Dr Nixon Contreras Briceño

Presentación del tema: "Dr Nixon Contreras Briceño"— Transcripción de la presentación:

1 Dr Nixon Contreras Briceño
Nuevo paradigma de la discapacidad: FUNCIONALISMO/DISCAPACIDAD CIF Portada de la presentación Dr Nixon Contreras Briceño MAYO 2007

2 Interacción de Conceptos 1980 CIDDM_1
Problemas de Salud (enferm./trastorno) Deficiencia Discapac Minusval (función/estructura) (Dism capac activ) (Desventaja Social)) Disablement is seen as an interaction/complex relationship between the health condition and the contextual factors (i.e. environmental and personal factors). There is a dynamic interaction among these factors: interventions at one element level have the potential to modify other related elements. The interactions are specific and not always in a predictable one-to-one relationship to each other. The dimensions indicated refer to a person’s experience or circumstances The interaction works in two directions; even the presence of the consequences may modify the health condition itself. One may : - have impairments without having activity limitations / disability (e.g. a disfigurement in leprosy may have no activity limitations); - have activity limitations / disability without evident impairments (e.g. poor performance in daily activities in many diseases); - have participation problems without impairments or activity limitations / disabilities (e.g. an HIV-positive person, or an ex- patient recovered from mental illness); - experience a degree of influence in a reverse direction (e.g. inactivity of muscles can cause atrophy; institutionalization may result in loss of social skills). The current scheme shown in the diagram demonstrates the “contextual factors” in and through which the disablement process takes place. These include factors that interact with the person with disability to determine the level and extent of the person’s “participation” of the persons in his or her surroundings. These factors can largely be grouped into two: environmental factors and personal factors. Environmental factors are extrinsic to (outside of) the individual (e.g. the attitudes of the society, architectural characteristics, the legal system) and are listed in the Contextual Factors section of the current classification. Personal factors, on the other hand, differ from the environmental factors but have an impact on how disablement is experienced. They include: gender, age, other health conditions, fitness, lifestyle, habits, upbringing, coping styles, social background, education, profession, past and current experience (past life events and concurrent events), overall behavior pattern and character style, individual psychological assets and other characteristics which may play a role in the experience of disablement.

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4 Limitaciones y Críticas
Abordaje Negativo Puede ser más interesante conocer las habilidades que conserva una persona… …que la descripción detallada de aspectos perdidos o limitados

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10 Limitaciones y Críticas
3. A la definición y organización de conceptos Confusión en definiciones: “deficiencia” y “discapacidad” Problemas de aplicación y utilización práctica de dichos conceptos Solapamientos, especialmente deficiencias y CIE

11 ENFOQUE MEDICO Cuidados medicos Tratamiento individual
PROBLEMA PERSONAL Cuidados medicos Tratamiento individual Ayuda profesional Ajuste personal Conducta Cuidados Politica Sanitaria Adaptacion individual While the polarized approaches of the medical and social models present a thesis - antithesis opposition, they may be seen in a harmony of synthesis; especially if one tries to capture the integration of the various dimensions of disablement in a “biopsychosocial” approach. The ICIDH-2, as an international health classification, therefore attempts to provide a synthesis that offers a coherent view of different dimensions of health at both biological and social levels IN this way we also mover away from a minority model of disability to a universal model,

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13 DISCAPACIDAD: MODELO SOCIAL
COMPLICADO CONJUNTO DE CONDICIONES MUCHAS DE LAS CUALES SON CREADAS POR EL CONTEXTO Y ES RESPONSABILIDAD COLECTIVA DE LA SOCIEDAD HACER LAS MODIFICACIONES AMBIENTALES NECESARIAS PARA LA INCORPORACION PLENA DE LAS PCD EN TODAS LAS AREAS DE LA VIDA SOCIAL

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15 ENFOQUE SOCIAL integracion biopsicosocial accion social
PROBLEMA SOCIAL integracion biopsicosocial accion social responsabilidad individual colectiva intervencion medioambiental actitud Derechos humanos politica publica Cambio social While the polarized approaches of the medical and social models present a thesis - antithesis opposition, they may be seen in a harmony of synthesis; especially if one tries to capture the integration of the various dimensions of disablement in a “biopsychosocial” approach. The ICIDH-2, as an international health classification, therefore attempts to provide a synthesis that offers a coherent view of different dimensions of health at both biological and social levels IN this way we also mover away from a minority model of disability to a universal model,

16 Modelo biopsicosocial CIF
FUNCIONALISMO/DISCAPACIDAD Deficiencia Actividad Participación (Función/Estructura) (Limitación en la Actividad) (Restric. en la Participación) La nueva clasificación se fundamenta en un modelo teórico complejo en el que la discapacidad es entendida como una interacción entre la “Condición de Salud” y los Factores Contextuales ambientales y personales. Existe una interacción dinámica entre todos estos elementos y dicha interacción es multidimensional y multidireccional lo que que da una idea mucho más exacta del proceso discapacitante. Así tanto cada uno de los conceptos insertados en el modelo de un modo independiente o todos ellos en conjunto, pueden desempeñar un papel en la discapacidad a cualquier nivel. Factores Ambientales Factores Personales

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18 discapacidad funcionamiento discapacidad

19 Funcionamiento y discapacidad
Ambiente Por último y tal y como hemos señalado anteriormente, la CIF incluye los factores contextuales ambientales y personales como Parte 2 de su estructura Persona

20 Funcionamiento como un espectro
C A P

21 Discapacidad como un espectro
D LA RP

22 Conceptos Claves en Funcionamiento y Discapacidad
CUERPO PERSONA SOCIEDAD Función/ Actividades Participación Estructura (limitación) (restricción) severidad, localización, dificultad, duración, grado, facilitadores y duración neces. de asistencia obstác. en el ambien. DEFICIENCIAS ACTIVIDADES PARTICIPACIÓN Impairments are a loss or abnormality of body structure or function or of a physiological or psychological function (e.g loss of vision) An activity is the nature and extent of functioning at the level of the person. Activities may be limited in nature, duration and quality. (e.g. taking care of oneself or performing activities required in a job) Participation is the nature and extent of a person's involvement in life situations in relation to Impairments, Activities, Health Conditions and Contextual factors. Participation may be restricted in nature, duration and quality. (e.g. being employed, participation in community activities or obtaining a driver’s license) The terms Impairments / Disabilities / Activity limitations /Handicaps / Participation restrictions have been used synonymously by health care workers in several different professions for decades. These all define the disadvantages for the person concerned. The ICIDH represented the first major international attempt to impose consistency in the use of terms in this field and it had a significant degree of acceptance.

23 Lesión Traumática Ocular
DEFICIENCIAS LIMITACIÓN DE RESTRICCIÓN ACTIVIDADES PARTICIPACIÓN pérdida de visión hacer quehaceres obtener una domésticos licencia de conducir A child with an attention deficit disorder will have poor attention which may be seen in focusing and sustaining attention and has an impairment in the regulation of arousal states. Such a child will experience difficulties in activities of following directions in school, in handling distraction while doing homework, and may get into difficulties with other children at school or play as he/she cannot wait his/her turn. Consequently such a child may be labeled as a ‘problem kid’ and may find that his/her participation in education at school and in play, sports and games is restricted because of exclusion by others.

24 Discapacidad en términos sencillos
Su cuerpo no funciona apropiadamente Usted esta limitado en sus actividades Enfrenta obstáculos en la sociedad para su participación Now, having heard the aims of the ICIDH-2 in some detail, the take home message for ICIDH in simple terms is: Your body doesn’t function properly You are limited in your activities You face barriers in society

25 Factores Contextuales
Ambientales e1. Productos y Tecnología (comida, ropa, educación, comunicación, industriales, recreativos, espirituales, arquitectura, etc) e2. Entorno natural y cambios en el entorno producidos por el hombre (orografía, clima, luz, sonido, etc) e3. Apoyo y relaciones (familia, amigos, profesionales, animales, etc.) e4. Actitudes (familia, amigos, sociedad, profesionales, etc.) e5. Servicios, Sistemas, Políticas. Personales Así se evalúan toda una serie de características propias del contexto en el que se desarrolla la condición de salud.

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29 ENFOQUE BIOPSICOSOCIAL
PROBLEMA PERSONAL Y PROBLEMA SOCIAL Cuidados medicos y integracion biopsicosocial Tratamiento individual y accion social Ayuda profesional y responsabilidad individual colectiva Ajuste personal y intervencion medioambiental Conducta y actitud Cuidados y Derechos humanos Politica Sanitaria y politica publica Adaptacion individual y Cambio social While the polarized approaches of the medical and social models present a thesis - antithesis opposition, they may be seen in a harmony of synthesis; especially if one tries to capture the integration of the various dimensions of disablement in a “biopsychosocial” approach. The ICIDH-2, as an international health classification, therefore attempts to provide a synthesis that offers a coherent view of different dimensions of health at both biological and social levels IN this way we also mover away from a minority model of disability to a universal model,

30 54 Asamblea Mundial de la Salud
Mayo 2001 Aprobación de la Clasificación Internacional del Funcionamiento de la Discapacidad y de la Salud CIF Resolución WHW 54.21 Así en mayo del presente año, la Asamblea Mundial de la Salud aprueba la nueva Clasificación mediante la resolución WHW mediante la cual “hace suya la CIF”, insta a los estados miembros a la utilización de dicha clasificación y pide a la Directora General que preste apoyo a los estados miembros para que hagan uso de la Clasificación

31 GRACIAS