Choose the appropriate training method according to the individual’s ability and start active and preventive rehabilitation training as early as possible so that the patient’s function and ability can be improved and compensated to the maximum extent possible, in order to obtain the maximum ability to perform activities of daily living and to participate in family and social activities again. Treatment and health care are generally carried out in accordance with rehabilitation medical advice. Wrong training methods should be avoided, and excessive force and stress should be avoided. Avoid pain and fatigue. The patient should take the initiative in training, and family members can participate in the treatment. The patient’s family should face up to the problem and the reality. They should encourage the patient to do everything within their own ability, fully consider the special needs of the patient in all aspects, create conditions for their normal life, and let them participate in all activities of the family, so that they can really become an equal member of the family.
Note: Stroke patients with high blood pressure, serious heart disease and other diseases should choose their training methods carefully under the guidance of professionals!
The helper stands on the affected side of the patient to protect and help, which can make the patient feel safe and can draw attention to the affected side. When moving the patient’s body, avoid forcing the upper limb on the affected side, as this may cause shoulder pain and subluxation. When assisting the patient in dressing and other activities, avoid lifting the affected limb incorrectly from the hands and feet, and protect the adjacent joints.
I. Correct bed position
For patients who are bedridden for a long period of time generally change position once every 2-3 hours. This can inhibit abnormal movement patterns and avoid the formation of pressure sores.
1.Supine position: head on the affected side, palms up, hands naturally extended, unable to be extended can be separated by a roll of cloth.
2. Affected-side position: the affected shoulder is stretched forward, the elbow is straight, the palm is up, and the healthy leg is on top.
3.Healthy side lying position: the affected side shoulder is stretched forward, not hanging down the wrist; the affected side hip is forward, knee is slightly flexed.
Turn over
Patients should learn to turn over as soon as possible, which can avoid the formation of pressure sores and facilitate the recovery of limb function.
Note: the correct crossed handshake posture! The thumb of the affected side is on top!
1.Turning from supine position to the affected side: raise the crossed hands, bend the knees, swing the upper limb to the healthy side, then swing to the affected side, and rely on inertia to turn to the affected side.
2.From supine position to healthy side lying position: hold the affected elbow with the healthy hand, insert the healthy leg under the affected leg, and use the healthy leg to move the affected leg to the healthy side when the body is rotating.
Third, the correct sitting posture
1.Sitting posture on bed: lower limbs are naturally straight and hands are crossed on the table.
2.Sitting position on the chair: feet flat on the ground, hands crossed. It can inhibit the flexion spasm of the upper limb on the affected side and the extension of the lower limb, which is conducive to the weight bearing of the lower limb on the affected side.
Four, sitting balance training
Key points: the affected upper limb to the body outside the back straight, palm down support on the chair, use the healthy hand to transfer the items from the affected side to the healthy side, you can also throw the ball, throw sandbags, etc.. Or move the body to the affected side or to the healthy side when sitting.
Five, the conversion of lying and sitting position
Key points: the healthy side lying position → the affected side upper limb on the abdomen → the healthy leg inserted under the affected leg and move the body to the bedside → the healthy side forearm and hand support the body upwards → sit up while the healthy leg drives the affected leg to move under the bed.
Note: If the patient cannot do it independently, the helper can stand on the patient’s healthy side and lift the healthy shoulder with one hand while the patient sits upward, and press the legs downward with the other hand to help complete the movement. Switch from sitting position to lying position in the opposite order of the above.
Sixth, trunk and lower limb training
When the patient can maintain the sitting position for more than 30 minutes, he/she can start to move in bed. Although the intensity is not great, it can help to recover the strength and prepare for standing and walking.
Key points: supine position, with the leg inserted under the affected leg and lifted off the bed.
Effects: Prevents muscle atrophy in the healthy leg, stimulates the affected leg and promotes recovery.
Point: Supine position, knee flexion, foot flat on the bed, head up, touch the knee with crossed hands, also can be two lateral extension.
Effects: Strengthens the abdominal muscles and inhibits spasm of the upper limb flexors and lower limb extensors.
Key points: supine position, crossed hands raised in front, bend the knees, raise the head and hands on the knees → release both knees to lie flat.
Effects: Strengthens the abdominal muscles and inhibits spasm of the upper limb flexors and lower limb extensors.
Key points: supine position, bend knees, feet flat on the bed, lift the hips.
Effects: Overcome pelvic retraction, enhance gluteus maximus muscle strength and stability of hip joint. When lifting the hips, you can increase the pressure on the shoulders and make them move forward.
Key points: supine position, with the foot perpendicular to the bed. The knee joint is pressed downward, and the muscles in the front of the thigh are tensed.
Effect: Facilitates leg extension during walking.
Points: supine position, bend the knee, foot flat on the bed, the affected leg slowly separated outward, and then slowly retracted, at this time, the healthy leg remains motionless. Then replace the healthy leg to do, the affected leg remains motionless.
Point: In the prone position, the helper helps the patient to flex the lower leg, and the patient gradually extends the knee to various angles and holds it, then gradually flexes it.
Effects: Facilitate hip extension and knee flexion when walking.
VII. Upper limb and hand training
Raise the crossed hands horizontally, over the head and behind the neck. Crossed hands on the table, pushing the ball in all directions. Hands to hold the hanging balloon; bend the elbow, touch the nose with the ball; back of the hand, palm pushing obstacles; move up and down; healthy hands wrapped wool.
VIII. Sitting transfer
As soon as the patient can grasp with the healthy hand and stand with the healthy foot, transfer training will be carried out as early as possible! Transfer characteristics: the patient moves to the side of the healthy side in front. It is best to make the bed, chair and toilet at the same height.
Sitting position on the bedside → feet on the ground → trunk in front of a short time → the healthy hand to hold the chair → elbow to support the body to stand up → weight on the healthy leg → healthy hand to move to the distal chair surface → homeopathic turn on the axis of the healthy foot → hips to the chair → slowly sit down.
Nine, standing balance training
Walking is a process of constantly breaking balance and constantly restoring balance. Therefore, standing balance is the basis for ensuring walking stability and safety.
The following factors affect the balance: paralysis of the affected trunk and lower limbs, impaired balance response, increased muscle tone and abnormal movement patterns, decreased physical strength and weakness of the healthy side of the lower limbs.
Training method: Stand with both hands supporting a fixed object, feet slightly apart, and try to support your weight with the affected foot. Slightly bend the knee!
Ten, sitting and standing conversion
Key points: the healthy side of the body near the support → two feet backward → waist forward to explore → with the healthy hand to grab the support → forward to the upper half of the body → the weight shifts to the two feet when the upward stand. Stand up and look forward with your chest, do not look down!
Without support, feet parallel to the ground, hands crossed fully forward, hip flexion body forward, the center of gravity moved to the feet, knees and hips, slowly stand up, chest upright.
For those who cannot complete the transition from sitting to standing independently, the helper should stand directly in front of the patient and use his or her feet and knees to hold the patient’s affected feet and knees respectively to help him or her stand.
Switching from standing to sitting: Patients have a sense of “falling” when sitting down, and the moment they are about to sit down is the most difficult for them, so they can stand up a little at first and then sit back down, gradually increasing the difficulty until they master it.
XI. Walking training
The recovery of walking ability plays a pivotal role in rehabilitation.
The key to success is “early trunk and lower limb training”!
When the patient’s walking ability is not reached, forcing him/her to walk will make him/her completely dependent on the healthy side, develop bad movement habits, form abnormal gait, and seriously affect his/her future life ability! The conditions that should be present when preparing to walk: the affected leg has sufficient weight-holding ability, the ability to stand and balance, and the ability to actively flex the knee and hip. The patient’s body should not be forward and should not lower the head or eyes to the ground. Older patients with poor balance and weight-holding ability should be trained to walk with a cane as soon as possible! The height of the cane should be at the height of the greater trochanter. A three- or four-legged cane can be used to increase walking stability and expand the support surface.
According to statistics, about 80% of patients can resume independent walking.
1. Three-step walking method: The healthy person stands with the cane in his hand → extend the cane forward about one step → the affected foot takes a step at the level of the cane → the healthy foot takes a step
Beyond the cane.
2.Two-step walking method: stand with cane in hand→stretch the cane while stepping on the affected foot→then step forward on the healthy foot.
Twelve, drive wheelchair training
According to statistics, about 20% of the patients have to use wheelchairs to walk. Early use of wheelchairs can enable patients to leave the bed and obtain a sitting position.
Key points: use the healthy hand to turn the hand wheel ring, use the healthy foot to support the ground drive.
XIII. Up and down stairs training
Point: Grasp the handrail with the able-bodied hand → step on the first step with the able-bodied foot → use the strength of the upper and lower limbs to lead the body upward → step on the affected leg.
First step on the affected leg → while supporting the body with the upper and lower limbs on the healthy side → then step on the healthy leg.