康复概论-6.ICF在康复医学中的应用课件

1、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 International Classification of Functioning, Disability and Health2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M 23.5功能与残疾的综合模式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

2、参与慢性膝关节不稳M 23.5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M 23.5功能与残疾的综合模式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M 23.5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

3、，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17身体结构和功能障碍活动受限参与限制残疾18身体结构和功能 与参与活动功能改善20ICF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2123b1 b8s1 s8d1 d9e1 e5章ICF 金字塔结构ICF身体功能身体结构活动与参与环境因素个人因素bsde24第一级：身体结构与功能Skin and related structuresStructures related to movementStr

4、uctures related to the genitourinary and reproductive systemsStructures related to the digestive, metabolic and endocrine systemsStructures of the cardiovascular, immunological and respiratory systems声音和言语相关的组织结构The eye, ear and related structuresStructures of the nervous systemFunctions of the skin

5、 and related structuresNeuromusculoskeletal and movement-related functionsGenitourinary and reproductive functionsFunctions of the digestive, metabolic and endocrine systemsFunctions of the cardiovascular, haematological, immunological and respiratory systems声音和言语功能Sensory functions and painMental f

6、unctionsChapter 8Chapter 7Chapter 6Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1身体结构 (s)身体功能 (b)25第一级：活动与参与主要的生活区域人际关系家庭区域个人自理活动交流一般任务与需求学习与应用技术社区、社会和公民活动Chapter 8Chapter 7Chapter 6Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1Chapter 926第一级：环境因素 (e)服务、体系与政策态度支持与关心自然环境和人类对环境的改造产品与技术Chapter 5Chapter 4

7、Chapter 3Chapter 2Chapter 127b1 b8s1 s8d1 d9e1 e5ChaptersICF 第二级结构ICF身体功能身体结构活动与参与环境因素个人因素bsdeb110 b899s110 s899d110 d999e110 e5992nd Level28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 (b

8、140 b189)30b 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d b 37ICF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 Sets39盲人摸象的故事40ICF and ICF Core Sets确定评定条目what to measure应用基础：how to measure41b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d

9、230d360d410 d415d430 e110e115e120e125e135e150 1454ICF 核心组合42b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d230d360d410 d415d430 e110e115e120e125e135e150 1454ICF 核心组合特定疾病特定环境43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

10、张力简要ICF核心组合全套ICF核心组合44 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 身体结构简要ICF核心组合全套ICF核心组合45d450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 活动与参与简要ICF核心组合全套ICF核心组合46e115 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

11、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 环境因素简要ICF核心组合全套ICF核心组合47 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b1141.012348949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

12、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)5051Problem-solving approach52Rehab-CycleAssessmentEvaluationAssignmentIntervention53AssessmentEvaluationAssignmentInterventionRehab-CycleICF ModelICF & ICF Core Sets54Diagnosis (ICD-10)Rehabilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody s

13、tructures & functionsactivities & participationpatient perspectiveWhat are the patients problems and needs from his/her perspective?What are the patients problems from the team perspective?Use the ICF Core Sets!55Diagnosis (ICD-10)Rehabilitaton goalsteam perspectiveenvironmental factorspersonal fact

14、orsbody structures & functionsactivities & participationpatient perspective56Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pa

15、in in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI ha

16、d to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategi

17、es+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 rehabilitationIntervention program goal:Long-term goal: 57Assessment with the ICF SheetPatients perspectiveRehab

18、ilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDi

19、fficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected

20、 because of the painMedication +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 functionsb715 Stability of joint functionsb730 Muscle power functionsb435 Immunological system functionss

21、7302 Structure of hands73011 Wrist joints73021 Joints of hand and fingerss75011 Knee joints7502 Structure of ankle and footd440 Fine hand used445 Hand and arm used430 Lifting and carrying objectsd630 Preparing mealsd640 Doing houseworkd4500 Walking short distancesd4551 ClimbingGoals of rehabilitatio

22、nIntervention program goal:Long-term goal: 58Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPai

23、n in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secreta

24、ryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +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 jointsIm

25、paired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) Degenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and

26、 carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal:Long-term goal: 59REHAB-CycleAssessment in three stepsIdentification of the problems and needs of the patient,Determination of the long-term, intervention program and cycl

27、e goals andIdentification of intervention targets related to the cycle goals.60Assessment with the ICF SheetGoals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining Patients perspectiveRehabilitation team perspectiveBody-Structur

28、es/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems i

29、n brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives i

30、n a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) Degenerative change

31、s in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal:Long-term

32、 goal: 61REHAB-CycleAssessment in three stepsIdentification of the problems and needs of the patient,Determination of the long-term, intervention program and cycle goals .Identification of intervention targets related to the cycle goals.62Assessment with the ICF SheetPatients perspectiveRehabilitati

33、on team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficult

34、ies in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected becaus

35、e of the painMedication +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 jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophal

36、angeal (MCP) Degenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationInt

37、ervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining What is related to (determine) the cycle goals?Determine the intervention targets63Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activitie

38、s/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and c

39、ombing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat;

40、 No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar dri

41、ft rightDegenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationInterven

42、tion program goal: Independence in self-care and housework Long-term goal: Vocational retraining 64Rehab-CycleAssessmentAssignment65Assignment Health ProfessionalsProgram or serviceInpatient or outpatient rehab, home rehabType of specific serviceSingle vs groupFirst intervention, refresher66Assessme

43、nt with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibil

44、itySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate

45、 relationship with my husband is also affected because of the painMedication +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 jointsImpaired joint stabilityImpaired muscle strengthInflamm

46、ation parameters in bloodSubluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift rightDegenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and car

47、rying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 67Assignment Health ProfessionalsProgram or serviceInpatient or outpatient rehab, home rehabType

48、 of specific serviceSingle vs groupFirst intervention, refresherIntervention68AssessmentAssignmentInterventionRehab-Cycle69Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic po

49、lyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProble

50、ms preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Self

51、-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift rightDegenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHou