Many people think of stroke rehabilitation as helping a patient to move around or doing physical therapy, but it’s not just that! What does “stroke rehabilitation” really mean? Let’s learn together today.
Post-stroke rehabilitation is a complex project
Post-stroke rehabilitation is a very complex and difficult systemic project. Post-stroke patients do not only have limited physical function, but also have psychological and mental impairment. Therefore, it is not only one-sided but also harmful to simply understand post-stroke rehabilitation as restoring the motor function of the limbs. The highest goal of post-stroke rehabilitation is to fully restore all functions of the patient.
The traditional view is that rehabilitation must wait until the stroke has stabilized before it begins. Many hospitals, especially primary care hospitals, artificially divide patients between neurology and rehabilitation units. The most common medical procedure is to treat the patient in the neurology department and wait until he/she is stabilized, then transfer him/her to the rehabilitation department at an opportune time or simply send him/her home to recover on his/her own. If this is not due to a financial problem of the patient, it is clearly a problem of the concept of treatment.
The modern view of stroke rehabilitation is that once a stroke has occurred, rehabilitation should be involved. The earlier the rehabilitation is carried out, the greater the benefit to the patient.
Stroke rehabilitation is everywhere
In the acute phase, pulmonary ultrasound therapy in comatose patients to improve pulmonary circulation and reduce sputum accumulation is a form of rehabilitation;
Correct positioning of the paralyzed limb to avoid dislocation and stiffness of the joint in a non-functional state due to muscle weakness is a form of rehabilitation;
Passive movement of limbs that are immobile due to paralysis to slow down muscle atrophy is a form of rehabilitation;
Air pressure wave therapy to prevent deep vein and pulmonary thrombosis in patients who are bedridden for long periods of time is a form of rehabilitation;
Bobath training of the upper limbs and bridge training of the lower limbs for patients with incomplete paralysis is a form of rehabilitation.
Installing a walking brace to assist the hemiplegic patient to walk or correct his walking posture is a form of rehabilitation;
Teaching aphasic patients to speak in a mirror is also a form of rehabilitation;
Teaching the patient to learn how to go to the toilet properly, how to hold chopsticks, how to comb hair, and how to write …… are all rehabilitation.
In short, everything that allows the patient to mitigate, compensate, and correct the various functional losses that should have resulted from the stroke injury is rehabilitation.
Develop an individualized rehabilitation plan
The degree of post-stroke rehabilitation intervention is not always the stronger or more aggressive. It is crucial to tailor a near-, mid- and long-term rehabilitation plan for each patient, and the prerequisite basis for the development of the plan is a thorough, scientific assessment of the patient. The assessment should take into account not only the natural evolution of stroke, but also the patient’s age, gender, occupation, personality, family conditions, pre-stroke status, personal rehabilitation expectations and cooperation with rehabilitation.
For example, when rehabilitating elderly stroke patients, it is important not to set an overly ambitious rehabilitation plan, but also to take into account the patient’s sanity, mental status, comprehension, cardiopulmonary function, degree of cooperation and the expectations of the patient himself and his family. The focus of early rehabilitation should be on reducing complications and creating conditions for subsequent rehabilitation. After the patient’s condition is stabilized and his or her sanity and spirit improve, a medium-term rehabilitation program should be started. In the case of young-adult stroke patients, a more aggressive rehabilitation program with higher target values is necessary because these patients tend to have a stronger desire for rehabilitation, a higher degree of cooperation, intact cardiopulmonary function, and a higher level of economic conditions and family importance.
According to the neurological rehabilitation regression characteristics, the recovery is fastest in the first 1~3 months and slower in the 4th~6th months. 7~12 months are almost finalized, and the focus of rehabilitation in this stage should be on the functional recovery that affects the patient’s future quality of life, such as walking and active limb movement. At this time, if the upper and lower limbs of the paralyzed side cannot be rehabilitated at the same time, priority should be given to the lower limbs; when the large and small joints cannot be trained at the same time, priority should be given to training the large joints. After six months, most of the patients have entered the plateau of rehabilitation effect, when most of the hemiplegic limbs have started to enter the spastic state, the focus of rehabilitation should be on daily living ability training, so that the patients can adapt to the new life as much as possible.
Post-stroke rehabilitation must be comprehensive and complete
The principle of comprehensiveness is to consider the physical dysfunction of the patient, but also to fully consider the psychological and cognitive problems of the patient. According to statistics, 40%-70% of stroke patients have different degrees of cognitive impairment, anxiety, depression, personality changes, etc. These problems, if not detected and intervened in time, not only seriously affect the effectiveness of rehabilitation, but also significantly reduce the quality of life of patients and their families. At the same time, secondary prevention of stroke must be carefully implemented in the rehabilitation process, and the risk factors for stroke recurrence must be strictly controlled by using drugs in accordance with the guidelines and actively changing the poor lifestyle to avoid stroke recurrence to the maximum extent possible.
The whole process means that rehabilitation must be carried out throughout the whole stroke process, i.e. from early stage to recovery; from hospitalization to community to home.