Walking training for super-early hemiplegic patients Clinically, gait training has the following requirements: 1, the affected limb can bear weight to reach more than 2/3 of the body weight; 2, dynamic balance of more than 3 levels; 3, the affected limb should have the function of active knee flexion and extension, hip flexion and extension. Weight reduction training for hemiplegic patients is not favored because weight bearing can stimulate the contraction of the lower limb anti-gravity muscles and improve proprioception on the affected side. Weight reduction training is detrimental to weight bearing and center of gravity transfer on the affected side, if weight bearing is not enough, weight bearing exercises can be done first. As to whether walking training is early or late, there is still a big controversy, I think that early training, first let the patient walk up, and then correct and train the hip flexion, ankle dorsiflexion and other functions, of course, this requires a certain amount of technology and knowledge as a backing. As for when the patient can be trained to walk, it mainly depends on the weight-bearing capacity of the affected side, generally speaking, if the affected side of the single-legged weight-bearing can last for more than 3min (within the double bar, the affected side of the knee joint is slightly flexed, the healthy side can be placed on a 20cm table, and the healthy hand can be a small amount of help), then the training can be started. Weight reduction training has been widely used in rehabilitation medicine in the clinical application of research. Weight reduction can reduce the load of upper body weight on the lower limbs to different degrees. In theory, it is beneficial to the early walking training of patients with insufficient support ability. Its benefits are: 1, conducive to improving and increasing the range of motion of the lower limb joints, the distribution of the center of gravity of the body tends to be symmetrical, thus improving the stability of the patient’s walking; 2, conducive to the patient’s early out-of-bed activities, although the patient’s lower limb muscle strength is less than 3; 3, conducive to the improvement of the speed of the walk, because after the weight reduction plate training, the extension range of the affected side of the hip joints increases, and the stride length is correspondingly increased; 4, conducive to promoting the recovery of normal gait, and improving walking ability. Normal gait recovery, improve walking ability, avoid and alleviate the lower extremity extensor muscle synergistic movement abnormal pattern, foot drop, inversion and other pathological gait; 5, is conducive to improving patient safety (under the protection of the weight reduction device), eliminating the patient’s nervousness and fear of walking, and better cooperate with the therapist’s treatment, and at the same time to help the gait training of the therapist reduced from 2 to 1 person. Traditional rehabilitation therapy has used weight reduction for early walking training, such as using the buoyancy of water for water walking, and utilizing various types of crutches or walkers to reduce lower limb weight bearing. It is PWS that targets stroke patients without walking ability with early walking training, which is often clinically effective. It has been found that PWS can result in improved walking symmetry, improved extension of the swing phase of the hip joint, increased excitation of the anti-gravity muscles, and increased activity of the biceps femoris, while decreasing the activity of the anterior tibialis muscle on the non-involved side. If PWS is combined with functional electrical stimulation, gait training in stroke patients can be further improved. CONCEPT OF GRAVITY-RESISTANT MUSCLES: Gravity-resistant and non-gravity-resistant muscles should be categorized according to whether the main function is to maintain posture or not. In general the extensor muscles contain a large number of slow muscle fibers and are the main gravity resisting muscles. However, some animals, such as monkeys, due to hanging from trees for a long time, their biceps brachii muscles become anti-gravity muscles for maintaining posture, and the semi-flexed state of the upper limb is a manifestation of increased muscle tension. After the human body walks upright, the upper limb biceps brachii muscle (flexor) becomes the key muscle to complete the operation of anti-gravity, so it should be anti-gravity muscle; for the lower limbs, gluteus maximus (the main role is to make the hip has been flexed straight, still have to make the external rotation of the thigh), quadriceps femoris muscle (the main role of the extension of the knee), the calf triceps muscle is also an anti-gravity muscle, in the gravitational environment, they are mainly to perform anti-gravity to maintain the posture of the function. 1, premature walking, aggravate the spasm of the upper limb, should fully consider the function of the upper limb, especially after the hand function, in the discussion of this issue. Lower extremity function recovery is much easier than upper extremity. 2, every lower limb training movements such as prone position knee flexion on the bed, itself is the basic action of walking training, because the function of the human lower limb is to walk, stand. So every therapist is doing the basic training of walking from the very beginning. It’s just not getting the patient to walk. 3, Everyone should clear that pt is not the same as lower extremity. When to really let the patient walk up, but also to see how the upper limb and lower limb separation. It should be analyzed on a case-by-case basis and there is no formula. For hemiplegic patients when to start practicing walking should be analyzed on a case-by-case basis: 1, if the patient’s disease duration is relatively short, the functional status and motor control can still be, and the response to the rehabilitation treatment is also very good (progress is relatively fast) patients, in the treatment of the patient should be normal or close to the normal gait walking as a long-term goal, for such patients should be trained step by step, I do not encourage them to I do not encourage them to walk too early, at least to achieve the affected side can load 3/4 of the weight, have a certain degree of dynamic balance (the healthy leg can step freely in all directions when the affected side loads the weight), the affected side can step forward with relative ease (of course, hip flexion, knee flexion does not have to be very full, ankle dorsiflexion can not be recommended as early as possible to use the AFO), if you do not reach the above indicators or to the pad of the basic training, balance training, weight-bearing training and pre-striding of the affected side. If the above indexes are not reached, the basic training on the mat, balance training, weight-bearing training on the affected side and preparation training before taking a step are the main focuses, and then start to contact walking and gait correction when the indexes are reached. If the patient’s functional condition is poor, such as persistent hypotonia, persistent severe spasticity, persistent balance dysfunction, etc., the so-called 3 principles cannot be used for such patients. If the principle of 3 is applied to such a patient, he may not be able to walk in his lifetime. Compensatory measures should be taken as early as possible for such patients, such as using crutches, adopting special walking methods, etc. No matter what methods are used, the most important thing is to let the patient be able to walk first, and then we can talk about gait problems on this basis, which may be more consistent with the reality. Of course, the problems encountered in the clinic are specific and complex, and the above is only a little bit of my own opinion, for your reference only. But one thing is certain, any patient should be carefully examined and evaluated first, and then according to the specific circumstances of the patient to determine a suitable goal (the formulation of the goal should not only take into account the condition of the patient, but also take into account the patient’s needs, the family’s economic conditions and other factors), and then the therapist and the patient to formulate a rehabilitation plan around the rehabilitation goal and according to the plan and work together to achieve the desired goal as soon as possible. We suggest the following sequence: 1, train the patient’s single and double-legged weight-bearing; 2, balance training: static, automatic; 3, training standing position flexion and extension of the hip, knee, ankle, as well as hip abduction; 4, pelvic control; 5, simple walking training; 6, daily life in the walk I suggest walking training as early as possible, if the patient due to physical weakness, and there is no desire not to do so, you can consider practicing in front of the ribbed wood to practice sitting up with a healthy hand to grip the ribbed wood. If the patient is weak and has no desire to walk, he can practice sitting up by grasping the rib cage with the healthy hand. If the trunk function improves, you can gradually practice walking with a parallel bar. Walking time should be short 5-10 minutes per session, and under the strict requirements of the therapist, more trunk, pelvis, and knee control training should be done outside of the treatment time. Note: 1, control the amount of movement 2, limit the incorrect alignment 3, the step should be small 4, the movement is as simple as possible easy to complete, so as to avoid compensation. Advantages: 1, weight-bearing to promote the recovery of proprioception 2, recovery of walking memory 3, reduce abnormal tension 4, meet the patient’s psychological requirements. Disadvantages: The therapist does not have good control over the amount of movement and alignment will have compensation and poor alignment, such as knee hyperextension.