1999年ICIDH改定会議（ロンドン、1999年４月22～24日）への日本協力センターのレポート Report of ICIDH Japan Collaborating Centre to 1999 ICIDH Revision meeting, London, 22-24 April, 1999

        Japan Collaborating Centre has been discussing on ICIDH-2 Beta- 2 Draft for some time. However, since the final draft has arrived only on April 17, we had a very short time for our report. Therefore, although there are many important issues, we will concentrate on a few most important points.

I. INTRODUCTION

1) The Title - Disablement instead Disability

        The title of the classification now uses 'disability' instead of 'disablement' that has been used since ICIDH-2 Beta-1 and in various intermediate versions of Beta-2. There is no explanation for the sudden change.
        It is true that in previous ICIDH-2-related meetings there have been comments on the unfamiliarity or even non-existence of the word 'disablement' in English. However, if you look through English dictionaries, this word is listed in most of them, including small ones.  The largest and most authoritative English dictionary (The Oxford English Dictionary, 2nd ed., 1989) lists 'disablement' with the definition of "The action of disabling; the fact or condition of being disabled" and gives historical record of this word's written use since 1684. And it has never been obsolete, being recorded over years in 1716, 1806, and 1884 as well.
        The title must include an umbrella term for the negative aspects of human functioning (one word for impairment, activity limitation, and participation restriction put together). we do not think that 'disability' is adequate for that purpose. 'Disability' has been used for the past nearly twenty years as defined by ICIDH in 1980 that is equivalent to what we call now 'activity limitation'. This well-defined, restricted (and restrictive) usage of 'disability' is now wide-spread and deeply rooted in the mind of people involved in ICIDH worldwide. If we used this word now as the umbrella term, there will be a great confusion. Therefore, we strongly advocate the use of 'disablement'. Its relative unfamiliarity itself is its advantage (no confusion with well-established meaning).  Thus the title must be ICIDH-2: International Classification of Functioning and Disablement.

2) The Model - Need for Subjective Dimension

        Body Function-Activity-Participation Model of ICIDH-2 is a great improvement compared with Impairment-Disability-Handicap Model of ICIDH.  However, ICIDH-2 still has the same weakness ICIDH had, in that both of them deal only with the objective aspects of functioning/disablement and does not include its subjective dimension.
        The importance of the subjective consequence of disease as an integral part of disablement process was first raised by one of us (Ueda) in 1981, who named it "disablement as an experience". Also in recent years quite a few papers have appeared in international journals that advocate the importance of subjective dimension of disablement.  We think it is imperative for ICIDH-2 Model to incorporate the subjective dimension.
        From a practical point of view, if it seems very difficult to develop an entirely new classification of subjective dimension within the time limit, we should at least introduce and integrate the subjective dimension into the Model, acknowledge its importance in the text of the Introduction, give definition with illustrative examples, then leave the classification itself as a future task. It is just like Personal factors that is integrated into the Model, explained in the text with many examples, but not included in the classification, and "their assessment is left to the user, if necessary".
        Japan Collaboration Centre is ready to be instrumental, in whatever way, in organizing a task force or a study group on the introduction of the subjective dimension into ICIDH-2.
 
II. SHORT VERSION

1) Activity: Chapter 3, 'Movement Activities' (a-6,7) - Is this activity or body function?

        It is doubtful if Chapter 3 of Activity (A310 - A379) really belong to Activities. Most of them are 'abstract' motion/posture of the body without concrete purpose, as they are presented here. In another word, they are not described as concrete purposeful activities, but only as abstract components that may be parts of a concrete purposeful activity, that are, by definition, Body Functions.
        Therefore they should be either transferred to Body Functions and Structures to occupy the place in or after Movement Functions or given more detailed explanation that give them more concrete purposefulness.
        For example, a320 Activities of changing body position should be accompanied by Inclusions: changing body position from supine to side-lying in bed under bed cover with or without the aid of  a handrail, etc.

2) Participation: Note (p-1) Some examples of 'involvement' are doubtful.

        'Having options for' is listed as one of the meanings of 'involvement'.  However, it is questionable. For example, a person may participate in gainful work without any options, and another person may not participate in it (by his own choice) although he/she has many work-related options. Generally speaking, ' having options for' may refer to the quality of participation but sometimes may mean only opportunity in the environment. Other examples such as 'having access to' and having opportunities for' have the same problem. A clear distinction should be made between actual participation and its mere possibility. At least these three examples should be eliminated.