Third party disability of family members of adults with dysphagia

Background: Third-party disability (TPD) has been studied in multiple patients including those with aphasia and hearing loss. Only one study has been done in relation to caregivers of adults with dysphagia. Third-party disability has been analysed using the International Classification of Function and Disability (ICF) framework. This study, therefore, used the ICF model to explore TPD of caregivers of adults with dysphagia for the context of Johannesburg in South Africa. Objectives: To describe how caregivers experience TPD when caring for adults with a dysphagia in Johannesburg. Methods: Data were collected from five primary adult caregivers, who were all family members, from government clinics in Johannesburg. This article reports the findings from the interviews that were analysed thematically using a top-down analysis approach. Results: Caregivers experienced challenges related to TPD mostly related to difficulties of being able to do activities of daily living for themselves, their household chores and attending social engagements. The use of body structure and function from the ICF model was not overtly applicable to the caregiver population. A new visual representation has been suggested to highlight the key themes to augment the social and psychological changes as seen on the ICF framework and demonstrated the specific interaction that these factors had on one another. Conclusion: Third-party disability is present in caregivers of patients with dysphagia. Healthcare workers need to be aware of the impact that this can have when preparing home management strategies. This newly devised representation can assist in creating a locally relevant patient-centred care approach but requires future input.

Pronóstico kinesiológico cardiorrespiratorio: un enfoque biopsicosocial / Cardiorespiratory Kinesiological Prognosis: a biopsychosocial approach

La kinesiología, fisioterapia o terapia física, se ha desarrollado de manera permanente a través de una perspectiva biopsicosocial, en la que identificar el contexto biomédico del usuario, junto con sus limitaciones en la actividad y restricciones en la participación es esencial para una atención individualizada del usuario en su contexto. Entidades como la Asociación Americana de Terapia Física (American Physical Therapist Association, APTA) y la Conferencia Mundial de Terapia Física (World Confederation for Physical Therapy, WCPT) o actualmente conocida como Fisioterapia Mundial (World Physiotherapy, WP), conceden como aspecto propio del kinesiólogo o fisioterapeuta la acción de diagnosticar, evaluar, tratar y pronosticar las disfunciones de usuarios con necesidades de atención en salud. Sin embargo, algunas de estas competencias profesionales no están del todo definidas para su aplicación en la práctica clínica. El presente artículo de comunicación profesional entrega las bases conceptuales en la que se sostienen los hitos necesarios para esta-blecer una propuesta metodológica de elaboración del pronóstico kinesiológico funcional basado en el área cardiorrespiratoria con un enfoque biopsicosocial según la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF). Esto, con la finalidad de que el pronóstico funcional sea incorporado como parte de la formación curricular en la profesión, así como dentro de un proceso continuo en la práctica kinesiológica

Kinesiology, Physiotherapy or Physical Therapy has been permanently developed on a biopsychosocial perspective. Identifying the user's biomedical context, along with his or her activity limitations and participation restrictions, is essential for individualized attention to the user in his or her context. Entities such as the American Physical Therapy Association and the World Confederation for Physical Therapy, or currently known as World Physiotherapy, give the kinesiologist or physical therapist the task of diagnosing, evaluating, treating, and predicting the dysfunctions of users with health care needs. However, some of these professional compe-tencies are not wholly defined for application in clinical practice, and less, in the curricular formation of the physiotherapy students. This article gives helpful concepts to elaborate a biopsychosocial cardiorespiratory functional prognosis for Kinesiology, based on the International Classification of Functioning, Disability, and Health (ICF), to incorporate as part of the curricular formation in the profession and within a continuous process in kinesiological practice

Quality of life and its predicting factors for Tunisian children with cerebral palsy

Background: Cerebral palsy (CP) can cause motor, sensory, perceptual, cognitive, communication and behavioural disorders. The complexity of this condition justifies measuring the quality of life (QOL) of children with CP. This measurement depends on personal and socio-economic factors, hence the relevance of performing it in our cultural context of Tunisia. Objectives: The objectives of this study were to assess the QOL of Tunisian children with CP and to identify predictive factors for QOL. Method: A cross-sectional study using a self-administered questionnaire (the CP QOL-Child) was employed. It included 68 children with CP and their parents who consulted the outpatient clinics of Physical Medicine and Rehabilitation of the University Hospital of Sahloul Sousse. Results: The QOL of children with CP was altered, and the mean total score for the CP QOL-Child was 59.3 (± 14). All domains were affected by this alteration. Six predictive factors for lowered QOL in children with CP were identified, namely age older than 6 years, swallowing disorders, more intense chronic pain, greater level of motor impairment, the use of botulinum toxin injection and the absence of verbal communication. Conclusion: Intervention with children with CP must be mindful of their altered QOL. Five out of the six predictive factors of QOL are modifiable through a multidisciplinary approach within the framework of the International Classification of Functioning, Disability and Health (ICF). Contribution: The multiplicity of the factors associated with QOL revealed by this study incites clinicians to adopt the ICF approach by displaying its practical implications on the efficiency of the medical intervention.

Use of the activities and participation profile to assess the functioning of physically inactive elderly / Uso do perfil de atividades e participação para avaliação da funcionalidade de idosos inativos fisicamente

Abstract Introduction: Physical inactivity negatively impacts the functional status of the elderly during aging. Objective: To describe the activity and participation profile of physically inactive elderly and to investigate associated factors. Methods: A cross-sectional study with physically inactive elderly, aged ≥ 60 years, both sexes, with good cognitive function and independent gait. Personal factors, clinical history, history of falls in the last year, and identification of activity and participation profiles were investigated. Nonparametric statistical tests (SPSS 20.0) were performed, considering p < 0.05 significant. Results: The elderly (n = 36) had a mean age of 72.5 years (±7.7). Most were women (78%), with one to four years of education (69%), retired (72%), referring episodes of falling (58%) and affected by two to four comorbidities (53%). In the activities and participation profile, most of the physically inactive elderly presented mild problems for: crawling, kneeling, squatting, walking long distances, walking on different surfaces, walking around obstacles, climbing, and using public transportation. However, kneeling, squatting, walking on different surfaces, and climbing represented higher percentages of elderly who presented some problem. The advancement of age (p = 0.045), female sex (p = 0.022), episodes of falls (p = 0.037), and comorbidities (p = 0.031) were identified as factors that can impact functioning. Conclusion: The physically inactive elderly presented a mild problem in activities and participation items that are more related to strength and walking. Elderly aged over 70, female, with episodes of falls and comorbidities were significantly associated with reduced or impaired functioning.

Resumo Introdução: A inatividade física impacta negativamente a funcionalidade dos idosos durante o envelhecimento. Objetivo: Descrever o perfil de atividade e participação de idosos inativos fisicamente e investigar fatores associados. Métodos: Estudo transversal com idosos inativos fisicamente, ≥ 60 anos, ambos os sexos, boa função cognitiva e independentes na marcha. Foram investigados fatores pessoais, história clínica, histórico de quedas no último ano e identificação do perfil de atividade e participação. Foram realizados testes estatísticos não paramétricos (SPSS 20.0), considerando p < 0,05. Resultados: Os idosos (n = 36) apresentaram média de 72,5 anos (± 7,7). A maioria era mulher (78%), com escolaridade de um a quatro anos de estudo (69%), aposentados (72%), referindo episódios de queda (58%) e acometidos por duas a quatro comorbidades (53%). No perfil de atividades e participação, a maioria dos idosos inativos fisicamente apresentaram problema leve para os itens: engatinhar, ajoelhar-se, agachar-se, andar longas distâncias, andar sobre superfícies diferentes, andar desviando-se de obstáculos, subir e utilizar transporte público. Entretanto, ajoelhar-se, agachar-se, andar sobre superfícies diferentes e subir compreendem maiores percentuais de idosos que apresentaram algum problema. Idade avançada (p = 0,045), sexo feminino (p = 0,022), episódios de quedas (p = 0,037) e presença de comorbidades (p = 0,031) foram identificados como fatores que podem impactar na funcionalidade. Conclusão: Idosos inativos fisicamente apresentaram problema leve nos itens das atividades e participação que estão mais relacionados à força e ao andar. Idosos com mais de 70 anos, do sexo feminino, com presença de episódios de quedas e de comorbidades, apresentaram associação significativa com a funcionalidade reduzida ou prejudicada.

Elaboração e validação de instrumento baseado no Core Set resumido da classificação internacional da funcionalidade para indivíduos com lesão medular aguda / Development and validation of an instrument based on the summarized Core Set of the international classification of functioning for individuals with acute spinal cord injury

A Lesão de Medula Espinhal (LME) é um trauma com efeitos devastadores na vida dos indivíduos. Estima-se que mais de 130.000 pessoas sejam afetadas por LME, a cada ano, em todo o mundo. Aproximadamente, 45% de todas as lesões são completas, deixando apenas uma pequena chance de recuperação funcional. As complicações ocasionadas pela LME influenciam a qualidade de vida dos indivíduos, aumentam as demandas de cuidados e os encargos sociais e econômicos de saúde. Este é um estudo metodológico, que teve o objetivo de construir e validar instrumento baseado no Core Set resumido da CIF, para indivíduos com lesão medular aguda traumática. Essa pesquisa foi aprovada pelo Comitê de Ética e desenvolvida nas seguintes etapas: 1 - Elaboração do instrumento a partir do Core set resumido da CIF para lesão medular aguda: "Elaboração e Validação de Instrumento baseado no Core Set resumido da Classificação Internacional da Funcionalidade para indivíduos com Lesão Medular Aguda"; 2- Validação do instrumento e coleta de dados pelos juízes; 3- Aplicação do pré-teste. O instrumento para validação de face e conteúdo composto por 15 categorias que integraram os componentes da CIF: funções do corpo (6), estrutura do copo (2), atividades e participação (2), fatores ambientais e fatores pessoais (5). A validade de conteúdo do instrumento foi feita por um comitê de vinte e dois juízes. Dos 22 juízes, 18 (81,8%) eram do sexo feminino e 4 (18,2%) do sexo masculino. A maioria era constituída por jovens, com média entre 40±10 anos, sendo que 3 participantes (13,6%) tinham idade entre 20 e 29 anos, 8 (36,4%) de 30 e 39 anos, 7 (31,8%) entre 40 e 49 anos, 3 (13,6%) 50 e 59 anos e 1 (4,5%) 60 e 69 anos. Cerca de 95,5 % relataram participar, nos últimos 2 anos, de eventos científicos na área temática da pesquisa, 13 (59,1%) realizavam estudos sobre a CIF e 14 (63,6%) a utilizavam na sua prática clínica. Todas as categorias obtiveram uma concordância de IVC >0,80, sendo assim, o instrumento, pode ser considerado validado. Na maioria das categorias, os juízes fizeram sugestões que visavam às modificações de termos, para serem substituídos ou reformulados, e os qualificadores repontuados, de acordo com os percentuais da CIF. Após consenso entre os pesquisadores foram realizadas as alterações sugeridas e elaborada a versão final do instrumento, com aplicação do pré-teste. O instrumento validado poderá contribuir para prática clínica dos profissionais da saúde, no processo de avaliação da funcionalidade dos indivíduos com lesão medular aguda

Spinal Cord Injury (SCI) is a trauma with devastating effects on the lives of individuals. It is estimated that more than 130,000 people are affected by SCI each year worldwide. Approximately 45% of all injuries are complete, leaving only a small chance of functional recovery. The complications caused by SCI influence the quality of life of individuals, increase the demands for care, and increase the social and economic burden of health care. This is a methodological study, which aimed to construct and validate an instrument based on the summarized ICF Core Set for individuals with traumatic acute spinal cord injury. This research was approved by the Ethics Committee and developed in the following stages: 1 - Development of the instrument from the summarized ICF core set for acute spinal cord injury: "Development and validation of an instrument based on the summarized core set of the International Classification of Functioning for individuals with acute spinal cord injury"; 2 - Validation of the instrument and data collection by the judges; 3 - Application of the pre-test. The instrument for face and content validation consisted of 15 categories that integrated the ICF components: body functions (6), body structure (2), activities and participation (2), environmental factors and personal factors (5). The content validity of the instrument was done by a committee of twenty-two judges. Of the 22 judges, 18 (81.8%) were female and 4 (18.2%) were male. The majority were young, averaging 40±10 years, with 3 participants (13.6%) aged 20-29 years, 8 (36.4%) 30-39 years, 7 (31.8%) 40-49 years, 3 (13.6%) 50-59 years, and 1 (4.5%) 60-69 years. About 95.5% reported participating, in the last 2 years, of scientific events in the thematic area of the research, 13 (59.1%) carried out studies about the ICF and 14 (63.6%) used it in their clinical practice. All categories obtained a CVI agreement >0.80, thus, the instrument can be considered validated. In most of the categories, the judges made suggestions that aimed at the modification of terms, to be replaced or reformulated, and the qualifiers were re-assessed, according to the ICF percentages. After consensus was reached among the researchers, the suggested changes were made and the final version of the instrument was prepared, with the application of the pre-test. The validated instrument may contribute to the clinical practice of health professionals in the process of evaluating the functionality of individuals with acute spinal cord injury

Are there still sex differences in the functioning of the elderly? / Ainda existem diferenças de sexo na funcionalidade dos idosos?

Abstract Introduction: Sex is one of the demographic characteristics that better differentiates the independence of the elderly, despite this distinction not being consensual. Objective: To know the differences in functioning associated with sex in elderly people aged ≥ 65 years according to the International Classification of Functioning, Disability, and Health (ICF). Methods: This was an analytical and cross-sectional observational study with a sample of 451 subjects. The instruments were a sociodemographic questionnaire identical to a ICF checklist and the Biopsychosocial Assessment Method. The student t, Mann-Whitney, chi-square, and Spearman correlation tests were used considering p < 0.05. Results: The average age was between 79.5 ± 7.5 years with a female prevalence (62.1%). Of the 43 variables studied, sex differences were found in 17 (39.5%). In the personal factors, women showed greater vulnerability in conjugality (p ≤ 0.001), cohabitation (p = 0.037), and economic income (p = 0.002). Nonetheless, they showed healthier behaviors in all health-related habits. As for environmental factors and body functions, greater fragility was once again observed in women: the need for assistive devices (p ≤ 0.001) and urinary incontinence (p = 0.021). In activities/participation, differences were found in mobility, where women experienced more restrictions, whereas men were more dependent on washing/drying clothes in domestic life (p = 0.022). Conclusion: Women are more unprotected in social and economic areas, while men showed more vulnerability in habits related to health. These differences are linked to demographic issues related to longevity, cultural differences, and socialization, and differences regarding activities/participation tend to dilute between sexes.

Resumo Introdução: O sexo é das caraterísticas demográficas que mais diferencia a independência dos idosos, apesar dessa distinção não ser consensual. Objetivo: Conhecer as diferenças da funcionalidade associadas ao sexo, de acordo com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) em idosos com idade ≥ 65 anos. Métodos: Estudo observacional, analítico e transversal com uma amostra de 451 indivíduos. Os instrumentos utilizados foram um questionário sociodemográfico idêntico à checklist da CIF e o Método de Avaliação Biopsicossocial. Utilizaram-se os testes de T-Student, Mann-Whitney, Qui-Quadrado e Correlação de Spearman, considerando-se p < 0,05. Resultados: A média de idade foi de 79,5 ± 7,5 anos, observando-se uma prevalência feminina (62,1%). Das 43 variáveis estudadas, foram encontradas diferenças entre os sexos em 17 (39,5%). Nos fatores pessoais, as mulheres apresentaram maior vulnerabilidade na conjugalidade (p ≤ 0,001), na coabitação (p = 0,037) e no rendimento econômico (p = 0,002). Em todos os hábitos relacionados com a saúde, contudo, revelaram comportamentos mais saudáveis. Nos fatores ambientais e nas funções do corpo, observou-se novamente maior fragilidade nas mulheres: na necessidade de dispositivos de auxílio (p ≤ 0,001) e na incontinência urinária (p = 0,021). Nas atividades/participação, as mulheres apresentaram maior restrição na mobilidade e os homens na vida doméstica (lavar/secar roupa p = 0,022). Conclusão: As mulheres apresentam-se mais desprotegidas nas dimensões social e econômica, enquanto os homens manifestam hábitos de saúde mais vulneráveis. Estas diferenças estão ligadas às questões demográficas de longevidade e às diferenças culturais e de socialização. As diferenças nos domínios das atividades/participação tendem a diluir-se entre os sexos.

Activity and participation experiences of people with disabilities in Ethiopia

Ethiopia, as a State Party to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), has committed to upholding the rights of people with disabilities in Ethiopia. There is little evidence, however, reflecting the impact of this commitment on the lived experiences of people with disabilities in Ethiopia. Objectives: This study sought to uncover how the experiences of participation and activity shape the enactment of rights for Ethiopians with disabilities as enshrined in the UNCRPD. Method: Analysis of 25 qualitative interviews with people with disabilities and family members living in Ethiopia used a reflexive thematic analysis approach to arrive at central themes. Results: People with disabilities in Ethiopia experience marginalization, distress and practical challenges in both routine daily activities and participation in broader social roles and opportunities. These experiences affect their ability to claim many of the rights afforded by the UNCRPD. Conclusion: Despite legislative efforts to bring about change in Ethiopia, people with disabilities continue to live on the social margins. A meaningful change will require substantial allocation of needed resources by the Ethiopian government to support national-level programs and policy change. It is critical that people with disabilities and their families are engaged in receiving relevant support and serve as change leaders. Contribution: This study illustrates how marginalization, distress and practical challenges in daily activities and social participation arise and are sustained for people with disabilities in Ethiopia. The findings can help to inform the country's efforts to enact the rights of Ethiopians with disabilities as enshrined in the United Nations Convention on the Rights of Persons with Disabilities

Activity and participation experiences of people with disabilities in Ethiopia

Ethiopia, as a State Party to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), has committed to upholding the rights of people with disabilities in Ethiopia. There is little evidence, however, reflecting the impact of this commitment on the lived experiences of people with disabilities in Ethiopia. Objectives: This study sought to uncover how the experiences of participation and activity shape the enactment of rights for Ethiopians with disabilities as enshrined in the UNCRPD. Method: Analysis of 25 qualitative interviews with people with disabilities and family members living in Ethiopia used a reflexive thematic analysis approach to arrive at central themes. Results: People with disabilities in Ethiopia experience marginalisation, distress and practical challenges in both routine daily activities and participation in broader social roles and opportunities. These experiences affect their ability to claim many of the rights afforded by the UNCRPD. Conclusion: Despite legislative efforts to bring about change in Ethiopia, people with disabilities continue to live on the social margins. A meaningful change will require substantial allocation of needed resources by the Ethiopian government to support national-level programmes and policy change. It is critical that people with disabilities and their families are engaged in receiving relevant support and serve as change leaders. Contribution: This study illustrates how marginalisation, distress and practical challenges in daily activities and social participation arise and are sustained for people with disabilities in Ethiopia. The findings can help to inform the country's efforts to enact the rights of Ethiopians with disabilities as enshrined in the United Nations Convention on the Rights of Persons with Disabilities

Actualidad: Perspectiva sobre discapacidad e inclusión en educación superior

Resumen Alrededor del 15% de la población mundial se encuentra en condición de discapacidad, cifras que van en aumento debido al incremento de las enfermedades crónicas no transmisibles, el envejecimiento, la accidentalidad y la violencia, adicionalmente, se considera que algún momento de la vida todos presentaremos algún tipo de discapacidad; este concepto ha cambiado a lo largo de la historia con diversos modelos, sin embargo actualmente, bajo el marco teórico de la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF), la discapacidad es entendida no solo como alteraciones anatómicas y/o fisiológicas, sino como la limitación en la realización de las actividades y la restricción en la participación, para lo cual interactúan diversos factores contextuales. La discapacidad se relaciona con aumento en la vulnerabilidad, lo que incluye el acceso a la educación, la cual es una base para el desarrollo personal y social, asociada además con mejora en la calidad de vida y la participación de las personas en condición de discapacidad, por lo que los países e instituciones deben aunar esfuerzos, ratificar compromisos y ejecutar estrategias para favorecer la inclusión educativa.

Abstract Around 15% of the world population is disabled, figures that are increasing due to the increase in chronic non-communicable diseases, aging, accidents and violence, additionally, it is considered that at some point in life everyone we will present some type of disability; this concept has changed throughout history with various models, however currently, under the theoretical framework of the International Classification of Functioning, Disability and Health (ICF), disability is understood not only as anatomical alterations and/or physiological, but as the limitation in the performance of activities and the restriction in participation, for which various contextual factors interact. Disability is related to an increase in vulnerability, which includes access to education, which is a basis for personal and social development, also associated with an improvement in the quality of life and the participation of people with disabilities. Therefore, countries and institutions must join forces, ratify commitments and implement strategies to promote educational inclusion.

Resumo Cerca de 15% da população mundial é deficiente, cifras que vêm aumentando devido ao aumento das doenças crônicas não transmissíveis, envelhecimento, acidentes e violência, além disso, considera-se que algum momento da vida é tudo que apresentaremos algum tipo de deficiência ; Este conceito mudou ao longo da história com vários modelos, porém atualmente, sob o referencial teórico da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), a deficiência é entendida não apenas como alterações anatômicas e / ou fisiológicas, mas como limitação na desempenho de atividades e a restrição de participação, para as quais diversos fatores contextuais interagem. A deficiência está relacionada com o aumento da vulnerabilidade, que inclui o acesso à educação, base para o desenvolvimento pessoal e social, associada também à melhoria da qualidade de vida e à participação das pessoas com deficiência, pelo que os países e instituições devem aderir forças, ratificar compromissos e implementar estratégias para promover a inclusão educacional.

Aplicação do refinamento das regras de ligação da CIF à Escala Visual Analógica e aos questionários Roland Morris e SF-36 / Application of the refinements of ICF linking rules to the Visual Analogue Scale, Roland Morris questionnaire and SF-36

Resumo A Escala Visual Analógica (EVA), o Questionário de Incapacidade de Roland Morris (RMDQ) e Questionário de Qualidade de Vida SF-36, amplamente utilizados, tiveram seu conteúdo conectado à CIF por regras propostas em 2002 e 2005. Em 2016 foram refinadas e ainda não foram aplicadas. Aplicar as regras de conexão de conteúdo refinadas para os instrumentos EVA, RMDQ e SF-36. Dois profissionais de saúde identificaram os conceitos significativos e vincularam às categorias mais específicas da CIF, um terceiro arbitrou divergências. O grau de concordância foi dado pelo coeficiente kappa. Houve alto grau de concordância (Kappa=0,93 p<0,001). O conceito principal da EVA foi conectado à categoria b280, os 24 conceitos principais do RMDQ, à categoria b28013 e os 27 adicionais a outras categorias. O SF-36 teve 36 conceitos principais e 30 adicionais identificados, do total, 17 não foram definíveis pela CIF. Dos conceitos conectados dos 3 instrumentos 39 referem-se à Funções do Corpo, 57 à Atividades e Participação e 4 à Fatores Ambientais. O refinamento das regras propiciou mais clareza no processo de identificar, relacionar o conteúdo dos instrumentos à CIF e expor os resultado e aumentou o número de conceitos identificados e categorias contempladas pelos instrumentos.

Abstract The Visual Analogue Scale (VAS), Roland Morris Disability Questionnaire (RMDQ), Short Form Health Survey (SF-36) are broadly used and had their content linked to ICF by the linking rules of 2002 and 2005. In 2016 were refined and were not applied yet. To apply the refinements of ICF linking rules to VAS, RMDQ, and SF-36. Two health professionals identified the meaningful concepts and linked to the most precise ICF categories and a third triggered in divergences. The degree of agreement was calculated by kappa statistic. There was almost perfect agreement (Kappa=0.93 p<0,001). The main concept of VAS was linked to ICF category b280, the 24 main concepts of RMDQ linked to b28013, and 27 additional linked to other categories. The SF-36 had 36 main concepts and 30 additional concepts identified which 27 were definable by the ICF and 17 do not. From the total of ICF linked concepts, 39 refer to Body Functions, 57 to Activities and Participation and 4 to Environmental Factors. The refinements of linking rules propitiated more clarity in the process to identify, to link instruments content with ICF and to expose the results. Thus, increased the number of identified and linked concepts as well as the categories in the instruments.

Deficiências e incapacidades em vítimas de acidentes de trânsito em Mato Grosso, Brasil / Disabilities in victims of traffic accidents in Mato Grosso, Brazil

Resumo Introdução Acidentes de trânsito são importante problema de saúde pública, contudo pouco se conhece sobre as sequelas deles decorrentes. Objetivo Analisar as deficiências e incapacidades em vítimas de acidentes de trânsito. Método Estudo transversal com base em dados primários de uma amostra de vítimas de acidentes de trânsito não fatais atendidas em serviços selecionados de urgência e emergência de Mato Grosso em setembro de 2014. O instrumento de coleta foi baseado no Checklist da Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Resultados Foram avaliadas 228 vítimas de acidentes de trânsito, predominando jovens, sexo masculino, motociclistas. Deficiências de função do corpo mais comprometidas foram as sensoriais e dor (49,3%) e neuromuscoloesqueléticas (45,8%), enquanto as de estrutura do corpo relacionavam-se ao movimento (85,5%); ambas apresentando gravidade moderada. Referente à limitação de atividade e restrição à participação, predominaram problemas relacionados à mobilidade (42,0%), prevalecendo gravidade moderada (30,5%). Dentre os fatores ambientais, destacaram-se como principais barreiras os serviços, sistemas e políticas (66,3%) e, como facilitadores, o apoio e relacionamento com familiares e amigos (40,9%). Conclusão Aproximadamente metade das vítimas de acidentes de trânsito apresentou deficiências e incapacidades. O estudo preenche uma lacuna importante para a compreensão deste problema de saúde pública.

Abstract Introduction Traffic accidents are an important public health problem; however, little is known about their consequences. Objective To analyze disabilities in traffic accident victims. Methods Cross-sectional study, based on primary data from a sample of victims of non-fatal traffic accidents, attended at selected emergency services in Mato Grosso in September 2014. The collection instrument was based on the International Classification Checklist Functionality, Disability, and Health. Results 228 victims of traffic accidents were evaluated, predominantly young men, motorcyclists. Body function deficiencies most affected were sensory and pain (49.3%) and neuromusculoskeletal (45.8%), while those of body structure were related to movement (85.5%); both presenting moderate severity. Regarding activity limitation and participation restriction, problems related to mobility predominated (42.0%), with moderate severity (30.5%). Among the environmental factors, services, systems, and policies stood out as barriers (66.3%) and the support and relationship with family and friends as facilitators (40.9%). Conclusion Approximately half of the victims of traffic accidents had disabilities. The study fills an important gap for understanding this public health problem.

Report on the 9th MHLW ICF Symposium"Looking to a New Stage of ICD-11 and ICF Utilization - Toward a Common Language in Various Fields" / 全日本鍼灸学会雑誌

The International Classification of Functioning, Disability and Health (ICF), adopted by WHO in 2001, is an evolution of the International Classification of Impairments, Disabilities and Handicaps (ICIDH). It is a model that integrates the levels of 1) body function and structures, 2) activity, and 3) participation, and uses a holistic approach by focusing on the health of the entire body with an emphasis on the positive aspects of being able to do things. In May 2019, the WHO General Assembly adopted ICD-11, revised after 30 years, and for the first time introduced the classification of diseases used in traditional medicine. A symposium organized by the Ministry of Health, Labour and Welfare of Japan (MHLW) was held online on February 20, 2021, and is reported here.

Effects of rhythmic auditory stimulation on functionality in Parkinson's disease / Repercussões da estimulação auditiva rítmica sobre a funcionalidade na doença de Parkinson

Abstract Introduction: Functionality is affected by the clinical characteristics and progression of Parkinson's disease (PD). Objective: Assess the effects of a therapeutic exercise program associated with music-based rhythmic auditory stimulation (RAS) on the Activities and Participation Profile (APP) related to mobility of people with PD. Methods: Intervention study investigating people with moderate PD recruited from the Hospital das Clínicas of the Federal University of Pernambuco and the Parkinson's Disease Association of Pernambuco. The APP related to mobility of the participants was assessed based on the International Classification of Functioning Disability and Health (ICF). The APP contains 23 activity/participation items scored from 0 (no problem) to 4 (complete problem). The intervention consisted of 10 outpatient sessions of a therapeutic exercise program associated with music-based RAS, applied using a smartphone application (ParkinSONS®), performed twice a week, with an average duration of 50 minutes per session. Given the metric nature of the variable and its non-normal distribution, Wilcoxon's test was applied, considering p < 0.05. Results: In the sample of 8 patients, there was a significant decline in APP scores after intervention (p = 0.018*), indicating a positive change. Scores for all the APP activities decreased following the intervention, except for "transferring oneself to the left side while lying down". Conclusion: In this study, a therapeutic exercise program associated with music-based RAS had a positive effect on the APP related to mobility of people with moderate PD.

Resumo Introdução: A funcionalidade é afetada pelas características clínicas e progressão da doença de Parkinson (DP). Objetivo: Avaliar as repercussões da aplicação de um protocolo de fisioterapia motora associado à estimulação auditiva rítmica (EAR) com música sobre o perfil de atividade e participação (PAP) relacionado à mobilidade de pessoas com DP. Métodos: Estudo de intervenção realizado com pessoas em estágio moderado de DP recrutadas no Hospital das Clínicas da Universidade Federal de Pernambuco e na Associação de Parkinson de Pernambuco. Estas foram avaliadas e reavaliadas mediante o PAP relacionado à mobilidade baseado na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). O PAP apresenta 23 itens de atividades/participação pontuados entre 0 (não há problema) e 4 (problema completo). A intervenção consistiu de 10 sessões ambulatoriais de fisioterapia motora associada à EAR com música fornecida por aplicativo instalado em smartphone (ParkinSONS®) duas vezes por semana, com duração média de 50 minutos por sessão. Devido à natureza métrica da variável e sua distribuição não normal, aplicou-se o teste de Wilcoxon, considerando p < 0.05. Resultados: Na amostra de oito pacientes, o PAP apresentou uma redução significativa dos escores após a intervenção (p = 0.018*), indicando mudança positiva no perfil. Todas as atividades do PAP apresentaram diminuição do escore após a intervenção, exceto "transferir-se para o lado esquerdo enquanto estiver deitado". Conclusão: Neste estudo, a aplicação de um protocolo de fisioterapia motora associada à EAR com música em pessoas no estágio moderado da DP apresentou repercussões positivas sobre o PAP relacionado à mobilidade baseado na CIF.

Voice disorders in teachers and the International Classification of Functioning, Disability and Health (ICF) / Trastornos de la voz en docentes y Clasificación Internacional de Funcionamiento, Discapacidad y Salud (CIF)

Introduction. Contemporary occupational diseases are increasingly expressed by function disorders, which include voice disorders, forcing workers to request a leave of absence from work and leading to an incapacity to perform their work activities. Teachers have the higher prevalence of vocal disorders among the professionals who use their voices professionally, which is reported as the second cause of teaching work absences in Brazil. Objective. To analyze the environment and organization aspects of the teaching work associated with the development of voice disorder of teachers, according to the International Classification of Functioning, Disability and Health (ICF). Method. This study consisted of two steps. Initially, an integrative bibliographic review was performed to search for references related to the topic in the LILACS, MEDLINE and SCIELO databases, using the health descriptors "voice disorders" and "teachers". Then, the selected articles were read in full in order to identify the work factors associated with the voice disorder and compared with the theoretical framework of the ICF, in order to identify possible indicators of loss of functioning and capacity for teaching work resulting from voice disorders. Results. The presence of dust and noise were the most prevalent environment as-pects. In turn, the high demand for work and the lack of autonomy to perform the work were identified as factors related to the organization of the work of the teaching work, as well as stress at work and the presence of situations of violence at school as the most reported work absences.Conclusion. As shown, the factors of teaching work described impact all compo-nents of functioning and lead to the incapacity of the teacher to work. The use of the ICF may contribute to systematize and quantify, in a standardized way, the loss of functioning and work capacity resulting from voice disorders, in addition to assis-ting in the development of public health promotion policies and in the prevention of vocal disorders in teachers.

Introducción. Las enfermedades ocupacionales contemporáneas se expresan cada vez más en trastornos funcionales, que incluyen trastornos de la voz, y que obligan a los trabajadores a solicitar una excedencia del trabajo, provocando la incapacidad para realizar sus actividades laborales. Los docentes tienen la mayor prevalencia de trastornos vocales entre aquellos que usan su voz profesionalmente, lo que se reporta como la segunda causa de ausencias laborales docentes en Brasil.Objetivo. Analizar los aspectos ambientales y organizativos de la labor docente asociados al desarrollo del trastorno de la voz de los docentes, según la Clasificación Internacional de Funcionamiento, Discapacidad y Salud (CIF).Método. Este estudio consta de dos pasos. Inicialmente se realizó una revisión bi-bliográfica integradora para buscar referencias relacionadas con el tema en las bases de datos Lilacs, Medline y SciELO, utilizando los descriptores de salud "trastornos de la voz" y "docentes". Luego, se leyeron íntegramente los artículos seleccionados con el fin de identificar los factores laborales asociados al trastorno de la voz y se com-pararon con el marco teórico de la CIF, con el fin de identificar posibles indicadores de pérdida de funcionamiento y capacidad para el trabajo docente derivados de los trastornos de la voz.Resultados. La presencia de polvo y ruido fueron los aspectos ambientales más prevalentes. A su vez, la alta demanda de trabajo y la falta de autonomía para reali-zarlo fueron identificados como factores relacionados con la organización del trabajo de la labor docente, así como el estrés en el trabajo y la presencia de situaciones de violencia en la escuela como las ausencias laborales más reportadas.Conclusión. Como se muestra, los factores del trabajo docente descritos impactan todos los componentes del funcionamiento y conducen a la incapacidad del maestro para trabajar. El uso de la CIF puede contribuir a sistematizar y cuantificar, de mane-ra estandarizada, la pérdida de funcionamiento y capacidad laboral derivada de los trastornos de la voz, además de ayudar en el desarrollo de políticas de promoción de la salud pública y en la prevención de los trastornos vocales en los docentes.

Objetivos de intervención en voz: Una propuesta para su análisis y redacción / Voice therapy goals: a proposal for analysis and writing

Este artículo de reflexión aborda aspectos que dan cuenta de la complejidad en el planteamiento de objetivos en torno a los marcos de abordaje vocal contemporáneos. Se plantea la complejidad de la selección y redacción de objetivos para la interven-ción en voz holística y ecléctica, y desde ella, la necesidad de incorporar el modelo CIF y las recomendaciones de la ASHA para el desarrollo de objetivos centrados en la persona, tanto a corto como a largo plazo. Se propone la utilización del método de análisis SMART y su aplicación específica para objetivos de intervención de la voz. Además, se abordan los aspectos formales que se deben considerar para una redacción precisa. Finalmente, se ejemplifica la propuesta mediante un caso clínico. Esta propuesta pretende ser de utilidad para fines terapéuticos y/o para el ámbito académico, tanto en la discusión de la formulación y diseño de planes terapéuticos como en el pensamiento reflexivo asociado al abordaje vocal.

This reflective article addresses aspects that deal with the complexity of objective setting in contemporary vocal approach frameworks. It addresses the complexity in selecting and writing objectives for holistic and eclectic voice therapy and the need to incorporate the ICF model and ASHA recommendations for the development of person-centered goals in both the short and long term. The use of the SMART analysis method is proposed and its specific application for voice therapy goal. Also, the formal aspects to be considered for precise wording are addressed. Finally, the proposal is exemplified through a clinical case. This proposal is intended to be useful for therapeutic and/or academic purposes, both in discussing the formula-tion and design of therapeutic plans and the reflective thinking associated with the vocal approach.

Instrumentos da prática clínica com versão em português e a abrangência de seus conteúdos usando a CIF como referência: uma revisão sistemática / Instrumentos de la práctica clínica con versión en portugués y alcance de sus contenidos tomando como referencia la CIF: una revisión sistemática / Health assessment instruments in Portuguese version and its comprehensiveness with ICF framework: a systematic review

RESUMO A prática clínica tem sido subsidiada por instrumentos que permitem acessar e registrar informações de funcionalidade e saúde dos indivíduos. Uma forma de conhecer qual conteúdo da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) os instrumentos contemplam é usá-la como referência para auxiliar o profissional na escolha do mais adequado para acessar informações biopsicossociais. O objetivo foi identificar instrumentos da prática clínica em saúde que tiveram seu conteúdo ligado com a CIF e a existência de versão na língua portuguesa deles. Para tanto foi realizada uma revisão sistemática nas bases de dados SciELO Brasil, Lilacs e PubMed com os descritores "CIF", "questionário" e "regra de ligação" em português e inglês. Três pesquisadores independentes realizaram a seleção, e o nível de concordância foi obtido pelo coeficiente Kappa. Os critérios de elegibilidade foram: estudos primários de ligação de conteúdo de questionários, escalas, índices e checklists com a CIF publicados após 2001 em língua portuguesa ou inglesa. Foram incluídos 61 artigos, sendo 19 de origem brasileira. Dos 250 instrumentos ligados à CIF, 158 (63,2%) apresentaram versão em português sendo que dos 37 que mais se repetiram nos estudos, dois não apresentam essa versão. O coeficiente Kappa mostrou concordância entre moderada e boa (p<0,001). Este estudo apresentou um panorama da ligação de conteúdo de instrumentos da prática clínica à CIF identificando quais têm versão em língua portuguesa, o que contribuirá para o potencial fortalecimento da abordagem biopsicossocial dos profissionais de saúde.

RESUMEN La práctica clínica ha sido subsidiada por instrumentos que permiten acceder y registrar informaciones de funcionalidad y salud de los individuos. Una forma de conocer qué contenidos de la Clasificación Internacional de Funcionalidad, Incapacidad y Salud (CIF) los instrumentos contemplan es usarla como referencia para auxiliar al profesional en la elección del más adecuado para acceder a informaciones biopsicosociales. Lo objetivo fue identificar los instrumentos de la práctica clínica en la salud que tuviesen su contenido vinculado con el CIF y la disponibilidad de la versión en el idioma portugués. Para ello se realizó una revisión sistemática en las bases de datos SciELO Brasil, Lilacs y PubMed con las palabras clave "CIF", "cuestionario" y "reglas de vinculación "en portugués e inglés. Tres investigadores independientes realizaron la selección, y el nivel de concordancia fue obtenido por el coeficiente Kappa. Los criterios de elegibilidad fueron: estudios primarios de vinculación del contenido de cuestionarios, escalas, índices y listas de control con CIF publicados después de 2001 en el idioma portugués o Ingles. Fueron incluidos 61 artículos, siendo 19 de origen brasilero. De los 250 instrumentos con contenido relacionado a CIF, 158 (63,2%) presentaron versión en portugués, siendo que de los 37 que más se repitieron en los estudios dos no presentaron esta versión. El coeficiente Kappa mostró concordancia entre moderada y buena (p <0,001). Se ha delineado un panorama de la vinculación del contenido de instrumentos de la práctica clínica a la CIF identificando cuáles tienen versión en la lengua portuguesa y su potencial fortalecimiento del enfoque biopsicosocial.

ABSTRACT Clinical practice has been subsidized by instruments that record and allow access to information on functionality and health of individuals. One way to approach the content of the International Classification of Functioning, Disability and Health (ICF) is to use it as a reference to aid the professional in choosing the most appropriate instrument to access biopsychosocial information. We intend to identify health assessment instruments that had their content linked to the contents of the ICF and the presence of the Portuguese version of them. A systematic review was conducted of the SciELO Brazil, Lilacs and PubMed databases with the descriptors "ICF", "questionnaire" and "linking rules" in Portuguese and English. Three independent researchers performed the papers' selection, and the level of agreement was obtained by the kappa coefficient. The eligibility criteria were primary studies for questionnaires, scales, indices and checklists content linking to ICF published after 2001 in Portuguese or English. A total of 61 articles were included, of which 19 were of Brazilian origin. Given the totality of 250 instruments with ICF-related content, 158 (63.2%) presented a Portuguese-language version; just two of the 37 most cited works presented a Portuguese version. The Kappa coefficient showed significative agreement between moderate and good. This study provided an overview of the content connection between clinical practice instruments to ICF, identifying which instruments have Portuguese translation and its potential for strengthening the biopsychosocial approach.

Applying the International Classification Of Functioning, Disability And Health (ICF) And Kawa Models In Family Medicine - A Case Of An Adolescent With A Stroke

@#The rehabilitation of a 19-year-old male with a congenital ventricular septal defect who suffered a haemorrhagic stroke from a ruptured mycotic aneurysm, secondary to infective endocarditis is described in this case study. This case study illustrates the application of the International Classification of Functioning, Disability and Health (ICF) model, and Kawa model in the structuring of a holistic, interdisciplinary team management. Application of both models provide clear communication within the interdisciplinary team and aids the team to understand the contextual factors in the interaction of the patient's rehabilitation journey.

The requirements for social participation of people with disabilities in the community in Honduras: A qualitative study / 国際保健医療

Background and Objectives  In Honduras, only a few rehabilitation centers have provided social participation services consistent with the International Classification of Functioning (ICF). The goal of this study were to describe how people with disabilities (PWD) felt a need to participate in society, and to clarify what aspects of social participation were of interest to PWD.Methods  A survey was conducted in a rehabilitation facility operated by the Intibucá department in Honduras. A semi-structured interview was conducted people with physical disabilities who attended the facility to analyze their needs and state of social participation.Results  In total, 22 PWDs participated in this study. Data analysis showed that the needs of PWD were classified into six categories: Improving the Social Environment, Improving Physical Function and Activities of daily living Ability, Reacquiring Work and Productive Activities, Acquiring Home Activities, Spending Time with Family, and Resuming Leisure Activities. Six participants were employed, and those who were unemployed were also limited in their community participation other than work.Conclusion  This study revealed that PWD in the Intibucá Department missed opportunities to participate in the community. PWD stated that improved physical functioning was essential for achieving social participation. Rehabilitation professionals need to develop shared decision-making based on an understanding of the social context of PWD, and both rehabilitation professionals and local community supporters working with PWD should partner with other professionals to support the social participation of PWD.

Contribuições da CIF para uma abordagem integral na atenção à Saúde de Crianças e Adolescentes / Contributions of ICF to an integral approach in the Health Care for Children and Adolescents

RESUMO Objetivo: Investigar a participação e funcionalidade de crianças e adolescentes com alterações de fala utilizando a Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Método: Pesquisa descritiva-analítica de abordagem qualitativa-quantitativa com 30 participantes com alteração de fala (CAF) e 30 com desenvolvimento típico de fala (DTF). Para a coleta de dados, realizaram-se entrevistas semiestruturadas com os participantes, estudo de prontuário, observação dos participantes quanto aos aspectos de fala e aplicação de questionário estruturado com os responsáveis. Os dados coletados foram utilizados para seleção de qualificadores das categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Para comparação dos qualificadores entre grupos, utilizou-se o Teste Mann-Whitney, e a análise de conteúdo temática, para as entrevistas. Resultados: Os participantes do grupo CAF relataram maior grau de dificuldade do que o grupo DTF. As alterações de fala repercutiram significativamente em Funções do Corpo (articulação e fluência), Atividades e Participação (conversa, relacionamentos, realização de rotinas e lidar com estresse) e Fatores Ambientais (atitudes de familiares, amigos e conhecidos). Conclusão: Os resultados evidenciam o impacto das alterações de fala e suas implicações sociais para estas crianças e adolescentes. A CIF permitiu compreender a saúde em complexidade e integralidade, possibilitando assim o planejamento de estratégias para amenizar o impacto dessas alterações individual e coletivamente. Podendo ser base, futuramente, para a criação de políticas públicas e ações que poderão melhorar a qualidade de vida e promover a saúde dessa população.

ABSTRACT Purpose: To investigate participation, and functionality of children and adolescents with speech disorders using the International Classification of Functioning, Disability and Health (ICF). Method: Descriptive and analytical research of qualitative and quantitative approach. The sample was composed of 30 participants with speech disorders and 30 with typical speech development. For data collection, it was conducted semi-structured interviews with the participants, medical record review, observation of speech aspects' participants, and analyzed study of medical records. The collected data were used to qualify the framework codes. The Mann-Whitney Test was used for comparison between groups, and thematic content analysis for the interviews. Results: Participants with speech disorders reported more difficulties than the participants with typical speech development. Speech disorders significantly impacted on the Body Functions (articulation and fluency), Activities and Participation (conversation, relationships, carrying out the routine and handling of stress) and Environmental Factors (attitudes of family, friends and acquaintances). Conclusion: The results show the impact of speech disorders and their social consequences for these children and adolescents. The ICF allowed us to comprehend health in all its complexity and integrality, making possible to plan strategies to soften the disorders impact in an individual and collective perspective. Then, ICF can be used, in the future, for elaboration of public policies and actions that will improve the quality of life and promote the health of this population.

The ICF in the pedagogical projects of Physiotherapy courses in Midwest Brazil / A CIF nos projetos pedagógicos dos cursos de Fisioterapia do Centro-Oeste brasileiro

Abstract Introduction: The course pedagogical projects (CPPs) of physical therapy programs in Brazil are based on National Curriculum Guidelines for Physiotherapy (NCGP) and the principles of the National Health System (SUS). The CPPs that guide professional training tend to use a biopsychosocial approach and propose familiarizing undergraduate students with the International Classification of Functionality, Disability and Health (ICF); as such, they should include the use of this instrument. Objective: Assess CPPs by exploratory document analysis and determine whether they propose teaching and using the ICF in student training. Method: Qualitative-quantitative study with document analysis of CPPs for physical therapy courses in Midwest Brazil, from which information related to the ICF was extracted. Results: The biopsychosocial model and NGCP were identified in the 10 CPPs analyzed and the ICF was found in the curriculum outline of 6 of these, indicating the incorporation of this framework in student training. However, the ICF was only identified in the course objectives and literature references of 4 and 2 CPPs, respectively, suggesting possible shortcomings in its application in these documents. Conclusion: The inclusion of the ICF in some CPPs indicates a positive change and favors understanding of functioning, but does not preclude the need for a broader approach to teaching this classification framework in the remaining CPPs in order to provide student training within a biopsychosocial context.

Resumo Introdução: Os projetos políticos pedagógicos dos cursos de Fisioterapia (PPCs) no Brasil são concebidos à luz das Diretrizes Curriculares Nacionais do Curso de Graduação em Fisioterapia (DCNF) e aos princípios do SUS. Assim, os PPCs que norteiam a formação profissional tendem a incluir uma proposta de familiarização dos graduandos com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) com uma abordagem biopsicossocial, portanto os PPCs deveriam contemplar o uso da CIF. Objetivo: Verificar, por meio da análise exploratória dos PPCs, se existem propostas de ensino e uso da CIF na formação dos alunos. Método: Estudo quali-quantitativo, realizado por meio da análise documental exploratória dos PPCs dos cursos de Fisioterapia do Centro Oeste Brasileiro, dos quais foram extraídas informações de interesse relacionadas à CIF. Resultados: O modelo biopsicossocial e o delineamento das DCNF foram identificados nos 10 PPCs analisados e a CIF foi encontrada na matriz curricular de 6 PPCs, o que aponta positivamente para incorporação da CIF no processo formativo do aluno. Entretanto, somente em 4 PPCs foi possível identificá-la nos objetivos do curso e nas referências bibliográficas de disciplinas obrigatórias, a CIF foi encontrada em apenas 2 PPCs, o que pode indicar nesses documentos, uma possível fragilidade da abordagem da CIF. Conclusão: A presença da CIF em alguns PPCs indica mudanças e favorece o entendimento da funcionalidade, o que não anula a necessidade de uma maior abordagem quanto ao ensino da CIF nos demais PPCs, visando a formação do aluno dentro de um contexto biopsicossocial.