基于ICF构建学习障碍儿童功能分析与运动康复方案研究

doi:10.3969/j.issn.1006-9771.2021.12.003

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (12): 1384-1392.doi: 10.3969/j.issn.1006-9771.2021.12.003

• 专题身体活动与健康及ICF应用 • 上一篇下一篇

基于ICF构建学习障碍儿童功能分析与运动康复方案研究

杨宝仪^1,^2,³,姜静远^1,^2,³,戴栖¹,王国祥^1,^2,³(),邱卓英^2,^3,^4,⁵(),蔡赓^1,^2,³,孙慧珍⁶,杨剑^2,^3,⁷,王少璞^2,⁸,朱婷^3,⁹,李安巧^2,³,郝传萍^2,^3,¹⁰,张萌^1,^2,³,周晟^1,^2,³,汤修齐^2,^3,¹¹,刘静^2,^3,¹¹

1. 苏州大学体育学院/运动康复研究中心,江苏苏州市 215021
2. 中国ICF研究院,山东潍坊市 261000
3. 世界卫生组织国际分类家族中国合作中心,北京市 100068
4. 中国康复研究中心/中国康复科学所,北京市 100068
5. 康复大学,山东青岛市 266071
6. 苏州高新区人民医院,江苏苏州市 215129
7. 华东师范大学体育与健康学院,青少年健康评价与运动干预教育部重点实验室,上海市 200241
8. 广东体育职业学院,广东广州市 510000
9. 深圳市龙岗区特殊教育学校,广东深圳市 518000
10. 北京联合大学特殊教育学院,北京市 100075
11. 武汉理工大学体育部体育科学研究所,湖北武汉市 430070

收稿日期:2021-11-05 修回日期:2021-11-23 出版日期:2021-12-25 发布日期:2021-12-29
通讯作者: 王国祥,邱卓英 E-mail:kwang63@163.com;qiutiger@hotmail.com
作者简介:杨宝仪(2001-),女,汉族,江苏盐城市人,主要研究方向：ICF,运动康复与残疾人体育。
基金资助:
国家社会科学基金项目(19BTY125)

Analysis of Functioning and Design of Individualized Rehabilitation Protocol for Children with Learning Disability Using ICF

YANG Bao-yi^1,^2,³,JIANG Jing-yuan^1,^2,³,DAI Qi¹,WANG Guo-xiang^1,^2,³(),QIU Zhuo-ying^2,^3,^4,⁵(),CAI Geng^1,^2,³,SUN Hui-zhen⁶,YANG Jian^2,^3,⁷,WANG Shao-pu^2,⁸,ZHU Ting^3,⁹,LI An-qiao^2,³,HAO Chuan-ping^2,^3,¹⁰,ZHANG Meng^1,^2,³,ZHOU Sheng^1,^2,³,TANG Xiu-qi^2,^3,¹¹,LIU Jing^2,^3,¹¹

1. School of Physical Education and Sport Sciences/Research Center of Sport and Exercise Rehabilitation, Soochow University, Suzhou, Jiangsu 215021, China
2. China Academy of ICF, Weifang, Shandong 261000, China
3. WHO-FIC Collaborating Center in China, Beijing 100068, China
4. China Rehabilitation Research Center/China Rehabilitation Research Institute, Beijing 100068, China
5. University of Health and Rehabilitation Sciences, Qingdao, Shandong 266071, China
6. The People's Hospital of Suzhou New District, Suzhou, Jiangsu 215129, China
7. College of Physical Education and Health, East China Normal University, Shanghai, 200241, China
8. Guangdong Vocational Institute of Sports, Guangzhou, Guangdong 510000, China
9. Longgang Special Education School, Shenzhen, Guangdong 518000, China
10. Special Education College of Beijing Union University, Beijing 100075, China
11. Institute for Sport Science, Department of Physical Education of Wuhan University of Technology, Wuhan, Hubei 430070, China

Received:2021-11-05 Revised:2021-11-23 Published:2021-12-25 Online:2021-12-29
Contact: WANG Guo-xiang,QIU Zhuo-ying E-mail:kwang63@163.com;qiutiger@hotmail.com
Supported by:
National Social Science Fund of China(19BTY125)

摘要/Abstract

摘要：

目的应用《国际功能、残疾和健康分类》(ICF)对学习障碍儿童的整体功能特点进行分析,并制定个别化运动康复方案。方法基于ICF的理论架构和ICD-11的疾病诊断,从儿童发展和成长的角度,对学习障碍儿童的认知、理解、注意和思维等功能进行分析,并根据“生物-心理-社会”的健康模式及身体活动的身心交互理论,构建针对学习障碍儿童以功能为导向的个别化运动康复方案。结果学习障碍儿童的身体功能障碍集中表现在精神功能方面,在活动和参与方面体现为学习和应用知识、完成一般任务、与人交流等的活动受限和参与局限,且学校环境中的教育用品和技术及其服务、政策和体制等因素也都会影响学习障碍儿童。运动康复有利于学习障碍儿童改善精神和运动功能,并有效提升智力、认知、注意力、沟通、活动等能力,促进儿童全面发展。根据《WHO关于身体活动和久坐行为的指南》以及相关国家身体活动指南中针对儿童的部分,选取适合学习障碍儿童的运动方案,进行中等强度到高强度的身体活动至少每天60 min,以及每周不少于3次的高强度训练,配合适宜的体育游戏和休闲体育活动可有效改善学习效果,降低学习障碍影响。结论运用ICD-11和ICF对学习障碍儿童的疾病、功能障碍和运动特点进行系统分析,基于身心交互作用理论和ICF的生物-心理-社会的健康模式,建立了整体康复和功能导向的运动康复方案,这些方案推荐每天进行至少60 min的中等强度身体活动,包括有氧运动和体育游戏等,以及每周至少3次且时长不低于30 min的高强度身体活动,包括肌力训练和体育竞赛等。结合儿童的学习障碍和运动功能特点,制定基于功能的个别化运动康复方案,可有效改善学习障碍儿童认知、注意和思维等功能,改善学习障碍,促进儿童的全面发展。

关键词: 国际功能、残疾和健康分类, 学习障碍, 运动康复

Abstract:

Objective To analyze the overall functioning of children with learning disabilities, and develop individualized exercise rehabilitation protocol using International Classification of Functioning, Disability and Health (ICF). Methods Based on the theoretical framework of ICF and the disease diagnosis of International Classification of Diseases (ICD-11), and with the perspective of child development, the functional profiles of cognition, understanding, attention, thinking, motor, and activity and participation of children with learning disabilities were analyzed. A function-oriented and individulized exercise rehabilitation protocol for children with learning disabilities was constructed in light of ICF bio-psycho-social health paradignm and the theory of somatic and mental interaction. Results The functional performance of children with learning disabilities mainly demonstrated in mental dysfunction in physical functioning in the activities and participation limitations, such as learning and applying knowledge, general tasks and demands, and communication. For the environment factors, products and technology for education, products and technology for culture, recreation and sports, and services, systems and policies could also affect children with learning disabilities. Physical activity was beneficial for children with learning disabilities to improve mental and motor functioning and to effectively enhance intellectual, cognitive, attentional, communication, and mobility skills for the overall development of the children. Physical activity for children with learning disabilities was selected according to WHO guidelines for physical activity and sedentary behavior for children, and moderate to vigorous physical activity for at least 60 minutes, as well as high-intensity training no less than three times a week, together with appropriate physical games and leisure physical activities could effectively improve learning outcomes and reduce learning disabilities. Conclusion The health condition, functioning and motor development of children with learning disability had been analyzed using ICD-11 and ICF, and with the theories of somatic and metal interaction and ICF bio-psycho-social model, the holistic and function-oriented exercise rehabilitation program was developed that recommended at least 60 minutes of moderate intensity physical activity, including aerobic exercise and physical games, per day, and at least three times a week of high intensity physical activity of no less than 30 minutes, including plyometrics and physical competition. The development of individualized function-based exercise rehabilitation programs incorporating the learning disability and motor function characteristics of children could effectively improve the cognitive, attentional, and thinking functions of children with learning disabilities, reduce learning disabilities, and promote the overall development of children.

Key words: International Classification of Functioning, Disability and Health, learning disability, exercise rehabilitation

中图分类号:

杨宝仪,姜静远,戴栖,王国祥,邱卓英,蔡赓,孙慧珍,杨剑,王少璞,朱婷,李安巧,郝传萍,张萌,周晟,汤修齐,刘静. 基于ICF构建学习障碍儿童功能分析与运动康复方案研究[J]. 《中国康复理论与实践》, 2021, 27(12): 1384-1392.

YANG Bao-yi,JIANG Jing-yuan,DAI Qi,WANG Guo-xiang,QIU Zhuo-ying,CAI Geng,SUN Hui-zhen,YANG Jian,WANG Shao-pu,ZHU Ting,LI An-qiao,HAO Chuan-ping,ZHANG Meng,ZHOU Sheng,TANG Xiu-qi,LIU Jing. Analysis of Functioning and Design of Individualized Rehabilitation Protocol for Children with Learning Disability Using ICF[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(12): 1384-1392.

图/表 5

表1

表2

ICF学习障碍儿童整体功能障碍情况"

成份	类目及编码	功能类目及编码	内容
身体结构(s)和身体功能(b)	精神功能(b1)	智力功能(b117)	智力水平通常正常,部分儿童低于正常水平
		注意力功能(b140)	学习时注意力难以集中,容易走神
		记忆功能(b144)	短时、长时记忆力较差
		思维功能(b160)	缺乏连贯和符合逻辑的思维
		高水平认知功能(b164)	理解知识能力、洞察力和判断力较低
		计算功能(b172)	难以完成简单、复杂的数学运算
		运动功能(b750-b789)	活动量低,整体运动水平较低
活动和参与(d)	学习和应用知识(d1)	学习阅读(d140)、阅读(d166)	难以流利、准确地阅读书面材料,对文字的理解和解释存在偏差和困难
		学习写作(d145)、写作(d170)	通过文字或符号等,在表达意思、传达信息、展示观点方面有困难
		学习计算(d150)、计算(d172)	不擅长利用数学原理来运算或解决问题
		集中注意力(d160)	学习时容易被身边的事物干扰,难以有目的地集中注意于某件事
	一般任务和要求(d2)	从事单项任务(d210)	在安排、处理或协调与学习相关的任务时有困难,且步骤和顺序不清晰
	一般任务和要求(d2)	从事多项任务(d220)	在安排、处理或协调与学习相关的任务时有困难,且步骤和顺序不清晰
	交流(d3)	交谈(d350)	不擅长通过会话、文字和符号等形式与他人交流学习相关内容,不愿意与他人沟通交流
	交流(d3)	讨论(d355)	不擅长通过会话、文字和符号等形式与他人交流学习相关内容,不愿意与他人沟通交流
	活动(d4)	改变身体的基本姿势(d410)	喜欢久坐或躺的姿势,不积极参与各种身体活动或运动项目
		保持一种身体姿势(d415)	喜欢久坐或躺的姿势,不积极参与各种身体活动或运动项目
		步行(d450)	喜欢独处,对于跑步、散步等活动积极性不高,且运动水平较普通儿童较低
		到处移动(d455)	喜欢独处,对于跑步、散步等活动积极性不高,且运动水平较普通儿童较低
环境因素(e)	用品和技术(e1)	教育用的用品和技术(e130)	缺乏适宜教学设备、书籍、教具、计算机等
	用品和技术(e1)	文化、娱乐和体育用的用品和技术(e140)	缺乏适用的体育活动器材、设备、场地等,如玩具、球类、乐器、特殊设计用品等
	服务、体制和政策(e5)	教育和培训的服务、体制和政策(e585)	缺乏针对性的培训机构和专业教师,没有权威的教育培训行政管理监督机制和政策

表2

图1

表3

基于ICF针对学习障碍儿童推荐的运动康复方案"

活动方式	活动量		涉及功能		运动间接效果	来源
活动方式	活动强度	活动时间	身体功能	活动和参与	运动间接效果	来源
粗大/精细活动	中等强度活动	≥ 60 min/d	智力功能(b117)、注意力功能(b140)	改变身体的基本姿势(d410)、保持一种身体姿势(d415)、步行(d450)	提升智力水平,提升认知能力,改善注意力不集中,控制注意力	《WHO关于身体活动和久坐行为的指南》(2020) 《美国人身体活动指南(第二版)》(2018) 《澳大利亚身体活动与久坐行为指南(青少年版)》(2017) 《加拿大身体活动和久坐行为指南》(2011) 《关于健康运动的全球指南》(2010)
基本动作练习	中等强度活动	≥ 60 min/d	智力功能(b117)、记忆功能(b144)	集中注意力(d160)、改变身体的基本姿势(d410)、保持一种身体姿势(d415)	提升认知水平,记忆力、理解能力,改善注意力不集中,提高身体平衡能力、稳定性、协调性
灵敏性运动	中等强度活动	≥ 60 min/d	记忆功能(b144)、思维功能(b160)	集中注意力(d160)	激发新的思维模式,改善刻板印象,提升记忆力、理解能力
肌力/肌耐力训练	中等强度活动	≥ 60 min/d	高水平认知功能(b164)	改变身体的基本姿势(d410)、保持一种身体姿势(d415)	增加身体姿势控制力,提升肌力和肌耐力,改善关节活动
肌力/肌耐力训练	高强度活动	≥ 3 d/周	高水平认知功能(b164)	改变身体的基本姿势(d410)、保持一种身体姿势(d415)	增加身体姿势控制力,提升肌力和肌耐力,改善关节活动
有氧运动	中等或高强度有氧运动	≥ 3 d/周	智力功能(b117)、注意力功能(b140)、高水平认知功能(b164)	改变身体的基本姿势(d410)、保持一种身体姿势(d415)、步行(d450)、到处移动(d455)	提升认知水平,思维灵活性等
竞技体育	中等到高强度活动	≥ 60 min/d	智力功能(b117)、注意力功能(b140)、记忆功能(b144)、思维功能(b160)	改变身体的基本姿势(d410)、交谈(d350)、讨论(d355)、到处移动(d455)	团队活动中增加与人沟通和交流的机会
休闲体育	低等到中等强度活动	≥ 60 min/d	智力功能(b117)、注意力功能(b140)、记忆功能(b144)、思维功能(b160)	改变身体的基本姿势(d410)、交谈(d350)、讨论(d355)、步行(d450)、到处移动(d455)	团队活动中增加与人沟通和交流的机会
体育竞赛	中等到高强度活动	≥ 60 min/d	思维功能(b160)、高水平认知功能(b164)	从事单项任务(d210)、从事多项任务(d220)、交谈(d350)、讨论(d355)、到处移动(d455)	在多人合作或单人模式的体育运动中提升处理任务的逻辑性、规划性,改善注意力
体育游戏(娱乐、益智)	中等强度活动	≥ 60 min/d	智力功能(b117)、注意力功能(b140)、记忆功能(b144)、思维功能(b160)	阅读(d166)、写作(d170)、计算(d172)、交谈(d350)、讨论(d355)	运动干预提升学习与认知功能,从而改善阅读、理解、写作、计算、表达等方面的不足

表3

图2

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疾病诊断	编码
发育性学习障碍	6A03
发育性学习障碍伴阅读受损	6A03.0
发育性学习障碍伴书面表达受损	6A03.1
发育性学习障碍伴数学受损	6A03.2
发育性学习障碍伴其他特指的学习受损	6A03.3
未特指的发育性学习障碍	6A03.Z

基于ICF构建学习障碍儿童功能分析与运动康复方案研究

Analysis of Functioning and Design of Individualized Rehabilitation Protocol for Children with Learning Disability Using ICF

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