I. Rehabilitation hospitalization criteria
After acute clinical drug treatment and/or surgical treatment (generally about 2-4 weeks), the vital signs are relatively stable, but there is persistent neurological dysfunction, or complications affecting functional activities, affecting self-care and return to family and society, and the following conditions are met.
1.No further deterioration of neurological symptoms ;
2.No change in condition requiring surgical management;
3.No serious dysfunction of other important organs;
4, CT and other imaging examinations do not see changes in the condition.
II. Clinical examination specifications
(A) General examination
1, three major examination routine.
2, routine blood biochemical examination, urine bacterial examination.
3.Electrocardiogram, abdominal ultrasound examination.
4.Chest X-ray and related parts X-ray examination.
5.Syphilis serology, HIV antibody, hepatitis marker determination.
6.Neurophysiological examination (including motor evoked potentials).
7, heart and lung function tests.
(B) Selective examination
1.Cerebrospinal fluid examination
Indications: suspected intracranial infection, intracranial high/low pressure or cerebrospinal fluid circulation dysfunction, etc. Need to understand the physicochemical properties of cerebrospinal fluid and observe intracranial pressure changes.
2.TCD examination
Indications: Need to understand intracranial vascular occlusion, malformation, sclerosis, aneurysm, blood changes and the detection of increased intracranial pressure, etc.
3.Electroencephalogram and topographic brain examination
Indications.
(1) When a clear diagnosis of epilepsy is needed
(2) When it is needed to assist other intracranial occupancies and intracranial infection diagnosis
(3)When there is a disorder of consciousness
(4) When it is necessary to help identify organic mental disorder or functional mental disorder.
4.Cranial CT and MRI examination
Indications.
(1)When further definite diagnosis is needed at the time of admission.
(2) When the condition changes and there are signs of exacerbation or rebleeding or infarction
(3)When there are signs of hydrocephalus, tumor, infection, etc. in combination
(4) Other conditions that require CT and MRI examinations to make a clear diagnosis.
5.Evoked potential examination
Indications: When differential diagnosis and prognosis are needed.
6.Cardiac ultrasound, neck ultrasound
Indications: When stroke is suspected to be caused by cardiovascular disease.
7.Cardiac and pulmonary function tests
Indications: When cardiac or pulmonary function is suspected to be reduced, it is necessary to understand the exercise load of the patient to guide the formulation of reasonable exercise prescription.
III. Clinical treatment specification
(A) Clinical routine treatment
1.Treatment of underlying diseases: hypertension, hyperlipidemia, diabetes, coronary heart disease, etc;
2.Continuing clinical treatment: regulation of blood pressure and cranial pressure, improvement of cerebral blood supply, cerebral socio-economic nutrition, symptomatic support treatment, etc;
3.Medication and clinical techniques to improve language, cognition, mental, swallowing, motor, bladder and intestinal dysfunction.
4.Chinese herbal medicine treatment.
(II) Management of common complications
1.Infection: including the treatment of respiratory system, urinary system and other infections;
2, spasticity: various types of anti-spasticity oral drugs, social meridian block (or dissolution) treatment, orthopedic applications or surgical treatment.
3.Psychiatric disorders: selection of psychotropic drugs or behavioral psychotherapy;
4.Pressure sores: postural treatment, drug exchange or surgical treatment; deep vein thrombosis: thrombolysis, application of anticoagulant drugs, etc.
5.Shoulder pain, shoulder subluxation, shoulder-hand syndrome: anti-inflammatory and analgesic drugs, orthopedic configuration, etc.
6. Prevention and treatment of other comorbidities: such as myasthenia gravis, osteoporosis, joint contracture, heterotopic ossification, postural hypotension, edema prevention and treatment, etc.
IV. Medical rehabilitation norms
(I) Functional evaluation
Initial evaluation is performed within 5 days after admission, one or more interim evaluations may be performed during hospitalization according to functional changes, and final evaluation is performed before discharge. The evaluation items are as follows.
1. Somatic function evaluation
Muscle strength evaluation, joint mobility evaluation, sensory evaluation, limb morphology evaluation, coordination evaluation, activity of daily living (ADL) evaluation, pain evaluation, evaluation of assistive device use, upper limb function evaluation and hand function evaluation for upper limb nerve injury, balance function evaluation 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, further aphasia standard examination and dysarthria examination for those with aphasia or dysarthria, swallowing disorder evaluation and spirometry examination if necessary.
(II) Rehabilitation treatment specifications
1.Physical therapy
(1) Exercise therapy: In the early stage, the main exercises are bed position placement, turning training, breathing training, sitting balance training, transfer training, joint mobility training, vasodilation training, etc.
In the recovery period, joint mobility training, stretching training, respiratory training, etc., and motor control training of the affected limb, as well as various body position changes and transfer training, as well as standing bed treatment and balance training in sitting, kneeling and standing positions and walking training, etc. were continued.
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.
Ultrashort wave therapy, pneumatic therapy, electromagnetic wave therapy, direct current therapy, spastic muscle electrical stimulation, neuromuscular electrical stimulation (NMES), functional electrical stimulation therapy, myoelectric biofeedback therapy, etc. are selected.
(3) Hydrotherapy: according to the patient’s specific situation, water exercise therapy can be carried out, etc.
2.Operational therapy
(1) cognitive training: for those with cognitive impairment, orientation, memory, attention, thinking, calculation and other training according to the results of cognitive evaluation; severe patients can be provided with a variety of sensory stimulation to improve cognitive ability in the early stage; computer-assisted cognitive training can be provided in the condition of the sound level, etc.
(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 according to the results of perceptual evaluation, such as visual scanning, color recognition, graphic recognition, image recognition training and spatial structure and position relationship training, etc. We can provide necessary auxiliary training labels and apparatus, and combine with actual life and work scenes for training.
(3) Activities of daily living (ADL) training: The training of balance, feeding, dressing and transferring can be carried out at the bedside in the early stage, and as far as possible in the treatment room when the situation allows, including balance, feeding, dressing, transferring, walking, toileting, bathing and personal hygiene, etc. The training can be carried out in the actual living environment or simulating the real life environment as far as possible.
(4) Upper limb functional training: improve motor control function through selective work activities, maintain and improve upper limb joint activities to reduce muscle tone, reduce pain, and improve manual dexterity and practical function.
(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: diction training, articulation training, communication skills training, etc. for those with dysarthria. Patients with aphasia need language training in listening, speaking, reading, writing, calculation, communication skills, etc. Some patients need to undergo feeding and swallowing training. Those who have speech disorders need to prefer targeted training.
4.Chinese medicine 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)Tui Na treatment: Generally, two weeks after the stroke, Tui Na treatment is started, based on the principle of benefitting qi and blood, opening the meridians and tonifying the liver and kidney, with reference to acupuncture points, and the main techniques are rolling, pressing, kneading, rubbing and rubbing.
(3) Other treatments: electroacupuncture, moxibustion, scalp acupuncture, water acupuncture, acupuncture point injection, fire cupping, Chinese medicine treatment, etc.
5.Adjunctive techniques
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; shoulder braces can be used to prevent and treat shoulder subluxation; 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.
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 rehabilitation therapist, supervise and guide patients to perform continuous training in the ward for joint mobility (ROM), muscle strength, activities of daily living (ADL), standing and walking, swallowing, verbal 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. Occupational social rehabilitation norms
(I) Vocational rehabilitation
1.Occupational rehabilitation evaluation
Occupational survey of injured workers, employment intention assessment, job demand analysis, active exertion consistency assessment, job simulation assessment, on-site job analysis assessment.
2.Vocational rehabilitation
According to different injury levels and individual differences, different rehabilitation programs are designed. Patients with quadriplegia can use the residual function of the upper limbs, and individualized skill training is the main focus, with the help of assistive devices or improved equipment if necessary; patients with paraplegia are provided with vocational rehabilitation training such as work endurance training, skill training and employment matching as needed.
(1) Vocational counseling: Assist patients to choose the direction of career development suitable for them and formulate potential work goals.
(2) Job matching: Match patients with appropriate jobs according to their degree of disability, cognitive function, physical function, interest, education, skill level, and work experience.
(3) Skill training: According to the patient’s cognitive and somatic function status and interests, the patient can choose to participate in computer operation training classes, handicraft production training classes, etc.
(II) Social rehabilitation
1.Social rehabilitation evaluation
Behavioral evaluation, post-injury stress disorder evaluation, social function evaluation, survival quality evaluation, community independent living skills evaluation, home environment evaluation. Home environment assessment for patients in need.
2.Social rehabilitation
The case manager (social worker or rehabilitation therapist) provides case management services for injured workers from the time they are admitted to the hospital until they return to work or community life.
(1) Rehabilitation counseling: In the form of “one-on-one” or “group” therapy, the injured worker is provided with counseling and guidance on work-related insurance policies, establishment of reasonable rehabilitation goals, adaptation to disability, stress relief, relationship with employers and family relations, etc.
(2) Guidance on the use of community resources: This includes providing injured workers with relevant employment policies and employment information, information on preferential policies for the disabled and related services, community medical care, use of community support networks, etc.
(3) Guidance for Caregivers of the Chronically Ill: Guidance for caregivers of the chronically ill on emotional stress relief, adaptation to disability, home rehabilitation skills, and home care, etc.
(4) Family rehabilitation skills guidance: Generally developed before the injured worker is discharged from the hospital, the family rehabilitation plan and specific techniques are given according to the actual situation of the injured worker after discharge. It is different from the rehabilitation plan and techniques implemented by professionals in rehabilitation institutions.
(5) Plus or minus guidance on environmental accessibility modifications: The case manager, in collaboration with an occupational therapist or rehabilitation engineer, provides consultation or guidance on appropriate modifications to the injured worker’s home and surroundings according to his or her physical function, so as to eliminate as many physical barriers to the injured worker’s home and community life as possible.
(6) Guidance on family financial arrangements and future livelihood: Assist injured workers and their families to make reasonable arrangements for family finances and explore the future livelihood of the family, so that injured workers and their families have sufficient psychological and ideological preparation to make adjustments and arrangements for their future lives. Improve their ability to cope with future changes.
(7) Work placement coordination and guidance: Before the injured worker is able to return to work, contact and negotiate with his/her employer to assess and coordinate the injured worker’s former workplace including the work environment, job arrangement and colleague relationship, etc., so as to prepare the injured worker to return to work and continue to follow up after discharge until he/she adapts to the workplace. Or visit the injured worker’s workplace within 2-3 weeks after his or her return to work to give guidance and assist him or her in adapting to his or her workplace.
(8) Follow up and coordination guidance for returning to the community: including communication and coordination with the injured worker, his family members, labor security departments, the community, and mutual aid groups for the disabled, etc., to assist the patient to adapt to community life.
VI. Rehabilitation discharge criteria
The vital signs are stable, the condition is stable, and the following conditions are present.
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.