ICF在脊髓損傷的應(yīng)用

國際功能、殘疾和健康分類

-脊髓損傷的核心組合

ICFCoreSetsforSCI.功能與殘疾的綜合模式2.環(huán)境因素個人因素相關(guān)因素活動身體功能與身體結(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4.環(huán)境因素個人因素相關(guān)因素活動身體功能與身體結(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5.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)部件相當(dāng)于障礙Impairments6.環(huán)境因素個人因素相關(guān)因素活動疼痛、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7.活動與參與活動指個人執(zhí)行任務(wù)或者個人的行動，代表個體功能參與指參加生活環(huán)境的活動，代表社會功能活動限制參與限制8.環(huán)境因素個人因素相關(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9.環(huán)境因素人們居住和生活的物理、社會和態(tài)度環(huán)境環(huán)境因素是個人之外的因素積極因素

(facilitator)消極因素(barrier)10.-住在4樓，無電梯+使用拐杖/康復(fù)/藥物治療個人因素相關(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11.個人因素包括性別、年齡、人種、體質(zhì)、生活方式、習(xí)慣、社會背景、其它社會功能12.-住在4樓，無電梯+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13.身體結(jié)構(gòu)和功能障礙活動受限參與限制殘疾14.身體結(jié)構(gòu)和功能與參與活動功能改善15.功能改善16.ICF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17.18.健康狀況〔疾病、外傷〕253項環(huán)境因素個人因素相關(guān)因素384項活動與參與493項身體結(jié)構(gòu)310項身體功能19.b1

–

b8s1

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s8d1

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d9e1

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e5章ICF–

金字塔結(jié)構(gòu)ICF身體功能身體結(jié)構(gòu)活動與參與環(huán)境因素個人因素bsde20.第一級：身體結(jié)構(gòu)與功能

SkinandrelatedstructuresStructuresrelatedtomovementStructuresrelatedtothegenitourinaryandreproductivesystemsStructuresrelatedtothedigestive,metabolicandendocrinesystemsStructuresofthecardiovascular,immunologicalandrespiratorysystems聲音和言語相關(guān)的組織結(jié)構(gòu)Theeye,earandrelatedstructuresStructuresofthenervoussystemFunctionsoftheskinandrelatedstructuresNeuromusculoskeletalandmovement-relatedfunctionsGenitourinaryandreproductivefunctionsFunctionsofthedigestive,metabolicandendocrinesystemsFunctionsofthecardiovascular,haematological,immunologicalandrespiratorysystems聲音和言語功能SensoryfunctionsandpainMentalfunctionsChapter8Chapter7Chapter6Chapter5Chapter4Chapter3Chapter2Chapter1身體結(jié)構(gòu)(s)身體功能(b)21.第一級：活動與參與主要的生活區(qū)域 人際關(guān)系家庭區(qū)域 個人自理活動交流一般任務(wù)與需求學(xué)習(xí)與應(yīng)用技術(shù)社區(qū)、社會和公民活動Chapter8Chapter7Chapter6Chapter5Chapter4Chapter3Chapter2Chapter1Chapter922.第一級：環(huán)境因素(e)服務(wù)、體系與政策態(tài)度支持與關(guān)系自然環(huán)境和人類對環(huán)境的改造產(chǎn)品與技術(shù)Chapter5Chapter4Chapter3Chapter2Chapter123.b1

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e5ChaptersICF–

第二級結(jié)構(gòu)ICF身體功能身體結(jié)構(gòu)活動與參與環(huán)境因素個人因素bsdeb110

–

b899s110

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s899d110

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d999e110

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e5992ndLevel24.第二級結(jié)構(gòu)–

舉例章節(jié) b1腦高級功能Mentalfunction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Specificmentalfunctions(b140–b189)25.ICFBodyFunctionsbb1100

–

b7809b11420

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b54509b1

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b8b110

–

b899BodyStructuresss1

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s8s110

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s899s1100

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s8309s11000

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s76009Activity&Participationdd1

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d9d110

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d999d1150

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d9309EnvironmentalFactorsee1

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e5e110

–

e599e1100

–

e5959ICF–

三級結(jié)構(gòu)Thehigherthemoreprecise26.b

腦高級功能Mentalfunctions 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27.ICF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(biāo)準(zhǔn)？28.開展ICF核心組合CoreSets

.瞎子摸象的故事30.ICFandICFCoreSets確定評定條目whattomeasure應(yīng)用根底：howtomeasure31.b1b130b134b152b180b1801

s299s710s720s730s73001s73011

d170d230d360d410d415d430

e110e115e120e125e135e150

1454ICF核心組合32.b1b130b134b152b180b1801

s299s710s720s730s73001s73011

d170d230d360d410d415d430

e110e115e120e125e135e150

1454ICF核心組合特定疾病特定環(huán)境33.骨關(guān)節(jié)炎OA–

身體功能b280 疼痛的感覺 b710 關(guān)節(jié)活動功能 b730 肌肉功能b770 步態(tài)b715 關(guān)節(jié)穩(wěn)定性b740 肌肉耐力b780 與肌肉相關(guān)的感覺和運動功能b760 自主運動的控制b134 睡眠功能b735肌肉張力簡要ICF核心組合全套ICF核心組合34.

s750 下肢結(jié)構(gòu)s730 上肢結(jié)構(gòu)s770 其它與運動相關(guān)的肌肉骨骼結(jié)構(gòu)

s740 骨盆結(jié)構(gòu)s720 肩部結(jié)構(gòu)OA–

身體結(jié)構(gòu)簡要ICF核心組合全套ICF核心組合35.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 如廁d430 抬舉和攜帶物品d640 做家務(wù)d910 社區(qū)生活d440 手精細(xì)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36.e115 與個人日常生活相關(guān)的產(chǎn)品與技術(shù)e310 近親e580 醫(yī)療效勞、體系和政策e150 公共場合的建筑設(shè)計、產(chǎn)品和技術(shù)

e355 醫(yī)務(wù)人員e540 交通效勞、體系和政策e120 個人室內(nèi)和室外活動和交通的產(chǎn)品與技術(shù)

e135 就業(yè)相關(guān)的產(chǎn)品與技術(shù)e155 私人使用的建筑設(shè)計、建造和建筑產(chǎn)品

e340個人護理人員和助手OA–

環(huán)境因素簡要ICF核心組合全套ICF核心組合37.

定量分級Qualifiers

問題的嚴(yán)重程度如何量化已經(jīng)清楚的?是功能障礙是什么并不清楚的?是b1141.012348938..定量分級(qualifier)0 沒有問題(無、缺乏、可以無視等) 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(yán)重問題(高、極端等) 50-95%4全部問題(最嚴(yán)重、全部受累等) 96-100%

8 無法特定(當(dāng)前的信息無法確定嚴(yán)重程度)9 無法應(yīng)用(不恰當(dāng)或者不可能使用)40.環(huán)境因素雙向分級障礙因素Barrier--促進因素Facilitator++41.42.Problem-solvingapproach43.Rehab-CycleAssessmentEvaluationAssignmentIntervention44.AssessmentEvaluationAssignmentInterventionRehab-CycleICFModelICF&ICFCoreSets45.Diagnosis(ICD-10)Rehabilitatongoalsteamperspectiveenvironmentalfactors personalfactors bodystructures&functionsactivities&participationpatientperspectiveWhatarethepatient'sproblemsandneedsfromhis/herperspective?Whatarethepatient'sproblemsfromtheteamperspective?UsetheICFCoreSets!46.Diagnosis(ICD-10)Rehabilitatongoalsteamperspectiveenvironmentalfactors personalfactors bodystructures&functionsactivities&participationpatientperspective47.AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+Whatarethepatients'problemsandneedsfromhis/herperspective?Whatarethepatients'problemsfromtherehabilitationteamperspective?UsetheICF-Core-setsasaChecklist!GoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

48.AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+b710Mobilityofjointfunctionsb715Stabilityofjointfunctionsb730Musclepowerfunctionsb435Immunologicalsystemfunctionss7302Structureofhands73011Wristjoints73021Jointsofhandandfingerss75011Kneejoints7502Structureofankleandfootd440Finehandused445Handandarmused430Liftingandcarryingobjectsd630Preparingmealsd640Doinghouseworkd4500Walkingshortdistancesd4551ClimbingGoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

49.AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

50.REHAB-CycleAssessmentinfourstepsIdentificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoalsandIdentificationofinterventiontargetsrelatedtothecyclegoals.51.AssessmentwiththeICFSheetGoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

Patient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

52.REHAB-CycleAssessmentinfourstepsIdentificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoalsandIdentificationofinterventiontargetsrelatedtothecyclegoals.53.AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

Whatisrelatedto(determine)thecyclegoals?Determinetheinterventiontargets54.AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

55.Rehab-CycleAssessmentAssignment56.Asignment HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresher57.AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

58.Asignment HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresherIntervention59.AssessmentAssignmentInterventionRehab-Cycle60.AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

61.AssessmentEvaluationAssignmentInterventionRehab-Cycle62.AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretrain