Early rehabilitation of stroke

  Stroke is a disease with a high incidence and disability rate in China. Rehabilitation training can reduce the disability rate and degree of disability of stroke, but many patients and their families do not know how to carry out stroke rehabilitation treatment. However, many patients and their families do not know how to carry out stroke rehabilitation. In fact, after the onset of stroke, postural placement and passive exercise can be used to prevent or reduce the occurrence of limb spasm and sequelae, and active training can be started after the condition is stabilized.  Early posture and passive exercise 1. Immediately after a stroke, it is best for the patient to adopt a healthy-side lying position. Face the healthy side and do not let it twist backwards; flex the shoulder 90-130°, extend the elbow and wrist, and place the upper limb on the pillow in front of the body; flex the hip and knee on the affected side as if stepping out on the pillow in front of the body, and do not dangle the foot. Next is the affected side lying and supine position, without putting any support on the bottom of the foot and without holding any object in the hand. During this period, attention should be paid to avoid semi-sitting position as much as possible to avoid lower limb spasm caused by tension neck reflex.2. Changing position can prevent decubitus ulcers and pulmonary infections, in addition, because supine position can strengthen the advantage of extensor muscles, healthy side lying can strengthen the advantage of flexor muscles on the affected side, and affected side lying can strengthen the advantage of extensor muscles on the affected side, constantly changing position can make the extensor and flexor muscle tension of the limb reach balance and prevent spasm. 3. The patient’s family or therapist can perform passive joint exercises for the patient to prevent joint limitation (contracture) and to promote blood circulation and increase sensory input to the limb. This rehabilitation should be done in conjunction with postural placement. Since turning and passive joint exercises can only prevent decubitus ulcers, pneumonia and joint contractures, but not other sequelae such as disuse muscle atrophy, and do not significantly promote functional recovery, the patient should also start the next phase of active training as early as possible. When the patient is conscious and the vital signs are stable for about one week, active rehabilitation training can be started. 1. Let the patient practice turning over in bed, which is one of the most basic trunk function training. This is one of the most basic trunk function training. Because the trunk is governed by bilateral cone bundles, paralysis is generally incomplete and recovery is faster. 2. Have the patient practice sitting up from the healthy or affected side, because sitting is one of the easiest movements for the patient to accomplish, and is also necessary to prevent postural hypotension and some activities of daily living such as standing and walking in the future. This should be done at the same time as the turning training, taking care not to let the patient sit with his back against an object. 3. Start the standing training after the patient can sit independently. After the patient is able to stand alone, let the patient’s weight gradually shift to the affected leg and train the weight-bearing ability of the affected leg. 4. Walk training can be started only when the patient can stand independently and balance, hold more than half of the weight of the affected leg, and can step forward. For most patients, it is not advisable to use a cane too early to avoid affecting the training of the affected side. Before walking training, practice alternating forward and backward steps and weight shifting of the legs. In recent years, early walking training with partial weight loss support devices has led to better results in terms of walking ability and walking speed recovery. 5. Start occupational therapy after the patient is able to sit independently. The content includes daily living ability training, such as eating, personal hygiene, dressing, bathing, doing housework, and participating in craft activities. In addition, physical therapy and acupuncture treatment are also performed, because functional electrical stimulation, biofeedback and acupuncture are useful for increasing sensory input and promoting functional recovery and motor control. Generally, after scientific and persistent training, patients can achieve the purpose of improving function, enhancing life ability and reducing the degree of disability.