中国脑性瘫痪康复指引-CIP2016.ppt

TheDevelopmentandChallengesofChinesePediatricRehabilitation中国儿童康复的发展与挑战,XiaojieLiCollegeofMedicalRehabMedicine,JiamusiUniversityRehabCenterforChildCerebralPalsy,Heilongjiangprovince李晓捷佳木斯大学康复医学院黑龙江省小儿脑瘫防治疗育中心,一、历史沿革History,探索开创阶段80-90Explorestage普及拓展阶段90-00Popularizationdevelopmentstage快速发展阶段00-今Rapiddevelopmentstage,20世纪80年代：白内障复明手术、小儿麻痹后遗症矫治、聋儿语训1980s:cataractandpoliosequelasurgery,trainingfordeafchildren,“八五”期间：增加低视力儿童配用助视器、智力残疾康复训练等EighthFive-yearplan:increasedlowvisiondevices,mentalrehabtraining,“九五”期间：增加了肢体残疾儿童矫治手术、残疾儿童辅助器具装配等Ninthfive-yearplan:Physicaldisabilitysurgery,assistivedevices,“十五”期间：提出到2015年残疾人“人人享有康复服务”的目标，包括残疾儿童Tenthfive-yearplan:Putforwardthegoalofeveryonegetrehabservicesby2015,“十一五”期间：加大对贫困残疾儿童康复的救助，提出“优先开展残疾儿童抢救性治疗和康复，对贫困残疾儿童给予补助，研究建立残疾儿童救助制度”“支持对06岁残疾儿童免费实施抢救性康复11thfive-yearplan:Increasepovertyrehabaidfor,putforwardprioritytodeveloprapidrehab,disabilitiessubsidies,assistancesystem,supportforthedisabledchildrenaged06freerehab,“十二五”期间：大规模、全方位开展残疾儿童康复，注重残疾儿童康复制度建设，建立残疾儿童早预防、早筛查、早转介、早治疗、早康复的工作机制Twelfthfive-yearplan:large-scale,comprehensiverehab,thedisabledchildrenrehabsystemconstruction,establishearlyprevention,screening,referrals,treatmentandrehabworkmechanism,二、康复服务现状Presentsituationofrehabilitationservices,医院康复Hospital-basedrehabilitation(HBR),Generalhospital,rehabhospital/centre,maternityandchildcarehospital,childrenshospital(publicandnonpublic)1000所,Institution-basedrehabilitation(IBR),disabledpersonsfederation,civilaffairs,nonpublic1000所,Community-basedrehabilitation(CBR),Beganinthelate1980205,000个？,机构康复,社区康复,Serviceway,PreventionandTreatmenofCP(forinstance,in12provinces,2013),79.67%could19.93%couldnot,Ifitispossibletogetdiagnosisandtreatmentintimeinlocal?,42.97%综合医院generalhospitals27.03%妇婴医院maternityandchildcarehospitals20.31%儿童医院childhospitals4.69%康复医院/中心rehabhospitals/centers2.97%残联系统康复中心rehabcentersindisabledpersonsfederationsystem1.88%社区诊所communityclinics0.16%民政系统康复中心rehabcentersinciviladministrationsystem,placeofdiagnosisandtreatment:generalhospitalmaternityandchildcarehospitalchildhospital,Rehabtrainingplaces康复训练场所,34.58%集中式康复centralized31.61%社区或家庭CBR33.80%集中式及社区centralized+CBR,综合医院,妇婴医院,儿童医院,mainlycentralizedrehab,prevalenceandRehabRequirementsofSpecialchildren,三、特殊儿童患病率及康复需求状况,12省/市12provinces/cities北京Beijing河南Henan山东Shandong山西Shanxi陕西Shannxi安徽Anhui湖南Hunan广东Guangdong广西Guangxi重庆Chongqin青海Qinghai黑龙江Heilongjiang323,805年龄1-6岁男M174，338女FM149，467,1.脑性瘫痪CerebralPalsy1-6yearsoldCPEpidemiologicalinvestigation（2013),distributionofchildren,Surveyareas,Beijing,Shandong,Henan,Shanxi,Shannxi,Anhui,Hunan,Guangdong,Guangxi,Qinghai,Heilongjiang,Chongqin,发病率为Incidence2.48(0.248%)总患病率为Prevalence2.45(0.245%)青海患病率最高为HighestprevalencewasinQinghai5.40(0.540%)山东患病率最低为thelowestwasinShandong1.04(0.104%)随机进行两两比较,任意两省患病率比较具有显著性差异Randompairwisecomparison,prevalenceofanyoneprovincecomparedwithanotheronehassignificantlydifferent（p0.0001）7岁儿童约1亿，脑瘫7Y，1Billion，CP250万(2,500,000)150%primaryandintermediatetitle,40%fortherelevantprofessionaltitleseries3.学历70%为专科及以下，本科不足30%，研究生仅占1.60%educationbackground-70%Specialtyandunder,40%Undergraduate,1.60%graduate3.职业来源50%康复治疗学或康复治疗技术，50%来源于其他职业Professionalsources-50%rehaborrehabtechnology,50%otherprofessionals4.从事6年以下工作占70%experience70%lessthan6yearsworks,队伍十分年轻，缺少成熟经验，专业基础较为薄弱，与发达国家差距较大Teamisveryyoung,lackofmatureexperiences,professionalfoundationisweak,thebiggapwiththedevelopedcountries,六、儿童康复队伍状况,Rehabpediatricianandtherapist,七、面临的挑战及策略Facingthechallengesandstrategies,1.政府主导，全社会关注和参与，相关领域共同努力Thegovernmentleading,thewholesocietyattentionandparticipation,jointeffortsinrelatedfield2.缓解供需矛盾的严重性（多种形式、机制办康复；社区康复的普及）Thecontradictionbetweensupplyanddemand3.均衡康复服务（地区间、城乡间；系统间：医疗、残联、民政、教育系统）Balancedrehabilitationservices4.缩小与国际先进的差距（监测平台、网络覆盖、队伍素质、服务质量等）Tonarrowthegapwiththeinternationaladvanced5.推进儿童康复规范化（质控、指南、路径、目标管理、循证医学）Promoterehabilitationstandardization6.发展综合康复（内外科结合、中西医结合、医教结合、全人发展观、ICF理念）Developmentofcomprehensiverehabilitation7.儿童康复的前伸与后延（与新生儿科、保健科、小儿神经科合作；三级医院的辐射、转诊；医疗康复机构与残联、民政、教育机构合作）Developmentofpediatricrehabilitationforwardandtreads,8.提高康复技术水平，加强康复队伍素质建设（学历教育、继续教育、考核准入及规范化培制度）Improvetheleveloftechnology,strengthentheconstructionoftheprofessionalquality9.加强康复护理与管理，环境改造Strengthenrehabilitationcareandmanagement,environmentaltransformation10.重视和发展亚专科康复Thedevelopmentofthespecializedrehabilitation11.均衡发展高科技辅助技术与简易实用技术（因需、因地、因人）Thebalanceddevelopmentofhigh-techassistivetechnologyandsimplepracticaltechnology12.各类示范项目的建立与经验传播Theestablishmentofallkindsofdemonstrationprojectsandexperience13.跨学科、跨系统合作开展基础与临床研究Interdisciplinarycol