Recent technological progress has brought about the rapid development of rehabilitation science, which is rooted in the medical model of disability. According to the American Institute of Medicine, rehabilitation combined with biomedical engineering should take advantage of the newest achievements in medical, social, and technical sciences related to their capacity to restore lost biological and body functions as well as their capacity to improve the quality and range of an individual’s interactions with their environment .
The basic model of disability used by rehabilitation science is a functional model which originally comes from the social sciences . In this model, the loss of auditory capacity is understood as a dynamic model composed of four sub-processes: 1) a pathological process occurring on a molecular level in the hair cells, 2) damage manifested as a sensory deficit, 3) functional disability (inability to perform a task, e.g. understanding spoken communication), and 4) difficulties encountered in his/her social life, e.g. difficulties in fulfilling social expectations [5, 6].
2.1. The International Classification of Functioning, Disability and Health (ICF)
Following the newest recommendations of audiological organizations, postsurgical care after CI provision should be based on the functional model of disability developed by the International Classification of Functioning, Disability and Health (ICF) [e.g. 7]. In this model, disability is a comprehensive term involving impairment, activity limitations, and participation restrictions . Impairment is a problem with a body function or structure (e.g. hearing loss); activity limitations are difficulties an individual may have in executing activities or tasks (e.g. cannot hear well enough to understand conversations); and participation restrictions are problems an individual may experience in involvement in everyday situations that would otherwise be accessible (e.g. poor hearing causes someone to stop using a telephone) . Moreover, the ICF defines an individual’s functioning (and their limitations) as an effect of a dynamic interaction between health condition(s) and the environment (i.e. contextual factors) . Relations between components of the ICF are shown in Fig. 1. (Fig. 1 here)
The ICF model of disability identifies five spheres of human functioning :
Body functions and structures – physiological functions of body structures and all anatomical body parts. Any (pathological) changes at this level are called damages / impairments.
Activity – the execution of an action/task/undertaking or beginning some action by an individual. Activity limitations are difficulties that an individual may have in executing such activities.
Participation – involvement in life situations. Participation restrictions are problems an individual may experience in becoming involved in life situations. This can involve environmental contextual factors and/or personal contextual factors.
The ICF includes lists of particular body functions and structures, names of actions and forms of participation, and a list of external (environmental) factors affecting each element of functioning and disability. ‘Personal factors’ are another element of contextual factors but are not classified in the ICF because they could potentially cover the entirety of human social and cultural diversity. The ICF classification describes situations related to an individual’s functioning and its limitations as well as a tool to organize this information. Further, the ICF classification establishes a structure for ordering this information in a logical and easily accessible way.
2.2. ICF core sets for hearing loss
The ICF was developed for use in different disciplines and sectors, especially those related to health care . This classification is increasingly being used as a clinical tool to evaluate health-related needs, to select appropriate management of specific health conditions, and to professionally evaluate and assess rehabilitation and its effects . The level of complexity of the ICF (it has 1424 assessment categories) makes its application to general medicine difficult . Several studies have been performed to facilitate the use of the ICF in caring for people with hearing loss. The results of these studies have led to the creation of core sets for hearing loss, which are lists of particular body functions and structures, forms of activity and participation, and external factors related to hearing impairment . The ICF core sets for hearing loss can be found online .
In this paper, these core sets are used to describe audiological rehabilitation for CI users. The term ‘audiological rehabilitation’ is here defined as a problem-solving exercise aimed at reducing the negative effects of hearing loss by creating conditions conducive to activity and the restoration of full participation in everyday life situations . A priority of audiological intervention is the provision of an appropriate hearing prosthesis to compensate for auditory function lost due to hearing loss . Audiological rehabilitation must, however, also take advantage of other strategies that aim to increase an individual’s scope of activities and participation, e.g. perceptual training, counselling, and education. This understanding of audiological rehabilitation seems to be the most convergent with the functional model of disability developed for the ICF. This paper describes the model of audiological rehabilitation for CI users based on the ICF classification.