1.What are the rehabilitation methods to improve the motor function of limbs after cerebral hemorrhage with hemiplegia symptoms?
Hemiplegia, also called hemiplegia, refers to the movement disorder of one upper and lower limb, facial muscle and lower tongue muscle, and is a common sequela of cerebral hemorrhage. Although patients with mild hemiplegia can still move, they tend to walk with the upper limb flexed and the lower limb straightened, and the paralyzed lower limb walks in a half circle with one step.
In severe cases, the patient is often bedridden and loses the ability to live. For patients with hemiplegia, the main rehabilitation methods to improve motor dysfunction are: correct body position placement; turning training; bedside self-assisted training; bedside passive training – including training of upper limbs, trunk and lower limbs on the hemiplegic side; bedside elevated sitting training; lying and sitting training; balance training (sitting and standing); walking training, etc.
2.Is hyperbaric oxygen therapy effective? Is it necessary to carry out hyperbaric oxygen therapy? How often should hyperbaric oxygen therapy be performed?
Hyperbaric oxygen therapy is to breathe pure oxygen in an environment with more than one atmosphere of pressure. Research has proved that hyperbaric oxygen therapy provides a new scientific and effective adjuvant therapy for the treatment of traumatic brain injury, which is of great practical significance to improve the prognosis of brain injury patients, increase the cure rate and reduce the disability rate. For patients with cerebral hemorrhage, hyperbaric oxygen therapy can reduce cerebral edema, rapidly lower intracranial pressure, and rapidly increase the oxygen content and oxygen storage capacity of brain tissue.
The therapeutic effects of hyperbaric oxygen are undeniable, but the requirements for hyperbaric oxygen are very high and not all patients with cerebral hemorrhage are suitable for hyperbaric oxygen therapy.
The indications for hyperbaric oxygen therapy in patients with cerebral hemorrhage include.
1, the duration of the disease is more than 6 hours and the next day cranial CT shows that the hematoma does not increase;
2.After 1-2 experimental hyperbaric oxygen therapy, the symptoms do not worsen and the CT shows that the cerebral hematoma does not increase in size;
3.Patients who have cleared cerebral hematoma, as long as their condition is stable and there are no signs of infection and fresh bleeding, should also implement hyperbaric oxygen therapy as soon as possible. Generally speaking, hyperbaric oxygen therapy can be performed once a day, and the course of treatment is 1-3 months of continuous treatment, which is selected according to the patient’s condition, and the earlier the patient starts after the vital signs are stable, the better the effect.
3.What is the effect of antispasticity drugs on limb hemiplegia?
Anti-spasticity drugs are a large class of drugs that reduce the tone of limbs. Muscle tone is the basis for maintaining various body postures and normal movements. For example, when the torso is standing, although no significant muscle contraction is seen, the muscles in front and behind the torso also maintain a certain tension to maintain the standing posture and body stability, which is called postural muscle tone. When cerebral hemorrhage occurs, some patients will have increased muscle tone, mainly manifesting as limb spasm, when the muscles of the hemiplegic side of the limb contract, causing patients to feel sudden severe pain, stiffness of joint muscles, and uncoordinated movements.
For the treatment of spasticity, in addition to manual therapy, anti-spasticity medication is a very important tool. Currently, baclofen tablets are used more often in clinical practice, mainly to relieve reflex muscle spasm, as well as to significantly relieve painful spasm, automaticity and clonus. Baclofen can relieve the spasticity of limbs, make muscle tone decrease, joints become flexible, effectively improve mobility, facilitate daily life and physical therapy, etc.
4.Is functional training systemic or just for the affected limb?
Rehabilitation after cerebral hemorrhage is a long-term process that requires systematic and standardized exercise and a persistent attitude. Starting from the early rehabilitation of cerebral hemorrhage, if the treatment only focuses on the improvement of the function of the affected side, but neglects the maintenance and strengthening of the healthy side and the whole body function, it will be detrimental to the patient’s recovery.
Many studies have found that after cerebral hemorrhage, there are often different degrees of disuse not only on the affected side but also on the healthy side, which becomes an important cause of poor prognosis. Therefore, rehabilitation should start from the acute stage, begin active training of bilateral limbs as early as possible, get out of bed early, and gradually increase the amount of activity without causing abnormal motor reactions in order to reduce the disuse syndrome as much as possible.
When the patient enters the middle and late stages of cerebral hemorrhage sequelae, the possibility of recovering the function of the affected limb becomes smaller, so it is especially important to strengthen the training of the healthy limb at this time. The purpose of training at this time is not only to complete daily life through the compensation of the healthy limb, but also to consider more activities, such as going out for shopping, traveling, and even working, so the functional training after cerebral hemorrhage is systemic.
5.What is the effect of acupuncture and physiotherapy on limb dysfunction?
Acupuncture has the therapeutic effect of unblocking the meridians, harmonizing yin and yang, and supporting the positive and eliminating the evil. Modern research proves that acupuncture can improve brain energy metabolism, reduce inflammatory response, reduce brain nerve damage, improve cerebral vascular diastolic function, play a role in brain protection and nerve repair, and promote the recovery of limb function.
There are many kinds of physiotherapy programs, and for patients with cerebral hemorrhage, the more commonly used programs are: low-frequency biofeedback electrical stimulation device and swallowing disorder treatment device. Low-frequency biofeedback electrical stimulation belongs to the category of low-frequency therapeutic instrument, which uses myoelectric biofeedback technology and combines various electrical stimulation modes to carry out muscle training treatment in order to improve muscle function and help patients rebuild and restore normal muscle movement function;
Swallowing disorder therapy instrument also belongs to the category of low frequency therapy instrument, the role of the treatment is to target the swallowing function related nerve electrical stimulation, strengthen the swallowing muscle group, alleviate the swallowing muscle disuse atrophy, improve the blood flow in the pharynx, to achieve the recovery and reconstruction of the swallowing reflex arc, and ultimately improve the patient’s swallowing function. These two instruments are widely used in clinical practice and to a large extent complement the rehabilitation therapy work of rehabilitation therapists.
6.How to assess the effect of rehabilitation? How long does it take for rehabilitation training to have an effect?
The assessment of rehabilitation effect, also known as rehabilitation evaluation, is the foundation of rehabilitation treatment. Without evaluation, it is impossible to formulate the next treatment plan and evaluate the effect of the treatment. Rehabilitation assessment is similar to the diagnosis of diseases in clinical medicine, but has its own professional characteristics. Rehabilitation assessment is not to determine the nature and type of disease, but to objectively and accurately assess the nature, scope and degree of functional impairment, and to estimate its developmental prognosis and regression, so as to lay a scientific foundation for the rehabilitation treatment plan.
Rehabilitation assessment mainly includes
1. Assessment of somatic functions: motor and sensory functions (muscle tone, muscle strength, balance, coordination, walking ability and overall motor function);
2, speech function assessment (aphasia, dysarthria, swallowing disorder, etc.);
3.Psychiatric assessment (Hamilton Depression Inventory, Hamilton Anxiety Inventory);
4. Assessment of the ability to perform activities of daily living;
5.Quality of life assessment, etc.
Rehabilitation training is a long-term process, and the course and efficacy of rehabilitation varies greatly depending on the patient’s condition. Clinically, it is generally believed that within six months after the onset of cerebral hemorrhage, especially within the first three months, is the best period for functional recovery and the golden period for rehabilitation training.
However, it does not mean that rehabilitation training can be stopped, only that the purpose of rehabilitation is different in different periods, so patients still need active rehabilitation training after six months, only that rehabilitation at this time can be gradually transformed from rehabilitation hospitals or rehabilitation wards to family or community rehabilitation.