1環境原因個人原因相關原因活動身體功效與身體結構參加健康情況

(疾病、外傷)功效與殘疾綜合模式康復概論ICF在康復醫學中的應用專家講座第1頁2健康情況健康情況是疾病、疾患、損傷或者外傷總稱健康情況能夠包含其它情況，比如老齡、應激、先天畸形以及遺傳原因等健康情況使用ICD-10作為標準編碼康復概論ICF在康復醫學中的應用專家講座第2頁康復概論ICF在康復醫學中的應用專家講座第3頁康復概論ICF在康復醫學中的應用專家講座第4頁康復概論ICF在康復醫學中的應用專家講座第5頁康復概論ICF在康復醫學中的應用專家講座第6頁7環境原因個人原因相關原因活動身體功效與身體結構參加慢性膝關節不穩

M23.5功效與殘疾綜合模式康復概論ICF在康復醫學中的應用專家講座第7頁8身體功效與身體結構身體功效指身體生理功效，包含心理功效身體結構指身體解剖結構，比如器官、肢體和相關部件康復概論ICF在康復醫學中的應用專家講座第8頁9環境原因個人原因相關原因活動疼痛、關節穩定性、交叉韌帶參加慢性膝關節不穩

M23.5功效與殘疾綜合模式康復概論ICF在康復醫學中的應用專家講座第9頁10活動與參加活動指個人執行任務或者個人行動，代表個體功效參加指參加生活環境活動，代表社會功效活動限制參加限制康復概論ICF在康復醫學中的應用專家講座第10頁11環境原因個人原因相關原因攜帶物體、彎膝、步行、攀爬疼痛、關節穩定性、交叉韌帶照料孫子、家務、幫助丈夫工作慢性膝關節不穩

M23.5功效與殘疾綜合模式康復概論ICF在康復醫學中的應用專家講座第11頁12環境原因人們居住和生活物理、社會和態度環境環境原因是個人之外原因主動原因

(facilitator)消極原因(barrier)康復概論ICF在康復醫學中的應用專家講座第12頁13-住在4樓，無電梯+使用拐杖/康復/藥品治療個人原因相關原因攜帶物體、彎膝、步行、攀爬疼痛、關節穩定性、交叉韌帶照料孫子、家務、幫助丈夫工作慢性膝關節不穩

M23.5功效與殘疾綜合模式康復概論ICF在康復醫學中的應用專家講座第13頁14個人原因包含性別、年紀、人種、體質、生活方式、習慣、社會背景、其它社會功效康復概論ICF在康復醫學中的應用專家講座第14頁15-住在4樓，無電梯+使用拐杖、康復治療、藥品治療60歲，生性主動相關原因攜帶物體、彎膝、步行、攀爬疼痛、關節穩定性、交叉韌帶照料孫子、家務、幫助丈夫工作慢性膝關節不穩

M23.5功效與殘疾綜合模式康復概論ICF在康復醫學中的應用專家講座第15頁16身體結構和功效障礙活動受限參加限制殘疾康復概論ICF在康復醫學中的應用專家講座第16頁17身體結構和功效與參加活動功效改進康復概論ICF在康復醫學中的應用專家講座第17頁18功效改進康復概論ICF在康復醫學中的應用專家講座第18頁19ICF是國際通用描述功效、殘疾和健康情況國際語言和概念康復概論ICF在康復醫學中的應用專家講座第19頁20康復概論ICF在康復醫學中的應用專家講座第20頁21健康情況（疾病、外傷）253項環境原因個人原因相關原因384項活動與參加493項身體結構310項身體功效康復概論ICF在康復醫學中的應用專家講座第21頁22b1

–

b8s1

–

s8d1

–

d9e1

–

e5章ICF–

金字塔結構ICF身體功效身體結構活動與參加環境原因個人原因bsde康復概論ICF在康復醫學中的應用專家講座第22頁23第一級：身體結構與功效

SkinandrelatedstructuresStructuresrelatedtomovementStructuresrelatedtothegenitourinaryandreproductivesystemsStructuresrelatedtothedigestive,metabolicandendocrinesystemsStructuresofthecardiovascular,immunologicalandrespiratorysystems聲音和言語相關組織結構Theeye,earandrelatedstructuresStructuresofthenervoussystemFunctionsoftheskinandrelatedstructuresNeuromusculoskeletalandmovement-relatedfunctionsGenitourinaryandreproductivefunctionsFunctionsofthedigestive,metabolicandendocrinesystemsFunctionsofthecardiovascular,haematological,immunologicalandrespiratorysystems聲音和言語功效SensoryfunctionsandpainMentalfunctionsChapter8Chapter7Chapter6Chapter5Chapter4Chapter3Chapter2Chapter1身體結構(s)身體功效

(b)康復概論ICF在康復醫學中的應用專家講座第23頁24第一級：活動與參加主要生活區域 人際關系家庭區域 個人自理活動交流普通任務與需求學習與應用技術小區、社會和公民活動Chapter8Chapter7Chapter6Chapter5Chapter4Chapter3Chapter2Chapter1Chapter9康復概論ICF在康復醫學中的應用專家講座第24頁25第一級：環境原因(e)服務、體系與政策態度支持與關心自然環境和人類對環境改造產品與技術Chapter5Chapter4Chapter3Chapter2Chapter1康復概論ICF在康復醫學中的應用專家講座第25頁26b1

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b8s1

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s8d1

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d9e1

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e5ChaptersICF–

第二級結構ICF身體功效身體結構活動與參加環境原因個人原因bsdeb110

–

b899s110

–

s899d110

–

d999e110

–

e5992ndLevel康復概論ICF在康復醫學中的應用專家講座第26頁27第二級結構–

舉例章節 b1腦高級功效Mentalfunction整體腦高級功效(b110

–b139)b110 意識b114 定向b117 智力b122 整體心理功效b126 個性b130 主觀能動性b134 睡眠b139 非特指整體心理功效特定腦高級功效Specificmentalfunctions(b140

–b189)康復概論ICF在康復醫學中的應用專家講座第27頁28ICFBodyFunctionsbb1100

–

b7809b11420

–

b54509b1

–

b8b110

–

b899BodyStructuresss1

–

s8s110

–

s899s1100

–

s8309s11000

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s76009Activity&Participationdd1

–

d9d110

–

d999d1150

–

d9309EnvironmentalFactorsee1

–

e5e110

–

e599e1100

–

e5959ICF–

三級結構Thehigherthemoreprecise康復概論ICF在康復醫學中的應用專家講座第28頁29b

腦高級功效Mentalfunctions 一級

b114

定向功效

二級

b1141地點定向

b1142人物定向

b11420自我定向

b11421他人定向ICF條目舉例三級四級康復概論ICF在康復醫學中的應用專家講座第29頁康復概論ICF在康復醫學中的應用專家講座第30頁康復概論ICF在康復醫學中的應用專家講座第31頁d

b

康復概論ICF在康復醫學中的應用專家講座第32頁康復概論ICF在康復醫學中的應用專家講座第33頁康復概論ICF在康復醫學中的應用專家講座第34頁康復概論ICF在康復醫學中的應用專家講座第35頁36ICF總條目：1454

有多少在特定疾病需要？

臨床和科研有何用途？

評判標準？康復概論ICF在康復醫學中的應用專家講座第36頁發展ICF關鍵組合CoreSets

康復概論ICF在康復醫學中的應用專家講座第37頁38盲人摸象故事康復概論ICF在康復醫學中的應用專家講座第38頁39ICFandICFCoreSets確定評定條目whattomeasure應用基礎：howtomeasure康復概論ICF在康復醫學中的應用專家講座第39頁40b1b130b134b152b180b1801

s299s710s720s730s73001s73011

d170d230d360d410d415d430

e110e115e120e125e135e150

1454ICF關鍵組合康復概論ICF在康復醫學中的應用專家講座第40頁41b1b130b134b152b180b1801

s299s710s720s730s73001s73011

d170d230d360d410d415d430

e110e115e120e125e135e150

1454ICF關鍵組合特定疾病特定環境康復概論ICF在康復醫學中的應用專家講座第41頁42骨關節炎OA–

身體功效b280 疼痛感覺 b710 關節活動功效 b730 肌肉功效b770 步態b715 關節穩定性b740 肌肉耐力b780 與肌肉相關感覺和運動功效b760 自主運動控制b134 睡眠功效b735肌肉張力簡明ICF關鍵組合全套ICF關鍵組合康復概論ICF在康復醫學中的應用專家講座第42頁43

s750 下肢結構s730 上肢結構s770 其它與運動相關肌肉骨骼結構

s740 骨盆結構s720 肩部結構OA–

身體結構簡明ICF關鍵組合全套ICF關鍵組合康復概論ICF在康復醫學中的應用專家講座第43頁44d450 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d910 小區生活d440 手精細活動d410 改變身體位置OA–

活動與參加簡明ICF關鍵組合全套ICF關鍵組合康復概論ICF在康復醫學中的應用專家講座第44頁45e115

與個人日常生活相關產品與技術e310 近親e580 醫療服務、體系和政策e150 公共場所建筑設計、產品和技術

e355 醫務人員e540 交通服務、體系和政策e120 個人室內和室外活動和交通產品與技術

e135 就業相關產品與技術e155 私人使用建筑設計、建造和建筑產品

e340個人護理人員和助手OA–

環境原因簡明ICF關鍵組合全套ICF關鍵組合康復概論ICF在康復醫學中的應用專家講座第45頁46

定量分級Qualifiers

問題嚴重程度怎樣量化已經清楚?是功效障礙是什么并不清楚?是b1141.0123489康復概論ICF在康復醫學中的應用專家講座第46頁康復概論ICF在康復醫學中的應用專家講座第47頁48定量分級(qualifier)0 沒有問題(無、缺乏、能夠忽略等)

0-4%

1輕度問題(輕、低等)

5-24%

2中度問題(中等、很好等)

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)康復概論ICF在康復醫學中的應用專家講座第48頁49康復概論ICF在康復醫學中的應用專家講座第49頁50Problem-solvingapproach康復概論ICF在康復醫學中的應用專家講座第50頁51Rehab-CycleAssessmentEvaluationAssignmentIntervention康復概論ICF在康復醫學中的應用專家講座第51頁52AssessmentEvaluationAssignmentInterventionRehab-CycleICFModelICF&ICFCoreSets康復概論ICF在康復醫學中的應用專家講座第52頁53Diagnosis(ICD-10)Rehabilitatongoalsteamperspectiveenvironmentalfactors personalfactors bodystructures&functionsactivities&participationpatientperspectiveWhatarethepatient'sproblemsandneedsfromhis/herperspective?Whatarethepatient'sproblemsfromtheteamperspective?UsetheICFCoreSets!康復概論ICF在康復醫學中的應用專家講座第53頁54Diagnosis(ICD-10)Rehabilitatongoalsteamperspectiveenvironmentalfactors personalfactors bodystructures&functionsactivities&participationpatientperspective康復概論ICF在康復醫學中的應用專家講座第54頁55AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+Whatarethepatients'problemsandneedsfromhis/herperspective?Whatarethepatients'problemsfromtherehabilitationteamperspective?UsetheICF-Core-setsasaChecklist!GoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

康復概論ICF在康復醫學中的應用專家講座第55頁56AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+b710Mobilityofjointfunctionsb715Stabilityofjointfunctionsb730Musclepowerfunctionsb435Immunologicalsystemfunctionss7302Structureofhands73011Wristjoints73021Jointsofhandandfingerss75011Kneejoints7502Structureofankleandfootd440Finehandused445Handandarmused430Liftingandcarryingobjectsd630Preparingmealsd640Doinghouseworkd4500Walkingshortdistancesd4551ClimbingGoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

康復概論ICF在康復醫學中的應用專家講座第56頁57AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)DegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

康復概論ICF在康復醫學中的應用專家講座第57頁58REHAB-CycleAssessmentinthreestepsIdentificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoalsandIdentificationofinterventiontargetsrelatedtothecyclegoals.康復概論ICF在康復醫學中的應用專家講座第58頁59AssessmentwiththeICFSheetGoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

Patient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)DegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

康復概論ICF在康復醫學中的應用專家講座第59頁60REHAB-CycleAssessmentinthreestepsIdentificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoals.Identificationofinterventiontargetsrelatedtothecyclegoals.康復概論ICF在康復醫學中的應用專家講座第60頁61AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)DegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

Whatisrelatedto(determine)thecyclegoals?Determinetheinterventiontargets康復概論ICF在康復醫學中的應用專家講座第61頁62AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

康復概論ICF在康復醫學中的應用專家講座第62頁63Rehab-CycleAssessmentAssignment康復概論ICF在康復醫學中的應用專家講座第63頁64Assignment HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresher康復概論ICF在康復醫學中的應用專家講座第64頁65AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

康復概論ICF在康復醫學中的應用專家講座第65頁66Assignment HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresherIntervention康復概論ICF在康復醫學中的應用專家講座第66頁67AssessmentAssignmentInterventionRehab-Cycle康復概論ICF在康復醫學中的應用專家講座第67頁68AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRig