Stroke is a disease with a high rate of disability. One of the serious problems is hemiplegia after a stroke. The recovery process of hemiplegia is a very complicated process. The treatments for hemiplegia, including two categories of pharmacological and non-pharmacological treatments, of which rehabilitation is one of the important measures, have some problems in clinical implementation that are often overlooked.
When to implement rehabilitation treatment after stroke is clinically important, and it is related to the prognosis of the disease and the patient’s quality of life. Generally after the onset of the disease, emphasis is often placed on medication, while rehabilitation is neglected. When the disease is stable and some adverse conditions have formed, intervention in rehabilitation means is often half the effort.
Rehabilitation training of motor function should be started 48h after the stabilization of the disease.
I. Objectives of rehabilitation therapy and training principles
1, the goal: through the combination of mainly exercise therapy, to prevent and control complications, reduce sequelae, adjust the psychological state, promote functional recovery, give full play to residual functions in order to strive for self-care and return to society.
2. Training principles: The main goal is to suppress abnormal and primitive reflex activities, improve motor patterns, and rebuild normal motor patterns; the second goal is to strengthen weaker muscle strength training.
Second, the principles of rehabilitation staging treatment
(I) Acute phase (0-1 week).
A few days after the onset of the disease, the main focus should be on rescue and early rehabilitation, mainly to prevent complications and secondary damage.
1. Prevention of complications.
Prevent decubitus ulcers, respiratory tract infection, deep vein thrombosis, etc.
2.Prevent joint contracture and deformation
(1) Passive activities; prevention of muscle atrophy, relief of joint pain, prevention and reduction of edema; sensory stimulation, high muscle tone – relaxation techniques; low muscle tone – stimulation techniques.
(2) Positioning: in the prone position: the limb should be placed in the anti-spastic position. Including: position placement of the healthy side, position placement of the affected side, position placement of the supine position.
(3) Turning training: prevent pressure sores and prepare for standing, including: turning to the healthy side and turning to the affected side.
(2) Treatment of recovery period (after 1 week)
1.Soft paralysis period: use various methods to restore and improve muscle tone and induce active activities of the limbs, and the patient should be encouraged to perform active activities in bed (turning over → sitting Ⅰ balance).
2.Spastic phase: control muscle spasm and abnormal movement patterns, and promote the emergence of dissociative movements.
3.Recovery period: promote better recovery of selective and speed movements, while continuing to inhibit muscle spasm.
Motor training according to the law of human motor development, from simple – complex, easy – difficult.
Turning → sitting → sitting balance → double body standing balance → single knee standing balance → sitting position → standing balance → walking.
Third, the method of rehabilitation treatment.
1.Exercise therapy.
Movement therapy is a general term for the treatment methods to improve movement disorders through active movement and passive movement.
2.Operational therapy.
Occupational therapy is the use of purposeful, selected operational activities as a therapeutic means to improve and subsidize the function of patients. Its purpose is to maximize the patient’s ability to care for themselves, work, leisure and other daily life, to improve the quality of life, is conducive to the patient’s return to the family and the ideal method of society.
3.Physiotherapy.
Traditional physiotherapy also has a special role in the rehabilitation of hemiplegia.
4.Rehabilitation of speech.
5.Rehabilitation of traditional medicine.
Traditional Chinese medicine has long been used for the treatment of hemiplegia, especially the use of acupuncture with limb movement has unique features. Acupuncture treatment should be involved immediately after stroke, and it has been widely used in clinical practice and has received very good curative effect.
Fourth, the rehabilitation care of stroke
If the patient cannot turn over by himself, he must be helped to change his sleeping position once every 2 hours to avoid bed sores and impotence of the affected limbs.
2.Eating a balanced diet, fixed food ration; use vegetable oil; eat less sweets and foods with high sodium content; avoid smoking, drinking alcohol and caffeinated beverages.
3, the affected limb rehabilitation training should be implemented according to the doctor’s instructions, effective daily rehabilitation is extremely beneficial to the recovery of the disease.
4. Correct posture (sitting and sleeping posture) can prevent tissue constriction, reduce edema, and help recovery of mobility.
V. Guidance for patients’ families
1.Tell the patient’s family about the risk factors of stroke and the ease of recurrence.
2.Turn the patient’s body and buckle the back regularly. Since stroke patients are mostly lying down, the position is not conducive to the smooth coughing of sputum, so turn the patient’s body and buckle the back regularly to promote coughing of sputum and avoid the formation of pneumonia.
3. Give the patient diligent massage, scrub, and change clothes.
4.Give the patient reasonable nutrition and light diet.
5.Strengthen the psychological guidance of patients and their families.
6. Pay attention to weather changes and prevent patients from catching cold and heat stroke.
Sixth, stroke complications
1.Lung infection.
2.Decubitus ulcer.
3.Acute gastrointestinal bleeding.
4.Cerebral heart syndrome.
5.Central respiratory distress.
6.Central erratic reflux.
7.Bladder and rectal dysfunction. Frequent diarrheal incontinence or urinary retention.
8.Renal failure and electrolyte disturbance.