Movement is produced by a combination of the motor system and the control system. Damage to either of these factors can lead to motor dysfunction. What results from an injury to the higher central nervous system is not only a decrease in muscle strength, but more importantly, changes in muscle tone, abnormalities in posture and movement patterns. Through awareness, we can better understand and learn the correct training method, avoid wrong training, so that the function can be restored in time.
I. Joint reaction Zou Zhihong, Department of Acupuncture and Moxibustion, Shenzhen Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine
It refers to the contraction of one part of the body muscles when force is exerted, which can cause the contraction of other parts of the muscles. For example, when the patient’s healthy hand holds something with force, it can cause the spasm of the affected limb to increase. Therefore, patients should avoid the occurrence of joint reactions caused by excessive force on any part of the body during training.
Second, joint movement
An unsuitable random movement induced when the patient wants to complete an activity. For example, when the patient tries to lift the affected upper limb, there will be scapular elevation and retraction, shoulder abduction and external rotation, elbow flexion, forearm rotation, wrist flexion, and thumb flexion and internal retraction. Therefore, the training of the affected limb strength will greatly aggravate the common movement of the affected limb, which will eventually lead to spasm or even contracture deformity of the affected limb.
Third, the nervous reflex
It is a reaction that the human body establishes and improves continuously during the development process to maintain body balance. Tension reflexes in daily life are automatic, coordinated and integrated with each other, so it is not easy for us to notice. However, after a brain injury, these reflexes become apparent and affect the patient’s activities. For example, when the patient is in supine position, the spasm of the extensor muscles increases, especially in the lower limbs and scapulae. Therefore, the patient should not lie in the supine position for too long.
When the patient is in semi-recumbent position, the head and trunk are flexed, which increases the tension of the extensor muscles of the affected leg and the flexor muscles of the affected upper limb. This is a very wrong position and should be avoided!
IV. Abnormal muscle tone
The resistance felt when the patient is given the limb to move is called abnormal muscle tone. When the muscle tone is too low to support the body to resist gravity and move; when the muscle tone is too high or spastic, the patient can only move according to the abnormal pattern even if he spends a lot of effort. The majority of patients have varying degrees of increased muscle tone, except in the soft paralysis stage. Creating a comfortable living environment for the patient and keeping him/her in a good frame of mind are good for the patient to recover normal muscle tone.
V. Specific posture
The patient often shows a typical spasticity pattern when standing.
Head: flexion to the affected side and rotation to the healthy side.
Upper extremity: scapula retraction, shoulder girdle drop, shoulder joint inversion and internal rotation, elbow flexion, forearm rotation forward, wrist flexion, finger flexion and internal rotation.
Trunk: flexion and posterior rotation to the affected side.
Lower extremities: pelvis rotates and lifts up on the affected side, hip extends and internally rotates, knee extends, foot plantar flexes and internally rotates, toes flexes and internally retracts.