Kineret Sharfi


Occupational Therapist (OT., MSc.)

Expertise: Child development and daily functioning with learning disabilities and attention difficulties throughout life.

A seniority of twelve years, including: early identification of at-risk children, evaluation and intervention among children with developmental delays, instruction for parents and educational teams, empowerment of adults with learning disabilities and attention difficulties.

Additional expertise: The ICF model, activity analysis and adaptations, clinical observations, inclusion of pupils with special needs in the general education system.

An Alternative Model for Identification of Strengths and Weaknesses in Body functions, Activity, Participation and Quality of Life Among Adults with Learning Disabilities: Construction of a correlated evaluation set and formation of a theoretical model.


Background: Learning disabilities (LD) is a term which refers to a large group of neurological disorders caused by deficits in the central nervous system which influence the individual's ability to efficiently maintain, process or convey information to others. The prevalence of LD among the general population is estimated between 10-15% however the discussion about the definition of LD is continuing worldwide and consequently, the data regarding the prevalence of LD in the total population has also been argued. In the up to date common definitions of LD the focus is on the deficient academic skills meaning an imperfect ability to listen, think, speak, write, spell, or perform mathematical calculations. Therefore LD are usually diagnosed within educational systems. However, the condition of individuals with LD is complicated since LD co-occur frequently with other health conditions which are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV/5) as Attention Deficit Hyperactivity Disorder (AD/HD), Developmental Coordination Disorder (DCD), and depression and anxiety disorders. These health conditions are known as related with limitations in the performance of daily activities and with decreased Quality of Life (QoL). Even though, only scarce literature relates to health conditions amongst individuals with LD in their adulthood. Literature reveals that the prognosis for daily functioning among adults with LD is varied and moves between personal and occupational fulfillment on one pole and anti-social behaviors, imprison and suicide on the other pole. Even thought, little is known about the daily functioning of the adults who function between those two poles and about their QoL. Due to the complexity of the issue of LD and evidence for limitations in various life domains in addition to the academic area, in this study concepts from the International Classification of Functioning, Disability and Health (ICF) model presented by the World Health Organization (WHO) in 2001 were used to investigate new issues regarding this population.

Aims: (a) to examine differences between adults with LD and a control
group in their body functions, daily activity and participation in various life
domains and QoL; (b) to identify unique associations between body functions of
adults with LD and their relations with the daily activity and participation of
adults with LD in various life domains; (c) to identify body functions of
adults with LD as well as activities and participation domains which might be
related with their QoL; (d) to elucidate a model to describe the relationships
that will be identified and a theoretical explanation based on the ICF model

Methods: The study is a quasi-experimental case-control design study. A
convenience sample of 110 adults from the Southern and Central regions of
Israel participated in the study. Data was collected between March 2011 and
August 2012 after ethical approval was obtained. The researcher met each
participant individually in a quiet location and he/she signed a written
informed consent. Each participant filled a socio-demographic questionnaire
followed by a set of questionnaires. Adults with LD were offered to ask for an
accommodation of having the questions read aloud, and a free professional
advisory hour for their participation.

The final sample size of 110
participants (55 adults with LD and 55 controls) was determined using the G*Power3
(version statistical power analysis program. The inclusion criteria were: 20-50 years of
age, with Hebrew reading and writing at the level of mother tongue, intact
vision and hearing or corrected with an aid, without motor or neurological
disabilities, generally healthy with no chronic diseases or significant
injuries which may influence daily activities and QoL. Participants of the
study group had to present an observation of LD signed by a formal
professional. Controls had to answer "no" to two questions:
"Have anyone ever told you that you may have a LD?" and "Did you
ever think you may have a LD?".

Results: (a) Adults with LD reported decreased body functions, limitations
in activity and participation and decreased QoL comparing to their matched
controls ; (b) Unique associations were revealed between specific body
functions of adults with LD and their daily activity and participation in
various life domains; (c) Body functions of adults with LD and their activity
and participation were related with their QoL; (d) A model will describe the
relationships that were identified and a theoretical explanation based on the
ICF model concepts is being processed.

importance and contribution: The
results of this study will strengthen the need in referring to this population
within a wide health perspective as the suggested ICF model and not only within
educational and psychological frameworks as they are usually treated. Future
research should continue examining the relationships between the various ICF
model components and search for additional variables which might be associated
with the daily activity and participation and QoL of adults with LD. In the
clinical field the findings will strengthen the need in evaluation and in
intervention processes to relate to various aspects of body functions and daily
activity and participation among this population, and to abandon the current
concept that LD are related with daily challenges only in the educational
systems. Understanding the needs of this population in various life domains
need to be considered in order to better befit intervention programs, to
enhance efficacy of intervention and to prevent secondary negative life