1、勵建安南京醫科大學國際功能、殘疾和健康分類-脊髓損傷的核心組合ICF Core Sets for SCI第一頁，共九十一頁。2功能與殘疾的綜合模式第二頁，共九十一頁。3環境因素個人因素相關因素活動身體功能與身體結構參與健康狀況(疾病、外傷)功能與殘疾的綜合模式第三頁，共九十一頁。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、應激、先天畸形以及遺傳因素等健康狀況使用ICD-10作為標準編碼第四頁，共九十一頁。5環境因素個人因素相關因素活動身體功能與身體結構參與慢性膝關節不穩M 23.5功能與殘疾的綜合模式第五頁，共九十一頁。6身體功能與身體結構身體功能指身

2、體的生理功能，包括心理功能身體結構指身體的解剖結構，例如器官、肢體和相關部件相當于障礙Impairments第六頁，共九十一頁。7環境因素個人因素相關因素活動疼痛、關節穩定性、交叉韌帶參與慢性膝關節不穩M 23.5功能與殘疾的綜合模式第七頁，共九十一頁。8活動與參與活動指個人執行任務或者個人的行動，代表個體功能參與指參加生活環境的活動，代表社會功能活動限制參與限制第八頁，共九十一頁。9環境因素個人因素相關因素攜帶物體、彎膝、步行、攀爬疼痛、關節穩定性、交叉韌帶照顧孫子、家務、協助丈夫工作慢性膝關節不穩M 23.5功能與殘疾的綜合模式第九頁，共九十一頁。10環境因素人們居住和生活的物理、社會和態

3、度環境環境因素是個人之外的因素積極因素 (facilitator)消極因素(barrier)第十頁，共九十一頁。11-住在4樓，無電梯+使用拐杖/康復/藥物治療個人因素相關因素攜帶物體、彎膝、步行、攀爬疼痛、關節穩定性、交叉韌帶照顧孫子、家務、協助丈夫工作慢性膝關節不穩M 23.5功能與殘疾的綜合模式第十一頁，共九十一頁。12個人因素包括性別、年齡、人種、體質、生活方式、習慣、社會背景、其它社會功能第十二頁，共九十一頁。13-住在4樓，無電梯+使用拐杖、康復治療、藥物治療60歲，生性積極相關因素攜帶物體、彎膝、步行、攀爬疼痛、關節穩定性、交叉韌帶照顧孫子、家務、協助丈夫工作慢性膝關節不穩M 2

4、3.5功能與殘疾的綜合模式第十三頁，共九十一頁。14身體結構和功能障礙活動受限參與限制殘疾第十四頁，共九十一頁。15身體結構和功能 與參與活動功能改善第十五頁，共九十一頁。16功能改善第十六頁，共九十一頁。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第十七頁，共九十一頁。18第十八頁，共九十一頁。19健康狀況疾病、外傷253項環境因素個人因素相關因素384項活動與參與493項身體結構310項身體功能第十九頁，共九十一頁。20b1 b8s1 s8d1 d9e1 e5章ICF 金字塔結構ICF身體功能身體結構活動與參與環境因素個人因素bsde第二十頁，共九十一頁。21第一級：身體

5、結構與功能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, immunological and respiratory systems聲音和言語相關的組織結構The eye, ear and relate

6、d structuresStructures of the nervous systemFunctions of the skin and related structuresNeuromusculoskeletal and movement-related functionsGenitourinary and reproductive functionsFunctions of the digestive, metabolic and endocrine systemsFunctions of the cardiovascular, haematological, immunological

7、 and respiratory systems聲音和言語功能Sensory functions and painMental functionsChapter 8Chapter 7Chapter 6Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1身體結構 (s)身體功能 (b)第二十一頁，共九十一頁。22第一級：活動與參與主要的生活區域人際關系家庭區域個人自理活動交流一般任務與需求學習與應用技術社區、社會和公民活動Chapter 8Chapter 7Chapter 6Chapter 5Chapter 4Chapter 3Chapter 2Chapte

8、r 1Chapter 9第二十二頁，共九十一頁。23第一級：環境因素 (e)服務、體系與政策態度支持與關系自然環境和人類對環境的改造產品與技術Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1第二十三頁，共九十一頁。24b1 b8s1 s8d1 d9e1 e5ChaptersICF 第二級結構ICF身體功能身體結構活動與參與環境因素個人因素bsdeb110 b899s110 s899d110 d999e110 e5992nd Level第二十四頁，共九十一頁。25第二級結構 舉例章節b1 腦高級功能 Mental function整體腦高級功能 (b11

9、0 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)第二十五頁，共九十一頁。26ICFBody Functions bb1100 b7809b11420 b54509b1 b8b110 b899Body Structuresss1 s8s110 s899s1100 s8309s11000 s76009Activity & Participationdd1 d9d110 d999d1150 d9309Env

10、ironmental Factorsee1 e5e110 e599e1100 e5959ICF 三級結構The higher the more precise第二十六頁，共九十一頁。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 條目舉例三級四級第二十七頁，共九十一頁。28ICF總條目：1454有多少在特定的疾病需要？臨床和科研有何用途？評判標準？第二十八頁，共九十一頁。開展ICF核心組合 Core Sets第二十九頁，共九十一頁。30瞎子摸象的故事第三十頁，共九十一頁

11、。31ICF and ICF Core Sets確定評定條目what to measure應用根底：how to measure第三十一頁，共九十一頁。32b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d230d360d410 d415d430 e110e115e120e125e135e150 1454ICF 核心組合第三十二頁，共九十一頁。33b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d230d360d410 d415d430 e110e115e12

12、0e125e135e150 1454ICF 核心組合特定疾病特定環境第三十三頁，共九十一頁。34骨關節炎OA 身體功能b280 疼痛的感覺b710 關節活動功能b730 肌肉功能b770 步態b715 關節穩定性b740 肌肉耐力b780 與肌肉相關的感覺和運動功能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核心組合第三十四頁，共九十一頁。35 s750下肢結構s730上肢結構s770其它與運動相關的 肌肉骨骼結構s740骨盆結構s720肩部結構OA 身體結構簡要ICF核心組合全套ICF核心組合第三十五頁，共九十一頁。36d450步行d540穿衣d4

13、45 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d910社區生活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核心組合第三十六頁，共九十一頁。37e115 與個人日常生活相關的產品與技術e310 近親e580 醫療效勞、體系和政策e150 公共場合的建筑設計、產品和技術e355 醫務人員e540 交通效勞、體系和政策e120 個人室內和室外活動和交通的產品與技術e135 就業相關的產品與技術e155 私人使用的建筑設計、建造和建筑產品e340 個人護理人員和助手OA 環境因素簡要ICF核心組合全套ICF核

14、心組合第三十七頁，共九十一頁。38 定量分級Qualifiers 問題的嚴重程度如何量化已經清楚的?是 功能障礙是什么并不清楚的?是b1141.0123489第三十八頁，共九十一頁。第三十九頁，共九十一頁。40定量分級(qualifier)0沒有問題(無、缺乏、可以無視等) 0-4% 1 輕度問題(輕、低等) 5-24% 2 中度問題(中等、較好等) 25-49% 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 (當前的信息無法確定嚴重程度)9無法應用 (不恰當或者不可能使用)第四十頁，共九十一頁。41環境因素雙向分級障礙因素Barrie

15、r -促進因素Facilitator + 第四十一頁，共九十一頁。42第四十二頁，共九十一頁。43Problem-solving approach第四十三頁，共九十一頁。44Rehab-CycleAssessmentEvaluationAssignmentIntervention第四十四頁，共九十一頁。45AssessmentEvaluationAssignmentInterventionRehab-CycleICF ModelICF & ICF Core Sets第四十五頁，共九十一頁。46Diagnosis (ICD-10)Rehabilitaton goalsteam perspecti

16、veenvironmental factorspersonal factorsbody structures & 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!第四十六頁，共九十一頁。47Diagnosis (ICD-10)Rehabilitato

17、n goalsteam perspectiveenvironmental factorspersonal factorsbody structures & functionsactivities & participationpatient perspective第四十七頁，共九十一頁。48Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-dia

18、gnosis 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 in lifting thin

19、gs 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 for hand use+,

20、Supportive husband+Self-help group+Motivated+adequate coping strategies+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:Lon

21、g-term goal: 第四十八頁，共九十一頁。49Assessment 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 fin

22、gersShortened 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

23、 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+b710 Mobility of joint functionsb715 Stability

24、of joint functionsb730 Muscle power functionsb435 Immunological system functionss7302 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

25、 Doing houseworkd4500 Walking short distancesd4551 ClimbingGoals of rehabilitationIntervention program goal:Long-term goal: 第四十九頁，共九十一頁。50Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis I

26、CD-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 in lifting things above

27、 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 for hand use+, Supporti

28、ve 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 rightDegenerative changes in fingersFingers

29、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 goal: 第五十頁，共九十一頁。51

30、REHAB-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 goals.第五十一頁，共九十一頁。52Assessment with the ICF SheetGoals of rehabilitationInter

31、vention program goal: Independence in self-care and housework Long-term goal: Vocational retraining Patients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in

32、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 had to g

33、ive 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 strategies+Imp

34、aired 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 swollen

35、Hallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal:Long-term goal: 第五十二頁，共九十一頁。53REHAB-CycleAssessment in four stepsIdentification of the problems

36、and needs of the patient,Determination of the long-term, intervention program and cycle goals andIdentification of intervention targets related to the cycle goals.第五十三頁，共九十一頁。54Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/Partic

37、ipationPersonal 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 h

38、airDifficulties 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 elev

39、ator 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 right

40、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 rehabilitationIntervention pro

41、gram goal: Independence in self-care and housework Long-term goal: Vocational retraining What is related to (determine) the cycle goals?Determine the intervention targets第五十四頁，共九十一頁。55Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities

42、/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 co

43、mbing 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;

44、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 drif

45、t 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 rehabilitationIntervent

46、ion program goal: Independence in self-care and housework Long-term goal: Vocational retraining 第五十五頁，共九十一頁。56Rehab-CycleAssessmentAssignment第五十六頁，共九十一頁。57Asignment Health ProfessionalsProgram or serviceInpatient or outpatient rehab, home rehabType of specific serviceSingle vs groupFirst interventio

47、n, refresher第五十七頁，共九十一頁。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 shoulderPain in hands and fing

48、ersShortened 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

49、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 stabil

50、ityImpaired 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

51、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 第五十八頁，共九十一頁。59Asignment Health ProfessionalsProgram or service

52、Inpatient or outpatient rehab, home rehabType of specific serviceSingle vs groupFirst intervention, refresherIntervention第五十九頁，共九十一頁。60AssessmentAssignmentInterventionRehab-Cycle第六十頁，共九十一頁。61Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Act

53、ivities/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

54、 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 in a fourth floor

55、 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 3 right, beginning uln

56、ar 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 Goals of rehabilitationIn

57、tervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 第六十一頁，共九十一頁。62AssessmentEvaluationAssignmentInterventionRehab-Cycle第六十二頁，共九十一頁。63Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities

58、/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 co

59、mbing 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;

60、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 drif