Stroke, commonly known as stroke, is a general term for a group of vascular diseases of the brain caused by a variety of different etiologies, also known as cerebrovascular accidents. Strokes can be divided into two categories: hemorrhagic (cerebral hemorrhage, subarachnoid hemorrhage) and ischemic (transient ischemic attack, cerebral thrombosis and cerebral embolism).
Cerebral hemorrhage accounts for 20% to 30% of all strokes, and refers to spontaneous hemorrhage caused by rupture of blood vessels in the brain parenchyma due to non-trauma. The cause of occurrence is mainly related to lesions of cerebral blood vessels, the majority of which are caused by rupture of small atherosclerotic vessels due to hypertension, and also occur due to rupture caused by congenital vascular malformation, etc.
1.What are the common sequelae after cerebral hemorrhage?
Most of the survivors have different degrees of dysfunction, including consciousness (drowsiness, coma, blurred consciousness, vegetative state, etc.), motor dysfunction (hemiparesis, balance dysfunction, abnormal walking function, etc.), sensory dysfunction (limb sensory loss, numbness, pain, etc.), speech dysfunction, swallowing dysfunction, diaphoresis, cognitive and mental disorders and facial palsy, which eventually lead to impairment of daily living ability.
2. What is the difference between early and late treatment of cerebral hemorrhage sequelae?
The rehabilitation treatment after cerebral hemorrhage should be carried out as early as possible according to the condition. Generally speaking, as long as the brain hemorrhage patient is clear, the vital signs are stable (temperature, blood pressure, pulse and respiration), and the neurological deficits no longer develop, early rehabilitation treatment is required after 48 hours. Within six months after the onset of cerebral hemorrhage, especially within the first three months, is the best period for functional recovery, which should not be neglected. Early rehabilitation during this period can minimize the impact of functional impairment on normal life if reasonable methods are applied. If you do not pay attention to the early rehabilitation treatment within the first 3 months, the motor function of the limbs may show abnormal patterns, and misuse syndrome or disuse syndrome may appear. Once these syndromes are formed and then intervened and corrected, it will not only require a long course of treatment, but also the effect of treatment is not good, which will cause pain and burden to the patients and their families.
3.What treatments are available to completely improve the sequelae of patients with cerebral hemorrhage that occurred within 3 months?
Brain hemorrhage is a central nervous system injury, and brain nerves cannot be regenerated after damage, so the treatment of brain hemorrhage sequelae is not a simple process of damage re-repair, but a more complicated re-repair process. Since human brain tissue has a strong ability of functional remodeling, the rehabilitation treatment after brain hemorrhage is to promote the functional remodeling of brain tissue to the maximum extent through reasonable and comprehensive training to reduce the impact of sequelae on life. In order to obtain good functional recovery, it is necessary to pass effective rehabilitation training after the condition is stabilized, so that patients can continuously strengthen learning, exercise, re-learning and re-exercising under the correct guidance of rehabilitation physicians and rehabilitation therapists in a continuous cycle, thus promoting the reorganization of brain tissue function, strengthening residual function and enhancing compensatory capacity to achieve good rehabilitation results.
The current rehabilitation treatment programs mainly include: training to improve motor function – exercise therapy, comprehensive training for hemiplegic limbs, balance function training, etc., speech training to improve speech function, swallowing training to improve swallowing function, cognitive training to improve cognitive function, and occupational therapy to improve daily living ability, etc. These rehabilitation treatments should preferably be carried out under the guidance of professional rehabilitation therapists, including physical therapists, occupational therapists and speech therapists, as well as professional rehabilitation equipment, so as to achieve better results.
4.How to treat the sequelae of cerebral hemorrhage in the early stage?
Rehabilitation after cerebral hemorrhage is mainly divided into three stages, the soft paralysis period, the recovery period and the sequelae period. The early stage is generally referred to as the soft paralysis stage, which is about 1 month after the onset of the disease. The rehabilitation treatment in this period is mainly carried out in neurology, neurosurgery or ICU wards, and early bedside rehabilitation is emphasized along with the administration of medication.
The purpose of rehabilitation treatment during this period is to prevent and treat possible complications, promote the recovery of muscle tone and the emergence of active activities, prevent the wasting state caused by long-term bed rest, help patients to move early and create good conditions for later functional training.
The content of rehabilitation treatment includes prevention of complications: regular turning (generally every 2 hours) or use of turning beds, alternating inflatable mattresses and other measures to prevent pressure sores; correct position placement: to avoid joint subluxation and soft tissue damage around joints, or even joint contracture due to prolonged abnormal position, which may adversely affect the patient’s later rehabilitation; breathing exercises: to keep the airway open and prevent respiratory tract This is one of the most basic trunk function training. Patients should learn to turn over to both sides as early as possible to avoid complications due to long-term fixation in one posture; maintain and improve joint range of motion: for patients in the soft palsy stage, passive activities of limbs should be carried out as early as possible to promote blood circulation and increase sensory input. At the same time, swallowing training can be performed at the bedside; low-frequency electrical stimulation induces contraction of innervated muscles to prevent muscle atrophy; pneumatic therapy prevents deep vein thrombosis in the limbs; shoulder joint protection orthosis prevents shoulder joint subluxation. When the patient’s strength has recovered, standing bed training can be carried out to help the patient increase the muscle strength and stability of the lower limbs, as well as sitting balance training to improve the patient’s balance function.
5.What functional exercises are available for patients with sequelae of cerebral hemorrhage within 3 months?
Generally, the recovery period is from the beginning of the second month to the end of the third month after the onset of cerebral hemorrhage, and the rehabilitation during this period is also called secondary rehabilitation, which is mainly carried out in secondary rehabilitation hospitals or rehabilitation centers.
The goal of this period is to restore or improve the patient’s motor ability to the maximum extent possible, including restoring normal muscle tone, inducing active and random movements, improving coordination of joints, improving sitting and standing balance, improving walking ability, improving fine hand function; improving cognition, speech, swallowing and other functions. We also prevent possible comorbidities such as shoulder subluxation, shoulder-hand syndrome, and joint stiffness.
In addition to continuing the treatment of delayed paralysis, the rehabilitation treatment will focus on the following: suppression of spasticity through passive stretching and postural control; strengthening of motor function training on the affected side, including muscle strength, coordination and stability training; balance training; walking training; occupational therapy, such as throwing and catching balls, inserting sticks and other playful training; speech function training, cognitive function training and swallowing function training, etc.
6.Is there any medication or surgery that can be used for the treatment of patients with sequelae of cerebral hemorrhage in the middle and late stages?
According to the current research results, drugs and surgery are not effective for patients with sequelae of cerebral hemorrhage in the middle and late stages. It is recommended that the primary disease, such as hypertension and hyperlipidemia, should be controlled with medications, and that medication and surgery should not be considered too much for patients with advanced cerebral hemorrhage. Patients with intermediate to advanced cerebral hemorrhage should enhance limb function or improve the ability to utilize existing limb function through rehabilitation training to improve patients’ activities of daily living and work ability.
7.What are the rehabilitation modalities that can improve the limb motor function for patients with the sequelae of cerebral hemorrhage in the middle and late stages?
The recovery of patients with cerebral hemorrhage is faster and more effective in the first few months, and most of the functions become slower after 6 months. If the limb functions are not fully recovered in more than 1 year, there will be different degrees of sequelae and the disuse of the limbs. Although the function of the hemiplegic limb cannot be recovered, it does not mean that the patient cannot recover.
The main rehabilitation treatments that can be carried out for patients in the middle and late stages are.
(1) Continue the various rehabilitation training in the recovery period to further improve the function or prevent the loss of function.
(2) Make full use of the residual function, and for those who have poor functional recovery, focus on the compensatory function of the healthy limb to strive for self-care in daily life to the maximum extent.
(3) Use the necessary assistive devices (such as canes, walkers, wheelchairs, braces) to compensate for the function of the affected limb at the appropriate time.
(4) If possible, make necessary modifications to the home and living community environment to improve the patient’s surroundings as much as possible to accommodate the disability.
(5) For patients with work potential who have not yet retired, provide vocational rehabilitation training as appropriate so that patients can return to society as much as possible.
(6) Pay attention to vocational, social and psychological rehabilitation.
8.Can acupuncture and botulinum toxin treatment improve the motor function of limbs? For what period of cerebral hemorrhage patients is it effective?
Acupuncture has a history of several thousand years in China, and is a very important treatment method for cerebral hemorrhage, running through all stages of the development of the disease and summarizing many useful experiences. At present, acupuncture is used to treat cerebral hemorrhage and its sequelae not only in China but also in many countries around the world. Acupuncture can adjust the yin and yang of the whole body, regulate the function of the internal organs and meridians, and achieve the effect of waking up the brain and opening up the meridians. Modern research proves that acupuncture can improve brain energy metabolism, reduce inflammatory response, reduce brain nerve damage, improve cerebral vascular diastolic function, and play a role in brain protection and nerve repair. Acupuncture intervention is feasible after the patient’s vital signs are stable, there is no new bleeding, and the condition is stable if there are no other contraindications. Early acupuncture interventions generally do not require changing the patient’s position, and the intensity of acupuncture should be low. Acupuncture interventions can be performed at different stages of the patient’s recovery, and generally within 2 years of the disease, acupuncture interventions will be helpful to the patient’s recovery.
Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum. It mainly inhibits the release of acetylcholine from nerve endings, causing muscle relaxation and paralysis. Therefore, for patients with cerebral hemorrhage, botulinum toxin can relieve abnormally increased muscle tone, and if there is no increased muscle tone, botulinum toxin injection treatment is not necessary. Generally, the effect of botulinum toxin lasts from 3 months to 6 months. Immediately after the injection, the patient should start a systematic rehabilitation, especially retraction training, to obtain a better treatment effect. Botulinum toxin is mainly used for patients in the spastic phase. Some patients in the posterior phase may also be treated with Botulinum toxin as appropriate due to excessive muscle tone that causes stiffness or pain in the limbs.