Changing Perspectives and Practice in Habilitation in Norway. A Study of Physiotherapists' Assessment of Children with Cerrebral Palsy, Based on ICIDH-2, 1998

The project objective was to describe and discuss physiotherapists information gathering and decision making as a basis for assessing children with cerrebral palsy, based on ICIDH-2.

Over the last twenty years there have been beydelige changes in care ideologies and theoretical reference frames for habilitation. The study's first part, which is a literature review, shows that these changes are so extensive, and have so many common characteristics that they can be said to have created a new paradigm for physiotherapy assessment of children with neurological disorders - from function-oriented to participation oriented treatment.
The study's second part is an empirical study of a group of physiotherapists collection of information when studying children with cerebral palsy. The data has been collected in two ways: 1) through a postal survey based on WHO's "International Classification and Impairments, Activities and Participation" (ICIDH-2) and 2) through investigation reports from a sample of physiotherapists who participated in the survey. Since the study's key concepts are built around ICIDH-2 the system's suitability to describe the information physiotherapists collect are also discussed.
The core of the physiotherapist's assessments can be summarized in the concept of motion: motion assumptions, basic movement activities, movement quality and use of assistive devices that can compensate for reduced mobility.
The physiotherapists also frequently collect information on a wide range of other impairments and activities, while the extent of participation-oriented information seems to be less. The information is obtained from many different sources. Additional tests of the child on business premises is emerging as the primary source by collecting central information. The literature review showed that over the past ten years good assessment tool have been developed for children with cerebral palse. These are seldom used by physiotherapists in the material. Overall, it seems physiotherapist's information retrieval is rooted in functional rehabilitation, but it also includes elements that might be related to participation oriented habilitation.
The results indicate that the chapters and categories the study has drawn from ICIDH-2 capture essential parts of the information physiotherapists collect, and that most categories are operationalized so that they can be recognized in the physiotherapist's language.

本项目旨在以国际功能、残疾和健康分类第二版（ICIDH-2）为框架，描述并探讨物理治疗师在评估脑性瘫痪（cerebral palsy）患儿时的信息收集与决策过程。

近二十年来，康复照护理念与康复评定的理论参照框架已发生广泛变革。本研究的第一部分为文献综述，结果显示此类变革幅度之大、共性特征之显著，已然形成了神经系统疾病患儿物理治疗评定的全新范式：从以功能为导向转向以参与为导向的康复干预。

本研究的第二部分为实证研究，聚焦于物理治疗师在评估脑性瘫痪患儿时的信息收集行为。数据收集采用两种方式：1）基于世界卫生组织（WHO）《国际损伤、活动与参与分类》（ICIDH-2）开展的邮寄问卷调查；2）调取参与调查的物理治疗师样本所提交的评定报告。由于本研究的核心概念均围绕ICIDH-2构建，因此本文亦探讨了该分类系统在描述物理治疗师所收集信息方面的适用性。

物理治疗师评定的核心可归结为运动相关维度：运动假设、基础运动活动、运动质量，以及可弥补活动能力下降的辅助器具使用情况。

物理治疗师亦会频繁收集各类其他损伤与活动相关信息，但以参与为导向的信息收集范围相对有限。此类信息可通过多种渠道获取，其中在诊疗场所内对患儿进行专项评估已成为核心信息的主要来源。文献综述显示，近十年来学界已开发出多款适用于脑性瘫痪患儿的优质评定工具，但在本次研究的样本中，物理治疗师极少使用此类工具。整体而言，物理治疗师的信息检索逻辑仍植根于功能康复，但亦包含部分与以参与为导向的适应性康复相关的要素。

研究结果表明，本研究从ICIDH-2中提取的章节与类别能够覆盖物理治疗师所收集信息的核心部分，且多数类别已实现操作化，可通过物理治疗师的专业话语体系予以识别。