I. Traumatic brain injury rehabilitation.
The rehabilitation treatment of traumatic brain injury is aimed at a comprehensive rehabilitation training for hemiplegia, limb dysfunction, mental retardation, speech disorder, swallowing disorder, malnutrition and epilepsy and other complications after traumatic brain injury to improve self-care ability, improve limb function, improve swallowing and speech function, and improve psychological adaptability. For different degrees of injury and disease duration, such as passive movement to promote wakefulness in vegetative state, improve joint movement, such as rehabilitation robot-assisted movement, weight reduction support system gait training, etc., so that patients can recover motor function and life self-care ability as early as possible and to the maximum extent, and improve patients’ psychological state, speech and cognitive function.
After the acute treatment (including open surgery, medication, etc.), the brain condition is stabilized, then timely rehabilitation of the sequelae of traumatic brain injury is required; the effects caused by traumatic brain injury are quite diverse, ranging from a vegetative state to nearly complete recovery, from tangible physical motor dysfunction to invisible behavioral cognitive abnormalities.
Professional rehabilitation is accomplished through the cooperation of a rehabilitation team. First, a traumatic brain injury rehabilitation physician assesses the patient in detail, draws up a rehabilitation goal for each case according to its different severity, sequelae and special needs, and then formulates a rehabilitation plan with the participation of physical therapists, occupational therapists, speech therapists, cognitive therapists, psychotherapists, social workers, etc. …and so on. Based on the rehabilitation goals, members of the rehabilitation team conduct separate assessments, discuss and adjust the rehabilitation goals and plans, and then carry out the relevant rehabilitation treatment.
We encourage the participation of patients and their families from the beginning to the end of the rehabilitation process, and we have created a round-the-clock rehabilitation. Whether it is the restoration of self-care or the rehabilitation of complex cognitive functions. Our patient, who is more like a student, is learning and improving every day. If a movement is taught during the day, there is homework to be applied when you return to the ward.
There is also a part of post-traumatic brain injury that is coma or vegetative state. For their rehabilitation, we can give various kinds of treatment methods with different sensory stimulation, from the traditional motor wake-up promotion, nerve stimulation wake-up promotion, to various kinds of sound and photoelectricity wake-up promotion, as well as acupuncture wake-up promotion, and we have had many cases of successful wake-up promotion in the late stage of vegetative patients. At the same time, we focus on the prevention of complications. Common complications include lung infection, urinary tract infection, bed sores, joint contracture, and we have standardized procedures, such as skin care and catheter care.
Second, the common problems of traumatic brain injury rehabilitation.
1.What are the sequelae after traumatic brain injury?
These sequelae are common after traumatic brain injury.
1. vegetative state, a state in which there is a lack of conscious activity and loss of language even after a period of severe traumatic brain injury, and only unconscious postural adjustment and motor functions are retained.
2, hemiplegia, also known as hemiplegia, is a motor impairment of one upper and lower limb, facial and lower tongue muscles, and it is one of the symptoms of the common sequelae of traumatic brain injury.
3, post-traumatic brain injury cognitive dysfunction, neurological dysfunction or psychogenic symptoms, including headache, hypersensitivity, irritability, concentration disorder, memory impairment, dizziness, insomnia, fatigue and other symptoms, also known as post-traumatic brain injury syndrome.
4, post-traumatic brain injury aphasia: loss of normal speaking ability and unclear speech.
5, post-traumatic brain injury epilepsy: post-traumatic epilepsy refers to epilepsy that occurs after traumatic brain injury.
2, can the hemiplegic limbs resume activities after traumatic brain injury?
After traumatic brain injury, due to partial brain tissue necrosis, its control of innervation-related limb sensory and motor impairment, due to the poor regeneration ability of brain tissue, it is generally believed that its control of limb sensory and motor recovery is poor. Through training, adjacent and homologous brain cells can develop and innervate to replace the function of necrotic brain cells and achieve partial functional recovery. Since the control of newly developed brain cells is relatively vague, under the guidance of therapists, dissociated movements can be generated and developed into functional movements, while inappropriate training can cause spasticity and affect functional activities. At present, there are many related training methods, most of which are ineffective. Through comprehensive developmental techniques such as sensory evoked stimulation, transcranial magnetic stimulation and rehabilitation robot, the neurodevelopmental ratio can be improved and partial function of the hemiplegic side can be restored.
3.Why does the hemiplegic side of the limb swell and what is the effect on the rehabilitation of traumatic brain injury?
On the one hand, when the limb is paralyzed, the muscles stop contracting because of the loss of innervation, so the squeezing pressure of the muscles on the veins also disappears, resulting in the obstruction of venous return. On the other hand, when the limb is paralyzed, the innervation is lost, so the diastolic function of the blood vessel is dysregulated, the contraction and diastolic response becomes sluggish, the venous blood return rate slows down, and the hemiplegic side of the limb will have a secondary nutritional metabolism disorder. As the blood does not return to the heart faster and the amount of blood stagnating in the veins increases, the pressure in the lumen of the veins increases and the fluid is easily squeezed outside the walls of the vessels and stagnates in the tissue spaces, resulting in swelling. In mild cases of limb swelling, by improving the conditions, making small blood vessels dilate and proliferate, and promoting lymphatic reflux, etc., so that venous blood can return to the heart as soon as possible, the edema will disappear quickly and will not produce greater harm. Otherwise, on the contrary, if the edema stays in the tissues for too long, the components of the blood will be deposited and turn into fibrous tissue. If this lesion occurs around a joint, joint stiffness and contracture can occur, so swelling of the limb should be treated aggressively.
First, a reasonable exercise program should be set, passive exercise with robotic passive functional exercise, biofeedback and other auxiliary exercises, local waxing and one-way pneumatic therapy, together with traditional medical treatment such as massage, herbal medicine and acupuncture on the affected limb. The treatment can achieve the effect of squeezing venous vessels, promote venous reflux, improve microcirculation and correct the nutritional metabolism disorder of the affected limb. In addition, bioelectric therapy, through the regulation of human microcirculation, to increase the regulation of water balance, so that the patient under the microcirculation, to achieve the subside of edema. Hyperbaric oxygen therapy also has a certain effect on edema reduction.
Secondly, we should pay attention to the elevation of the affected limb. When sitting, the forearm should be elevated with a brace or other support, or placed on the armrest of a chair. When lying down, the lower limb on the affected side should be padded 10-20 cm to reduce the effect of perfusion due to gravity and promote venous blood return to reduce the swelling of the affected limb.
4. Can traumatic brain injury patients do strength training?
The traditional concept of stroke rehabilitation is to avoid strength training of the affected limb in order to avoid worsening the abnormal muscle tone in patients with spasticity. However, recent studies have challenged this notion.
Most studies have shown that muscle strength impairment in patients with traumatic brain injury is dominated by a slowing of muscle contraction and that the main cause of spasticity is inadequate active muscle strength rather than excessive contraction of antagonistic muscles. Therefore, reasonable muscle training did not aggravate the motor control disorder. After reasonably designed target movements, selection of appropriate assistive devices and application of upper limb rehabilitation robot training, the speed of muscle contraction is accelerated and the development of inferior muscle groups is promoted, which makes muscle control and activity speed increase, and postural movements, which also need muscle strength and muscle control to achieve, generally speaking, the determining biomechanical factors of maximum gait speed after 4 weeks are changed from Generally, the biomechanical determinants of maximum stride speed after 4 weeks are converted from postural control and weight transfer to knee extension muscle strength, and therefore knee extension muscle strength training is required. Early strength training can improve muscle strength and correspondingly improve function for rehabilitation purposes.
Walking training with partial weight reduction support uses a computer-controlled body suspension device to reduce the load of the patient’s body weight on the lower extremity and then perform walking training. The outstanding advantage is to avoid excessive body load affecting the patient’s walking and mentality. It achieves gradual progress and avoids bad posture, which is more effective than traditional exercise.
In addition, for trunk instability, performing trunk muscle control has attracted attention in recent years. Through trunk core muscle training, trunk control can be strengthened and the improvement of physical function can be enhanced, which especially helps to improve balance.
5.What is the role of occupational therapy in the rehabilitation of traumatic brain injury?
For the physical and psychological barriers that exist after traumatic brain injury, occupational activities can help patients rebuild their confidence and make them willing to engage in life activities. Occupational therapy enables patients to gain a sense of victory and lay the foundation for social reintegration.
Through life state restructuring, patients adapt to their mid- to long-term dysfunction and re-establish their life patterns.
Through a series of training and simulation, patients can adapt to life, work and society as soon as possible.
6.What training should be done for self-care of traumatic brain injury
Self-care is simply to have the self-care of daily living, the use of basic tools and the self-care of activities outside. Due to physiological and psychological dysfunction, patients with traumatic brain injury are often unable to take care of themselves for simple actions such as eating, dressing, sleeping, turning over, going to the toilet and bathing, not to mention daily activities such as going shopping.
Through assessment, according to the patient’s own needs, using the homework activity itself as the training treatment means, together with the corresponding auxiliary apparatus, and tapping into the patient’s residual functions, the traumatic brain injury patient can be made to complete these movements independently or with little help, and achieve self-care or partial self-care.
The center has a home simulation area, covering the bedroom, toilet, washroom and kitchen simulation areas of daily life, so that patients with traumatic brain injury can adapt to home and family life as soon as possible. The center is also equipped with an advanced life simulation area, which uses modern sound and light technology and robotic rehabilitation simulation technology to simulate community scenarios so that patients can adapt to community life as soon as possible. The center also organizes indoor and outdoor field simulations to enable patients to return to society as soon as possible.
7.What is the wake-up promotion for vegetative patients?
It is not as simple as advertised to promote the awakening of a vegetative person, which can be achieved by using acupuncture means. The center uses advanced modern equipment and the existing stimulation means to achieve the wakefulness of the vegetative person. We use hyperbaric oxygen and drugs to promote brain cell recovery, transcranial magnetic stimulation and peripheral nerve stimulation under stereotactic positioning to promote awakening, robot-assisted movement therapy to promote awakening through proprioception while maintaining joint mobility, and acupuncture and medication to promote awakening through traditional medicine to activate the meridians and needles. There are also music therapy, speech to promote awakening, auditory and visual stimulation such as lighting, sensory training to promote awakening, etc.
8.What is the role of cognitive rehabilitation?
Early cognitive training can improve patients’ cognitive ability, increase interest and participation in rehabilitation, promote recovery of somatomotor function and psychological rehabilitation, enhance self-care ability in daily life, and reduce the occurrence of dementia after traumatic brain injury.
9.What is the application of rehabilitation robot in traumatic brain injury?
The rehabilitation robot is a new type of robot that can produce purposeful movements, and can be used to simulate activity training for hemiplegic patients, and its training effect is significantly better than conventional rehabilitation treatment.