ICF在脊髓损伤的应用-励建安.ppt

2功能与残疾的综合模式功能与残疾的综合模式3环境因素环境因素个人因素个人因素相关因素相关因素活动活动身体功能身体功能与身体结与身体结构构健康状况健康状况( (疾病、外伤疾病、外伤) )功能与残疾的综合模式4健康状况 健康状况是疾病、疾患、损伤或者外伤的总称 健康状况可以包括其他情况，例如老龄、应激、先天畸形以及遗传因素等 健康状况使用ICD-10作为标准编码5环境因素环境因素个人因素个人因素相关因素相关因素活动活动身体功能与身体功能与身体结构身体结构慢性膝关节不稳M 23.5功能与残疾的综合模式6 身体功能指身体的生理功能，包括心理功能 身体结构指身体的解剖结构，例如器官、肢体和相关部件 相当于障碍Impairments7环境因素环境因素个人因素个人因素相关因素相关因素活动活动疼痛、关节疼痛、关节稳定性、交稳定性、交叉韧带叉韧带慢性膝关节不稳M 23.5功能与残疾的综合模式8活动与参与 活动指个人执行任务或者个人的行动，代表个体功能 参与指参加生活环境的活动，代表社会功能 活动限制 参与限制9环境因素环境因素个人因素个人因素相关因素相关因素携带物体、弯膝携带物体、弯膝、步行、攀爬、步行、攀爬疼痛、关疼痛、关节稳定性节稳定性、交叉韧、交叉韧带带照顾孙子、家务照顾孙子、家务、协助丈夫工作、协助丈夫工作慢性膝关节不稳M 23.5功能与残疾的综合模式10环境因素 人们居住和生活的物理、社会和态度环境 环境因素是个人之外的因素 积极因素积极因素 (facilitator) 消极因素消极因素(barrier)11- -住在住在4 4楼，无电梯楼，无电梯+ +使用拐杖使用拐杖/ /康复康复/ /药物治疗药物治疗个人因素个人因素相关因素相关因素携带物体、弯膝携带物体、弯膝、步行、攀爬、步行、攀爬疼痛、关节疼痛、关节稳定性、交稳定性、交叉韧带叉韧带照顾孙子、家务照顾孙子、家务、协助丈夫工作、协助丈夫工作慢性膝关节不稳M 23.5功能与残疾的综合模式12个人因素 包括性别、年龄、人种、体质、生活方式、习惯、社会背景、其它社会功能13- -住在住在4 4楼，无电梯楼，无电梯+ +使用拐杖、康复治疗、药物使用拐杖、康复治疗、药物治疗治疗6060岁，生性积极岁，生性积极相关因素相关因素携带物体、弯膝携带物体、弯膝、步行、攀爬、步行、攀爬疼痛、关疼痛、关节稳定性节稳定性、交叉韧、交叉韧带带照顾孙子、家务照顾孙子、家务、协助丈夫工作、协助丈夫工作慢性膝关节不稳M 23.5功能与残疾的综合模式14身体结构和功能障碍身体结构和功能障碍活动受限活动受限参与限制参与限制残疾15身体结构和功能身体结构和功能 与参与与参与活动活动功能改善16功能改善17ICFICF是国际通用的描述功能、残疾和健是国际通用的描述功能、残疾和健康状况的国际语言和概念康状况的国际语言和概念Health condition(disease, trauma)Environmental factorsPersonal factorsContextual factorsThe biopsychosocial model of functioning and disabilityActivityBody functionand body structureParticipationParticipation1819健康状况（疾病、外伤）健康状况（疾病、外伤）253253项环境因项环境因素素个人因素个人因素相关因素相关因素384384项活动与参与项活动与参与493493项身体结构项身体结构310310项身体功能项身体功能20章章21第一级：身体结构与功能22第一级：活动与参与23第一级：环境因素2425第二级结构 举例章节章节 b1 脑高级功能脑高级功能 Mental function整体脑高级功能整体脑高级功能 (b110 b139)特定的脑高级功能特定的脑高级功能Specific mental functions (b140 b189)26The higher the more preciseThe higher the more precise27b 脑高级功能Mental functions一级 b114 定向功能 二级 b1141 地点定向 b1142 人物定向 b11420自我定向b11421他人定向ICF 条目举例三级四级28ICF总条目：总条目：1454有多少在特定的疾病需要？有多少在特定的疾病需要？临床和科研有何用途？临床和科研有何用途？评判标准？评判标准？发展ICF核心组合 Core Sets30瞎子摸象的故事31ICF and ICF Core Sets 确定评定条目确定评定条目 what to measure 应用基础：应用基础： how to measure32b1b1b130b130b134b134b152b152b180b180b1801b1801 s299s299s710s710s720 s720 s730s730s73001s73001s73011s73011 d170d170d230d230d360d360d410 d410 d415d415d430d430 e110e110e115e115e120e120e125e125e135e135e150e150 14541454ICF ICF 核心组合核心组合33b1b1b130b130b134b134b152b152b180b180b1801b1801 s299s299s710s710s720 s720 s730s730s73001s73001s73011s73011 d170d170d230d230d360d360d410 d410 d415d415d430d430 e110e110e115e115e120e120e125e125e135e135e150e150 14541454ICF ICF 核心组合核心组合34骨关节炎OA 身体功能b280 疼痛的感觉疼痛的感觉b710 关节活动功能关节活动功能b730 肌肉功能肌肉功能b770 步态步态b715 关节稳定性关节稳定性b740 肌肉耐力肌肉耐力b780 与肌肉相关的感觉和运动功能与肌肉相关的感觉和运动功能b760 自主运动的控制自主运动的控制b134 睡眠功能睡眠功能b735 肌肉张力肌肉张力简要简要ICFICF核心组合核心组合全套全套ICFICF核心组核心组合合35 s750下肢结构下肢结构s730上肢结构上肢结构s770其它与运动相关的其它与运动相关的 肌肉骨骼结构肌肉骨骼结构s740骨盆结构骨盆结构s720肩部结构肩部结构OA 身体结构简要简要ICFICF核心组合核心组合全套全套ICFICF核心组核心组合合36d450 步行步行d540 穿衣穿衣d445 手和手臂使用手和手臂使用d510 自我洗浴自我洗浴d470 使用交通工具使用交通工具d530 如厕如厕d430 抬举和携带物品抬举和携带物品d640 做家务做家务d910 社区生活社区生活d440 手精细活动手精细活动d410 改变身体位置改变身体位置OA 活动与参与简要简要ICFICF核心组合核心组合全套全套ICFICF核心组核心组合合37e115 与个人日常生活相关的产品与技术与个人日常生活相关的产品与技术e310 近亲近亲e580 医疗服务、体系和政策医疗服务、体系和政策e150 公共场合的建筑设计、产品和技术公共场合的建筑设计、产品和技术e355 医务人员医务人员e540 交通服务、体系和政策交通服务、体系和政策e120 个人室内和室外活动和交通的产品与个人室内和室外活动和交通的产品与技术技术e135 就业相关的产品与技术就业相关的产品与技术e155 私人使用的建筑设计、建造和建筑产私人使用的建筑设计、建造和建筑产品品e340 个人护理人员和助手个人护理人员和助手OA 环境因素简要简要ICFICF核心核心组合组合全套全套ICFICF核心组合核心组合38 定量分级定量分级Qualifiers 问题的严重程度如何量化已经清楚的?是 功能障碍是什么功能障碍是什么并不清楚的?是b1141. 0 1 2 3 4 8 940定量分级(qualifier)0 0 没有问题没有问题(无、缺乏、可以忽视等) 0-4%0-4% 1 1 轻度问题轻度问题(轻、低等) 5-24%5-24% 2 2 中度问题中度问题(中等、较好等) 25-49%25-49% 3 3 严重问题严重问题(高、极端等) 50-95%50-95% 4 4 全部问题全部问题(最严重、全部受累等)96-100%96-100% 8 8无法特定无法特定 (当前的信息无法确定严重程度)9 9 无法应用无法应用 (不恰当或者不可能使用)41环境因素双向分级 障碍因素Barrier - 促进因素Facilitator + 424344Rehab-CycleAssessmentAssessmentEvaluationEvaluationAssignmentAssignmentInterventionIntervention45AssessmentAssessmentEvaluationEvaluationAssignmentAssignmentInterventionInterventionRehab-CycleICF ModelICF & ICF Core Sets46Diagnosis (ICD-10) Rehabilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody structures & functionsactivities & participationpatient perspectiveUse the ICF Core Sets!Use the ICF Core Sets!47Diagnosis (ICD-10) Rehabilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody structures & functionsactivities & participationpatient perspective48Assessment with the Assessment with the ICF SheetICF SheetPatientPatients s perspectiveperspectiveRehabilitation team Rehabilitation team perspectiveperspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsPersonal FactorsReha-diagnosis ICD-10Reha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulderPain in hands and fingersPain in hands and fingersShortened mobility and flexibilityShortened mobility and flexibilitySwelling in finger, wrist and knee Swelling in finger, wrist and knee jointsjointsDifficulties in getting dressedDifficulties in getting dressedProblems in brushing teeth and combing Problems in brushing teeth and combing hairhairDifficulties in lifting things above the Difficulties in lifting things above the headheadProblems preparing mealsProblems preparing mealsProblems doing houseworkProblems doing houseworkI had to give up my job I had to give up my job as a secretaryas a secretaryAll my free-time All my free-time activities are affectedactivities are affectedMy intimate relationship My intimate relationship with my husband is also with my husband is also affected because of the affected because of the painpainMedication +Medication +Lives in a fourth floor flat; No elevator Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Needs aids for hand use+, Supportive husband+Self-help group+Self-help group+Motivated+Motivated+adequate coping strategies+adequate coping strategies+Use the ICF-Core-sets as a Use the ICF-Core-sets as a Checklist !Checklist !Goals of rehabilitationGoals of rehabilitationIntervention program goal:Intervention program goal:Long-term goal:Long-term goal: 49Assessment with the Assessment with the ICF SheetICF SheetPatientPatients s perspectiveperspectiveRehabilitation team Rehabilitation team perspectiveperspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsPersonal FactorsReha-diagnosis ICD-10Reha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulderPain in hands and fingersPain in hands and fingersShortened mobility and flexibilityShortened mobility and flexibilitySwelling in finger, wrist and knee Swelling in finger, wrist and knee jointsjointsDifficulties in getting dressedDifficulties in getting dressedProblems in brushing teeth and combing Problems in brushing teeth and combing hairhairDifficulties in lifting things above the Difficulties in lifting things above the headheadProblems preparing mealsProblems preparing mealsProblems doing houseworkProblems doing houseworkI had to give up my job I had to give up my job as a secretaryas a secretaryAll my free-time All my free-time activities are affectedactivities are affectedMy intimate relationship My intimate relationship with my husband is also with my husband is also affected because of the affected because of the painpainMedication +Medication +Lives in a fourth floor flat; No elevator Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Needs aids for hand use+, Supportive husband+Self-help group+Self-help group+Motivated+Motivated+adequate coping strategies+adequate coping strategies+b710 Mobility of joint functionsb710 Mobility of joint functionsb715 Stability of joint functionsb715 Stability of joint functionsb730 Muscle power functionsb730 Muscle power functionsb435 Immunological system functionsb435 Immunological system functionss7302 Structure of hands7302 Structure of hands73011 Wrist joints73011 Wrist joints73021 Joints of hand and fingerss73021 Joints of hand and fingerss75011 Knee joints75011 Knee joints7502 Structure of ankle and foots7502 Structure of ankle and footd440 Fine hand used440 Fine hand used445 Hand and arm used445 Hand and arm used430 Lifting and carrying objectsd430 Lifting and carrying objectsd630 Preparing mealsd630 Preparing mealsd640 Doing houseworkd640 Doing houseworkd4500 Walking short distancesd4500 Walking short distancesd4551 Climbingd4551 ClimbingGoals of rehabilitationGoals of rehabilitationIntervention program goal:Intervention program goal:Long-term goal:Long-term goal: 50Assessment with the Assessment with the ICF SheetICF SheetPatientPatients s perspectiveperspectiveRehabilitation team Rehabilitation team perspectiveperspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsPersonal FactorsReha-diagnosis ICD-10Reha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulderPain in hands and fingersPain in hands and fingersShortened mobility and flexibilityShortened mobility and flexibilitySwelling in finger, wrist and knee Swelling in finger, wrist and knee jointsjointsDifficulties in getting dressedDifficulties in getting dressedProblems in brushing teeth and combing Problems in brushing teeth and combing hairhairDifficulties in lifting things above the Difficulties in lifting things above the headheadProblems preparing mealsProblems preparing mealsProblems doing houseworkProblems doing houseworkI had to give up my job I had to give up my job as a secretaryas a secretaryAll my free-time All my free-time activities are affectedactivities are affectedMy intimate relationship My intimate relationship with my husband is also with my husband is also affected because of the affected because of the painpainMedication +Medication +Lives in a fourth floor flat; No elevator Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Needs aids for hand use+, Supportive husband+Self-help group+Self-help group+Motivated+Motivated+adequate coping strategies+adequate coping strategies+Impaired mobility of jointsImpaired mobility of jointsImpaired joint stabilityImpaired joint stabilityImpaired muscle strengthImpaired muscle strengthInflammation parameters in bloodInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) Subluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar joints 2 and 3 right, beginning ulnar drift rightdrift rightD Degenerative changes in fingersegenerative changes in fingersFingers and wrist joints swollenFingers and wrist joints swollenRight knee swollenRight knee swollenBoth ankle joints swollenBoth ankle joints swollenHallux valgus positiion, rightleftHallux valgus positiion, rightleft Fine hand useFine hand useHand and arm useHand and arm useLifting and carrying objectsLifting and carrying objectsPreparing mealsPreparing mealsHouseworkHouseworkWalking short distancesWalking short distancesClimbing stairsClimbing stairs Goals of rehabilitationGoals of rehabilitationIntervention program goal:Intervention program goal:Long-term goal:Long-term goal: 51AssessmentAssignmentInterventionEvaluationREHAB-CycleAssessment in four stepsIdentification of the problems and needs of the patient,Determination of the long-term, intervention program and cycle goals andIdentification of intervention targets related to the cycle goals.52Assessment with the Assessment with the ICF SheetICF SheetGoals of rehabilitationGoals of rehabilitationIntervention program goal:Intervention program goal: Independence in self-care and housework Long-term goal:Long-term goal: Vocational retraining PatientPatients s perspectiveperspectiveRehabilitation team Rehabilitation team perspectiveperspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsPersonal FactorsReha-diagnosis ICD-10Reha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulderPain in hands and fingersPain in hands and fingersShortened mobility and flexibilityShortened mobility and flexibilitySwelling in finger, wrist and knee Swelling in finger, wrist and knee jointsjointsDifficulties in getting dressedDifficulties in getting dressedProblems in brushing teeth and combing Problems in brushing teeth and combing hairhairDifficulties in lifting things above the Difficulties in lifting things above the headheadProblems preparing mealsProblems preparing mealsProblems doing houseworkProblems doing houseworkI had to give up my job I had to give up my job as a secretaryas a secretaryAll my free-time All my free-time activities are affectedactivities are affectedMy intimate relationship My intimate relationship with my husband is also with my husband is also affected because of the affected because of the painpainMedication +Medication +Lives in a fourth floor flat; No elevator Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Needs aids for hand use+, Supportive husband+Self-help group+Self-help group+Motivated+Motivated+adequate coping strategies+adequate coping strategies+Impaired mobility of jointsImpaired mobility of jointsImpaired joint stabilityImpaired joint stabilityImpaired muscle strengthImpaired muscle strengthInflammation parameters in bloodInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) Subluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar joints 2 and 3 right, beginning ulnar drift rightdrift rightD Degenerative changes in fingersegenerative changes in fingersFingers and wrist joints swollenFingers and wrist joints swollenRight knee swollenRight knee swollenBoth ankle joints swollenBoth ankle joints swollenHallux valgus positiion, rightleftHallux valgus positiion, rightleft Fine hand useFine hand useHand and arm useHand and arm useLifting and carrying objectsLifting and carrying objectsPreparing mealsPreparing mealsHouseworkHouseworkWalking short distancesWalking short distancesClimbing stairsClimbing stairs Goals of rehabilitationIntervention program goal:Long-term goal: 53AssessmentAssignmentInterventionEvaluationREHAB-CycleAssessment in four stepsIdentification of the problems and needs of the patient,Determination of the long-term, intervention program and cycle goals andIdentification of intervention targets related to the cycle goals.54Assessment with the Assessment with the ICF SheetICF SheetPatientPatients s perspectiveperspectiveRehabilitation team Rehabilitation team perspectiveperspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsPersonal FactorsReha-diagnosis ICD-10Reha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulderPain in hands and fingersPain in hands and fingersShortened mobility and flexibilityShortened mobility and flexibility