I. Introduction
Rehabilitation assessment is the rehabilitation medicine
There is no unified definition of rehabilitation functional assessment, and a more consistent description is that rehabilitation functional assessment is the process of qualitative and/or quantitative description of the functional status and its level of sick, injured and disabled patients, and the reasonable interpretation of its results [1].
Rehabilitation assessment is divided into two parts
1. Clinical assessment refers to the process of synthesizing all information about the disease, functional disorders, and clinical aspects, including symptoms, signs, disease diagnosis, results of various auxiliary examinations, and the patient’s overall physical and mental condition.
2.Functional assessment describes the process of individual’s ability and whether it is limited or not, and the assessment of the local single function of the body.
Features of rehabilitation assessment
Rehabilitation assessment is a clinical assessment
The level of understanding of the disease determines the judgment of the condition and its prognosis, and rehabilitation assessment is largely based on this. Only with an in-depth understanding of these issues can proper functional assessment and rehabilitation treatment be carried out.
Rehabilitation assessment is the assessment of function and impairment
Clinical diagnosis is based on history, physical examination and ancillary tests to make a correct diagnosis. Once a medical diagnosis is established, the rehabilitation physician must determine the functional outcome of the disease.
Rehabilitation Assessment is Comprehensive
Rehabilitation medicine is not limited to a single organ system, but focuses on the whole patient. The ultimate goal of rehabilitation is to restore the patient’s physical, psychological and social well-being.
Rehabilitation assessment is a multi-disciplinary assessment
The medical history and physical examination are of high importance and are the basis for further assessment, but due to their characteristics, they also have limitations and need to be assessed by physical therapists, occupational therapists, speech therapists, psychotherapists, etc. [2].
III. Some terms related to rehabilitation
Measurement, assessment and evaluation
Measurement is the process of determining the value of a particular aspect of a subject using accepted criteria; assessment is the method of determining the value of one or more measurements according to certain requirements; and evaluation is the act of making a final judgment on the subject based on the results of measurement and assessment.
Rehabilitation Collaborative Group
Rehabilitation medicine is a multidisciplinary profession and often requires the participation of multiple professionals in the process of rehabilitation assessment and treatment.
Rehabilitation Assessment Council
Rehabilitation assessment meeting is an important form of rehabilitation assessment. In the meeting, the group members will fully express their opinions on the nature, location, degree, development, prognosis and rehabilitation goals of the patient’s functional impairment based on their own examination and analysis, and propose rehabilitation countermeasures, rehabilitation goals and treatment treatment opinions (including near, medium and long term) in their respective fields, and evaluate, modify and supplement the implementation of the plan. At the end of the treatment, a group meeting is then held to summarize the rehabilitation efficacy and provide opinions for the next stage of treatment or the destination of rehabilitation after discharge [3].
IV. Target of rehabilitation assessment
Impairment, disability and handicap
With the aging of the population, the increasing incidence of various disabling diseases, and the increase of accidental injuries, the number of disabled people in society has become very considerable.
1. Disability is any loss or abnormality in structure or function, psychologically, physiologically or anatomically, regardless of the cause. For example, joint pain, restricted movement, breathing difficulties, ataxia.
2.Disability is a limitation or lack of ability due to a disabling condition to the extent that the person is unable to perform activities within the normal range and in the normal manner.
3. Disability is a limitation or hindrance to a person’s ability to perform normal social roles and disadvantage due to a handicap or disability. For example, orientation recognition disability, physical autonomy disability, mobility disability, employment disability.
Impairments, activity limitations, and participation restrictions
Six types of disabilities
Visual disability, hearing disability, speech disability, intellectual disability, physical disability, and mental disability.
V. Meaning and role of rehabilitation assessment
The significance of rehabilitation assessment
1. From the patient’s point of view, the assessment can deepen the patient’s understanding of his or her disease and activity ability, help the patient set appropriate treatment goals, enhance confidence, increase enthusiasm for treatment, and prompt the patient to work harder to help himself or herself and actively participate in treatment. For some patients with chronic diseases, he will be encouraged to respond to the rehabilitation doctor about the situation as early as possible, one to prevent and reduce the deterioration of the disease and the loss of function.
2. From the perspective of rehabilitation doctors and therapists, a comprehensive, systematic and accurate assessment can make up for the shortcomings of medical history and general clinical examination, make it easy to detect problems at an early stage, understand specifically what areas the patient needs help in and how to provide and receive help, encourage him to develop a more appropriate rehabilitation plan, keep track of the patient’s condition and functional changes, and guide our rehabilitation medical work. Ultimately, through the results of the rehabilitation assessment, we can determine the consequences of rehabilitation and thus control the quality of rehabilitation treatment.
3. From the social point of view, through the assessment, we can identify the problems in social rehabilitation, such as social support for the provision of financial assistance, improvement of service quality, environmental conditions and deficiencies in policies and regulations, and provide a basis for society to provide assistance to people with disabilities. In addition, the assessment can provide the government with new information on the onset of disability.
The role of rehabilitation assessment
1.Getting to know the situation of functional disorders
Understand the nature, scope and degree of functional impairment
2.Develop rehabilitation plan
Different functional disorders of different nature require different treatment measures and methods, for which it is necessary to find and analyze the causes of functional disorders and the specific factors that prevent patients from returning to society and their homes.
3.Evaluate the effect of treatment
A complete rehabilitation process should begin and end with evaluation. Through evaluation, the patient’s functional disorders are identified and prioritized, and appropriate treatment plans are formulated based on the evaluation results, as well as more effective treatment methods, prognosis, and the efficiency of health resources.
VI. Rehabilitation assessment content and staging
1.Complaint, history of present illness, past history, functional history (communication, eating, grooming, bathing, toileting, dressing, bed activities, transferring, movement), systematic review, personal history, social history, occupational history, family history, physical examination, and functional assessment.
Functional assessment includes.
(1) Somatic function assessment generally includes: joint movement function assessment, muscle strength assessment, upper and lower extremity function assessment, and physical function assessment.
(1) Physical function assessment includes: assessment of joint movement, muscle strength, upper and lower limb function, gait analysis, neurophysiological assessment, assessment of spasticity and relaxation, assessment of sensory and perceptual functions, assessment of coordination and balance, assessment of postural and primitive reflexes, assessment of the ability to perform activities of daily living, assessment of the ability to wear prostheses or orthoses on the upper and lower limbs, assessment of the ability to wear spinal orthoses, etc.
(2) Assessment of mental and psychological functions
Generally, the assessment includes: assessment of emotion, assessment of post-disability psychological status, assessment of pain, assessment of disuse and anosognosia, assessment of dementia, assessment of non-dementia cognitive impairment (attention, memory, thinking), assessment of personality, etc.
(3) Language function assessment
Generally, it includes: assessment of aphasia, assessment of dysarthria, assessment of speech disorders, assessment of demented speech, assessment of speech delay, assessment of swallowing function, assessment of audiometry and instrumental assessment of articulation function, etc.
(4) Social function assessment
Generally, it includes: social life ability assessment, quality of life assessment, medical assessment of employability, etc.
2.Stage of rehabilitation assessment
(1) Initial assessment is done at the beginning of the patient’s admission to the hospital. The purpose is to gain a comprehensive understanding of the patient’s functional status and degree of impairment, causes of disability, and rehabilitation potential, so as to determine rehabilitation goals and formulate rehabilitation treatment plans.
(2) Mid-term assessment
This is done in the middle of the rehabilitation treatment period. The purpose is to assess the patient’s overall functional status, the rehabilitation effect or lack thereof, analyze the causes, and adjust the rehabilitation treatment plan accordingly. The mid-term evaluation can be conducted several times.
(3) Final assessment
This is done at the end of the rehabilitation treatment. The purpose is to assess the patient’s overall functional status after rehabilitation treatment, evaluate the effect of rehabilitation treatment, and make recommendations for returning to family and society or for further rehabilitation treatment.