[Relevance of personal contextual factors of the ICF for use in practical social medicine and rehabilitation]. / Bedeutung der personbezogenen Faktoren der ICF für die Nutzung in der praktischen Sozialmedizin und Rehabilitation.

Personal contextual factors play an essential part in the model of the International Classification of Functioning, Disability and Health (ICF). The WHO has not yet classified personal factors for global use although they impact on the functioning of persons positively or negatively. In 2010, the ICF working group of the German Society of Social Medicine and Prevention (DGSMP) presented a proposal for the classification of personal factors into 72 categories previously arranged in 6 chapters. Now a positioning paper has been added in order to stimulate a discussion about the fourth component of the ICF, to contribute towards a broader and common understanding about the nature of personal factors and to incite a dialogue among all those involved in health care as well as those people with or with-out health problems in order to gain a comprehensive perspective about a person's condition.

[Personal factors of the ICF]. / Personbezogene Faktoren der ICF.

PURPOSE: The presentation aims at illustrating the draft proposal of personal factors of the ICF for German-speaking regions which has been published in 2010 by the working group ICF of Faculty II "Social Medicine and Rehabilitation" of the German Society for Social Medicine and Prevention, DGSMP. For this reason, each personal factor is illustrated by two examples. Thus, the benefit is intended to be convincing. METHODS: Applying a qualitative approach, the working group ICF consisting of members of various professions and institutions including a patients' representative selected for each item one example the factor serving as a facilitator and a second the factor serving as a barrier. RESULTS: The components of the personal factors, as proposed, are presented, each factor is accompanied by two examples. CONCLUSION: The presentation demonstrates the various possibilities of applying personal factors and intends to prove that the selection of items chosen makes sense. The process of a comprehensive discussion about the possible format of the component of personal factors in the ICF should lead to a further optimization of the proposal and the preparation of a discussion at an international level.

[Personal contextual factors of the ICF draft from the Working Group "ICF" of Specialty Group II of the Geman Society for Social Medicine and Prevention]. / Personbezogene Faktoren der ICF - Entwurf der AG "ICF" des Fachbereichs II der Deutschen Gesellschaft für Sozialmedizin und Prävention (DGSMP).

Personal contextual factors play an essential part in the ICF model in relation to patient-centred care. It is generally assumed that their classification must refer to the country-specific social and cultural setting and its particular linguistic terms. Therefore personal factors are not classified as yet by the WHO for general use. In Germany in 2006 a group of experts working on the medical advisory board of statutory health insurance published a proposal for a systematic classification of relevant personal factors to describe the background of an individual's life and living. This classification was now further analysed and thoroughly revised by a more comprehensive group of German specialists working in different health care insurances and institutions, authorised by the German Society for Social Medicine and Prevention (DGSMP), supported by German-speaking Swiss ICF specialists. This classification is published as work in progress intending to broaden and prepare the process of discussion for a consensus conference to be held in Germany in 2011.

The implementation of the 'International Classification of Functioning, Disability and Health' (ICF) in daily practice of neurorehabilitation: an interdisciplinary project at the Kantonsspital of Lucerne, Switzerland.

PURPOSE: The current paper describes the implementation of ICF as a standard language and framework for description of human functioning and disability for common use in every day work by the multiprofessional team. METHOD: An interdisciplinary project team involving all rehabilitation specialities was constituted. The extensive original document of ICF was broken down to a simplified raster for body functions and structures, activities and participation, as well as for contextual factors. These rasters had to cover the most important aspects concerning the patients treated on our unit. Checklists on the basis of these rasters were worked out for use by the different specialized teams. Using these checklists, rehabilitation conferences, form and language of interdisciplinary communication, goal setting and documentation were introduced newly in every day work for the interdisciplinary rehabilitation team, structured strictly based on the ICF-criteria. RESULTS: Since April 2002 the ICF-based processes are implemented in routine work for all members of the rehabilitation staff. First experiences show good acceptance by the team members, improvements in communication and documentation as well as substantial gains in content and handling of rehabilitation conferences. As a result of the implementation we observed, that participation, context and domiciliary interventions gained quite more influence in every day work at the unit. CONCLUSION: Implementation improved considerably the quality of interdisciplinary work processes and contributed to a more systematic approach to rehabilitation tasks by the team members.

[Speech rehabilitation in aphasia in the concept of International Classification of Impairments, Disabilities and Handicaps (ICDH0)]. / Sprachrehabilitation bei Aphasie im Konzept der Internationalen Klassifikation der Schädigungen, Fähigkeitsstörungen und Beeinträchtigungen (ICIDH).

A neurogenic disorder of acquired speech, aphasia not only is a speech disorder but also implies restriction in communicative independence. In line with the WHO's principle of attending to the consequences of disease as well, speech rehabilitation has to deal not only with aphasia in terms of speech disorder (i.e., impairment) but also with aphasia in terms of communicative ability disorder (i.e., disability) as well as with aphasia in terms of psychosocial interference (i.e., handicap). Current speech therapy orientations can be assigned to these three dimensions and the need for these three levels of approach can be assessed accordingly in light of the course of the condition. Given the speech disorder's frequently limited amenability to therapeutic intervention, a psycholinguistics-communication oriented speech rehabilitation as well as counselling and psychologically focussed measures are increasingly relevant to enable a more appropriate response to reduced communicative independence and ensuing psychosocial handicaps.

Rehabilitation of the elderly patient with stroke: an analysis of short-term and long-term results.

All 104 patients, aged 65 years and older, admitted to our rehabilitation unit during the years 1984-1987 were studied. It was the objective to get data on the extent of hospital care, functional outcome and the situation of living 2-5 years after discharge. During inpatient rehabilitation, an equal improvement in activities of daily living (ADL) for patients 65-74 years of age as well as for patients older than 75 years was found. In spite of these findings, older patients had to be discharged to institutional care more often than younger patients. Furthermore, the old patient group had a greater drop of functional abilities at the time of follow-up than the young patient group. Of the 86 patients originally returning home, 84% were still living at home or had been living at home when death occurred, whereas only 16% had been admitted to institutional care during the follow-up period. At the time of follow-up, two-thirds of the surviving patients assessed their health status as equal or improved, compared with the time of discharge. In our patients, deterioration of health status was predominantly due to causes other than the original stroke.

[Thromboembolism complications following acute hemiplegias]. / Thromboembolische Komplikationen nach akuten Hemiplegien.

143 patients with acute onset of hemiplegia transferred to our unit for rehabilitation were analysed retrospectively for the development of deep vein thrombosis or pulmonary emboli. 26% of the patients had suffered thromboembolic events, in more than half of the cases within the initial four weeks after hospital admission. Hemiplegia seems to be the main risk factor for thromboembolic complications, whereas age and sex had no further impact on the rate of occurrence in our series. Nor did we find a correlation between the extent of the paresis in the involved lower extremity or the degree of restriction of mobility and the incidence of thromboembolic disease. Because of the high frequency of thromboembolic complications in our patients we recommended prophylactic treatment with low dose heparin given subcutaneously, followed by oral anticoagulant therapy with vitamin K antagonists, provided there are no contraindications.

[Chronic defibrination syndrome and thrombocytopenia in splenic hamartoma (splenoma)]. / Chronisches Defibrinierungssyndrom und Thrombozytopenie bei einem Hamartom der Milz (Splenom).

In a 41-year-old woman who had suffered from hypofibrinogenemia, thrombocytopenia, leukopenia and splenomegaly for several years a causative hamartoma of the spleen (splenoma) was removed surgically. The results of a preoperative therapeutic trial with heparin, the marked accumulation of 125I-activity in the splenoma following intravenous injection of radioiodinated fibrinogen, the immunohistochemical demonstration of extensive fibrinogen deposits in the splenoma, and normalization of fibrinogen levels and blood cell counts after surgery point to the pathogenetic role of this rare splenic tumor. The salient clinical and pathological features of 41 splenoma cases in the literature are briefly reviewed. Hematologic signs were observed in only 9 splenoma patients.

Effects of angiotensin II and noradrenaline on intrarenal haemodynamics in the rat.

The haemodynamic effects of angiotensin II and noradrenaline were studied in the rat kidney. These pressors were given by intravenous infusion in stepwise increasing doses. Intrarenal haemodynamics were analyzed by the 133xenon washout technique, 85krypton autoradiography and silastic casting of the renal vascular tree. Angiotensin II induced significant changes in intrarenal haemodynamics before any changes in systemic blood pressure were detected. The decrease in mean renal blood flow (2.91 ml.min-1.g-1 in controls, 1.76 ml.min-1.g-1 in rats given 50 mug of angiotensin II.kg-1.h-1) reflects a reduction in component I blood flow rate (from 3.9 to 2.9 ml.min-1.g-1) as well as a decrease in the fraction of total renal blood flow supplied to component I of the washout curve (from 84% to 62%). With noradrenaline an increase in total renal resistance occurred simultaneously with the elevation of mean arterial blood pressure. The resulting reduction in mean renal blood flow (from 2.76 ml.min-1.g-1 in controls to 1.55 ml.min-1.g-1 in rats given 1000 mug of noradrenaline kg-1.h-1) reflects a decrease in component I blood flow rate with lower infusion rates and a drop in component I flow fraction (from 82% to 52%) whith higher doses. In contrast to canine kidneys, no evidence for a patchy cortical vasoconstriction was found in the rat. Using autoradiography it was possible to attribute component I to the renal cortex and subcortical area of the kidney.