残疾学基础概论.ppt

1、概论残疾学基础,康复医学概论,案例,May have caused paralysis of legs (Body Function) Affects ability to walk or climb stairs (Activity) Impedes ability to attend school or find employment within the current environment (Participation) BUT.,残疾的定义,残疾（disability）：是指因外伤、疾病、发育缺陷或精神因素造成明显的身心功能障碍，以致不同程度地丧失正常生活、工作和学习能力的一种状态

2、。 广义的残疾包括病损、残障在内，成为人体身心功能障碍的总称。,残疾人（people with disability，disabled person）：是指心理、生理、人体结构上，某种组织、功能丧失或者不正常，使得部分或全部失去以正常方式从事个人或社会生活能力的人。 1975年在联合国大会上通过的“关于残疾者权利的宣言”对“残疾人”的定义已作了明确的规定：“不论是先天或后天原因，身体或精神不健全而完全或部分地不能保证通常的个人生活或社会生活需要的人” 。,近年来残疾的趋势,残疾的变化与社会人口分布的变化有关，残疾具有高龄化的趋势； 中枢神经系统伤病引起的功能障碍日益增多，尤其是脑血管意外和儿童

3、脑性瘫痪有重度化的倾向； 多重障碍者有增多的趋势，其中以肢体功能障碍合并精神障碍者为多。,致残原因,疾病 营养不良 遗传 意外事故 物理、化学因素 社会、心理因素,国际残疾分类 国际残损、残疾和残障分类ICIDH 国际功能、残疾和健康分类ICF,我国的残疾分类 视力残疾 听力残疾 言语残疾 智力残疾 精神残疾 肢体残疾,常用的残疾分级,与残疾有关的术语,功能与功能障碍 功能是指组织、器官、肢体的特征性活动。本应具有的功能不能正常发挥时称为功能障碍 能力与能力减弱或丧失 能力是指个体的行为能力。能力减退称为能力减弱，能力丧失称为无能力 以上所造成的社会环境后果 行动、独立自主、就业、经济自给和社

4、会生活,残疾的分类（ICIDH，1980）,残损（impairment ） 功能与功能障碍器官水平 残疾（disability） 能力与能力减弱或丧失个体水平 残障（handicap） 文化、社会、经济和环境形成不良后果社会水平,国际残损、残疾和残障分类 ICIDH概念模式图,不仅注重残疾，而且注重残疾的转归、结果。 以残疾为出发点，从不同的层次来剖析残疾状况及其结果，是国际疾病分类（ICD）的一个进步。,国际功能、残疾和健康分类,2001年5月第54届世界卫生大会上正式签署并定名了“国际功能、残疾和健康分类” （International Classification of Function

5、ing, Disability and Health，英文缩写ICF）,中文简称为国际功能分类。,International Classification ofFunctioning, Disabilityand Health ICF Approved by the World Health Assembly in May 2001,ICF概念模式图,ICF建立在一种残疾性的社会模式基础上，从残疾人融入社会的角度出发，将残疾性作为一种社会性问题，并强调社会集体行动，要求改善环境以使残疾人充分参与社会生活的各个方面。,国际新旧残疾分类比较Internationalclassification,I

6、CIDH Impairment （残损） Disability （残疾） Handicap （残障）,ICF Functioning Body function Body structure （身体功能或结构损伤） Activities limitations （活动受限） Participation restrictions （参与受限）,ICF的特点,广泛性： 平等性： 准确定义： 类目使用中性词语： 结构与功能分离： 用活动替代残疾：,16,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

7、准编码,17,健康状况(疾病、外伤),疾病的生物医学模式,诊断-功能-ICD10,ICD - 10: M 23.5 Tear of articular cartilage of knee,Health condition(disease, trauma),Environmental factors,Personal factors,Contextual factors,Activity,Body functionand body structure,Participation,The integrative model of functioning and disability,Health

8、condition(disease, trauma),Environmental factors,Personal factors,Contextual factors,Activity,Body functionand body structure,Participation,Tear of articular cartilage of kneeM 23.5,The integrative model of functioning and disability,Tear of articular cartilage of knee M 23.5,Environmental factors,P

9、ersonal factors,Contextual factors,Activity,Body functionand body structure,Participation,The integrative model of functioning and disability,Body Function & Structure,Body functions are physiological functions of body systems, including psychological functions 身体功能指身体的生理功能，包括心理功能 Body structures ar

10、e anatomical parts of the body, such as organs, limbs and their components 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,Tear of articular cartilage of knee M 23.5,Environmental factors,Personal factors,Contextual factors,Activity,Participation,Pain, stability of joints,muscle power,Cruciate ligament,T

11、he integrative model of functioning and disability,Tear of articular cartilage of knee M 23.5,Environmental factors,Personal factors,Contextual factors,Activity,Participation,Pain, stability of joints,muscle power,Cruciate ligament,The integrative model of functioning and disability,Activity & Parti

12、cipation,Activity is the execution of a task or action by an individual. It represents the individual perspective of functioning. 活动指个人执行任务或者个人的行动，代表个体功能 Participation is involvement in a life situation. It represents the societal perspective of functioning.,Activity limitations 活动受限,Activity & Part

13、icipation,Participation is involvement in a life situation. It represents the societal perspective of functioning. 参与指参加生活环境的活动，代表社会功能,Participation restrictions 参与限制,Tear of articular cartilage of kneeM 23.5,Environmental factors,Personal factors,Contextual factors,Activity,Participation,Pain, stab

14、ility of joints,muscle power,Cruciate ligament,Take care of her grandchildDoing houseworkAssisting her husband with his business,Carrying objects, kneeling, walking, climbing,The integrative model of functioning and disability,Tear of articular cartilage of knee M 23.5,Environmental factors,Personal

15、 factors,Contextual factors,Activity,Participation,Pain, stability of joints,muscle power,Cruciate ligament,Take care of her grandchildDoing houseworkAssisting her husband with his business,Carrying objects, kneeling, walking, climbing,The integrative model of functioning and disability,Environmenta

16、l Factors环境因素,Environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives 人们居住和生活的物理、社会和态度环境 Environmental factors are external to individuals and can have positive (facilitator) or negative (barrier) influence on the individual 环境因素是个人

17、之外的因素 积极因素 (facilitator) 消极因素(barrier),Tear of articular cartilage of knee M 23.5,Environmental factors,Personal factors,Contextual factors,Activity,Participation,Pain, stability of joints,muscle power,Cruciate ligament,Take care of her grandchildDoing houseworkAssisting her husband with his busines

18、s,Carrying objects, kneeling, walking, climbing,The integrative model of functioning and disability,Personal Factors个人因素,e.g. gender, age, race, fitness, lifestyle, habits, social background, other health conditions 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,Tear of articular cartilage of knee M 23.5,Environ

19、mental factors,Personal factors,Contextual factors,Activity,Participation,Pain, stability of joints,muscle power,Cruciate ligament,Take care of her grandchildDoing houseworkAssisting her husband with his business,Carrying objects, kneeling, walking, climbing,60 year oldMotivated,The integrative mode

20、l of functioning and disability,Functioning is the human experience in relation to,in the interaction with health conditions, personal and environmental factors,Disability is the human experience of,in the interaction with health conditions, personal and environmental factors,Optimal Functioning,Con

21、tents and Structureof the ICF - Practice -,Case Study I,A 32-year-old woman, after a few hours of typing and data entry on the computer , complained of pain , numbness and tingling in both hands and pain in wrists. She also experience some weakness in her hands , which caused her to drop objects. An

22、 EMG was performed and she was diagnosed with Carpal Tunnel Syndrome (G56.0).,Which component? Which chapter within the selected component is the most appropriated? Which category within the selected chapter is the most precise?,38,Body Functions and Structures,Skin and related structures,Functions

23、of the skin and related structures,Structures related to movement,Neuromusculoskeletal and movement-related functions,Structures related to the genitourinary and reproductive systems,Genitourinary and reproductive functions,Structures related to the digestive, metabolic and endocrine systems,Functio

24、ns of the digestive, metabolic and endocrine systems,Structures of the cardiovascular, immunological and respiratory systems,Functions of the cardiovascular, haematological, immunological and respiratory systems,Structures involved in voice and speech,Voice and speech functions,The eye, ear and rela

25、ted structures,Sensory functions and pain,Structures of the nervous system,Mental functions,39,Activities and Participation,1Learning &Applying Knowledge 2General Tasks and Demands 3Communication 4Movement 5Self Care 6Domestic Life Areas 7Interpersonal Interactions 8Major Life Areas 9Community, Soci

26、al & Civic Life,40,Environmental Factors,1. Products and technology 2. Natural environment and human-made changes to the environment 3. Support and relationships 4. Attitudes 5. Services, systems and policies,41,第一级：身体结构与功能,身体结构 (s),身体功能 (b),42,第一级：活动与参与,43,第一级：环境因素 (e),44,ICF 第二级结构,45,第二级结构 举例,章节b1

27、 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),46,ICF,Body Functions b,b1100 b7809 b11420 b54509,b1 b8,b110 b899,Body Structures s,s1 s8,s110 s899,s1100 s8309 s11000 s76009,Activit

28、y & Participation d,d1 d9,d110 d999,d1150 d9309,Environmental Factors e,e1 e5,e110 e599,e1100 e5959,ICF 三级结构,ICF 条目举例,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,47,三级,四级,Case Study I,A 32-year-old woman, after a few hours of typing and data entry on the comput

29、er d360, complained of pain b280, numbness b265 and tingling b265 in both hands and pain in wrists. She also experience some weakness in her hands b730, which caused her to drop objects. An EMG was performed and she was diagnosed with Carpal Tunnel Syndrome (G56.0).,d360 Using communication devices

30、and techniques b280 Sensation of pain b265 Touch function b730 Muscle power functions,Case Study II,A 28-year-old woman, a housekeeper in a hotel, complains of tight shoulder pain_. She has extreme difficulty carrying things with her right arm _ . She has severe problems to perform her Work in the h

31、otel and to take care of her 6-month old child . Without the help of his colleagues she would already be on sick leave. She has pain at night if she sleeps on the right side. She has got used to sleep on the left side. Therefore she sleeps well . On exam she has weakness rotating her shoulder to the

32、 outside and away from the body. The diagnosis of Rotator cuff syndrome (M75.1) was made. She was give subacromial injection and a physical therapy program . Her pain was dramatically better.,Case Study II,A 28-year-old woman, a housekeeper in a hotel, complains of tight shoulder pain_b28016. She ha

33、s extreme difficulty carrying things with her right arm d430. She has severe problems to perform her Work in the hotel d850 and to take care of her 6-month old child d660. Without the help of his colleagues e325 she would already be on sick leave. She has pain at night if she sleeps on the right sid

34、e. She has got used to sleep on the left side. Therefore she sleeps well b134. On exam she has weakness rotating her shoulder b710 to the outside and away from the body. The diagnosis of Rotator cuff syndrome (M75.1) was made. She was give subacromial injection e1101 and a physical therapy program e

35、580. Her pain was dramatically better., Qualifiers,what is the extent of the problem,Until now the ? was,what is the problem,and now the ? is,b1141.,0,1,2,3,4,8,9,Uniform or generic scale (qualifier),0NO problem (none, absent, negligible,.) 0-4% 1 MILD problem (slight, low,.) 5-24% 2 MODERATE proble

36、m (medium, fair.) 25-49% 3 SEVERE problem (high, extreme,.) 50-95% COMPLETE problem (total,.) 96-100% 8not specified (the available information does not suffice to specify the severity of the problem) 9not applicable (it is inappropriate or not possible to apply the code),53,定量分级(qualifier),0没有问题(无、

37、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),ICF,0NO problem (none, absent, negligible,)0-4% 1 MILD problem (slight, low,.)5-24% 2 MODERATE problem (medium, fair.)25-49% 3 SEVERE problem (high, extreme,

38、.)50-95% 4 COMPLETE problem (total,.)96-100% 8not specified (the available information does not suffice to specify the severity of the problem) 9not applicable (it is inappropriate or not possible to apply the code),ICF,Case Study II,A 28-year-old woman, a housekeeper in a hotel, complains of tight

39、shoulder pain_b28016.2. She has extreme difficulty carrying things with her right arm d4302.3. She has severe problems to perform her Work in the hotel d850.3 and to take care of her 6-month old child d6600.3. Without the help of his colleagues e325.+3 she would already be on sick leave. She has pai

40、n at night if she sleeps on the right side. She has got used to sleep on the left side. Therefore she sleeps well b134.0. On exam she has weakness rotating her shoulder b710.2 to the outside and away from the body. The diagnosis of Rotator cuff syndrome (M75.1) was made. She was give subacromial inj

41、ection e1101.+3 and a physical therapy program e355.+3. Her pain was dramatically better.,Case Study III,A 40 year old woman with a whiplash injury 4 months earlier complains about very strong pain in the neck , severe headache , dizziness , slightly reduced muscle power and mild anxiety . The X-ray

42、 shows distorsion of the ligaments of neck region . Her ability to walk , cook , clean, handle a computer and drive a car are reasonable limited. In consultation with her physician it was mutually agreed to wait till the problems are reduced before she can return to her old full-time fixed-hours job

43、. She is on sick leave, since she can not hold down her job as a secretary and the workplace policies does not allow her for flexible work hours, and to work from home.,Case Study III,A 40 year old woman with a whiplash injury 4 months earlier complains about very strong pain in the neck b28010, sev

44、ere headache b28010, dizziness b2401, slightly reduced muscle powerb730 and mild anxiety b152. There is a moderate distorsion of the ligaments of neck region s7105. Her ability to walk d450, cook d630, clean, handle a computer and drive a car d4751 are reasonable limited. In consultation with her ph

45、ysician it was mutually agreed to wait till the problems are reduced before she can return to her old full-time fixed-hours job. She is on sick leave, since she can not hold down her job d850 as a secretary and the workplace policies e5902 does not allow her for flexible work hours, and to work from

46、 home.,Case Study III,A 40 year old woman with a whiplash injury 4 months earlier complains about very strong pain in the neck b28010.3, severe headache b28010.3, dizziness b2401, slightly reduced muscle power b730.1 and mild anxiety b152.1. There is a moderate distorsion of the ligaments of neck re

47、gion s7105.2. Her ability to walk d450, cook d630, clean, handle a computer and drive a car d4751 are reasonable limited. In consultation with her physician it was mutually agreed to wait till the problems are reduced before she can return to her old full-time fixed-hours job. She is on sick leave,

48、since she can not hold down her job d850.4 as a secretary and the workplace workplace policies e5902.3 does not allow her for flexible work hours, and to work from home.,Exercise Mrs. Backer,发展ICF核心组合 Core Sets,63,64,65,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

49、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,66,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,67,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,68,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