(1) Clinical examination

Occupational therapists observe and understand the patient's condition and cardiac function through routine examinations such as erythrocyte sedimentation rate, myocardial enzyme spectrum, blood pressure, resting electrocardiogram, 24-hour dynamic electrocardiogram, echocardiography and vector diagram, and grade the cardiac function (table 13-3- 1). In addition, attention should be paid to monitoring the risk factors of coronary heart disease (such as blood pressure, blood sugar and blood lipid, etc.). ).

Table 13-3- 1 cardiac function grading standard

(2) motor function evaluation

With the improvement of patients' activity ability, they can accept low-level ECG exercise test and enter rehabilitation stage II-III. The metabolic equivalent of symptom-limited ECG exercise test should be measured regularly as a basis for evaluating work ability and making therapeutic observation. Because the exercise intensity and end point are limited by the patient's ability, the exercise test itself is safe. At present, there are no serious accidents reported. In addition, cardiopulmonary response of long contraction exercise such as hemodynamic response of dynamic exercise (involving

(3) cardiovascular risk classification

The risk classification of cardiovascular diseases such as acute myocardial infarction can be used as the basis for physical therapy, occupational therapy and internal and surgical treatment. According to clinical manifestations, examinations and other objective indicators, low, medium and high-risk patients do not need ECG monitoring and close exercise monitoring, including energy consumption after simple coronary artery recanalization >: 7.5 milliseconds (3 weeks after ischemic attack), and no serious arrhythmia caused by myocardial ischemia and left ventricular dysfunction; Moderately dangerous patients only need intermittent ECG monitoring, including energy consumption of 65438±0.5 mmHg) or ischemic ST segment depression >: 2mm, myocardial ischemia induced by low-level exercise or persistent ischemia after exercise, and persistent ventricular arrhythmia (spontaneous or induced).

Operational capability evaluation

(a) Assessing the degree of disability of patients with cardiovascular diseases

Cardiovascular disease leads to abnormal overall comprehensive living ability of patients. To evaluate the functional disability caused by cardiovascular disease from the overall level of patients, the key point is to evaluate the basic daily living ability of patients, that is, whether patients can live completely independently. If the patient has angina pectoris or palpitation and shortness of breath after a little activity, it may affect the smooth completion of daily activities such as dressing, eating, washing, bathing, going to the toilet and urinating. I need help from others, not to mention going out shopping independently, participating in various social activities, and professional activities that require certain activity ability. There are many methods to evaluate the ability of daily living, and Pap index and functional independence are usually used.

It should be noted that the pathological changes and the degree of cardiac function damage caused by cardiovascular diseases have different effects on the daily activities of different individuals, that is, the degree of ventricular dysfunction is not closely related to the working ability of the body. That is to say, even patients with cardiac function grade 3 may have different ADL scores. Some patients can take care of themselves, while others need to rely on their lives.

1. Determination of activity ability

Although ADL evaluation can be used as an index to judge the physical activity ability of patients with cardiovascular diseases, patients with acute myocardial infarction should not be allowed to blindly carry out these activities. It is necessary to actually and objectively measure the potential of patients' physical activity and determine the actual energy consumed by an activity. In cardiac rehabilitation, the energy consumption realized by this method is mainly through measuring the metabolic equivalent level of various activities. Generally, it is expressed by metabolicequivalentofthetask). The energy consumption during meditation is 1MET, which is equivalent to 3.5 ml (O2)/(kg min). When patients get up, walk or do other activities, this metabolic demand and the factors related to the increase of oxygen consumption in daily life, such as emotional use of small muscle groups, daily entertainment and self-care activities, can have a nonlinear relationship with energy consumption, which can continuously produce high heart rate, such as thermal environment, emotional stress, upper limb use, isometric activities, especially activities of 2 ~ 3 meters. Isometric techniques and environmental factors of rhythmic position muscle groups can affect energy consumption during activities, metabolic equivalents of various activities, and the maximum metabolic equivalent of patients' activities can be obtained from tables 13-3-2 and 13-3-3, which can be used as the basis for formulating occupational treatment plans and subjective fatigue grading (see clinical rehabilitation function evaluation for specific evaluation methods).

Table 13-3-2 Energy requirements for various operations (American Heart Association, 1989)

Table 13-3-3 Metabolic Equivalents for Daily Activities and Entertainment

2. Assessment of the degree of disability in patients with cardiovascular diseases.

As a member of society, whether patients with cardiovascular diseases can resume normal social activities and play their role in family society is the main index to evaluate the effect of cardiovascular rehabilitation. In the evaluation process, it is necessary to know whether the patient can resume normal husband and wife sex life at home, normal activities and contact with family and friends, participate in recreational activities and resume paid work, and restore the patient's satisfactory social role. Whether you have a positive and optimistic attitude towards life and a series of activities will be used as an index to judge the patient's physical working ability and whether he can adapt to the needs of his social environment, guide the therapist to choose the appropriate occupational therapy, and help the patient really become valuable, not only for his family, but also for the society.

At present, the assessment of disability grade is based on patients' quality of life. The main table 13-3-4 lists the main range of quality of life formulated by the World Health Organization (WHO) (second only to WHO) 1995, but the problems listed in WHO-100 are all comprehensive QOL. For every specific health problem, such as cardiovascular and cerebrovascular diseases, cancer, etc. A unique QOL scale should be developed. At present, there is no recognized unified scale at home and abroad, but the six ranges listed in WHOQOL- 100 and the problems involved in each range are mostly applicable to patients with cardiovascular diseases (refer to relevant evaluation chapters for specific evaluation).

Table 13-3-4 Main scope of WHO QOL- 100 scale

3. The relationship between the classification of cardiac function and the ability to resume work.

The type and degree of cardiovascular disease damage are very important for making rehabilitation programs, but the correlation between cardiac function classification and clinical situation, maximum oxygen consumption and physical labor ability is not very close. Because oxygen consumption is an easy-to-measure index, MET is usually used as the objective standard of energy demand in specific work, and patients with clinical symptoms of cardiac function grade III may still reach 4 MET. This means that patients can still do some light or moderate work while sitting or even standing. Therefore, it is necessary to have a good understanding of the relationship between the clinical situation of cardiac function classification and the maximum oxygen consumption (table 13-3-5).

4. Assessment of employability

Restoring employability is a very important thing for most patients with cardiovascular diseases. The ultimate goal of cardiac rehabilitation is to improve the quality of life of patients with heart disease and return them to their families and society. The evaluation of whether to restore their employability depends not only on the exact diagnosis of the disease and the type of work they are expected to resume, but also on other objective and subjective factors. It is necessary to evaluate the physical ability and working environment of different types of work.

Table 13-3-5 Relationship between clinical situation of cardiac function classification and maximal oxygen consumption

(1) Energy requirements of different jobs: Table 13-3-6 lists the physical energy requirements of some common jobs.

Table 13-3-6 Physical Fitness Requirements for Common Jobs

(2) Evaluation of working environment: When evaluating the energy consumption and exertion required for a certain job, the influence of working environment must be further considered. For example, under the conditions of high temperature, high humidity and high altitude (low air pressure), although the energy demand of a certain job is not high, the patient's working ability is greatly reduced. Therefore, the rehabilitation plan should be implemented in a similar situation to the actual environment where the patient is about to resume work. For example, it is not appropriate to implement rehabilitation programs in air-conditioned rehabilitation institutions.

(3) Determination of working ability: The evaluation of patients' ability to return to work and social life must integrate the following factors: diagnosis and classification, different types of heart diseases have different working abilities; The attitude and understanding of patients and their families towards returning to work; The nature of the work to be resumed and the familiarity of the patient with the work, and whether the patient can effectively adapt to the work; Can you get along and cooperate with your superiors?

(4) Work simulation and testing: Work simulation and testing are the last means to test physical fitness when returning to work. In order to evaluate the physical strength of patients when they return to work, the special working environment can be simulated. Physical tests to restore the workplace are usually carried out in a rehabilitation center simulating the working environment or a nearby factory village after the physical training in the hospital rehabilitation plan. If cardiac rehabilitation work is carried out in the community where patients live, the equipment needed for this work should be tried as close as possible or directly. Rehabilitation personnel should judge the patient's physical ability to resume this specific work according to the results of the simulation work, and require managers, such as managers, team leaders and their colleagues to understand the significance and safety of this work simulation and testing. Rehabilitation personnel and community workers of patients and their families must also understand the same content.