The ICF is a framework for functioning and disability in relation to a health condition

1. ICF - CVA
Dr. Maheshwari Harishchandre
Assistant Profesor
M.P.Th (Neurosciences)
DVVPF College of Physiotherapy,
Ahmednagar

2. Objective
• At the end of lecture learner should be
able to write ICF – format in CVA patients.

3. • A 35 yrs. Old male suffered from Rt. CVA
since 1 month; with decreased higher
mental function, facial weakness, loss of
sensation on Lt. UL & LL, VII & VIII C.N
involvement, Gr. II spasticity in Lt. Elbow
flexors & he need assistance to come in
sitting position. His left hand is dominant;
living on 2nd floor & earning member in
family.

4. Structural Impairment
Structural Impairment Source of Information Clinical reasoning
Lobes – Frontal lobe, parietal
lobe
Technical investigation (CT
scan, MRI Brain)
Hemorrhagic/ Ischemic infarct
VII & VIII C.N involvement Clinical investigation (C.N test
, Weber’s test)
VII & VIII nerve nucleus
Rt. Brain Clinical &technical
investigation
Hemorrhagic/ Ischemic
Primary motor cortex Technical investigation (MRI) Infarct
Primary sensory cortex Technical investigation (MRI) Infarct
Structure of mouth, larynx,
pharynx (voice & speech)
Post. Portion of temporal gyrus
Technical investigation (MRI) Infarct
Structure of Upper limb/ Lower
limb
Primary motor cortex & internal
capsule
Technical investigation (MRI) Infarct

5. Functional Impairment
Functional Impairment Source of Information Clinical Reasoning
Decreased mental fn – attention ,
orientation
Patient reported questionnaire &
clinical investigation
Prefrontal cortex & reticular system
Loss of Memory Clinical investigation Fronto-temporal lobe & limbic system
Loss of Sensation over Lt. UL &
LL
Clinical investigation (sensory
assessment)
Primary sensory area
Pain Clinical investigation ,patient history Ventral posterolateral nucleus of
thalamus
Difficulty in performing facial
movement
Patient reported questionnaire &
clinical investigation (Facial Grading
Scale)
C.N VII & Nucleus
Hearing difficulty Clinical investigation (C.N test,
weber’s test)
C.N VIII & nucleus,
Difficulty to perform activity on Lt.
Side
Clinical investigation Primary motor Cortex
Difficulty to maintain Balance Patient reported questionnaire &
clinical investigation (BBS)
Vestibular nuclei

6. Functional Impairment Source of information Clinical Reasoning
Increased tone in muscles Patient reported questionnaire &
clinical investigation (MAS)
Primary motor cortex &
cerebellum
Difficulty to do transition Patient reported questionnaire &
clinical investigation (BBA)
weakness
Unable to stand
Unable to walk without support
Patient reported questionnaire &
clinical investigation (BBS)
Primary motor cortex & internal
capsule

7. Activity Limitation
Impairments Source of
Information
Clinical reasoning
Changing body position
1. lying down
2. squatting
3. Kneeling
4. sitting
5. Standing
6. bending
Patient reported
questionnaire
(BBS), Clinical
investigation
Weakness UL & LL , Spasticity
Maintaining body position
1.Maintaining a lying
2.Squatting
3.Kneeling
4. sitting
5. standing position
Clinical
investigation
(Asses ment )
Weakness UL & LL muscles
Transferring oneself
1. Transferring oneself while sitting or lying
Clinical
investigation,
Patient reported
questionnaire
(BBS)
Body weakness, Loss of
Balance

8. Impairments Source of Information Clinical Reasoning
Lifting & carrying objects
1.Lifting
2.carrying in the hands or arms,
or on shoulders, hip, back or
head
3.putting down
Clinical investigation , Patient
reported questionnaire (BBS,
FIM, Jabson’s hand function
test)
Upper limb & Hand muscle
weakness
Trunk muscle weakness
Fine Hand Use
1. Picking up
2. Grasping
3. Manipulating
4. Releasing
Clinical investigation , Patient
reported questionnaire
(Jabson’s Hand Function test,
ARAT)
Hand muscle weakness
Spasticity
Hand & Arm Use
1.Pulling
2. Pushing objects
3. Reaching
4.Turning or twisting the hands
or arms
5. Throwing
6. Catching
Clinical investigation (Hand
Function assessment)
Hand Muscle weakness
Moving around
crawling, climbing, running,
jogging, jumping and swimming
Clinical investigation (Mat
activites)
Body weakness

9. Impairments Source of Information Clinical Reasoning
Walking
1.walking short or long
distances
2. Walking on different
surfaces
3. Walking around
obstacles
Clinical investigation, Patient
reported questionnaire (DGI)
Weakness – HIP, Knee & Ankle
Muscles
Using Transportation
1.Using human-powered
transportation
2. Using private
motorized 3. Public
transportation
Clinical investigation Weakness – Upper limb & lower
limb muscle weakness
Driving
1.Driving human-
powered transportation
2.Motorized vehicles
Clinical invetigation , Patient
reported questionnaire (FIM)
Weakness – Shoulder , Elbow &
wrist muscle weakness

10. ENVIORNMENTAL
FACTOR

11. Environmental Factors
Facilitator
Barrier
Source of
Information
Clinical Reasoning
Facilitator - Products or
substances for personal
consumption
1. Food
2. Drink
3. Drugs
Clinical
Investigation,
Patient reported
questionnaire
Upper limb muscle
weakness
Facilitator - Products and
technology for personal use in
daily living
1.general and assistive products
and technology for personal use
Clinical
Investigation,
Patient reported
questionnaire
Hospital admitted
Barrier - Products and
technology for personal indoor
and outdoor
mobility and transportation
1. General and assistive products
and technology for personal indoor
and outdoor mobility and
transportation
Clinical
Investigation,
Patient reported
questionnaire
Weakness

12. Environmental Factors Source of
Information
Clinical Reasoning
Barrier - Design, construction and
building products and technology
of buildings for public use- e150
1.Design
2.construction and building products
technology of entrances and exits
3. Facilities and routing
e.G work places, shops, theatres
Clinical
Investigation, case
history
Weakness, Hospital
admitted
Facilitator - Personal care
providers and personal assistants
1. ImmediateFamily
2. Extended family
3. Friends
Case history Assist for personal
care
Facilitator - Health professionals
e355
1. Doctors, nurses, physiotherapists,
occupational therapists, speech
therapists, audiologists, orthotist-
prosthetists
Clinical
investigation &
Case history
Improve patients
ADLs

13. Environmental Factors Source of Information Clinical Reasoning
Facilitator - Health
services, systems and
policies
(shopping, housework,
transport, child care,
self care)- e575
Case history Assistance for health
services & policies

15. SUMMARY
• Introduction
• Structural & Functional Impairments
• Activity & Participation Restriction
• Environmental factors

16. References
• ICF - Coreset

17. THANK
YOU……