康复学报 (Jan 2024)
Guidelines for Stroke Critical Rehabilitation
Abstract
Stroke is a disease in which cerebral blood vessels are damaged by a variety of causes, producing focal or overall brain tissue damage. With the acceleration of population aging and urbanization, stroke has become the leading cause of death and disability among adult residents in China. Many studies and guidelines suggest that early rehabilitation should be carried out as soon as possible for critically ill stroke patients when their vital signs are stable. Early systematic rehabilitation intervention is of great significance in improving the overall functional status, reducing the duration of mechanical ventilation, reducing the number of days of intensive care hospitalization, and reducing medical costs. The development of stroke critical care rehabilitation guidelines based on the principles of evidence-based medicine can provide clinicians with comprehensive and standardized practice guidelines. This guideline standardizes the implementation process of stroke critical care rehabilitation from the aspects of scope, definition, terminology, principles, general rules of implementation, rehabilitation content, conditions of rehabilitation implementation, and quality control of rehabilitation, forming a scientific, standardized, and unified operational guideline. The main contents include: ①principle: severe stroke rehabilitation should follow the principles of early rehabilitation, individualization, safety and control, and comprehensive intervention; ②general rules of rehabilitation implementation; ③rehabilitation implementation process: including the establishment of personal files, signing of the Informed Consent Form, assessment of rehabilitation intervention, rehabilitation assessment, formulation of rehabilitation goals and plans, implementation of rehabilitation training, assessment of rehabilitation efficacy, referral, and follow-up; ④rehabilitation content: timing of intervention, rehabilitation assessment (history), rehabilitation quality control, and rehabilitation quality control. Timing of rehabilitation intervention, rehabilitation assessment (history assessment, physical examination, laboratory examination, imaging examination, assessment of conscious state, cognitive function assessment, motor function assessment, swallowing function assessment, ADL function assessment, mental state assessment, respiratory function assessment, diarrhea function assessment, pain assessment, agitation and sedation assessment, cooperation assessment, delirium assessment, nutritional assessment, screening for deep vein thrombosis), rehabilitation goals and plan development; content of rehabilitation intervention The content of rehabilitation intervention (motor function rehabilitation, circulatory function rehabilitation, respiratory function rehabilitation, swallowing function rehabilitation, consciousness disorder rehabilitation, bladder function rehabilitation, rectal function rehabilitation, musculoskeletal joint rehabilitation, skin management, pain and agitation management, deep vein thrombosis management, shoulder subluxation management, nutritional support management), the frequency of rehabilitation interventions, rehabilitation education, the requirements of rehabilitation implementation, the evaluation of the efficacy of rehabilitation, and the indicators of suspension of rehabilitation interventions. intervention pause indicators, rehabilitation efficacy evaluation, referral, follow-up; ⑤rehabilitation implementation conditions: basic conditions, environmental and facility conditions, personnel conditions; ⑥rehabilitation quality control: rehabilitation quality control system, rehabilitation quality assessment system, service feedback mechanism, emergency plan. This guideline will effectively promote the promotion and popularization of stroke intensive rehabilitation at all levels of medical institutions in China and provide guidance for all levels of medical institutions to carry out stroke intensive rehabilitation with good clinical applicability and effectiveness.
