I. CASE QUALITY 1. Patient Li Moumou Age 52 Gender Female The patient appeared unconscious after trauma on February 3, 2012, and was hospitalized in Brain Hospital, where he underwent craniotomy hematoma removal and debridement decompression surgery on February 25, 2012, and was treated for a fracture of the right clavicle. On April 3, 2012, he underwent internal fixation of right clavicle fracture. On May 15, 2012, the patient underwent titanium mesh repair of cranial defect, and was treated with brain cell metabolism, anti-infection, anti-epilepsy and symptomatic treatment. Now, the patient’s consciousness was clear, but he was still paralyzed on the right side of the limbs, and he came to our hospital for further treatment. His symptoms included unfavorable movement of the right side of the limbs, high flexor tone of the right upper limb, and inwardly retracted position of the thumb of the right hand. The right lower limb was in the state of abduction and external rotation, and the foot plantarflexion was in a mild inversion position. Speech was slurred, coughing from time to time, no choking on drinking water, frequent urination, stools were available. 2. The patient had epileptic seizures for about 3-5 minutes once every 30 days, and had periarthritis pain in the left shoulder joint with activity limitation. 3.CT shows left temporoparietal postoperative changes Postoperative head trauma Right clavicle fracture 4.Diagnosis Traumatic brain injury recovery 5.Patient intervened in the rehabilitation treatment for 3 and a half months after the injury. Rehabilitation evaluation at the time of admission 1. The modified Barthel index was assessed to be 30 points with severe functional defects. He could control his bowel movements, was occasionally incontinent, needed partial help with eating, needed two or one strong and skillful person to help him with transfers, and could move independently in a wheelchair. 2.Right upper limb flexor muscle tone improved Ashworth grading one plus grade, hand flexor muscle tone grade 2, thumb inward position, right lower limb muscle tone normal, right lower limb inner handpiece muscle tone grade 2, right lower limb flexor muscle strength MMT grading grade 2, extensor muscle grade 3. 3.Pain in right shoulder joint with limitation of joint mobility, pain and limitation of movement when passive forward flexion is at 60 degrees, pain and limitation of movement when passive abduction is at 40 degrees, pain and limitation of movement when passive internal and external rotation is at 20 degrees, pain and limitation of movement when passive internal and external rotation is at 20 degrees, pain and limitation of movement when passive internal and external rotation is at 20 degrees. Pain with limited motion at 20 degrees of passive external rotation, 40 degrees of passive abduction, and 20 degrees of passive internal and external rotation. The pain was graded at level 5 on a 10-point scale. The right side of the limb had normal superficial and deep sensation. 5. Ueda Min graded the right upper limb at grade 2, the right hand at grade 4, and the right lower limb at grade 4. 6. Active forward flexion of the shoulder joint of 20 degrees abduction and 20 internal and external rotation could not be completed. The hip joint of the right lower limb was unable to complete 30 degrees of forward flexion and 30 degrees of posterior body, 1 degree of adduction and 20 degrees of abduction, internal and external rotation could not be completed, knee flexion could not be completed, and ankle dorsiflexion was 5 degrees. 7. Turning over and sitting up could not be completed, transferring needed a lot of help from one person to complete, and standing up needed a lot of help from one person to complete. 8, the patient has complete aphasia. 3, condition analysis and rehabilitation treatment 1, the patient’s whole body more than one major joint activity is limited, to the left side of the upper limb shoulder joints lower limb ankle joints are more obvious, consider two causes, one is the patient’s post-injury treatment process, there is no limb passive activities, resulting in contracture of the soft tissues around the joints, the ductility decreases; the second is the patient’s craniocerebral injury, the upper motor neurons are damaged, resulting in muscle tone Secondly, after the craniocerebral injury, the upper motor neurons of the patient were damaged, resulting in increased muscle tone, which was not conducive to limb movement and further aggravated the contracture of soft tissues around the joints. For the above reasons, joint mobility training, soft tissue stretching technology, and facilitating technology are given as treatments; medication mainly uses drugs that nourish the nerves, improve cerebral circulation, and reduce muscle tone to improve the metabolism of brain cells and promote the recovery of injured brain cells. 2.Due to the damage of upper motor neuron after the injury, the patient’s muscle tone was elevated, with the right upper limb flexor muscle tone and finger flexor muscle tone elevated obviously, and the lower limb adductor muscle tone and Achilles tendon contracture obviously, coupled with the lack of passive activities and incorrect limb placement after the injury, resulting in the right limb in the state of mild contracture. To address the above causes, treatment was given with placement of the good limb position, right upper limb dystonia relief treatment, Bobath joint point control, and increase of right upper limb extensor muscle tone. Right hand dystonia relief treatment, hand splint wearing, hand rehabilitation application, ice water stimulation. Extension and relaxation of lower limb adductors, relaxation and extension of calf triceps, control of hip flexion extension and adduction abduction, strengthening of ankle dorsiflexion. 3, the patient due to post-injury paralysis of the right side of the limb plus the left shoulder joint with frozen shoulder with pain and activity limitation makes the patient turn over and sit up more difficult, for the above reasons, to give you the left shoulder joint pain treatment and expand the activities of the left shoulder joint treatment, treatment and acupuncture, intermediate frequency, ultrashort wave and exercise therapy. 4 transfer training, stand up training, stand up bed training, 4, stand and stand up in the balance bar and the affected lower limb weight bearing training, walking training. 5, speech training. 5.Speech training 4.Rehabilitation care 1.Positioning of good limbs 2.Turning over regularly 5.Rehabilitation efficacy 1.Modified Barthel index rating 80 points, eating needs partial help, dressing needs half help, going up and down the stairs needs help, bathing dependence, all other things can be done alone. 2.Right upper limbs modified AI, right upper limbs modified AI, right upper limbs modified AI, right upper limbs modified AI, right upper limbs modified AI, right upper limbs modified AI. 2.Right upper limb modified Ashworth grading flexor muscle first grade, hand flexor muscle tension one plus grade, right lower limb muscle tension is normal. 3, right shoulder joint activity pain with limitation, passive forward flexion 90 degrees abduction 80 degrees internal and external rotation 20 degrees pain, pain up to level 5, pain with 10 levels of grading method grading. 4.Right upper limb Ueda Min graded grade 6, hand grade 6, right lower limb grade 8. 5.Shoulder joint can be active forward flexion 90 degrees abduction 70 degrees back extension 20 degrees, elbow joint can be flexed 0—70 degrees range of independent completion. 6, turn over to sit up, transfer, stand up can be completed independently. 7. The patient can finish independently by himself/herself. 8, motor aphasia After treatment, the patient can repeat simple statements spontaneously. The patient was paralyzed on the right side of the body after the injury, and the pain in the right shoulder joint was accompanied by activity limitation. Frozen shoulder in the left shoulder joint was aggravated by the long-term braking state, resulting in activity limitation. In addition to comprehensive hemiplegic limb training, the patient was given comprehensive rehabilitation treatment 3.5 months after the injury, which improved blood circulation in the head and upper limbs of the affected side, maintained and expanded the mobility of the shoulder joints on both sides, thus relieving the pain symptoms to a greater extent in a short period of time and facilitating early hemiplegic limb functional training, so that the rehabilitative effect could be significantly improved. Comprehensive treatment of frozen shoulder in the left shoulder joint was also provided, thus improving the patient’s daily life activities.