The treatment cost is up to several million, the professional institutions are scarce, and the disability rate is as high as 46%.

There are 256.5 million children in China. In the context of childhood diseases, there is a disease that does not die, but it can drag down an entire family, and the cost of treatment is millions. The disease has about 6 million patients in China, and behind the 6 million patients, there are 6 million families seeking medical care.

This disease is the cerebral palsy of children. At present, the incidence of cerebral palsy in newborns is about 5‰, which is still high, and there is no technical means to prevent or screen. Observing future trends, the situation is not optimistic. It is expected that 1 million children will be added in the next decade. Parents' disregard or delay in treatment will result in a disability rate of 46%.

Like the original intention of most medical students, the desire to "salvate and save people" has made Liu Jianjun the idea of ​​learning medicine. But in the next 50 years, he chose to recover from a child who had just started.

"At that time, considering the choice of children's rehabilitation, I felt that the foundation of children's rehabilitation is weak. Some people need to do something for their children, so that children who have problems at birth can live a normal life, and they can better reflect the value of the rehabilitation doctor. Rehabilitation training or giving medical advice may change their life." Liu Jianjun told the arterial network reporter.

Professor Liu Jianjun, Chief Physician of the Children's Rehabilitation Division

In the 1980s, many diseases eventually led to disability. Our country's medical system has never conducted in-depth research on the recovery of the disease, which directly led to a surge in the number of disabled people. At that time, Deng Pufang, chairman of the National Disabled Persons' Federation, visited. After the rehabilitation system in Japan and the United States, it was decided to introduce Western advanced rehabilitation concepts and rehabilitation techniques into China.

In 1988, the state officially approved the establishment of the China Rehabilitation Research Center. Since then, China's rehabilitation business has opened a new page, and numerous medical personnel have invested in the rehabilitation industry.

On the page of Liu Jianjun's good doctor online, there will be parents' counseling every day, ask him to help see the children. Online, his good doctor's personal website was visited more than 1 million times. The parents of these children with cerebral palsy found Liu Jianjun from the north and the south, hoping to restore the child's athletic ability through professional rehabilitation.

Although he has nearly 26 years of clinical rehabilitation experience, Liu Jianjun is known as “the youngest chief physician in the domestic rehabilitation field”. He is a backbone expert in the field of treatment of young and middle-aged cerebral palsy in China, and is a botulinum toxin nerve block in the rehabilitation field in China. The pioneer and the most authoritative expert.

Since he started his career, Liu Jianjun has successfully restored the athletic ability of tens of thousands of children with cerebral palsy, enabling them to live like normal people. For doctors, "recovering one person and saving one family" is their greatest wish.

6 million children with cerebral palsy, the number of beds is "a cup of water"

The start of the night, the foundation is thin, is the description of the status quo of rehabilitation in the rehabilitation practitioners. In the environment of the top three hospitals, the rehabilitation department is a weak department even now. Although there are policy support, the hospitals in the top three must have rehabilitation departments. However, due to the long recovery period and the long bed time, many rehabilitation departments in the top three hospitals are very small. There is only one clinic in the clinic, and the number of beds is even less. Liu Jianjun believes that because of the weak foundation, the development of the rehabilitation department is now at a stage of rapid growth.

In the recent 80 Rehabilitation Hospitals released by the Eric Hospital Management Research Center, China Rehabilitation Research Center Beijing Pok Oi Hospital undoubtedly occupied the top position.

Beijing Bo'ai Hospital is affiliated to the China Rehabilitation Research Center, which is known as the “Concord” of the rehabilitation community. In 1988 in China, the rehabilitation industry was just getting started, and the development of Zhongkang started from scratch. Thirty years of achievements are also a powerful testimony to the 30 years of development of Chinese rehabilitation medicine.

The China Rehabilitation Research Center is directly affiliated to the China Disabled Persons' Federation. It currently has six institutions including Beijing Pok Oi Hospital, Rehabilitation Medical College, Rehabilitation Medical Research Institute, Rehabilitation Engineering Research Institute, Rehabilitation Information Research Institute and China Disabled Persons' Federation Social Service Guidance Center. Beijing Bo'ai Hospital was established in 1988 and belongs to the third-grade general hospital, which is a central government funded institution. The hospital covers an area of ​​more than 220 acres, with a construction area of ​​120,000 square meters, more than 1600 employees, and 1,100 beds.

Beijing Boai Hospital has many advantages such as neurological rehabilitation, spinal cord injury rehabilitation, child rehabilitation, bone and bone joint rehabilitation and traditional medical rehabilitation. It has long been committed to the study of rehabilitation of children and draws on the rehabilitation design and rehabilitation of advanced countries such as Japan and the United States. The concept, the recovery effect of children with cerebral palsy in the hospital is more than 90%.

Liu Jianjun told reporters that for the rehabilitation system in Europe and America, the advanced point lies in the process of rehabilitation evaluation, and through the scientific rehabilitation evaluation, the corresponding rehabilitation program is formulated.

In this not-so-small market, there are only a handful of professional medical institutions, and Liu Jianjun’s current China Rehabilitation Research Center, Beijing Pok Oi Hospital, is one of the most famous.

Liu Jianjun's pediatric rehabilitation department has 7 attending doctors, more than 20 rehabilitation training therapists, 15 nurses, and a total of 50 beds. But these 50 beds are the largest children's rehabilitation department in Beijing.

Even if it is enlarged to the domestic level, only Heilongjiang Jiamusi Children's Healing Center, Qingdao Children's Rehabilitation Center, Zhengzhou Zhengda Sanfu Hospital have a special child rehabilitation department, and there are large-scale beds.

For the newly added children of cerebral palsy and the children who need rehabilitation for a long time, the institutions that can provide diagnosis, treatment and rehabilitation for the whole process management are very limited, and the public medical resources are far from meeting the market demand.

An accident at birth will make a child's life disabled

"There is no way to prevent this disease," Liu Jianjun said.

Premature birth, low birth weight, birth asphyxia, and hyperbilirubinemia have long been considered to be the four major causes of cerebral palsy in children, but these major causes are not preventable. "I can't check it during pregnancy, so the incidence of cerebral palsy in children has not decreased. Unlike other diseases, it is slowly declining with the development of science and technology."

When a child reaches the age of climbing, he will not climb, or will not sit alone, or will not stand alone, or even walk, the parents of the child know that these conditions are not normal, but what is the case Clearly, some parents even think that their children are only developing later than their peers. They don’t understand the cerebral palsy until after the last visit. When parents understand, they often miss the best treatment time. According to relevant data, the morbidity rate of children with cerebral palsy is as high as 46%, and 65% of children with cerebral palsy are not effectively treated for reasons such as poverty.

Liu Jianjun said that in the children's cerebral palsy, the main difficulties and challenges encountered are early detection, but with the development of perinatal medicine, maternal health awareness, birth asphyxia, nuclear jaundice significantly reduced, premature infants, low birth weight The survival rate of children has increased significantly, and the number of children with cerebral palsy caused by these two reasons has also increased.

The early manifestations of cerebral palsy are increased muscle tone, residual residual reflexes, and retarded exercise, and the earlier the treatment intervention, the better.

Unlike other departments in rehabilitation hospitals, patients in the pediatric rehabilitation department may have language problems, intellectual problems, behavioral problems, visual and auditory problems, etc., in addition to basic dyskinesias. complex.

Liu Jianjun revealed that the main problem to be overcome in children with cerebral palsy is paralysis. At present, a more innovative and effective treatment is botulinum toxin injection. In addition, a large sample of comparative experiments in the hospital proved that the botulinum toxin injection combined with rehabilitation training, the patient's rehabilitation effect is better.

"It is indeed a very difficult situation to deal with," Liu Jianjun described.

"In general, the newborn is about 350 grams to 400 grams, and the brain weight is 1/4 of the weight of the adult brain. That is to say, the remaining 3/4 is slowly developed in the back, then it is two years old. In order to develop to 75% of the adult weight, three years old can approach the weight of the adult brain." Liu Jianjun believes that compared with adult rehabilitation, children's rehabilitation actually has greater potential, and some of the ability to lose due to brain damage, etc. is also easier Healed.

The clinical pathway is an important means for the implementation of standardized management of the Children's Rehabilitation Division to improve the efficiency of rehabilitation. The doctor needs to formulate detailed rehabilitation projects for the assessment results of the children. “What to do in the first week, what to do in the second week, and to go to the hospital. All need to be clearly formulated and standardized and standardized in the subsequent rehabilitation process," said Liu Jianjun.

Compared with traditional rehabilitation of children, the current evaluation system is more comprehensive and scientific. “The original focus is on athletic ability assessment, and now intelligence, language, and behavior must be evaluated.”

High cost, long recovery period, treatment rate not exceeding 10%

As Liu Jianjun said, for a long time, children's cerebral palsy is considered to be incurable. "Before talking about cerebral palsy, it is said that there is no way to cure. If a child gets sick, he will go home and be a vegetative person." In the 1980s, the concept of child rehabilitation began to rise.

The rehabilitation of children with cerebral palsy is a long-term, continuous process. Liu Jianjun introduced that the golden age of cerebral palsy rehabilitation in children aged 0-3 years old, before the age of 6 can get timely rehabilitation training, the effect is better.

However, for children with cerebral palsy, they often miss the golden age of rehabilitation because of the reasons of “no bed” and “high treatment cost”. Most children need to stay up to 18 years old and even rehabilitate for life. In such a long cycle, few parents insisted.

According to Liu Jianjun, at Beijing Pok Oi Hospital, “If there are more than a dozen patients in the outpatient clinic, there may be only one who will receive systematic rehabilitation training.” In the children’s rehabilitation department where they are located, there are children who line up all the year round, which is a few weeks long. In a few months, 50 beds were in short supply.

Compared with adult rehabilitation, children's rehabilitation technology is more difficult to manage and manage, and the threshold is higher. There is a serious shortage of medical institutions with children's rehabilitation functions.

And the family of children with cerebral palsy usually change the fate of the whole family because of a child's illness. The disease is poor due to illness, and the situation of returning to poverty due to illness is not uncommon. The psychological and cost burden is very high. %.

Some parents are rushing to medical institutions in Beijing, Shanghai, Chengdu and other places, the average annual treatment cost is close to 200,000 yuan. "Because the rehabilitation effect can not be immediate, and the rehabilitation costs are high, most parents have to give up treatment for their children."

In the process of cerebral palsy rehabilitation, if you are undergoing rehabilitation treatment in a hospital for a long time, the cost of a treatment is about 40,000 yuan, and the cost of two treatments per year is about 80,000. "After more than a decade, some parents can spend millions." .

In addition, some patients will also choose community rehabilitation, family rehabilitation and other methods to reduce rehabilitation costs.

The current medical insurance coverage of children's rehabilitation projects is not perfect. Take Beijing as an example. Since April 15, 2011, the rehabilitation of children with cerebral palsy has begun to be included in the scope of medical insurance reimbursement, and it is stipulated that “for basic medical insurance for urban residents” Students and children who have undergone rehabilitation for cerebral palsy are eligible for basic medical insurance reimbursement. The basic medical insurance fund will not pay more than 6 months per year before the age of 3; after 3 years, the annual payment will not exceed 3 Month."

In terms of life cycle, children with cerebral palsy face the problem of survivability, requiring 24-hour uninterrupted care, and day-to-day rehabilitation training. Some children with cerebral palsy die within a few weeks of birth; some lives can only be maintained until 8 to 9 years old, although the life expectancy of children with cerebral palsy may be shorter than ordinary people, but most can live to adulthood and even old age.

However, cerebral palsy is not synonymous with mental retardation. Some children with cerebral palsy are not well coordinated, but their brain damage is small, and there is no intellectual problem. Through hard work, they can live, study, and even go to college. Liu Jianjun revealed that among children with cerebral palsy, "75% have intellectual problems, and 25% are unaffected by intelligence."

According to the statistics of the International Federation of Physical Medicine and Rehabilitation, the number of rehabilitation therapists in developed countries such as Europe, America and Japan is generally 30 to 70:100,000. The proportion of rehabilitation workers in China is about 0.4:100,000 (according to international caliber). At present, there are less than 20,000 rehabilitation medical professionals in China.

The shortage of talents indirectly creates a gap in the professional institutions in the market. In this case, the hospital usually adopts internal training methods, especially the direction of children's rehabilitation. There is no special child rehabilitation program in the school, only from the present. Rehabilitation graduates or rehabilitation physicians are trained.

For the rehabilitation of children in China, the basic situation is that there are fewer professional institutions, fewer beds, and shortage of talents. For doctors, saving a child is equivalent to saving the whole family. Every family whose children have cerebral palsy often goes through such a process. First, it is grief, then anger, then helpless, and finally give up. In fact, they are also forced by the reality, as long as there is a hint of hope, "to cure the child's cerebral palsy" is still their larger wish.

"One point of hard work, one point of harvest" is the biggest feeling of Liu Jianjun's 26 years of work. "Early efforts to carry out rehabilitation treatment, in fact, the impact on the child's life is still quite large, so it must be early to say that you should not be afraid of trouble. If you work hard to do rehabilitation, then he will definitely get the reward in the future." For parents, it is necessary to insist on the rehabilitation of the child, as well as the rehabilitation workers.

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