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ICFCoreSetsforSCI 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M23 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M23 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M23 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M23 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M23 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 26 ICF BodyFunctionsb b1100 b7809b11420 b54509 b1 b8 b110 b899 BodyStructuress s1 s8 s110 s899 s1100 s8309s11000 s76009 Activity Participationd d1 d9 d110 d999 d1150 d9309 EnvironmentalFactorse e1 e5 e110 e599 e1100 e5959 ICF 三级结构 27 b脑高级功能Mentalfunctions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CoreSets 30 瞎子摸象的故事 31 ICFandICFCoreSets 确定评定条目whattomeasure应用基础 howtomeasure 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 solvingapproach 44 Rehab Cycle 45 Assessment Evaluation Assignment Intervention Rehab Cycle ICFModelICF ICFCoreSets 46 Diagnosis ICD 10 Rehabilitatongoals teamperspective environmentalfactors personalfactors bodystructures functions activities participation patientperspective Whatarethepatient sproblemsandneedsfromhis herperspective Whatarethepatient sproblemsfromtheteamperspective UsetheICFCoreSets 47 Diagnosis ICD 10 Rehabilitatongoals teamperspective environmentalfactors personalfactors bodystructures functions activities participation patientperspective 48 AssessmentwiththeICFSheet Patient sperspective Rehabilitationteamperspective Body Structures FunctionsActivities Participation PersonalFactors Reha diagnosisICD 10chronicpolyarthritis ICD M05 9 EnvironmentalFactors Medication Livesinafourthfloorflat Noelevator Needsaidsforhanduse Supportivehusband Self helpgroup Motivated adequatecopingstrategies Whatarethepatients problemsandneedsfromhis herperspective Whatarethepatients problemsfromtherehabilitationteamperspective UsetheICF Core setsasaChecklist GoalsofrehabilitationInterventionprogramgoal Long termgoal 49 AssessmentwiththeICFSheet Patient sperspective Rehabilitationteamperspective Body Structures FunctionsActivities Participation PersonalFactors Reha diagnosisICD 10chronicpolyarthritis ICD M05 9 EnvironmentalFactors Medication Livesinafourthfloorflat Noelevator Needsaidsforhanduse Supportivehusband Self helpgroup Motivated adequatecopingstrategies b710Mobilityofjointfunctionsb715Stabilityofjointfunctionsb730Musclepowerfunctionsb435Immunologicalsystemfunctionss7302Structureofhands73011Wristjoints73021Jointsofhandandfingerss75011Kneejoints7502Structureofankleandfoot d440Finehandused445Handandarmused430Liftingandcarryingobjectsd630Preparingmealsd640Doinghouseworkd4500Walkingshortdistancesd4551Climbing GoalsofrehabilitationInterventionprogramgoal Long termgoal 50 AssessmentwiththeICFSheet Patient sperspective Rehabilitationteamperspective Body Structures FunctionsActivities Participation PersonalFactors Reha diagnosisICD 10chronicpolyarthritis ICD M05 9 EnvironmentalFactors Medication Livesinafourthfloorflat Noelevator Needsaidsforhanduse Supportivehusband Self helpgroup Motivated adequatecopingstrategies ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal MCP joints2and3right beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion right left FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs GoalsofrehabilitationInterventionprogramgoal Long termgoal 51 REHAB Cycle Assessmentinfoursteps Identificationoftheproblemsandneedsofthepatient Determinationofthelong term interventionprogramandcyclegoalsandIdentificationofinterventiontargetsrelatedtothecyclegoals 52 AssessmentwiththeICFSheet GoalsofrehabilitationInterventionprogramgoal Independenceinself careandhouseworkLong termgoal Vocationalretraining Patient sperspective Rehabilitationteamperspective Body Structures FunctionsActivities Participation PersonalFactors Reha diagnosisICD 10chronicpolyarthritis ICD M05 9 EnvironmentalFactors Medication Livesinafourthfloorflat Noelevator Needsaidsforhanduse Supportivehusband Self helpgroup Motivated adequatecopingstrategies ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal MCP joints2and3right beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion right left FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs GoalsofrehabilitationInterventionprogramgoal Long termgoal 53 REHAB Cycle Assessmentinfoursteps Identificationoftheproblemsandneedsofthepatient Determinationofthelong term interventionprogramandcyclegoalsandIdentificationofinterventiontargetsrelatedtothecyclegoals 54 AssessmentwiththeICFSheet Patient sperspective Rehabilitationteamperspective Body Structures FunctionsActivities Participation PersonalFactors Reha diagnosisICD 10chronicpolyarthritis ICD M05 9 EnvironmentalFactors Medication Livesinafourthfloorflat Noelevator Needsaidsforhanduse Supportivehusband Self helpgroup Motivated adequatecopingstrategies ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal MCP joints2and3right beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion right left FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs GoalsofrehabilitationInterventionprogramgoal Independenceinself careandhouseworkLong termgoal Vocationalretraining Whatisrelatedto determine thecyclegoals Determinetheinterventiontargets 55 AssessmentwiththeICFSheet Patient sperspective Rehabilitationteamperspective Body Structures FunctionsActivities Participation PersonalFactors Reha diagnosisICD 10chronicpolyarthritis ICD M05 9 EnvironmentalFactors Medication Livesinafourthfloorflat Noelevator Needsaidsforhanduse Supportivehusband Self helpgroup Motivated adequatecopingstrategies ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal MCP joints2and3right beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion right left FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs GoalsofrehabilitationInterventionprogramgoal Independenceinself careandhouseworkLong termgoal Vocationalretraining 56 Rehab Cycle Assessment Assignment 57 Asignment HealthProfessionalsProgramorserviceInpatientoroutpatientrehab homerehabTypeofspecificserviceSinglevsgroupFirstintervention refresher 58 AssessmentwiththeICFSheet Patient sperspective Rehabilitationteamperspective Body Structures FunctionsActivities Participation PersonalFactors Reha diagnosisICD 10chronicpolyarthritis ICD M05 9 EnvironmentalFactors Medication Livesinafourthfloorflat Noelevator Needsaidsforhanduse Supportivehusband Self helpgroup Motivated adequatecopingstrategies ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal MCP joints2and3right beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion right left FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs GoalsofrehabilitationInterventionprogramgoal Independenceinself careandhouseworkLong termgoal Vocationalretraining 59 Asignment HealthProfessionalsProgramorserviceInpatientoroutpatientrehab homerehabTypeofspecificserviceSinglevsgroupFirstintervention refresher 60 Assessment Assignment Intervention Rehab Cycle 61 AssessmentwiththeICFSheet Patient sperspective Rehabilitationteamperspective Body Structures FunctionsActivities Participation PersonalFactors Reha diagnosisICD 10chronicpolyarthritis ICD M05 9 EnvironmentalFactors Medication Livesinafourthfloorflat Noelevator Needsaidsforhanduse Supportivehusband Self helpgroup Motivated adequatecopingstrategies ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal MCP joints2and3right beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion right left FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs GoalsofrehabilitationInterventionprogramgoal Independenceinself careandhouseworkLong termgoal Vocationalretraining 62 Assessment Evaluation Assignment Intervention Rehab Cycle 63 AssessmentwiththeICFSheet Patient sperspective Rehabilitationteamperspective Body Structures FunctionsActivities Participation PersonalFactors Reha diagnosisICD 10chronicpolyarthritis ICD M05 9 EnvironmentalFactors Medication Livesinafourthfloorflat Noelevator Needsaidsforhanduse Supportivehusband Self helpgroup Motivated adequatecopingstrategies ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal MCP joints2and3right beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion right left FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs GoalsofrehabilitationInterventionprogramgoal Independenceinself careandhouseworkLong termgoal Vocationalretraining 64 ICFClinicalPractice RehabCycle ICFSheet ModelReferenceforthedocumentationoffunctioningbasedonhistory examandanalysisMulti disciplinarycommunicationandgoalsettingICFCoreSetsGuideformulti disciplinaryassessmentBasisforinstitutional professional nationalorinternationalguidelineshowtomeasurespecificcategoriesGuidefortheassignmentofinterventionsandinterventionmanagement 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 Volume36 Supplement44 August2004 ICFCORESETSFORCHRONICCONDITIONS JournalofRehabilitationMedicine 67 SCI ICFConcensusConference 医生护士PTOTSW