康复概论——6.ICF在康复医学中的应用

.,牛燕媚（讲师）天津医科大学康复与运动医学系,国际功能、残疾和健康分类InternationalClassificationofFunctioning,DisabilityandHealth,.,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,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,.,.,.,.,.,8,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,.,9,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,.,10,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,.,11,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,.,12,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,.,13,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),.,14,-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,.,15,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,.,16,-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,.,17,残疾,.,18,功能改善,.,19,功能改善,.,20,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,.,21,.,22,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,.,23,ICF金字塔结构,.,24,第一级：身体结构与功能,身体结构(s),身体功能(b),.,25,第一级：活动与参与,.,26,第一级：环境因素(e),.,27,ICF第二级结构,.,28,第二级结构举例,章节b1脑高级功能Mentalfunction整体脑高级功能(b110b139)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(b140b189),.,29,ICF,BodyFunctionsb,b1100b7809b11420b54509,b1b8,b110b899,BodyStructuress,s1s8,s110s899,s1100s8309s11000s76009,ActivityNoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,Whatarethepatientsproblemsandneedsfromhis/herperspective?,Whatarethepatientsproblemsfromtherehabilitationteamperspective?,UsetheICF-Core-setsasaChecklist!,GoalsofrehabilitationInterventionprogramgoal:Long-termgoal:,.,57,AssessmentwiththeICFSheet,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,b710Mobilityofjointfunctionsb715Stabilityofjointfunctionsb730Musclepowerfunctionsb435Immunologicalsystemfunctionss7302Structureofhands73011Wristjoints73021Jointsofhandandfingerss75011Kneejoints7502Structureofankleandfoot,d440Finehandused445Handandarmused430Liftingandcarryingobjectsd630Preparingmealsd640Doinghouseworkd4500Walkingshortdistancesd4551Climbing,GoalsofrehabilitationInterventionprogramgoal:Long-termgoal:,.,58,AssessmentwiththeICFSheet,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)DegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Long-termgoal:,.,59,REHAB-Cycle,Assessmentinthreesteps,Identificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoalsandIdentificationofinterventiontargetsrelatedtothecyclegoals.,.,60,AssessmentwiththeICFSheet,GoalsofrehabilitationInterventionprogramgoal:Independenceinself-careandhouseworkLong-termgoal:Vocationalretraining,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)DegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Long-termgoal:,.,61,REHAB-Cycle,Assessmentinthreesteps,Identificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoals.Identificationofinterventiontargetsrelatedtothecyclegoals.,.,62,AssessmentwiththeICFSheet,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)DegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Independenceinself-careandhouseworkLong-termgoal:Vocationalretraining,Whatisrelatedto(determine)thecyclegoals?,Determinetheinterventiontargets,.,63,AssessmentwiththeICFSheet,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Independenceinself-careandhouseworkLong-termgoal:Vocationalretraining,.,64,Rehab-Cycle,Assessment,Assignment,.,65,Assignment,HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresher,.,66,AssessmentwiththeICFSheet,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Independenceinself-careandhouseworkLong-termgoal:Vocationalretraining,.,67,Assignment,HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresher,.,68,Assessment,Assignment,Intervention,Rehab-Cycle,.,69,AssessmentwiththeICFSheet,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Independenceinself-careandhouseworkLong-termgoal:Vocationalretraining,.,70,Assessment,Evaluation,Assignment,Intervention,Rehab-Cycle,.,71,AssessmentwiththeICFSheet,Pati