康复概论——6.ICF在康复医学中的应用.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,1,环境因素,个人因素,相关因素,活动,身体功能与身体结构,参与,健康状况,(,疾病、外伤,),功能与残疾的综合模式,2,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,作为标准编码,8,身体功能与身体结构,身体功能指身体的生理功能，包括心理功能,身体结构指身体的解剖结构，例如器官、肢体和相关部件,9,环境因素,个人因素,相关因素,活动,疼痛、关节稳定性、交叉韧带,参与,慢性膝关节不稳,M 23.5,功能与残疾的综合模式,10,活动与参与,活动指个人执行任务或者个人的行动，代表个体功能,参与指参加生活环境的活动，代表社会功能,活动限制,参与限制,11,环境因素,个人因素,相关因素,携带物体、弯膝、步行、攀爬,疼痛、关节稳定性、交叉韧带,照顾孙子、家务、协助丈夫工作,慢性膝关节不稳,M 23.5,功能与残疾的综合模式,12,环境因素,人们居住和生活的物理、社会和态度环境,环境因素是个人之外的因素,积极因素,(facilitator),消极因素,(barrier),13,-,住在,4,楼，无电梯,+,使用拐杖,/,康复,/,药物治疗,个人因素,相关因素,携带物体、弯膝、步行、攀爬,疼痛、关节稳定性、交叉韧带,照顾孙子、家务、协助丈夫工作,慢性膝关节不稳,M 23.5,功能与残疾的综合模式,14,个人因素,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,15,-,住在,4,楼，无电梯,+,使用拐杖、康复治疗、药物治疗,60,岁，生性积极,相关因素,携带物体、弯膝、步行、攀爬,疼痛、关节稳定性、交叉韧带,照顾孙子、家务、协助丈夫工作,慢性膝关节不稳,M 23.5,功能与残疾的综合模式,16,身体结构和功能障碍,活动受限,参与限制,残疾,17,身体结构和功能,与参与,活动,功能改善,18,功能改善,19,ICF,是国际通用的描述功能、残疾和健康状况的国际语言和概念,20,21,健康状况（疾病、外伤）,253,项环境因素,个人因素,相关因素,384,项活动与参与,493,项身体结构,310,项身体功能,22,b,1,b,8,s,1,s,8,d,1,d,9,e,1,e,5,章,ICF,金字塔结构,ICF,身体功能,身体结构,活动与参与,环境因素,个人因素,b,s,d,e,23,第一级：身体结构与功能,Skin and related structures,Structures related to movement,Structures related to the genitourinary and reproductive systems,Structures related to the digestive,metabolic and endocrine systems,Structures of the cardiovascular,immunological and respiratory systems,声音和言语相关的组织结构,The eye,ear and related structures,Structures of the nervous system,Functions of the skin and related structures,Neuromusculoskeletal and movement-related functions,Genitourinary and reproductive functions,Functions of the digestive,metabolic and endocrine systems,Functions of the cardiovascular,haematological,immunological and respiratory systems,声音和言语功能,Sensory functions and pain,Mental functions,Chapter 8,Chapter 7,Chapter 6,Chapter 5,Chapter 4,Chapter 3,Chapter 2,Chapter 1,身体结构,(s),身体功能,(b),24,第一级：活动与参与,主要的生活区域,人际关系,家庭区域,个人自理,活动,交流,一般任务与需求,学习与应用技术,社区、社会和公民活动,Chapter 8,Chapter 7,Chapter 6,Chapter 5,Chapter 4,Chapter 3,Chapter 2,Chapter 1,Chapter 9,25,第一级：环境因素,(e),服务、体系与政策,态度,支持与关心,自然环境和人类对环境的改造,产品与技术,Chapter 5,Chapter 4,Chapter 3,Chapter 2,Chapter 1,26,b,1,b,8,s,1,s,8,d,1,d,9,e,1,e,5,Chapters,ICF,第二级结构,ICF,身体功能,身体结构,活动与参与,环境因素,个人因素,b,s,d,e,b,1,10,b,8,99,s,1,10,s,8,99,d,1,10,d,9,99,e,1,10,e,5,99,2nd Level,27,第二级结构,举例,章节,b1,脑高级功能,Mental function,整体脑高级功能,(b1,10,b1,39,),b110,意识,b,1,14,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(b1,40,b1,89,),28,ICF,Body,Functions b,b,1,10,0,b,7,80,9,b,1,14,2,0,b,5,45,0,9,b,1,b,8,b,1,10,b,8,99,Body,Structures,s,s,1,s,8,s,1,10,s,8,99,s,1,10,0,s,8,30,9,s,1,10,0,0,s,7,60,0,9,Activity&,Participation,d,d,1,d,9,d,1,10,d,9,99,d,1,15,0,d,9,30,9,Environmental,Factors,e,e,1,e,5,e,1,10,e,5,99,e,1,10,0,e,5,95,9,ICF,三级结构,The higher the more precise,29,b,脑高级功能,Mental functions,一级,b,1,14,定向功能,二级,b,1,14,1,地点定向,b,1,14,2,人物定向,b,1,14,2,0,自我定向,b,1,14,2,1,他人定向,ICF,条目举例,三级,四级,d,b,36,ICF,总条目：,1454,有多少在特定的疾病需要？临床和科研有何用途？评判标准？,发展,ICF,核心组合,Core Sets,38,盲人摸象的故事,39,ICF and ICF Core Sets,确定评定条目,what to measure,应用基础：,how to measure,40,b1,b130,b134,b152,b180,b1801,s299,s710,s720,s730,s73001,s73011,d170,d230,d360,d410,d415,d430,e110,e115,e120,e125,e135,e150,1454,ICF,核心组合,41,b1,b130,b134,b152,b180,b1801,s299,s710,s720,s730,s73001,s73011,d170,d230,d360,d410,d415,d430,e110,e115,e120,e125,e135,e150,1454,ICF,核心组合,特定疾病,特定环境,42,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,简要,ICF,核心组合,全套,ICF,核心组合,43,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,简要,ICF,核心组合,全套,ICF,核心组合,44,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,简要,ICF,核心组合,全套,ICF,核心组合,45,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、体系和政策,e120,个人室内和室外活动和交通的产品与技术,e135,就业相关的产品与技术,e155,私人使用的建筑设计、建造和建筑产品,e340,个人护理人员和助手,OA,环境因素,简要,ICF,核心组合,全套,ICF,核心组合,46,定量分级,Qualifiers,问题的严重程度如何量化,已经清楚的,?,是,功能障碍是什么,并不清楚的,?,是,b,1,14,1.,0,1,2,3,4,8,9,48,定量分级,(qualifier),0,没有问题,(,无、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,),49,50,Problem-solving approach,51,Rehab-Cycle,Assessment,Evaluation,Assignment,Intervention,52,Assessment,Evaluation,Assignment,Intervention,Rehab-Cycle,ICF Model,ICF&ICF Core Sets,53,Diagnosis(ICD-10),Rehabilitaton goals,team perspective,environmental factors,personal factors,body structures&functions,activities&participation,patient perspective,What are the patients problems and needs from his/her perspective?,What are the patients problems from the team perspective?,Use the ICF Core Sets!,54,Diagnosis(ICD-10),Rehabilitaton goals,team perspective,environmental factors,personal factors,body structures&functions,activities&participation,patient perspective,55,Assessment with the,ICF Sheet,Patient,s perspective,Rehabilitation team perspective,Body-Structures/Functions,Activities/Participation,Personal Factors,Reha-diagnosis ICD-10,chronic polyarthritis ICD:M05.9,Environmental Factors,Pain in right knee and shoulder,Pain in hands and fingers,Shortened mobility and flexibility,Swelling in finger,wrist and knee joints,Difficulties in getting dressed,Problems in brushing teeth and combing hair,Difficulties in lifting things above the head,Problems preparing meals,Problems doing housework,I had to give up my job as a secretary,All my free-time activities are affected,My intimate relationship with my husband is also affected because of the pain,Medication+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 problems from the rehabilitation team perspective?,Use the ICF-Core-sets as a Checklist!,Goals of rehabilitation,Intervention program goal:,Long-term goal:,56,Assessment with the,ICF Sheet,Patient,s perspective,Rehabilitation team perspective,Body-Structures/Functions,Activities/Participation,Personal Factors,Reha-diagnosis ICD-10,chronic polyarthritis ICD:M05.9,Environmental Factors,Pain in right knee and shoulder,Pain in hands and fingers,Shortened mobility and flexibility,Swelling in finger,wrist and knee joints,Difficulties in getting dressed,Problems in brushing teeth and combing hair,Difficulties in lifting things above the head,Problems preparing meals,Problems doing housework,I had to give up my job as a secretary,All my free-time activities are affected,My intimate relationship with my husband is also affected because of the pain,Medication+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 functions,b715 Stability of joint functions,b730 Muscle power functions,b435 Immunological system functions,s7302 Structure of hand,s73011 Wrist joint,s73021 Joints of hand and fingers,s75011 Knee joint,s7502 Structure of ankle and foot,d440 Fine hand use,d445 Hand and arm use,d430 Lifting and carrying objects,d630 Preparing meals,d640 Doing housework,d4500 Walking short distances,d4551 Climbing,Goals of rehabilitation,Intervention program goal:,Long-term goal:,57,Assessment with the,ICF Sheet,Patient,s perspective,Rehabilitation team perspective,Body-Structures/Functions,Activities/Participation,Personal Factors,Reha-diagnosis ICD-10,chronic polyarthritis ICD:M05.9,Environmental Factors,Pain in right knee and shoulder,Pain in hands and fingers,Shortened mobility and flexibility,Swelling in finger,wrist and knee joints,Difficulties in getting dressed,Problems in brushing teeth and combing hair,Difficulties in lifting things above the head,Problems preparing meals,Problems doing housework,I had to give up my job as a secretary,All my free-time activities are affected,My intimate relationship with my husband is also affected because of the pain,Medication+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 joints,Impaired joint stability,Impaired muscle strength,Inflammation parameters in blood,Subluxation of metacarpophalangeal(MCP),D,egenerative changes in fingers,Fingers and wrist joints swollen,Right knee swollen,Both ankle joints swollen,Hallux valgus positiion,rightleft,Fine hand use,Hand and arm use,Lifting and carrying objects,Preparing meals,Housework,Walking short distances,Climbing stairs,Goals of rehabilitation,Intervention program goal:,Long-term goal:,58,REHAB-Cycle,Assessment in three steps,Identification of the problems and needs of the patient,Determination of the long-term,intervention program and cycle goals and,Identification of intervention targets related to the cycle goals.,59,Assessment with the,ICF Sheet,Goals of rehabilitation,Intervention program goal:,Independence in self-care and housework,Long-term goal:,Vocational retraining,Patient,s perspective,Rehabilitation team perspective,Body-Structures/Functions,Activities/Participation,Personal Factors,Reha-diagnosis ICD-10,chronic polyarthritis ICD:M05.9,Environmental Factors,Pain in right knee and shoulder,Pain in hands and fingers,Shortened mobility and flexibility,Swelling in finger,wrist and knee joints,Difficulties in getting dressed,Problems in brushing teeth and combing hair,Difficulties in lifting things above the head,Problems preparing meals,Problems doing housework,I had to give up my job as a secretary,All my free-time activities are affected,My intimate relationship with my husband is also affected because of the pain,Medication+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 joints,Impaired joint stability,Impaired muscle strength,Inflammation parameters in blood,Subluxation of metacarpophalangeal(MCP),D,egenerative changes in fingers,Fingers and wrist joints swollen,Right knee swollen,Both ankle joints swollen,Hallux valgus positiion,rightleft,Fine hand use,Hand and arm use,Lifting and carrying objects,Preparing meals,Housework,Walking short distances,Climbing stairs,Goals of rehabilitation,Intervention program goal:,Long-term goal:,60,REHAB-Cycle,Assessment in three steps,Identification of the problems and needs of the patient,Determination of the long-term,intervention program and cycle goals.,Identification of intervention targets related to the cycle goals.,61,Assessment with the,ICF Sheet,Patient,s perspective,Rehabilitation team perspective,Body-Structures/Functions,Activities/Participation,Personal Factors,Reha-diagnosis ICD-10,chronic polyarthritis ICD:M05.9,Environmental Factors,Pain in right knee and shoulder,Pain in hands and fingers,Shortened mobility and flexibility,Swelling in finger,wrist and knee joints,Difficulties in getting dressed,Problems in brushing teeth and combing hair,Difficulties in lifting things above the head,Problems preparing meals,Problems doing housework,I had to give up my job as a secretary,All my free-time activities are affected,My intimate relationship with my husband is also affected because of the pain,Medication+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 joints,Impaired joint stability,Impaired muscle strength,Inflammation parameters in blood,Subluxation of metacarpophalangeal(MCP),D,egenerative changes in fingers,Fingers and wrist joints swollen,Right knee swollen,Both ankle joints swollen,Hallux valgus positiion,rightleft,Fine hand use,Hand and arm use,Lifting and carrying objects,Preparing meals,Housework,Walking short distances,Climbing stairs,Goals of rehabilitation,Intervention program goal:,Independence in self-care and housework,Long-term goal:,Vocational retraining,What is related to(determine)the cycle goals?,Determine the intervention targets,62,Assessment with the,ICF Sheet,Patient,s perspective,Rehabilitation team perspective,Body-Structures/Functions,Activities/Participation,Personal Factors,Reha-diagnosis ICD-10,chronic polyarthritis ICD:M05.9,Environmental Factors,Pain in right knee and shoulder,Pain in hands and fingers,Shortened mobility and flexibility,Swelling in finger,wrist and knee joints,Difficulties in getting dressed,Problems in brushing teeth and combing hair,Difficulties in lifting things above the head,Problems preparing meals,Problems doing housework,I had to give up my job as a secretary,All my free-time activities are affected,My intimate relationship with my husband is also affected because of the pain,Medication+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 joints,Impaired joint stability,Impaired muscle strength,Inflammation parameters in blood,Subluxation of metacarpophalangeal(MCP),joints 2 and 3 right,beginning ulnar drift right,D,egenerative changes in fingers,Fingers and wrist joints swollen,Right knee swollen,Both ankle joints swollen,Hallux valgus positiion,rightleft,Fine hand use,Hand and arm use,Lifting and carrying objects,Preparing meals,Housework,Walking short distances,Climbing stairs,Goals of rehabilitation,Intervention program goal:,Independence in self-care and housework,Long-term goal:,Vocational retraining,63,Rehab-Cycle,Assessment,Assignment,64,Assignment,Health Professionals,Program or service,Inpatient or outpatient rehab,home rehab,Type of specific service,Single vs group,First intervention,refresher,65,Assessment with the,ICF Sheet,Patient,s perspective,Rehabilitation team perspective,Body-Structures/Functions,Activities/Participation,Personal Factors,Reha-diagnosis ICD-10,chronic polyarthritis ICD:M05.9,Environmental Factors,Pain in right knee and shoulder,Pain in hands and fingers,Shortened mobility and flexibility,Swelling in finger,wrist and knee joints,Difficulties in getting dressed,Problems in brushing teeth and combing hair,Difficulties in lifting things above the head,Problems preparing meals,Problems doing housework,I had to give up my job as a secretary,All my free-time activities are affected,My intimate relationship with my husband is also affected because of the pain,Medication+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 joints,Impaired joint stability,Impaired muscle strength,Inflammation parameters in blood,Subluxation of metacarpophalangeal(MCP),joints 2 and 3 right,beginning ulnar drift right,D,egenerative changes in fingers,Fingers and wrist joints swollen,Right knee swollen,Both ankle joints swollen,Hallux valgus positiion,rightleft,Fine hand use,Hand and arm use,Lifting and carrying