What are the criteria and rules for rehabilitation in a patient with unknown medical history and demographics?

Rehabilitation Center Admission Criteria and Rules

Patients must meet three core requirements for rehabilitation admission: medical stability with vital signs controlled and acute processes resolved, minimum functional capacity to follow at least one-step commands with stamina for program participation, and demonstrated potential for functional improvement with specific, measurable goals established collaboratively with the team. 1

Medical Stability Requirements

The patient must satisfy all of the following before rehabilitation admission: 1

• Confirmed diagnosis established (mechanism may be unclear initially, as in cryptogenic stroke, but this should not delay rehabilitation access) 1
• All acute medical issues addressed, including shortness of breath, congestive heart failure, and other comorbidities 1
• Vital signs stable with no acute disease processes precluding active participation 1
• Medical investigations completed or follow-up plan established with appointments scheduled before discharge from acute care 1
• Appropriate prevention interventions started when etiology is clarified 1

Minimum Functional Capacity Criteria

The patient must demonstrate: 1

• Stamina to participate in the program demands and schedule 1
• Ability to follow at minimum one-step commands, with communication support if required 1
• Sufficient attention, short-term memory, and insight to progress through the rehabilitation process 1
• Tolerance for at least 3 hours of therapy per day, 5 days per week for inpatient rehabilitation facility admission 2

Rehabilitation Potential Assessment

The patient must show: 1

• Potential to return to premorbid/baseline functioning or increase post-stroke functional level with rehabilitation participation 1
• Post-stroke functional status below pre-stroke status with potential for improvement 1
• Specific, measurable, attainable, realistic, and timely (SMART) goals that can be established 1
• Consent and willingness from patient or substitute decision-maker to participate in the program (exception: reduced motivation secondary to depression) 1

Absolute Exclusion Criteria

Patients are excluded if they have: 1

• Severe cognitive impairment preventing learning and therapy participation 1
• Inappropriate behavior putting self or others at risk (aggressive, etc.) 1
• Terminal illness with expected short survival 1
• Unwillingness to participate in the program 1
• Adequate treatment elsewhere with needs already being met 1

Initial Assessment Requirements

Assessment must begin within 48 hours of admission by rehabilitation professionals in direct contact with the patient. 1

The initial evaluation must include: 1

• Patient function, safety, physical readiness, and ability to learn and participate in rehabilitation therapies 1
• Transition planning considerations during the initial assessment 1
• Standardized, valid assessment tools for impairment, functional activity limitations, role participation restrictions, and environmental factors; tools adapted for communication limitations where required 1
• Priority screening including safety evaluation (cognition, fitness to drive), swallowing, communication, and mobility by a clinician with stroke rehabilitation expertise 1

Comprehensive Pre-Admission Assessment Domains

Beyond basic eligibility, a thorough assessment must document: 2

• Current ADL independence level compared to pre-morbid functional status to establish rehabilitation potential 2
• Detailed neurological assessment of residual motor, sensory, cognitive, and communication deficits 2
• All active medical conditions impacting rehabilitation participation, including diabetes, cardiac disease, and chronic pain 2
• Complete medication review with attention to timing, meal relationships, and required adjustments for exercise or therapy 2
• Depression screening using valid tools, as depression affects 20-45% of rehabilitation populations and significantly impacts outcomes 2
• Home environment and support system, including who the patient lives with, caregiver capability, and need for modifications 2
• Vocational and leisure goals for working-age patients, as employment is a critical quality-of-life outcome 2

Multidisciplinary Team Requirements

The core rehabilitation team must include physiatrists or physicians with stroke rehabilitation expertise, occupational therapists, physiotherapists, speech-language pathologists, nurses, social workers, and dietitians. 1

Additional team members may include recreation therapists, psychologists, vocational therapists, educational therapists, kinesiologists, and rehabilitation therapy assistants. 1

All professional team members must have specialized training in stroke care and recovery and be trained in supported conversation to interact with patients who have communication limitations such as aphasia. 1

Reassessment Protocol

For patients who do not initially meet criteria, rehabilitation needs should be reassessed weekly during the first month and at intervals as indicated by their health status thereafter. 1

Goal Setting and Treatment Planning

Goals must be developed in consensus with the patient, family, and rehabilitation team, covering both short-term and longer-term objectives that are realistic given current disability levels and recovery potential. 1

The clinical team should: 1

• Propose the preferred rehabilitation environment based on recovery expectations 1
• Describe treatment options including the rehabilitation process, prognosis, estimated length of stay, therapy frequency, and discharge criteria 1
• Reach shared decisions with patient, family, and caregiver about the optimal rehabilitation environment and preferred treatment 1
• Provide interactive and written patient/caregiver education including information on driving resumption, patient rights, support groups, and audiovisual stroke programs 1

Critical Pitfalls to Avoid

Depression is an independent risk factor for poor outcomes and mortality; failure to screen and treat significantly compromises rehabilitation success. 2

Discharge failures occur when caregiver capability is overestimated or support systems are inadequate. 2

For diabetic patients, errors in insulin timing or exercise adjustments can lead to dangerous hypoglycemia, requiring specific documentation of diabetes type, nutritional history, medication timing, routine changes for exercise, and history of hypoglycemia episodes. 2