ICIDH-1, issued in , has been under revision since The ICIDH, based on the biopsychosocial disease model, describes disease consequences in three dimensions: Structural and functional body impairments. In the field of geriatrics ICIDH is also helpful as a coherent conceptual framework and reference manual to determine and code the disabilities and handicaps with regard to daily living competence. In view of the high frequency of geriatric patients with multimorbidity, i.

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Since then, there is continuous revision going on. A global common language in the field of disability has long been wanted. The first part is the theoretical explanation of the consequences of diseases. It proposes the concepts and definitions of impairment, disability and handicap and discusses the relation between these dimensions showing the conceptual model illustrated in Figure 1.

This is based on a linear model implying progression from disease, impairment, disability to handicap. The impairment is characterized as an abnormality of structure or function of body or organ including mental function. The disability is characterized as a restriction of activities resulting from an impairment. And the handicap is the social level of the consequences of diseases characterized as the individual's disadvantage resulting from impairment or disability.

The second part of the ICIDH is three independent classifications of impairments items , disabilities items and handicaps 72 items. Today ICIDH is available in 15 languages including Japanese and Chinese, and is used in a variety of fields such as medical, vocational, educational, and social rehabilitation, policy and administration, statistics, research, and education and training.

In paralled with the wider use of the ICIDH, criticisms and requests for revision have grown and led to the revision process. Since WHO has organized annual meetings. The field test consists of "alpha test" June 96 - Dec 96 , "beta test 1" Jul 97 - Dec 97 and "beta test 2" During the "alpha test" phase a set of draft proposals for ICIDH-2 was prepared by the coordination of WHO and discussed among those who had already been involved in the revision process.

Now a new draft is coming by the first week of July to be tested in the "beta test 1" phase. The participants will be asked to evaluate the draft ICIDH-2 concerning the ease of use, applicability, relevance of main and sub categories and definitions, etc. The results of the "beta test 1" will be used to prepare a revised draft which will be discussed in a revision meeting in Tokyo in March planned , and be tested in the "beta test 2".

WHO is looking for a government or non-government agency in each country which is willing to work as a field test coordinating site.

Although the draft ICIDH-2 is not available at this moment, early June , the followings have been proposed and discussed so far. All of them will be tested in the beta test 1. Figure 2 has been discussed in the alpha test. It emphasizes the role of contextual or environmental factors and bidirectional interaction among factors replacing the unidirectional relationship in figure 1.

The second option is "in the context of a health experience, participation is a person's involvement in life situations.

A restriction of participation is a reduction in the nature or extent of a person's involvement in life situation. Contextual factors usually interact with impairments, activities and participation. Especially they play an important role in determining the level of participation. These factors can largely be grouped into environmental or extrinsic factors on the one hand and personal or intrinsic factors on the other. However, so far the personal factors are not included in the proposed definition nor classification of Context.

Context is defined: "context includes the features, aspects, attributes of, or objects, structures, human-made organizations, service provision, and agencies in, the physical, social and attitudinal environment in which people live and conduct their lives.

It was one of a series of review meetings which is planned to be held once in every two years during the Decade. About participants representing GOs or NGOs from 28 countries in the region discussed the future targets as well as the progress in the past two "71 time bound targets" and many recommendations.

ESCAP members, i. The followings are excerpts from the Report of the Meeting. Target 3. The governments of the region may undertake steps to include questions on disability in the national population census as a long-term measure. Minimal levels of data shall be collected by all countries using standard terminology in accordance with the WHO International Classification of Impairment, Disability and Handicap.

An individualized rehabilitation plan or service plan can be broken down into intervention plans in every dimension of the disablement. The assessment of the impairments leads to the treatment plan and the assessment of the disability limitation of activities in ICIDH-2 will be used to identify the rehabilitation services needs, including needs for technical devices. And the Assessment of the nature and extent of participation in conjunction with the assessment of the contexts lead to the services plans, including residential resources, transportation, home help services, recreational services, incoming support services and physical adjustment of working environment.

The evaluation of the nature and extent of participation can give the overall effectiveness of various interventions. I would like to explain this aspect by showing recent Japanese experiences in the field of mental health policy. Last ten years in Japan, we experienced a successful policy expansion in mental health with the help of the conceptual framework of the ICIDH.

The understanding and recognition of the different dimensions, i. In , the Advisory Council on Public Health recommended a new understanding to the Minister of Health and Welfare that people with mental disorder are not merely people with illness, but also with disability who experience difficulty, restriction or disadvantage in their social life.

This Council Recommendation resulted in the amendment of the Mental Hygiene Act the following year which renamed it to Mental Health Act and provided a new facilities for social and vocational rehabilitation.

In s the Act was revised a few times and group home program was established. This program provides accommodation, meal, consultation, and other daily living assistance in a group home.

It is neither treatment nor training but assistance and support. Medical treatment response to disease or impairment, and rehabilitation or training to disability, and social support to micro environment. Our goal is to eliminate handicap. To achieve this, every possible approach should be used. It will be very useful in all Asian and Pacific countries.

International Classification of Impairments, Disabilities, and Handicaps. Go to the top of this page. Go to the upper category. ICIDH consists of two parts: a conceptual model and three classifications. Graphic Illustration of Conceptual Model Figure 2 has been discussed in the alpha test. Definitions of Participation "Participation is the nature and extent of a person's involvement in life situations in relationship to impairments, activities and contextual factors" is proposed as a first option.

Definition and Classification of Context Contextual factors usually interact with impairments, activities and participation. Other important points include: 1. In "Information and Public Awareness": Target 3. Recommendation 7: The governments of the region may undertake steps to include questions on disability in the national population census as a long-term measure.


International Classification of Functioning, Disability and Health

Functioning and disability are viewed as a complex interaction between the health condition of the individual and the contextual factors of the environment as well as personal factors. The picture produced by this combination of factors and dimensions is of "the person in his or her world". The classification treats these dimensions as interactive and dynamic rather than linear or static. It allows for an assessment of the degree of disability, although it is not a measurement instrument.







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