身心障礙鑑定功能量表之運用

Application of the Functioning Scale of the Disability Evaluation System

根據身心障礙者權益保障法，台灣身心障礙鑑定新制採行世界衛生組織「國際健康功能與身心障礙分類系統」（ICF）精神，於2012年7月開始由醫療團隊評估身體功能與構造以及活動與參與面向。因此障礙鑑定功能量表編制團隊乃參考「世界衛生組織障礙評估手冊2.0版」與「兒童與家庭追蹤調查表」設計「身心障礙鑑定功能量表成人版」與「身心障礙鑑定功能量表兒童版」。成人版共94 題，領域1 至領域6 （認知、四處走動、生活自理、與他人相處、居家活動/工作與學習、社會參與）與領域8（動作活動）皆有表現與「在生活情境下能力」或能力面向之題項，領域7（環境因子）為收集個案自覺環境障礙因素。兒童版，包括四部分共79題：兒童健康概況，家庭及社區的參與，兒童日常生活上的問題與兒童的環境因素。家庭及社區的參與4個領域（居家生活、鄰里及社區生活、學校生活、家庭及社區生活）皆有參與獨立性（在生活情境下能力）與參與頻率（表現）面向之題項。本文並以兩個個案為例，包括一位中風成人與一位腦性麻痺青少年，來說明功能量表評估結果，如何轉換及計算障礙分數，障礙分數之意義與解釋，與運用功能量表評估結果來協助臨床決策。期待功能量表之運用，可以協助臨床人員落實ICF 促進個案活動與參與之精神。

According to The People with Disabilities Rights Protection Act, the local authority in Taiwan launched disability identifications based on the results of disability evaluation by a medical team since July 2012. The content of the disability evaluation includes body function and structures as well as activity and participations of the ICF/ICF-CY. The Functioning Scale of the Disability Evaluation System (FUNDES), Adult version and Child version, has been designed to assess the activities and participation based on the "WHO Disability Assessment Schedule II" and "Child and Family Follow-up Survey" separately. The Adult version of FUNDES contains 94 items, with performance and capability qualifiers in Domain 1 - 6 (Cognition, Mobility, Self-care, Getting alone, Life activities and Participation), and capability and capacity qualifiers in Domain 8 (Motor action). The Domain 7 (Environmental attributes) contains items that measure the perceived environmental barriers. The Child version of FUNDES contains 4 parts and 79 items: Physical and emotional health, Participation, the Child and Adolescent Factors Inventory, and the Child and Adolescent Scale of Environment. There are items with independence (capability) and frequency (performance) dimensions in the Participation part. This article introduces the scoring, the interpretation of the disability scores of the FUNDES and its clinical application by using two examples, one adult with stroke and one adolescent with cerebral palsy. Hope the main focus of the ICF, enhancing the full participation of people with disabilities in society, could be achieved through the application of the FUNDES.