Rehabilitation medicine is a study discipline on the prevention, diagnosis, assessment, functional repair, treatment and management of disabilities and functional disorders. Its purpose is to reduce or eliminate functional disorders, help the injured, sick and disabled to restore their physical, psychological, occupational and social life functions to the maximum extent possible according to their actual needs and physical potential, improve their ability to live, learn, and work independently, and improve their quality of life.
The four pillars of modern medicine: rehabilitation medicine, health care medicine, preventive medicine, and therapeutic medicine
Neurorehabilitation is a discipline specializing in the prevention and rehabilitation of disorders caused by neurological diseases. It has changed the disconnect between neurology and rehabilitation, and enabled the diagnosis and treatment of neurological and muscular diseases to reach a new overall level.
I. History of international neurological rehabilitation: the needs of the times and the product of social progress
The first century war in the 1940s, British orthopedic specialist Robert Jones’ main treatments: electrotherapy, massage, corrective gymnastics, and occupational therapy.
The second century war, physical therapy + multidisciplinary treatment integrated, such as physical therapy, psychotherapy, occupational therapy, speech therapy, prosthesis, orthopedic brace assembly.
1947 American Board of Physical Medicine and Rehabilitation Medicine established
1951 International Society of Physical Medicine and Rehabilitation established
1969 The International Society for Rehabilitation was established
The rise of rehabilitation medicine reflects the change of modern human needs for health care, and is also the result of technological progress.
II. Development status and challenges of neurorehabilitation in China
Modern rehabilitation in China began in the 1980s
In 1989, the Cerebrovascular Disease Rehabilitation Committee was established, which met once in 2 years and published the Journal of Cerebrovascular Disease Rehabilitation.
In 1989, the Neurology Branch of the Chinese Medical Association established the Rehabilitation Group.
1.Insufficient breadth of neurological rehabilitation from the lack of rehabilitation resources
(1) Society’s awareness and knowledge about stroke rehabilitation are not enough, including many medical personnel engaged in neurology, and many patients have not received formal rehabilitation treatment or have missed the best rehabilitation period.
(2) Rehabilitation treatment has not been included in social health insurance in many areas, making many patients unable to afford treatment and abandoning it. It is necessary for the government and neurological rehabilitation workers to vigorously promote and popularize rehabilitation knowledge.
(3) The training of rehabilitation personnel is seriously lagging behind. Neurological rehabilitation physicians are required to have both a foundation in neurology and a grasp of modern rehabilitation theory. China’s rehabilitation clinical talent team mainly comes from Chinese medicine physiotherapists and clinicians.
(4) There is a serious shortage of high-level rehabilitation therapists. There are 20,000 modern rehabilitation therapists, with an average of 1-2 M100,000.
(5) Rehabilitation institutions and three-tier rehabilitation system are not sound, and community rehabilitation is carried out less.
2. Insufficient breadth of neurological rehabilitation from the lag of rehabilitation treatment.
(1) The disorder of neurological rehabilitation treatment is a very serious problem facing the process of neurological rehabilitation in China at present. It is also one of the main problems that affect the efficacy of rehabilitation. The neurorehabilitation work is very arbitrary and does not follow the specific order of recovery after central nervous system injury. Rehabilitation means are varied and methods that are not proven effective are also used for patients. This undermines the rigor and scientific nature of rehabilitation treatment, and is ineffective in producing serious complications. Standardization of neurorehabilitation is imperative.
(2) Traditional rehabilitation techniques are mostly used, and modern rehabilitation techniques such as motor relearning, compulsory motor therapy, and computer-assisted technology are rarely used.
(3) There is a lack of quantitative and accurate assessment tools for the assessment of rehabilitation effects, and the assessment results are not objective and reproducible.
III. Why do neurological diseases need rehabilitation treatment?
Neurological diseases, especially cerebrovascular diseases, are characterized by high morbidity and high disability rate. Neurological rehabilitation is the most effective method to reduce the disability rate as confirmed by evidence-based medicine, and is an indispensable key link in the organization and management of neurological diseases.
(1) In the acute phase of the disease: rehabilitation should be started as early as possible, which can prevent related complications. For example, to prevent shoulder pain, shoulder dislocation, joint contracture after hemiplegia, wasting muscle and joint atrophy after bed rest, wasting lung function decline, vascular embolism, etc.
(2) In the recovery period of the disease: Adopt comprehensive rehabilitation treatment measures to help patients to realize their own potential, carry out functional enhancement and compensatory training of the disease disability, avoid complications or secondary disabilities caused by reduced movement, shorten the duration of hospitalization, change the non-functional life state, reduce the degree of disability, reduce blind ineffective medication, and reduce the economic and labor burden of society and families.
(3) At the later stage of the disease: to develop family and community rehabilitation plans and programs with hospital rehabilitation as the backbone, to provide necessary rehabilitation education to patients and their families, and to carry out corresponding home and community rehabilitation to improve patients’ social adaptability. Conduct relevant vocational rehabilitation training so that patients can truly return to society.
4. The current recommended three-stage rehabilitation system
In other words, patients in the acute stage should receive clinical and early rehabilitation treatment in the cerebrovascular ward of a general hospital. The main content of rehabilitation treatment is to assist clinical treatment and prevent the occurrence of secondary complications. Patients are then transferred to the rehabilitation department for further treatment. For patients who cannot achieve full self-care, they are transferred to the cerebrovascular disease rehabilitation center for rehabilitation treatment.
V. Research hotspots in the field of neurorehabilitation
1. Brain plasticity: the theoretical basis of neurological rehabilitation
2. Research progress of neurorehabilitation technology
(1) Motor relearning method
(2) Compulsory use of motor therapy: overcoming acquired disuse is the intrinsic driving force
(3) New revolution in the field of neurorehabilitation through the application of computer-related assistive technologies
Rehabilitation Assistive Robotics
In 1991, the first upper limb rehabilitation robot was created in the United States to assist patients with upper motor neuron palsy in upper limb functional training.
Brain-computer interface technology
Technology that establishes external information and control between the human brain and a computer without relying on the neuromuscular system. Electrical signals are acquired through intracranial or scalp electrodes, processed to extract signal characteristics reflecting the user’s intentions, and translated into control commands output from external devices. This system is expected to help paralyzed patients achieve motor function reconstruction and improve their ability to live.
Virtual Reality Technology
This is a technology that uses computerized multimedia technology to simulate a real environment and interacts with objects in the virtual environment by using various sensing devices to create a sense of immersion in the user’s environment. This technology can provide patients with various treatment scenarios and stimuli, set scenarios and tasks according to patients’ actual conditions, provide feedback on treatment effects, and store and analyze data to guide the next step of treatment. It also makes remote rehabilitation possible, which can benefit more patients. Currently, it is mainly used for the assessment and treatment of cognitive disorders.