基于世界卫生组织国际分类家族构建言语嗓音功能障碍的诊断、评估和康复体系

目的 基于《国际疾病分类》第11次修订本(ICD-11)、《国际功能、残疾和健康分类》(ICF)和《国际健康干预分类》(ICHI)探讨言语嗓音功能障碍的诊断标准、功能评估和整体康复干预方案。 方法 基于ICD-11和ICF对言语嗓音障碍及其常见疾病诊断标准进行分析,确认疾病和功能诊断标准。采用ICF的理论,分析言语嗓音功能评估工具的主要内容和评估指标。基于ICF和ICHI对现有言语嗓音功能康复方法进行分析,构建结构化言语嗓音康复干预方案。 结果和结论 言语嗓音功能障碍诊断为“语音障碍”(MA82),属于“涉及言语或语音的症状或体征”中的一种,与之相关的疾病为言语障碍(MA80)、喉恶性肿瘤(2C23)、脑出血(8B00)、喉水肿(CA0H.3)等。言语嗓音功能障碍属身体功能障碍,并可能影响交流等活动和参与(d3、d7、d8、d9),以及环境因素和个人因素。对言语嗓音功能的评估应从嗓音产生功能(b3100)和嗓音音质功能(b3101)两方面进行。结构化言语嗓音康复治疗方案主要涉及身体结构与功能、活动和参与、环境因素和健康行为四个方面,方法包括评估类(评估、测试、观察)、训练治疗类(训练、辅导)、教育咨询类(教育、建议、咨询)和支持类(社会支持和心理支持)等。

Construction of System of Diagnosis,Assessment and Rehabilitation Interventions for Impairment of Speech and Voice Function Using WHO Family International Classificiations

Objective To explore diagnosis and assessment of voice function and develop a framework of rehabilitation for it based on International Classification of Diseases 11th Revision(ICD-11),International Classification of Functioning,Disability and Health(ICF)and International Classification of Health Interventions(ICHI).Methods The diagnostic criteria of voice disorders and its complications were discussed with ICD-11 and ICF.The tools of assessment were analysed with ICF.A comprehensive intervention system was developed for the rehabilitation of voice function based on the joint use of ICF and ICHI.Results and Conclusion Voice disorders are classified to Voice Disturbance(MA82),within the category of Symptoms or Signs Involving Speech or Voice.Voice disorders may be symptoms or signs of Speech Disturbance(MA80),Malignant Neoplasms of Larynx(2C23),Intracerebral Haemorrhage(8B00),Oedema of Larynx(CA0H.3),and the others.Voice disorder is impairment at body function,and influence activity and participation(d3,d7,d8 and d9),which may involve in environmental and personal factors.The evaluation of voice function involes in production of voice(b3100)and quality of voice(b3101).A structured rehabilitation solution has been developed with the interventions at body structure,body function,activities and participation,environmental factors and personal factors,including assessment(assessment,test,observation),training and treatment(training,assisting),educational counseling(education,advicing,counseling),and support(psychological and social).