慢性中風個案之「國際健康功能與身心障礙分類系統」和「個案處理模式」之應用

Application of the International Classification of Functioning (ICF) Model and the Client Management Model for a Patient with Chronic Stroke

中風常導致行走功能的問題，這常是多因子互相影響後的結果。本個案為一位67 歲慢性中風病患，於2011 年5 月腦部電腦斷層掃瞄後診斷為右側基底核及放射冠出血。本篇使用「個案處理模式」進行「評量分析－治療介入－再評量分析」的互動循環程序，再合併「國際健康功能與身心障礙分類系統」分析，從損傷層面、功能層面併以環境及個人因子層面完整分析此個案。發現個案因其健康狀態造成的左側肢體感覺異常、左下肢肌力不足、不對稱步態以及動態站立平衡能力不足，會影響個案行走活動能力，經由給予行走輔具後，個案現在可以在旁人監督下行走，但個案行走速度和行走距離的表現仍不佳，綜合考量個案為慢性中風個案，神經學恢復已達穩定，因此對其不對稱步態進行介入，並且提升動態站立平衡能力以增進行走速度和距離的表現。因此針對個案不對稱步態以及動態站立平衡問題，使用任務導向模式進行此問題之介入方式，四週後，個案行走速度及步態對稱性皆有改善。本報告顯示合併「國際健康功能與身心障礙分類系統」及「個案處理模式」，可以更完整分析慢性中風患者的活動功能，根據此分析結果再使用任務導向進行介入，不僅可以增進慢性中風患者行走速度和距離表現，也能改善其步態對稱性，促使其行走功能以達最佳狀態。

Stroke may result in impaired walking function. Walking function can be considered as an interaction of multiple factors. Our reported case is a 67-year-old patient, with chronic stroke whose MRI examination on 2011/5 revealed right basal ganglia and corona radiate hemorrhage. We used client management model with the cycle of evaluation-intervention-reevaluation and the ICF model in the process of our examination and evaluation. The case was analyzed comprehensively from the aspects of impairment and function as well as the environmental and personal aspects. The results showed that our case had left limb paresthesia, weakness, asymmetrical gait and insufficient dynamic standing balance which affected his mobility. After being provided with a walking device, walking ability has improved. However, the gait speed and walking distance were still insufficient. Since the case was a patient of chronic stroke, the neurologic progress has reached a plateau. Therefore, the intervention was through improving symmetry of gait and dynamic standing balance to increase the gait speed and walking distance. After four-week intervention with task-oriented approach, both asymmetrical gait and gait speed have improved. Our report showed that using the combined "ICF model" and "client management model" could comprehensively analyze activity function. Task-oriented approach could be used to effectively increase gait speed, walking distance, and improving asymmetrical gait to maximize ambulation function.