ICF在脊髓损伤的应用ppt课件

国际功能、残疾和健康分类国际功能、残疾和健康分类 -脊髓损伤的核心组合脊髓损伤的核心组合 ICF Core Sets for SCI 1 2 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 参与参与 健康状况 (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 个人因素 相关因素 活动身体功能与身体结构 参与参与 慢性膝关节不稳 M 23.5 功能与残疾的综合模式 6 身体功能与身体结构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 Impairments 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 参与参与 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 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 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 (facilitator) 消极因素 (barrier) 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 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 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 14 身体结构和功能障碍 活动受限 参与限制 残疾 15 身体结构和功能 与参与活动 功能改善 16 功能改善 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 18 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 20 b1 b8 s1 s8 d1 d9 e1 e5 章 ICF 金字塔结构金字塔结构 ICF 身体功能身体功能 身体结构身体结构 活动与参与活动与参与 环境因素环境因素 个人因素个人因素 b s d e 21 第一级：身体结构与功能 Skin and related structures Structures related to movement Structures related to the genitourinary and reproductive systems Structures related to the digestive, metabolic and endocrine systems Structures of the cardiovascular, immunological and respiratory systems 声音和言语相关的组织结构声音和言语相关的组织结构 The eye, ear and related structures Structures of the nervous system Functions of the skin and related structures Neuromusculoskeletal and movement -related functions Genitourinary and reproductive functions Functions of the digestive, metabolic and endocrine systems Functions of the cardiovascular, haematological, immunological and respiratory systems 声音和言语功能声音和言语功能 Sensory functions and pain Mental functions Chapter 8 Chapter 7 Chapter 6 Chapter 5 Chapter 4 Chapter 3 Chapter 2 Chapter 1 身体结构身体结构 (s)身体功能身体功能 (b) 22 第一级：活动与参与 主要的生活区域主要的生活区域 人际关系人际关系 家庭区域家庭区域 个人自理个人自理 活动活动 交流交流 一般任务与需求一般任务与需求 学习与应用技术学习与应用技术 社区、社会和公民活动社区、社会和公民活动 Chapter 8 Chapter 7 Chapter 6 Chapter 5 Chapter 4 Chapter 3 Chapter 2 Chapter 1 Chapter 9 23 第一级：环境因素 (e) 服务、体系与政策服务、体系与政策 态度态度 支持与关系支持与关系 自然环境和人类对环境的改造自然环境和人类对环境的改造 产品与技术产品与技术 Chapter 5 Chapter 4 Chapter 3 Chapter 2 Chapter 1 24 b1 b8 s1 s8 d1 d9 e1 e5 Chapters ICF 第二级结构第二级结构 ICF 身体功能身体功能 身体结构身体结构 活动与参与活动与参与 环境因素环境因素 个人因素个人因素 b s d e b110 b899 s110 s899 d110 d999 e110 e599 2nd Level 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 (b110 b139) b110 意识意识 b114 定向定向 b117 智力智力 b122 整体心理功能整体心理功能 b126 个性个性 b130 主观能动性主观能动性 b134 睡眠睡眠 b139 非特指的整体心理功能非特指的整体心理功能 特定的脑高级功能 Specific mental functions (b140 b189) 26 ICF Body Functions b b1100 b7809 b11420 b54509 b1 b8 b110 b899 Body Structure s s s1 s8 s110 s899 s1100 s8309 s11000 s76009 Activity No elevator Needs aids for hand use+, Supportive husband+ Self-help group+ Motivated+ adequate coping strategies+ Use the ICF-Core-sets as a Checklist ! Goals of rehabilitation Intervention program goal: Long-term goal: 49 Assessment with the ICF Sheet Patient s perspective Rehabilitation team perspective Body-Structures/Functions Activities/Participation Personal Factors Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9 Environmental Factors Pain in right knee and shoulder Pain in hands and fingers Shortened mobility and flexibility Swelling in finger, wrist and knee joints Difficulties in getting dressed Problems in brushing teeth and combing hair Difficulties in lifting things above the head Problems preparing meals Problems doing housework I had to give up my job as a secretary All my free-time activities are affected My intimate relationship with my husband is also affected because of the pain Medication + 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 functions b715 Stability of joint functions b730 Muscle power functions b435 Immunological system functions s7302 Structure of hand s73011 Wrist joint s73021 Joints of hand and fingers s75011 Knee joint s7502 Structure of ankle and foot d440 Fine hand use d445 Hand and arm use d430 Lifting and carrying objects d630 Preparing meals d640 Doing housework d4500 Walking short distances d4551 Climbing Goals of rehabilitation Intervention program goal: Long-term goal: 50 Assessment with the ICF Sheet Patient s perspective Rehabilitation team perspective Body-Structures/Functions Activities/Participation Personal Factors Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9 Environmental Factors Pain in right knee and shoulder Pain in hands and fingers Shortened mobility and flexibility Swelling in finger, wrist and knee joints Difficulties in getting dressed Problems in brushing teeth and combing hair Difficulties in lifting things above the head Problems preparing meals Problems doing housework I had to give up my job as a secretary All my free-time activities are affected My intimate relationship with my husband is also affected because of the pain Medication + 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 joints Impaired joint stability Impaired muscle strength Inflammation parameters in blood Subluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift right Degenerative changes in fingers Fingers and wrist joints swollen Right knee swollen Both ankle joints swollen Hallux valgus positiion, rightleft Fine hand use Hand and arm use Lifting and carrying objects Preparing meals Housework Walking short distances Climbing stairs Goals of rehabilitation Intervention program goal: Long-term goal: 51 REHAB-Cycle Assessment in four steps 1. Identification of the problems and needs of the patient, 2. Determination of the long-term, intervention program and cycle goals and 3. Identification of intervention targets related to the cycle goals. 52 Assessment with the ICF Sheet Goals of rehabilitation Intervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining Patient s perspective Rehabilitation team perspective Body-Structures/Functions Activities/Participation Personal Factors Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9 Environmental Factors Pain in right knee and shoulder Pain in hands and fingers Shortened mobility and flexibility Swelling in finger, wrist and knee joints Difficulties in getting dressed Problems in brushing teeth and combing hair Difficulties in lifting things above the head Problems preparing meals Problems doing housework I had to give up my job as a secretary All my free-time activities are affected My intimate relationship with my husband is also affected because of the pain Medication + 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 joints Impaired joint stability Impaired muscle strength Inflammation parameters in blood Subluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift right Degenerative changes in fingers Fingers and wrist joints swollen Right knee swollen Both ankle joints swollen Hallux valgus positiion, rightleft Fine hand use Hand and arm use Lifting and carrying objects Preparing meals Housework Walking short distances Climbing stairs Goals of rehabilitation Intervention program goal: Long-term goal: 53 REHAB-Cycle Assessment in four steps 1. Identification of the problems and needs of the patient, 2. Determination of the long-term, intervention program and cycle goals and 3. Identification of intervention targets related to the cycle goals. 54 Assessment with the ICF Sheet Patient s perspective Rehabilitation team perspective Body-Structures/Functions Activities/Participation Personal Factors Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9 Environmental Factors Pain in right knee and shoulder Pain in hands and fingers Shortened mobility and flexibility Swelling in finger, wrist and knee joints Difficulties in getting dressed Problems in brushing teeth and combing hair Difficulties in lifting things above the head Problems preparing meals Problems doing housework I had to give up my job as a secretary All my free-time activities are affected My intimate relationship with my husband is also affected because of the pain Medication + 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 joints Impaired joint stability Impaired muscle strength Inflammation parameters in blood Subluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift right Degenerative changes in fingers Fingers and wrist joints swollen Right knee swollen Both ankle joints swollen Hallux valgus positiion, rightleft Fine hand use Hand and arm use Lifting and carrying objects Preparing meals Housework Walking short distances Climbing stairs Goals of rehabilitation Intervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 55 Assessment with the ICF Sheet Patient s perspective Rehabilitation team perspective Body-Structures/Functions Activities/Participation Personal Factors Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9 Environmental Factors Pain in right knee and shoulder Pain in hands and fingers Shortened mobility and flexibility Swelling in finger, wrist and knee joints Difficulties in getting dressed Problems in brushing teeth and combing hair Difficulties in lifting things above the head Problems preparing meals Problems doing housework I had to give up my job as a secretary All my free-time activities are affected My intimate relationship with my husband is also affected because of the pain Medication + 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 joints Impaired joint stability Impaired muscle strength Inflammation parameters in blood Subluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift right Degenerative changes in fingers Fingers and wrist joints swollen Right knee swollen Both ankle joints swollen Hallux valgus positiion, rightleft Fine hand use Hand and arm use Lifting and carrying objects Preparing meals Housework Walking short distances Climbing stairs Goals of rehabilitation Intervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 56 Rehab-Cycle Assessment Assignment 57 Asignment Health Professionals Program or service Inpatient or outpatient rehab, home rehab Type of specific service Single vs group First intervention, refresher 58 Assessment with the ICF Sheet Patient s perspective Rehabilitation team perspective Body-Structures/Functions Activities/Participation Personal Factors Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9 Environmental Factors Pain in right knee and shoulder Pain in hands and fingers Shortened mobility and flexibility Swelling in finger, wrist and knee joints Difficulties in getting dressed Problems in brushing teeth and combing hair Difficulties in lifting things above the head Problems preparing meals Problems doing housework I had to give up my job as a secretary All my free-time activities are affected My intimate relationship with my husband is also affected because of the pain Medication + 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 joints Impaired joint stability Impaired muscle strength Inflammation parameters in blood Subluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift right Degenerative changes in fingers Fingers and wrist joints swollen Right knee swollen Both ankle joints swollen Hallux valgus positiion, rightleft Fine hand use Hand and arm use Lifting and carrying objects Preparing meals Housework Walking short distances Climbing stairs Goals of rehabilitation Intervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 59 Asignment Health Professionals Program or service Inpatient or outpatient rehab, home rehab Type of specific service Single vs group First intervention, refresher Intervention 60 Assessment Assignment Intervention Rehab-Cycle 61 Assessment with the ICF Sheet Patient s perspective Rehabilitation team perspective Body-Structures/Functions Activities/Participation Personal Factors Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9 Environmental Factors Pain in right knee and shoulder Pain in hands and fingers Shortened mobility and flexibility Swelling in finger, wrist and knee joints Difficulties in getting dressed Problems in brushing teeth and combing hair Difficulties in lifting things above the head Problems preparing meals Problems doing housework I had to give up my job as a secretary All my free-time activities are affected My intimate relationship with my husband is also affected because of the pain Medication + 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 joints Impaired joint stability Impaired muscle strength Inflammation parameters in blood Subluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift right Degenerative changes in fingers Fingers and wrist joints swollen Right knee swollen Both ankle joints swollen Hallux valgus positiion, rightleft Fine hand use Hand and arm use Lifting and carrying objects Preparing meals Housework Walking short distances Climbing stairs Goals of rehabilitation Intervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 62 Assessment Evaluation Assignment Intervention Rehab-Cycle 63 Assessment with the ICF Sheet Patient s perspective Rehabilitation team perspective Body-Structures/Functions Activities/Participation Personal Factors Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9 Environmental Factors Pain in right knee and shoulder Pain in hands and fingers Shortened mobility and flexibility Swelling in finger, wrist and knee joints Difficulties in getting dressed Problems in brushing teeth and combing hair Difficulties in lifting things above the head Problems preparing meals Problems doing housework I had to give up my job as a secretary All my free-time activities are affected My intimate relationship with my husband is also affected because of the pain Medication + 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 joints Impaired joint stability Impaired muscle strength Inflammation parameters in blood Subluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift right Degenerative changes in fingers Fingers and wrist joints swollen Right knee swollen Both ankle joints swollen Hallux valgus positiion, rightleft Fine hand use Hand and arm use Lifting and carrying objects Preparing meals Housework Walking short distances Climbing stairs Goals of rehabilitation Intervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 64 ICF Clinical Practice - RehabCycle ICF Sheet / Model Reference for the documentation of functioning based on history, exam and analysis Multi-disciplinary communication and goal setting ICF Core Sets Guide for multi-disciplinary assessment Basis for institutional, professional, national or international guidelines how to measure specific categories Guide for the assignment of i