteria: stroke, humans, ≥ 18 years, outcomes related to ICF movement-related categories, physiotherapeutic handling techniques, control group as placebo or no intervention, including experiments where both groups have the same intervention and the experimental group has one extra intervention. Nine studies were included and a best evidence synthesis is presented. Recommendations with limited evidence favor slow-stroke back massage for shoulder pain, range-of-motion exercises for upper-limb and lower-limb structures and functions of muscles and joints, proprioceptive neuromuscular facilitation (PNF) for gait step, walking backwards with hip facilitation for gait parameters and performance, and conventional physiotherapy with facilitation techniques for gait parameters. Recommendations with indicative findings favor PNF with trunk rhythmic stabilizations for function and mobility of upper limbs. Recommendations with limited evidence show the non-efficacy of Bobath therapy for upper-limb function and activity and facilitation of the step on body weight support treadmill training for gait parameters and performance. In conclusion, some hands-on interventions have limited evidence in stroke rehabilitation.
via Taylor & Francis Online :: Hands-on physiotherapy interventions and stroke and International Classification of Functionality, Disability and Health outcomes: A systematic review – European Journal of Physiotherapy –.
Background: Homonymous visual field defects (HVFD) are common after postchiasmatic acquired brain injury and may have a significant impact on independent living and participation in society. Vision-related difficulties experienced in daily life are usually assessed using questionnaires. The current study 1) links the content of 3 of these questionnaires to the International Classification of Functioning, Disability and Health (ICF) and 2) provides analyses of vision-related difficulties reported by patients with HVFD and minimal comorbidities.
Methods: Fifty-four patients with homonymous hemianopia or quadrantanopia were asked about difficulties experienced in daily life because of their HVFD. This was performed during a structured interview including 3 standardized questionnaires: National Eye Institute Visual Functioning Questionnaire, Independent Mobility Questionnaire, and Cerebral Visual Disorders Questionnaire. The reported difficulties were linked to the ICF according to the ICF linking rules. Main outcome measures were presence or absence of experienced difficulties.
Results: The ICF linking procedure resulted in a classification table that can be used in future studies of vision-related difficulties. Besides well-known difficulties related to reading, orientation, and mobility, a high proportion of patients with HVFD reported problems that previously have not been documented in the literature, such as impaired light sensitivity, color vision, and perception of depth.
Conclusions: A systematic inventory of difficulties experienced in daily life by patients with HVFD was performed using the ICF. These findings have implications for future study, assessment and rehabilitation of patients with HVFD.