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(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),26,ICF,BodyFunctionsb,b1100b7809b11420b54509,b1b8,b110b899,BodyStructuress,s1s8,s110s899,s1100s8309s11000s76009,ActivityNoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,Whatarethepatientsproblemsandneedsfromhis/herperspective?,Whatarethepatientsproblemsfromtherehabilitationteamperspective?,UsetheICF-Core-setsasaChecklist!,GoalsofrehabilitationInterventionprogramgoal:Long-termgoal:,49,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:,50,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:Long-termgoal:,51,REHAB-Cycle,Assessmentinfoursteps,Identificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoalsandIdentificationofinterventiontargetsrelatedtothecyclegoals.,52,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)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Long-termgoal:,53,REHAB-Cycle,Assessmentinfoursteps,Identificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoalsandIdentificationofinterventiontargetsrelatedtothecyclegoals.,54,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,Whatisrelatedto(determine)thecyclegoals?,Determinetheinterventiontargets,55,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,56,Rehab-Cycle,Assessment,Assignment,57,Asignment,HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresher,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)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Independenceinself-careandhouseworkLong-termgoal:Vocationalretraining,59,Asignment,HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresher,60,Assessment,Assignment,Intervention,Rehab-Cycle,61,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,62,Assessment,Evaluation,Assignment,Intervention,Rehab-Cycle,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,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心理学家,第一世界第二世界第三世界,白人黑人黄人,2007年11月14-19日，瑞士，Nottwil,68,69,Nottwil，Swiss,70,71,72,73,74,共计35人，分为五组，全体合影,75,76,第二组合影,77,C5损伤，ASIAA，9年，护士，南非,78,T12损伤，ASIAA，10年，治疗师，越南,79,评审会议第一版SCI-ICF核心组合,测试和验证I