A Organização Mundial de Saúde tem hoje duas classificações de referência para a descrição dos estados de saúde: a CID-10 (Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde) e a CIF (Classificação Internacional de Funcionalidade, Incapacidade e Saúde). A utilização da CIF vem sendo aguardada com grande expectativa pelas organizações de pessoas com deficiências e instituições relacionadas. A falta de definição clara de “deficiência" ou “incapacidade" tem sido apontada como um impedimento para a promoção de saúde de pessoas com deficiência. Este trabalho tem como objetivo apresentar definições de deficiência, discutindo a utilização da CID-10 e da CIF e a contribuição da CIF para melhorar a compreensão sobre definições de deficiência a partir do conceito de funcionalidade e dos fatores contextuais. Foram revisados alguns diferentes conceitos/definições de deficiência, bem como publicações envolvendo a aplicação da CIF. São apresentadas algumas categorias de diagnósticos de estados de saúde da CID-10 hoje utilizadas em alguns sistemas, além de elementos da recém-apresentada CIF, que podem contribuir para diferentes campos de aplicabilidade no que diz respeito ao entendimento das definições de deficiência ou incapacidade. / The World Health Organization has nowadays two reference classifications for description of health conditions: ICD-10 (International Statistical Classification of Diseases and Health Related Problems) and ICF (International Classification of Functioning, Disability and Health). Organizations of people with disabilities and related institutions are waiting with high expectation for the ICF utilization. Lack of clear definition of “disability" is being pointed out as a deterrent for promoting the health of people with disabilities. The objective of this work is to evaluate definitions of disability, and discuss the use of ICD-10 and ICF and the contribution of ICF to improve understanding of definitions of disability through functioning and contextual factors. Some different definitions of disability have been reviewed, as well as publications involving ICF application. Diagnostic categories of health conditions of ICD-10 used in some systems are presented, as well as ICF components that could contribute for different fields of applicability regarding the understanding of definitions of disability.

Rehabilitation outcomes are an important measurement of trauma system effectiveness. However, currently there is no clinically applicable trauma rehabilitation score or framework available to evaluate health and rehabilitation needs after trauma. The World report on Disability (2011) recommended the application of the World Health Organisation International Classification of Function, Disability and Health (ICF) as a framework for all aspects of rehabilitation. A standardised language, based on coded categories would aid in international efforts to evaluate health and disability globally. The ICF framework has not been applied in trauma rehabilitation or trauma systems to date. The objectives were to investigate rehabilitation needs of trauma patients and evaluate to what extent the ICF can be used as a framework to capture and assess health and rehabilitation outcome of patients following traumatic injuries. Two cohort studies with 103 and 308 patients respectively demonstrated the utility of the Rehabilitation Complexity Scale (RCS) in an acute trauma setting. The RCS outperformed other acute measures and rehabilitation complexity correlated with length of stay and discharge destination. A systematic review of 34 articles confirmed that outcome measures frequently used in trauma outcome studies represent only six percent of health concepts contained in the ICF. A quantitative international on-line questionnaire with expert clinicians working in trauma (n=217), identified 121 ICF categories pertinent to rehabilitation and health outcome of trauma patients. Qualitative patient interviews (n=32) identified nearly double the amount of ICF categories (n=234) compared to clinicians. Combined analysis of qualitative and quantitative data presents 109 ICF categories important for rehabilitation and health outcome assessment of trauma patients, using the ICF as a framework. This thesis describes the need for improved outcome evaluation of trauma patients. It demonstrates the acceptability of the ICF language and framework amongst clinicians and suggests the application of the ICF as a framework for trauma service delivery and outcome assessment.

Philosophiae Doctor - PhD (Physiotherapy) / Stroke is a debilitating medical and neurological condition. It is the leading cause of adult disability worldwide. Disability from stroke covers the three key classifications of the WHO-ICF framework on human function centred on health and health related issues, implying that the disability in stroke involve structural and activity limitations to participation restriction. Rehabilitation remains the hallmark of managing the plethora of neurological deficits accompanying stroke. Currently, the key advocacy in neuroscientific studies for stroke rehabilitation is that therapy should be directed towards task specificity. Task Specific Training most recently, the form of Circuit Class Therapy and the intensity of multiple repetition of the task has been identified as physiological mechanisms behind sustained motor learning following stroke.Circuit Class Therapy (CCT) is a form of Task Specific Training (TST) that involves the practice of structuring tasks in a circuit or series of workstations. It offers the patient the ability to practice multiple tasks in a conducive environmental because of its three key features of utilisation of different workstations that allow people to practice intensively in a meaningful and progressive way to suit their respective needs; the efficient utilisation of therapists'/trainees' time; and the group dynamics such as peer support and social support. Although these features are attainable following CCT challenges remain in selecting the most efficient intensity that could produce these benefits in stroke survivors. This study investigated the effectiveness of differing intensities of CCT in the rehabilitation of stroke survivors using the ICF framework to guide patients� response assessments after training.

Introdução: Verifica a utilização da CIF em Fisioterapia. Objetivo. Realizar uma revisão dos trabalhos publicados sobre as formas de uso da CIF em Fisioterapia. Método. Revisão sistemática de artigos publicados em revistas indexadas que tratam sobre o panorama atual da utilização da CIF na prática da Fisioterapia. Entre os artigos selecionados, a CIF é objeto de estudo e sua aplicabilidade em Fisioterapia é testada pelos pesquisadores. Resultados. 155 artigos foram levantados nas bases de dados pesquisadas. Destes, 13,5% preenchiam os critérios de inclusão. Dentre os excluídos, 80,6% eram artigos informativos sobre a CIF, 14,9% eram sobre aplicação em outras áreas e em 4,5%, a CIF não era objeto de estudo. 18 artigos foram selecionados, 1 estudo de corte seccional, 4 estudos de caso, 5 revisões bibliográficas e 8 consensos para criação de regras de relacionamento entre as medidas funcionais existentes e a CIF. Conclusões. A análise dos artigos permitiu mostrar a tendência de uso parcial da classificação. Apesar da dificuldade que os profissionais encontram em utilizá-la, a CIF é vista como uma saída para a resolução de um problema em Fisioterapia: a unificação da linguagem. A CIF, como classificação ou como modelo, tende a servir de base para a estruturação dos serviços de Fisioterapia tanto como guia para a prática do processo de reabilitação como para formação de um sistema de informação. / Introduction. Verify Physical Therapy uses of ICF. Objective. The main objective of this paper is to make a literature review about ICF use in Physical Therapy practice and to show how the ICF has been used by the physical therapists. Method. Literature review of published index journals papers about using of the ICF in Physical Therapy practice. Among the selected papers, ICF is the study object and its use is tested by researchers. Results. 155 papers were found at data basis. Among these, 13,5% got the inclusion criterious. Among the excluded, 80,6% were informative papers about ICF, 14,9% were about ICF applications in others professionals areas and at 4,5%, the ICF was not the studied object. 18 papers were selected, 1 seccional cut, 4 cases studies, 5 literatures reviews and 8 consensus to create linking rules for functioning measures to ICF. Conclusions. The selected group of papers shows there is a tendence for parcial use of ICF with summary lists of codes. Although ICF is complex and difficult to use, it is a useful tool for a common language to physical therapists. The ICF, as a classification or as a model, seems to become the base for Physical Therapy services like a way to indicate clinical decisions and to compose an information data system.

DNA methylation is a key epigenetic mark which undergoes global reprogramming during early mammalian embryonic development, resulting in almost complete erasure of the mark after fertilisation of the zygote. Genome-wide patterns of DNA methylation are subsequently re-established in the implanting blastocyst by de novo DNA methyltransferases Dnmt3a and Dnmt3b along with their catalytically inactive co-factor Dnmt3l, while these DNA methylation patterns are maintained through cell divisions by maintenance methyltransferase Dnmt1. The exact mechanisms by which these DNA methyltransferase enzymes are targeted to specific genomic regions remain unclear, but may involve interaction with modified histones and/or the participation of co-factors. Lsh (lymphoid specific helicase), a putative chromatin remodelling helicase, has been implicated in facilitating de novo methylation, as Lsh knockout embryos and derived somatic cell lines display substantial but specific DNA methylation losses at repetitive elements and single copy genes. This study aims to define the requirement for Lsh in establishing de novo DNA methylation and gene expression patterns during the early stages of mouse embryonic development. The '2i' culture system using two small molecule kinase inhibitors was harnessed to convert lsh-/- mouse embryonic stem cells (mESCs) to a hypomethylated 'ground state' of pluripotency. Culture conditions were then altered to transition these ground state mESCs to cells representing later, more methylated stages of development ('serum' mESCs, epiblast stem cells and embryoid bodies). Implementation of this model system suggests that Lsh does not contribute to DNA methylation establishment in a pluripotent context, but rather is important for facilitating de novo DNA methylation during differentiation to culture models representing later developmental stages. These investigations also reveal that Lsh differentially regulates DNA methylation at major and minor satellite repeats depending on cellular context, and that this regulation may involve a role for Lsh in maintenance of DNA methylation.

A Organização Mundial de Saúde (OMS) definiu a qualidade de vida como a percepção do indivíduo sobre si, no contexto de valores em que vive e em relação a: metas, expectativas, parâmetros e relações sociais. O objetivo do estudo foi realizar a equivalência dos instrumentos de qualidade de vida (University of Washington - Quality of life (UW-QOL), Brief Core Set Questionnaire - Head and Neck - BCSQ H&N), em pacientes com câncer de boca, diagnosticados na Liga de Neoplasia Bucal (LINB) e o Oral Health Impact Profile (OHIP-14) para pacientes que buscaram por atendimento de urgência, com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Foram entrevistados 50 pacientes atendidos pela Liga de Neoplasias da FOUSP e 100 pacientes do Setor de Urgências da Clínica Odontológica da FOUSP. Os escores de cada instrumento foram pontuados e, em seguida, verificou-se a frequência de ocorrência dos domínios. As categorias mais frequentes nos instrumentos de qualidade de vida UW-QOL, foram: b152 (Ansiedade - Funções Emocionais), b510 (Funções de ingestão - saliva), b250 (Função gustativa). No questionário BCSQ H&N, as categorias mais frequentes foram: b510 (Funções de ingestão), b310 (Funções da voz) e b152 (Funções emocionais). No questionário OHIP-14, as categorias mais pontuadas foram: b280 (Sensação de dor), b152 (Funções emocionais) e b130 (Funções da energia e dos impulsos - Atividade). Foi observada equivalência entre os domínios dos instrumentos de qualidade de vida e a CIF. Assim, a CIF constitui instrumento útil para avaliar a real situação de saúde do paciente, além dos aspectos clínicos. / The World Health Organization (WHO) defined quality of life as the perception of the individual in his life, in the context of values in which they live and in relation to their goals, expectations, parameters and social relations. The objective of the study was to perform the equivalence of quality of life instruments, University of Washington - Quality of Life (UW-QOL), Brief Core Set Questionnaire - Head and Neck (BCSQ H&N) in patients with diagnosed oral cancer in the League of Oral Neoplasms (LINB); and the Oral Health Impact Profile (OHIP-14) for patients who sought for emergency care, with the International Classification of Functioning, Disability and Health (ICF). Fifty patients from the Oral Neoplasms League and 100 patients from the Urgency Clinic at FOUSP were interviewed. Each instrument\'s scores were registered and the occurrence frequency of each domain was verified. The most frequent categories of instruments in quality of life UW-QOL were: b152 (Anxiety - Emotional functions), b510 (Ingestion functions - saliva), b250 (Taste function). At BCSQ H&N the most frequent categories were: b510 (Ingestion functions), b310 (Voice functions) and b152 (Emotional functions). In the OHIP-14 questionnaire, the highest scoring categories were: b280 (Sensation of pain), b152 (Emotional functions) and b130 (Energy and drive functions - Activity). Equivalences was observed among the instruments´ domains and ICF. Thus, ICF is a useful tool to perform real evaluations on the patients´ health, adding information to the clinical aspects.

The International Classification of Function, Disability and Health-Children and Youth Version (ICY-CY), (WHO, 2007) provides an important framework for the holistic consideration of children with communication disorders such as cleft lip and palate. It allows for understanding the effects of a cleft lip and palate on a child’s ability to communicate in structured and natural contexts, going beyond a focus on body structures and functions in order to examine the ways that environmental and personal factors influence the child. Over the years, a number of researchers have applied the ICF-CY framework to children with communication impairments such as speech sound disorders, language impairments, and stuttering. While there is an emerging body of research and literature on this topic, the ICF-CY does not yet appear to be widely applied clinically to children with cleft lip and palate. The aim of the study was to conduct a comprehensive narrative review of the application of the ICF-CY to children with cleft lip and palate, in order to illustrate its use in this population, to identify research needs, and to make recommendations for clinical application to assessment and intervention and integrating the ICF-CY in cleft palate curricula. A systematic search of the literature was conducted by following a specific search strategy and a systematized selection of publications for review to limit researcher bias. Computer searches of electronic data bases, as well as hand searches, were conducted to identify publications and sources that addressed the ICF-CY or ICF in children with cleft lip and palate. Publications and sources that met the inclusion criteria were selected for review. Each source was summarized according to the author(s) and publication year, and a qualitative description of each was made according to structured review procedures and templates. Applications of the specific ICF-CY components to children with cleft lip and palate were mapped, and recommendations for clinical application and future research were described. It is suggested that the ICF-CY framework should be included in cleft palate curricula to provide future speech-language pathologists with a holistic perspective on children with cleft lip and palate and to extend their thinking about the impact of speech impairment associated with cleft lip and palate. Training to adopt the ICF-CY framework will also facilitate collaborative interdisciplinary care of children with cleft lip and palate. Using the ICF-CY framework in the assessment of children in this population will focus intervention on the ultimate goal of improvement of the child's ability to communicate in natural settings. This narrative review will also serve as the theoretical underpinning for a planned survey of the clinical assessment practices of speech-language pathologists treating children with cleft lip and palate.

ASHA endorsed the WHO ICF framework in the Scope of Practice in SLP in describing the breadth of the SLP role in the management of communication disorders. Survey results of SLPs will be presented with regard to the inclusion of the ICF framework in working with children with SSD.

No description available.

ASHA endorsed the WHO ICF framework in the Scope of Practice in SLP in describing the breadth of the SLP role in the management of communication disorders. Survey results of SLP graduate programs will be presented with regard to the inclusion and importance of ICF in the curriculum.