Myths of late stroke rehabilitation

  Post-stroke rehabilitation myths: Myth 1: Expect a panacea.  Many stroke patients fantasize that there is a magic pill that they can take to get better, but unfortunately, medical technology does not yet have such a pill. Any idea of recovery by virtue of a “magic pill” is undesirable and impossible.  In fact, one of the most important tasks after a stroke is to strengthen rehabilitation exercises, including training in motor function, speech, swallowing and self-care. Only with hard training and strong perseverance can stroke patients recover and achieve self-care and return to their families and society as soon as possible.  Myth 2: It is better to stay still and not move during the acute bed rest period.  Acute stroke rehabilitation is an important part of the stroke treatment unit, but is often neglected by clinicians and families, focusing on drug therapy and emphasizing rest and immobility. This can lead to so many clinical complications, such as lung infections, pressure sores, shoulder pain, joint contractures, and venous thrombosis of the lower extremities, which seriously affect the prognosis of rehabilitation.  In fact, even comatose patients with massive cerebral hemorrhage, severe cerebral infarction and hemiplegia combined with severe pulmonary infection can undergo rehabilitation treatment such as good limb placement, passive position change and passive joint movement for hemiplegia to prevent decubitus ulcers, avoid or reduce the occurrence of future spasms and eliminate the possibility of “disuse syndrome”. This will greatly shorten the hospital stay and reduce the cost of treatment. This will lay a good foundation for comprehensive functional rehabilitation in the future.  Misconception 3: Rehabilitation is a late stage task and is optional.  Some doctors and patients do not know enough about rehabilitation and think that rehabilitation is a late work and optional.  In fact, it is advisable to start rehabilitation of hemiplegia as early as possible. After the patient’s vital signs (such as respiration, blood pressure, pulse, pupil changes, etc.) are stable and neurological symptoms no longer develop for 48h, generally speaking, 2-3d after the onset of cerebral infarction, and cerebral hemorrhage can be slightly delayed to about 7-10d, early, scientific and reasonable bedside rehabilitation can and should be carried out for the patient in a gradual manner while the neurosurgical ward is being treated with drugs. Treatment.  Myth 4: Over-reliance on doctors or family members and excessive passive treatment.  Some patients become sensitive and vulnerable after the disease, manifesting themselves as over-dependence on doctors and family members and lack of initiative in rehabilitation training, believing that doctors’ manipulation, acupuncture or family massage is the treatment and their own active training is useless. In fact, for stroke patients, active training is ten times stronger than passive treatment. The current principle of rehabilitation is early, intensive, active rehabilitation.  Myth 5: Not focusing on basic movement training and forcing to practice walking or climbing stairs.  Some patients and family members are anxious, and when the affected limb is slightly mobile, they are eager to get started and can’t wait to start intensive training in walking or stair climbing with a few people holding and pulling them.  In fact, the patient’s mood is understandable, but the method is not desirable. If you don’t pay attention to the basic movement training and ignore the stage of the patient’s movement pattern, forcing walking or stair climbing will easily damage the knee joint and cause pain, and will easily lead to foot drop and inversion, resulting in hemiplegic gait and abnormal walking pattern, which will stall the subsequent rehabilitation.  Myth 6: Rehabilitation is a doctor’s job and has little to do with family members.  Many patients’ families mistakenly believe that rehabilitation is the doctor’s business, and as long as the patient receives treatment in the hospital, everything will be fine, and it has little to do with them.  In fact, in the rehabilitation process of hemiplegic patients, the family or family members play a very important role. On the one hand, the warmth of the family, the affection of the family and the supervision of the training are the most powerful support for the hemiplegic patient to overcome the disability; on the other hand, the training of the hemiplegic patient’s daily living ability, such as dressing, eating and toileting, is not only feasible but also very effective in the family. It can be said that whether a hemiplegic can return to his family and reintegrate into society depends largely on the quality of the family’s support for the continued rehabilitation of the hemiplegic.  Misconception 7: Only the rehabilitation treatment in the hospital is important, but the rehabilitation actions are not implemented in daily life.  After all, the time for rehabilitation in the hospital is limited, and the recovery process of dysfunction is slow, requiring a long period of repeated training and stimulation before the function can be restored to a considerable degree. The only way to solve this contradiction is to rely on the patient to implement rehabilitation training actions in daily life and form habits, in order to speed up and consolidate the rehabilitation effect.  Myth 8: There is no rule for the recovery of the affected limb.  Generally speaking, the recovery of motor function of hemiplegic patients is relatively faster with the recovery of head, trunk and large joints, and the recovery of motor function of lower limbs is earlier than the recovery of motor function of upper limbs. The recovery of motor function of the limbs occurs in the order of proximal then distal. For example, the recovery of motor function of the upper extremity is generally preceded by the recovery of shoulder joint activity, and gradually the elbow and wrist joints recover, while the recovery of finger function is relatively slow, with the thumb recovering the slowest. Of course, sometimes the order of hemiplegic limb function recovery may change due to the specificity of hemiplegic lesions and other reasons.