Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment on communication means that not only does the person with hearing impairment experience the consequences but also his or her frequent communication partners. This thesis investigates the impact of hearing impairment on spouses and uses the World Health Organization’s term “third-party disability.” Third-party disability is defined as the impairments, activity limitations, and participation restrictions experienced by the family due to the health condition of their significant other, and was identified by the World Health Organization as an area for future development and application of the International Classification of Functioning, Disability and Health (ICF). Despite a number of studies previously published on the effect of hearing impairment on family members, including younger couples and carers, there remain substantial gaps in knowledge and understanding of the difficulties specifically relating to older people and factors associated with third-party hearing disability. This thesis focuses on the third-party disability experienced by normally hearing spouses (termed the “spouses” in this thesis) of older people with hearing impairment (termed the “partners” in this thesis). To add empirical data to the body of research, this series of studies first explored the lived experience of spouses of older people with hearing impairment in a qualitative study, then identified the ICF domains and categories that described third-party hearing disability, described the extent of third-party hearing disability in this population, modelled the contribution of factors to third-party hearing disability, and developed and psychometrically tested a scale to measure the third-party disability of spouses of older people with hearing impairment. Studies conducted within this thesis were therefore completed in two phases. Ten spouses of older people with hearing impairment participated in the first qualitative phase, consisting of semi-structured in-depth interviews. Results of this study showed that spouses experience a number of effects as a result of their partners’ hearing impairment including: (1) the broad ranging effects of the hearing impairment on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ hearing impairment; (3) the effect of acceptance of the hearing impairment on the spouse; and (4) the impact of ageing and retirement. Findings were then linked to the ICF to identify the most typical and relevant domains and categories of the ICF for spouses of older people with hearing impairment. The majority of themes were able to be linked to the ICF, with most linking to codes in the activities and participation component. A number of contextual factors were also identified that influenced the spouses’ third-party disability. In the second phase, a further 100 older couples affected by hearing impairment participated in a quantitative face-to-face survey to describe the nature and degree of third-party disability in spouses, and to examine factors associated with third-party hearing disability. Concepts identified in the first qualitative study were used to formulate a 36-item tool for measuring spouses’ third-party hearing disability, namely the Significant Other Scale for Hearing Disability (SOS-HEAR). The majority of spouses in this study (98%) reported some degree of third-party hearing disability on at least one item of the SOS-HEAR. Communication difficulties between the couple were the central source of stress reported by spouses, followed by emotional problems in the spouse. Three factors were found to be significantly associated with greater third-party hearing disability: (1) lower relationship satisfaction as described by spouses; (2) a larger spouse-partner age difference; and (3) greater hearing disability in the hearing impaired partner as perceived by the spouse. The scaling properties of the SOS-HEAR were then examined, with a revised 27-item questionnaire found to be a reliable means of measuring older spouses’ third-party hearing disability. Use of the SOS-HEAR is proposed as a means of identifying spouses of older people with hearing impairment in need of intervention. If spouses are identified as experiencing third-party hearing disability, health professionals are then in a position to facilitate discussions with the couple about the impact of the hearing loss on their daily functioning. The inclusion of spouses in rehabilitation takes into account the needs of both members of the couple such that they become partners in rehabilitation. In summary, this research has shown that hearing impairment in older people has an effect on the spouse, as they too experience situations of communication activity limitations and participation restrictions. It is clear that the lives of participants in this study were considerably affected as a result of their partners’ hearing impairment, with spouses reporting a wide variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. This series of studies has highlighted the potentially important role of family-centred intervention in rehabilitation for older adults with hearing impairment, and strongly suggests the need for increased inclusion of spouses and significant others in the rehabilitation process.

This thesis uses the International Classification of Functioning, Disability and Health (ICF) model (World Health Organisation, 2001) to explore the multidimensional presentation of strengths and problems in young people with cystic fibrosis (CF), firstly examining its theoretical “fit” to the health condition, and secondly using it to characterise the performance of those with CF. Few studies in the literature demonstrate such an holistic approach to the physiotherapy assessment and management of this population. It was expected that this description of performance would provide a framework for identifying key areas for physiotherapy exercise intervention. This then formed the basis for further studies to examine the effect of a targeted exercise program (compared to current exercise practice) on inpatient outcomes, as well as on outcomes of outpatient management. The position paper included provides theoretical support for the ICF model as an appropriate tool in the management of young people with CF. Building on this, Study 1 explored the practical utility of the ICF model for describing the presentation of young inpatients and outpatients with CF. Eighty-four participants with CF were recruited as a consecutive series who satisfied selection criteria to provide a cross-sectional view at younger (7-12 years, n=51) and older (13-17 years, n=33) ages. Musculoskeletal, respiratory and physiological measures represented the body structures and functions domain, the six-minute walk test and jump tests were included in the activities domain, and participation was described by the Cystic Fibrosis Questionnaire–Revised Version and Fels Physical Activity Questionnaire. Contextual factors were also considered (age, gender, inpatient/outpatient status). In this exploratory study, performance of this population was compared to normative data where available. Also, correlations between measures within and between ICF domains were examined as suggested by the model itself. Finally, effects of contextual factors on performance were investigated using univariate analysis of variance. This first study and the position paper support the ICF model as an effective tool for describing performance of young people with CF, and for investigating functional relationships within and between domains. Results showed significant differences in this population compared to normative data, and interrelationships were identified within and between ICF domains. Between inpatients and outpatients in the specified age groups, there was a statistically significant difference in means for a number of measures, whereby inpatients displayed consistently poorer mean scores than outpatients, with this effect significantly stronger in the older age group. The application of the ICF model was useful for highlighting areas to target in physiotherapy exercise intervention, and for substantiating selected measures to assess the program’s effectiveness across domains. Study 2 was a randomised controlled trial with blinded assessor, which investigated the effectiveness of a 10-14 day inpatient-based exercise program (the Cystic Fibrosis: Fitness Challenge) (CF:FC) tailored for young people with CF (7-17 years). The CF:FC program (n=15) included exercise strategies based on recommendations from previous work in the field, and from findings from Study 1. This program included a portable exercise package (FitKitTM) designed to be adaptable to limited space environments such as at the hospital bedside, important when inpatients with CF are isolated according to infection control procedures. Participants in the control program (n=16) received the current exercise practice provided for young people with CF at a tertiary hospital, which included mainly aerobic-type activities to affect airway clearance. Performance on study measures (scoped within the framework of the ICF model, presented in Study 1) were compared pre- and post-intervention (admission and completion of the inpatient exercise program) between the groups. This trial showed significant improvements for participants in both groups from admission to discharge for a range of measures, including respiratory function, muscle strength and quality of life measures. Participants in the intervention group showed significantly greater improvements for some measures, for example: ankle dorsiflexor strength, six-minute walk distance and perception of their respiratory status. The continuation of the intervention and control programs into the outpatient setting was the focus of Study 3. The FitKitTM was provided for the intervention group, incorporating strategies to enhance adherence including a physical activity log (PAL) and internet-based follow-up. The control home exercise program consisted of the current practice provided on discharge. Interestingly, the control group improved significantly in hip abductor strength and six-minute walk distance during the outpatient period, whereas the intervention group sustained the improvements gained in the inpatient period but generally showed no further significant improvement. When the change from inpatient admission to outpatient follow-up was considered, it was apparent that greater improvements during the inpatient period provided a ‘buffer’ to accommodate for possible deteriorations in function in the outpatient phase. Issues regarding adherence to exercise programs during the outpatient period are discussed. This thesis confirms the usefulness of the ICF model for describing young people with CF, guiding assessment and review processes to achieve comprehensive management, and strengthening the evidence-base for targeted physiotherapy exercise intervention. A novel, tailored exercise program is introduced which is effective during inpatient periods, and provides a maintenance effect during outpatient periods, but strategies to enhance adherence during outpatient periods require further investigation.

ABSTRACT Speech-language pathology practice in the acute hospital setting has changed dramatically over the last 25 years. A significant increase in the number of referrals and a broadening of the speech-language pathologist’s caseload to include patients with dysphagia has meant there has been less time to see hospital inpatients with communication disabilities. This change in practice has caused speech-language pathologists working in the acute hospital setting to question their role in relation to patients with communication disabilities in the acute hospital setting. The thesis applies the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework to explore the role of speech-language pathologists in the acute hospital setting, specifically the acute hospital stroke unit, in relation to patients with communication disabilities. The ICF proposes that a health condition can be understood in terms of four separate components. These components are Body Structures and Functions, Activities and Participation, Environmental Factors and Personal Factors. Whilst the distinction between body structures and body functions within the ICF Body Functions and Structures component is clear, there is less clarity about the relationship between the ICF concepts of activity and participation in the ICF Activities and Participation component. Therefore, the first part of the thesis explores the conceptual similarities and differences between the concepts of activity and participation generally and communication activity and communication participation in particular. This discussion concludes that the ICF concepts of activity and participation are distinct concepts that are considered separately in this thesis. Following this conceptual clarification, the thesis applies the ICF framework to patients with communication disabilities in the acute hospital stroke unit. Specifically, patients with communication disabilities are described from the perspective of communication-related body functions within the ICF Body Structures and Functions component, communication activities within the ICF Activities and Participation component and communication-related environmental factors in the ICF Environmental Factors component. It is important to understand how many patients experience a communication disability in the acute hospital stroke unit so that adequate supports can be developed. Therefore an efficient way of identifying patients in acute hospital stroke units with a communication-related body function impairment such as hearing, vision, speech, language and/or cognitive communicative impairment was required. Hence, the first study describes the development of ICF compatible scales, called the OHW scales, to rate a patient’s degree of speech, language and cognitive communicative impairment. These three rating scales were called the OHW scales because they reflect the WHO framework and also represent the authors’ initials. The concurrent validity and interrater reliability of the OHW scales were then investigated. Results indicated that the OHW had acceptable levels of concurrent validity against standardised measures of speech, language and cognitive communicative impairment. The speech and cognitive communicative OHW scales also demonstrated moderately high interrater reliability, but exact agreement on the OHW language impairment scale was low. At a minimum, the OHW scales were valid measures of speech, language and cognitive communicative impairment and therefore they were used by the researcher to determine the number of patients with communication-related impairments in the acute hospital stroke unit. Patients in acute hospital stroke units may have communication-related impairments, such as speech, language or cognitive communicative impairments as a consequence of stroke. Patients may also have communication-related impairments (e.g., in hearing, vision and cognitive communicative) due to ageing and age related illnesses. Therefore, the second study of the thesis describes the number of patients with communication-related impairments in acute stroke units, regardless of the cause. Of the 69 patients screened, 88% had a mild or more severe communication-related impairment. In addition, 69% of inpatients, screened on two or more measures, had multiple communication-related impairments. Although many patients in acute stroke units have communication-related impairments, what may be particularly important is how many patients experience difficulty communicating their healthcare needs with healthcare providers in acute hospital stroke units. The ICF describes a person’s ability to carry out an activity, such as communicate healthcare needs, as an activity limitation. The ICF describes activity limitations in four different ways. Two ways are capacity with assistance and performance. Capacity with assistance indicates the person’s highest probable level of function in an activity given assistance and performance indicates a person’s level of function in the context of everyday life. Therefore, the third study of the thesis details how many patients experienced capacity with assistance limitation, that is, difficulty communicating their healthcare needs given assistance, and performance limitation, that is, difficulty communicating their healthcare needs during everyday healthcare routines. Results indicated that 51% of 65 patients had a capacity with assistance limitation and 57% had a performance limitation. Strong and significant relationships were found between patients’ degree of communication-related impairments and their degree of communication activity limitation, in both capacity with assistance and performance. Furthermore, the presence of a communication-related impairment accounted for up to 77% of the variance in a patient’s capacity with assistance limitation. Such impairments only accounted for up to 32% of the variance in a patient’s performance limitation. This finding suggests that other factors, such as environmental factors also affect a patient’s ability to communicate, particularly during everyday health care routines. In light of this, a review of the literature on the range of environmental factors that influence communication between patients with communication-related impairments and healthcare providers in the acute hospital setting was conducted. The review of the literature indicated the need for research on the environmental factors that influence communication between patients and healthcare providers in the acute hospital stroke unit. Therefore, the final study of the thesis investigates this further. This study employed a focused ethnographic methodology to identify the range of environmental factors that appeared to influence communication between patients and their healthcare providers. Seven themes were identified including the healthcare providers’ knowledge of communication-related impairments, skills, attitudes, and individual characteristics. Other themes included the presence of family, the physical environment and hospital systems and services. In summary, this series of studies indicates that the majority of patients admitted into acute hospital stroke units have a communication-related impairment and approximately half to two thirds of patients experience difficulty communicating their healthcare needs with healthcare providers. Whilst having a communication-related impairment increases the likelihood that a patient will experience difficulty communicating with healthcare providers, other factors, such as the communicative environment also appear to play an important role. Speech-language pathologists working in the acute hospital stroke unit may have an important role in identifying patients who are experiencing difficulty communicating their healthcare needs and supporting these patients and their healthcare providers to communicate in optimal ways. Further research is required to demonstrate that improving a patient’s ability to communicate with his or her healthcare providers improves a patient’s health outcomes. With this evidence, speech-language pathologists may be more able to support patients with communication disabilities to get the healthcare they deserve.

Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment on communication means that not only does the person with hearing impairment experience the consequences but also his or her frequent communication partners. This thesis investigates the impact of hearing impairment on spouses and uses the World Health Organization’s term “third-party disability.” Third-party disability is defined as the impairments, activity limitations, and participation restrictions experienced by the family due to the health condition of their significant other, and was identified by the World Health Organization as an area for future development and application of the International Classification of Functioning, Disability and Health (ICF). Despite a number of studies previously published on the effect of hearing impairment on family members, including younger couples and carers, there remain substantial gaps in knowledge and understanding of the difficulties specifically relating to older people and factors associated with third-party hearing disability. This thesis focuses on the third-party disability experienced by normally hearing spouses (termed the “spouses” in this thesis) of older people with hearing impairment (termed the “partners” in this thesis). To add empirical data to the body of research, this series of studies first explored the lived experience of spouses of older people with hearing impairment in a qualitative study, then identified the ICF domains and categories that described third-party hearing disability, described the extent of third-party hearing disability in this population, modelled the contribution of factors to third-party hearing disability, and developed and psychometrically tested a scale to measure the third-party disability of spouses of older people with hearing impairment. Studies conducted within this thesis were therefore completed in two phases. Ten spouses of older people with hearing impairment participated in the first qualitative phase, consisting of semi-structured in-depth interviews. Results of this study showed that spouses experience a number of effects as a result of their partners’ hearing impairment including: (1) the broad ranging effects of the hearing impairment on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ hearing impairment; (3) the effect of acceptance of the hearing impairment on the spouse; and (4) the impact of ageing and retirement. Findings were then linked to the ICF to identify the most typical and relevant domains and categories of the ICF for spouses of older people with hearing impairment. The majority of themes were able to be linked to the ICF, with most linking to codes in the activities and participation component. A number of contextual factors were also identified that influenced the spouses’ third-party disability. In the second phase, a further 100 older couples affected by hearing impairment participated in a quantitative face-to-face survey to describe the nature and degree of third-party disability in spouses, and to examine factors associated with third-party hearing disability. Concepts identified in the first qualitative study were used to formulate a 36-item tool for measuring spouses’ third-party hearing disability, namely the Significant Other Scale for Hearing Disability (SOS-HEAR). The majority of spouses in this study (98%) reported some degree of third-party hearing disability on at least one item of the SOS-HEAR. Communication difficulties between the couple were the central source of stress reported by spouses, followed by emotional problems in the spouse. Three factors were found to be significantly associated with greater third-party hearing disability: (1) lower relationship satisfaction as described by spouses; (2) a larger spouse-partner age difference; and (3) greater hearing disability in the hearing impaired partner as perceived by the spouse. The scaling properties of the SOS-HEAR were then examined, with a revised 27-item questionnaire found to be a reliable means of measuring older spouses’ third-party hearing disability. Use of the SOS-HEAR is proposed as a means of identifying spouses of older people with hearing impairment in need of intervention. If spouses are identified as experiencing third-party hearing disability, health professionals are then in a position to facilitate discussions with the couple about the impact of the hearing loss on their daily functioning. The inclusion of spouses in rehabilitation takes into account the needs of both members of the couple such that they become partners in rehabilitation. In summary, this research has shown that hearing impairment in older people has an effect on the spouse, as they too experience situations of communication activity limitations and participation restrictions. It is clear that the lives of participants in this study were considerably affected as a result of their partners’ hearing impairment, with spouses reporting a wide variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. This series of studies has highlighted the potentially important role of family-centred intervention in rehabilitation for older adults with hearing impairment, and strongly suggests the need for increased inclusion of spouses and significant others in the rehabilitation process.

The objective of this dissertation thesis is the application of the International Classification of Functioning, Disability and Health (ICF) with mentally retarded persons, or the examination of ways of application of its data for a possible inclusion of mentally retarded persons into society. The thesis deals with the system of the ICF classification, its application within the framework of research as well as the subsequent possible application in practice when reviewing the situation of disabled persons.The results of the thesis bring a recommendation how it is possible to proceed when reviewing the situation of a mentally retarded client in practice and how to use the ICF classification as a tool of support of psychosocial inclusion of these persons.

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.

Introdução. A linguagem comum e padronizada oferecida pela Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) permite a categorização dos estados de saúde relacionados à funcionalidade e incapacidade facilitando a construção de sistemas de informação. Ainda hoje, o uso da CIF é limitado pela sua complexidade. Alguns instrumentos para facilitar sua aplicação foram criados sem, no entanto, suprir todas as necessidades para seu uso em algumas áreas. O objetivo deste trabalho é construir facilitadores para que a CIF possa ser aplicada na área de Fisioterapia. Métodos. Foram desenvolvidos três estudos: dois consensos com especialistas e uma análise do uso da CIF em um inquérito de saúde, apresentados no formato de artigos científicos. Os dois primeiros estudos estruturam ferramentas de coleta de dados por meio adaptado da técnica Delphi e o terceiro estudo explora o uso da CIF como ferramenta classificatória de resultados de um inquérito de saúde aplicado em pessoas com incapacidades. Resultados. Um conjunto de categorias relevantes da CIF para Fisioterapia Geral e para cada especialidade da área reconhecida pela Classificação Brasileira de Ocupações foi definido (primeiro artigo). Foi estruturada uma proposta de ferramenta classificatória para uso em Fisioterapia do Trabalho (segundo artigo). O terceiro artigo apresenta benefícios do uso da CIF em inquéritos de saúde como meio de geração de dados sobre a incapacidade. Conclusões. Os estudos indicam que a operacionalização da CIF será mais adequada se houver um menor número de categorias em uso. Em princípio, sugere-se três simplificações: redução do número de categorias, escolha de categorias de baixo nível de complexidade (segundo estrutura da classificação) e uso do qualificador \"não especificado\" / Introduction. The common language and standard offered by the International Classification of Functioning, Disability and Health (ICF) enables the categorization of functioning and disability, facilitating the construction of information systems. Even today, the completed use of ICF is limited by its complexity. Some tools aimed to facilitate its application were created withoutcovering all the needs for its use by some areas. The objective of this thesis is topropose facilitators to ICF application in the field of Physical Therapy. Methods. We developed three studies: two consensuses with experts and a review of the use of the ICF in a health survey, presented in the format of scientific papers. The first two studies structured data collection tools through Delphi technique adapted and the third study explores the use of the ICF as a tool for classifying the results of a health survey applied to a population with disabilities. Results. A set of ICF categories relevant to General Physiotherapy and for each specialty recognized by the Brazilian Classification of Occupations was defined (first article). We got a classification tool for use by Physiotherapists of Occupational Health (second article). The third article presents the benefits of using the ICF in health surveys as a way to generate data on disability. Conclusions. The use of the ICF is facilitated by a list with a small number of categories. Actually, it is suggested three simplifications: reducing the number of categories, selecting categories of low complexity (second classification structure) and use of the \"unspecified\" qualifier

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.

Leprosy it mainly affects the skin and the peripheral nervous system, causes multiple deformities and body disfigurations, interfering directly in the individual’s personal and professional life. The International Classification of Functioning, Disability and Health (ICF) is an instrument that classifies and assists to describe function and disability related to health conditions, reflecting a new approach to identify dysfunctions, classifying them in the biological, individual and social context. The objective of this study is to identify, through a clinical study, the main dysfunctions presented in cases of leprosy and thus to select categories to develop the core set of the ICF for leprosy. The type of this study is clinical descriptive, cross-sectional with quantitative and qualitative analysis. The sample was composed of patients with leprosy, who were recruited at the Centers of leprosy in Sergipe. For data collection with the quantitative approach, validated and standardized functional evaluations were used that represented each ICF domain. In the data collection of the qualitative approach, a structured, standardized questionnaire developed by WHO was used. The data were recorded in Office 2010 program to calculate means, frequencies and percentages. The dysfunctions prevalent in at least 5% of the participating volunteers were selected to be extracted the categories of the ICF with their respective codes to compose the core set. Participants in this study were 29 patients with leprosy. The mean age of the participants was 44.9 (± 13.72), predominance of 60% men. In the study with a quantitative approach, the most relevant functional disabilities were in the body structure domain, where "Structures of areas of skin - s810" was the most prevalent with 78%, in the body function domain the most representative category were "Touch function - b265" with 100% prevalence of participants who presented deficits in sensory. In the field of activity and participation the category: “Carrying, moving and handling objects - d430” had 100% of the participants with limitations. In the area related to participation the category: “Recreation and Leisure - d920”, 89% of the participants had restriction to participate. Regarding environmental impact, the category "Health services, systems and policies - e580" represented a barrier to 56% of participants. Different from what was found in the quantitative study, the results collected in the qualitative study demonstrated a greater number of categories in the environmental factors domain. However, when the amount of categories in the two studies were compared considering the total number of categories of the ICF, with the relative frequency of categories, we observed that the environmental domain is the “incapacity” most prevalent in both studies with the quantitative and qualitative approach. The ICF categories in each domain found in the quantitative study and the qualitative study help to map the functional disabilities of patients with leprosy. / Hanseníase afeta principalmente a pele e o sistema nervoso periférico, provocando múltiplas deformidades e desfigurações no corpo, interferindo diretamente na vida pessoal e profissional do indivíduo. A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) é um instrumento que classifica e auxilia na descrição da funcionalidade e da incapacidade relacionadas às condições de saúde, classificando-as no âmbito biológico, individual e social. O objetivo deste estudo é identificar através de um estudo clínico as principais disfunções apresentadas em casos de hanseníase e com isso selecionar categorias para desenvolver o core set da CIF para hanseníase. Trata-se de um estudo observacional, transversal, com abordagem de análise quantitativa e qualitativa, composta por pacientes com hanseníase, que foram recrutados nos centros de referência em hanseníase do Estado de Sergipe. Para coleta de dados da abordagem quantitativa foram utilizadas avaliações funcionais validadas que representassem cada domínio da CIF. Já na coleta de dados da abordagem qualitativa foi utilizado um questionário estruturado, padronizado, desenvolvido pela OMS. Os dados foram registrados no programa Office 2010 para cálculo das médias, frequências e porcentagens. As disfunções prevalentes em pelo menos 5% dos voluntários participantes foram selecionadas para serem extraídas as categorias da CIF com seus respectivos códigos para compor o core set. Participaram desse estudo 29 pacientes com hanseníase, com idade média de 44,9 (±13,72), predomínio do sexo masculino (60%). No estudo com abordagem quantitativa, as incapacidades funcionais mais relevantes foram no domínio estrutura do corpo, sendo que “Estrutura das áreas da pele - s810” foi a mais prevalente com 78%, no domínio função do corpo a categoria mais representativa foi “Função tátil - b265” com 100% de prevalência dos participantes que apresentaram déficit na sensibilidade. No domínio atividade e participação a categoria: “Levantar e carregar objetos - d430” apresentou limitação em 100% dos participantes. Já no domínio relativo a participação a “Recreação e Lazer - d920” foi observada como restrição a participação em 89% dos participantes. Em relação ao impacto ambiental a categoria “Serviços, sistemas e políticas de saúde - e580” representou uma barreira para 56% dos participantes. Diferente do encontrado no estudo quantitativo, os resultados coletados no estudo qualitativo demonstraram um número maior de categorias no domínio fatores ambientais. Porém, quando as quantidades de categorias nos dois estudos são comparadas considerando o número total de categorias da CIF, obtendo uma frequência relativa de categorias, observou-se que as incapacidades relativas ao domínio ambiente são prevalentes nos dois estudos tanto na abordagem quantitativa quanto na qualitativa. As categorias da CIF, em cada domínio, encontradas no estudo quantitativo e no estudo qualitativo auxiliam a mapear as incapacidades funcionais de pacientes com hanseníase. / Lagarto, SE

Objetivo: aplicação do core set resumido genérico da CIFCJ para crianças e jovens de 0 a 18 anos com paralisia cerebral em um grupo de pacientes, através de um instrumento baseado no próprio core set, que operacionalize a coleta de dados funcionais. Métodos: Para algumas categorias, foi possível traçar uma relação entre o que se desejava avaliar e instrumentos escolhidos através de revisão da literatura. Nestes casos, as alternativas de resposta desses instrumentos foram agrupadas de forma que satisfizessem os critérios dos qualificadores da CIFCJ. Nos casos em que isso não fosse possível criou-se uma tabela de correspondência para cada item. Todos os pacientes foram classificados de acordo com o sistema de classificação da função motora grossa (GMFCS). Foram avaliados 33 pacientes dos ambulatórios e do Centro de Reabilitação de neurologia infantil do Hospital das Clínicas de Ribeirão Preto, divididos em 3 grupos, de acordo com sua faixa etária, e desenvolvidas tabelas para descrever os qualificadores de cada componente. Os dados do questionário do core set resumido de 0 a 18 anos da CIFCJ-PC foram inseridos em bancos de dados, digitados em planilha do Excel, e a análise descritiva simples deu-se através do programa estatístico SPSS. Resultados: Para cinco categorias foi possível utilizar escalas sem necessidade de perguntas auxiliares. A avaliação realizada apenas por perguntas objetivas, ocorreu em um item de funções do corpo, em três domínios de atividades e participação, e em todos os oito descritores do componente Fatores ambientais. A idade dos participantes variou entre 4 meses e 18 anos, com maior frequência (33%) de pacientes GMFCS III. A frequência de alguma forma de problema nas funções intelectuais foi de 75%, variando entre 63-81% nos três grupos etários. A Sensação de dor (b280) obteve a menor prevalência de deficiências de algum grau, existindo em maior número no grupo de 0 a 6 anos. Encontramos 91% das crianças e jovens avaliados apresentando limitação em algum grau para deslocar-se por diferentes locais (d460). Os principais facilitadores foram Família imediata (e310) (91%), Produtos e tecnologias para uso pessoal na vida diária (e115) (85%) e Serviços, políticas e sistemas de saúde (e580) (82%). A maior barreira entre os fatores ambientais foram Produtos e tecnologias usados em projeto, arquitetura e construção de edifícios (e150). Conclusão: O core set resumido da CIFCJ para crianças e jovens com paralisia cerebral de 0 a 18 anos permite gerar um perfil funcional dos pacientes com esta condição de saúde e identifica as áreas a serem mais bem trabalhadas para cada indivíduo. Aponta ainda as influências, deficiências e barreiras comuns a maioria desses indivíduos, podendo ajudar a diagnosticar problemas na área de saúde, economia e serviço social. / Objective: To apply the common brief ICF-CY core set for children and youth with cerebral palsy in a group of patients, through instruments based on the core set itself, that operationalize the data collection in functioning. Methods: For some categories, it was possible to correlate the domains and an instrument selected through literature review. In these cases, the response alternatives were grouped to satisfy the criteria of the ICF-CY qualifiers. When this was not possible, we created a correlation for each item. All patients were classified according to GMFCS. Thirty-three patients from the outpatient clinics and the Children\'s Neurology Rehabilitation Center (CER) of the Hospital das Clínicas de Ribeirão Preto (HCRP) were divided into three groups, according to their age group. Tables were developed to describe the qualifiers of each component. Data from the ICF-CY common brief core set for children and youth with CP were entered into databases, typed in an Excel spreadsheet, and the simple descriptive analysis was done through the SPSS statistical program. Results: For five categories, it was possible to use scales without the need for auxiliary questions. The evaluation performed with only objective questions, occurred in an item of the component functions of the body, in three domains of activities and participation, and in all eight descriptors of the Environmental factors component. The participants aged from 4 months to 18 years, with a greater frequency (33%) of GMFCS III patients. The prevalence of some sort of problem in intellectual functions was 75%, varying between 63-81% in the three age groups. Sensation of pain (b280) obtained the lowest prevalence of deficiencies, existing in a greater number in the group of 0 to 6 years. We found 91% of the children and young people evaluated, showing some degree of limitation for Moving around different locations (d460). The main facilitators were Immediate family (e310) (91%), Products and technology for personal use in daily living (e115) (85%) and Health services, systems and policies (e580) (82%). The biggest barrier in environmental factors was Design, construction and building products and technology of buildings for public use (e150). Conclusion: common brief ICF-CY core set for children and youth with cerebral palsy is very useful to generate a functional profile for patients with CP, and to identify the areas to be better worked for each individual. This core set also points out influences, deficiencies and barriers that are common for most of these children, and should help on identifying problems in health, economy and social services.