Demographic information BRIEF ICF CORE SET for MUSCULOSKELETAL CONDITIONS for ACUTE CARE H1 이 checklist 를완성할때가능한모든정보를사용하고출처를기록하시오 [1] 서면기록 [2] 대상자 [3] 다른정보제공자 [4] 직접관찰 H2 Date / / H3 Case ID,, H4 Participant No,, day month year CE or CS Case No 1st or 2nd Evalu FTC Site Participant A 인구통계학적정보 DEMOGRAPHIC INFORMATION A1 성명 성 : 이름 : A2 성별 여자 : 남자 : A3 생년월일 년 월 일 A4 주소 ( 선택사항 ) A5 정규교육 ( 학력 ) A6 결혼상태 가장적당한것을선택하시오 [1] 미혼 [4] 이혼 [2] 기혼 [5] 사별 [3] 별거 [6] 동거 A7 현재직업 가장적당한것을선택하시오 [1] 유급고용직 [6] 은퇴 [2] 자영업 [7] 해직 ( 건강상이유 ) [3] 자선사업 [8] 해직 ( 다른이유 ) [4] 학생 [9] 기타 [5] 가사 특이사항 A8 현재나타나는의학적진단, 가능한국제질병분류코드를기입할것 [1] 나타나는의학적상태없음 [2] ICD code : [3] ICD code : [4] ICD code : [5] 질병, 장애, 손상이있으나특성이나진단을모르는경우 [ 문서정보 ] 이 ICF Checklist 는 광주씨티재활병원재활센터 에서사용하기위해관련문헌을참고하여제작한것입니다 우리말용어는보건복지부에서번역발행한 국제기능 장애 건강분류 에나오는용어를사용하였습니다 참고문헌 : Jerome B et al ICF Core Sets; Manual for Clinical Practice Hogrefe 2012
Body functions PART 1a: IMPAIRMENTS OF BODY FUNCTIONS 평가치 Qualifier: Extent of impairments 0 손상없음 No impairment 1 경도손상 Mild impairment 2 중도손상 Moderate impairment 3 고도손상 Severe impairment 4 완전손상 Complete impairment 8 분류되어있지않음 Not specified 신체기능요약목록 Short List of Body Functions 평가치 b1 정신기능 MENTAL FUNCTIONS b130 에너지와욕동기능 Energy and drive functions b1300 에너지수준 Energy level b1301 동기부여 Motivation b1302 식욕 Appetite b1303 갈망 Craving b1304 충동조절 Impulse control b152 감정기능 Emotional functions b1520 정서의적절성 Appropriateness of emotion b1521 감정의조절 Regulation of emotion b1522 감정의범위 Range of emotion b4 심혈관계, 혈액학적, 면역학적그리고호흡기계의기능 FUNCTIONS OF THE CARDIOVASCULAR, HAEMATOLOGICAL, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS b415 혈관기능 Blood vessel functions b4150 동맥의기능 Functions of arteries b4151 모세혈관의기능 Functions of capillaries b4152 정맥의기능 Functions of veins b440 호흡기능 Respiration functions b4400 호흡수 Respiration rate b4401 호흡리듬 Respiratory rhythm b4402 호흡깊이 Depth of respiration b455 운동내성기능 Exercise tolerance functions b4550 일반적인신체적지구력 General physical endurance b4551 유산소능력 Aerobic capacity b4552 피로도 Fatiguability b5 소화기계, 대사및내분비계의기능 FUNCTIONS OF THE DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS b525 배변기능 Defecation functions b5250 분변제거 Elimination of faeces b5251 분변경도 Faecal consistency b5252 배변빈도 Frequency of defecation b5253 분변자제 Faecal continence b5254 방귀 Flatulence
Body functions 신체기능요약목록 Short List of Body Functions 평가치 b6 비뇨생식기와생식기능 GENITOURINARY AND REPRODUCTIVE FUNCTIONS b620 배뇨기능 Urination functions b6200 배뇨 Urination b6201 배뇨횟수 Frequency of urination b6202 배뇨자제 Urinary continence b7 신경근육골격및운동과연관된기능들 NEUROMUSCULOSKELETAL AND MOVEMENT-RELATED FUNCTIONS b710 관절의가동기능 Mobility of joint functions b7100 한관절의가동성 Mobility of a single joint b7101 여러관절의가동성 Mobility of several joints b7102 전반적인관절가동성 Mobility of joints generalized b735 근긴장도기능 Muscle tone functions b7350 분리된근육과근육군의긴장도 Tone of isolated muscles and muscle groups b7351 한지근육의긴장도 Tone of muscles of one limb b7352 신체편측근육의긴장도 Tone of muscles of one side of body b7353 하반신근육의긴장도 Tone of muscles of lower half of body b7354 사지근육의긴장도 Tone of muscles of all limbs b7355 몸통근육의긴장도 Tone of muscles of trunk b7356 신체모든근육의긴장도 Tone of all muscles of the body 그외신체기능 ANY OTHER BODY FUNCTIONS
Body structures PART 1b: IMPAIRMENTS OF BODY STRUCTURES 첫번째평가치 : 손상정도 Extent of impairment 두번째평가치 : 변화상태 Nature of the change 세번째평가치 : 손상위치 Location of impairment 0 손상없음 No impairment 1 경도손상 Mild impairment 2 중도손상 Moderate impairment 3 고도손상 Severe impairment 4 완전손상 Complete impairment 8 기타특이적인사항 Not specified 9 상세불명 Not applicable 0 구조변화없음 No change in structure 1 완전손실 Total absence 2 부분손실 Partial absence 3 부분추가 Additional part 4 이형차원 Aberrant dimensions 5 불연속성 Discontinuity 6 일탈상황 Deviating position 7 구조상의질적변화, 분비액의누적포함 Qualitative changes in structure, including accumulation of fluid 8 기타특이적인사항 Not specified 9 상세불명 Not applicable 0 한부위이상 More than one region 1 우측 Right 2 좌측 Left 3 양측 Both sides 4 앞면 Front 5 뒷면 Back 6 기부 ( 근위 ) Proximal 7 원심 ( 원위 ) Distal 8 기타특이적인사항 Not specified 9 상세불명 Not applicable 신체구조요약목록 Short List of Body Structures 평가치 1 Extent 평가치 2 Nature 평가치 3 Location s4 심혈관계, 면역계및호흡기계구조 STRUCTURES OF THE CARDIOVASCULAR, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS s410 심혈관계구조 Structure of cardiovascular system s4100 심장 Heart s41000 심방 Atria s41001 심실 Ventricles s4101 동맥 Arteries s4102 정맥 Veins s4103 모세혈관 Capillaries s7 운동관련구조 STRUCTURES RELATED TO MOVEMENT s710 두부및경부구조 Structure of head and neck region s7100 두개골 Bones of cranium s7101 안면골 Bones of face s7102 경부골 Bones of neck region s7103 두부및경부관절 Joints of head and neck region s7104 두부근및경부근 Muscles of head and neck region s7105 두부및경부의인대와근막 Ligaments and fasciae of head and neck region s730 상지구조 Structure of upper extremity s7300 상완구조 Structure of upper arm s73000 상완골 Bones of upper arm s73001 주관절 Elbow joint s73002 상완근육 Muscles of upper arm s73003 상완인대및근막 Ligaments and fasciae of upper arm
Body structures 신체구조요약목록 Short List of Body Structures 평가치 1 Extent 평가치 2 Nature 평가치 3 Location s7301 전완구조 Structure of forearm s73010 전완골 Bones of forearm s73011 손목관절 Wrist joint s73012 전완근육 Muscles of forearm s73013 전완인대및근막 Ligaments and fasciae of forearm s7302 손구조 Structure of hand s73020 손뼈 Bones of hand s73021 손및손가락관절 Joints of hand and fingers s73022 손근육 Muscles of hand s73023 손인대및근막 Ligaments and fasciae of hand s740 골반부구조 Structure of pelvic region s7400 골반부뼈 Bones of pelvic region s7401 골반부관절 Joints of pelvic region s7402 골반부근육 Muscles of pelvic region s7403 골반부인대및근막 Ligaments and fasciae of pelvic region s760 흉곽구조 Structure of trunk s7600 척추구조 Structure of vertebral column s76000 경추 Cervical vertebral column s76001 흉추 Thoracic vertebral column s76002 요추 Lumbar vertebral column s76003 천추 Sacral vertebral column s76004 미골 Coccyx s7601 흉곽근육 Muscles of trunk s7602 흉곽인대및근막 Ligaments and fasciae of trunk s8 피부및관련구조 SKIN AND RELATED STRUCTURES s810 피부관련구조 Structure of areas of skin s8100 두부및경부피부 Skin of head and neck region s8101 견관절부피부 Skin of the shoulder region s8102 상지부피부 Skin of upper extremity s8103 골반부피부 Skin of pelvic region s8104 하지부피부 Skin of lower extremity s8105 흉곽및등피부 Skin of trunk and back 그외신체기능 ANY OTHER BODY STRUCTURES
Activities & Participation PART 2: ACTIVITY LIMITATIONS & PARTICIPATION RESTRICTION 첫번째요건 : 수행 (Performance) 참여제약 (Participation Restriction) 의정도 두번째요건 : 능력 (Capacity; 도움없이 ) 활동제한 (Activity Limitation) 의정도 0 어려움없음 No difficulty 1 경도어려움 Mild difficulty 2 중도어려움 Moderate difficulty 3 고도어려움 Severe difficulty 4 완전어려움 Complete difficulty 8 분류되어있지않음 Not specified 0 어려움없음 No difficulty 1 경도어려움 Mild difficulty 2 중도어려움 Moderate difficulty 3 고도어려움 Severe difficulty 4 완전어려움 Complete difficulty 8 분류되어있지않음 Not specified 활동과참여영역의요약목록 Short List of A&P domains 수행평가치 능력평가치 d2 일반적인임무와요구 GENERAL TASKS AND DEMANDS d240 스트레스및여타심리적요구에의대응 Handling stress and other psychological demands d4 이동 MOBILITY d2400 책임수행 Handling responsibilities d2401 스트레스대응 Handling stress d2402 위기대응 Handling crisis d410 기본적인자세변화 Changing basic body position d4100 눕기 Lying down d4101 쪼그리고앉기 Squatting d4102 무릎꿇기자세 Kneeling d4103 앉기 Sitting d4104 기립 Standing d4105 구부리기자세 Bending d4106 몸의중심이동 Shifting the body s centre of gravity d415 자세유지 Maintaining a body position d4150 눕기자세유지 Maintaining a lying position d4151 쪼그리고앉기자세유지 Maintaining a squatting position d4152 무릎꿇기자세유지 Maintaining a kneeling position d4153 앉기자세유지 Maintaining a sitting position d4154 기립자세유지 Maintaining a standing position d420 자리이동 Transferring oneself d4200 앉아서자리이동 Transferring oneself while sitting d4201 누워서자리이동 Transferring oneself while lying d450 보행 Walking d4500 단거리보행 Walking short distances d4501 장거리보행 Walking long distances
Activities & Participation 활동과참여영역의요약목록 Short List of A&P domains 수행평가치 능력평가치 d4502 상이한지면보행 Walking on different surfaces d4503 장애물선회보행 Walking around obstacles d5 자기관리 SELF-CARE d510 씻기 Washing oneself d5100 신체일부씻기 Washing body parts d5101 전신씻기 Washing whole body d5102 말리기 Drying oneself d520 신체일부관리 Caring for body parts d5200 피부관리 Caring for skin d5201 치아관리 Caring for teeth d5202 모발관리 Caring for hair d5203 손톱관리 Caring for fingernails d5204 발톱관리 Caring for toenails d530 대소변처리 Toileting d5300 배뇨조절 Regulating urination d5301 배변조절 Regulating defecation d5302 월경관리 Menstrual care d550 먹기 Eating 그외활동과참여 ANY OTHER ACTIVITIES AND PARTICIPATION
Environmental factors PART 3: ENVIRONMENTAL FACTORS 평가치 Qualifier in environment: Barriers or facilitators 0 방해요인없음 No barrier 1 경도방해요인 Mild barrier 2 중도방해요인 Moderate barrier 3 고도방해요인 Severe barrier 4 완전방해요인 Complete barrier 8 분류되어있지않은방해요인 Barrier, not specified 0 촉진요인없음 No facilitator +1 경도촉진요인 Mild facilitator +2 중도촉진요인 Moderate facilitator +3 상당한촉진요인 Substantial facilitator +4 완전촉진요인 Complete facilitator +8 분류되어있지않은촉진요인 Facilitator, not specified 환경요약목록 Short List of Environment 방해요인평가치 촉진요인평가치 e1 제품과기술 PRODUCTS AND TECHNOLOGY e110 개인소비용품또는물질 Products or substances for personal consumption e1100 식품 Food e1101 약품 Drugs e3 지원과관계 SUPPORT AND RELATIONSHIPS e355 보건전문가 Health professionals e4 태도 ATTITUDES e420 친구의개인적인태도 Individual attitudes of friends 그외다른환경적인자들 ANY OTHER ENVIRONMENTAL FACTORS