1、牛燕媚（講師）天津醫科大學康復與運動醫學系國際功能、殘疾和健康分類 International Classification of Functioning, Disability and Health2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8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10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

2、參與慢性膝關節不穩M 23.5功能與殘疾的綜合模式11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12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14-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15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16-住在4樓

3、，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 23.5功能與殘疾的綜合模式17身體結構和功能障礙活動受限參與限制殘疾18身體結構和功能 與參與活動功能改善20ICF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2123b1 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bsde24第一級：身體結構與功能Skin and related structuresStructures related to movementStr

4、uctures 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 related structuresStructures of the nervous systemFunctions of the skin

5、 and related structuresNeuromusculoskeletal and movement-related functionsGenitourinary and reproductive functionsFunctions of the digestive, metabolic and endocrine systemsFunctions of the cardiovascular, haematological, immunological and respiratory systems聲音和言語功能Sensory functions and painMental f

6、unctionsChapter 8Chapter 7Chapter 6Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1身體結構 (s)身體功能 (b)25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 2Chapter 1Chapter 926第一級：環境因素 (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的改造產品與技術Chapter 5Chapter 4

7、Chapter 3Chapter 2Chapter 127b1 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 Level28第二級結構 舉例章節b1 腦高級功能 Mental function整體腦高級功能 (b110 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 (b

8、140 b189)30b 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d b 37ICF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？發展ICF核心組合 Core Sets39盲人摸象的故事40ICF and ICF Core Sets確定評定條目what to measure應用基礎：how to measure41b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d

9、230d360d410 d415d430 e110e115e120e125e135e150 1454ICF 核心組合42b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d230d360d410 d415d430 e110e115e120e125e135e150 1454ICF 核心組合特定疾病特定環境43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

10、張力簡要ICF核心組合全套ICF核心組合44 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45d450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46e115 與個人日常生活相關的產品與技術e310 近親e580 醫療服務、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 交通服

11、務、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核心組合47 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b1141.012348949定量分級(qualifier)0沒有問題(無、缺乏、可以忽視等) 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

12、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)5051Problem-solving approach52Rehab-CycleAssessmentEvaluationAssignmentIntervention53AssessmentEvaluationAssignmentInterventionRehab-CycleICF ModelICF & ICF Core Sets54Diagnosis (ICD-10)Rehabilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody s

13、tructures & 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!55Diagnosis (ICD-10)Rehabilitaton goalsteam perspectiveenvironmental factorspersonal fact

14、orsbody structures & functionsactivities & participationpatient perspective56Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pa

15、in 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 the headProblems preparing mealsProblems doing houseworkI ha

16、d 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+, Supportive husband+Self-help group+Motivated+adequate coping strategi

17、es+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:Long-term goal: 57Assessment with the ICF SheetPatients perspectiveRehab

18、ilitation team perspectiveBody-Structures/Functions Activities/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 jointsDi

19、fficulties 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 activities are affectedMy intimate relationship with my husband is also affected

20、 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 of joint functionsb730 Muscle power functionsb435 Immunological system functionss

21、7302 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 Doing houseworkd4500 Walking short distancesd4551 ClimbingGoals of rehabilitatio

22、nIntervention program goal:Long-term goal: 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 shoulderPai

23、n 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 give up my job as a secreta

24、ryAll 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+Impaired mobility of jointsIm

25、paired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) Degenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and

26、 carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal:Long-term goal: 59REHAB-CycleAssessment in three stepsIdentification of the problems and needs of the patient,Determination of the long-term, intervention program and cycl

27、e goals andIdentification of intervention targets related to the cycle goals.60Assessment with the ICF SheetGoals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining Patients perspectiveRehabilitation team perspectiveBody-Structur

28、es/Functions Activities/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 i

29、n 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 activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives i

30、n 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 stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) Degenerative change

31、s 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 program goal:Long-term

32、 goal: 61REHAB-CycleAssessment in three stepsIdentification 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.62Assessment with the ICF SheetPatients perspectiveRehabilitati

33、on team perspectiveBody-Structures/Functions Activities/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 jointsDifficult

34、ies 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 activities are affectedMy intimate relationship with my husband is also affected becaus

35、e 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 stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophal

36、angeal (MCP) 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 rehabilitationInt

37、ervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining What is related to (determine) the cycle goals?Determine the intervention targets63Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activitie

38、s/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 c

39、ombing 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;

40、 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 dri

41、ft 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 rehabilitationInterven

42、tion program goal: Independence in self-care and housework Long-term goal: Vocational retraining 64Rehab-CycleAssessmentAssignment65Assignment Health ProfessionalsProgram or serviceInpatient or outpatient rehab, home rehabType of specific serviceSingle vs groupFirst intervention, refresher66Assessme

43、nt 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 fingersShortened mobility and flexibil

44、itySwelling 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 activities are affectedMy intimate

45、 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 stabilityImpaired muscle strengthInflamm

46、ation 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 useHand and arm useLifting and car

47、rying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 67Assignment Health ProfessionalsProgram or serviceInpatient or outpatient rehab, home rehabType

48、 of specific serviceSingle vs groupFirst intervention, refresherIntervention68AssessmentAssignmentInterventionRehab-Cycle69Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic po

49、lyarthritis 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 the headProble

50、ms 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+, Supportive husband+Self

51、-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 and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHou