Professional Documents
Culture Documents
PERIOSTAL-VISCERAL
(zones of Vogler-Krauss)
REFLECTORY
CONNECTIONS SUBCUTANEOUS-CONNECTIVE
TISSUE- VISCERAL
(zones of Leube-Dicke)
IN
BULGARIA
ICF
Body functions Activities Participation
() (Limitations) (Disability)
Physiotherapy, electrotherapy,
massages, ergotherapy
In different groups ofdiseases
Or
Synergic combination of different
physical modalities and
techniques:
Complex rehabilitation programme
for every health condition
Thessaloniki, 2012
Prof. Ivet Koleva, DM, PhD, DMSc
In therapy we apply the
PHYSICAL-THERAPEUTIC AND
REHABILITATION PUZZLE
KINESI PREFORMED
(physio) MODALITIES
(electro/magneto/light/th)
therapy
HYDRO/
ERGO
BALNEO/
(occupational)
PELOIDO/ therapy
CLIMATO-th
The found is always adapted diet and strict medication of the basic disease
Devices for electro-therapy
(low and middle frequency)
ELECTRODES
for electrotherapy with
low frequency and middle frequency currents
,
Low frequency pulsed
magnetic field
LASER
THERAPY, PUNCTURE, ACUPUNCTURE
EATING
ADL
---
ADL
---
ADL
---
ADL
ADL
SPA
Sanus Per Aquam
or
health by water
In clinical rehabilitation practice we apply the
CHOLISTIC APPROACH
to the patient
from the analysis to the synthesis
PRM doctor
PATIENT
Physiotherapist
Ergo therapist
HEALTH
2012 43
STAR OF LIFE
More specifically, key factors that have been found to influence whether
people are healthy or unhealthy include: social status, education literacy,
employment (work), social and physical environment; health care services,
culture, etc.
The PEO model
PERSON ENVIRONMENT
OCCUPATION MODEL OF
PERFORMANCE
PEO MODEL
First described by Law et al 1996
Doesnt prescribe specific assessments or methods of intervention
GUIDES CLINICAL REASONING ABOUT WHAT WE CHOOSE & WHY
PERSON
SKILLS & ABILITIES - MUSCLE STRENGTH, VISUAL-PERCEPTION,
COGNITIVE ABILITIES
INTRINSIC MOTIVATION, VALUES & GOALS
Each person is unique; Person could also apply to a group of people e.g. students with a disability in a school
ENVIRONMENT
PHYSICAL; SENSORY; SOCIAL; CULTURAL; INSTITUTIONAL
OCCUPATION
GROUPS OF ACTIVITIES THAT HELP A PERSON BE for example: A student, A player,
A brother, A friend
Includes: Writing an essay, riding a skateboard, playing football, making a snack
Multiple avenues for intervention:
PERSONcomponent skills e.g. strength, balance, coordination, social
skills
ENVIRONMENTraising awareness, physical adaptations, visual
timetables
OCCUPATIONhandwriting programmes, visual prompts for dressing,
teach to ride a bike
ACTIVITIES
PERSONAL
FACTORS
PARTICIPATION
BODY FUNCTIONS
ICF CHECKLIST - Version 2.1a, Clinician Form
Demographical data ; Diagnosis ICD-X revision
First Qualifier: Extent of impairments
0 No impairment means the person has no problem
1 Mild impairment means a problem that is present less than 25% of the time, with an intensity a
person can tolerate and which happens rarely over the last 30 days.
2 Moderate impairment means that a problem that is present less than 50% of the time, with an
intensity, which is interfering in the persons day to day life and which happens occasionally over the
last 30 days.
3 Severe impairment means that a problem that is present more than 50% of the time, with an
intensity, which is partially disrupting the persons day to day life and which happens frequently over
the last 30 days.
4 Complete impairment means that a problem that is present more than 95% of the time, with an
intensity, which is totally disrupting the persons day to day life and which happens every day over
the last 30 days.
8 Not specified means there is insufficient information to specify the severity of the impairment.
9 Not applicable means it is inappropriate to apply a particular code (e.g. b650 Menstruation
functions for woman in pre-menarche or post-menopause age).
BODY FUNCTIONS
CHAPTER 1
MENTAL FUNCTIONS
This chapter is about the functions of the brain: both
global mental functions, such as consciousness,
energy and drive, and specific mental functions, such
as memory, language and calculation mental
functions.
b1. MENTAL FUNCTIONS
b110 Consciousness
b114 Orientation (time, place, person)
b117 Intellectual ( incl. Retardation, dementia)
b130 Energy and drive functions
b134 Sleep
b140 Attention
b144 Memory
b152 Emotional functions
b156 Perceptual functions
b164 Higher level cognitive functions
b167 Language
BODY FUNCTIONS
CHAPTER 2
SENSORY FUNCTIONS AND PAIN
This chapter is about the functions of the senses, seeing,
hearing, tasting and so on, as well as the sensation of pain.
CHAPTER 3
VOICE AND SPEECH FUNCTIONS
b410 Heart
b420 Blood pressure
b430 Haematological (blood)
b435 Immunological (allergies, hypersensitivity)
b440 Respiration (breathing)
BODY FUNCTIONS
CHAPTER 5
FUNCTIONS OF THE DIGESTIVE,
METABOLIC AND ENDOCRINE SYSTEMS
b515 Digestive
b525 Defecation
b530 Weight maintenance
b555 Endocrine glands (hormonal changes)
BODY FUNCTIONS
CHAPTER 6
GENITO-URINARY AND
REPRODUCTIVE FUNCTIONS
d4. MOBILITY
d430 Lifting and carrying objects
d440 Fine hand use (picking up, grasping)
d450 Walking
d465 Moving around using equipment (wheelchair, skates, etc.)
d470 Using transportation (car, bus, train, plane, etc.)
d475 Driving (riding bicycle and motorbike, driving car, etc.)
d5. SELF CARE
d510 Washing oneself (bathing, drying, washing hands, etc)
d520 Caring for body parts (brushing teeth, shaving, grooming, etc.)
d530 Toileting
d540 Dressing
d550 Eating
d560 Drinking
d570 Looking after one`s health
Short List of A&P domains - 3
d6. DOMESTIC LIFE
d620 Acquisition of goods and services (shopping, etc.)
d630 Preparation of meals (cooking etc.)
d640 Doing housework (cleaning house, washing dishes laundry, ironing,
etc.)
d660 Assisting others
d7. INTERPERSONAL INTERACTIONS AND
RELATIONSHIPS
d710 Basic interpersonal interactions
d720 Complex interpersonal interactions
d730 Relating with strangers
d740 Formal relationships
d750 Informal social relationships
d760 Family relationships
d770 Intimate relationships
d8. MAJOR LIFE AREAS
Short List of A&P domains - 4
(Performance)
(1) In your present surroundings, how much of a problem do you actually have in
walking long distances (such as a kilometer or more)?
(2) Is this problem walking made worse, or better, by your actual surroundings?
(3) Is your capacity to walk long distances without assistance more or less than what
you actually do in your present surroundings?
GENERAL QUESTIONS FOR
PARTICIPATION & ACTIVITIES - 2
II. SELF CARE
(Capacity)
(1) In your present state of health, how much difficulty do you have washing yourself,
without assistance?
(2) How does this compare with someone, just like yourself only without your health
condition?
(Or: "than you had before you developed your health problem or had the accident?)
(Performance)
(1) In your own home, how much of a problem do you actually have washing
yourself?
(2) Is this problem made worse, or better, by the way your home is set up or the
specially adapted tools you use?
(3) Is your capacity to wash yourself without assistance more or less than what you
actually do in your present surroundings?
GENERAL QUESTIONS FOR
PARTICIPATION & ACTIVITIES - 3
III. DOMESTIC LIFE
(Capacity)
(1) In your present state of health, how much difficulty do you have cleaning the floor
of your where you live, without assistance?
(2) How does this compare with someone, just like yourself only without your health
condition?
(Or: "than you had before you developed your health problem or had the accident?)
(Performance)
(1) In your own home, how much of a problem do you actually have cleaning the
floor?
(2) Is this problem made worse, or better, by the way your home is set up or the
specially adapted tools you use?
(3) Is your capacity to clean your floor without assistance more or less than what you
actually do in your present surroundings?
GENERAL QUESTIONS FOR
PARTICIPATION & ACTIVITIES - 4
IV. INTERPERSONAL INTERACTIONS
(Capacity)
(1) In your present state of health, how much difficulty do you have making new
friends , without assistance?
(2) How does this compare with someone, just like yourself only without your health
condition?
(Or: "than you had before you developed your health problem or had the accident?)
(Performance)
(1) In your present situation, how much of a problem do you actually have making
friends?
(2) Is this problem making friends made worse, or better, by anything (or anyone) in
your surroundings?
(3) Is your capacity to make friends, without assistance, more or less than what you
actually do in your present surroundings?
GENERAL QUESTIONS FOR
PARTICIPATION & ACTIVITIES - 5
V. MAJOR LIFE AREAS
(Capacity)
(1) In your present state of health, how much difficulty do you have getting done all
the work you need to do for your job, without assistance?
(2) How does this compare with someone, just like yourself only without your health
condition?
(Or: "than you had before you developed your health problem or had the accident?)
(Performance)
(1) In your present surroundings, how much of a problem do you actually have getting
done all the work you need to do for your job?
(2) Is this problem fulfilling your job requirements made worse, or better, by the way
the work environment is set up or the specially adapted tools you use?
(3) Is your capacity to do your job, without assistance, more or less than what you
actually do in your present surroundings?
GENERAL QUESTIONS FOR
PARTICIPATION & ACTIVITIES - 6
VI. MAJOR LIFE AREAS
(Capacity)
(1) In your present state of health, how much difficulty do you have participating in
community gatherings, festivals or other local events, without assistance?
(2) How does this compare with someone, just like yourself only without your health
condition?
(Or: "than you had before you developed your health problem or had the accident?)
(Performance)
(1) In your community, how much of a problem do you actually have participating in
community gatherings, festivals or other local events?
(2) Is this problem made worse, or better, by the way your community is arranged or
the specially adapted tools, vehicles or whatever you use?
(3) Is your capacity to participate in community events, without assistance, more or
less than what you actually do in your present surroundings?
PART 3: ENVIRONMENTAL FACTORS
Environmental factors make up the physical, social and attitudinal environment in
which people live and conduct their lives.
Qualifier in environment:
0 No barriers 0 No facilitator
Barriers or facilitator
PERSONAL
BODY
FACTORS ACTI
FUNCTIONS
Technical Age, sex, VITIES
assistance Polymorbidity, Operating Management PARTICI
PAIN
Health culture contact contact PATION
Verticalization
Range Family
ENVIRONMENT
of Motion Mobility
Home Leisure
Transport
MUSCLE Employment Locomotion Social life
WEAKNESS Health (rates
(performance
based) Transport Political
(time Services related) activities
COORDI
based) Assurance
NATION Grasp
Family
Friends ADL
SOMATOSCOPY
AND
ANTROPOMETRY
SOMATOSCOPY
INSPECTION
for determinate qualities of the patients body:
BODY MASS
DEVELOPMENT OF MUSCULAR SYSTEM
SQUELETON (thorax, vertebral spine, lower extremities, foot)
POSITION of the body
LOCOMOTION
DEGREES OF QUALITATIVE EVALUATION :
GOOD
FAIR
POOR
PHOTOSOMATOSCOPY
SOMATOSCOPY
STATURE HEIGHT in standing position men 170 +/- 6 m; women 156 +/- 5 m;
HEIGHT in sitting position on a chair 40 cm, from the vertex to the floor;
LONGITUDINAL MEASUREMENT OF THE BODY measurement from the
suprasternal point (incisura) to the symphysis;
LONGITUDINAL MEASURES OF EXTREMITIES standard measures of upper
and lower extremities
MEASUREMENT OF DIAMETERS
(BIACROMIAL; Sagital diameter of the thorax , pelvic diameter; distantia cristarum, distantia
spinarum, distantia trochanterica) circul measurement
MEASUREMENT OF BODY MASS kg;
BODY WEIGHT body-mass index;
CENTIMETRY (THORACAL DIAMETER, chest measurement, waist measurement, haunch measurement, abdominal
measurement) in centimeters;
EVALUATION OF THE PULMONAR VITAL CAPACITY SPIROMETRY
EVALUATION OF MUSCLE FORCE DINAMOMETRY
NUAL MUSCLE TESTING
ANTROPOMETRY
VALUATION OF THE SPINE (VERTEBRAL) MOBILITY
CERVICAL REGION flexion, extension, lateroflexion, rotation;
HORACAL REGION flexion (distance fingers-floor, tests Ott, Forestier
valuation in centimeters;
LUMBO-SACRAL SPINE (Schober test) cm
PERSONAL
BODY
FACTORS ACTI
FUNCTIONS
Technical Age, sex, VITIES
assistance Polymorbidity, Operating Management PARTICI
PAIN
Health culture contact contact PATION
Verticalization
Range Family
ENVIRONMENT
of Motion Mobility
Home Leisure
Transport
MUSCLE Employment Locomotion Social life
WEAKNESS Health (rates
(performance
based) Transport Political
(time Services related) activities
COORDI
based) Assurance
NATION Grasp
Family
Friends ADL
Current article presents the concepts of Bulgarian rehabilitation school about the necessity of application of
the principles of the functional evaluation and of the International Classification of Functioning, Disability
and Health (WHO, 2001) in clinical rehabilitation practice and in educational processus.
Functional evaluation of rehabilitation patient is an obligatory part of the rehabilitation algorithms of a lot of
neurological, orthopedical-traumatological and rhumatological conditions. Principal points of the functional
analysis and of the rehabilitation complexes of some socially important diseases are mentioned (stroke,
multiple sclerosis, Parkinsonism, traumatic brain injuries, medullar lesions; poliomyelitis; radiculopathies,
diabetic polyneuropathy; spondyloarthrosis, coxarthrosis, gonarthrosis; metabolic syndrome, etc).
Functional evaluation and ICF are presented in the educational plans of students in Medicine and in the
processus of specialization in Physical and Rehabilitation Medicine (Medical University of Pleven) ,
students in Medical rehabilitation and Ergotherapy (Medical Universities of Pleven and Sofia), students in
Rehabilitation (Medical colleges of Sofia and Stara Zagora). We introduced some specialized disciplines
v.gr. Functional evaluation in Rehabilitation and Functional evaluation and ICF in the educational
programme of students in Medical Rehabilitation and of PRM trainees. For quantitative evaluation of the
level of competence of students and trainees we applied series of electronic tests, especially created for
the rehabilitation practice and adapted to the role of different members of the rehabilitation team: medical
doctors - PRM specialists; PRM trainees; specialists and students in Rehabilitation, Physiotherapy, Medical
rehabilitation and Ergotherapy.
NEUROREHABILITATION
POST-GRADUATE COURSE ICF & FUNCTIONAL EVALUATION IN
MU Pleven
PROFESSIONAL
COMPETENCES
BIO-ETHICS;
THEORETICAL PRACTICAL
KNOWLEDGE SKILLS CAPACITIES FOR
TEAM WORK
Rehabilitation Occupational
Medicine Therapy
Body
Activities &
Structures
Participation
& Functions
Personal and
Environmental
Factors
40
35
30
25
20 woman
15 man
10
5
0
sex
Physical therapy - theory
Physical therapy practical skills
Ergotherapy - theory
Ergotherapy practical skills
FUNCTIONAL EVALUATION
Kinesitherapy specialized
methods
-
-
-
4.5 Professional competences
Number of students
Theory Practice
4 4 4
3.5 3 3
RESULTS
3
2.5 2
2
2 2
1.5 1
1 1
0.5
0
0 - 25 %
0 25 - 50 % 50 - 75 % 75 - 90 % 90 - 100 %
Theory 0 1 2 4 4
Practice 1 2 3 3 2
STUDENTS OPINION
ABOUT THE INTRODUCTION OF MASTERS THESIS
ILLUSTRATION
ICF
MODERN DEVICES