The ICF framework and third party disability: application to the spouses of persons with aphasia

The World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) provides a framework for understanding functioning and disability of persons with a health condition. WHO refers to "third party disability" as the study of the life functioning of family members when faced with a health condition of their significant others. The spouses of persons with aphasia (PWAs) have been referred to as the "hidden victims" of aphasia. Traditionally, rehabilitation and societal efforts have been directed solely at the person who has the overt disability. Although it has been long acknowledged that the spouses of PWAs can also have significant difficulties, the focus and resources of therapy are usually not provided to address spouses' problems directly. In addition, PWAs depend on their communicative environments to maintain and develop the skills learned in therapy. The long-term outcomes of aphasia therapy are greatly influenced by being in a facilitative environment. Thus, understanding and providing appropriate intervention and support services for spouses may help not only the spouses but also the PWAs to have positive long-term outcomes. This article examines whether the ICF framework can be used to study third party disability of the spouses of PWAs and how the ICF could be used to develop clinically applicable research in this crucial area.