Semin Hear 2016; 37(03): 161-162
DOI: 10.1055/s-0036-1584413
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

International Classification of Functioning, Disability and Health in Audiological Practices

Mridula Sharma Guest Editor
1   Department of Linguistics, Macquarie University, Sydney, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
20 July 2016 (online)

The ICF or International Classification of Functioning, Disability and Health is a theoretical framework that has been endorsed by the World Health Organization. The framework is an amalgamation of one's medical, social, and individual perspectives of health and hence is referred to as a biopsychosocial model. The framework was introduced to focus on well-being and functioning rather than on disease or even disability.

Why the ICF? There have always been the medical and social models of disability. Although the medical model made the disability the focus, the social model regarded the disability to be a result of environment and not an attribute of the individual. The ICF in a way is an amalgamation of both medical and social models of disability. The advantage of the ICF lies in its focus on the participation and activities rather than disability per se. It emphasizes that social participation is vital, as are the goal-directed activities. More importantly, the framework emphasizes the significance of one's environment.

Do we need a framework in audiology? Current audiology literature admits the inadequacy of the definition of hearing loss, and it is also accepting of the fact that the pure tone audiogram is not a good enough measure for recognizing the difficulties people have nor how well they are able to compensate. Clinical audiologists observe that any two individuals with same hearing loss seldom have the similar level of difficulty. Another perspective is regarding the expectation of clients and what they need or how the hearing loss impacts their quality of life and their family. Consequently, there are factors that need to be considered when planning rehabilitation. Although the decision is made about the difficulty a patient has, equally important are factors that will ensure success. Clinical audiologists often gather pieces of information from case history, observation, or general discussions. The difficulty is that there is a lack of consistency. The practice of determining deficits and relevant context is highly dependent on audiologists and their experience. Hence a framework such as the ICF is useful to ensure consistency and to find that balance between participation and restrictions or activities and the limitations. The ICF was included within the scope of Practice for Audiology in 2004. The purpose was to encourage audiologists to use the ICF framework when planning rehabilitation in adults with hearing loss. The aim was to move away from the difficulties defined by the audiogram. The focus was to plan rehabilitation outcomes with consideration of the difficulties the person faces in real-life situations (participation restrictions), personal limitations that the person may have in completing a task (activity limitation), and the physical as well as the social environment in which the person lives.

Since 2004, what is the status in audiology service provisions? There have been publications since 2004 on the utility of the ICF in the diagnosis and management of hearing loss in adults. It is curious that the framework has not been extended for other audiological disorders. In 2012, we penned a chapter on how the ICF can be used to diagnose and manage auditory processing disorders. At about the same time, the white paper introduced by the Western Ontario group also encouraged the use of the ICF when considering the diagnosis and management of APD. These are both worth mentioning as they broadened the utility of the ICF to other audiological disorders. It was an attempt to remind researchers and clinicians of the importance of the client perspective and that the test battery was only important as long as it addressed the concerns of the individual. This was then presented at the online American Speech-Language-Hearing Association conference. The exercise made me appreciate that perhaps one of the reasons uptake of the ICF framework is limited may be due to few guidelines on how the ICF could be utilized for the other complex audiological disorders. This current special edition is an attempt to address this gap.

What are the other advantages of the ICF? The applications of the ICF on service provision have been identified at the individual, institutional, and social levels. At the individual level, the aims are about the individual's functioning: how to maximize functioning or evaluating outcomes. The institutional-level goals may be about the general service that is provided, whereas at the social level the information may be useful in creating regulations or policies. The current issue showcases various complex audiological disorders and their management and how ICF can be applied to these cases.

What is the aim of the current special edition? This edition of Seminars in Hearing has eight articles by leading researchers and clinical audiologists discussing the framework from various perspectives including case studies to show how the framework can be applied in clinical practice. The first article provides a summary of the framework in adults and the various components that can applied to any individual. Included in the article are the brief and comprehensive core sets that are also useful for defining functioning. The second article discusses application of the ICF during rehabilitation that centers on an older person with hearing loss and his family. We have an article that applies the ICF to an adult with mild head injury and another one that shows application of the ICF with adults with stroke. We have included one article that pertains to adolescents with hearing loss and two others that discuss the early intervention programs including teleaudiology. Several other complex disorders have not been included in the edition, such as auditory neuropathy disorders, tinnitus, semicircular canal dehiscence, sudden hearing loss, and Meniere disease. There are examples in this edition, however, that can be extended to include other disorders. Each article contains background and examples with the view to provide the application of the ICF framework.

It is not the intention of this special edition to provide a blueprint of a clinical appointment that all audiologists need to adopt. The ICF framework is flexible and not a rigid, rule-driven system. The framework is more like a guideline, and the aim of this edition is to provide strategies on what multifactorial factors may need to be considered for each client. Finally, we would like to thank all the reviewers who spent their valuable time to provide feedback. The edition mainly aims to highlight the application and benefits of the ICF across a variety of clinical scenarios.