Using the International Classification of Functioning, Disability and Health Model to characterize body functions and structures, activities and participation in physical activity and the status of quality of life among individuals with central nervous system lesions




Dobrinsky, Jill A.

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Regular physical activity is significant for overall health and can reduce the risk of chronic disease and health related conditions. Individuals with central nervous system CNS lesions experience impairments that limit their participation in physical activity and reduce quality of life; therefore it is even more important to understand the relationship between the barriers and affordances to engaging in physical activity for this cohort. The current study has uniquely identified a population (n= 11) based on the common experience of spasticity in the lower limb resulting from an CNS lesion across multiple diagnostic categories and used the International Classification of Functioning, Disability and Health model (ICF) (WHO, 2001) to characterize the impairments in body structure and functions, activities and contextual factors to better understand their influence on physical activity levels in this cohort. The findings showed that each individual experienced physical impairments for multiple body functions and structures comprising reduced ankle range of motion (M= 9.98 PlantarFlexion), spasticity as measured by the Ankle Plantar Flexor Tone Scale (middle ankle range resistance M= 1.56, stretch reflex M= 1.64) as well as some reports of pain on a Visual Analog Scale (Usual, M =1.10, and Worst pain, M= 1.64). On average the cohort presented with mild to moderate impairments in their mobility as measured by Timed Up and Go (M= 28.28 seconds), walking velocity (M= 74.94cm/sec Gaitrite mat) and falls (M= .91). Findings from both the Physical Survey for Individuals with Physical Disabilities (PASIPD) and semi-structured interviews suggest that participation in physical activity was low across life roles including areas of work and employment, recreation and leisure, domestic life and selfcare. The physical component summary (PCS) scores of the Short-Form 36 Version 2 Quality of life Survey were lower than average norms (M=38.12, SD=7.53), while the mental components summary (MCS) scores were on par with average ranges (M=50.61, SD=10.02); however the overall MCS score was slightly higher than the trend reflected in the mental health sub-scores which ranged from between slightly below average to average. Clearly aligning with the ICF model, the volume and intensity of physical activity was hampered by physical impairments, fear of falling, cost of activities, poor weather, a lack of transportation, and cut backs to services as reported in the semi-structured interviews. However, the quantitative relationships between the domains of the ICF were less obvious. Through qualitative interviews the participants’ positive outlook toward participating in life roles was strongly expressed. Despite barriers, individuals were finding ways to be somewhat active and were motivated to do more and overcome their functional limitations.



Disabilities, Quality of life, Physical activity