I. Early rehabilitation: Patients in this stage generally show delayed paralysis, no random muscle contraction and no joint reaction, and the organism is basically in a fully relaxed state; equivalent to Brunnstrom recovery stage 1-2.
(I) Basic purpose: The basic purpose of early rehabilitation is to prevent future comorbidities that will seriously affect the rehabilitation process, such as swelling, muscle atrophy, joint movement limitation, etc.; to strive for early functional improvement and prevent complications.
(B) Early rehabilitation methods.
1. Correct position: teach family members and nursing staff to adopt correct position placement, including supine position, healthy-side lying and affected-side lying methods, and require turning once every 2 hours and patting the back several times.
2.Turning exercise: cross your hands in front of you, turn to both sides respectively, and support the bed with both feet.
3.Self-assisted exercises in bed: crossed front planks with both hands, overhead, side lifts, finger nose, legs flexed to support the bed to lift the buttocks, feet crossed to move laterally, etc.
4.Bedside passive exercises – upper limbs: scapular girdle, shoulder joint, elbow joint, wrist and finger joints.
5.Bedside passive exercise – trunk pulling, back muscle squeezing stimulation.
6.Bedside passive exercise – lower extremities: hip, knee and ankle toe joints.
7.Methods to promote muscle contraction: use sudden stretching of muscles to cause muscle contraction.
8.Expectoration
9, bed head elevation sitting training: bed head gradually elevated, each position the patient can maintain for 30 minutes, then gradually add 10 degrees of retraining until you can sit up on the edge of the bed, no leaning position balance exercises.
10, facial, muscle stimulation: mouth opening, cheek puffing, tooth knocking, stretching, top palate, etc., frozen cotton (or ice containing) and taste stimulation.
11, breathing control exercises: ask the patient to inhale deeply – exhale slowly and relax.
12.Sitting training: Before the head of the bed is raised to 90 degrees, first train the patient to lift the head and shoulders with lateral posterior one-handed support until they can support sitting up.
13.Sitting balance: correct sitting posture, bedside sitting balance, including front and back, left and right in all directions.
14.Sitting exercise: to strengthen the balance training, including crossed hands before flattening, lateral focus, crossed hands pointing to the nose, crossed hands pointing forward to objects; muscle strength training of the healthy side of the lower limbs, etc., can be taught to family members and nursing staff, and then supervise the patient to practice several times a day.
15.Transfer from bed to wheelchair (or chair).
16.Sitting and standing exercises: if available, patients can be given bed standing at an early stage to help patients regain a sense of verticality, regain control of anti-gravity muscles, regain self-regulation of blood pressure, improve standing balance and overcome upright hypotension. In general, patients with cerebral infarction are required to reach bedside sitting after 3-4 days of enrollment in the treatment group, and can be trained to stand within two weeks, and the auxiliary strength depends on the condition; patients with cerebral hemorrhage should try to reach bedside sitting within two weeks and standing within four weeks.
17. Do activities of daily living with healthy hands: eating, dressing, washing, etc.
18.Cognitive and speech therapy.
19.Application of tui na and acupuncture treatment.
20.Application of physical therapy such as medium frequency.
21.Psychotherapy, etc.
(2) Mid-term rehabilitation: Patients in this stage can obviously show the flexor synergistic movement of upper limbs and extensor synergistic movement of lower limbs, and can gradually achieve independent movement of certain muscles and joints, equivalent to B recovery stage 3-5.
(I) The purpose of mid-term rehabilitation: to suppress the synergistic movement pattern, train the muscles and joints to move independently at will as much as possible, improve the coordination of each joint, and gradually restore the patient’s motor ability.
(II) Mid-term rehabilitation methods: from passive – assisted – active.
1.Inhibit the spasticity pattern of the upper limbs.
2.Stretching the trunk to promote and change trunk mobility, inhibit trunk tension and spasticity.
3.Hold hands on knees left and right light body to control upper and lower limb spasm.
4.Flexion of the shoulder joint down with the affected hand touching the therapist’s hand and then touching their forehead, and then touching their opposite shoulder to train the elbow joint random flexion and extension function.
5.Limb placement and holding activity: During the activity of the affected hand, instruct to stop at any angle and hold it in this position for a moment to improve the spatial control of the affected upper limb.
6.Autonomous movements of shoulder joints in all directions: shoulder forward planks, shoulder abduction, shoulder external rotation.
7.Autonomous movements of the elbow joint in all directions: elbow, extension, forearm rotation forward and backward.
8.Autonomous movements of wrist and fingers: wrist dorsiflexion, lateral deviation, thumb abduction, opposite fingers, etc.
9.Activities of shoulder girdle: upward, outward, downward.
10.Bridge movement training hip extension control.
11.Control training of internal and external hip and abduction: do it on the affected side in the healthy neutral position and on the healthy side in the affected neutral position.
12, knee flexion and extension control training.
13.Flexion-extension control training of the knee joint in hip extension position.
14.Patient draped position training lower limb preparation for weight-bearing exercise.
15.Flexion of the affected knee in the prone position.
16.Support training of the upper limb on the affected side.
17.Small range of flexion and extension of the elbow joint under the affected upper limb.
18.Pushing objects forward with the affected hand or picking up objects with crossed hands.
19.Pushing objects with the back of the hand.
20.Rotating forearm to press play-doh.
21.Flexion of the lower limb on the affected side.
22.Pick up small objects with fingers (over the midline).
23.Muscle strength training of the lower limb on the healthy side.
24.Flexion and extension knee exercise of the affected lower limb.
25.Standing balance training: move the center of gravity back and forth.
26.Standing balance exercises: crossed hands (depending on the situation), front planks over the head, front planks followed by trunk rotation, etc.
27.Sit and stand control training, and decomposition exercises.
28.Do elbow flexion and extension exercises to promote elbow extension or independent support of the affected hand by supporting the wall with both hands.
29.Standing with legs in front and behind and shifting the weight to flex and extend the affected knee in a small range.
30.Bend the knee in hip extension position.
31.Bend the hip and knee in preparation for stepping.
32.Internal abduction, adduction and lowering pelvic training of the affected lower limb.
33.Stand on one leg separately with support.
34.Low stride training to control pelvic lift for stride.
(C) Rehabilitation arrangement: The above items basically need therapist’s help and guidance to complete, generally 1-2 times a day, 45 minutes each time, 4-5 days a week, once a day in the family, and once a day in the afternoon to instruct family members to practice.
(IV) Precautions: All joints should be maintained at maximum joint range of motion, and treatment should be within the range of pain-free or tolerated by the patient, avoiding violence and using gentle techniques; the therapist should give appropriate protection, and the auxiliary force should be large to small, encouraging the patient to complete independently.
III. Post-rehabilitation
(a) Rehabilitation purpose: Patients in this stage can use the affected limb to a large extent, equivalent to Brunnstorm recovery stage 5-6. The purpose of rehabilitation training is how to use the affected side more freely, how to better apply the skills acquired through training in daily life, improve various ADL abilities, improve speed on the basis of ensuring the quality of movement, and maximize the quality of life.
(II) Rehabilitation methods: Continue the previous phase of training, further consolidate, improve and apply to daily life.
1. Fine motor strengthening training for fingers.
2.Lateral walking training: first to the healthy side and then to the back side.
3.Improve gait training: pelvis relaxation, knee flexion strengthening training.
4.Gait improvement training: ankle dorsiflexion and stretching.
5.Promote the lower limb support ability of the affected side: standing position, with the healthy leg in front and the affected leg behind, instructing the weight to shift forward, and the heel of the affected foot cannot leave the ground.
6.Promote the lower limb support ability of the affected side, with the affected limb bearing weight and the healthy limb stepping forward and backward.
7.Do cross-over movement of both feet alternately in standing position.
8.Family ADL guidance.
9.Room modification.
(C) on the use of assistive devices.
1.Foot rest – foot drop.
2, wrist dorsal extension splint – flexion wrist spasm.
3, crutches, walking aid arrogance.
4, wheelchair, etc.