Pediatric neurorehabilitation and the ICF.

INTRODUCTION: One of the major intended uses of the International Classification of Functioning, Disability and Health (ICF) is the clinical world of rehabilitation. The intrinsic qualities of ICF, especially in its children and youth version (ICF-CY) seem to perfectly match the needs for the complex process of pediatric neurorehabilitation. OBJECTIVES: We here report on the effect that the implementation of ICF-CY had on team members and families when it was used as a guiding structure in framing the rehabilitation project in a pediatric outpatient clinic dealing with adolescents with cerebral palsy and complex needs. The two-year experience was positive and an ad-hoc questionnaire delivered to team members and families returned very positive remarks. CONCLUSION: The main messages coming from this experience is on the feasibility of the introduction of ICF-CY language and the bio-psycho-social model in the described setting and on the positive response by the stakeholders.

Italian ICF training programs: describing and promoting human functioning and research.

Purpose of the article is to report on 5 years of ICF training experiences in Italy aimed at promoting a consistent approach to ICF's field application. More than 7000 persons participated in around 150 training events: almost half were organised by political bodies, at national, regional or local level, directly linked to implementation experiences. Few training events were organised by the school sector, while training commissioned by NGOs represent a relevant area and, in our opinion, constitute the first step towards a full inclusion of persons with disabilities. Central pillars of our training modules are: the inclusion of all ICF components in the description of functional profiles, the need of providing brief theoretical background information before moving to practical aspects and the importance of providing personalised face to face training modules, in contrast to self-administered learning modules, or web-based protocols. On the basis of our experience, we can conclude that training's objectives are generally reached: trainees improved their knowledge of the ICF and its related tools, and are able to begin practical applications in their contexts.

Projecting and programming rehabilitation based on ICF-CY format in a neuropediatric hospital unit.

OBJECTIVE: To follow-up the impact of a format based upon the International Classification of Functioning Disability and Health, version for children and youth (ICF-CY) as a roadmap for in-hospital pediatric neuro-rehabilitation. DESIGN: Longitudinal study in a single Centre testing with impact assessment. SUBJECTS/PATIENTS: The team members of a tertiary care pediatric neuro-rehabilitation unit approaching 88 consecutive patients with various physical and/or neurological conditions. METHODS: A revised version of the protocol ICF-CY based format for rehabilitation projecting and programming was applied for 24 months. Impact on the rehabilitation team was assessed with an ad hoc questionnaire. RESULTS: Fifteen questionnaires were returned, all of them reporting strongly positive judgements. Time constraint was no longer considered the main problem, probably because of a learning effect. Ongoing utilization reduced the time needed and the problems perceived in completing the task. CONCLUSION: This application confirmed that ICF contribute to improve the quality of interdisciplinary work and to share the rehabilitation process between team members and family. Indeed ICF-CY works efficiently as a roadmap for in-hospital pediatric neuro-rehabilitation. Its implementation results in perceived improvements in the process, ongoing utilization reduces the time needed and the problems encountered in completing the task.

Children with disability at school: the application of ICF-CY in the Veneto region.

PURPOSE: To show the feasibility and consequences at 1 year of the use of the International Classification of Functioning, Disability and Health, version for Children and Youth (ICF-CY) in the process of social and scholastic inclusion for students with disability in a district of Northeastern Italy (Treviso province). METHODS: We describe the novel procedure for inclusion of students with disability launched by disability and education Services of the Treviso Province. The protocol was organized in four steps and involved health professionals and teachers throughout the whole Province. The implementation was preceded by intensive exposure of the involved professionals to the ICF-CY model and structure and by workshops in which the participants elaborated the actual documents accompanying the process of scholastic inclusion according to the specific Law (104/1992): the notification card, the identification of the student with disabilities, the functional diagnosis, the dynamic functional profile and the individual educational plan. RESULTS: The results show that the adherence to the new protocol was very satisfactory, as well as the perceived validity and relevance of the new documents elaborated with ICF language. The experimentation in progress provided interesting indications on the way to apply the ICF-CY to the scholastic inclusion processes. CONCLUSIONS: The largest alphabetization effort on ICF attempted in a Public Health System (disability service) and in the school system improve the social and scholastic participation of student with disability and can reduce the barriers in the environment.

Disseminating the WHO International Classification of Functioning Health and Disability (ICF) in the Veneto region of Italy.

PURPOSE: To show the feasibility and effect of a large formation effort focused on the International Classification of Functioning, Disability and Health (ICF), which may introduce a revolutionary new conceptual framework for people involved in rehabilitation services. METHODS: We here describe the large information/formation project launched by the Regional Direction for Social Services of the Veneto region (Italy). Here we describe the first of the two steps of the project, aimed to reach 900 health professionals throughout the whole region. They were exposed to a structured modular course consisting of a mix of frontal lectures and workshop sessions. During the workshop sessions the participants were confronted with questions referring to the actual application of ICF in their services. RESULTS: The results show that the attendance (90%) was very high. The workshop sessions provided interesting indications on the possible applications of ICF in the clinical settings, as well as points of strength and potential problems that the implementation of ICF may have in the Regional Health Service. CONCLUSIONS: To our knowledge this is the largest alphabetization effort on ICF attempted in a public health system, and it indicates a possible effective approach to its controlled diffusion and future implementation.