ICF在脊髓损伤的应用-励建安

励建安(Jiànān)南京医科大学国际功能(gōngnéng)、残疾和健康分类

-脊髓损伤的核心组合

ICFCoreSetsforSCI第一页，共九十一页。精选ppt功能与残疾的综合(zōnghé)模式第二页，共九十一页。2精选ppt环境因素个人(gèrén)因素相关(xiāngguān)因素活动(huódòng)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。3精选ppt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(kěyǐ)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。4精选ppt环境因素个人(gèrén)因素相关(xiāngguān)因素活动(huódòng)身体功能与身体结构参与慢性膝关节不稳

M23.5功能与残疾的综合模式第五页，共九十一页。5精选ppt身体(shēntǐ)功能与身体(shēntǐ)结构身体功能指身体的生理功能，包括心理(xīnlǐ)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。6精选ppt环境因素个人(gèrén)因素相关(xiāngguān)因素活动(huódòng)疼痛、关节稳定性、交叉韧带参与慢性膝关节不稳

M23.5功能与残疾的综合模式第七页，共九十一页。7精选ppt活动(huódòng)与参与活动指个人执行任务或者(huòzhě)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(huódòng)限制参与限制第八页，共九十一页。8精选ppt环境因素个人(gèrén)因素相关(xiāngguān)因素携带物体(wùtǐ)、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

M23.5功能与残疾的综合模式第九页，共九十一页。9精选ppt环境因素人们居住和生活(shēnghuó)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)第十页，共九十一页。10精选ppt-住在4楼，无电梯+使用(shǐyòng)拐杖/康复/药物治疗个人(gèrén)因素相关(xiāngguān)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

M23.5功能与残疾的综合模式第十一页，共九十一页。11精选ppt个人(gèrén)因素包括(bāokuò)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。12精选ppt-住在4楼，无电梯+使用拐杖、康复治疗(zhìliáo)、药物治疗(zhìliáo)60岁，生性(shēngxìng)积极相关(xiāngguān)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

M23.5功能与残疾的综合模式第十三页，共九十一页。13精选ppt身体结构和功能障碍活动受限参与限制残疾(cánjí)第十四页，共九十一页。14精选ppt身体结构和功能与参与活动功能(gōngnéng)改善第十五页，共九十一页。15精选ppt功能(gōngnéng)改善第十六页，共九十一页。16精选pptICF是国际通用的描述功能(gōngnéng)、残疾和健康状况的国际语言和概念第十七页，共九十一页。17精选ppt第十八页，共九十一页。18精选ppt健康状况（疾病(jíbìng)、外伤）253项环境因素个人(gèrén)因素相关(xiāngguān)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。19精选pptb1

–

b8s1

–

s8d1

–

d9e1

–

e5章ICF–

金字塔结构(jiégòu)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。20精选ppt第一级：身体结构(jiégòu)与功能

SkinandrelatedstructuresStructuresrelatedtomovementStructuresrelatedtothegenitourinaryandreproductivesystemsStructuresrelatedtothedigestive,metabolicandendocrinesystemsStructuresofthecardiovascular,immunologicalandrespiratorysystems声音和言语相关的组织结构Theeye,earandrelatedstructuresStructuresofthenervoussystemFunctionsoftheskinandrelatedstructuresNeuromusculoskeletalandmovement-relatedfunctionsGenitourinaryandreproductivefunctionsFunctionsofthedigestive,metabolicandendocrinesystemsFunctionsofthecardiovascular,haematological,immunologicalandrespiratorysystems声音和言语功能SensoryfunctionsandpainMentalfunctionsChapter8Chapter7Chapter6Chapter5Chapter4Chapter3Chapter2Chapter1身体(shēntǐ)结构(s)身体(shēntǐ)功能

(b)第二十一页，共九十一页。21精选ppt第一级：活动(huódòng)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Chapter8Chapter7Chapter6Chapter5Chapter4Chapter3Chapter2Chapter1Chapter9第二十二页，共九十一页。22精选ppt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Chapter5Chapter4Chapter3Chapter2Chapter1第二十三页，共九十一页。23精选pptb1

–

b8s1

–

s8d1

–

d9e1

–

e5ChaptersICF–

第二级结构(jiégòu)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

–

e5992ndLevel第二十四页，共九十一页。24精选ppt第二级结构(jiégòu)

–

举例章节 b1脑高级功能(gōngnéng)

Mentalfunction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Specificmentalfunctions(b140–b189)第二十五页，共九十一页。25精选pptICFBodyFunctionsbb1100

–

b7809b11420

–

b54509b1

–

b8b110

–

b899BodyStructuresss1

–

s8s110

–

s899s1100

–

s8309s11000

–

s76009Activity&Participationdd1

–

d9d110

–

d999d1150

–

d9309EnvironmentalFactorsee1

–

e5e110

–

e599e1100

–

e5959ICF–

三级结构(jiégòu)Thehigherthemoreprecise第二十六页，共九十一页。26精选pptb

脑高级功能Mentalfunctions 一级

b114

定向功能

二级

b1141地点(dìdiǎn)定向

b1142人物定向

b11420自我定向

b11421他人定向ICF条目(tiáomù)举例三级四级第二十七页，共九十一页。27精选pptICF总条目：1454

有多少在特定的疾病需要(xūyào)？

临床和科研有何用途？

评判标准？第二十八页，共九十一页。28精选ppt发展ICF核心(héxīn)组合CoreSets

第二十九页，共九十一页。精选ppt瞎子摸象(xiāzǐmōxiàng)的故事第三十页，共九十一页。30精选pptICFandICFCoreSets确定评定(píngdìng)条目whattomeasure应用基础：howtomeasure第三十一页，共九十一页。31精选pptb1b130b134b152b180b1801

s299s710s720s730s73001s73011

d170d230d360d410d415d430

e110e115e120e125e135e150

1454ICF核心组合第三十二页，共九十一页。32精选pptb1b130b134b152b180b1801

s299s710s720s730s73001s73011

d170d230d360d410d415d430

e110e115e120e125e135e150

1454ICF核心组合特定疾病特定环境第三十三页，共九十一页。33精选ppt骨关节炎OA–

身体(shēntǐ)功能b280 疼痛的感觉 b710 关节活动功能 b730 肌肉功能b770 步态(bùtài)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。34精选ppt

s750 下肢结构(jiégòu)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(shēntǐ)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。35精选pptd450 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(huódòng)d410 改变身体位置OA–

活动(huódòng)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。36精选ppte115

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(jiànzhù)设计、建造和建筑(jiànzhù)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核心组合第三十七页，共九十一页。37精选ppt

定量(dìngliàng)分级Qualifiers

问题(wèntí)的严重程度如何量化已经(yǐjing)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。38精选ppt第三十九页，共九十一页。精选ppt定量(dìngliàng)分级(qualifier)0 没有问题(无、缺乏、可以忽视(hūshì)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。40精选ppt环境因素双向分级(fēnjí)障碍因素Barrier--促进(cùjìn)因素Facilitator++第四十一页，共九十一页。41精选ppt第四十二页，共九十一页。42精选pptProblem-solvingapproach第四十三页，共九十一页。43精选pptRehab-CycleAssessmentEvaluationAssignmentIntervention第四十四页，共九十一页。44精选pptAssessmentEvaluationAssignmentInterventionRehab-CycleICFModelICF&ICFCoreSets第四十五页，共九十一页。45精选pptDiagnosis(ICD-10)Rehabilitatongoalsteamperspectiveenvironmentalfactors personalfactors bodystructures&functionsactivities&participationpatientperspectiveWhatarethepatient'sproblemsandneedsfromhis/herperspective?Whatarethepatient'sproblemsfromtheteamperspective?UsetheICFCoreSets!第四十六页，共九十一页。46精选pptDiagnosis(ICD-10)Rehabilitatongoalsteamperspectiveenvironmentalfactors personalfactors bodystructures&functionsactivities&participationpatientperspective第四十七页，共九十一页。47精选pptAssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+Whatarethepatients'problemsandneedsfromhis/herperspective?Whatarethepatients'problemsfromtherehabilitationteamperspective?UsetheICF-Core-setsasaChecklist!GoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

第四十八页，共九十一页。48精选pptAssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+b710Mobilityofjointfunctionsb715Stabilityofjointfunctionsb730Musclepowerfunctionsb435Immunologicalsystemfunctionss7302Structureofhands73011Wristjoints73021Jointsofhandandfingerss75011Kneejoints7502Structureofankleandfootd440Finehandused445Handandarmused430Liftingandcarryingobjectsd630Preparingmealsd640Doinghouseworkd4500Walkingshortdistancesd4551ClimbingGoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

第四十九页，共九十一页。49精选pptAssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

第五十页，共九十一页。50精选pptREHAB-CycleAssessmentinfourstepsIdentificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoalsandIdentificationofinterventiontargetsrelatedtothecyclegoals.第五十一页，共九十一页。51精选pptAssessmentwiththeICFSheetGoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

Patient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

第五十二页，共九十一页。52精选pptREHAB-CycleAssessmentinfourstepsIdentificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoalsandIdentificationofinterventiontargetsrelatedtothecyclegoals.第五十三页，共九十一页。53精选pptAssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

Whatisrelatedto(determine)thecyclegoals?Determinetheinterventiontargets第五十四页，共九十一页。54精选pptAssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

第五十五页，共九十一页。55精选pptRehab-CycleAssessmentAssignment第五十六页，共九十一页。56精选pptAsignment HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresher第五十七页，共九十一页。57精选pptAssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

第五十八页，共九十一页。58精选pptAsignment HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresherIntervention第五十九页，共九十一页。59精选pptAssessmentAssignmentInterventionRehab-Cycle第六十页，共九十一页。60精选pptAssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

第六十一页，共九十一页。61精选pptAssessmentEvaluationAssignmentInterventionRehab-Cycle第六十二页，共九十一页。62精选pptAssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

第六十三页，共九十一页。63精选pptICFClinicalPractice-RehabCycleICFSheet/ModelReferenceforthedocumentationoffunctioningbasedonhistory,examandanalysisMulti-disciplinarycommunicationandgoalsettingICFCoreSetsGuideformulti-disciplinaryassessmentBasisforinstitutional,professional,nationalorinternationalguidelineshowtomeasurespecificcategoriesGuidefortheassignmentofinterventionsandinterventionmanagement第六十四页，共九十一页。64精选ppt健康(jiànkāng)相关情况慢性全身性疼痛腰痛骨性关节炎骨质疏松类风湿性关节炎慢性缺血性心脏病糖尿病肥胖(féipàng)阻塞性肺疾病抑郁乳腺癌脑卒中第六十五页，共九十一页。65精选pptVolume36,Supplement44/August2004ICFCORESETSFORCHRONICCONDITIONSJournalofRehabilitationMedicine第六十六页，