Page 110 - Handbook of Electronic Assistive Technology

Chapter 4 • Assessment and Outcomes 97

ICF has two parts: part one is ‘Functioning and Disability’ and part 2 is ‘Contextual
Factors’. Part one has two components: (1) Body Function and Structures and (2) Activities
and Participation. Part 2 also has two components: (1) Environmental Factors and (2)
Personal Factors (WHO ICF, 2001). Within the ICF, AT devices are seen to be an environ-
mental factor used to overcome health state impairments, and health-related limitations
and restriction. Disability ‘is regarded not as an impairment of the individual or shortcom-
ings of the environment but instead as arising at the interface of the individual and the
environment’ (Bauer et al., 2011).
While ICF carefully defines the key concepts related to health and is considered as ‘a
meaningful and practical system that can be used by various consumers for health policy,
quality assurance and outcome evaluation in different cultures’ (WHO ICF, 2001) it has its
own challenges.
The Assistive Technology Outcome Measurement System project performed a compre-
hensive evaluation of ICF for its ability to serve as an organising framework for AT out-
comes and concluded the following challenges (Edyburn and Smith, 2002):

• The coding system is complicated and subjective.
• It lacks specificity. For example, the use of Dycem as a nonslip surface during eating.
Consider two patients from different patient groups using this: one with burns to
both hands and one with impaired swallowing ability. Both would be scored as
having a deficit in the area of eating benefiting from Dycem; however, the functional
performance (and appropriate interventions) of these patients is remarkably
different.
• The system does not adequately consider qualifiers of performance such as safety
or task/activity completion time. Therefore an individual could be depicted as not
having a deficit, when in fact the person is not functional due to the poor quality of
performance.
• Overlap and relationship between ‘body structure and functions’ with ‘activities
and participation’. Essentially, the ambiguity due to the overlap and relationship of
the major ICF categories precludes mapping of an AT device to one and only one
category.

Individually Prioritised Problem Assessment

This is a generic tool that can be used for individual goals at the start of service delivery.
Prior to intervention the individual is asked to rate the activities that they have problems
performing in their daily life. The individual is then asked to rate the same activities a
few months post intervention (Wessels et al., 2002). It has been used in service delivery
with clients requiring support in mobility, hearing, speech-related communication and
self-care.
It is reported to fit well into the process of service delivery and facilitates the actual
assessment.