康復(fù)概論——6.ICF在康復(fù)醫(yī)學(xué)中的應(yīng)用

.,牛燕媚（講師）天津醫(yī)科大學(xué)康復(fù)與運(yùn)動(dòng)醫(yī)學(xué)系,國(guó)際功能、殘疾和健康分類InternationalClassificationofFunctioning,DisabilityandHealth,.,2,環(huán)境因素,個(gè)人因素,相關(guān)因素,活動(dòng),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,.,3,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(zhǔn)編碼,.,.,.,.,.,8,環(huán)境因素,個(gè)人因素,相關(guān)因素,活動(dòng),身體功能與身體結(jié)構(gòu),參與,慢性膝關(guān)節(jié)不穩(wěn)M23.5,功能與殘疾的綜合模式,.,9,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,.,10,環(huán)境因素,個(gè)人因素,相關(guān)因素,活動(dòng),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)M23.5,功能與殘疾的綜合模式,.,11,活動(dòng)與參與,活動(dòng)指?jìng)€(gè)人執(zhí)行任務(wù)或者個(gè)人的行動(dòng)，代表個(gè)體功能參與指參加生活環(huán)境的活動(dòng)，代表社會(huì)功能,活動(dòng)限制,參與限制,.,12,環(huán)境因素,個(gè)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)M23.5,功能與殘疾的綜合模式,.,13,環(huán)境因素,人們居住和生活的物理、社會(huì)和態(tài)度環(huán)境環(huán)境因素是個(gè)人之外的因素積極因素(facilitator)消極因素(barrier),.,14,-住在4樓，無(wú)電梯+使用拐杖/康復(fù)/藥物治療,個(gè)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)M23.5,功能與殘疾的綜合模式,.,15,個(gè)人因素,包括性別、年齡、人種、體質(zhì)、生活方式、習(xí)慣、社會(huì)背景、其它社會(huì)功能,.,16,-住在4樓，無(wú)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)M23.5,功能與殘疾的綜合模式,.,17,殘疾,.,18,功能改善,.,19,功能改善,.,20,ICF是國(guó)際通用的描述功能、殘疾和健康狀況的國(guó)際語(yǔ)言和概念,.,21,.,22,健康狀況（疾病、外傷）,253項(xiàng)環(huán)境因素,個(gè)人因素,相關(guān)因素,384項(xiàng)活動(dòng)與參與,493項(xiàng)身體結(jié)構(gòu)310項(xiàng)身體功能,.,23,ICF金字塔結(jié)構(gòu),.,24,第一級(jí)：身體結(jié)構(gòu)與功能,身體結(jié)構(gòu)(s),身體功能(b),.,25,第一級(jí)：活動(dòng)與參與,.,26,第一級(jí)：環(huán)境因素(e),.,27,ICF第二級(jí)結(jié)構(gòu),.,28,第二級(jí)結(jié)構(gòu)舉例,章節(jié)b1腦高級(jí)功能Mentalfunction整體腦高級(jí)功能(b110b139)b110意識(shí)b114定向b117智力b122整體心理功能b126個(gè)性b130主觀能動(dòng)性b134睡眠b139非特指的整體心理功能特定的腦高級(jí)功能Specificmentalfunctions(b140b189),.,29,ICF,BodyFunctionsb,b1100b7809b11420b54509,b1b8,b110b899,BodyStructuress,s1s8,s110s899,s1100s8309s11000s76009,ActivityNoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,Whatarethepatientsproblemsandneedsfromhis/herperspective?,Whatarethepatientsproblemsfromtherehabilitationteamperspective?,UsetheICF-Core-setsasaChecklist!,GoalsofrehabilitationInterventionprogramgoal:Long-termgoal:,.,57,AssessmentwiththeICFSheet,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,b710Mobilityofjointfunctionsb715Stabilityofjointfunctionsb730Musclepowerfunctionsb435Immunologicalsystemfunctionss7302Structureofhands73011Wristjoints73021Jointsofhandandfingerss75011Kneejoints7502Structureofankleandfoot,d440Finehandused445Handandarmused430Liftingandcarryingobjectsd630Preparingmealsd640Doinghouseworkd4500Walkingshortdistancesd4551Climbing,GoalsofrehabilitationInterventionprogramgoal:Long-termgoal:,.,58,AssessmentwiththeICFSheet,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)DegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Long-termgoal:,.,59,REHAB-Cycle,Assessmentinthreesteps,Identificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoalsandIdentificationofinterventiontargetsrelatedtothecyclegoals.,.,60,AssessmentwiththeICFSheet,GoalsofrehabilitationInterventionprogramgoal:Independenceinself-careandhouseworkLong-termgoal:Vocationalretraining,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)DegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Long-termgoal:,.,61,REHAB-Cycle,Assessmentinthreesteps,Identificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoals.Identificationofinterventiontargetsrelatedtothecyclegoals.,.,62,AssessmentwiththeICFSheet,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)DegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Independenceinself-careandhouseworkLong-termgoal:Vocationalretraining,Whatisrelatedto(determine)thecyclegoals?,Determinetheinterventiontargets,.,63,AssessmentwiththeICFSheet,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Independenceinself-careandhouseworkLong-termgoal:Vocationalretraining,.,64,Rehab-Cycle,Assessment,Assignment,.,65,Assignment,HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresher,.,66,AssessmentwiththeICFSheet,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Independenceinself-careandhouseworkLong-termgoal:Vocationalretraining,.,67,Assignment,HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresher,.,68,Assessment,Assignment,Intervention,Rehab-Cycle,.,69,AssessmentwiththeICFSheet,Patientsperspective,Rehabilitationteamperspective,Body-Structures/FunctionsActivities/Participation,PersonalFactors,Reha-diagnosisICD-10chronicpolyarthritisICD:M05.9,EnvironmentalFactors,Medication+Livesinafourthfloorflat;NoelevatorNeedsaidsforhanduse+,Supportivehusband+Self-helpgroup+,Motivated+adequatecopingstrategies+,ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,rightleft,FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs,GoalsofrehabilitationInterventionprogramgoal:Independenceinself-careandhouseworkLong-termgoal:Vocationalretraining,.,70,Assessment,Evaluation,Assignment,Intervention,Rehab-Cycle,.,71,AssessmentwiththeICFSheet,Pati