ICF在脊髓损伤的应用-励建安.ppt

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,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,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,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,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,残疾,15,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,ICF 金字塔结构,21,第一级：身体结构与功能,身体结构 (s),身体功能 (b),22,第一级：活动与参与,23,第一级：环境因素 (e),24,ICF 第二级结构,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 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),26,ICF,Body Functions b,b1100 b7809 b11420 b54509,b1 b8,b110 b899,Body Structures s,s1 s8,s110 s899,s1100 s8309 s11000 s76009,Activity & Participation d,d1 d9,d110 d999,d1150 d9309,Environmental Factors e,e1 e5,e110 e599,e1100 e5959,ICF 三级结构,27,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,三级,四级,28,ICF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？,发展ICF核心组合 Core Sets,30,瞎子摸象的故事,31,ICF and ICF Core Sets,确定评定条目 what to measure 应用基础： how to measure,32,33,34,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,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,36,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,37,e115 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,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.,0,1,2,3,4,8,9,40,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),41,环境因素双向分级,障碍因素Barrier - 促进因素Facilitator +,42,43,Problem-solving approach,44,Rehab-Cycle,45,Assessment,Evaluation,Assignment,Intervention,Rehab-Cycle,ICF Model ICF & ICF Core Sets,46,Diagnosis (ICD-10),Rehabilitaton goals,team perspective,environmental factors,personal factors,body structures & functions,activities & participation,patient perspective,What are the patients problems and needs from his/her perspective?,What are the patients problems from the team perspective?,Use the ICF Core Sets!,47,Diagnosis (ICD-10),Rehabilitaton goals,team perspective,environmental factors,personal factors,body structures & functions,activities & participation,patient perspective,48,Assessment with the ICF Sheet,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,Medication + Lives in a fourth floor flat; No elevator 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 rehabilitation Intervention program goal: Long-term goal:,49,Assessment with the ICF Sheet,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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,Identification of the problems and needs of the patient, Determination of the long-term, intervention program and cycle goals and 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,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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,Identification of the problems and needs of the patient, Determination of the long-term, intervention program and cycle goals and Identification of intervention targets related to the cycle goals.,54,Assessment with the ICF Sheet,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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,What is related to (determine) the cycle goals?,Determine the intervention targets,55,Assessment with the ICF Sheet,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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,60,Assessment,Assignment,Intervention,Rehab-Cycle,61,Assessment with the ICF Sheet,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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 interventions and intervention management,65,健康相关情况,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 阻塞性肺疾病 抑郁 乳腺癌 脑卒中,66,Volume 36, Supplement 44 / August 2004,ICF CORE SETS FOR CHRONIC CONDITIONS,Journal of Rehabilitat