21134002 |Disability (finding)| and 40226000 |Impairment (finding)| (Old Jira)

SNOMED Groups Translation User Group
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Content copied from previous Jira ticket, submitted by @cdanielsen (DK)

We are having trouble translating concepts about Disability correctly. In Danish we have concepts describing
• MEANING A: impaired bodily functions both physical and mental (in Danish: funktionsnedsættelse)
• MEANING B: impaired ability to perform bodily functions including taking part in activities (in Danish: funktionsevnenedsættelse - evne = able)

SNOMED CT has the siblings 21134002 |Disability (finding)| and 40226000 |Impairment (finding)|.
• Does the ‘ability’ in the word ‘disability’ in the concept 21134002 |Disability (finding)| mean that it holds the meaning “impaired ability to perform bodily functions including taking part in activities” and
• Does 40226000 |Impairment (finding)| then hold the meaning “impaired bodily functions both physical and mental“?

21134002 |Disability (finding)|has 26 direct children and most are modeled
• Interprets: General clinical state (observable entity)
• Has interpretation: Impaired (qualifier value)
• Finding site: xxx (body structure)
This leads me to expect that it holds the meaning of Impairment “impaired bodily functions both physical and mental” (MEANING A above). I think this is stressed by the attribute/value pair Has interpretation: Impaired (qualifier value).

But a few children are modeled in a different way for instance 228160005 |Hand function disability (finding)|
Interprets: General clinical state (observable entity)
Has interpretation: Impaired (qualifier value)
Interprets: Ability to perform hand functions (observable entity)
This leads me to expect that it has the meaning “impaired ability to perform bodily functions including taking part in activities” which fits the meaning of Disability (MEANING B above). However, this concept is also defined by the attribute/value pair Has interpretation: Impaired (qualifier value).

40226000 |Impairment (finding)| has only one direct child 116150007 |Impairment class (finding)|.
• Should most of the ancestors of Disability be children of Imparement instead?
• And should there perhaps be children of Disability modeled with Interprets: Ability to xxx (observable entity)?

We can see that some other countries have translation issues with these two concepts as well and that the Dutch translation has a definition added to Disability which supports the idea that the meaning of the concept has to do with the “ability to..” namely, “Difficulties that someone has in performing certain activities due to a disorder.”

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The schema Monica presented (in the old Jira ticket), based on ICF, seems like a good starting point.

The question is also whether the modelling should represent this schema. We had a look at two of the children of 364972005 |Finding related to ability to perform hand functions (finding)|:

A 228149001 |Impairment of hand function (finding)|
Interprets > 284180008 |Ability to perform hand functions (observable entity)|

B 228160005 |Hand function disability (finding)|
Interprets > 278844005 |General clinical state (observable entity)|
Has interpretation > 260379002 |Impaired (qualifier value)|
Interprets > 284180008 |Ability to perform hand functions (observable entity)|

Should these be rearranged so that 228149001 |Impairment of hand function (finding)| would be a descendant of 40226000 |Impairment (finding)|and modelled with Has interpretation > 260379002 |Impaired (qualifier value)| ?

We are unsure if this is an “outlier” or there are more examples of this.

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We cannot make a 1-1-mapping from disability and impairment to the Swedish terms funktionsnedsättning and funktionshinder either, so the issue is relevant for us as well. The reference to ICF is relevant as impaired activities is specified with ICF codes in Sweden. I will check to see if we have good examples of concepts where we are struggling.

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In looking at WHO definitions, we have:

Impairment (The Biological Fact) - WHO Definition: Any loss or abnormality of psychological, physiological, or anatomical structure or function. In Swedish

Disability (The Social Result) - WHO Definition: The umbrella term for the interaction between a person’s impairment and the barriers in their environment (attitudinal or physical).

So, all disabilities result from impairments, but often the environmental barrier is not stated, but implied. How to refine the modeling of concepts to reflect this requires some additional investiagtion to avoid semantic equivalence errors.