Demographic information BRIEF ICF CORE SET for NEUROLOGICAL 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 b110 의식기능 Consciousness functions b1100 의식의상태 State of consciousness b1101 의식의연속성 Continuity of consciousness b1102 의식의질 Quality of consciousness b140 주의력기능 Attention functions b1400 주의력유지 Sustaining attention b1401 주의력이동 Shifting attention b1402 주의력분할 Dividing attention b1403 주의력공유 Sharing attention b167 언어의정신기능 Mental functions of language b1670 언어의수용 Reception of language b16700 구어의수용 Reception of spoken language b16701 문어의수용 Reception of written language b16702 신호언어의수용 Reception of sign language b1671 언어의표현 Expression of language b16710 구두언어의표현 Expression of spoken language b16711 서면언어의표현 Expression of written language b16712 수화표현 Expression of sign language b1672 통합언어기능 Integrative language functions b2 감각기능및통증 SENSORY FUNCTIONS AND PAIN b215 안구내외부구조의기능 Functions of structures adjoining the eye b2150 안구내재근 ( 불수의근 ) 의기능 Functions of internal muscles of the eye b2151 안검기능 Functions of the eyelid b2152 안구외재근 ( 외안근 ; 수의근 ) 의기능 Functions of external muscles of the eye b2153 누선기능 Functions of lachrymal glands b235 전정기능 Vestibular functions b2350 위치전정기능 Vestibular function of position b2351 균형전정기능 Vestibular function of balance b2352 운동성결정전정기능 Vestibular function of determination of movement b240 청각및전정기능과관련된감각 Sensations associated with hearing and vestibular functions
Body functions 신체기능요약목록 Short List of Body Functions 평가치 b4 b2400 귀울림또는이명 Ringing in ears or tinnitus b2401 어지러움증 Dizziness b2402 쓰러지는느낌 Sensation of falling b2403 어지러움이나현훈과연관된구토 Nausea associated with dizziness or vertigo b2404 귀속자극 Irritation in the ear b2405 이압 Aural pressure b270 온도및기타자극과관련된감각기능 Sensory functions related to temperature and other stimuli b2700 온도에대한감수성 Sensitivity to temperature b2701 진동에대한감수성 Sensitivity to vibration b2702 압력에대한감수성 Sensitivity to pressure b2703 유해자극에대한감수성 Sensitivity to a noxious stimulus 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 b430 혈액계의기능 Haematological system functions b4300 혈액생산 Production of blood b4301 혈액의산소운반기능 Oxygen-carrying functions of the blood b4302 혈액의대사물운반기능 Metabolite-carrying functions of the blood b4303 응고기능 Clotting functions b440 호흡기능 Respiration functions b4400 호흡수 Respiration rate b4401 호흡리듬 Respiratory rhythm b4402 호흡깊이 Depth of respiration 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 b535 소화기계와연관된감각 Sensations associated with the digestive system b5350 오심감각 Sensation of nausea b5351 팽만한감각 Feeling bloated b5352 복부경련감각 Sensation of abdominal cramp b7 신경근육골격및운동과연관된기능들 NEUROMUSCULOSKELETAL AND MOVEMENT-RELATED FUNCTIONS b710 관절의가동기능 Mobility of joint functions b7100 한관절의가동성 Mobility of a single joint
Body functions 신체기능요약목록 Short List of Body Functions 평가치 b7101 여러관절의가동성 Mobility of several joints b7102 전반적인관절가동성 Mobility of joints generalized 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 s1 신경계구조 STRUCTURES OF THE NERVOUS SYSTEM s110 뇌구조 Structure of brain s1100 대뇌피질구조 Structure of cortical lobes s11000 전두엽 Frontal lobe s11001 측두엽 Temporal lobe s11002 두정엽 Parietal lobe s11003 후두엽 Occipital lobe s1101 중뇌구조 Structure of midbrain s1102 간뇌구조 Structure of diencephalon s1103 대뇌기저핵및관련구조 Basal ganglia and related structures s1104 소뇌구조 Structure of cerebellum s1105 뇌간구조 Structure of brain stem s11050 연수 Medulla oblongata s11051 교뇌 Pons s1106 뇌신경구조 Structure of cranial nerves s120 척수및관련구조 Spinal cord and related structures s1200 척수구조 Structure of spinal cord s12000 경수 Cervical spinal cord s12001 흉수 Thoracic spinal cord s12002 요천수 Lumbosacral spinal cord s12003 마미 ( 말총 ) Cauda equina s1201 척수신경 Spinal nerves
Body structures 신체구조요약목록 Short List of Body Structures 평가치 1 Extent 평가치 2 Nature 평가치 3 Location 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 그외신체구조 ANY OTHER BODY STRUCTURES
Activities & Participation PART 2: ACTIVITY LIMITATIONS & PARTICIPATION RESTRICTIONS 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 d3 의사소통 COMMUNICATION d360 의사소통장비및기술의이용 Using communication devices and techniques d3600 원거리통신장비이용 Using telecommunication devices d3601 기록장비이용 Using writing machines d3602 의사소통기술이용 Using communication techniques d4 이동 MOBILITY 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 d465 장비를이용한이동 Moving around using equipment d5 자기관리 SELF-CARE d510 씻기 Washing oneself
Activities & Participation 활동과참여영역의요약목록 Short List of A&P domains 수행평가치 능력평가치 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 d540 몸단장 Dressing d5400 옷입기 Putting on clothes d5401 옷벗기 Taking off clothes d5402 신발신기 Putting on footwear d5403 신발벗기 Taking off footwear d5404 적절한옷차림 Choosing appropriate clothing d550 먹기 Eating d560 마시기 Drinking d7 대인관계 INTERPERSONAL INTERACTIONS AND RELATIONSHIPS d760 가족관계 Family relationships d7600 부모로서자녀와의관계 Parent-child relationships d7601 자녀로서부모와의관계 Child-parent relationships d7602 형제자매관계 Sibling relationships d7603 확대가족관계 Extended family relationships 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 e120 개인의실내 외이동및수송용제품및기술 Products and technology for personal indoor and outdoor mobility and transportation e1200 개인의실내 외이동및수송용일반제품및기술 General products and technology for personal indoor and outdoor mobility and transportation e1201 개인의실내 외이동및수송용보조제품및기술 Assistive products and technology for personal indoor and outdoor mobility and transportation e3 지원과관계 SUPPORT AND RELATIONSHIPS e315 확대가족 Extended family e4 태도 ATTITUDES e465 사회적표준, 관행및이념 Social norms, practices and ideologies e5 서비스, 시스템및정책 SERVICES, SYSTEMS AND POLICIES e550 법률서비스, 시스템및정책 Legal services, systems and policies e5500 법률서비스 Legal services e5501 법률시스템 Legal systems e5502 법률정책 Legal policies e570 사회보장서비스, 시스템및정책 Social security services, systems and policies e5700 사회보장서비스 Social security services e5701 사회보장시스템 Social security systems e5702 사회보장정책 Social security policies 그외다른환경적인자들 ANY OTHER ENVIRONMENTAL FACTORS