icf在脊髓损伤的应用-励建安.ppt

励建安 南京医科大学,国际功能、残疾和健康分类-脊髓损伤的核心组合ICF Core Sets for SCI,2,功能与残疾的综合模式,3,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,4,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,5,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,慢性膝关节不稳M 23.5,功能与残疾的综合模式,6,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 相当于障碍Impairments,7,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,8,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,9,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,10,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),11,-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,12,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,13,-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,14,残疾,15,功能改善,16,功能改善,17,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,18,19,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,20,ICF 金字塔结构,21,第一级：身体结构与功能,身体结构 (s),身体功能 (b),22,第一级：活动与参与,23,第一级：环境因素 (e),24,ICF 第二级结构,25,第二级结构 举例,章节b1 脑高级功能 Mental function 整体脑高级功能 (b110 b139) b110意识 b114 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 (b140 b189),26,ICF,Body Functions b,b1100 b7809 b11420 b54509,b1 b8,b110 b899,Body Structures s,s1 s8,s110 s899,s1100 s8309 s11000 s76009,Activity 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:,49,Assessment with the ICF Sheet,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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:,50,Assessment with the ICF Sheet,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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 Degenerative 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:,51,REHAB-Cycle,Assessment in four 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.,52,Assessment with the ICF Sheet,Goals of rehabilitation Intervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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 Degenerative 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:,53,REHAB-Cycle,Assessment in four 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.,54,Assessment with the ICF Sheet,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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 Degenerative 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,55,Assessment with the ICF Sheet,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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 Degenerative 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,56,Rehab-Cycle,Assessment,Assignment,57,Asignment,Health Professionals Program or service Inpatient or outpatient rehab, home rehab Type of specific service Single vs group First intervention, refresher,58,Assessment with the ICF Sheet,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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 Degenerative 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,59,Asignment,Health Professionals Program or service Inpatient or outpatient rehab, home rehab Type of specific service Single vs group First intervention, refresher,60,Assessment,Assignment,Intervention,Rehab-Cycle,61,Assessment with the ICF Sheet,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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 Degenerative 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,62,Assessment,Evaluation,Assignment,Intervention,Rehab-Cycle,63,Assessment with the ICF Sheet,Patients perspective,Rehabilitation team perspective,Body-Structures/Functions Activities/Participation,Personal Factors,Reha-diagnosis ICD-10 chronic polyarthritis ICD: M05.9,Environmental Factors,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 Degenerative 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,64,ICF Clinical Practice - RehabCycle,ICF Sheet / Model Reference for the documentation of functioning based on history, exam and analysis Multi-disciplinary communication and goal setting ICF Core Sets Guide for multi-disciplinary assessment Basis for institutional, professional, national or international guidelines how to measure specific categories Guide for the assignment of interventions and intervention management,65,健康相关情况,慢性全身性疼痛 腰痛 骨性关节炎 骨质疏松 类风湿性关节炎 慢性缺血性心脏病 糖尿病 肥胖 阻塞性肺疾病 抑郁 乳腺癌 脑卒中,66,Volume 36, Supplement 44 / August 2004,ICF CORE SETS FOR CHRONIC CONDITIONS,Journal of Rehabilitation Medicine,67,SCI-ICF Concensus Conference,医生 护士 PT OT SW 心理学家,第一世界 第二世界 第三世界,白人 黑人 黄人,2007年11月14-19日，瑞士，Nottwil,68,69,Nottwil， Swiss,70,71,72,73,74,共计35人，分为五组，全体合影,75,76,第二组合影,77,C5损伤，ASIA A，9年，护士，南非,78,T12损伤，ASIA A，10年，治疗师，越南,79,评审会议 第一版SCI-ICF核心组合,测试和验证ICF核心组合第一版,多中心患者数据 (ICF为基础的数据采集),专家意见 调查表方式,文献回顾,Phase I,Phase II,初步研究,3 年,患者座谈,80,评审原则,挑战： As few as possible for clinical practice 从临床实用的角度，选取尽量少的条目 As many as possible for necessary 从必要性的角度，选取尽量多的条目 时期定义： Early post acute phase 急性期后早期、亚急性期、积极康复训练期 Start of active rehabilitation to completion of comprehensive rehabilitation 开始于主动康复介入，结束于全面康复完成,81,SCI核心组合-身体功能 b,全套： 亚急性期：62 慢性期：44 核心： 亚急性期：8（肌力、呼吸、肌张力、排尿、大便、皮肤保护、痛觉、情绪） 慢性期：10（肌力、呼吸、肌张力、排尿、大便、皮肤保护、痛觉、情绪、关节活动度、性功能）,82,SCI核心组合-身体结构 s,全套： 亚急性期：14 慢性期：19 核心： 亚急性期：3（脊髓及相关结构、呼吸系统结构、泌尿系统结构） 慢性期：4 （脊髓及相关结构、呼吸系统结构、泌尿系统结构、皮肤结构）,83,SCI核心组合-活动与参与 d,全套： 亚急性期：53 慢性期：64 核心： 亚急性期：6（步行、自我洗浴、如厕、穿衣、吃饭、饮水） 慢性期：8 （户外步行、自我转移、改变体位、手/臂使用、如厕、使用交通工具、执行生活常规、使用设备户外活动）,84,SCI核心组合-环境因素 e,全套： 亚急性期：32 慢性期：41 核心： 亚急性期：5（个人日常活动相关的产品和技术、与室内和室外活动和交通相关的产品和技术、直系亲属、生活护理者、医务人员） 慢性期：？,85,评审会议 第一版SCI-ICF核心组合,测试和验证ICF核心组合第一版,多中心患者数据 (ICF为基础的数据采集),专家意见 调查表方式,文献回顾,Phase I,Phase II,初步研究,3 年,患者座谈,86,Phase I: 审核ICF全套核心项目,国际多中心研究,定量研究,定量研究,定性研究,医务人员的观点,患者的观点,87,Phase II: 验证ICF全套核心项目,国际多中心研究,定量研究,定量研究,定性研究,医务人员的观点,患者的观点,88,WHO Conference 2008,http:/www3.who.int/icfwww.ICF-research-branch.org,gerold.stuckimed.uni-uenchen.dealarcos.ciezamed.uni-uenchen.de,90,问题,为什么需要共同语言 如何确定共同语言 如何验证共同语言 如何使用共同语言,