ICF, Aphasia, and EBP: Comprehensive Study Notes

WHO-ICF, EBP, Healthcare Continuum

  • Source: CSDIG-522 presentation by Jeffrey Hornof, M.A., CCC-SLP (Page 1)

  • Focus areas: introductory framework linking WHO-ICF, Evidence-Based Practice (EBP), and the Healthcare Continuum

Open Discussion (Context for Aphasia understanding)

  • Prompted reflection on aphasia video: initial thoughts and potential shifts in perspective about aphasia (Page 2)

Population and Public Health Approaches

  • Stroke aphasia prevalence: 30% to 35%30\%\text{ to }35\% of stroke survivors have aphasia

  • Consequences of aphasia and stroke:

    • Higher healthcare costs

    • Longer hospital stays

    • Poor long-term outcomes

    • Social isolation, depression, reduced quality of life

    • Long-term service needs

  • Education dimensions:

    • Patient-centered education

    • Community education

    • Public awareness

    • Public health approaches
      (Page 3)

Aphasia Book Definition Revisited

  • Aphasia definition: acquired selective impairment of language modalities and functions due to a focal brain lesion in the language-dominant hemisphere

  • Impacts include communicative and social functioning, overall quality of life, and the quality of life of relatives and caregivers (Page 4)

WHO-ICF Framework

  • WHO: International Classification of Functioning, Disability, and Health (ICF)

  • Core components:

    • Body structure and functioning

    • Activity and participation

  • Purpose: broadens classic biomedical models toward holistic service delivery

  • Aim: help individuals communicate and engage in daily life activities (Page 5)

ICF Framework Details

  • ICF (WHO, 2001) framework to describe and organize function and disability in standard language

  • Functions and disability defined to describe changes in:

    • Body Function

    • Body Structure

    • Capacity Level (Standard Environment)

    • Level of Performance (Familiar Environment)

  • Emphasizes health and functioning over disease alone (Course: CSDIG 522, Fall 2022; Lisa Osier) (Page 6)

  • Visual simplification: HEALTH change OVER DISABILITY (Page 7)

ICF vs ICD-10

  • ICD-10: International Statistical Classification of Diseases and Related Health Problems

    • Etiological framework focused on diagnosis and health conditions

  • ICF: Classifies functioning and disability associated with health conditions

  • Complementary relation: Use ICF and ICD-10 together to form a broader picture of health and functioning (Page 8)

  • Examples linking health conditions to impairments:

    • Stroke → Aphasia, Hemiparesis

    • Panic Disorder → Anxiety

    • Spinal Injury → Paralysis (Page 9)

Collaboration

  • (Page 10) Conceptual emphasis on collaborative approaches across disciplines to address functioning and participation within health contexts

Why Do We Need ICF?

  • Diagnosis alone does not predict:

    • Service needs

    • Length of hospitalization

    • Level of care or functional outcomes

  • Presence of a disease does not predict:

    • Work performance

    • Return to work potential

    • Social integration

    • Disability benefits (Page 11)

ICF Examples: Linking Health Condition, Impairment, Activity, and Participation

  • Example 1: Panic Disorder → Anxiety; Not capable of going out alone; Impacts social relationships

  • Example 2: Spinal Injury → Paralysis; Incapable of using public transportation; No accommodations in public transport

  • Example 3: Stroke → Aphasia; Hemiparesis; Not capable of working independently or going out of house alone; Aphasia impacts social relationships

  • Example 4: Formal Mental Health Issue; None impairment; None participation restriction; Unemployed due to hiring manager prejudice of mental health (Page 12-13)

4 Principles of ICF

  • Universality

  • Equality

  • Neutrality

  • Environmental Influence (Page 14)

Concept Check

  • (Page 15) Quick recall/check of ICF concepts

Intervention: Mapping Health Condition to Participation Pathways

  • Intervention vs Prevention framework across stages:

    • Health Condition: Medical treatment/care; Medication; Immunization; Nutrition

    • Impairment: Medical treatment/care; Medication; Surgery; Prevention of development of further activity limitations

    • Activity Limitation: Assistive devices; Personal assistance; Rehabilitation therapy; Preventive rehabilitation

    • Participation Restriction: Accommodations; Public education; Anti-discrimination law; Universal design; Environmental change; Employment strategies; Accessible services; Lobbying for change

  • (Page 16) This depicts how ICF connects medical treatment to broader life participation through environmental and personal factors

ICF Impact and Public Health Purposes

  • ICF contributes to: OVERALL POPULATION HEALTH, PREVALENCE & INCIDENCE OF NON-FATAL HEALTH OUTCOMES, MEASURE HEALTH CARE NEEDS, PERFORMANCE & EFFECTIVENESS OF HEALTH CARE SYSTEMS

  • Public health purposes include: needed disability benefits, policy development at state and national levels, social planning, and research impact (Page 17)

ICF Applications

  • Individual Level:

    • Assessment of functioning level

    • Treatment planning to maximize functioning and address activity/participation restrictions

    • Evaluation of treatment outcomes

    • Self-evaluation of communication capacity

  • Institutional Level:

    • Resource planning for health care and services

    • Quality improvement and outcome management

    • Managed care considerations and cost-effectiveness improvements

  • Social Level:

    • Disability benefits criteria evidence-based and justifiable

    • Environmental accessibility improvements (Page 18)

ICF Model: Components and Relationships

  • Core components to map:

    • Body Function and Structure

    • Activities

    • Participation

    • Environmental Factors

    • Personal Factors

  • Visualized as: Body Function/Structures ↔ Activity ↔ Participation, all influenced by Environmental and Personal Factors (Page 20)

SLP & ICF Model: Aphasia

  • Aphasia profile example: reduced speaking and writing; unable to add to conversations; unable to express information at home or work; impacts roles in family and job demands; age, motivation, and family support as contributing factors

  • (Page 21)

Language and Identity in Disability

  • Language framing: Person First Language vs Identity-First Language

  • ASHA (2022) guidance: advocates for recognizing disability language and respecting individual preferences; identity-first perspectives may empower some individuals

  • Quote from J.R. Thorpe (2017) on identity-first language advocacy

  • (Pages 22-23)

APA Disability Language Guidance (Seventh Edition, 2019 Update)

  • APA guidance emphasizes maintaining dignity and honoring both person-first and identity-first perspectives

  • Authors should respect expressed preferences of people with disabilities regarding identification; style should be guided by those preferences (Page 23)

Practical Guidance on Language Preference

  • Not sure what to use? Ask the individual about their preference

  • If unsure, use both respectfully until a preference is established (Page 24)

Aphasia Therapy: Behavioral vs Nonbehavioral Options

  • Behavioral therapy options:

    • One-on-one therapy

    • Group therapy

    • Computer-based therapy

    • Telepractice

    • Technology as a forward-looking horizon ("the great horizon")

  • Nonbehavioral therapy options:

    • Pharmacotherapy

    • Noninvasive brain stimulation approaches

  • (Page 25)

Evidence-Based Practice (EBP)

  • Core components: Clinical Expertise, Scientific Evidence, Patient & Caregiver Perspectives

  • EBP integrates three domains: clinical expertise, best available evidence, and patient values/preferences (Page 26)

Steps of EBP

1) Convert the need into an answerable question
2) Identify the best evidence to answer the question
3) Critically assess the evidence in the context of clinical experience and patient wishes
4) Apply the results to clinical practice as appropriate
5) Evaluate performance

  • (Page 27)

EBP Resources

  • EBP Reference materials include: How to initiate and implement EBP, EBP Catalog, EBP Toolkit, Evidence Maps, Glossary, Tutorials

  • Source: ASHA Practice Portal (Page 28)

Healthcare Continuum

  • Conceptual map of patient journey through healthcare settings from admission to outpatient and home care (Page 29)

Medical Settings: Inpatient to Rehabilitation Spectrum

  • Hospital: 24-hour care; varying types and sizes; trauma levels; specialty services (Page 31)

  • LTAC (Long-Term Acute Care): Specialty hospital; 24-hour care (Page 31)

  • Acute Rehabilitation Hospital (Inpatient Rehab): Intensive rehab (3+ hours/day) (Page 31)

  • Sub-Acute Rehab (Skilled Nursing Facility, SNF): Less intense rehab (≥30 minutes) (Page 32)

  • Long-Term Care (Nursing Home): Chronic illness/disability management (Page 32)

  • Home Health: In-home services; cost-effective (Page 32)

  • Outpatient: High-functioning patients; less frequent; requires transportation (Page 33)

  • Day Rehabilitation: Daily, intensive services; transportation required (Page 33)

Hospital and Care Pathways (Illustrative Models)

  • Page 34–38 depict crosswalks of settings and transitions among Direct Admit, Emergency Department, ICU, specialty units, and rehabilitation pathways across inpatient and outpatient routes

  • Visual examples include two scenarios:

    • EXAMPLE #1 Stroke (Pages 39)

    • EXAMPLE #2 TBI (Page 40)

  • Purpose: illustrate how patients move through hospital and rehabilitation services depending on condition and needs

Questions?

  • Final prompt for audience questions and discussion (Page 41)

Notes on key concepts and connections

  • The ICF framework is designed to complement ICD-10 by focusing on functioning and participation rather than solely on disease or disability. This dual lens supports holistic assessment, planning, and outcome evaluation across individuals, institutions, and society.

  • In aphasia and speech-language pathology, applying ICF helps translate impairment-based observations (e.g., aphasia, hemiparesis) into measurable activity limitations and participation restrictions (e.g., communication challenges, social engagement, ability to work or attend school).

  • The integration of ICF with EBP provides a structured, evidence-informed approach to choosing interventions that maximize functioning while respecting patient and family preferences, social contexts, and environmental barriers.

  • Language choices in disability discourse (person-first vs identity-first) reflect ethical considerations of autonomy, dignity, and empowerment. The APA and ASHA emphasize honoring individual preferences, which may vary by person and context.

  • The healthcare continuum emphasizes the importance of seamless transitions between settings (inpatient, sub-acute, long-term, home, outpatient) to optimize outcomes and resource use.

Formulas and numerical references used in this content

  • Aphasia prevalence among stroke survivors: 30% to 35%30\%\text{ to }35\%

  • Rehab intensity in acute inpatient settings: ≥3 hours/day\ge 3\ \text{hours/day}

  • Other quantitative references include general ranges for therapy duration and service needs as noted in the slide content (see pages 3, 16, 31–33).