Stroke is a disorder that causes focal neurological deficit and dysfunction due to a sudden onset of intracerebral infarction or hemorrhage, the symptoms of which last for more than 24 hours (synonyms: stroke, cerebral infarction, cerebral hemorrhage, cerebrovascular accident).
Incidence
The annual incidence of stroke in China is 200 per 100,000 population, with 1.5 million new cases of stroke each year and a stroke disability rate of 70-80%.
In order to reduce the disability rate, rehabilitation can provide more comprehensive and targeted training for patients to improve their functions and strive to return to their families and society.
Etiology
Cerebral ischemia: arterial embolism and thrombosis due to atherosclerosis resulting in cerebral ischemic lesions.
Cerebral hemorrhage: On the basis of hypertension and cerebrovascular lesions, a sudden neurological stimulation or a sharp increase in physical load leads to a surge in blood pressure exceeding the capacity of cerebral vessels, thus causing a rupture of the vessels and resulting in cerebral hemorrhage.
Cardiac embolism: causes cerebral hemisphere infarction.
Risk factors: old age, hypertension, heart disease, transient ischemic attack (TIA), smoking, diabetes mellitus, antiphospholipid antibodies, hyperlipidemia, family history, sedentary lifestyle, blood hypercoagulable state.
Signs and symptoms.
The diagnosis is not difficult based on focal neurological symptoms and imaging findings.
1, hemiparesis, hemiplegia, hemianesthesia, hemianopsia, aphasia, visual field deficits with damage to the cerebral hemispheres (internal carotid system).
2, pontocerebellar or cerebellar damage (vertebrobasilar system): diplopia, vertigo, ataxia, facial palsy, dysphagia, dysarthria.
3. cerebellar damage headache, nausea, vomiting, ataxia.
4, varying degrees of impaired consciousness.
5, typical lesions are seen on cranial CT and MRI examinations, which help to confirm the diagnosis.
Other relevant clinical and laboratory tests
Depending on the need for assessment of the primary cause and differential diagnosis
Functional assessment
State of consciousness: MMSE (Brief Mental State Examination Form.
Degree of spasticity: measured by modified Ashworth classification scale.
ADL: MBI, modified Barthel Index scale.
Motor function: Brunnstrom assessment hair method.
balance: the ability to assess the fall index with instruments
Speech function: aphasia screening scale.
emotional state: Hamilton Depression Inventory.
Composite: clinical neurological deficit score in Chinese stroke patients.
Some of the above assessments allow a more specific analysis of the disease and thus targeted rehabilitation treatment.
Exercise therapy and physical factor therapy
Postural therapy (anti-spasticity position)
For those with upper extremity flexor spasm and lower extremity extensor spasm; in the supine position, the affected upper extremity is positioned 30° out, elbow and wrist extended, forearm rotated back, and shoulder padded with a soft pillow. The affected lower limb is mildly flexed at the hip and knee, and a soft pillow is placed in each of the N fossa and the sole of the foot.
Early treatment
Simple exercises in bed in the early stage and help to increase walking speed.
Recovery period: practical walking training, gradually increase walking distance and walking speed, continue to correct gait and enhance stair climbing exercises. Passive joint exercises and massage of paralyzed muscles, passive-active exercises, training of turning over, sitting up, standing up on an inclined bed, transferring out of bed to a chair sitting position and standing and walking ability.
Gait training can also be performed with partial support of weight-reducing walkers (for moderate to severe gait abnormalities)
Walking in an ankle-foot orthosis (AFO) to correct foot drop and pronated gait and to help increase walking speed, if necessary
Recovery period: Practical walking training, gradually increase walking distance and walking speed, continue to correct gait, and enhance stair climbing exercises.
Physical factor therapy “Functional electrical stimulation (FES) (to improve muscle strength), acupuncture or electroacupuncture (to improve hand function) for muscles with a moderate degree of paralysis, mainly those related to ankle/knee/hip movement”
For hemiplegic shoulder
1. functional electrical stimulation therapy (FES) to reduce subluxation
2. TENS treatment (pain reduction).
3.Acupuncture treatment (pain reduction and improvement of muscle strength or electroacupuncture treatment to reduce subluxation)
4.Heat therapy and massage.