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in combination with the empirical tests of the model, should provide the information necessary to direct effective interventions.


As IOM begins the process of reconsidering its seminal works Disability in America and Enabling America, published nearly 15 and 10 years ago, respectively, clear advances have occurred in the conceptualization of disability, but more work is needed in clarifying concepts. WHO’s ICF has incorporated a major concept advocated by Enabling America—environmental factors—and ICF, as the currently accepted international model, should be the starting point for advocating future conceptual revisions. Seven steps have been outlined to improve the ICF conceptualization, including the differentiation of activities and participation, the addition of quality of life to the model, elaboration of the impact of environmental factors, the development of personal factors, refinement of the graphic depiction of the model, definition of research strategies to better measure the domains of the model, and validation of the model by testing the interrelationships among its concepts and deriving interventions to improve the lives of people with disabilities.


1. World Health Organization. International Classification of Impairments, Disabilities and Handicaps: a Manual of Classification Relating to the Consequences of Disease. Geneva, Switzerland: World Health Organization; 1980.

2. World Health Organization. International Classification of Functioning, Disability, and Health. Geneva, Switzerland: World Health Organization; 2001.

3. The Americans with Disabilities Act. P.L. 101-336. 1990.

4. National Institute on Disability and Rehabilitation Research. National Institute on Disability and Rehabilitation Research (NIDRR) Long Range Plan for Fiscal Years 1999-2003. Web Page. Available at Last accessed October 18, 2005.

5. Institute of Medicine. Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Washington, DC: National Academy Press; 1997.

6. Whiteneck GG, Charlifue SW, Gerhart KA, Overholser JD, Richardson GN. Quantifying handicap: a new measure of long-term rehabilitation outcomes. Archives of Physical Medicine and Rehabilitation 1992; 73:519–526.

7. Whiteneck G, Brooks C, Charlifue S, et al. Guide for Use of CHART: Craig Hospital Assessment and Reporting Technique. Englewood, CO: Craig Hospital; 1992.

8. Willer B, Rosenthal M, Kreutzer J, Gordan W, Rempel R. Assessment of community integration following rehabilitation for traumatic brain injury. Journal of Head Trauma and Rehabilitation 1993; 8:75–87.

9. Craig Hospital Research Department; Craig Hospital Inventory of Environmental Factors (CHIEF) Manual, Version 3.0. Englewood, CO: Craig Hospital; 2001.

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