康复概论——6ICF在康复医学中的应用

1、 2 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 3 健康状况健康状况 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 8 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 9 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

2、部件 10 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 11 活动与参与活动与参与 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 12 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、 交叉韧带交叉韧带 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

3、式 13 环境因素环境因素 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) 14 - -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 15 个人因素个人因素 包括性别、年龄、人种、体质、生活

4、方式、习惯、社会背景、其它社会功能 16 - -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、 交叉韧带交叉韧带 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 17 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 18 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 19 功能改善

5、20 ICFICF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 factors Personal factors Contextual factors The biopsychosocial model of functioning and disability Activity Body function and body structure ParticipationParticipation 21 22 健康状况（疾病、外伤）健康

6、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 23 章章 24 第一级：身体结构与功能第一级：身体结构与功能 25 第一级：活动与参与第一级：活动与参与 26 第一级：环境因素第一级：环境因素 27 28 第二级结构第二级结构 举例举例 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 (b

7、140 b189) 29 The higher the more preciseThe higher the more precise 30 b 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 条目举例条目举例 三级 四级 d b 37 ICF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？ 发展发展ICF核心组合核心组合 Core Sets 39 盲人摸象的故事盲人摸象的故事 40

8、 ICF 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 measure 41 b1b1 b130b130 b134b134 b152b152 b180b180 b1801b1801 s299s299 s710s710 s720 s720 s730s730 s73001s73001 s73011s73011 d170d170 d230d230 d360d360 d410 d410 d415d415 d430d430 e110e110 e115e115 e120e120 e125e125 e135e135 e150

9、e150 14541454 ICF ICF 核心组合核心组合 42 b1b1 b130b130 b134b134 b152b152 b180b180 b1801b1801 s299s299 s710s710 s720 s720 s730s730 s73001s73001 s73011s73011 d170d170 d230d230 d360d360 d410 d410 d415d415 d430d430 e110e110 e115e115 e120e120 e125e125 e135e135 e150e150 14541454 ICF ICF 核心组合核心组合 43 骨关节炎骨关节炎OA 身体

10、功能身体功能 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 44 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

11、结构 OA 身体结构身体结构 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 45 d450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 46 e115 与个人日常生活相关的产品与个人日常生活相关的产品 与技术与技术

12、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、产品公共场合的建筑设计、产品 和技术和技术 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个人室内和室外活动和交通 的产品与技术的产品与技术 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、建造私人使用的建筑设计、建造 和建筑产品和建筑产品 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 4

13、7 定量分级定量分级Qualifiers 问题的严重程度如何量化 已经清楚的已经清楚的?是是 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 9 49 定量分级定量分级(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) 50-50- 95%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

14、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) 50 51 52 Rehab-Cycle AssessmentAssessment EvaluationEvaluation AssignmentAssignment InterventionIntervention 53 AssessmentAssessment EvaluationEvaluation AssignmentAssignment InterventionIntervention Rehab-Cycle ICF Model ICF No elevator Lives in a fourth floor

15、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

16、 of rehabilitationGoals of rehabilitation Intervention program goal:Intervention program goal: Long-term goal:Long-term goal: 57 Assessment with the Assessment with the ICF SheetICF Sheet PatientPatients s perspectiveperspective Rehabilitation team Rehabilitation team perspectiveperspective Body-Str

17、uctures/Functions Activities/Participation Personal FactorsPersonal Factors Reha-diagnosis ICD-10Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9 Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulder Pain in hands and fingersPain in hands an

18、d fingers Shortened mobility and flexibilityShortened mobility and flexibility Swelling in finger, wrist and knee Swelling in finger, wrist and knee jointsjoints Difficulties in getting dressedDifficulties in getting dressed Problems in brushing teeth and combing Problems in brushing teeth and combi

19、ng hairhair Difficulties in lifting things above the Difficulties in lifting things above the headhead Problems preparing mealsProblems preparing meals Problems doing houseworkProblems doing housework I had to give up my job I had to give up my job as a secretaryas a secretary All my free-time All m

20、y free-time activities are affectedactivities are affected My intimate relationship My intimate relationship with my husband is also with my husband is also affected because of the affected because of the painpain Medication +Medication + Lives in a fourth floor flat; No elevator Lives in a fourth f

21、loor 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 functions b715 Stabili

22、ty of joint functionsb715 Stability of joint functions b730 Muscle power functionsb730 Muscle power functions b435 Immunological system functionsb435 Immunological system functions s7302 Structure of hands7302 Structure of hand s73011 Wrist joints73011 Wrist joint s73021 Joints of hand and fingerss7

23、3021 Joints of hand and fingers s75011 Knee joints75011 Knee joint s7502 Structure of ankle and foots7502 Structure of ankle and foot d440 Fine hand used440 Fine hand use d445 Hand and arm used445 Hand and arm use d430 Lifting and carrying objectsd430 Lifting and carrying objects d630 Preparing meal

24、sd630 Preparing meals d640 Doing houseworkd640 Doing housework d4500 Walking short distancesd4500 Walking short distances d4551 Climbingd4551 Climbing Goals of rehabilitationGoals of rehabilitation Intervention program goal:Intervention program goal: Long-term goal:Long-term goal: 58 Assessment with

25、 the Assessment with the ICF SheetICF Sheet PatientPatients s perspectiveperspective Rehabilitation team Rehabilitation team perspectiveperspective Body-Structures/Functions Activities/Participation Personal FactorsPersonal Factors Reha-diagnosis ICD-10Reha-diagnosis ICD-10 chronic polyarthritis ICD

26、: M05.9 Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulder Pain in hands and fingersPain in hands and fingers Shortened mobility and flexibilityShortened mobility and flexibility Swelling in finger, wrist and knee Swelling in finger, wrist and

27、knee jointsjoints Difficulties in getting dressedDifficulties in getting dressed Problems in brushing teeth and combing Problems in brushing teeth and combing hairhair Difficulties in lifting things above the Difficulties in lifting things above the headhead Problems preparing mealsProblems preparin

28、g meals Problems doing houseworkProblems doing housework I had to give up my job I had to give up my job as a secretaryas a secretary All my free-time All my free-time activities are affectedactivities are affected My intimate relationship My intimate relationship with my husband is also with my hus

29、band is also affected because of the affected because of the painpain Medication +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 grou

30、p+ Motivated+Motivated+ adequate coping strategies+adequate coping strategies+ Impaired mobility of jointsImpaired mobility of joints Impaired joint stabilityImpaired joint stability Impaired muscle strengthImpaired muscle strength Inflammation parameters in bloodInflammation parameters in blood Sub

31、luxation of metacarpophalangeal (MCP) Subluxation of metacarpophalangeal (MCP) D Degenerative changes in fingersegenerative changes in fingers Fingers and wrist joints swollenFingers and wrist joints swollen Right knee swollenRight knee swollen Both ankle joints swollenBoth ankle joints swollen Hall

32、ux valgus positiion, rightleftHallux valgus positiion, rightleft Fine hand useFine hand use Hand and arm useHand and arm use Lifting and carrying objectsLifting and carrying objects Preparing mealsPreparing meals HouseworkHousework Walking short distancesWalking short distances Climbing stairsClimbi

33、ng stairs Goals of rehabilitationGoals of rehabilitation Intervention program goal:Intervention program goal: Long-term goal:Long-term goal: 59 Assessment Assignment Intervention Evaluation REHAB-Cycle Assessment in three steps 1. Identification of the problems and needs of the patient, 2. Determina

34、tion of the long-term, intervention program and cycle goals and 3. Identification of intervention targets related to the cycle goals. 60 Assessment with the Assessment with the ICF SheetICF Sheet Goals of rehabilitationGoals of rehabilitation Intervention program goal:Intervention program goal: Inde

35、pendence in self-care and housework Long-term goal:Long-term goal: Vocational retraining PatientPatients s perspectiveperspective Rehabilitation team Rehabilitation team perspectiveperspective Body-Structures/Functions Activities/Participation Personal FactorsPersonal Factors Reha-diagnosis ICD-10Re

36、ha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9 Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulder Pain in hands and fingersPain in hands and fingers Shortened mobility and flexibilityShortened mobility and flexibility Swelling in finger,

37、wrist and knee Swelling in finger, wrist and knee jointsjoints Difficulties in getting dressedDifficulties in getting dressed Problems in brushing teeth and combing Problems in brushing teeth and combing hairhair Difficulties in lifting things above the Difficulties in lifting things above the headh

38、ead Problems preparing mealsProblems preparing meals Problems doing houseworkProblems doing housework I had to give up my job I had to give up my job as a secretaryas a secretary All my free-time All my free-time activities are affectedactivities are affected My intimate relationship My intimate rel

39、ationship with my husband is also with my husband is also affected because of the affected because of the painpain Medication +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+, Suppo

40、rtive husband+ Self-help group+Self-help group+ Motivated+Motivated+ adequate coping strategies+adequate coping strategies+ Impaired mobility of jointsImpaired mobility of joints Impaired joint stabilityImpaired joint stability Impaired muscle strengthImpaired muscle strength Inflammation parameters

41、 in bloodInflammation parameters in blood Subluxation of metacarpophalangeal (MCP) Subluxation of metacarpophalangeal (MCP) D Degenerative changes in fingersegenerative changes in fingers Fingers and wrist joints swollenFingers and wrist joints swollen Right knee swollenRight knee swollen Both ankle

42、 joints swollenBoth ankle joints swollen Hallux valgus positiion, rightleftHallux valgus positiion, rightleft Fine hand useFine hand use Hand and arm useHand and arm use Lifting and carrying objectsLifting and carrying objects Preparing mealsPreparing meals HouseworkHousework Walking short distances

43、Walking short distances Climbing stairsClimbing stairs Goals of rehabilitation Intervention program goal: Long-term goal: 61 Assessment Assignment Intervention Evaluation REHAB-Cycle Assessment in three steps 1. Identification of the problems and needs of the patient, 2. Determination of the long-te

44、rm, intervention program and cycle goals . 3. Identification of intervention targets related to the cycle goals. 62 Assessment with the Assessment with the ICF SheetICF Sheet PatientPatients s perspectiveperspective Rehabilitation team Rehabilitation team perspectiveperspective Body-Structures/Funct

45、ions Activities/Participation Personal FactorsPersonal Factors Reha-diagnosis ICD-10Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9 Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulder Pain in hands and fingersPain in hands and fingers Sho

46、rtened mobility and flexibilityShortened mobility and flexibility Swelling in finger, wrist and knee Swelling in finger, wrist and knee jointsjoints Difficulties in getting dressedDifficulties in getting dressed Problems in brushing teeth and combing Problems in brushing teeth and combing hairhair D

47、ifficulties in lifting things above the Difficulties in lifting things above the headhead Problems preparing mealsProblems preparing meals Problems doing houseworkProblems doing housework I had to give up my job I had to give up my job as a secretaryas a secretary All my free-time All my free-time a

48、ctivities are affectedactivities are affected My intimate relationship My intimate relationship with my husband is also with my husband is also affected because of the affected because of the painpain Medication +Medication + Lives in a fourth floor flat; No elevator Lives in a fourth floor flat; No

49、 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 joints Impaired joint stabilityImpaired jo

50、int stability Impaired muscle strengthImpaired muscle strength Inflammation parameters in bloodInflammation parameters in blood Subluxation of metacarpophalangeal (MCP) Subluxation of metacarpophalangeal (MCP) D Degenerative changes in fingersegenerative changes in fingers Fingers and wrist joints s

51、wollenFingers and wrist joints swollen Right knee swollenRight knee swollen Both ankle joints swollenBoth ankle joints swollen Hallux valgus positiion, rightleftHallux valgus positiion, rightleft Fine hand useFine hand use Hand and arm useHand and arm use Lifting and carrying objectsLifting and carr

52、ying objects Preparing mealsPreparing meals HouseworkHousework Walking short distancesWalking short distances Climbing stairsClimbing stairs Goals of rehabilitation Intervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 63 Assessment with the Assessm

53、ent with the ICF SheetICF Sheet PatientPatients s perspectiveperspective Rehabilitation team Rehabilitation team perspectiveperspective Body-Structures/Functions Activities/Participation Personal FactorsPersonal Factors Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9 Environmental Factors Env

54、ironmental Factors Pain in right knee and shoulderPain in right knee and shoulder Pain in hands and fingersPain in hands and fingers Shortened mobility and flexibilityShortened mobility and flexibility Swelling in finger, wrist and knee Swelling in finger, wrist and knee jointsjoints Difficulties in

55、 getting dressedDifficulties in getting dressed Problems in brushing teeth and combing Problems in brushing teeth and combing hairhair Difficulties in lifting things above the Difficulties in lifting things above the headhead Problems preparing mealsProblems preparing meals Problems doing houseworkP

56、roblems doing housework I had to give up my job I had to give up my job as a secretaryas a secretary All my free-time All my free-time activities are affectedactivities are affected My intimate relationship My intimate relationship with my husband is also with my husband is also affected because of

57、the affected because of the painpain Medication +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

58、coping strategies+adequate coping strategies+ Impaired mobility of jointsImpaired mobility of joints Impaired joint stabilityImpaired joint stability Impaired muscle strengthImpaired muscle strength Inflammation parameters in bloodInflammation parameters in blood Subluxation of metacarpophalangeal (

59、MCP) Subluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar joints 2 and 3 right, beginning ulnar drift rightdrift right D Degenerative changes in fingersegenerative changes in fingers Fingers and wrist joints swollenFingers and wrist joints swollen Right knee swollenRight kn

60、ee swollen Both ankle joints swollenBoth ankle joints swollen Hallux valgus positiion, rightleftHallux valgus positiion, rightleft Fine hand useFine hand use Hand and arm useHand and arm use Lifting and carrying objectsLifting and carrying objects Preparing mealsPreparing meals HouseworkHousework Wa