[Personal factors of the ICF]. / Personbezogene Faktoren der ICF.

PURPOSE: The presentation aims at illustrating the draft proposal of personal factors of the ICF for German-speaking regions which has been published in 2010 by the working group ICF of Faculty II "Social Medicine and Rehabilitation" of the German Society for Social Medicine and Prevention, DGSMP. For this reason, each personal factor is illustrated by two examples. Thus, the benefit is intended to be convincing. METHODS: Applying a qualitative approach, the working group ICF consisting of members of various professions and institutions including a patients' representative selected for each item one example the factor serving as a facilitator and a second the factor serving as a barrier. RESULTS: The components of the personal factors, as proposed, are presented, each factor is accompanied by two examples. CONCLUSION: The presentation demonstrates the various possibilities of applying personal factors and intends to prove that the selection of items chosen makes sense. The process of a comprehensive discussion about the possible format of the component of personal factors in the ICF should lead to a further optimization of the proposal and the preparation of a discussion at an international level.

[Personal contextual factors of the ICF draft from the Working Group "ICF" of Specialty Group II of the Geman Society for Social Medicine and Prevention]. / Personbezogene Faktoren der ICF - Entwurf der AG "ICF" des Fachbereichs II der Deutschen Gesellschaft für Sozialmedizin und Prävention (DGSMP).

Personal contextual factors play an essential part in the ICF model in relation to patient-centred care. It is generally assumed that their classification must refer to the country-specific social and cultural setting and its particular linguistic terms. Therefore personal factors are not classified as yet by the WHO for general use. In Germany in 2006 a group of experts working on the medical advisory board of statutory health insurance published a proposal for a systematic classification of relevant personal factors to describe the background of an individual's life and living. This classification was now further analysed and thoroughly revised by a more comprehensive group of German specialists working in different health care insurances and institutions, authorised by the German Society for Social Medicine and Prevention (DGSMP), supported by German-speaking Swiss ICF specialists. This classification is published as work in progress intending to broaden and prepare the process of discussion for a consensus conference to be held in Germany in 2011.

[Speech rehabilitation in aphasia in the concept of International Classification of Impairments, Disabilities and Handicaps (ICDH0)]. / Sprachrehabilitation bei Aphasie im Konzept der Internationalen Klassifikation der Schädigungen, Fähigkeitsstörungen und Beeinträchtigungen (ICIDH).

A neurogenic disorder of acquired speech, aphasia not only is a speech disorder but also implies restriction in communicative independence. In line with the WHO's principle of attending to the consequences of disease as well, speech rehabilitation has to deal not only with aphasia in terms of speech disorder (i.e., impairment) but also with aphasia in terms of communicative ability disorder (i.e., disability) as well as with aphasia in terms of psychosocial interference (i.e., handicap). Current speech therapy orientations can be assigned to these three dimensions and the need for these three levels of approach can be assessed accordingly in light of the course of the condition. Given the speech disorder's frequently limited amenability to therapeutic intervention, a psycholinguistics-communication oriented speech rehabilitation as well as counselling and psychologically focussed measures are increasingly relevant to enable a more appropriate response to reduced communicative independence and ensuing psychosocial handicaps.

Case report: top hearing performances of a postlingually deaf cochlear implant user.

On the occasion of the Cochlear Implant Symposium in Geneva in October 1991, top hearing results attained by a young postlingually deaf woman with cochlear implant systems were presented in video recordings. These data are centered on demanding hearing performances in test situations and in a telephone conversation. For various reasons, two reimplantations were necessary in this deaf patient. Initially, she was provided with a single-channel extra-cochlear electrode of the Vienna type, which she found to improve her lipreading substantially, and she attained an unexpectedly good understanding of speech on a purely auditory basis. Today, this postlingually deaf women uses a multichannel intracochlear electrode of the Nucleus type. The excellent results with the first extracochlear system are clearly surpassed with the intracochlear system. Not least because of her above-average speech competence, the cochlear implant user attains a high degree of open speech understanding. Her verbal hearing efficiency is comparable to that of a person with mild to moderately severe hearing loss.

[Auditory and communication learning in patients with cochlear implants]. / Hör- und Kommunikations-Lernen bei Cochlear Implant-Trägern.

Nowadays the cochlear implant (CI) offers a new method of hearing, especially for deaf patients who do not benefit from conventional hearing aids. However, it may be difficult to get used to this kind of hearing advice. CI users have special problems in interpreting strange acoustic sensations and relating them to auditory features of language and noise they knew before the onset of deafness. An interdisciplinary approach is very important for rehabilitation. Beside otological examination and the surgical implantation, audiological assessment is needed for the correct adjustment of the speech processor and for measurement of performance. Also auditory management and counselling of deaf patients is an important part of CI rehabilitation. A learning programme in hearing and communicating ("hearing training") is offered to CI users that takes account of different linguistic levels. Auditory learning by the use of CI is based on different abilities of the deaf patient, of which the most important are speech skills and learning capacity. Although success rates vary, it certainly improves speech intelligibility during lip reading, communication behaviour, and recognition of environmental noise. The latter ability improves orientation in the acoustic surroundings. CI rehabilitation may improve the psychosocial attitude of the deaf.