1、勵建安南京醫(yī)科大學(xué)國際功能、殘疾和健康分類-脊髓損傷的核心組合ICF Core Sets for SCI12021/10/23 星期六2功能與殘疾的綜合模式2021/10/23 星期六3環(huán)境因素個人因素相關(guān)因素活動身體功能與身體結(jié)構(gòu)參與健康狀況(疾病、外傷)功能與殘疾的綜合模式2021/10/23 星期六4健康狀況健康狀況是疾病、疾患、損傷或者外傷的總稱健康狀況可以包括其他情況，例如老齡、應(yīng)激、先天畸形以及遺傳因素等健康狀況使用ICD-10作為標(biāo)準編碼2021/10/23 星期六5環(huán)境因素個人因素相關(guān)因素活動身體功能與身體結(jié)構(gòu)參與慢性膝關(guān)節(jié)不穩(wěn)M 23.5功能與殘疾的綜合模式2021/10/2

2、3 星期六6身體功能與身體結(jié)構(gòu)身體功能指身體的生理功能，包括心理功能身體結(jié)構(gòu)指身體的解剖結(jié)構(gòu)，例如器官、肢體和相關(guān)部件相當(dāng)于障礙Impairments2021/10/23 星期六7環(huán)境因素個人因素相關(guān)因素活動疼痛、關(guān)節(jié)穩(wěn)定性、交叉韌帶參與慢性膝關(guān)節(jié)不穩(wěn)M 23.5功能與殘疾的綜合模式2021/10/23 星期六8活動與參與活動指個人執(zhí)行任務(wù)或者個人的行動，代表個體功能參與指參加生活環(huán)境的活動，代表社會功能活動限制參與限制2021/10/23 星期六9環(huán)境因素個人因素相關(guān)因素攜帶物體、彎膝、步行、攀爬疼痛、關(guān)節(jié)穩(wěn)定性、交叉韌帶照顧孫子、家務(wù)、協(xié)助丈夫工作慢性膝關(guān)節(jié)不穩(wěn)M 23.5功能與殘疾的綜合

3、模式2021/10/23 星期六10環(huán)境因素人們居住和生活的物理、社會和態(tài)度環(huán)境環(huán)境因素是個人之外的因素積極因素 (facilitator)消極因素(barrier)2021/10/23 星期六11-住在4樓，無電梯+使用拐杖/康復(fù)/藥物治療個人因素相關(guān)因素攜帶物體、彎膝、步行、攀爬疼痛、關(guān)節(jié)穩(wěn)定性、交叉韌帶照顧孫子、家務(wù)、協(xié)助丈夫工作慢性膝關(guān)節(jié)不穩(wěn)M 23.5功能與殘疾的綜合模式2021/10/23 星期六12個人因素包括性別、年齡、人種、體質(zhì)、生活方式、習(xí)慣、社會背景、其它社會功能2021/10/23 星期六13-住在4樓，無電梯+使用拐杖、康復(fù)治療、藥物治療60歲，生性積極相關(guān)因素攜帶物

4、體、彎膝、步行、攀爬疼痛、關(guān)節(jié)穩(wěn)定性、交叉韌帶照顧孫子、家務(wù)、協(xié)助丈夫工作慢性膝關(guān)節(jié)不穩(wěn)M 23.5功能與殘疾的綜合模式2021/10/23 星期六14身體結(jié)構(gòu)和功能障礙活動受限參與限制殘疾2021/10/23 星期六15身體結(jié)構(gòu)和功能 與參與活動功能改善2021/10/23 星期六16功能改善2021/10/23 星期六17ICF是國際通用的描述功能、殘疾和健康狀況的國際語言和概念2021/10/23 星期六182021/10/23 星期六19健康狀況（疾病、外傷）253項環(huán)境因素個人因素相關(guān)因素384項活動與參與493項身體結(jié)構(gòu)310項身體功能2021/10/23 星期六20b1 b8s1

5、 s8d1 d9e1 e5章ICF 金字塔結(jié)構(gòu)ICF身體功能身體結(jié)構(gòu)活動與參與環(huán)境因素個人因素bsde2021/10/23 星期六21第一級：身體結(jié)構(gòu)與功能Skin and related structuresStructures related to movementStructures related to the genitourinary and reproductive systemsStructures related to the digestive, metabolic and endocrine systemsStructures of the cardiovascular,

6、 immunological and respiratory systems聲音和言語相關(guān)的組織結(jié)構(gòu)The eye, ear and related structuresStructures of the nervous systemFunctions of the skin and related structuresNeuromusculoskeletal and movement-related functionsGenitourinary and reproductive functionsFunctions of the digestive, metabolic and endocr

7、ine systemsFunctions of the cardiovascular, haematological, immunological and respiratory systems聲音和言語功能Sensory functions and painMental functionsChapter 8Chapter 7Chapter 6Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1身體結(jié)構(gòu) (s)身體功能 (b)2021/10/23 星期六22第一級：活動與參與主要的生活區(qū)域人際關(guān)系家庭區(qū)域個人自理活動交流一般任務(wù)與需求學(xué)習(xí)與應(yīng)用技術(shù)社區(qū)、社

8、會和公民活動Chapter 8Chapter 7Chapter 6Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1Chapter 92021/10/23 星期六23第一級：環(huán)境因素 (e)服務(wù)、體系與政策態(tài)度支持與關(guān)系自然環(huán)境和人類對環(huán)境的改造產(chǎn)品與技術(shù)Chapter 5Chapter 4Chapter 3Chapter 2Chapter 12021/10/23 星期六24b1 b8s1 s8d1 d9e1 e5ChaptersICF 第二級結(jié)構(gòu)ICF身體功能身體結(jié)構(gòu)活動與參與環(huán)境因素個人因素bsdeb110 b899s110 s899d110 d99

9、9e110 e5992nd Level2021/10/23 星期六25第二級結(jié)構(gòu) 舉例章節(jié)b1 腦高級功能 Mental function整體腦高級功能 (b110 b139)b110意識b114 定向b117 智力b122 整體心理功能b126 個性b130 主觀能動性b134 睡眠b139 非特指的整體心理功能特定的腦高級功能Specific mental functions (b140 b189)2021/10/23 星期六26ICFBody Functions bb1100 b7809b11420 b54509b1 b8b110 b899Body Structuresss1 s8s11

10、0 s899s1100 s8309s11000 s76009Activity & Participationdd1 d9d110 d999d1150 d9309Environmental Factorsee1 e5e110 e599e1100 e5959ICF 三級結(jié)構(gòu)The higher the more precise2021/10/23 星期六27b 腦高級功能Mental functions一級 b114 定向功能 二級 b1141 地點定向 b1142 人物定向 b11420自我定向b11421他人定向ICF 條目舉例三級四級2021/10/23 星期六28ICF總條目：1454有多

11、少在特定的疾病需要？臨床和科研有何用途？評判標(biāo)準？2021/10/23 星期六發(fā)展ICF核心組合 Core Sets292021/10/23 星期六30瞎子摸象的故事2021/10/23 星期六31ICF and ICF Core Sets確定評定條目what to measure應(yīng)用基礎(chǔ)：how to measure2021/10/23 星期六32b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d230d360d410 d415d430 e110e115e120e125e135e150 1454ICF 核心組合2021/10

12、/23 星期六33b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d230d360d410 d415d430 e110e115e120e125e135e150 1454ICF 核心組合特定疾病特定環(huán)境2021/10/23 星期六34骨關(guān)節(jié)炎OA 身體功能b280 疼痛的感覺b710 關(guān)節(jié)活動功能b730 肌肉功能b770 步態(tài)b715 關(guān)節(jié)穩(wěn)定性b740 肌肉耐力b780 與肌肉相關(guān)的感覺和運動功能b760 自主運動的控制b134 睡眠功能b735 肌肉張力簡要ICF核心組合全套ICF核心組合2021/10/23 星期六35

13、s750下肢結(jié)構(gòu)s730上肢結(jié)構(gòu)s770其它與運動相關(guān)的 肌肉骨骼結(jié)構(gòu)s740骨盆結(jié)構(gòu)s720肩部結(jié)構(gòu)OA 身體結(jié)構(gòu)簡要ICF核心組合全套ICF核心組合2021/10/23 星期六36d450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如廁d430抬舉和攜帶物品d640做家務(wù)d910社區(qū)生活d440手精細活動d410改變身體位置OA 活動與參與簡要ICF核心組合全套ICF核心組合2021/10/23 星期六37e115 與個人日常生活相關(guān)的產(chǎn)品與技術(shù)e310 近親e580 醫(yī)療服務(wù)、體系和政策e150 公共場合的建筑設(shè)計、產(chǎn)品和技術(shù)e355 醫(yī)務(wù)人員e54

14、0 交通服務(wù)、體系和政策e120 個人室內(nèi)和室外活動和交通的產(chǎn)品與技術(shù)e135 就業(yè)相關(guān)的產(chǎn)品與技術(shù)e155 私人使用的建筑設(shè)計、建造和建筑產(chǎn)品e340 個人護理人員和助手OA 環(huán)境因素簡要ICF核心組合全套ICF核心組合2021/10/23 星期六38 定量分級Qualifiers 問題的嚴重程度如何量化已經(jīng)清楚的?是 功能障礙是什么并不清楚的?是b1141.01234892021/10/23 星期六392021/10/23 星期六40定量分級(qualifier)0沒有問題(無、缺乏、可以忽視等) 0-4% 1 輕度問題(輕、低等) 5-24% 2 中度問題(中等、較好等) 25-49%

15、3 嚴重問題(高、極端等) 50-95% 4 全部問題(最嚴重、全部受累等)96-100% 8無法特定 (當(dāng)前的信息無法確定嚴重程度)9無法應(yīng)用 (不恰當(dāng)或者不可能使用)2021/10/23 星期六41環(huán)境因素雙向分級障礙因素Barrier -促進因素Facilitator + 2021/10/23 星期六422021/10/23 星期六43Problem-solving approach2021/10/23 星期六44Rehab-CycleAssessmentEvaluationAssignmentIntervention2021/10/23 星期六45AssessmentEvaluatio

16、nAssignmentInterventionRehab-CycleICF ModelICF & ICF Core Sets2021/10/23 星期六46Diagnosis (ICD-10)Rehabilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody structures & functionsactivities & participationpatient perspectiveWhat are the patients problems and needs from his/her perspe

17、ctive?What are the patients problems from the team perspective?Use the ICF Core Sets!2021/10/23 星期六47Diagnosis (ICD-10)Rehabilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody structures & functionsactivities & participationpatient perspective2021/10/23 星期六48Assessment with the I

18、CF 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 flexibilitySwelling i

19、n 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 relationship

20、 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+What are the patients problems and needs from his/her perspective?What are the patients problem

21、s from the rehabilitation team perspective?Use the ICF-Core-sets as a Checklist !Goals of rehabilitationIntervention program goal:Long-term goal: 2021/10/23 星期六49Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal

22、 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 combing hairDifficulties

23、 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; No elevator Needs aids

24、 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 functionss7302 Structure of hands73011 Wrist joints73021 Joints of hand and fingerss75011 Knee

25、 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 rehabilitationIntervention program goal:Long-term goal: 2021/10/23 星期六50Assessment with the ICF S

26、heetPatients 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 flexibilitySwelling in fi

27、nger, 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 relationship wit

28、h 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 strengthInflammation parameters

29、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 objectsPrep

30、aring mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal:Long-term goal: 2021/10/23 星期六51REHAB-CycleAssessment in four stepsIdentification of the problems and needs of the patient,Determination of the long-term, intervention program and cycle goals

31、andIdentification of intervention targets related to the cycle goals.2021/10/23 星期六52Assessment with the ICF SheetGoals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining Patients perspectiveRehabilitation team perspectiveBody-St

32、ructures/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 dressedProb

33、lems 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 because of the painMedication +L

34、ives 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 metacarpophalangeal (MCP) joints 2 and

35、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 mealsHouseworkWalking short distancesClimbing stairs Goa

36、ls of rehabilitationIntervention program goal:Long-term goal: 2021/10/23 星期六53REHAB-CycleAssessment in four stepsIdentification of the problems and needs of the patient,Determination of the long-term, intervention program and cycle goals andIdentification of intervention targets related to the cycle

37、 goals.2021/10/23 星期六54Assessment 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 fingers

38、Shortened 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 secretaryAll my free-time act

39、ivities 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 jointsImpaired joint stability

40、Impaired 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 use

41、Hand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining What is related to (determine) the cycle goals?Determine the inte

42、rvention targets2021/10/23 星期六55Assessment 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 an

43、d 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 secretaryAll my free

44、-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 jointsImpaired joint

45、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

46、 hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 2021/10/23 星期六56Rehab-CycleAssessmentAssignment2021/10/2

47、3 星期六57Asignment Health ProfessionalsProgram or serviceInpatient or outpatient rehab, home rehabType of specific serviceSingle vs groupFirst intervention, refresher2021/10/23 星期六58Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/Par

48、ticipationPersonal 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 combin

49、g 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; No e

50、levator 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 drift ri

51、ghtDegenerative 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 rehabilitationIntervention

52、program goal: Independence in self-care and housework Long-term goal: Vocational retraining 2021/10/23 星期六59Asignment Health ProfessionalsProgram or serviceInpatient or outpatient rehab, home rehabType of specific serviceSingle vs groupFirst intervention, refresherIntervention2021/10/23 星期六60Assessm

53、entAssignmentInterventionRehab-Cycle2021/10/23 星期六61Assessment 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 shou

54、lderPain 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

55、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 strategies+Impaired mobility of j

56、ointsImpaired 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 posit

57、iion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 2021/10/23 星期六62AssessmentEvaluation

58、AssignmentInterventionRehab-Cycle2021/10/23 星期六63Assessment 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 shoulde

59、rPain 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 sec

60、retaryAll 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 join