PHYSICAL THERAPY: THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING (ICF) IN THE DEVELOPMENT OF EARLY INTERVENTION PROGRAMS

L. Araujo¹, T. Melo², V. Israel³

Background: The biopsychosocial (BPS) model of the International Classification of Functioning (ICF) has been used in the therapeutic context. However, few studies have used this instrument to develop and systematize early intervention physical therapy programs. The first years of the children’s life are considered critical for their neuropsychomotor development (NPMD), as they are more exposed to the effects of stimuli, as well as internal and external adversities. Therefore, developing an intervention and health promotion program for small children from a BPS standpoint must have their functioning in view, regarding the dimensions of body functions and structures, activities, and participation, and the contexts with personal and environmental factors.

Purpose: To describe and systematize the use of the ICF in the development of two early intervention physical therapy programs, on land and in water, for children 4 to 18 months old.

Methods: Both physical therapy programs – named Early Intervention Program (EIP) and Kids Intervention Therapy – Aquatic Environment (KITE) – are designed to take place at the day care center and in the therapy pool (respectively), twice a week, for four weeks, in sessions lasting 45 to 60 minutes. Their planning includes progression parameters and guidelines for home activities. The assessments and interventions are systematized based on the BPS model of the ICF, in the domains approaching health condition, functions (b) and structure (s) (assessment questionnaire), activities and participation (d) (AIMS assessment, Denver II, and PedsQL™), personal factors (questionnaire, ABEP – Brazilian Association of Research Companies –, and AHEMD-IS), and environmental factors (AHEMD-IS).

Results: The ICF dimensions were considered as follows: concerning the health condition related to the NPMD, they were classified as typical, at-risk, or delayed. As for the body functions (b) and structures (s), each child’s particularities were considered, indicating their progression in the EIP and KITE. The activities and participation (d) encompassed functional movements, on land and in water, considering the child’s age group and the NPMD stages. The activities, performed to the sound of child songs, were structured around three axes – locomotor, stabilizer, and manipulative –, with weekly progression parameters. The participation considered the involvement of the baby, family, day care center, and society through the interaction with these environments and the guidelines for home activities. The contextual factors involved the participation of the family; the environmental factors encompassed the structuring of the EIP and KITE at the day care center, in the therapy pool, at home or school; and the personal factors included each child’s neuromotor experiences, as the core of the intervention along with the family, and the necessary adaptations according to each one’s individuality.

Conclusion(s): This study enabled the description and systematization of the use of the ICF to develop two early intervention physical therapy programs, on land and in water, for children 4 to 18 months old – aiming to follow up the child’ development throughout life with a functional health indicator.

Implications: Physical therapists may ground their choice for the best assessment instrument, as well as the early intervention with babies, both in clinical use and research.

Funding, acknowledgements: This study was financed in part by the  CAPES (Brazil - Finance Code 001).

Keywords: Early Intervention, Hydrotherapy, International Classification of Functioning

Topic: Paediatrics

Did this work require ethics approval? Yes

Institution: Federal University of Parana, Brasil

Committee: Research Ethics Committee of the Federal University of Paraná, Brazil

Ethics number: 1 714 810