Biomedical Engineering Reference
In-Depth Information
between professionals and users all require a change of attitudes and practices concerning
the role of the psychologist in the whole ATA process.
It is reasonable to assume that the deafening silence on the psychologist's role in the ATA
process is largely due to the absence of personal factor codes in the ICF.
8.2 Nothing about “Psycho” without Psychologists:
The ICF and the Need for Its Revision
The second part of the ICF covers “contextual factors” and is divided into two components:
environmental factors and personal factors. The latter are not actually coded in the ICF
framework but are involved in the process of functioning and disability and are comprised
in the conceptual background of the classification (Geyh et al. 2011). Personal factors are
defined in the ICF as “the particular background of an individual's life and living and
comprise features of the individual that are no part of a health condition or health states”
(WHO 2001, p. 23). They include
gender, race, age, other health conditions, fitness, lifestyle, habits, upbringing, coping
styles, social background, education, profession, past and current experience, overall
behaviour pattern and character style, individual psychological assets and other char-
acteristics, all or any of which may play a role in disability at any level. (WHO 2001,
pp. 23-24)
They encompass one domain (internal influences on functioning and disability) and one
construct (impact of the attributes of the person) (Table 8.1). The domain is “what” the
ICF classifies in each of its components at the highest semantic level (e.g., mental func-
tions, structures of the nervous system, learning and applying knowledge, etc.). The con-
struct refers to “how” each category is weighed in an operational way by means of specific
qualifiers. For example (WHO 2001, p. 217 Annex 2), the performance of a person (positive
aspect: functioning qualifier to weigh) who lost his leg [body structure domain (cod. s750);
negative aspect: impairment qualifier (cod. s750.4)] in a work-related accident and since
then has used a cane [environmental factor construct (cod. e1201); positive aspect: facilita-
tor qualifier (1201. + 3)] but faces moderate difficulties in walking around [activity and
participation construct; negative aspect: activity limitation qualifier (cod. d4500.2)] because
the pavements in the neighborhood are very steep and have a very slippery surface [envi-
ronmental factors construct; negative aspect: barriers qualifier (cod. e2100.-3)] is classified
as “moderate restriction in performance of walking short distances”: cod. d4500.2.
According to a previous vignette, the use of the aid, the cane, reduces the impact of
the physical impairment and the environmental barriers on the individual's performance,
although the individual's capacity without assistance and/or in a standardized environ-
ment might be considered more limited (e.g., cod. d4500.2 3). This entire assessment pro-
cess may be carried out by a multidisciplinary team, in which a (clinical) psychologist
professional might not be necessary because competence in human cognition, emotion,
behavior, and social relations systems are not essential for classifying the person in the
example or for assigning him the aid (the cane). According to such biosocial perspectives
on functioning and disability classification, “psycho” remains just a prefix to a word to
say that the internal influences and the impact of attributes of the person on functioning
