Professional associations’ role in advancing the ICF in speech-language pathology

from the International Journal of Speech-Language Pathology

The ICF framework reflects a conceptual change in the approach to diagnosis and intervention across the spectrum of speech-language pathology services. The American Speech-Language-Hearing Association (ASHA), the professional association of speech-language pathologists and audiologists in the United States, has adopted this framework in its cardinal policy documents and sought to provide information and resources to its members about the ICF. This chapter discusses the history of ASHA’s involvement in the ICF and its continued role in promoting the adoption of the ICF framework. It therefore highlights how the ICF can influence policy.

Speech, hearing, and communication across five national disability surveys: Results of a DISTAB study using the ICF to compare prevalence patterns

from the International Journal of Speech-Language Pathology

This paper describes how the International Classification of Functioning, Disability and Health (ICF) can be used as a statistical tool and addresses the implications of the DISTAB study in which speech, hearing and communication prevalence rates were examined in adults across five countries – Canada, France, the Netherlands, South Africa and the United States. The implications of the study results for hearing and swallowing disorders as well as the methodological issues raised by the DISTAB study are described. The authors also address the role of ICF and related methodologies such as cross-walking and the inclusion of persons with communication disorders in future surveys. They recommend that all areas of functioning covered by communication disorders be fully explored in ICF to maximize the use of ICF as a force for social policy.

The contribution and impact of the International Classification of Functioning, Disability and Health on quality of life in communication disorders

from the International Journal of Speech-Language Pathology

Past discussions of the International Classification of Functioning, Disability and Health (ICF) have focused minimally, if at all, on quality of life. This paper critically discusses the contribution of the ICF to quality of life concept development, and the impact that the ICF has had thus far on health-related quality of life measurement. “Contribution” focuses on modelling the relationship between disablement and quality of life, evaluating the content of existing instruments, and thinking holistically about the individual. “Impact” relates to the association of quality of life with functioning, pathology and outcomes, the trend towards life compartmentalization, and the disproportionate emphasis on individuals’ functioning at the expense of their life context. Examples are drawn from adult acquired conditions (mainly aphasia), and terminology used in the paper reflects a rehabilitation stage of service provision. The World Health Organization’s approach to quality of life definition and measurement is also discussed. An operational definition of quality of life for adults with acquired communication and swallowing disorders is presented, alongside an alternative conceptualization of quality of life. This paper ends with recommendations for future research concerning the importance of context, the subjective or personal perspective, and having a goals orientation for life as well as rehabilitation. It is also argued here that the ICF and quality of life are different constructs and that quality of life should be the starting point for understanding the client’s perspective of his/her goals and/or his/her disability.

The ICF Activities and Participation related to speech-language pathology

from the International Journal of Speech-Language Pathology

Increasingly speech-language pathologists are considering the effects of a client’s communication and/or swallowing disability on the client’s day to day life. The activities and life situations that make up a person’s everyday life are described in the Activities and Participation component of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF). This paper describes the Activities and Participation component of the ICF and how communication is currently represented in this component. This paper then explores the current debate between the concepts of activities and participation and how this can continue to inform and develop our understanding of communication activity and communication participation into the future.

The ICF as a framework for interdisciplinary doctoral education in rehabilitation: Implications for speech-language pathology

from the International Journal of Speech-Language Pathology

This paper describes the use of the International Classification of Functioning, Disability and Health (ICF) as an educational framework for the development of the Doctoral Programme in Rehabilitation Sciences at the University of Western Ontario in London, Canada. The ICF and the concepts underlying disability and universalism provided the framework from which the programme evolved. As a result, this interdisciplinary programme was facilitated through use of the ICF and efforts to present a common language. We believe that this framework was essential in providing an enriched educational environment for graduate students. Details of the programme’s structure, its requirements, and the optimized opportunities for interdisciplinary academic study are described. Additionally, we address coursework and the explicitly designed opportunity for developing a programme of independent research for each student. This includes discussion concerning a new vision for comprehensive examination that provides an ideal opportunity for those interested in communication disorders. Finally, we reflect on both the successes and challenges that have been faced by our programme including student perceptions and the suitability of this educational model for addressing larger and more complex questions specific to functioning and disability in the context of the traditional academic environment.

The ICF Body Functions and Structures related to speech-language pathology

from the International Journal of Speech-Language Pathology

Body Functions and Body Structures form one component of the International Classification of Functioning, Disability and Health (ICF). Coding of items within these ICF chapters can be useful in speech-language pathology to provide a holistic overview of an individual’s condition, but only if this component is considered alongside the other components that make up the ICF. This paper outlines the Body Functions and Body Structures codes that are most relevant to speech-language pathology and discusses the overlap that occurs with the Activities and Participation component. A review of the strengths and limitations of the ICF Body Structures and Body Functions components is also presented.

The ICF Contextual Factors related to speech-language pathology

from the International Journal of Speech-Language Pathology

The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) conceptualizes functioning and disability as a dynamic interaction between a person’s health condition and their contextual factors. Contextual factors “represent the complete background of an individual’s life and living” and comprise two components: Environmental Factors and Personal Factors. This review aims to: (1) discuss why contextual factors are important for speech-language pathologists to address in their clinical practice, (2) describe how environmental factors are coded in the ICF, (3) identify environmental factors that are relevant for people with communication disorders, and (4) identify personal factors that are relevant for people with communication disorders. Research on environmental factors that can influence the functioning of individuals with various communication disorders is presented, in addition to studies on personal factors that are important for speech-language pathologists to consider. The paper concludes that speech-language pathologists need to address contextual factors routinely, in order to provide a holistic approach to intervention for their clients. Furthermore, although a number of contextual factors that are relevant for people with communication disorders have been reported in the literature, more research is needed in this area.

The ICF-CY and children with communication disabilities

from the International Journal of Speech-Language Pathology

The International Classification of Functioning, Disability and Health Children and Youth Version (ICF-CY) (World Health Organization, 2007) provides a relevant framework for consideration of children with communication disability by professionals such as speech-language pathologists and audiologists. This paper describes the international and interdisciplinary context in which the ICF-CY was created; then focuses on three major considerations in the development of the ICF-CY: the inclusion of universal perspectives on the rights of children, the need for adherence to the structure of the ICF and the specific issues regarding the use of qualifiers with children. The prevalence and incidence of children with communication and hearing disability is outlined and the literature relating to core sets of ICF-CY codes for children with communication disability is discussed. Next, the ICF-CY is applied to assessment and intervention practices of speech-language pathologists. To exemplify the status quo, the primary focus of 56 assessment tools and 22 intervention approaches for children with speech impairment is categorized using the ICF-CY. This analysis demonstrates speech-language pathologists’ current emphasis on Body Functions when working with children with speech impairment. Finally, this paper presents a discussion of role of the ICF-CY in advocacy for children with communication disability.

The use of the ICF in speech-language pathology research: Towards a research agenda

from the International Journal of Speech-Language Pathology

The International Classification of Functioning, Disability and Health (ICF) facilitates a wide range of research in speech-language pathology. In addition to framing the development of assessment tools and evaluating interventions, the ICF can also be used to evaluate concepts such as third party disability or environmental factors that prevent or facilitate communication accessibility. In this paper, a model proposed by Stucki and Grimby is used to describe research on a continuum from basic to professional, and from cell to society. We translate this model to speech-language pathology by using examples from our programme of research in the Communication Disability Centre. The model also allows the identification of broad gaps in speech-language pathology research to date. The paper concludes with recommendations for a research agenda for the ICF in speech-language pathology. In particular, it is argued that unless speech-language pathology researchers fully understand the constructs of the ICF as applied to communication disability, valid measures for professional practice research cannot be developed.

Use of the ICF for clinical practice in speech-language pathology

from the International Journal of Speech-Language Pathology

The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) (WHO, 2001) states that one of its five possible applications is for clinical use. The ICF is both a conceptual framework and a classification system with a complex numerical coding system and operational definitions. Thus, the practical and useful application of the classification system for recording assessment results could prove difficult. However, an agreed upon clinical interpretation of the ICF by clinicians is essential for it to be able to communicate complex clinical assessments to other professionals, third party payers, administrators, health care policy makers, and the consumers of our services. The American Psychological Association and the World Health Organization are working on finalizing the Procedural Manual and Guide for the Standardized Application of the ICF: A Manual for Health Professionals. This Procedural Manual is being designed to provide health professionals with directions for clinical use of the ICF, including additional information about the clinical interpretation of each code, to facilitate reliable and valid clinical use of the ICF. This article addresses issues discussed in the Procedural Manual and a range of complex issues regarding the clinical use of the ICF by speech-language pathologists.

Cortical areas involved in Arabic number reading

from Neurology

Objective: Distinct functional pathways for processing words and numbers have been hypothesized from the observation of dissociated impairments of these categories in brain-damaged patients. We aimed to identify the cortical areas involved in Arabic number reading process in patients operated on for various brain lesions.

Methods: Direct cortical electrostimulation was prospectively used in 60 brain mappings. We used object naming and two reading tasks: alphabetic script (sentences and number words) and Arabic number reading. Cortical areas involved in Arabic number reading were identified according to location, type of interference, and distinctness from areas associated with other language tasks.

Results: Arabic number reading was sustained by small cortical areas, often extremely well localized (<1 cm2). Over 259 language sites detected, 43 (17%) were exclusively involved in Arabic number reading (no sentence or word number reading interference detected in these sites). Specific Arabic number reading interferences were mainly found in three regions: the Broca area (Brodmann area 45), the anterior part of the dominant supramarginal gyrus (Brodmann area 40; p < 0.0001), and the temporal–basal area (Brodmann area 37; p < 0.05). Diverse types of interferences were observed (reading arrest, phonemic or semantic paraphasia). Error patterns were fairly similar across temporal, parietal, and frontal stimulation sites, except for phonemic paraphasias, which were found only in supramarginal gyrus.

Conclusion: Our findings strongly support the fact that the acquisition through education of specific symbolic entities, such as Arabic numbers, could result in the segregation and the specialization of anatomically distinct brain areas.

Physiological and psychological stress reactivity in chronic tinnitus

from the Journal of Behavioral Medicine

Abstract  Several models of tinnitus maintenance emphasize the importance of cognitive, emotional and psychophysiological processes. These factors contribute to distress in patients with decompensated tinnitus symptoms. We investigated whether tinnitus patients show increased physiological levels of arousal, more intense stress reactivity patterns and exaggerated psychological strain compared to healthy controls. Seventy tinnitus patients and 55 healthy controls underwent various stress tests. Muscular reactivity and peripheral arousal as well as strain ratings were assessed. Tinnitus patients reported significantly more strain during stress tests compared to healthy controls. Few physiological reactivity patterns differed significantly between the two groups. The physiological data thus only partly supported a hyperreactivity hypothesis. Strain reports and physiological data were only marginally correlated. Tinnitus patients show maladaptive appraisal processes during stress exposure, yet physiological reactivity is only slightly affected. Treatment programs for patients with decompensated tinnitus symptoms should account for appraisal processes and coping mechanisms in stressful situations.

Consanguinity and deafness in Omani children

from the International Journal of Audiology

This study was based on a national retrospective analysis of 1400 questionnaires on the causes of deafness in Omani children, collected from 1986 to 2000. It was found that 70% of the deaf children were from parents of consanguineous marriages, and 30% from non-consanguineous unions. In those with consanguineous families 70.16% were first cousin marriages, 17.54% were second cousins, and 10.86% were from the same tribe. The proportion arising from first cousin marriages was higher than the background rate of first cousin marriages in Oman. In the total cohort, 45% had other family members with hearing loss. There was a greater chance of other relatives being affected in the consanguineous group as opposed to the non-consanguineous group (29.7% versus 15.3%). In most cases the affected relative was a deaf sibling (67.8%). We have demonstrated a higher rate of consanguinity amongst parents of deaf children in Oman and suggest this is associated with a higher frequency of autosomal recessive deafness in this paediatric population.

The effects of very slow rates of stimulus presentation on event-related potential estimates of hearing threshold

from the International Journal of Audiology

The present study evaluated the use of slow rates of stimulus presentation on the accuracy of the N1-P2 cortical response in estimating hearing threshold. Long interstimulus intervals (ISI) allow the non-specific component of the N1 response to emerge, believed to reflect widespread cortical arousal that facilitates sensory and motor responses. We examined whether the non-specific N1 would be elicited at intensity levels near threshold. Event-related potentials were recorded to 0.5-, 1.0, and 4.0-kHz tone bursts with a long ISI (8-12 s) while the eleven subjects read a book. The stimulus level varied from -5 to 45 dB nHL. The 1.0-kHz tone burst was also presented with a shorter ISI (1.5-2.5 s), akin to that typically used in the audiological setting. The amplitude of N1-P2 was significantly enhanced in the long compared to short ISI condition, but, importantly, only for the stimuli with a level 25 dB nHL. Therefore, the N1-P2 recorded with long ISIs was not more precise in estimating threshold than that recorded with short ISIs, remaining visible to within 10 dB of behavioural threshold.

Tone-evoked ABR in full-term and preterm neonates with normal hearing

from the International Journal of Audiology

This study was designed to investigate the feasibility of applying tone-ABRs in the nursery and neonatal intensive care unit (NICU), and to provide normative tone-ABR data from neonates. Normative tone-ABR latency data were determined. The study obtained intensity series of tone-ABRs from thirty preterm neonates and twenty full-term neonates who had confirmed normal peripheral auditory function after passing both an OAE and ABR screening examination. ABRs were collected in response to 500, 1500, and 4000 Hz tone bursts at 70, 50, 30, and 20 dB nHL. Mean wave V latencies were compared between groups, ears, and by gender. Responses to tone bursts of 20 and 30 dB nHL were detected in 97% and 100% of all ears respectively, in addition to responses to the higher-intensity stimuli. Preterm neonates’ ABRs showed significantly longer latencies than those of the full-term infants. Tone-ABR evaluation was found to be both feasible and reliable as a measure of auditory function in neonates.