Saturday, 22 November 2014

SEVEN YEARS AGO IN TEL AVIV

Where are we now with the ICF?

Norman Perrin has kicked off his new blog format with some thoughts on 'research, cerebral palsy and education' (with a second posting on this promised soon):
I do so wish that more people in the position that he occupied until recently, that is responsible for running a Conductive Education centre, were to express some of the awkward questions that they see arising out of what they are involved in.

The ICF again

Among important points that Norman raises here is the question of the ICF (the WHO's International Classification of Functioning, Disability and Health). He quotes a passage from the WHO stating that the ICF represents 'a philosophical shift' in the way that the field of cerebral palsy regards the interventions that it provides –
'The field has chosen a philosophical shift away from almost exclusively redressing physical impairments underlying functional problems to adopting an additional focus onmaximizing children’s environment, their independence in daily activities, and their community participation.'

Readers must make their own judgement of this. You can read Norman's own on his blog. He expresses himself as 'optimistic' as how this will play out in practice at the local level. Sorry, Norman, I myself am nothing like optimistic about how things will continue to be at the hands of the street-level bureaucrats (and of the street level academics and researchers). I fear that the ICF, like all systems of classification of human affairs, brings with it the dangerous possibility of reinforcing the philosophical status quo.

My view

A vignette from Tsad Kadima's twentieth-anniversary conference held in Tel Aviv in 2007, referring to its concluding Round Table...

I was contributing to a plenary Round Table, being quizzed along with leading physiotherapist Sarah Capelovitch by paediatrician Peter Rosebaum. Peter is an international very big wheel in the paediatrics of cerebral palsy – and a major ICF-buff. Inter alia Peter posed us both the following question –

Today, the ICF is a central framework, which should guide our work and thinking, both for clinical and research activities in childhood disability. Please try to ‘place’ the ideas of the approach you represent into the ‘modern’ conceptual framework of the ICF.

Ex tempore, I began my reply by stating the following position–

Conductive Education has remained largely untouched by the International Classification of Functioning, Heath and Disability. Internally at least, Conductive Education has not needed this, as it has already implicitly moved on to the next stage, which involves mechanisms for change not just classification.

One does hear from time to time that benefits will accrue to Conductive Education from the existence of the ICF. It would be interesting to hear what benefits there have actually been.

As for a 'philosophical shift' I would be more convinced that there is indeed a revolution in process if less attention were directed to what after all is just a classification system of how things are. Conductive Education (not uniquely), like human development itself. is a dynamic, educational process.

ICF classifies aspects of the world as it is. Conductive Education is concerned with a vital factor that links such aspects in the process of development  learning, and a conscious effort to ensure this through teaching.

ICF's may have all sorts of useful functions in its own world, but I still hold to what I said seven years ago, that Conductive Education is already step ahead of that world (again not uniquely), representing a different pradigme, one characterised by effecting change.

References

Perrin, N.(2014) Pondering research, cerebral palsy and education (1), C.E. Jottings, 20 November

Schenker, R., Capelovitch, S., Sutton, A., Rosenbaum, P. (2010) Conductive Education and NDT-Bobath: experts' discussion on history, development and current practice, Israeli Journal of Occupational Therapy, vol.19, no 2


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