The use of the International Classification of Functioning, Disability and Health to understand the health and functioning experiences of people with chronic conditions from the person perspective: a systematic review.

PURPOSE: This systematic review examines the literature to identify the context and extent of implementation of the International Classification of Functioning, Disability and Health (ICF) model to understand the experience of health and functioning in persons with chronic conditions from the person perspective. METHOD: The literature search was conducted through five electronic databases between 2001 and December 2012. Reference lists of included papers were also searched. Articles in which the ICF was used to understand the health and functioning experience of adults with chronic conditions from the person-perspective were included. Data were extracted and analysed to identify the year of publication, geographical location, health condition, context of ICF use, authors' remarks and identified limitations of the ICF. RESULTS: Thirty-seven qualitative and mixed-methods studies were included representing 18 countries and a range of chronic conditions. The ICF was found to be used to elicit and analyse people's narratives, with the majority of studies reporting that the ICF provides a comprehensive analysis of experiences and needs from the person perspective. Some limitations to its use and the need to classify the "personal factors" component were reported. CONCLUSION: The ICF has been used to provide a comprehensive understanding of health and functioning in persons with chronic conditions from the person perspective, although there are currently relatively few studies which have used the ICF in this context. Limitations regarding its use were reported which should be considered by users of the model and during its revision process. IMPLICATIONS FOR REHABILITATION: The ICF encourages a bio-psycho-social and person-centred approach to healthcare and may provide a useful tool for guiding clinical assessment and encouraging clinicians to consider the multitude of factors which impact health, which may result in more specific and individualised treatment targeted at individual needs. Using a common framework that can be understood across health disciplines may enhance interdisciplinary communication and collaboration, improving health care delivery. The ICF may be used to compare perspectives of individuals and their health professionals and to identify people's needs that are not adequately being addressed, which may have significant implications for improving healthcare provided and overall health outcomes.

GaitaBase: Web-based repository system for gait analysis.

The need to share gait analysis data to improve clinical decision support has been recognised since the early 1990s. GaitaBase has been established to provide a web-accessible repository system of gait analysis data to improve the sharing of data across local and international clinical and research community. It is used by several clinical and research groups across the world providing cross-group access permissions to retrieve and analyse the data. The system is useful for bench-marking and quality assurance, clinical consultation, and collaborative research. It has the capacity to increase the population sample size and improve the quality of 'normative' gait data. In addition the accumulated stored data may facilitate clinicians in comparing their own gait data with others, and give a valuable insight into how effective specific interventions have been for others.

Gait function in newly diagnosed children with autism: Cerebellar and basal ganglia related motor disorder.

We investigated gait in newly diagnosed children with autism. From our previous study with 6- to 14-year-olds, we hypothesized that motor symptoms indicative of basal ganglia and cerebellar dysfunction would appear across the developmental trajectory of autism. Two groups were recruited: children with autism (eight males, three females; mean age 5 y 10 mo [SD 9 mo]; range 4 y 4 mo-6 y 9 mo) and a comparison group of typically developing children (eight males, three females; mean age 5 y 9 mo [SD 1 y 1 mo]; range 4 y 3 mo-7 y 2 mo). The GAITRite Walkway was used to gather data from average gait and intra-walk measurements. Experienced physiotherapists analyzed gait qualitatively. Groups were matched according to age, height, weight, and IQ; although not statistically significant, IQ was lower in the group with autism. Spatiotemporal gait data for children with autism were compatible with findings from patients with cerebellar ataxia: specifically, greater difficulty walking along a straight line, and the coexistence of variable stride length and duration. Children with autism were also less coordinated and rated as more variable and inconsistent (i.e. reduced smoothness) relative to the comparison group. Postural abnormalities in the head and trunk suggest additional involvement of the fronto-striatal basal ganglia region. Abnormal gait features are stable across key developmental periods and are, therefore, promising for use in clinical screening for autism.

Gait function in high-functioning autism and Asperger's disorder : evidence for basal-ganglia and cerebellar involvement?

Gait abnormalities have been widely reported in individuals with autism and Asperger's disorder. There is controversy as to whether the cerebellum or the basal-ganglia frontostriatal regions underpin these abnormalities. This is the first direct comparison of gait and upper-body postural features in autism and Asperger's disorder. Clinical and control groups were matched according to age, height, weight, performance, and full scale IQ. Consistent with Hallet's (1993) cerebellar-gait hypothesis, the autistic group showed significantly increased stride-length variability in their gait in comparison to control and Asperger's disorder participants. No quantitative gait deficits were found for the Asperger's disorder group. In support of Damasio and Maurer's (1982) basal-ganglia frontostriatal-gait hypothesis, both clinical groups were rated as showing abnormal arm posturing, however, only the Asperger's group were rated as significantly different from controls in terms of head and trunk posturing. While DSM-IV-TR suggests that Asperger's disorder, but not autism, is associated with motoric clumsiness, our data suggest that both clinical groups are uncoordinated and lacking in motor smoothness. Gait differences in autism and Asperger's disorder were suggested to reflect differential involvement of the cerebellum, with commonalities reflecting similar involvement of the basal-ganglia frontostriatal region.