What do you know about rehabilitation of hemiplegia?

  For patients with cerebrovascular disease, especially hemiplegia, at this stage, when there is no fundamental progress in drug treatment, the way out is rehabilitation, not to consume most of the patient’s treatment costs for drug treatment, especially for patients with insufficient funds, a reasonable allocation of treatment costs is not only beneficial to the patient, but also meaningful to the patient’s family and society. With the development of technology and medical progress, the survival rate of stroke is much higher than before, but 70%-80% of the survivors have different degrees of functional impairment – motor, sensory, speech, swallowing, cognitive impairment, etc., which becomes a heavy burden for the family and society.  Neurological rehabilitation is a product of the specialization of rehabilitation treatment, mainly focusing on the rehabilitation assessment and rehabilitation treatment of motor and sensory dysfunctions caused by neurological diseases, with emphasis on stroke rehabilitation, traumatic brain injury rehabilitation, spinal cord rehabilitation, pediatric cerebral palsy rehabilitation, peripheral nerve injury rehabilitation, etc. The following is a brief introduction of common and self-preventable methods for hemiplegic patients: I. Rehabilitation of hemiplegic soft phase The soft phase is mainly about the placement of good limbs and passive activities to maintain good joint mobility.  Correct position: 1. Supine position: In order to maintain the correct supine position, three pillows should be used. One pillow should be placed under the head, but not too high, with the face facing the affected side; one pillow should be placed slightly higher than the trunk at the back of the shoulder to prevent the scapula from shrinking back and forth, so that the shoulder joint is in an external booth and the extended upper limb is placed on the pillow. The forearm is straight and rotated, the palm of the hand is up, the fingers are extended and spread; another pillow is used to prevent the affected side of the pelvis from retracting, and a pillow is placed under the affected pelvis and thighs to prevent the hip joint from abducting and rotating, so that the knee joint is in a mildly flexed position. 2. A pillow is placed under the upper limb of the affected side, so that the shoulder of the affected side is extended forward, the elbow joint is extended, the forearm is rotated forward, and the wrist joint is dorsally extended. The pelvis of the affected side is rotated forward and the hip joint is naturally placed in a semi-flexed position on the pillow. The affected foot and lower leg are kept in a vertical position as far as possible. 3. Reclining on the affected side: the affected side is on the bottom and the healthy side is on the top. The upper limb of the affected side is stretched forward so that the shoulder is forward, the upper arm is stretched forward to avoid compression and retraction of the shoulder joint, the elbow joint is extended, and the fingers are spread out with the palm up. The lower extremity on the healthy side is placed on the pillow with the hip and knee flexed forward, the hip on the affected side is slightly posteriorly extended, and the knee is flexed.  Maintain or change joint mobility through passive activities to prevent joint contracture. Before the patient is unable to do active exercises, passive exercises of the affected limb should be done twice a day or more until active movements are restored, with the order of activities from large to small joints, and the range of activities from small to large, with the ruler being fully stretched and slowly performed.  Rehabilitation of shoulder subluxation Glenohumeralsubluxation (GHS), also known as malaligned shoulder, is very common in patients with hemiplegia. GHS may be associated with shoulder pain in patients with hemiplegia, may be associated with brachial plexus injury, and is a sign of poor prognosis for the upper extremity. Shoulder subluxation does not appear immediately after hemiparesis, but is usually detected after the first few weeks of the disease when sitting and other activities begin. In the early stage, patients may not feel any discomfort, but some patients may experience pulling discomfort or pain when the affected upper limb is draped on the side of the body for a longer period of time, and these symptoms may be reduced or disappear when the upper limb is supported or lifted. With the prolongation of time, more intense shoulder pain may appear, and more patients with combined shoulder joint limitation than those without subluxation.  Stimulating the activity and tension of the stabilizing muscles around the shoulder and protecting the full range of painless passive mobility of the shoulder joint should be done without damaging the shoulder joint and its surrounding tissues. When moving the shoulder joint passively, the range of passive movement of the shoulder joint during the flaccid phase should be controlled at 50% of the normal mobility, and as the muscle strength increases, the joint mobility increases. Always keep in mind to strengthen the protection of the affected shoulder, never pull the affected upper limb to prevent aggravating the dislocation, causing shoulder pain and making treatment more difficult. Protecting the vulnerable shoulder joint during daily treatment must avoid causing pain during passive motion or other therapeutic activities, but also when helping the patient move in bed or transfer to a wheelchair. The entire treatment team must be aware of this potential hazard and be carefully instructed in positioning, helping the patient move, or performing activities of daily living to protect the shoulder joint, improve scapular girdle laxity, ease proximal control of the upper extremity, and inhibit distal spasm. It is also possible to prevent the aggravation of subluxation by using shoulder belt suspension.