ICF在脊髓损伤的应用-励建安

1、励建安南京医科大学国际功能、残疾和健康分类-脊髓损伤的核心组合ICF Core Sets for SCI第一页，共九十一页。2功能与残疾的综合模式第二页，共九十一页。3环境因素个人因素相关因素活动身体功能与身体结构参与健康状况(疾病、外伤)功能与残疾的综合模式第三页，共九十一页。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作为标准编码第四页，共九十一页。5环境因素个人因素相关因素活动身体功能与身体结构参与慢性膝关节不稳M 23.5功能与残疾的综合模式第五页，共九十一页。6身体功能与身体结构身体功能指身

2、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Impairments第六页，共九十一页。7环境因素个人因素相关因素活动疼痛、关节稳定性、交叉韧带参与慢性膝关节不稳M 23.5功能与残疾的综合模式第七页，共九十一页。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第八页，共九十一页。9环境因素个人因素相关因素携带物体、弯膝、步行、攀爬疼痛、关节稳定性、交叉韧带照顾孙子、家务、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第九页，共九十一页。10环境因素人们居住和生活的物理、社会和态

3、度环境环境因素是个人之外的因素积极因素 (facilitator)消极因素(barrier)第十页，共九十一页。11-住在4楼，无电梯+使用拐杖/康复/药物治疗个人因素相关因素携带物体、弯膝、步行、攀爬疼痛、关节稳定性、交叉韧带照顾孙子、家务、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第十一页，共九十一页。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、其它社会功能第十二页，共九十一页。13-住在4楼，无电梯+使用拐杖、康复治疗、药物治疗60岁，生性积极相关因素携带物体、弯膝、步行、攀爬疼痛、关节稳定性、交叉韧带照顾孙子、家务、协助丈夫工作慢性膝关节不稳M 2

4、3.5功能与残疾的综合模式第十三页，共九十一页。14身体结构和功能障碍活动受限参与限制残疾第十四页，共九十一页。15身体结构和功能 与参与活动功能改善第十五页，共九十一页。16功能改善第十六页，共九十一页。17ICF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第十七页，共九十一页。18第十八页，共九十一页。19健康状况疾病、外伤253项环境因素个人因素相关因素384项活动与参与493项身体结构310项身体功能第十九页，共九十一页。20b1 b8s1 s8d1 d9e1 e5章ICF 金字塔结构ICF身体功能身体结构活动与参与环境因素个人因素bsde第二十页，共九十一页。21第一级：身体

5、结构与功能Skin and related structuresStructures related to movementStructures related to the genitourinary and reproductive systemsStructures related to the digestive, metabolic and endocrine systemsStructures of the cardiovascular, immunological and respiratory systems声音和言语相关的组织结构The eye, ear and relate

6、d structuresStructures of the nervous systemFunctions of the skin and related structuresNeuromusculoskeletal and movement-related functionsGenitourinary and reproductive functionsFunctions of the digestive, metabolic and endocrine systemsFunctions of the cardiovascular, haematological, immunological

7、 and respiratory systems声音和言语功能Sensory functions and painMental functionsChapter 8Chapter 7Chapter 6Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1身体结构 (s)身体功能 (b)第二十一页，共九十一页。22第一级：活动与参与主要的生活区域人际关系家庭区域个人自理活动交流一般任务与需求学习与应用技术社区、社会和公民活动Chapter 8Chapter 7Chapter 6Chapter 5Chapter 4Chapter 3Chapter 2Chapte

8、r 1Chapter 9第二十二页，共九十一页。23第一级：环境因素 (e)服务、体系与政策态度支持与关系自然环境和人类对环境的改造产品与技术Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1第二十三页，共九十一页。24b1 b8s1 s8d1 d9e1 e5ChaptersICF 第二级结构ICF身体功能身体结构活动与参与环境因素个人因素bsdeb110 b899s110 s899d110 d999e110 e5992nd Level第二十四页，共九十一页。25第二级结构 举例章节b1 脑高级功能 Mental function整体脑高级功能 (b11

9、0 b139)b110意识b114 定向b117 智力b122 整体心理功能b126 个性b130 主观能动性b134 睡眠b139 非特指的整体心理功能特定的脑高级功能Specific mental functions (b140 b189)第二十五页，共九十一页。26ICFBody Functions bb1100 b7809b11420 b54509b1 b8b110 b899Body Structuresss1 s8s110 s899s1100 s8309s11000 s76009Activity & Participationdd1 d9d110 d999d1150 d9309Env

10、ironmental Factorsee1 e5e110 e599e1100 e5959ICF 三级结构The higher the more precise第二十六页，共九十一页。27b 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 条目举例三级四级第二十七页，共九十一页。28ICF总条目：1454有多少在特定的疾病需要？临床和科研有何用途？评判标准？第二十八页，共九十一页。开展ICF核心组合 Core Sets第二十九页，共九十一页。30瞎子摸象的故事第三十页，共九十一页

11、。31ICF and ICF Core Sets确定评定条目what to measure应用根底：how to measure第三十一页，共九十一页。32b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d230d360d410 d415d430 e110e115e120e125e135e150 1454ICF 核心组合第三十二页，共九十一页。33b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d230d360d410 d415d430 e110e115e12

12、0e125e135e150 1454ICF 核心组合特定疾病特定环境第三十三页，共九十一页。34骨关节炎OA 身体功能b280 疼痛的感觉b710 关节活动功能b730 肌肉功能b770 步态b715 关节稳定性b740 肌肉耐力b780 与肌肉相关的感觉和运动功能b760 自主运动的控制b134 睡眠功能b735 肌肉张力简要ICF核心组合全套ICF核心组合第三十四页，共九十一页。35 s750下肢结构s730上肢结构s770其它与运动相关的 肌肉骨骼结构s740骨盆结构s720肩部结构OA 身体结构简要ICF核心组合全套ICF核心组合第三十五页，共九十一页。36d450步行d540穿衣d4

13、45 手和手臂使用d510自我洗浴d470使用交通工具d530如厕d430抬举和携带物品d640做家务d910社区生活d440手精细活动d410改变身体位置OA 活动与参与简要ICF核心组合全套ICF核心组合第三十六页，共九十一页。37e115 与个人日常生活相关的产品与技术e310 近亲e580 医疗效劳、体系和政策e150 公共场合的建筑设计、产品和技术e355 医务人员e540 交通效劳、体系和政策e120 个人室内和室外活动和交通的产品与技术e135 就业相关的产品与技术e155 私人使用的建筑设计、建造和建筑产品e340 个人护理人员和助手OA 环境因素简要ICF核心组合全套ICF核

14、心组合第三十七页，共九十一页。38 定量分级Qualifiers 问题的严重程度如何量化已经清楚的?是 功能障碍是什么并不清楚的?是b1141.0123489第三十八页，共九十一页。第三十九页，共九十一页。40定量分级(qualifier)0没有问题(无、缺乏、可以无视等) 0-4% 1 轻度问题(轻、低等) 5-24% 2 中度问题(中等、较好等) 25-49% 3 严重问题(高、极端等) 50-95% 4 全部问题(最严重、全部受累等)96-100% 8无法特定 (当前的信息无法确定严重程度)9无法应用 (不恰当或者不可能使用)第四十页，共九十一页。41环境因素双向分级障碍因素Barrie

15、r -促进因素Facilitator + 第四十一页，共九十一页。42第四十二页，共九十一页。43Problem-solving approach第四十三页，共九十一页。44Rehab-CycleAssessmentEvaluationAssignmentIntervention第四十四页，共九十一页。45AssessmentEvaluationAssignmentInterventionRehab-CycleICF ModelICF & ICF Core Sets第四十五页，共九十一页。46Diagnosis (ICD-10)Rehabilitaton goalsteam perspecti

16、veenvironmental factorspersonal factorsbody structures & functionsactivities & participationpatient perspectiveWhat are the patients problems and needs from his/her perspective?What are the patients problems from the team perspective?Use the ICF Core Sets!第四十六页，共九十一页。47Diagnosis (ICD-10)Rehabilitato

17、n goalsteam perspectiveenvironmental factorspersonal factorsbody structures & functionsactivities & participationpatient perspective第四十七页，共九十一页。48Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-dia

18、gnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting thin

19、gs above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+,

20、Supportive husband+Self-help group+Motivated+adequate coping strategies+What are the patients problems and needs from his/her perspective?What are the patients problems from the rehabilitation team perspective?Use the ICF-Core-sets as a Checklist !Goals of rehabilitationIntervention program goal:Lon

21、g-term goal: 第四十八页，共九十一页。49Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fin

22、gersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time

23、 activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+b710 Mobility of joint functionsb715 Stability

24、of joint functionsb730 Muscle power functionsb435 Immunological system functionss7302 Structure of hands73011 Wrist joints73021 Joints of hand and fingerss75011 Knee joints7502 Structure of ankle and footd440 Fine hand used445 Hand and arm used430 Lifting and carrying objectsd630 Preparing mealsd640

25、 Doing houseworkd4500 Walking short distancesd4551 ClimbingGoals of rehabilitationIntervention program goal:Long-term goal: 第四十九页，共九十一页。50Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis I

26、CD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above

27、 the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supporti

28、ve husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift rightDegenerative changes in fingersFingers

29、and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal:Long-term goal: 第五十页，共九十一页。51

30、REHAB-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.第五十一页，共九十一页。52Assessment with the ICF SheetGoals of rehabilitationInter

31、vention program goal: Independence in self-care and housework Long-term goal: Vocational retraining Patients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in

32、right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to g

33、ive up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Imp

34、aired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift rightDegenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollen

35、Hallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal:Long-term goal: 第五十二页，共九十一页。53REHAB-CycleAssessment in four stepsIdentification of the problems

36、and needs of the patient,Determination of the long-term, intervention program and cycle goals andIdentification of intervention targets related to the cycle goals.第五十三页，共九十一页。54Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/Partic

37、ipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing h

38、airDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elev

39、ator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift right

40、Degenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention pro

41、gram goal: Independence in self-care and housework Long-term goal: Vocational retraining What is related to (determine) the cycle goals?Determine the intervention targets第五十四页，共九十一页。55Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities

42、/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and co

43、mbing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat;

44、No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drif

45、t rightDegenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervent

46、ion program goal: Independence in self-care and housework Long-term goal: Vocational retraining 第五十五页，共九十一页。56Rehab-CycleAssessmentAssignment第五十六页，共九十一页。57Asignment Health ProfessionalsProgram or serviceInpatient or outpatient rehab, home rehabType of specific serviceSingle vs groupFirst interventio

47、n, refresher第五十七页，共九十一页。58Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fing

48、ersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time

49、activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabil

50、ityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift rightDegenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand

51、useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 第五十八页，共九十一页。59Asignment Health ProfessionalsProgram or service

52、Inpatient or outpatient rehab, home rehabType of specific serviceSingle vs groupFirst intervention, refresherIntervention第五十九页，共九十一页。60AssessmentAssignmentInterventionRehab-Cycle第六十页，共九十一页。61Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Act

53、ivities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth

54、 and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor

55、 flat; No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning uln

56、ar drift rightDegenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIn

57、tervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 第六十一页，共九十一页。62AssessmentEvaluationAssignmentInterventionRehab-Cycle第六十二页，共九十一页。63Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities

58、/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and co

59、mbing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat;

60、No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drif