Importance of Rehabilitation Medicine

  With the development of society, the improvement of people’s living standard, as well as the progress of medicine and the development of health care, resulting in serious aging of society, more chronic diseases, more psycho-psychiatric disorders, lower death rate, higher disability rate, as well as more traffic accidents, work-related injuries, etc., in order to improve their quality of life, rehabilitation treatment is needed, and what is needed more is early rehabilitation treatment.  The World Health Organization has taken rehabilitation medicine, clinical medicine, preventive medicine and health care medicine as the basic functions of modern hospitals. In China, modern rehabilitation medicine has been introduced since the early 80s and combined with traditional rehabilitation, so rehabilitation medical institutions or rehabilitation medicine departments, generally have both Western medical doctors, nurses and rehabilitation therapists, as well as Chinese medicine related personnel, so it is an emerging interdisciplinary discipline, is a model of combined Chinese and Western medicine. Because of the late start of rehabilitation medicine in China, most people and even doctors are not familiar with it and do not understand it.  Its service targets are mainly people with disabilities, as well as elderly and chronically ill patients with various functional disorders that affect normal life, learning and work. The Department of Rehabilitation specializes in the treatment of patients with hemiplegia due to cerebral infarction and cerebral hemorrhage; patients with paralysis and other cognitive impairment due to traumatic brain injury; patients with quadriplegia and paraplegia after spinal trauma or spinal occupancy surgery; patients with amputation and post-operative orthopedic limb dysfunction due to traumatic car accident; also treats neck, shoulder, waist and leg pain and other disorders; at the same time, it carries out cardiopulmonary rehabilitation in internal medicine, geriatric rehabilitation, oncology rehabilitation and The department also provides cardiopulmonary rehabilitation, geriatric rehabilitation, oncology rehabilitation and hospice care. With the development of social needs and rehabilitation medicine, the treatment targets are extended to special patients with chronic diseases and psycho-psychiatric disorders that cannot be cured. Also because of the development of social needs, the target group has been extended to subhealth groups.  In order to improve the quality of life of patients, it is necessary to rely on rehabilitation medicine. For example: among patients with cerebrovascular accidents, active rehabilitation can enable 95% of patients to regain the ability to walk and take care of themselves, and 30% of patients to return to work, while without rehabilitation the above two aspects of recovery is only 6% and 5%. It has been studied that paralyzed patients who adhere to rehabilitation training within 2 years still have functional improvement.  Because of the late start of rehabilitation medicine, not only the people do not understand, even clinicians do not understand the importance of early rehabilitation. For clinicians, their duty is to save lives and maintain health, or at least not to cause new damage and new accidents to patients. On this issue, no one would disagree. For example, a patient with a cerebral hemorrhage should be absolutely bedridden, administered various therapeutic measures, given many, many fluids, and reviewed at intervals with an MRI or CT to see if the lesion has been absorbed. If there is a lot of absorption, not only the doctor is happy, but also the patient’s family. However, few people think about early rehabilitation, especially for paralyzed patients. For patients with cerebral hemorrhage, the earlier the recovery time, the better. For patients with cerebral infarction, bedside rehabilitation should be started three days after the onset of the disease.  Therefore, early rehabilitation is an option for paralyzed patients one week after their vital signs have stabilized. However, it is important to point out that early rehabilitation is never a crude treatment regardless of the patient’s condition. Rather, it is a scientific and gradual transition from passive training to active training and purposeful training. Early rehabilitation is not a brute force, not a matter of course.  The reason why rehabilitation medicine emphasizes early rehabilitation of stroke patients is based on the theory of brain plasticity and functional reorganization. In the past, it was thought that the nervous system was impossible to regenerate after a neurological injury. Therefore, many stroke patients lived with physical dysfunction for the rest of their lives. Later, medical doctors put forward the theory of brain plasticity. That is, after a brain injury, the body has the ability to repair itself, just as any part of the body will repair and heal itself after a breakage.  Brain tissue also performs some of the patient’s functions through intra- and inter-system functional reorganization such as regeneration of axons and long shoots of side branches, and re-activation of previously unused tissue. With rehabilitation, although many patients do not return to their original level of function, 95% of patients can regain the ability to walk and 30% can return to light work. The prerequisite to achieve functional reorganization is to do purposeful and selective training. The period from day 3 to day 30 after brain injury is the period when rehabilitation training is most effective.  In addition to the rehabilitation of hemiplegic patients with stroke, early rehabilitation is also emphasized for paraplegic patients. For many patients with spinal fractures and spinal cord injuries, rehabilitation should not be started after the fractures have healed. If rehabilitation is started only after the fractures have healed, many complications such as osteoporosis, urinary tract infection, deep vein thrombosis, joint contracture, etc. will occur, and the recovery of the nervous system will also be affected.  Special emphasis is placed on the fact that some patients with spinal cord injury are not completely injured, and if they can seize the opportunity, early rehabilitation can not only promote functional recovery, but also achieve twice the result with half the effort. For patients with spinal cord injuries, even if the fracture does not heal, the rehabilitation physician will adopt many feasible treatments to promote both neurological recovery and fracture healing, which will also reduce many, many complications. Some patients with benign spinal tumors have limb immobility before surgery, or limb immobility after surgery.  The rehabilitation surgeon also has to analyze whether the patient has a complete injury or an incomplete injury. If it is an incomplete injury, it is very important to provide reasonable and timely rehabilitation training early. Early rehabilitation should also be emphasized for patients with complete injuries. This is because it is within the area of complete injury that the zone of partial function preservation (ZPP) can exist. It is also believed that the reason for some recovery of the lower extremities after spinal cord injury is due to the role of the central-type generator structures present in the lumbar spinal cord.  The role of rehabilitation is important in both brain and spinal cord injuries. It is important to emphasize not only early rehabilitation, but also persistent rehabilitation. The role of rehabilitation is amazing. The father of a professor of rehabilitation medicine in the United States had a brainstem infarction at age 66, and after rehabilitating himself to walk and care for himself, he took up mountaineering and died of a myocardial infarction at age 77 while climbing to 9,000 feet. The professor of rehabilitation medicine then performed an autopsy on his father and was surprised to find that only 3% of his father’s conus fasciculus was intact, while 97% of that portion had pathological changes. This shows how strong the compensatory capacity of human beings is, and the performance of this compensatory capacity depends on rehabilitation training, especially early and scientific training.