Avaliação da funcionalidade em crianças com disfunções neurológicas usando a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) como referência

Abstract

Introduction: The operationalization of the biopsychosocial approach recommended by WHO presents theoretical and methodological difficulties due to the complexity of the International Classification of Functioning, Disability and Health (ICF). Cerebral palsy (CP) can trigger impairments in structures and body functions, limitations in activities and participation restrictions. Contextual factors may influence as barriers or facilitators to the performance and capacity of children with CP. Thus, the multidimensional model of the ICF can be used to investigate the functioning of this disease. Considering the ICF, some issues may arise for the operationalization of the biopsychosocial perspective: 1) What categories of ICF should comprise a CP assessment by a rehabilitation team? 2) What items are documented in the records? 3) Do the professionals know the ICF model? 4) Are the concepts of the ICF easily managed? 5) What is the functional and contextual profile of children with neurological disorders? Given these issues, the goal of this thesis was to apply the ICF model with different purposes with the aim to initiate a debate on the use of this classification by health professionals in children with neurological disorders. Methods: Five studies were developed (two empirical studies, a records analysis of a Rehabilitation Center, a panel of experts and a literature review). Results: An ICF code sets for the evaluation of CP has been raised through the perceptions of professionals involved with the rehabilitation of the CP and through analysis of medical records. Impairments in the body functions, limitations in activities and influence of environmental factors on the functioning of CP were observed by empirical study. Issues related to the capacity of the ICF construct were performed in order to start a discussion about the methods used to investigate the activity and participation component. Final Considerations: The operationalization of the biopsychosocial approach requires the articulation of different theoretical and empirical methods. The CP is presented with a heterogeneous functional profile, since there are different impairments in cognitive and motor functions. Environmental factors should be considered in the evaluations of the rehabilitation team, because they act as facilitators or barriers to the functioning of the cases. Conceptual and methodological advances are needed to accomplish the WHO purpose