ICF在脊髓损伤的应用-励建安.ppt

励建安励建安(Jin n)(Jin n)南京医科大学南京医科大学国际功能(gngnng)(gngnng)、残疾和健康分类-脊髓损伤的核心组合ICF Core Sets for SCI第一页，共九十一页。功能与残疾的综合功能与残疾的综合(zngh)(zngh)模式模式第二页，共九十一页。2环境因素环境因素个人个人(grn)(grn)因素因素相关相关(xinggun)(xinggun)因素因素活动活动(hu dng)(hu dng)身体功能身体功能与身体结与身体结构构参与参与参与参与健康状况健康状况(疾病、外伤疾病、外伤)功能与残疾的综合模式第三页，共九十一页。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(ky)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作为标准编码第四页，共九十一页。4环境因素环境因素个人个人(grn)(grn)因素因素相关相关(xinggun)(xinggun)因素因素活动活动(hu dng)(hu dng)身体功能与身体功能与身体结构身体结构参与参与参与参与慢性膝关节不稳M 23.5功能与残疾的综合模式第五页，共九十一页。5身体(shnt)(shnt)功能与身体(shnt)(shnt)结构身体功能指身体的生理功能，包括心理(xnl)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第六页，共九十一页。6环境因素环境因素个人个人(grn)(grn)因素因素相关相关(xinggun)(xinggun)因素因素活动活动(hu dng)(hu dng)疼痛、关节稳定疼痛、关节稳定性、交叉韧带性、交叉韧带参与参与参与参与慢性膝关节不稳M 23.5功能与残疾的综合模式第七页，共九十一页。7活动(hu dng)与参与活动指个人执行任务或者(huzh)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(hu dng)限制参与限制第八页，共九十一页。8环境因素环境因素个人个人(grn)(grn)因素因素相关相关(xinggun)(xinggun)因素因素携带物体携带物体(wt)(wt)、弯膝、步行、攀弯膝、步行、攀爬爬疼痛、关节疼痛、关节稳定性、交稳定性、交叉韧带叉韧带照顾孙子、家务、协照顾孙子、家务、协助丈夫工作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第九页，共九十一页。9环境因素人们居住和生活(shnghu)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积极因素(facilitator)消极因素消极因素(barrier)第十页，共九十一页。10-住在住在4 4楼，无电梯楼，无电梯+使用使用(shyng)(shyng)拐杖拐杖/康复康复/药物治药物治疗疗个人个人(grn)(grn)因素因素相关相关(xinggun)(xinggun)因素因素携带物体、弯膝、携带物体、弯膝、步行、攀爬步行、攀爬疼痛、关节稳疼痛、关节稳定性、交叉韧定性、交叉韧带带照顾孙子、家务、协照顾孙子、家务、协助丈夫工作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第十一页，共九十一页。11个人(grn)因素包括(boku)性别、年龄、人种、体质、生活方式、习惯、社会背景、其它社会功能第十二页，共九十一页。12-住在住在4 4楼，无电梯楼，无电梯+使用拐杖、康复治疗使用拐杖、康复治疗(zhlio)(zhlio)、药物治疗药物治疗(zhlio)(zhlio)6060岁，生性岁，生性(shngxng)(shngxng)积极积极相关相关(xinggun)(xinggun)因素因素携带物体、弯膝、携带物体、弯膝、步行、攀爬步行、攀爬疼痛、关节疼痛、关节稳定性、交稳定性、交叉韧带叉韧带照顾孙子、家务、协照顾孙子、家务、协助丈夫工作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第十三页，共九十一页。13身体结构和功能障碍身体结构和功能障碍活动受限活动受限参与限制参与限制残疾(cn j)第十四页，共九十一页。14身体结构和功能身体结构和功能 与参与与参与活动活动功能(gngnng)改善第十五页，共九十一页。15功能(gngnng)改善第十六页，共九十一页。16ICFICF是国际通用的描述功能是国际通用的描述功能(gngnng)(gngnng)、残疾和、残疾和健康状况的国际语言和概念健康状况的国际语言和概念第十七页，共九十一页。17第十八页，共九十一页。18健康状况（疾病健康状况（疾病(jbng)(jbng)、外伤）、外伤）253253项环境因素项环境因素个人个人(grn)(grn)因素因素相关相关(xinggun)(xinggun)因素因素384384项活动与参与项活动与参与493493项身体结构项身体结构310310项身体功能项身体功能第十九页，共九十一页。19b b b b1 1 1 1 b b b b8 8 8 8s s s s1 1 1 1 s s s s8 8 8 8d d d d1 1 1 1 d d d d9 9 9 9e e e e1 1 1 1 e e e e5 5 5 5章章ICF ICF 金字塔结构金字塔结构(jigu)(jigu)(jigu)(jigu)ICFICF身体功能身体功能身体功能身体功能身体结构身体结构身体结构身体结构活动与参与活动与参与活动与参与活动与参与环境因素环境因素环境因素环境因素个人因素个人因素个人因素个人因素b b b bs s s sd d d de e e e第二十页，共九十一页。20第一级：身体结构(jigu)与功能Skin and related structuresSkin and related structuresStructures related to movementStructures related to movementStructures related to the genitourinary Structures related to the genitourinary and reproductive systemsand reproductive systemsStructures related to the digestive,Structures related to the digestive,metabolic and endocrine systemsmetabolic and endocrine systemsStructures of the cardiovascular,Structures of the cardiovascular,immunological and respiratory systemsimmunological and respiratory systems声音和言语相关的组织结构声音和言语相关的组织结构声音和言语相关的组织结构声音和言语相关的组织结构The eye,ear and related structuresThe eye,ear and related structuresStructures of the nervous systemStructures of the nervous systemFunctions of the skin and related Functions of the skin and related structuresstructuresNeuromusculoskeletal and movement-Neuromusculoskeletal and movement-related functionsrelated functionsGenitourinary and reproductive Genitourinary and reproductive functionsfunctionsFunctions of the digestive,metabolic Functions of the digestive,metabolic and endocrine systemsand endocrine systemsFunctions of the cardiovascular,Functions of the cardiovascular,haematological,immunological and haematological,immunological and respiratory systemsrespiratory systems声音和言语功能声音和言语功能声音和言语功能声音和言语功能Sensory functions and painSensory functions and painMental functionsMental functionsChapter 8Chapter 8Chapter 7Chapter 7Chapter 6Chapter 6Chapter 5Chapter 5Chapter 4Chapter 4Chapter 3Chapter 3Chapter 2Chapter 2Chapter 1Chapter 1身体身体身体身体(shnt)(shnt)结构结构结构结构 (s)(s)身体身体身体身体(shnt)(shnt)功能功能功能功能 (b)(b)第二十一页，共九十一页。21第一级：活动(hu dng)与参与主要的生活区域主要的生活区域人际关系人际关系家庭区域家庭区域个人自理个人自理活动活动交流交流一般任务与需求一般任务与需求学习与应用技术学习与应用技术社区、社会和公民活动社区、社会和公民活动Chapter 8Chapter 7Chapter 6Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1Chapter 9第二十二页，共九十一页。22第一级：环境因素(e)服务、体系与政策服务、体系与政策态度态度支持与关系支持与关系自然环境和人类对环境的改造自然环境和人类对环境的改造产品与技术产品与技术Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1第二十三页，共九十一页。23b b b b1 1 1 1 b b b b8 8 8 8s s s s1 1 1 1 s s s s8 8 8 8d d d d1 1 1 1 d d d d9 9 9 9e e e e1 1 1 1 e e e e5 5 5 5ChaptersChaptersChaptersChaptersICF ICF 第二级结构第二级结构(jigu)(jigu)(jigu)(jigu)ICFICF身体功能身体功能身体功能身体功能身体结构身体结构身体结构身体结构活动与参与活动与参与活动与参与活动与参与环境因素环境因素环境因素环境因素个人因素个人因素个人因素个人因素b b b bs s s sd d d de e e eb b b b1 1 1 110101010 b b b b8 8 8 899999999s s s s1 1 1 110101010 s s s s8 8 8 899999999d d d d1 1 1 110101010 d d d d9 9 9 999999999e e e e1 1 1 110101010 e e e e5 5 5 5999999992nd 2nd 2nd 2nd LevelLevelLevelLevel第二十四页，共九十一页。24第二级结构(jigu)举例章节章节b1 脑高级功能脑高级功能(gngnng)Mental function整体脑高级功能整体脑高级功能(b110 b139)b110b110意识意识意识意识b b1 114 14 定向定向定向定向b117 b117 智力智力智力智力b122 b122 整体心理功能整体心理功能整体心理功能整体心理功能b126 b126 个性个性个性个性b130 b130 主观能动性主观能动性主观能动性主观能动性b134 b134 睡眠睡眠睡眠睡眠b139 b139 非特指的整体心理功能非特指的整体心理功能非特指的整体心理功能非特指的整体心理功能特定的脑高级功能特定的脑高级功能Specific mental functions(b140 b189)第二十五页，共九十一页。25ICFICFICFICFBody Body Body Body Functions Functions Functions Functions b b b bb b b b1 1 1 1101010100 0 0 0 b b b b7 7 7 7808080809 9 9 9b b b b1 1 1 1141414142 2 2 20 0 0 0 b b b b5 5 5 5454545450 0 0 09 9 9 9b b b b1 1 1 1 b b b b8 8 8 8b b b b1 1 1 110101010 b b b b8 8 8 899999999Body Body Body Body StructuresStructuresStructuresStructuress s s ss s s s1 1 1 1 s s s s8 8 8 8s s s s1 1 1 110101010 s s s s8 8 8 899999999s s s s1 1 1 1101010100 0 0 0 s s s s8 8 8 8303030309 9 9 9s s s s1 1 1 1101010100 0 0 00 0 0 0 s s s s7 7 7 7606060600 0 0 09 9 9 9Activity&Activity&Activity&Activity&Participation Participation Participation Participationd d d dd d d d1 1 1 1 d d d d9 9 9 9d d d d1 1 1 110101010 d d d d9 9 9 999999999d d d d1 1 1 1151515150 0 0 0 d d d d9 9 9 9303030309 9 9 9Environmental Environmental Environmental Environmental FactorsFactorsFactorsFactorse e e ee e e e1 1 1 1 e e e e5 5 5 5e e e e1 1 1 110101010 e e e e5 5 5 599999999e e e e1 1 1 1101010100 0 0 0 e e e e5 5 5 5959595959 9 9 9ICF ICF 三级结构三级结构(jigu)(jigu)(jigu)(jigu)The higher the more preciseThe higher the more precise第二十六页，共九十一页。26b 脑高级功能Mental functions一级 b114 定向功能 二级 b1141 地点(ddin)定向 b1142 人物定向 b11420自我定向b11421他人定向ICF 条目(tiom)举例三级四级第二十七页，共九十一页。27ICF总条目：总条目：1454有多少在特定的疾病需要有多少在特定的疾病需要(xyo)？临床和科研有何用途？临床和科研有何用途？评判标准？评判标准？第二十八页，共九十一页。28发展ICF核心(hxn)组合 Core Sets第二十九页，共九十一页。瞎子摸象(xi z m xing)的故事第三十页，共九十一页。30ICF and ICF Core Sets确定评定确定评定(pngdng)条目条目what to measure应用基础：应用基础：how to measure第三十一页，共九十一页。31b1b1b130b130b134b134b152b152b180b180b1801b1801 s299s299s710s710s720 s720 s730s730s73001s73001s73011s73011 d170d170d230d230d360d360d410 d410 d415d415d430d430 e110e110e115e115e120e120e125e125e135e135e150e150 14541454ICF ICF 核心组合核心组合第三十二页，共九十一页。32b1b1b130b130b134b134b152b152b180b180b1801b1801 s299s299s710s710s720 s720 s730s730s73001s73001s73011s73011 d170d170d230d230d360d360d410 d410 d415d415d430d430 e110e110e115e115e120e120e125e125e135e135e150e150 14541454ICF ICF 核心组合核心组合特定疾病特定疾病特定环境特定环境第三十三页，共九十一页。33骨关节炎OA 身体(shnt)功能b280 疼痛的感觉疼痛的感觉b710 关节活动功能关节活动功能b730 肌肉功能肌肉功能b770 步态步态(b ti)b715 关节稳定性关节稳定性b740 肌肉耐力肌肉耐力b780 与肌肉相关的感觉和运动功能与肌肉相关的感觉和运动功能b760 自主运动的控制自主运动的控制b134 睡眠功能睡眠功能b735 肌肉张力肌肉张力简要简要ICFICF核心组合核心组合全套全套ICFICF核心组核心组合合第三十四页，共九十一页。34 s750下肢结构下肢结构(jigu)s730上肢结构上肢结构s770其它与运动相关的其它与运动相关的 肌肉骨骼结构肌肉骨骼结构s740骨盆结构骨盆结构s720肩部结构肩部结构OA 身体(shnt)结构简要简要ICFICF核心组合核心组合全套全套ICFICF核心组核心组合合第三十五页，共九十一页。35d450步行步行d540穿衣穿衣d445 手和手臂使用手和手臂使用d510自我洗浴自我洗浴d470 使用交通工具使用交通工具d530如厕如厕d430抬举和携带物品抬举和携带物品d640 做家务做家务d910社区生活社区生活d440手精细活动手精细活动(hu dng)d410改变身体位置改变身体位置OA 活动(hu dng)与参与简要简要ICFICF核心组合核心组合全套全套ICFICF核心组核心组合合第三十六页，共九十一页。36e115 与个人日常生活相关的产品与技术与个人日常生活相关的产品与技术e310 近亲近亲e580 医疗服务、体系和政策医疗服务、体系和政策e150 公共场合的建筑设计、产品和技术公共场合的建筑设计、产品和技术e355 医务人员医务人员e540 交通服务、体系和政策交通服务、体系和政策e120 个人室内和室外活动和交通的产品与技个人室内和室外活动和交通的产品与技术术e135 就业相关的产品与技术就业相关的产品与技术e155 私人使用的建筑私人使用的建筑(jinzh)设计、建造和建设计、建造和建筑筑(jinzh)产品产品e340 个人护理人员和助手个人护理人员和助手OA 环境因素简要简要ICFICF核心核心组合组合全套全套ICFICF核心组合核心组合第三十七页，共九十一页。37 定量定量(dngling)(dngling)分级分级Qualifiers 问题(wnt)的严重程度如何量化已经(y jing)清楚的?是 功能障碍是什么功能障碍是什么并不清楚的?是b1141.01 23489第三十八页，共九十一页。38第三十九页，共九十一页。定量(dngling)分级(qualifier)0 0没有问题没有问题(无、缺乏、可以忽视(hsh)等)0-4%0-4%1 1 轻度问题轻度问题(轻、低等)5-24%5-24%2 2 中度问题中度问题(中等、较好等)25-49%25-49%3 3 严重问题严重问题(高、极端等)50-95%50-95%4 4 全部问题全部问题(最严重、全部受累等)96-100%96-100%8 8无法特定无法特定(当前的信息无法确定严重程度)9 9无法应用无法应用(不恰当或者不可能使用)第四十页，共九十一页。40环境因素双向分级(fn j)障碍因素Barrier -促进(cjn)因素Facilitator +第四十一页，共九十一页。41第四十二页，共九十一页。42Problem-solving approach第四十三页，共九十一页。43Rehab-CycleAssessmentAssessmentEvaluationEvaluationAssignmentAssignmentInterventionIntervention第四十四页，共九十一页。44AssessmentAssessmentEvaluationEvaluationAssignmentAssignmentInterventionInterventionRehab-CycleICF ModelICF&ICF Core Sets第四十五页，共九十一页。45Diagnosis(ICD-10)Rehabilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody structures&functionsactivities&participationpatient perspectiveUse the ICF Core Sets!Use the ICF Core Sets!第四十六页，共九十一页。46Diagnosis(ICD-10)Rehabilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody structures&functionsactivities&participationpatient perspective第四十七页，共九十一页。47Assessment with the Assessment with the ICF SheetICF SheetPatientPatients perspectives perspectiveRehabilitation team perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsPersonal FactorsReha-diagnosis ICD-10Reha-diagnosis ICD-10chronic polyarthritis ICD:M05.9Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulderPain in hands and fingersPain in hands and fingersShortened mobility and flexibilityShortened mobility and flexibilitySwelling in finger,wrist and knee Swelling in finger,wrist and knee jointsjointsDifficulties in getting dressedDifficulties in getting dressedProblems in brushing teeth and combing hairProblems in brushing teeth and combing hairDifficulties in lifting things above the Difficulties in lifting things above the headheadProblems preparing mealsProblems preparing mealsProblems doing houseworkProblems doing houseworkI had to give up my job as I had to give up my job as a secretarya secretaryAll my free-time activities All my free-time activities are affectedare affectedMy intimate relationship My intimate relationship with my husband is also with my husband is also affected because of the affected because of the painpainMedication+Medication+Lives in a fourth floor flat;No elevator Lives in a fourth floor flat;No elevator Needs aids for hand use+,Supportive husband+Needs aids for hand use+,Supportive husband+Self-help group+Self-help group+Motivated+Motivated+adequate coping strategies+adequate coping strategies+Use the ICF-Core-sets as a Checklist!Use the ICF-Core-sets as a Checklist!Goals of rehabilitationGoals of rehabilitationIntervention program goal:Intervention program goal:Long-term goal:Long-term goal:第四十八页，共九十一页。48Assessment with the Assessment with the ICF SheetICF SheetPatientPatients perspectives perspectiveRehabilitation team perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsPersonal FactorsReha-diagnosis ICD-10Reha-diagnosis ICD-10chronic polyarthritis ICD:M05.9Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulderPain in hands and fingersPain in hands and fingersShortened mobility and flexibilityShortened mobility and flexibilitySwelling in finger,wrist and knee Swelling in finger,wrist and knee jointsjointsDifficulties in getting dressedDifficulties in getting dressedProblems in brushing teeth and combing hairProblems in brushing teeth and combing hairDifficulties in lifting things above the Difficulties in lifting things above the headheadProblems preparing mealsProblems preparing mealsProblems doing houseworkProblems doing houseworkI had to give up my job as I had to give up my job as a secretarya secretaryAll my free-time activities All my free-time activities are affectedare affectedMy intimate relationship My intimate relationship with my husband is also with my husband is also affected because of the affected because of the painpainMedication+Medication+Lives in a fourth floor flat;No elevator Lives in a fourth floor flat;No elevator Needs aids for hand use+,Supportive husband+Needs aids for hand use+,Supportive husband+Self-help group+Self-help group+Motivated+Motivated+adequate coping strategies+adequate coping strategies+b710 Mobility of joint functionsb710 Mobility of joint functionsb715 Stability of joint functionsb715 Stability of joint functionsb730 Muscle power functionsb730 Muscle power functionsb435 Immunological system functionsb435 Immunological system functionss7302 Structure of hands7302 Structure of hands73011 Wrist joints73011 Wrist joints73021 Joints of hand and fingerss73021 Joints of hand and fingerss75011 Knee joints75011 Knee joints7502 Structure of ankle and foots7502 Structure of ankle and footd440 Fine hand used440 Fine hand used445 Hand and arm used445 Hand and arm used430 Lifting and carrying objectsd430 Lifting and carrying objectsd630 Preparing mealsd630 Preparing mealsd640 Doing houseworkd640 Doing houseworkd4500 Walking short distancesd4500 Walking short distancesd4551 Climbingd4551 ClimbingGoals of rehabilitationGoals of rehabilitationIntervention program goal:Intervention program goal:Long-term goal:Long-term goal:第四十九页，共九十一页。49Assessment with the Assessment with the ICF SheetICF SheetPatientPatients perspectives perspectiveRehabilitation team perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsPersonal FactorsReha-diagnosis ICD-10Reha-diagnosis ICD-10chronic polyarthritis ICD:M05.9Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulderPain in hands and fingersPain in hands and fingersShortened mobility and flexibilityShortened mobility and flexibilitySwelling in finger,wrist and knee Swelling in finger,wrist and knee jointsjointsDifficulties in getting dressedDifficulties in getting dressedProblems in brushing teeth and combing hairProblems in brushing teeth and combing hairDifficulties in lifting things above the Difficulties in lifting things above the headheadProblems preparing mealsProblems preparing mealsProblems doing houseworkProblems doing houseworkI had to give up my job as I had to give up my job as a secretarya secretaryAll my free-time activities All my free-time activities are affectedare affectedMy intimate relationship My intimate relationship with my husband is also with my husband is also affected because of the affected because of the painpainMedication+Medication+Lives in a fourth floor flat;No elevator Lives in a fourth floor flat;No elevator Needs aids for hand use+,Supportive husband+Needs aids for hand use+,Supportive husband+Self-help group+Self-help group+Motivated+Motivate