I Early recovery.
Patients in this stage generally show delayed paralysis, no random muscle contraction, and no joint reaction, and the organism is basically in a state of total relaxation; 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, and limited joint movement; to strive for early functional improvement and prevent complications. Zhang Tingfeng, Rehabilitation Center, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
(II) 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 exercises: hands crossed in front of the flat, respectively, to both sides of the rotation, feet propped up in bed.
3 bedside self-assisted exercises: hands crossed in front of the flat, overhead, lateral lift, finger nose, legs bent to support the bed to lift the buttocks, feet crossed lateral shift, 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 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: require patients to inhale deeply – slow exhale, relax.
12.Sitting training: Before the head of the bed is raised up to 90 degrees, first train the patient to lift the head and shoulders with one hand support behind the side 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 in front of the flat, side, crossed hands pointing to the nose, crossed hands pointing to the front; lower limb muscle strength training on the healthy side, 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, with auxiliary strength depending on the condition; patients with cerebral hemorrhage should try to reach bedside sitting within two weeks and standing within four weeks.
17.Do the activities of daily living with healthy hands: eating, dressing, washing, etc.
18.Apply electrical stimulation: low frequency DC stimulation, TENS, etc.
19.Application of myoelectric feedback technology.
20.Application of tui na acupuncture treatment.
21.Application of cerebral circulation therapy to promote cerebral blood circulation.
22.Speech therapy.
23.Psychotherapy.
(iii) Rehabilitation arrangement.
Instruct patients and family members to complete 1, 2, 3, 8, 9, 10, 11, 17 several times a day; 4, 5, 6, 7, 12, 13, 14, 15 must be completed by the therapist once a day for 45 minutes each time; 18, 19, 20, 21, 22 can be determined by each unit to carry out or not; 23, 24 if no professional this training, the therapist in the process of functional training In the process of functional training, therapists should conduct simple language training, including simple vocal exercises, and be responsible for the psychological guidance of patients so that they can cooperate as much as possible and carry out rehabilitation treatment in the best condition.
Mid-term rehabilitation
At this stage, the patient can obviously show the flexor synergistic movement of the upper limbs and extensor synergistic movement of the lower limbs, and gradually achieve independent movement of some muscles and joints, which is 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.
(2) Medium-term rehabilitation methods.
From passive to assistive to active
24. Inhibit the spasticity pattern of the upper limbs.
25.Stretching the trunk to promote and improve trunk mobility, inhibit trunk tension and spasticity.
26.Hold the knee with both hands and lightly the body from left to right to control the spasm of upper and lower limbs.
27.Flexion of the shoulder joint down with the affected hand touching the therapist’s hand and then touching his own forehead, and then touching his opposite shoulder to train the elbow joint random flexion and extension function.
28.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.
29.Autonomous movements of the shoulder joint in all directions: anterior shoulder planks, shoulder abduction, and shoulder external rotation.
30.Autonomous movements of the elbow joint in all directions: elbow, extension, forearm rotation.
31.Autonomous movements of the wrist and fingers: wrist dorsiflexion, lateral deviation, thumb abduction, opposite fingers, etc.
32.Activities of shoulder girdle: upward, outward, downward.
33.Bridge movement training hip extension control.
34.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.
35.Knee flexion and extension control training.
36.Flexion-extension control training of the knee joint in hip extension position.
37.Patient draped position training lower limb preparation for weight-bearing exercise.
38.Flexion of the affected knee in the prone position training.
Sitting position.
39.Support training of the upper limb on the affected side.
40.Small range of flexion and extension of the elbow joint under the affected upper limb.
41.Pushing objects forward with the affected hand or picking up objects with crossed hands.
42.Pushing objects with the back of the hand.
43.Rotating forearm to press play-doh.
44.Flexion of the lower limb on the affected side.
45.Pick up small objects with fingers (over the midline).
46.Muscle strength training of the lower limb on the healthy side.
47.Flexion and extension knee exercise of the affected lower limb.
Standing position.
48.Standing balance training: shift the center of gravity left and right back and forth.
49.Standing balance exercises: crossed hands (depending on the situation) front planks over the head, front planks after the torso left and right rotation, etc.
50.Sit and stand control training, and decomposition exercises.
51.Do elbow flexion and extension exercises to promote elbow extension or independent support of the affected hand by supporting the wall with both hands.
52.Standing with the legs in front and behind, shifting the weight in order to flex and extend the affected knee in a small range.
53: Flex the knee in hip extension position.
54.Bend the hip and knee in preparation for stepping.
55.Internal abduction, adduction and lowering pelvic training of the affected lower extremity.
56.Stand on one leg separately with support.
57.Low stride training to control the pelvis up and down for stride.
58.Footёno scarcity theft II?
59.Walking training within the double bar (three points): the upper limb on the healthy side holds the bar forward -> then the lower limb on the affected side follows – then the lower limb on the healthy side takes a step forward.
60, walking training with crutches (three points, two points): the able-bodied hand holding the crutches forward – the affected lower limb to step forward – the able-bodied foot to follow.
61, up and down the stairs: up / healthy hand support – healthy side of the lower limb – the affected side of the lower limb
Down/healthy hand support – the affected lower limb – the healthy side of the lower limb
62. Bedside ADL training: Washing, dressing and undressing, and bowel handling, etc.
(III) Rehabilitation arrangement: The above items basically need therapists’ 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 in the afternoon to guide family members to practice.
(D) Precautions
All joints should be kept at maximum joint range of motion, and treatment should be within the range of painlessness 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: In this period, the patient can use the affected limb to a large extent, which is 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, increase 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
63.Finger fine motor strengthening training
64.Lateral walking training 7 first to the healthy side and then to the back side
65.Gait improvement training: pelvis relaxation, knee flexion strengthening training
66.Gait improvement training: ankle dorsiflexion and stretching
67.Promote the lower limb support ability of the affected side: standing position, the healthy leg in front, the affected leg in the back, instruct the weight to shift forward, the affected foot heel cannot leave the ground.
68.Promote the lower limb support ability on the affected side, with the affected limb bearing weight and the healthy limb stepping forward and backward.
69.Do crossover exercises in standing position with both feet in turn.
70.Family ADL guidance.
71. Modification of living room.
(iii) The rehabilitation arrangement is the same as the previous phase.
This period of training is mainly assisted by community rehabilitation doctors and family members and volunteers, 3-4 times a week. Follow up at home or outpatient once every two weeks.
(iv) About the use of assistive devices.
72.Foot brace – foot drop
73.Wrist dorsal extension splint–flexion wrist spasm.
74.Crutches, walking aid.
75.Wheelchair.
(V) Training on family members and volunteers.
Training once every 2 weeks, by the rehabilitation therapist at home or family members to the hospital, training content for the patient’s home training program methods, require the patient’s family and volunteers to record the training content once every 2 weeks.
(vi) On the recording of rehabilitation treatment.
The therapist is required to record once a week in the early stage, and once every 2 weeks after the second month of the disease. The records should include: the patient’s functional status, the current stage of the problem; the current stage of the rehabilitation purpose; the current stage of the treatment content, which can be filled in with the aforementioned content numbers, and can be filled in other columns if there are additions.