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1、励建安励建安南京医科大学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 SCI12021/10/23 星期六2功能与残疾的综合模式功能与残疾的综合模式2021/10/23 星期六3环境因素环境因素个人因素个人因素相关因素相关因素活动活动身体功能身体功能与身体结与身体结构构参与参与参与参与健康状况健康状况(疾病、外伤疾病、外伤)功能与残疾的综合模式2021/10/23 星期六4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2021/10/23 星期六5
2、环境因素环境因素个人因素个人因素相关因素相关因素活动活动身体功能与身体功能与身体结构身体结构参与参与参与参与慢性膝关节不稳M 23.5功能与残疾的综合模式2021/10/23 星期六6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Impairments2021/10/23 星期六7环境因素环境因素个人因素个人因素相关因素相关因素活动活动疼痛、关节疼痛、关节稳定性、交稳定性、交叉韧带叉韧带参与参与参与参与慢性膝关节不稳M 23.5功能与残疾的综合模式2021/10/23 星期六8活动与参与活动指个人执行任务或者个人的行动，代表
3、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2021/10/23 星期六9环境因素环境因素个人因素个人因素相关因素相关因素携带物体、弯膝、携带物体、弯膝、步行、攀爬步行、攀爬疼痛、关疼痛、关节稳定性、节稳定性、交叉韧带交叉韧带照顾孙子、家务、照顾孙子、家务、协助丈夫工作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2021/10/23 星期六10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积极因素(facilitator)消极因素消极因素(barrier)2021/10/23 星期六11-住在住在4 4楼，无电梯楼，无电梯+使用拐杖
4、使用拐杖/康复康复/药物治疗药物治疗个人因素个人因素相关因素相关因素携带物体、弯膝、携带物体、弯膝、步行、攀爬步行、攀爬疼痛、关节疼痛、关节稳定性、交稳定性、交叉韧带叉韧带照顾孙子、家务、照顾孙子、家务、协助丈夫工作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2021/10/23 星期六12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2021/10/23 星期六13-住在住在4 4楼，无电梯楼，无电梯+使用拐杖、康复治疗、药物使用拐杖、康复治疗、药物治疗治疗6060岁，生性积极岁，生性积极相关因素相关因素携带物体、弯膝、携带物体、弯膝、步行、攀爬步行
5、、攀爬疼痛、关疼痛、关节稳定性、节稳定性、交叉韧带交叉韧带照顾孙子、家务、照顾孙子、家务、协助丈夫工作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2021/10/23 星期六14身体结构和功能障碍身体结构和功能障碍活动受限活动受限参与限制参与限制残疾2021/10/23 星期六15身体结构和功能身体结构和功能 与参与与参与活动活动功能改善2021/10/23 星期六16功能改善2021/10/23 星期六17ICFICF是国际通用的描述功能、残疾和健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康状况的国际语言和概念2021/10/23 星期六182021/10/23 星期
6、六19健康状况（疾病、外伤）健康状况（疾病、外伤）253253项环境因项环境因素素个人因素个人因素相关因素相关因素384384项活动与参与项活动与参与493493项身体结构项身体结构310310项身体功能项身体功能2021/10/23 星期六20b b b b1 1 1 1 b b b b8 8 8 8s s s s1 1 1 1 s s s s8 8 8 8d d d d1 1 1 1 d d d d9 9 9 9e e e e1 1 1 1 e e e e5 5 5 5章章ICF ICF 金字塔结构金字塔结构ICFICFICFICF身体功能身体功能身体功能身体功能身体结构身体结构身体结构身
7、体结构活动与参与活动与参与活动与参与活动与参与环境因素环境因素环境因素环境因素个人因素个人因素个人因素个人因素b b b bs s s sd d d de e e e2021/10/23 星期六21第一级：身体结构与功能Skin and related structuresSkin and related structuresStructures related to movementStructures related to movementStructures related to the Structures related to the genitourinary and reprod
8、uctive genitourinary and reproductive systemssystemsStructures related to the digestive,Structures related to the digestive,metabolic and endocrine systemsmetabolic and endocrine systemsStructures of the cardiovascular,Structures of the cardiovascular,immunological and respiratory immunological and
9、respiratory systemssystems声音和言语相关的组织结构声音和言语相关的组织结构声音和言语相关的组织结构声音和言语相关的组织结构The eye,ear and related structuresThe eye,ear and related structuresStructures of the nervous systemStructures of the nervous systemFunctions of the skin and related Functions of the skin and related structuresstructuresNeurom
10、usculoskeletal and Neuromusculoskeletal and movement-related functionsmovement-related functionsGenitourinary and reproductive Genitourinary and reproductive functionsfunctionsFunctions of the digestive,metabolic Functions of the digestive,metabolic and endocrine systemsand endocrine systemsFunction
11、s of the cardiovascular,Functions of the cardiovascular,haematological,immunological and haematological,immunological and respiratory systemsrespiratory systems声音和言语功能声音和言语功能声音和言语功能声音和言语功能Sensory functions and painSensory functions and painMental functionsMental functionsChapter 8Chapter 8Chapter 7C
12、hapter 7Chapter 6Chapter 6Chapter 5Chapter 5Chapter 4Chapter 4Chapter 3Chapter 3Chapter 2Chapter 2Chapter 1Chapter 1身体结构身体结构身体结构身体结构 (s)(s)身体功能身体功能身体功能身体功能 (b)(b)2021/10/23 星期六22第一级：活动与参与主要的生活区域主要的生活区域主要的生活区域主要的生活区域人际关系人际关系人际关系人际关系家庭区域家庭区域家庭区域家庭区域个人自理个人自理个人自理个人自理活动活动活动活动交流交流交流交流一般任务与需求一般任务与需求一般任务与需求
13、一般任务与需求学习与应用技术学习与应用技术学习与应用技术学习与应用技术社区、社会和公民活动社区、社会和公民活动社区、社会和公民活动社区、社会和公民活动Chapter 8Chapter 8Chapter Chapter 7 7Chapter Chapter 6 6Chapter Chapter 5 5Chapter Chapter 4 4Chapter Chapter 3 3Chapter 2Chapter 2Chapter Chapter 1 1ChapterChapter 9 92021/10/23 星期六23第一级：环境因素(e)服务、体系与政策服务、体系与政策服务、体系与政策服务、体系与
14、政策态度态度态度态度支持与关系支持与关系支持与关系支持与关系自然环境和人类对环境的改造自然环境和人类对环境的改造自然环境和人类对环境的改造自然环境和人类对环境的改造产品与技术产品与技术产品与技术产品与技术Chapter 5Chapter 5Chapter 4Chapter 4Chapter 3Chapter 3Chapter 2Chapter 2Chapter 1Chapter 12021/10/23 星期六24b b b b1 1 1 1 b b b b8 8 8 8s s s s1 1 1 1 s s s s8 8 8 8d d d d1 1 1 1 d d d d9 9 9 9e e e
15、 e1 1 1 1 e e e e5 5 5 5ChaptersChaptersChaptersChaptersICF ICF 第二级结构第二级结构ICFICF身体功能身体功能身体功能身体功能身体结构身体结构身体结构身体结构活动与参与活动与参与活动与参与活动与参与环境因素环境因素环境因素环境因素个人因素个人因素个人因素个人因素b b b bs s s sd d d de e e eb b b b1 1 1 110101010 b b b b8 8 8 899999999s s s s1 1 1 110101010 s s s s8 8 8 899999999d d d d1 1 1 11010
16、1010 d d d d9 9 9 999999999e e e e1 1 1 110101010 e e e e5 5 5 5999999992nd 2nd 2nd 2nd LevelLevelLevelLevel2021/10/23 星期六25第二级结构 举例章节章节 b1 脑高级功能脑高级功能 Mental function整体脑高级功能整体脑高级功能(b110 b139)b110b110意识意识意识意识b b1 114 14 定向定向定向定向b117 b117 智力智力智力智力b122 b122 整体心理功能整体心理功能整体心理功能整体心理功能b126 b126 个性个性个性个性b13
17、0 b130 主观能动性主观能动性主观能动性主观能动性b134 b134 睡眠睡眠睡眠睡眠b139 b139 非特指的整体心理功能非特指的整体心理功能非特指的整体心理功能非特指的整体心理功能特定的脑高级功能特定的脑高级功能Specific mental functions(b140 b189)2021/10/23 星期六26ICFICFICFICFBody Body Body Body Functions Functions Functions Functions b b b bb b b b1 1 1 1101010100 0 0 0 b b b b7 7 7 7808080809 9 9
18、9b b b b1 1 1 1141414142 2 2 20 0 0 0 b b b b5 5 5 5454545450 0 0 09 9 9 9b b b b1 1 1 1 b b b b8 8 8 8b b b b1 1 1 110101010 b b b b8 8 8 899999999Body Body Body Body StructureStructureStructureStructures s s ss s s ss s s s1 1 1 1 s s s s8 8 8 8s s s s1 1 1 110101010 s s s s8 8 8 899999999s s s s1
19、 1 1 1101010100 0 0 0 s s s s8 8 8 8303030309 9 9 9s s s s1 1 1 1101010100 0 0 00 0 0 0 s s s s7 7 7 7606060600 0 0 09 9 9 9Activity&Activity&Activity&Activity&ParticipatiParticipatiParticipatiParticipationononond d d dd d d d1 1 1 1 d d d d9 9 9 9d d d d1 1 1 110101010 d d d d9 9 9 999999999d d d d
20、1 1 1 1151515150 0 0 0 d d d d9 9 9 9303030309 9 9 9Environmental Environmental Environmental Environmental FactorsFactorsFactorsFactorse e e ee e e e1 1 1 1 e e e e5 5 5 5e e e e1 1 1 110101010 e e e e5 5 5 599999999e e e e1 1 1 1101010100 0 0 0 e e e e5 5 5 5959595959 9 9 9ICF ICF 三级结构三级结构The high
21、er the more preciseThe higher the more precise2021/10/23 星期六27b 脑高级功能Mental functions一级 b114 定向功能 二级 b1141 地点定向 b1142 人物定向 b11420自我定向b11421他人定向ICF 条目举例三级四级2021/10/23 星期六28ICF总条目：总条目：1454有多少在特定的疾病需要？有多少在特定的疾病需要？临床和科研有何用途？临床和科研有何用途？评判标准？评判标准？2021/10/23 星期六发展ICF核心组合 Core Sets292021/10/23 星期六30瞎子摸象的故事20
22、21/10/23 星期六31ICF and ICF Core Sets确定评定条目确定评定条目what to measure应用基础：应用基础：how to measure2021/10/23 星期六32b1b1b130b130b134b134b152b152b180b180b1801b1801 s299s299s710s710s720 s720 s730s730s73001s73001s73011s73011 d170d170d230d230d360d360d410 d410 d415d415d430d430 e110e110e115e115e120e120e125e125e135e135e
23、150e150 14541454ICF ICF 核心组合核心组合2021/10/23 星期六33b1b1b130b130b134b134b152b152b180b180b1801b1801 s299s299s710s710s720 s720 s730s730s73001s73001s73011s73011 d170d170d230d230d360d360d410 d410 d415d415d430d430 e110e110e115e115e120e120e125e125e135e135e150e150 14541454ICF ICF 核心组合核心组合特定疾病特定疾病特定环境特定环境2021/1
24、0/23 星期六34骨关节炎OA 身体功能b280 疼痛的感觉疼痛的感觉b710 关节活动功能关节活动功能b730 肌肉功能肌肉功能b770 步态步态b715 关节稳定性关节稳定性b740 肌肉耐力肌肉耐力b780 与肌肉相关的感觉和运动功能与肌肉相关的感觉和运动功能b760 自主运动的控制自主运动的控制b134 睡眠功能睡眠功能b735 肌肉张力肌肉张力简要简要ICFICF核心组合核心组合全套全套ICFICF核心组核心组合合2021/10/23 星期六35 s750下肢结构下肢结构s730上肢结构上肢结构s770其它与运动相关的其它与运动相关的 肌肉骨骼结构肌肉骨骼结构s740骨盆结构骨盆结
25、构s720肩部结构肩部结构OA 身体结构简要简要ICFICF核心组合核心组合全套全套ICFICF核心组核心组合合2021/10/23 星期六36d450 步行步行d540 穿衣穿衣d445 手和手臂使用手和手臂使用d510 自我洗浴自我洗浴d470 使用交通工具使用交通工具d530 如厕如厕d430 抬举和携带物品抬举和携带物品d640 做家务做家务d910 社区生活社区生活d440 手精细活动手精细活动d410 改变身体位置改变身体位置OA 活动与参与简要简要ICFICF核心组合核心组合全套全套ICFICF核心组核心组合合2021/10/23 星期六37e115 与个人日常生活相关的产品与技
26、术与个人日常生活相关的产品与技术e310 近亲近亲e580 医疗服务、体系和政策医疗服务、体系和政策e150 公共场合的建筑设计、产品和技术公共场合的建筑设计、产品和技术e355 医务人员医务人员e540 交通服务、体系和政策交通服务、体系和政策e120 个人室内和室外活动和交通的产品与个人室内和室外活动和交通的产品与技术技术e135 就业相关的产品与技术就业相关的产品与技术e155 私人使用的建筑设计、建造和建筑产私人使用的建筑设计、建造和建筑产品品e340 个人护理人员和助手个人护理人员和助手OA 环境因素简要简要ICFICF核心核心组合组合全套全套ICFICF核心组合核心组合2021/1
27、0/23 星期六38 定量分级定量分级Qualifiers 问题的严重程度如何量化已经清楚的?是 功能障碍是什么功能障碍是什么并不清楚的?是b1141.0 1 2 3 4 8 92021/10/23 星期六392021/10/23 星期六40定量分级(qualifier)0 0 没有问题没有问题(无、缺乏、可以忽视等)0-4%0-4%1 1 轻度问题轻度问题(轻、低等)5-24%5-24%2 2 中度问题中度问题(中等、较好等)25-49%25-49%3 3 严重问题严重问题(高、极端等)50-95%50-95%4 4 全部问题全部问题(最严重、全部受累等)96-100%96-100%8 8无
28、法特定无法特定(当前的信息无法确定严重程度)9 9 无法应用无法应用(不恰当或者不可能使用)2021/10/23 星期六41环境因素双向分级障碍因素Barrier -促进因素Facilitator +2021/10/23 星期六422021/10/23 星期六432021/10/23 星期六44Rehab-CycleAssessmentAssessmentEvaluationEvaluationAssignmentAssignmentInterventionIntervention2021/10/23 星期六45AssessmentAssessmentEvaluationEvaluationA
29、ssignmentAssignmentInterventionInterventionRehab-CycleICF ModelICF&ICF Core Sets2021/10/23 星期六46Diagnosis(ICD-10)Rehabilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody structures&functionsactivities&participationpatient perspectiveUse the ICF Core Sets!Use the ICF Core Sets!202
30、1/10/23 星期六47Diagnosis(ICD-10)Rehabilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody structures&functionsactivities&participationpatient perspective2021/10/23 星期六48Assessment with the Assessment with the ICF SheetICF SheetPatientPatients s perspectiveperspectiveRehabilitation t
31、eam perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsPersonal FactorsReha-diagnosis ICD-10Reha-diagnosis ICD-10chronic polyarthritis ICD:M05.9Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and s
32、houlderPain in hands and fingersPain in hands and fingersShortened mobility and flexibilityShortened mobility and flexibilitySwelling in finger,wrist and knee Swelling in finger,wrist and knee jointsjointsDifficulties in getting dressedDifficulties in getting dressedProblems in brushing teeth and co
33、mbing Problems in brushing teeth and combing hairhairDifficulties in lifting things above the Difficulties in lifting things above the headheadProblems preparing mealsProblems preparing mealsProblems doing houseworkProblems doing houseworkI had to give up my job I had to give up my job as a secretar
34、yas a secretaryAll my free-time All my free-time activities are affectedactivities are affectedMy intimate relationship My intimate relationship with my husband is also with my husband is also affected because of the affected because of the painpainMedication+Medication+Lives in a fourth floor flat;
35、No elevator Lives in a fourth floor flat;No elevator Needs aids for hand use+,Supportive husband+Needs aids for hand use+,Supportive husband+Self-help group+Self-help group+Motivated+Motivated+adequate coping strategies+adequate coping strategies+Use the ICF-Core-sets as a Use the ICF-Core-sets as a
36、 Checklist!Checklist!Goals of rehabilitationGoals of rehabilitationIntervention program goal:Intervention program goal:Long-term goal:Long-term goal:2021/10/23 星期六49Assessment with the Assessment with the ICF SheetICF SheetPatientPatients s perspectiveperspectiveRehabilitation team perspectiveRehabi
37、litation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsPersonal FactorsReha-diagnosis ICD-10Reha-diagnosis ICD-10chronic polyarthritis ICD:M05.9Environmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulderPain in hands
38、and fingersPain in hands and fingersShortened mobility and flexibilityShortened mobility and flexibilitySwelling in finger,wrist and knee Swelling in finger,wrist and knee jointsjointsDifficulties in getting dressedDifficulties in getting dressedProblems in brushing teeth and combing Problems in bru
39、shing teeth and combing hairhairDifficulties in lifting things above the Difficulties in lifting things above the headheadProblems preparing mealsProblems preparing mealsProblems doing houseworkProblems doing houseworkI had to give up my job I had to give up my job as a secretaryas a secretaryAll my
40、 free-time All my free-time activities are affectedactivities are affectedMy intimate relationship My intimate relationship with my husband is also with my husband is also affected because of the affected because of the painpainMedication+Medication+Lives in a fourth floor flat;No elevator Lives in
41、a fourth floor flat;No elevator Needs aids for hand use+,Supportive husband+Needs aids for hand use+,Supportive husband+Self-help group+Self-help group+Motivated+Motivated+adequate coping strategies+adequate coping strategies+b710 Mobility of joint functionsb710 Mobility of joint functionsb715 Stabi
42、lity of joint functionsb715 Stability of joint functionsb730 Muscle power functionsb730 Muscle power functionsb435 Immunological system functionsb435 Immunological system functionss7302 Structure of hands7302 Structure of hands73011 Wrist joints73011 Wrist joints73021 Joints of hand and fingerss7302
43、1 Joints of hand and fingerss75011 Knee joints75011 Knee joints7502 Structure of ankle and foots7502 Structure of ankle and footd440 Fine hand used440 Fine hand used445 Hand and arm used445 Hand and arm used430 Lifting and carrying objectsd430 Lifting and carrying objectsd630 Preparing mealsd630 Pre
44、paring mealsd640 Doing houseworkd640 Doing houseworkd4500 Walking short distancesd4500 Walking short distancesd4551 Climbingd4551 ClimbingGoals of rehabilitationGoals of rehabilitationIntervention program goal:Intervention program goal:Long-term goal:Long-term goal:2021/10/23 星期六50Assessment with th
45、e Assessment with the ICF SheetICF SheetPatientPatients s perspectiveperspectiveRehabilitation team perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsPersonal FactorsReha-diagnosis ICD-10Reha-diagnosis ICD-10chronic polyarthritis ICD:M05.9Env
46、ironmental Factors Environmental Factors Pain in right knee and shoulderPain in right knee and shoulderPain in hands and fingersPain in hands and fingersShortened mobility and flexibilityShortened mobility and flexibilitySwelling in finger,wrist and knee Swelling in finger,wrist and knee jointsjoint
47、sDifficulties in getting dressedDifficulties in getting dressedProblems in brushing teeth and combing Problems in brushing teeth and combing hairhairDifficulties in lifting things above the Difficulties in lifting things above the headheadProblems preparing mealsProblems preparing mealsProblems doin
48、g houseworkProblems doing houseworkI had to give up my job I had to give up my job as a secretaryas a secretaryAll my free-time All my free-time activities are affectedactivities are affectedMy intimate relationship My intimate relationship with my husband is also with my husband is also affected be
49、cause of the affected because of the painpainMedication+Medication+Lives in a fourth floor flat;No elevator Lives in a fourth floor flat;No elevator Needs aids for hand use+,Supportive husband+Needs aids for hand use+,Supportive husband+Self-help group+Self-help group+Motivated+Motivated+adequate co
50、ping strategies+adequate coping strategies+Impaired mobility of jointsImpaired mobility of jointsImpaired joint stabilityImpaired joint stabilityImpaired muscle strengthImpaired muscle strengthInflammation parameters in bloodInflammation parameters in bloodSubluxation of metacarpophalangeal(MCP)Subl