A crestal medullary injury is a structural/functional damage to the crestal medulla caused by a variety of different injury factors, resulting in altered movement, sensation, and function below the level of injury. The potential for recovery from crestal medullary injury is high. Early recovery occurs within a few days to 6 months; patients may also have further recovery for about 2 years thereafter. The presence of early movement of the distal limb, such as active movement of the toes, often predicts good recovery potential. Spastic movements are of no prognostic value. Those with sensation at the site of paralysis have a better chance of recovery of motor function. Areas with normal sensation have a greater than 50% chance of motor recovery. Active functional exercise makes a 100% effort for a 1% hope. Even if the disease history is long, there must be great potential with rehabilitation.
I. Specific contents of rehabilitation treatment
(1) Physical therapy: including muscle strength training, balance training and coordination training; posture and transfer training; weight reduction and weight reduction training; standing and walking training, wheelchair training; physiotherapy, myoelectric biofeedback therapy, etc.
(2) Occupational therapy: including activities of daily living training, recreation and work training, etc.
(3) Application of orthotics: including ankle-foot orthotics, knee-ankle-foot orthotics, etc., and upper limb orthotics.
(4) Psychotherapy: including some psychological guidance, and biofeedback therapy.
II. Stages of rehabilitation training
(A) Acute instability phase (after injury or crestal crestal myeloplasty ~ 4 weeks)
1.Whistle function training
Including thoracic whistling (thoracolumbar segment injury) and abdominal whistling (cervical segment injury) training; postural sputum evacuation training and passive thoracic movement training. Two times a day, moderate compression of the sternum to make the ribs move and prevent adhesions of the cribriform or transverse rib joints. It is prohibited for those who have rib fractures and other chest injuries.
2.Bladder function training
In the emergency phase, indwelling urinary catheters are mostly used because it is difficult to control the amount of intake. After stopping intravenous rehydration, intermittent catheterization (4 times a day) and voluntary urination or reflex urination training should be started.
3.Whole body joint training (good limb position placement)
Shoulder joint abduction should not exceed 90° for cervical instability and hip flexion should not exceed 90° for thoracolumbar instability; exceeding the above angle may cause secondary damage to the crestal crestal medulla. When the patient is in bed or in cervical traction, no rotation, flexion, extension and other exercises of the crestal crutches should be performed before the doctor prescribes them.
4.Muscle strengthening training
In principle, all muscles that can be actively exercised and do not affect the stability of the fracture should be exercised so that muscle atrophy or muscle strength decline does not occur during the acute period.
5.Adaptive training of blood circulation and autonomic function
Include training from supine to sitting up, from bedside sitting to wheelchair sitting, and transition to inclined bed.
6.Psychological rehabilitation
The casualty should be given warmth to encourage them to overcome their dependence and complete various training tasks to achieve the goal of rehabilitation as soon as possible. Encourage the wounded to express their joy, anger, sadness and happiness, so that their deepest pain can be ventilated, thus helping them to complete the rehabilitation treatment well.
7. Training and treatment for prevention of deep vein thrombosis and pressure sores
2 hours interval axial turning, etc.
(II) Acute stabilization period (about 4 to 12 weeks)
In this period, on the basis of continuing the above-mentioned training, the following contents are added.
1.Tetraplegia
You can do some standing training, through electric rising bed, auxiliary apparatus or therapist to help him to complete the position change or movement; training of daily living activities, such as washing and eating; training of crestal spine, we should consider using some neck circumference to avoid excessive movement of the neck; bladder training can do some clean catheterization, regular and quantitative drinking and regular urination; reflex bladder training.
2.Paraplegia
In addition to the tetraplegia training program, we can add assisted standing and residual muscle strength training, and activities of daily living training. For patients with good crestal stability or with strong external fixation and under close supervision, experienced therapists can instruct patients to start walking training with the help of weight-shifting walking orthoses, knee-ankle-foot orthoses or ankle-foot orthoses.
(iii) Chronic phase (after 12 weeks)
All types of crestal medullary injuries should be continued on the basis of the rehabilitation contents of the acute phase, strengthening the training of walking ability, wheelchair ability and the ability to perform activities of daily living, strengthening psychological rehabilitation, as well as various education and training for the purpose of returning to the family and society. In addition, the form of rehabilitation implementation is coordinated by physiotherapists, occupational therapists, psychological rehabilitators, and prosthetists and orthotists under the planning, organization, and overall assessment of rehabilitation physicians. Regular working group meetings are also held to assess the effectiveness of the treatment and fine-tune the rehabilitation content. When there is no professional staff condition, it can be transferred to qualified medical institutions or temporarily carried out by medical staff under the guidance of professional staff. Training in the acute phase should be done with protective supports such as collars and waist girths. Chronic training should be aimed at consolidating the effect of treatment, the intensity and content varies from person to person.
Third, the crestal medullary injury common rehabilitation training content and methods
1.turning training
For the crestal medullary complete injury of the limb paralysis and the upper limb has function of the patient applicable. The purpose is to.
(1) prevent pressure sores caused by prolonged local pressure on the body.
(2) Prevent and control pulmonary infections.
(3) To improve the patient’s mobility in bed.
2.Sit up training
Applicable objects are the same as turning training. The purpose is to.
(1) improve the ability to live independently on a daily basis and to complete activities such as eating, dressing and undressing and studying in a sitting position.
(2) lay a good foundation for further training.
3.Sitting balance training
Applicable objects are the same as turning training, and the purpose is the same as sitting up training. Specific methods.
(1) The patient sits with legs straight.
(2) Slowly raise the hands upward, then lower them, repeatedly carry out lifting and releasing activities, and gradually extend the lifting time.
4.Support decompression and mobility training
It is applicable to patients with complete injury of cervical 7~thoracic 2 and normal or basically normal function of upper limbs. The purpose is to.
(1) increase the support of the two upper limbs.
(2) reduce localized pressure on the body from body weight to avoid decubitus ulcers.
(3) improve the ability to move the body in bed.
Specific methods.
①Moving to the front training; the patient sits on the bed, legs straight, hands behind him to support the bed; hands forcefully support the hips to lift off the bed and move forward.
②Move to the side training: the patient sits on the bed, legs straight, hands on both sides of the body to support the bed; hands forceful support, hips lift off the bed and move to the side.
5.Transfer training
It is applicable to paraplegic patients with some function or normal function of upper limbs. The purpose is to.
(1) Complete the transfer between the bed and the wheelchair and create conditions for using the wheelchair.
(2) Improve the ability to live independently.
Specific methods.
①Assisted transfer training (transfer from wheelchair to bed): The trainer faces the patient and holds both knees against the patient’s knees; the patient holds the trainer’s shoulder with one hand and the other hangs down naturally; the trainer holds the patient’s hip with both hands and lifts the patient with force; help the patient slowly transfer to bed.
②Transfer training to the front (from wheelchair to bed): the wheelchair is facing the bed, gate the wheelchair; the patient puts his legs on the bed; the patient holds the armrest of the wheelchair with both hands and supports it with force, and moves his hips from the front of the wheelchair to the bed.
(3) Transfer training to the side; the wheelchair is inclined to the bed at an angle of 45 degrees and the wheelchair is gated; the patient supports the bed with one hand and the outer armrest of the wheelchair with the other hand, so that the hips leave the wheelchair and transfer to the bed.
6.Standing training
(1) Stand up training
The trainer faces the patient, stands with legs apart, holds both hands under the patient’s armpits and lifts upward with force; the patient wears orthotics on the lower limbs, leans forward and stands up with force supporting the crutches.
(2) Standing training in parallel bars
The patient’s lower limbs with orthotics, holding the parallel bar with both hands to stand (other firm fixtures such as railings can be used in the home instead); the trainer holds the patient’s hip with one hand and the patient’s chest with the other hand; the patient stands straight with the chest up, and the standing time is gradually extended, 20-30 minutes per standing.