Search Results (161)

Background: Spinal cord injury is a life-changing condition for individuals who have previously been independent in activities of daily living. Motor recovery prognosis for individuals with complete spinal cord lesion above thoracic level ten is poor after nine months of injury. Although the corticospinal tract is responsible for voluntary mobility functions such as walking, it is possible, through neuroplasticity, that involuntary lower limb movements can be trained. Methods: This case study discusses the use of multi-modal rehabilitation strategies, from weightbearing exercises using traditional manual-controlled exoskeleton to ambulation using advanced automotive exoskeleton. Results: The patient’s perspective showed themes that align with the World Health Organization’s International Classification of Functioning and Disability. In spinal cord injury, majority of concerns are in environmental and personal factors. This could be due to the perceived permanent disability in complete spinal cord lesion. The moderate-intensity two-hour intervention using traditional and advanced exoskeletons during physical rehabilitation showed that it was possible to stimulate deep sensations, and muscle pull and cramp for a patient diagnosed with complete spinal cord lesion. Conclusions: The use of traditional and advanced exoskeletons in weightbearing exercises may benefit patients with complete spinal cord lesions in regaining deep sensations in the lower limbs. Full article

Multimorbidity has emerged as a pressing public health concern on a global scale, primarily driven by population aging and the epidemiological transition, which has resulted in an increased prevalence of chronic non-communicable diseases. Objective: The objective of the study was to investigate the functioning profile of individuals with multimorbidity in Chile, focusing on capacity and performance, and to explore the association between multimorbidity and compromised functioning. Methods: Data from the II ENDISC, a cross-sectional population study conducted in Chile in 2015, were analyzed. The sample comprised 12,265 randomly selected individuals aged 17 and above, who were interviewed using the Model Disability Survey. Generalized linear models (GLMs) were employed to assess the impact of multimorbidity on capacity and performance. Results: The results revealed that individuals with multimorbidity presented worse capacity scores (38.31 vs. 19.72) and performance scores (44.51 vs. 27.28) compared to those without multimorbidity. Furthermore, adjusted risk through GLM shows that individuals with multimorbidity had a higher risk of experiencing worse capacity (1.39) and performance (1.29) scores. Gender, self-rated health, age, employment status, and education level were identified as factors associated with varying degrees of impact on functioning. Conclusions: These findings underscore the importance of addressing multimorbidity and its associated factors in healthcare planning and intervention strategies, particularly for socioeconomically vulnerable populations, to enhance well-being and functioning among individuals with multimorbidity. Full article

Background/Objectives: This article aims to investigate the multifaceted effects of alcohol on neurophysiopathological development from gestational stages through adult life and the consequent dynamic-relational challenges in individuals with Fetal Alcohol Spectrum Disorder (FASD). FASD, resulting from prenatal alcohol exposure (PAE), is characterized by a range of neurological, cognitive, behavioral, and sometimes physical impairments. This article explores how alcohol and its toxic metabolites cross the placenta, inducing direct cellular toxicity and epigenetic alterations that disrupt critical neurodevelopmental processes such as neurogenesis and brain circuit formation. Clinically, individuals with FASD exhibit diverse deficits in executive functioning, learning, memory, social skills, and sensory-motor abilities, leading to significant lifelong disabilities. A central focus is the application of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) criteria to comprehensively frame these disabilities. The ICF’s biopsychosocial model allows for a multidimensional assessment of impairments in body functions and structures, limitations in activities, and restrictions in participation, while also considering the crucial role of environmental factors. Methods: PubMed and Semantic Scholar databases were searched for relevant papers published in English. Results: This article highlights the utility of the ICF in creating individualized functioning profiles to guide interventions and support services, addressing the limitations of traditional assessment methods. Conclusions: While the ICF framework offers a robust approach for understanding and managing FASD, further research is essential to develop and validate FASD-specific ICF-based assessment tools to enhance support and social participation for affected individuals. Full article

Background: Muscle health is an emerging concept linked to physical performance and functional independence. However, the term lacks a standardized definition and is often used as a broad muscle-related outcome descriptor. Clinical communication and research would benefit from a conceptual model of muscle health grounded in an established framework. Methods: We conducted systematic search and narrative synthesis to identify multifactorial measurement approaches explicitly described under ‘muscle health’. PubMed and CINAHL were searched for clinical and randomized controlled trials published in the past 5 years (final search: March 2025) that used the term “muscle health.” Studies were reviewed for explicit definitions of “muscle health,” and all identified outcomes (e.g., strength, mass) and measurement tools (e.g., grip strength, ultrasound) were synthesized. This review was retrospectively registered (INPLASY202580069). Results: Of the 65 clinical or randomized controlled trials that met inclusion criteria, 29 provided an operational definition of ‘muscle health’, while 36 inferred measurements without a clear definition. The identified measurements spanned four primary categories, with body composition/muscle mass being the most common (92.3%), followed by muscle performance (78.5%), physical function (63.1%), and tissue composition (30.8%). Most studies included more than one muscle health metric (93.9%). Common assessment methods included DXA (44.6%), grip strength (64.6%), and gait speed (27.7%). Conclusions: While there are common measurement approaches, the definition of muscle health varies widely in the cited works. The framework of the International Classification of Functioning, Disability and Health, was used to identify domains aligned with muscle health components of muscle morphology/morphometry (e.g., mass and composition), functional status (performance-based tasks), and physical capacity (muscle performance). This framework provides a structured basis for evaluating muscle health in research and clinical practice. Consistent use of these domains could enhance assessment and support efforts to standardize testing and interpretation across settings. Full article

Background/Objectives: Cerebral palsy (CP) is the most common cause of motor disability in childhood and is frequently associated with cognitive impairments that limit autonomy and participation. While motor function is a known predictor of functional outcomes, the specific contribution of cognitive domains within the International Classification of Functioning, Disability and Health (ICF) framework remains unexplored. This systematic review examines the relationship between cognitive domains and the ICF components of Activities and Participation, and Environmental Factors in people with CP. Methods: Following PRISMA guidelines, a systematic search was conducted across six databases (PubMed, PsycINFO, CENTRAL, CINAHL, ERIC, and WOS) for studies published between 2002 and 2025. Eligible studies included participants with CP (n = 3056) and analyzed associations between cognitive functions and ICF domains using standardized tools and statistical methods. Risk of bias was evaluated using the Oxford Centre for Evidence-Based Medicine criteria. Results: Forty-four studies met inclusion criteria, involving mostly children and adolescents with spastic CP and mild to moderate motor impairment. General intellectual functioning, language, and visual perception were the most studied domains, showing consistent associations with ICF chapters such as Learning and applying knowledge, Communication, and Mobility. Although fewer studies examined Environmental Factors, relevant associations emerged with support systems, attitudes, and services. Heterogeneity in assessment methods and participant profiles was observed, and adult representation was limited. Conclusions: Cognitive functioning is significantly associated with multiple ICF domains in CP. Environmental Factors remain insufficiently addressed. Further research should consider CP heterogeneity and promote standardized assessments to support ICF-based intervention planning. Full article

Background/Objectives: Pediatric acquired brain injury (ABI) often results in persistent challenges that extend beyond motor impairments, affecting quality of life (QoL), social participation, and engagement in physical activity. Given the complexity and chronicity of these outcomes, there is a pressing need for multidimensional interventions grounded in the International Classification of Functioning, Disability and Health (ICF). Sport-based exercise interventions, when developmentally adapted and tailored to individual interests, may promote intrinsic motivation, peer connection, and sustainable engagement—factors especially relevant in pediatric ABI populations, who often experience reduced physical activity and social isolation. However, standardized, replicable protocols specifically tailored to this population remain scarce. This study presents the protocol for a randomized controlled trial evaluating the effects of a 16-week sport-based intervention on QoL, social participation, physical activity engagement, and motor functioning tailored for adolescents with pediatric ABI. Methods: Participants will be randomly assigned to an intervention group or a control group receiving usual care. The intervention consists of one weekly 60-minute session, led by trained professionals in adapted physical activity and pediatric neurorehabilitation. It combines sport-based motor skill training, cooperative games, and group activities specifically tailored to each child’s developmental level, motor abilities, and preferences. Outcomes will be assessed at baseline and following the 16-week intervention period, focusing on QoL, participation, physical activity engagement, and motor functioning. Discussion: This study introduces a structured, child-centered model that bridges clinical rehabilitation and community-based sport. By integrating motor and psychosocial targets through a group sport-based intervention, it aims to enhance recovery across ICF domains. Findings may inform interdisciplinary practice and support the development of sustainable strategies to promote long-term engagement and well-being in adolescents with ABI. Full article

Stroke rehabilitation requires comprehensive assessments aligned with the International Classification of Functioning, Disability, and Health (ICF) biopsychosocial model. Linking assessment tools to the ICF helps integrate this approach by identifying aspects of functioning they address. This study aimed to analyze the content of the most used assessment tools for post-stroke rehabilitation through systematic linkage with the ICF. A scoping review was conducted, including (1) the identification of clinical trials on post-stroke rehabilitation published between 2014 and 2024 in the PubMed, LILACS, SciELO, and PEDro databases to select the most commonly used assessment tools, followed by (2) the ICF linkage methodology to map the most cited tools to the content of ICF categories and domains. From the 897 studies reviewed, 29 tools were identified—21 were newly linked and 8 had pre-existing ICF links. The analysis identified 261 ICF categories: 53% related to Activities, 31% to Body Functions, 15% to Participation, and 1% to Environmental Factors. No tool covered the Body Structure domain. The findings highlight a focus on Activities and Body Functions, reinforcing the need to integrate Participation and Environmental Factors into post-stroke rehabilitation assessments. The results offer an overview of ICF categories covered by each tool, supporting informed decisions in rehabilitation research and practice. Full article

Background: Social and financial services are essential for the inclusion and well-being of people with disabilities (PWDs), who often rely on family caregivers to access these systems. In Saudi Arabia, where disability inclusion is a strategic goal under Vision 2030, understanding caregiver experiences is crucial to identifying service gaps and improving accessibility. Objectives: This study aimed to explore caregivers’ perspectives on awareness, perceived barriers, and accessibility of social and financial services for PWDs in Saudi Arabia. The analysis is grounded in Andersen’s Behavioural Model of Health Service Use and the WHO’s International Classification of Functioning, Disability and Health (ICF) framework. Methods: A cross-sectional survey was conducted with 3353 caregivers of PWDs attending specialised day schools. The survey collected data on demographic characteristics, service awareness, utilisation, and perceived obstacles. Exploratory Factor Analysis (EFA) identified latent constructs, and Structural Equation Modelling (SEM) was used to test relationships between awareness, barriers, and accessibility. Results: Findings reveal that over 70% of caregivers lacked awareness of available services, and only about 3% had accessed them. Key challenges included technological barriers, complex procedures, and non-functional or unclear service provider platforms. Both User Barriers and Service Barriers were negatively associated with Awareness and Accessibility. Awareness, in turn, significantly predicted perceived Accessibility. Caregiver demographics, such as age, education, gender, and geographic location, also influenced awareness and service use. Conclusions: There is a pressing need for targeted awareness campaigns, accessible digital service platforms, and simplified service processes tailored to diverse caregiver profiles. Inclusive communication, decentralised outreach, and policy reforms are necessary to enhance service access and promote the societal inclusion of PWDs in alignment with Saudi Arabia’s Vision 2030. Full article

Disability Certification is an instrument that can contribute to the identification of persons with disabilities who are potential beneficiaries of social protection programmes. In Colombia, the disability certification process was changed in 2020 to include a human rights perspective. However, little information exists on how far the process aligns with the recommendations made by the Convention on the Rights of Persons with Disabilities or to what extent it provides useful information for the operation of the country’s social protection system. This study aims to analyse how the changes implemented in 2020 have contributed to the identification and determination of persons with disabilities in social protection programmes in Colombia. This research uses an analytical-descriptive design, in which legal documents related to the social protection programme and disability certification were analysed. In addition, we conducted semi-structured interviews in Colombia with people with disabilities, professionals conducting the certification, and with key stakeholders, and we analysed the information using thematic analysis. Colombia changed its certification process in 2020, moving from a capacity-to-work assessment to a process of assessing functioning capacity and participation limitations following the International Classification of Functional Disability and Health. However, the new certification process has not provided an instrument to contribute to determining persons with disabilities who should be prioritised or receive social benefits in Colombia. The certification does not establish the support needs of people with disabilities, does not recommend reasonable adjustments to support their participation in society, and has not been used systematically in social protection programmes. Finally, individuals with disabilities commented that the disability certification is a process that does not open up opportunities to receive social benefits and social transfers, and in most cases, it is an expensive and lengthy process. Disability certification in Colombia is not an instrument that determines the needs of people with disabilities, nor the reasonable accommodations that they require in order to participate in society. Full article

Background/Objectives: Population health problems are among the world’s main concerns. However, mortality and morbidity alone do not fully encompass the health experience of populations. International efforts are underway to verify health experiences using functioning as the third health indicator. The aim of the study was to compare the functioning profile of the Chilean population with mortality and morbidity rates due to neurological, circulatory, respiratory, and musculoskeletal diseases at the regional level. Methods: An ecological study was conducted with the secondary dataset II Estudio Nacional de la Discapacidad (ENDISC) and mortality and hospitalization rates from the Departamento de Estadísticas e Información en Salud. The II-ENDISC was a national household survey, based on the Model Disability Survey, carried out in 2015. Results: The correlation of functioning with morbidity and mortality rates was determined by Spearman’s correlation. The correlation values of the mortality and morbidity coefficients with the performance and disability data were not relevant and significant (p < 0.35; p > 0.05). This suggests a lack of a linear relationship between these indicators at the regional level. Conclusions: The analysis of the Chilean population revealed that performance values, as an expression of functioning, do not correlate with morbidity or mortality rates. This discrepancy underscores the limitations of relying solely on traditional health indicators to capture the complexity of population health. Our findings support the conceptual value of functioning as a complementary and distinct health indicator, rather than a proxy for morbidity or mortality. Full article

Background: Remote interprofessional education (IPE) often fails to reflect cognitive differences across disciplines, limiting students’ ability to form collaborative identities and clarify professional roles. Prior research has focused on attitudinal change, with less attention to reflective and epistemological learning. Objective: This study aimed to examine whether making profession-specific reasoning patterns visible through structured comparison and guided reflection in a brief, remote IPE intervention could enhance students’ understanding of disciplinary perspectives and their interprofessional competence. Methods: Final-year Japanese university students in OT and MHSW participated in a two-session remote IPE intervention. In the first session, the students independently assessed a video case using the International Classification of Functioning, Disability and Health (ICF) core sets. In the second, the profession-specific results were aggregated, visualized, and shared as feedback to prompt guided reflection. A convergent mixed-methods design was used, combining pre-/post-surveys using the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IEPS), with qualitative analysis of the written reflections. Results: Significant improvement was observed in the IEPS Competence and Autonomy subscale among the MHSW students with low baseline scores. No significant changes were found in the RIPLS scores. Thematic analysis indicated increased awareness of disciplinary perspectives and recognition of complementary roles. Conclusions: A structured comparison approach can promote role clarity, reflective learning, and interprofessional identity in brief, remote IPE settings. Full article

The Life Impact Burn Recovery Evaluation (LIBRE) Profile was developed to assess long-term social participation outcomes for adult burn survivors. Traditional clinical burn recovery outcomes focus on early physical complications and psychosocial issues, but there is a growing need for quantitative measures of long-term recovery that assess experiences deemed relevant to burn survivors. The LIBRE Profile, co-produced with input from burn survivors and clinicians and grounded in the World Health Organization’s International Classification of Functioning, Disability and Health (WHO-ICF) conceptual framework, addresses the measurement gap by focusing on six domains of social participation: social interactions, social activities, family and friends, work and employment, romantic relationships, and sexual relationships. The LIBRE Profile uses Item Response Theory (IRT) and computer adaptive tests (CAT) to minimize respondent burden while maintaining accuracy. Psychometric evaluations have validated the LIBRE Profile as a reliable and clinically useful tool that can help clinicians and burn survivors monitor recovery and inform personalized care. Future work includes LIBRE Profile development for pediatric populations, further international language translations, and the development of an APP for broader personal and clinical use. This paper provides a comprehensive overview of the LIBRE Profile’s development, psychometric foundations, and future directions, advocating for its adoption in clinical practice and burn survivor communities. Full article

Background/Objectives: Robotic rehabilitation holds great potential for improving patient outcomes, but the integration of these technologies into clinical practice is hindered by a lack of comprehensive tools for assessing patients’ needs. This systematic review aimed to identify gaps in the current literature, with a focus on methodologies and tools for evaluating such needs, particularly those based on the International Classification of Functioning, Disability, and Health (ICF) framework. Methods: A systematic review of qualitative studies published between 2021 and 2023 was conducted, updating a previous (2020) review. Studies were identified through PubMed, Scopus, and Web of Science using inclusion criteria focused on qualitative methods capturing patients’ experiences with robotic and technological rehabilitation devices. Results: The review analyzed 19 new studies and 20 from the prior review, revealing a reliance on semi-structured interviews targeting small, heterogeneous populations. No studies employed standardized ICF-based tools, and gaps were noted in the exploration of conditions such as Parkinson’s disease, frailty, or conditions that allowed for multi-device experiences. Conclusions: The findings emphasize the necessity for tailored surveys grounded in the ICF framework to completely evaluate the needs of patients suffering from sensory, motor, and/or cognitive disorders caused by different health conditions. This work lays the foundation for more inclusive, effective, and patient-centered robotic rehabilitation strategies. Full article

Background/Objectives: The global population is aging rapidly, increasing the need for appropriate health care. Older people often prefer to remain in their homes for as long as possible as they age. Therefore, it is crucial to assess their overall health and understand the individualized care needs for developing tailored home care services. This systematic review aims to examine the major domains of a range of assessment tools used for older people receiving home care services. Methods: A systematic search of Medline and PsycINFO via Ovid, CINAHL via EBSCO, Web of Science, and Scopus was conducted to identify studies investigating assessment of older people requiring home care services. The literature findings were systematically synthesized and classified using the International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO). Results: A total of 32 studies were included in the systematic review. Three primary categories were identified based on the WHO ICF classification system: (1) body functions, (2) activities and participation, and (3) environmental factors. Body functions included physical functions and mental functions. Mobility, self-care, and domestic life were three major aspects within the ICF category of activities and participation. Regarding the environmental factors, support, relationships, and services provided to older people were commonly considered in the included studies. Among them, the most assessed domains were physical, psychological, cognitive, functional, and nutritional assessment. Conclusions: The synthesis of findings in this review reveals major domains in various assessment tools, contributing to the development of a comprehensive framework to guide the assessment for older people requiring home care services. Full article

Background: Spinal cord injuries (SCI) are devastating conditions which often cause multiple permanent physical impairments and psychosocial complications. Discharge from hospital is often delayed and precious health resources are consumed. In Hong Kong SAR, China, the government welfare system and the public hospital system have worked together to address these problems through partnership with non-governmental organizations. An SCI transitional care facility (the Jockey Club New Page Inn, JCNPI) run by a non-governmental organization (SAHK), was inaugurated in 2008. Objectives: Review the local experience of the implementation of SCI transitional care in Hong Kong SAR, China. Methods: A narrative review of the service model, facilitators and barriers, and future development. Service output and outcomes were evaluated with quantitative and qualitative means. Results: The SCI transitional care in Hong Kong provides person-centred transitional care and support, including a time-limited residential rehabilitation, a post-discharge community day rehabilitation programme, and a residential respite care. The current intervention strategy is based on the WHO’s International Classification of Functioning, Disability, and Health (ICF). In the past 16 years, a total of 226 clients were discharged from the residential rehabilitation service. A total of 223 (98.6%) clients have successfully returned to community living. Positive feedback was received from the service users. Conclusions: The SCI transitional care has transformed care for SCI patients from the previous biomedical-oriented, hospital-based rehabilitation into a journey with an empowering and participatory approach addressing their biopsychosocial needs. The model has proven to be a key player in the continuum of care and sustainable community reintegration of individuals with SCI. Full article