I. Rehabilitation hospitalization criteria
Rehabilitation treatment should be started as soon as possible after the acute stage with clinical drug treatment and/or surgery, after the vital signs are relatively stable, suitable for persistent neurological dysfunction, or complications affecting functional activities, affecting self-care and return to family and society, and meeting the following conditions.
1. Stable vital signs and no further deterioration of clinical symptoms;
2. No change in condition requiring surgical treatment;
3. No serious dysfunction of other important organs;
4. No serious complications affecting life or rehabilitation treatment;
5. No change in the condition on CT and other imaging examinations.
II. Clinical examination specifications
(A) General routine examination
1.Blood, urine and stool routine.
2, liver and kidney function, blood lipids, blood sugar, ion.
3.Electrocardiogram, chest X-ray or chest radiograph and X-ray examination of related parts;
4.If the head CT or MRI was not reviewed within half a month before admission, check after admission and review anytime when the condition changes.
(II) Selective examination
1, coagulation function, platelet aggregation test, screening for infectious diseases (hepatitis A, hepatitis B, hepatitis C, hepatitis E
Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis E, Syphilis, AIDS, etc.), cardiac enzyme profile;
2, lower extremity arterial ultrasound; carotid artery, cerebrovascular ultrasound or whole brain angiography;
3.Electroencephalography, electromyography, evoked potential examination;
4.Cardiac ultrasound, heart and lung function tests.
III. Clinical treatment standard
(A) Clinical treatment
1.Treatment of basic diseases: hypertension, hyperlipidemia, diabetes, coronary heart disease, etc;
2. Class II preventive drug therapy: anti-platelet aggregation drug therapy for ischemic stroke;
3. Continuing clinical treatment: regulation of blood pressure and cranial pressure, improvement of cerebral blood supply, nutrition of cerebral nerves, symptomatic support therapy, etc;
4.Medication and clinical techniques to improve language, cognition, psychology, swallowing, motor, bladder and intestinal dysfunction.
5.Chinese herbal medicine treatment.
(B) Management of common complications
1.Infection: including treatment of respiratory system, urinary system, skin infection, etc.;
2.Spasticity: various types of anti-spasticity oral medications, nerve block treatment, orthopedic device application treatment.
3.Pressure sores: postural treatment, drug exchange treatment, etc.; deep vein thrombosis: thrombolysis, application of anticoagulant drugs, etc.
4.Shoulder pain, shoulder dislocation, shoulder-hand syndrome: anti-inflammatory and analgesic drugs, orthopedic device configuration, etc.
5. Prevention and treatment of other comorbidities: such as muscle atrophy, osteoporosis, joint contracture, heterotopic ossification, postural hypotension, edema prevention and treatment, etc.
IV. Medical rehabilitation norms
(I) Functional assessment
Initial assessment is conducted within 5 days after admission, one or more interim assessments may be conducted during hospitalization according to functional changes, and final assessment is conducted before discharge. The assessment items are as follows.
1. Somatic function assessment
Muscle strength assessment, joint mobility assessment, sensory assessment, coordination assessment, activities of daily living (ADL)
assessment, pain assessment, assistive device use assessment, upper limb function assessment and hand function assessment for upper limb nerve injury, balance function assessment and walking gait analysis for lower limb nerve injury, etc.
2.Psychiatric evaluation: cognitive function evaluation, personality evaluation, and emotional evaluation for those with related problems.
3.Language and swallowing function evaluation: firstly, screening for aphasia and dysarthria, and screening for the presence or suspicion of aphasia and dysarthria.
If aphasia and dysarthria are present or suspected, further aphasia standard examination and dysarthria examination should be conducted, and swallowing disorder evaluation should be conducted if necessary.
(B) Rehabilitation treatment standard
1. Physical therapy
(1) Exercise therapy: In the acute stage, the main exercises are complication prevention training (turning training, breathing training, passive movement of limbs) and joint contracture and deformation prevention training (placement of functional position in bed, joint mobility training), and transfer training, sitting and standing balance training, walking training, etc. according to the condition.
During the recovery period, joint mobility training, stretching training, respiratory training, etc., and motor control training of the affected limb, as well as various position changes and transfer training are continued, along with standing bed treatment, balance training in sitting, kneeling and standing positions and walking training, etc.
In the later stage, on the basis of continuing to strengthen the previous treatment, the patient will gradually carry out weight-reduced walking, assisted walking and independent walking according to the patient’s motor control function, muscle strength, balance function, etc.
(2) Physical factor therapy.
Magnetic therapy, pneumatic therapy, direct current therapy, neuromuscular electrical stimulation, functional electrical stimulation therapy, myoelectric biofeedback therapy, ultrasound, wax therapy, etc. are selected.
2.Operational therapy
(1) Cognitive training: According to the results of cognitive assessment, computer-aided cognitive training system can be used to train orientation, memory, attention, thinking, calculation, visual-spatial structure, etc. In severe patients, a variety of sensory stimulation can be performed early to improve cognitive ability;
(2) Treatment of perceptual disorders: for those who have perceptual disorders, we can provide corresponding training for dyslexia and dyscalculia. The training content can be selected from visual scanning, color recognition, graphic recognition, image recognition training and spatial structure and position relationship training according to the results of perceptual evaluation, and provide necessary auxiliary training apparatus and combine the training with actual life and work scenes.
(3) Behavioral training for daily life: early training of balance, feeding, dressing and transferring can be carried out at the bedside, and as far as possible in the treatment room when the situation allows, including balance, feeding, dressing, transferring, walking, toileting, bathing, personal hygiene, etc., and training in the actual living environment of the patient or simulating the real life environment as far as possible.
(4) Upper limb functional training: through selective work activities to improve motor control function, maintain and improve upper limb joint activity, reduce muscle tone, and reduce muscle tension.
(4) Upper limb functional training: to improve motor control function, maintain and improve upper limb joint activity, reduce muscle tone, reduce pain, and improve manual dexterity and practical function through selective work activities.
(5) Functional training guidance: including guidance on activities of daily living, training and guidance on the use of assistive devices, and guidance on environmental modifications and environmental rehabilitation for patients in need.
(5) Functional training guidance: including guidance on activities of daily living, training and guidance on the use of assistive devices, and guidance on environmental modification and environmental adaptation training for patients in need.
(3) Language therapy: for patients with dysarthria, diction training, articulation training, communication skills training, etc.
Patients with aphasia need language training in listening, speaking, reading, writing, calculation, and communication skills.
4. Swallowing training: Swallowing therapy instruments and manipulation training are used, and some patients need to undergo ingestion-swallowing training.
5.Chinese medicine rehabilitation treatment
(1) Acupuncture treatment: Combination of staged treatment and evidence-based treatment, with acupuncture points mainly for Yang meridians and supplemented by Yin meridians.
(2) Tuina treatment: generally, two weeks after the stroke, Tuina treatment is started, based on the principles of benefitting qi and blood, opening meridians and tonifying
The principle of selecting acupuncture points with reference to the acupuncture points of liver and kidney, and the main techniques are rolling, pressing, kneading, rubbing and rubbing.
(3) Other treatments: electroacupuncture, moxibustion, scalp acupuncture, acupuncture point injection, fire cupping, Chinese medicine treatment, etc.
6.Adjunctive technology
Early or severe cases need to be equipped with ordinary wheelchairs, patients with foot drop or inversion need to be equipped with ankle-foot orthoses, those with knee instability need to be equipped with knee-ankle-foot orthoses, patients with balance disorders need to be equipped with four-legged canes or walking sticks, those with hand dysfunction need to be equipped with necessary self-help devices such as eating self-help devices, etc. Shoulder braces can be used for prevention and treatment of shoulder subluxation, and some patients need to use hand function orthoses or anti-spasticity orthoses.
(C) Rehabilitation nursing standard
1. Rehabilitation nursing assessment
This includes assessment of skin condition, risk factors for pressure ulcers, safety risk factors, function of the bowels, and knowledge of the disease.
Evaluation of the degree of knowledge.
2. Rehabilitation nursing care
(1) Postural care: good limb placement, position change, position transfer, etc;
(2) Bladder and bowel function training, bowel management;
(3) Extended rehabilitation treatment: according to the advice of the rehabilitation therapist, supervise and guide the patient in the ward for continuous training of joint mobility, muscle strength, activities of daily living, standing and walking, swallowing, speech communication, etc.
(4) Prevention and care of complications: care for prevention of secondary injuries, prevention and care of various types of infections, prevention and care of shoulder pain and pressure sores, care of urinary incontinence, prevention of deep vein embolism, joint contracture and care of use syndrome, etc.
3. Psychological care, family rehabilitation and community rehabilitation nursing guidance.
V. Guidance on home or community rehabilitation skills.
Before the patient is discharged from the hospital, according to the patient’s actual situation, give guidance on home or community rehabilitation plans and specific techniques after discharge, or suggestions for social reintegration.
VI. Rehabilitation discharge criteria
Smooth vital signs, stable condition, and the following conditions.
1. The time limit for rehabilitation hospitalization has been reached.
2. No serious complications or complications have been controlled.
3. The expected rehabilitation goal has been achieved or the criteria for termination of rehabilitation treatment have been met.