1.6.1 International classification of Functioning, Disability and Health (ICF)

The World Health Organization (WHO) has systematically developed a model of disability that considers the ongoing interaction between an individual’s health and contextual factors. This model acknowledges that disability is a universal human experience, is aetiologically neutral, and lies on a continuum from no disability to complete disability.  The International Classification of Functioning, Disability and Health, also commonly known as the ICF, is a classification of health and health-related domains and considers the dynamic interactions between a person’s health condition and contextual aspects of a person’s life including personal and environmental factors. The ICF is the international standard for framing, describing, recording and measuring functioning and disability (WHO, 2001).

The aims of the ICF (WHO, 20015) are to:

• provide a scientific basis for understanding and studying health and health-related states, outcomes, determinants, and changes in health status and functioning;
• establish a common language for describing health and health-related states in order to improve communication between different users, such as health care workers, researchers, policy-makers and the public, including people with disabilities;
• permit comparison of data across countries, health care disciplines, services and time; and
• provide a systematic coding scheme for health information systems.

When using the ICF in practice, health professionals may use both the ICF Categories and ICF Qualifiers to describe a person’s health.  ICF Categories include:

• body functions
• activities and participation
• environment factors
• body structures

ICF Qualifiers describe aspects of whether the health condition is a barrier or facilitator, the nature of the change in body structure, the extent to which a person’s capacity may be affected, and the extent or magnitude of the impairment and associated performance.

For this stage of your stage of learning, we will just focus on the ICF Categories within the framework (Figure 2).  We can describe a person’s health in terms of these domains, specifically: body structures and body functions/impairments; activities/activity limitations; participation/participation restrictions. Environmental and personal factors can be described as barriers or facilitators and may highlight how we might need to support people to achieve their rights, goals and maximum levels of functioning. The framework diagram below highlights the interaction between each of the domains.  We can’t view a single domain without consideration for the other domains.  Speech pathologists must explore and integrate consideration for all ICF domains when providing services to individuals, families and communities.

Let’s explore each of these ICF categories:

There are many resources and publications available for you to explore that further relate and apply the ICF to aspects of speech pathology practice:

• Voice disorders

  • Ma, E. P., Yiu, E. M. & Abbott, K. V. (2007). Application of the ICF in Voice Disorders. Seminars in Speech and Language, 28(4), 343-350.

• Cognitive-communication disorders

  • Larkins, B. (2007). The Application of the ICF in Cognitive-Communication Disorders Following Traumatic Brain Injury. Seminars in Speech and Language, 28(4), 334-342.

• Aphasia

  • American Speech-Language-Hearing Association [ASHA]. (n.d.). Person-centred focus on function: Aphasia.  https://www.asha.org/siteassets/uploadedfiles/icf-aphasia.pdf?srsltid=AfmBOor2WhuonjB0YJbF82L-5Aowt8Mgf-kWcgdG_Iys1mm2gji7waoG

• Developmental language disorders

  • Kwok, E. Y. L., Rosenbaum, P., & Cunningham, B. J. (2022). Speech-language pathologists’ treatment goals for preschool language disorders: An ICF analysis. International Journal of Speech-Language Pathology, 25(6), 885–892. https://doi.org/10.1080/17549507.2022.2142665

Let’s have a look at a further example of the application of the ICF related to childhood apraxia of speech (CAS) [note, just the speech difficulties associated with CAS are represented in the example below]: