THE INTERNATIONAL CLASSIFICATION OF IMPAIRMENTS, DISABILITIES, AND HANDICAPS (ICIDH):
ITS USE IN REHABILITATION
Marijke de Kleijn - de Vrankrijker,8 Christa Seidelb
& Ursula Tschernerb
When considering areas that could benefit from the International Classification of Impairments, Dis- abilities, and Handicaps (ICIDH), one of the first that comes to mind is rehabilitation (1).
Definition of rehabilitation
The best known definition of the term "rehabili- tation" seems to be the "Vienna" definition (1955), which reads as follows: "Rehabilitation is the com- plex of measures and activities aimed at raising the physical, mental, social, occupational and economic possibilities of a handicapped person to the highest possible level he can achieve and/or at maintaining them at this level" .c
The United Nations World Programme of Action concerning Disabled Persons (2) established in 1983, developed the following definition taking into ac- count the ICIDH definitions:
"Rehabilitation means a goal-oriented and time- limited process aimed at enabling an impaired person to reach an optimum mental, physical and/
or social functional level, thus providing her or him with tools to change her or his own life. It can involve measures intended to compensate for a loss of function or a functional limitation (for example by technical aids) and other measures
· intended to facilitate social adjustment or readjust- ment".
Rehabilitation activities are clearly focused on (po- tential) consequences of diseases, accidents and conditions from birth. This explains why the ICIDH is of interest to all those involved in rehabilitation.
Since the publication of the ICIDH in 1980 several types of application in the rehabilitation field have been reported in the literature. This article aims to provide an overview of the application of the ICIDH in the field of rehabilitation, showing possibilities and giving examples of actual use. The authors hope to stimulate the use of the classification and the exchange of information; this may avoid duplication of effort and could lead to improvements in the classification.
• WHO Collaborating Centre for the ICIDH, Zoetermeer, The Netherlands; and Ministry of Welfare, Health and Cultural Affairs, Rijswijk, The Netherlands.
b Rehabilitation Centre, Klinikum Berlin-Buch, Berlin, German Democratic Republic.
c Lower House of Parliament. Outline of the present defini- tion with regard to rehabilitation policy. 1976-1977 Session. Leid- schendam, The Netherlands, 15 March 1977. (p. 6).
d Bangma, B. D. Use of the IC/OH in the period 1983-1985;
Education and training; Research and concepts of the IC/OH.
Rotterdam University Hospital, 1985. Papers presented at a meeting held in Voorburg, The Netherlands, 24-28 June 1985. (WHO documents DES/ICIDH/85.20, 21 & 22).
This article is confined to experiences with respect to rehabilitation facilities, which means a somewhat restricted area of rehabilitation. A broader overview of applications, including other areas, is given by de Kleijn & Muller (3) and by the Dutch National Council for Public Health (4), from which some parts of this article are derived.
Possibilities of the ICIDH
Why are classifications important? Using the same classification means speaking a common language and using a common framework. This leads to better understanding and communication, which in turn can result in improved services. A classification also means structuring a certain area, thus facilitating policy formulation, data collection, statistics and documentation of information. Comparability of data and exchange of information can both be enhanced.
This also holds for a classification such as the ICIDH, within the area of rehabilitation (5-7).
Depending on the user's aim, the IDH classification can be used to different extents (basic concepts, some details/codes/categories, one of the three sub- classifications or all parts/details) and at different levels. At the micro level (individual), the classifica- tion can be used directly in patient care: for diagno- sis, problem ascertainment and evaluation of treat- ment. At the mesa level (organizations) its uses are to be found within institutions. Data collected at the micro level can serve as a source of information for policy making and planning, for example, to define priorities for allocating available resources among different sections and functions of the institutions, and to determine the number of staff required for certain purposes. The macro levels include all those which exceed the level of the institution: local, regional, national, federal and international levels.
On each of these levels, consistency is needed for policy formulation and for data collection. Following are some examples of actual use of the ICIDH for various purposes to different extents and at different levels, in a number of countries.
General applications of the ICIDH Micro level
Most examples of ICIDH use in general rehabilitation seem to be at the micro level (individual).
At Rotterdam University Hospitald (8) the ICIDH is used in the daily routine of the rehabilitation depart- ment (diagnostics), in the curricula of medical students and specialists in rehabilitation medicine, as well as in postgraduate education. It is also being used in a research project involving 1 OOO patients, the purpose of which is to check the usefulness of
I and D codes in classifying rehabilitation diagnoses and evaluating rehabilitation practice. The latter pro- jects showed that ICIDH contributes considerably to the elaboration of concepts in the philosophy and methodology of rehabilitation. Adequate training of physicians and other personnel is however neces- sary in order to obtain reliable findings, and use of the ICIDH appears to be very time-consuming; es- sential items are missing in some chapters and in other chapters the classification of items is not prac- tical.
Lankhorst et al. (9) report on a feasibility study con- ducted in the Centre for Rheumatology and Re- habilitation, Amsterdam (The Netherlands) in the early 1980s: 1 148 patients were classified by their physician, the opinion of the physicians about the feasibility of the ICIDH was recorded, and 21 patients were classified twice to assess reliability. The results suggest that the I code is suitable for patients with locomotor disorders. The use of the D code present- ed several problems (very time-consuming, and low reliability of D code assignments). The H code seemed to allow for simple meaningful scorings (making it tempting to use it as a substitute for the D code), and, as a result of this project, the Centre used only the H code for some time. In the opinion of Lankhorst, the resulting handicap profile turned out to be a useful summary of the patient's dis- abilities but not a measure of the social con- sequences of disablement, which was the original aim of the handicap classification. Another criticism concerns the absence within the ICIDH of subjective perception of impairments and disabilities.
Because of these experiences the Centre later started a project (10) aiming at the development of an in- strument based on the ICIDH which can be used in the daily practice of rehabilitation medicine. The instrument is an adapted version of the D(isability) list, consisting of 28 items in five fields (mobility, self-care, social activities, psychological status and communication). Four-point severity scales were used for rating disabilities and related perceived problems. The instrument has been used for screen- ing disabilities and problems in 400 patients. Feasibi- lity was excellent, and the average amount of time needed was 3 minutes per patient. A computerized data-base structure was developed for evaluation of serial data from individuals or patient groups during the rehabilitation process. Analysis of disabilities and related problems shows that adaptive processes are relevant in rehabilitation medicine. Perceived problems are often less severe than objectively
•Charpentier, P. L'appon de la classification internationale des handicaps en reeducation. A propos de 950 dossiers. In: Council of Europe, Committee on the Rehabilitation and Resettlement of the Disabled, Committee of Experts on the Application of the WHO Classification of Impairments, Disabilities and Handicaps, Records of the second session, 6-8 December 1988. Strasbourg, Council of Europe, 1988. (CD-P-RR (88) 13).
1Putterman, A. H. The use of the International Classification of Impairments, Disabilities, and Handicaps, as a planning instrument in rehabilitation. Montreal, Constance Lethbridge Rehabilitation Centre, 1987. Paper presented at the third Canadian congress on rehabilitation, Quebec, June 1987.
9Zendel, I. H. Rehabilitation planning expen system (RP!X) classifier. Montreal, Constance Lethbridge Rehabilitation Centre, 1987. Paper presented at the third Canadian congress on rehabilita- tion, Quebec, June 1987.
h Nieuwenhuijsen, E. R. The IC/OH as a framework for document- ing small gains in rehabilitation. East Lansing, Disability Research Systems, 1987. Paper submitted for the proceedings of the pre- congress day of the third Canadian congress on rehabilitation, Quebec, June 1987.
assessed disabilities in a chronic phase of disease;
this may influence the action taken.
Minaire (11) reports on ICIDH use in France for indi- vidual assessments in rehabilitation, and for the education and training of staff. In the rehabilitation centre of Coubert (France) the ICIDH has been in use since 1982. Charpentier mentions some experiences based on the analysis of 953 case files in this centre.
For each admission and discharge are included:
1 main diagnosis, up to 5 secondary diagnoses, up to 8 impairments, up to 10 disabilities, up to 5 handicaps. The impairments recorded appeared to be mainly skeletal and disfiguring impairments.
Within the disability area of personal care, locomo- tor and body disposition disabilities are most often reported. A significant difference in the severity of most disabilities is found between admission and discharge, providing an indication of the effective- ness of treatment. At the handicap level significant differences between admission and discharge have been found only for physical independence and mobility handicaps. Charpentier concludes that the ICIDH makes it possible to identify rehabilitation needs of patients and to evaluate the services re- quired.
Nadeau et al. (12) announced the introduction of the ICIDH in a computerized hospital information system. In Montreal, Puttermant describes intake forms used by nurses, the preparation of a treatment plan which sets goals for each recorded impairment and disability and that of discharge summaries, all based on the ICIDH.
The system resulted in improved communication, more comprehensive treatment, better treatment planning, better informed clients and improvement in documentation. From the same centre, Zendel9 announced the development of a rehabilitation plan- ning expert system; the introduction of such systems in the area of rehabilitation may encounter some problems, particularly in the area of ethics.
The ICIDH as a framework for documentin~ small gains is described by Nieuwenhuijsen. The Michigan Commission for the Blind wanted to create an instrument that allowed for quantitative measures of small gains in functional ability. These small gains must be measured in order to demonstrate pro- gramme effectiveness. The instrument, now in use;
is based on the ICIDH including most of the D codes.
In Australia, Ford (13) carried out a project in Caulfield Hospital which involved a number of ex- ercises to educate staff about the principles and projected uses of the ICIDH. Within selected units of the hospital, the possibilities of the classification to serve as a summary of the patient's physical, intel- lectual and social status at the time of discharge from hospital were examined. The main difficulties encountered were logistical. The routine use of the classification as part of a patient's discharge status was abandoned because of the time needed for consultation and discussion between disciplines.
A more optimistic report has been given by Last (14) who has described experiences with the ICIDH in Australia's largest nursing home. Coding has been undertaken for 102 residents using the ICIDH. This has proved simple and effective as a means of categorizing impairments and disabilities. A compu- ter program allows for the storage and retrieval of up to 8 ICD diagnoses, 6 impairments, 30 disabilities and 6 handicaps per resident. Experienced nurses
Wld hlth statist. quart., 42 (1989)
can code a person in half an hour. Periodic review every six months is now planned for all residents.
The handicap code was abandoned because its usefulness was less obvious. The system will allow for efficient surveillance of the progress of individual residents, will highlight those calling for clinical review, and will identify those who may benefit from specific management and research programmes.
Macro level
Most of the examples mentioned above concern the use of the ICIDH at the micro level (individual), although some are tending to serve at the mesa level (organization). To our knowledge, only a very few examples exist at macro level. One of them is the UN programme already mentioned (2). The Council of Europe (15) used the ICIDH concepts in a similar way in its policy statements on the rehabilita- tion of disabled people.
L 'Office des personnes handicapees du Quebec, a provincial government agency mandated to oversee and, if necessary, enforce the application of legisla- tion concerning the rights of handicapped persons in Quebec, has proposed a comprehensive policy aim- ing at the social integration of disabled persons through the elimination of factors contributing to an eventual impairment (e.g. chemical agents, rubella, alcohol and drug abuse), an intervention model to prevent or minimize the impact of impairment or disability as well as the elimination of physical and social barriers (e.g. convenience of buildings, access to the workforce, adequate income). In January 1984 the Quebec government officially adopted On equal terms (16) which is based on the conceptual model of the ICIDH.
In another sense, but still at the macro level, the use of the ICIDH concepts and categories is reported within the framework of community-based rehabili- tation in Punjab, Pakistan (see Finnstam et al. (17) and Grimby et al. (18).; Van der Meulen used the ICIDH concepts in a comparable way in Guinea- Bissau (Community-based rehabilitation in Guinea- Bissau, personal communication, 1988).
In the area of training, Der Wegweiser fur Artzte (19) is another example of the use of ICIDH concepts, terms and categories in an informative booklet sent to all medical doctors in the Federal Republic of Germany.
; See also Use of the WHO classification in assessing the prevalence of diseases, impairments and handicaps in Punjab Province, Pakistan, p. 157 of this issue.
i Ferngren, H. Is JC/OH of value in medical rehabilitation of disabled children? Some Scandinavian experiences. Stockholm, St.
Giiran's Children's Hospital, 1985. Paper presented at a meeting held in Voorburg, The Netherlands, 24-28 June 1985. (WHO document DES/ICIDH/85.18).
• Andrada, M. G. et al. Children with spinal cord lesions and their rehabilitation problems. Paper presented at the Rehabilitation International Conference, Lisbon, June 1984.
I Kamczuk, L. G. & Martinow, W. L. [Utilization of the International Classification of Impairments, Disabilities, and Handicaps in the analysis of injured children and their families-for example, of children with cerebral palsy]. Paper presented at an international symposium on assessment criteria to estimate the need for rehabilitation measures, Dresden, 6-10 June 1988. (In German).
Use of the ICIDH for the rehabilitation of special groups
Children and adolescents
Pfeiffer (20) compared the current register of con- sequences of disease in children and young people in Czechoslovakia with the ICIDH. He examined the medical records of children with locomotor dis- orders and made use of the majority of items from the ICIDH. For some disabilities he developed special severity scales, which are derived to some extent from the I code. He also consulted a group of specialists interested in the problems of children with deafness, blindness and psychiatric disabilities.
Ferngren et al.i (21) tested the ICIDH on the admis- sion records of 60 mentally-retarded children in Sweden. They compared the results with medical, psychological and social data and found a positive correlation between the scores of the ICIDH and the records; they divided the mentally retarded children into two groups: one with mild and the other with severe mental retardation, and were especially inter- ested to note the severity of disabilities to see whether it was possible to identify progress in people moving from a big institution to smaller group homes. The conclusion was that the D code was useful in some aspects concerning personal care. Ferngren modified the handicap code of ICIDH for a study of 6-7 year-old mentally-retarded children and concluded that it is possible to use it for children in this age group.
In the German Democratic Republic, Seidel &
Tscherner (22) examined 480 physically or mentally impaired children in the age group 12-16 years, including 208 with moderate mental retardation, and classified them with the help of the D code. Especi- ally for severely physically-impaired children in this age group, selected items are suitable to specify degrees of disability. Good differentiating items (based on factor analyses) are "self-care", "manual skill" and "locomotion". For children with moderate mental retardation most scales are only of limited value because of lack of reliable data on the degree of disability.
In Portugal, Andrada et al.k made a retrospective study of a group of 98 children with spinal cord lesions using the D and H codes, in view of the rehabilitation efforts and problems connected with these children's integration into the community.
They selected D code scales (locomotion, excretion and mobility) and H code scales (physical independ- ence, social integration, school and occupational integration) and used condensed severity scales. The authors emphasize that the detail for quantification provided by the ICIDH must be used to improve evaluation records.
Kamczuk & Martinow' (USSR) tested 197 cerebral palsy children aged 7-14 years by means of ICIDH scales. The examination provided data about the type of disability and the problems facing these children and their families. The data are suitable for making complex medicosocial proposals for re- habilitation in order to solve the social problems of the children's families.
Patients in rehabilitation
At the Cologne rehabilitation centre (Federal Republic of Germany) headed by Jochheim, several doctoral theses have studied the applicability of the
ICIDH to special diagnostic groups. Volkmann (23), Pohlmann (24) and Wassenberg (25) investigated the need for rehabilitation among cancer patients. They used two questionnaires they had designed with the ICIDH in mind. The authors concluded that the hand- icap instrument can serve only as a rough but very easily applicable tool for the detection of severe handicaps in larger populations. The disability classi- fication provides a large amount of information for the exact assessment of disabled persons and can be useful for the analysis of rehabilitation needs as well as for medical certificates.
Grimby et al. (26) followed 76 consecutive stroke patients in a rehabilitation ward over a period of 18 months in Sweden. The authors believe that the WHO system can be useful in describing the type and pattern of disablements in a group of patients admitted to a rehabilitation ward and that it provides information on staffing demands and criteria for admittance and discharge. The authors propose to restrict the ICIDH to two categories of consequences of disease or trauma: impairments and disabilities.
The conclusions of Alaranto & Kallio (27) are based on 212 patients who were evaluated one year after an operation for lumbar disc herniation in Finland, using the ICIDH concepts. The severity of disorders, impairments and disabilities was scaled into four classes. Handicap was evaluated by a team consist- ing of a physician, a social worker and a psy- chologist. The discerning analysis of these data items revealed a high correlation with the classes of occupational handicap. The severity scale for dis- ability was not suited to most patients with low back pain. Assignment to the different scale categories of occupational handicap was relatively easy. The authors found it helpful to combine the ICIDH with the model proposed by Purola (28) who defined illness as "a disturbance in the equilibrium between the individual's internal psychobiological system and the state of his external system of social con- nections". Using both models it becomes easier to define the aim of medical rehabilitation of patients with chronic low back pain and to overcome social problems.
Two Cuban investigationsm confirm the necessity of applying the D code. 94 case reports of an ortho- paedic hospital were analysed and 115 patients were examined whose severity of disability and prognosis had been assessed by a team of physicians. The authors make a differentiated item analysis and dev- elop proposals on changes in some scales.
Elderly people
In Denmark Dalgaard & Horwitz (29) assessed 50 geriatric patients, inpatients as well as outpatients.
The authors reached the following conclusions. The I code is useful in assessing treatment strategies for geriatric patients, for checking all the organ systems, and for determining priority of treatment in a re- levant range. The D code is useful in everyday
mAstarian, R. et al. [Comments on the utilization of the classification of disabilities in morbidity surveys]. Paper presented at an international symposium on assessment criteria to estimate the need for rehabilitation measures, Dresden, 6-10 June 1988. (In German).
n Seidel, C. State of the ICIDH in the German Democratic Republic. Rehabilitation Centre in Klinikum Berlin-Buch, 1987. Paper presented at the International lCIDH Workshop, pre-congress day of the third Canadian congress on rehabilitation, Quebec, June 1987.
clinical practice. The outcome and efficiency of treat- ment can be evaluated from admission to discharge.
The D code is also used for assessing and evaluating the need for aids and assistance.
The H profile is noted as the best overview measure for evaluating the need for institutional care, and for aids and support services.
In the German Democratic Republic, 500 residents of an old people's home were interviewed.n The object was to find a method suitable for measuring dis- abilities in the elderly. The aim of the first stage of the investigation was to construct appropriate scales of the D code by means of Guttman's scalogram analysis (30). Five different scales for measurement were found, enabling the interviewer to specify what a person can and cannot do. A substantial reduction in the number of D code items can, therefore, be made.
The Cologne rehabilitation centre also tested older people using the ICIDH. Scheele (31) assessed 107 residents of an old people's home by means of modified classifications of disabilities and handicaps.
Compared with other questionnaires of handicaps in elderly people, the one developed by the Cologne rehabilitation centre makes possible a substantially more differentiated registration. The prognostic assessment provides important indications of def- . icits and seems promising for therapy and improve- ment. The H code enables a summarizing overview of the consequences of disabilities for social life.
Both classification systems may serve as a basis for planning various intervention measures.
Conclusions
The examples mentioned above illustrate that the ICIDH has been applied by workers in the field of rehabilitation in many countries. The conceptual model is perceived as a helpful tool, although most authors make critical remarks and suggestions for improvement, which should be taken into account in case of revision of the classification. Most of the examples given above relate to ad hoe applications or research, only a few to implementation in routine use. The latter should be stimulated and experiences reported.
Regarding the level of application, many of the users apply the ICIDH at the micro level. In some cases the complete classification is chosen (codes or terms in medical records and discharge summaries), in other cases an instrument (form, questionnaire, scale) based on selected items of the ICIDH has been developed. Applications should be analysed in depth to find out whether frequently-used applications or instruments could be standardized.
Very few applications relate to the mesa level, which explains the lack of statistical data in this contribu- tion. More research in this area should be encour- aged, and the results published, both at mesa and macro levels. In order to stimulate use and to im- prove the quality of communication and data, ICIDH should be included in the curriculum of students and in the training of staff.
The ICIDH may also serve as the basis for obtaining better information on special groups, i.e. information
Wld hlth statist. quart., 42 (1989)
on the degree of severity of disabilities, changes in severity and profile of disabilities, and consequently, rehabilitation health-care measures. The ICIDH can serve as a basis for differentiating between various health-care groups. Future research using the ICIDH should include aspects of age groups and specificity of impairment. The methodological basis of the dis- ability and severity scales must be specified, and
methods should be more closely linked to the pro- cess aspects of illness.
Acknowledgements
We wish to thank Angelique Grootscholten and Constance Scholten for their contribution in produc- ing this article.
SUMMARY
This article intends to show possibilities and ex- amples of actual use of ICIDH in rehabilitation. Most of the examples concern the use of the classification at the individual level (patient profile, assessment of patient needs, evaluation of treatment, discharge status). Some can serve at mesa level: aggregated data (statistics) for evaluation of treatment at insti- tutional level, determination of numbers of staff
required. A few other examples concern the use of the ICIDH at macro level in rehabilitation: national policy, education and training of professionals, com- munity-based rehabilitation programmes. Special attention is given to examples of ICIDH use in re- habilitation of special groups such as children, the mentally retarded, cancer patients, elderly people, geriatric patients.
RESUME
Classification internationale des handicaps:
deficiences, incapacites et desavantages (CIH) - son utilisation aux fins de la readaptation
Le but de cet article est de montrer et d'illustrer les possibilites offertes par la classification internatio- nale des handicaps aux fins de la readaptation. La plupart des exemples concernent !'utilisation de la classification au niveau de l'individu (profil du pa- tient, evaluation de ses besoins, evaluation du traite- ment, etat
a
la sortie). Certaines de ces utilisations concernent le niveau intermediaire: donnees glo- bales (statistiques) pour !'evaluation des traitements en institution et determination des effectifs de per-sonnel requis. Ouelques autres exemples concernent
!'utilisation de la classification au niveau superieur:
politique nationale, enseignement et formation de professionnels, programmes de readaptation dans la communaute. Entin, une attention particuliere est apportee aux exemples d'utilisation de la classifica- tion pour la readaptation de groupes particuliers, tels les enfants, les handicapes mentaux, les cance- reux, les personnes agees et les patients des ser- vices de geriatrie.
REFERENCES- REFERENCES
1. WORLD HEAL TH ORGANIZATION. International Classi- fication of Impairments, Disabilities, and Hand- icaps-a manual of classification relating to the consequences of disease. Geneva, WHO, 1980.
ORGANISATION MONDIALE DE LA SANTE. Classification internationale des handicaps: deficiences, inca- pacites et desavantages - un manuel de classifi- cation des consequences des maladies. Paris, CTNERHI-INSERM, 1988.
2. UNITED NATIONS. World Programme of Action concerning Disabled Persons. New York, United Nations, 1983.
3. DE KLEIJN-DE VRANKRIJKER, M. W. & MULLER, M.
Challenge of standardizing the measurement of consequences of disease and injury. In:
Cote, R. A. et al. (eds), Role of informatics in health data coding and classification systems.
Amsterdam, Elsevier, 1985.
4. WORKING GROUP ON CLASSIFICATION ANO COOING. The IC/OH: a classification relating to the con- sequences of diseases. Zoetermeer, National Council for Public Health, 1989.
5. Wooo, P. H. N. Appreciating the consequences of disease: the International Classification of Im- pairments, Disabilities, and Handicaps. WHO Chronicle, 34: 376-380 (1980).
Wooo, P.H. N. Comment mesurer les con- sequences de la maladie: la Classification inter- nationale des infirmites, incapacites et han- dicaps. Chronique OMS, 34: 400-405 (1980).
6. WAGSTAFF, S. The use of the International Classi- fication of Impairments, Disabilities, and Hand- icaps in rehabilitation. Physiotherapy, 68 (7):
233-234 (1982).
7. SCHUMACHER, K. The International Classification of Impairments, Disabilities, and Handicaps (ICIDH):
relevance to physical therapy and rehabilitation.
In: Proceedings of the 10th International Con- gress of the World Confederation of Physical Therapy, Sydney, May 1987. Sydney, 1987.
8. BANGMA, B. D. ET AL. Rehabilitation medicine:
theory and practice. Rotterdam, Erasmus Uni- versity, 1988.
9. LANKHORST, G. J. ET AL Preliminary experiences with WHO's ICIDH: a user's report. International rehabilitation medicine, 7 (2): 70-72 (1985).
10. J1wA-80ERRIGTER, H. ET AL Application of the ICIDH in rehabilitation medicine. International disability
studies: (In press-Sous presse).
11. M1NAIRE, P. The development of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) in France. In: Classification internationale des handicaps: du concept
a
/'application - Document preparatoire; choix d'articles concernant la classification des han- dicaps presentes par ordre alphabetique auteurs.
Vanves, CTNERHI, 1988.
12. NADEAU, D. ET AL Classification des handicaps:
apport de la convivialite en informatique hos- pitaliere. In: Classification internationale des handicaps: du concept
a
/'application - Docu- ment preparatoire; choix d'articles concernant la classification des handicaps presentes par ordre alphabetique auteurs. Vanves, CTNERHI, 1988.13. FORD, B. International Classification of Impair- ments, Disabilities, and Handicaps: exercises in its applications in a hospital medical record.
International rehabilitation medicine, 6 (4): 191- 193 (1984).
14. LAST, P. M. First experiences with ICIDH in Australia's largest nursing home. International rehabilitation medicine, 7 (2): 63-66 (1985).
15. COUNCIL OF EUROPE. A coherent policy for the rehabilitation of disabled people. Resolution AP (84) 3 adopted by the Committee of Ministers on 17 September 1984 at the 375th meeting of the Ministers' Deputies-A model rehabilitation pro- gramme for national authorities. Strasbourg, Council of Europe, 1984.
16. OFFICE DES PERSONNES HANDICAPEES DU QUEBEC. On equal terms; the social integration of hand- icapped persons; a challenge for everyone.
Quebec, Office des personnes handicapees du Quebec, 1984.
17. F1NNSTAM, J. ET AL Evaluation of community- based rehabilitation in Punjab, Pakistan. I-Use of the WHO manual "Training disabled people in the community". International disability studies, 10 (2): 54-58 (1988).
18. GRIMBY, G. ET AL Evaluation of community-based rehabilitation in Punjab, Pakistan. II-The preva- lence of diseases, impairments, and handicaps.
International disability studies, 10 (2): 59-60 (1988).
19. FEDERAL WORKING GROUP ON REHABILITATION ET AL.
[Rehabilitation of the disabled - guidelines for physicians/. Cologne, Deutscher Artzte Verlag, 1984. (In German).
GROUPE DE TRAVAIL FEDERAL POUR LA REHABILITATION ET AL [La rehabilitaion des handicapes - diregtives pour /es medecins/. Cologne, Deutscher Artzte Verlag, 1984. (En allemand).
20. PFEIFFER, J. Functional evaluation of cerebral palsy using the ICIDH. International rehabilitation medicine, 8 (1): 11-14 (1986).
21. FERNGREN, H,. & LAGERGREN, J. Classification of handicaps in 6-7 year-old mentally retarded children; usefulness and inter-observer agree- ment of a child-adapted handicap code of WHO's ICIDH. International disability studies, 10 (4):
155-158 (1988).
22. SEIDEL, C. & TscHERNER, U. Application of the Classification of Disabilities to children from 12 to under 16 years of age. International rehabilita-
tion medicine, 7 (2): 73-75 (1985).
23. VOLKMANN, A. [Classification of oncology cases according to WHO, proposed rehabilitation and aspects of psychosocial cancer aftercare: a study of 100 patients at Cologne University Surgical Clinic/. Cologne, Cologne University Medical Faculty, 1985. (Diss. A). (In German).
VOLKMANN, A. [Classification des cas de cancer d'apres /'OMS, rehabilitation proposee et aspects psychosociaux de la post-cure du can- cer: etude de 100 patients de la Clinique de chirurgie de l'Universite de Cologne/. Cologne, Faculte de medecine de l'Universite de Cologne, 1985. (Diss. A). (En allemand).
24. POHLMANN, U. [Classification of oncology cases according to WHO, and their proposed rehabili- tation: a study of 100 patients at Cologne Uni- versity's Gynaecology Clinic/. Cologne, Cologne University Medical Faculty, 1987. (Diss. A). (In German).
POHLMANN, U. [Classification des cas de cancer d'apres /'OMS et /eur rehabilitation proposee:
etude de 100 patientes de la Clinique de gyneco- logie de /'Universite de Cologne/. Cologne, Faculte de medecine de l'Universite de Cologne, 1987. (Diss. A). (En allemand).
25. WASSENBERG, S. [Classification of oncology cases from the ear-nqse-and-throat department accord- ing to WHO's IC/OH codes and their rehabilita- tion/. Cologne, Cologne University Medical Fac- ulty, 1987. (Diss. Al. (In German).
WASSENBERG, S. [Classification des cas de cancer du departement d'oto-rhino-laryngologie d'apres /es codes CIH de /'OMS, et leur rehabilitation/.
Cologne, Faculte de medecine de l'Universite de Cologne, 1987. (Diss. A). (En allemand).
26. GRIMBY, G. ET AL On the application of the WHO handicap classification in rehabilitation. Scan- dinavian journal of rehabilitation in medicine, 20 (3): 93-98 (1988).
27. ALARANTA, H. & KALLIO,
v.
The concept of con- sequences of disease in patients with low-back pain. International rehabilitation medicine, 8( 1 ):8-10 (1986).
28. PuROLA, T. A systems approach to health and health policy. Medical care, 10: 373-379 (1972).
29. DALGAARD, 0.
z.
& HORWITZ, N. The International Classification of Impairments, Disabilities, and Handicaps evaluated by EDP-based medical re- cord linkage in geriatric medicine. International disability studies, 9(3): 116-117 (1987).30. BLACK, J. A. & CHAMPION, D. J. Methods and issues in social research. New York, Wiley, 1976.
31. SCHEELE, R. [Disabilities and handicaps of the elderly: a survey of the residents of an old people's and an old people's nursing home from the point of view of rehabilitation/. Cologne, Cologne University Medical Faculty, 1986. (Diss.
A). (In German).
SCHEELE, R. [lncapacites et desavantages des per- sonnes agees: etude des residents d'une maison de retraite et d'une clinique pour retraites du point de vue de la rehabilitation]. Cologne, Faculte de medecine de l'Universite de Cologne, 1986. (Diss. A). (En allemand).
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