ICF在脊髓损伤的应用课件

1、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.国际功能、残疾和健康分类-脊髓损伤的核心组合ICF Co功能与残疾的综合模式2.功能与残疾的综合模式2.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4.健康状况健康状况是疾病、疾患、损伤或者外伤的总称4.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

2、慢性膝关节不稳M 23.5功能与残疾的综合模式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身体功能与身体结构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Impairments6.身体功能与身体结构身体功能指身体的生理功能，包括心理功能6.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8.活动与

3、参与活动指个人执行任务或者个人的行动，代表个体功能活动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 (facilitator)消极因素(barrier)10.环境因素人们居住和生活的物理、社会和态度环境10.-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

4、关节不稳M 23.5功能与残疾的综合模式11.-住在4楼，无电梯个人因素相关因素携带物体、弯膝、步行、攀爬个人因素包括性别、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-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 23.5功能与残疾的综合模式13.-住在4楼，无电梯60岁，生性积极相关因素携带物体、弯膝、步身体结构和功能障碍活动受限参与限制残疾14.身体结构和功能障碍活动受限残疾14.身体结构和

5、功能 与参与活动功能改善15.身体结构和功能 与参与活动功能改善15.功能改善16.功能改善16.ICF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17.ICF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118.18.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19.健康状况（疾病、外伤）253项环境因素个人因素相关因素384b1 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bsde20.b1 b8s1 s8d1 d9e1 e5章I第一级：身体结构与功能Skin

6、 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 related structu

7、resStructures 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 and resp

8、iratory 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)21.第一级：身体结构与功能Skin and related s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 3Chapte

9、r 2Chapter 1Chapter 922.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 123.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b1 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 Level24.b1 b8s1 s8d1

10、 d9e1 e5Ch第二级结构 举例章节b1 脑高级功能 Mental function整体脑高级功能 (b110 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)25.第二级结构 举例章节b1 脑高级功能 Mental fICFBody Functions bb1100 b7809b11420 b54509b1 b8b110 b899Body Structuresss1 s8s110 s899s1100

11、 s8309s11000 s76009Activity & Participationdd1 d9d110 d999d1150 d9309Environmental Factorsee1 e5e110 e599e1100 e5959ICF 三级结构The higher the more precise26.ICFBody b1100 b7809b1 b8b1b 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27.b 脑高级功能Mental functionsI

12、CF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？28.ICF总条目：1454有多少在特定的疾病需要？临床和科研发展ICF核心组合 Core Sets.发展ICF核心组合 Core Sets.瞎子摸象的故事30.瞎子摸象的故事30.ICF and ICF Core Sets确定评定条目what to measure应用基础：how to measure31.ICF and ICF Core Sets确定评定条目31.b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d230d360d410 d415d43

13、0 e110e115e120e125e135e150 1454ICF 核心组合32.b1s299d170e11032.b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d230d360d410 d415d430 e110e115e120e125e135e150 1454ICF 核心组合特定疾病特定环境33.b1s299d170e110特定疾病特定环境33.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b76

14、0 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34.骨关节炎OA 身体功能b280 疼痛的感觉 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35. OA 身体结构简要d450步行d540穿衣d445 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36.d450步行OA 活动与参与简要ICF核

15、心组合全套ICe115 与个人日常生活相关的产品与技术e310 近亲e580 医疗服务、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 交通服务、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核心组合37.e115 与个人日常生活相关的产品与技术OA 环境因素 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b1141.012348938. 已经清楚的?是 功能障碍

16、是什么并不清楚的?是b1141.定量分级(qualifier)0没有问题(无、缺乏、可以忽视等) 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)40.定量分级(qualifier)0没有问题(无、缺乏、可以忽环境因素双向分级障碍因素Barrier -促进因素Facilitator + 41.环境因素双向分级障碍因素Barrier -41.42.42.Problem-solving

17、approach43.Problem-solving approach43.Rehab-CycleAssessmentEvaluationAssignmentIntervention44.Rehab-CycleAssessmentEvaluatioAssessmentEvaluationAssignmentInterventionRehab-CycleICF ModelICF & ICF Core Sets45.AssessmentEvaluationAssignmentDiagnosis (ICD-10)Rehabilitaton goalsteam perspectiveenvironme

18、ntal 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!46.Diagnosis (ICD-10)RehabilitatoDiagnosis (ICD-10)Reha

19、bilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody structures & functionsactivities & participationpatient perspective47.Diagnosis (ICD-10)RehabilitatoAssessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/Participat

20、ionPersonal 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 hairD

21、ifficulties 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 elevator

22、 Needs aids for hand use+, 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 rehabilitationIn

23、tervention program goal:Long-term goal: 48.Assessment with the ICF SheetPAssessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain i

24、n 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

25、 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+, Supportive husband+Self-help group+Motivated+adequate coping strategies+b

26、710 Mobility of joint functionsb715 Stability 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 Liftin

27、g and carrying objectsd630 Preparing mealsd640 Doing houseworkd4500 Walking short distancesd4551 ClimbingGoals of rehabilitationIntervention program goal:Long-term goal: 49.Assessment with the ICF SheetPAssessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/F

28、unctions Activities/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 br

29、ushing 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 activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a

30、fourth floor 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, b

31、eginning ulnar 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 reha

32、bilitationIntervention program goal:Long-term goal: 50.Assessment with the ICF SheetPREHAB-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 th

33、e cycle goals.51.REHAB-CycleAssessment in four Assessment with the ICF SheetGoals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining Patients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/Particip

34、ationPersonal 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 hai

35、rDifficulties 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 elevat

36、or 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 rightDe

37、generative 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 progr

38、am goal:Long-term goal: 52.Assessment with the ICF SheetGREHAB-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.53.REHAB-Cycle

39、Assessment in four Assessment 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 fingersShor

40、tened 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 activit

41、ies 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 stabilityImpa

42、ired 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 useHand

43、 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 What is related to (determine) the cycle goals?Determine the interven

44、tion targets54.Assessment with the ICF SheetPAssessment 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 shoulderPai

45、n 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 give up my job as a secreta

46、ryAll 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+Impaired mobility of jointsIm

47、paired 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 swollenHallux valgus positiion, r

48、ightleft Fine hand 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 55.Assessment with the ICF SheetPRehab-Cycl

49、eAssessmentAssignment56.Rehab-CycleAssessmentAssignmenAsignment Health ProfessionalsProgram or serviceInpatient or outpatient rehab, home rehabType of specific serviceSingle vs groupFirst intervention, refresher57.Asignment Health ProfessionAssessment with the ICF SheetPatients perspectiveRehabilita

50、tion team perspectiveBody-Structures/Functions Activities/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 jointsDifficu

51、lties 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 activities are affectedMy intimate relationship with my husband is also affected beca

52、use 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 stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpoph

53、alangeal (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 useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short

54、distancesClimbing stairs Goals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 58.Assessment with the ICF SheetPAsignment Health ProfessionalsProgram or serviceInpatient or outpatient rehab, home rehabType of specific serviceS

55、ingle vs groupFirst intervention, refresherIntervention59.Asignment Health ProfessionAssessmentAssignmentInterventionRehab-Cycle60.AssessmentAssignmentInterventiAssessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal

56、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 hairDifficulties

57、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 elevator Needs aids

58、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 rightDegenerative cha

59、nges 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 program goal: Indep

60、endence in self-care and housework Long-term goal: Vocational retraining 61.Assessment with the ICF SheetPAssessmentEvaluationAssignmentInterventionRehab-Cycle62.AssessmentEvaluationAssignmentAssessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Ac