ICF bridges the gulf between the social and medical models of disability.

I have recently been involved in helping to set up an assessment tool for children with mobility difficulties requiring postural support in their wheelchairs. These children usually have neurological and orthopaedic problems which means they require a lot more than just an ordinary wheelchair.
This has led us to thinking about the models of disability adopted by different health professionals and how this influences their practice. Since the 80s in the UK, there have been two quite opposed approaches, the medical vs. the social model. As a quick summary, the social model says that the person is not disabled but it is their environment that disables them. The medical model is said to want to “cure” the individual and wants them to fit in and adapt to their environment so that the onus rests on the individual. What is emerging from the research in this area is that this divergence in approaches is not helpful to this client group (Crow 1996, Shakespeare and Watson 2002, Shakespeare 2006). The social model does not acknowledge issues which are related to impairment. Although our society must continue to improve access and inclusion, it is indeed very difficult to participate in the activities which matter to you if you are in pain or need surgery (Fauconnier et al 2009).
Liz Crow and Tom Shakespeare, both disabled themselves, have analysed this dichotomy which appears to be unique to Britain, where the social model has been adopted in an extreme manner, and feel it is high time to bring the two aspects together so that all aspects of life can be included in any approach involving people with disabilities.
This has been at the heart of our assessment process, and one of the most useful tool available to us is the WHO International Classification of Functioning, Disability and Health (ICF and ICF-CY for young people). This classification includes all aspects of an individual’s personal circumstances, starting with the body structures and their functions and leading on to the individual’s environment and activities in all spheres of life. It establishes a “common language for understanding and investigating health and health-related states” ( McDonald et al 2004). By doing this it “bridges the ... gulf between the medical and social models of disability” (Shakespeare 2006). By using the ICF-CY, we have been able to draw up an assessment tool (still being developed) which truly takes into consideration all aspects of a child’s life which are relevant to their use of mobility aids; hopefully this gives them access to the product which best helps their physical as well as their social and emotional needs, whilst providing them the best postural support in seating. This also makes use of professional expertise and experience, in order to make available to the user and their families all the necessary information to make an informed choice.


Crow L. (1996) Including all of our lives: renewing the social model of disability in Disability and Illness: exploring the divide, Disability Press
Fauconnier J. Et al. (2009) Participation in life situations of 8-12 year old children with cerebral palsy: cross sectional European study BMJ 338: 1548 (on line)
McDonald, R., Surtees, R. And Wirz, S. (2004) The International Classidfication of Functioning, Disability and Health provides a model for adaptive seating interventions for children with cerebral palsy British Journal of Occupational Therapy 67(7) 293-305
Shakespeare, T. And Watson, N. (2002) The social model of disability: an outdated ideology? Research in Social Science and Disability 2: 9-28
Shakespeare, T. (2006) Disability Rights and Wrongs, Routledge, Oxford
WHO (2007) International classification of Functioning, Disability and Health – Children and Youth Version