What are the sequelae of stroke?
The most common consequences of hemiplegia are the “three deviations”, speech impairment, swallowing impairment, cognitive impairment, impairment in activities of daily living, and bowel and urinary impairment.
”Triple hemiplegia”
Hemiparesis: Impairment in the movement of one limb.
Hemisensory: Sensory impairment on one side, that is, no sensation on one limb, which can have serious consequences. For example, when a patient was cold, his lover felt sorry for him, so she filled a hospital saline bottle with hot water and put it under his right foot to keep him warm. However, this patient had right-sided hemiplegia and could not feel his right side, so he did not feel the hot water bottle under his foot, and the next day he found that the bottom of his foot was burned. Therefore, this kind of sensory disorder must be alerted.
Hemiplegia: The patient can only see objects on one side.
Cognitive impairment
Inability to recognize family members, places, time, etc. He does not know whether it is winter or summer, at home or in the hospital.
Speech dysfunction
In medicine, it is called aphasia, which means that the person cannot speak. Patients with right-sided hemiplegia are prone to aphasia, while those with left-sided hemiplegia are not. Why is that? Because in the brain, the speech center of ordinary people is on the left side, but patients with right hemiplegia have a lesion on the left side of the brain, which affects the speech center and leads to aphasia.
Impaired ability to perform daily activities
The patient is unable to take care of himself/herself, such as washing, dressing and eating.
Swallowing disorder.
It is easy to choke and cough when eating or drinking, which may lead to aspiration pneumonia, asphyxia, or even respiratory arrest in severe cases. For patients with swallowing disorders, we will first insert a nasal feeding tube and help him to swallow training, and only after the training, the tube can be removed.
Fecal and urinary disorders
This refers to urinary and fecal incontinence.
Recommendations for “prevention of secondary stroke”.
A) Strictly control blood pressure below 140/90 mmHg, the younger the person, the tighter the control. It is best to monitor blood pressure changes daily and take blood pressure at least once a week.
B) If you are taking antihypertensive drugs, do not stop them at will, but increase or decrease them according to medical advice.
C) 24-hour stable control of blood pressure, so that blood pressure fluctuations are small, do not lower the blood pressure too low.
D) Effective control of blood glucose, blood lipids and blood viscosity.
E) Reduce weight to reach normal standard.
F)Quit smoking and alcohol, and have a low salt and low fat diet.
G)Adhere to aerobic physical exercise, such as jogging, swimming, cycling, practicing taijiquan, etc.
Acute cerebrovascular disease, also known as stroke or strokes in Chinese medicine. It is called stroke because of its rapid onset, multiple evidence and rapid changes, just like the wind in nature, which is good at moving and changing. Despite active treatment, most stroke patients still have sequelae, such as paralysis, aphasia, incontinence, abnormal personality, dementia, etc.
Post-stroke functional recovery care
1, limb movement dysfunction should be actively guided and assisted to carry out functional exercises, starting from simple flexion and extension, requiring adequate activities, reasonable and moderate, avoiding damage to muscles and joints, 2 to 4 times a day, 5 to 30 min each time, and with drug therapy, massage the affected limb, with acupuncture and physiotherapy, to promote blood circulation in the affected limb, in order to facilitate functional recovery.
2, unfavorable language Patients with language disorders are more anxious, so it is necessary to contact patients more often in nursing, induce and encourage patients to speak as early as possible, correct pronunciation patiently, and persevere from simple to complicated.
3, crooked corners of the mouth Clinically, it is common to see incomplete closure of the eyelid on the affected side, drooping corners of the mouth, salivation, inability to puff the cheeks, wrinkle the forehead and close the eyes. Patients often have negative emotions and lose confidence in treatment. Nurses should sympathize and care for patients, give spiritual encouragement, soothe their emotions, encourage them to do more eye, mouth and facial exercises, and massage the affected area frequently.
Post-stroke recovery exercises
The principles of doing passive exercises are.
Start with simple movements, sit from the proximal end of the limb to the distal end, and train step by step to eventually achieve functional recovery of the affected limb. Families should do passive exercises slowly and gently, with regularity, avoiding forceful tugging or large movements. Gradually increase the amplitude and range of passive activities, at least 2 times a day, each time each action should be repeated about 10 times, and be persistent.
When doing passive exercise, it is better for the patient’s upper and lower limbs on the healthy side to do the same action, so that the diffusion of nerve impulses on the healthy side can stimulate the production of muscle excitatory impulses on the affected side, which is conducive to the functional recovery of the affected limbs.
The common methods of passive exercise are.
The passive movement of the upper limb starts with the shoulder. The family members and bedside companions hold the patient’s shoulder with one hand, hold the patient’s elbow with the other hand, and make the upper arm abduction, adduction, upward and downward movements. The movements should be gentle to prevent joint injury or dislocation caused by muscle relaxation around the shoulder joint. When doing passive forearm exercises, the family member holds the patient’s wrist with one hand, palm up, and the other hand holds the elbow joint to flex, extend and internally rotate the forearm. The passive movement of the hand is done by holding the patient’s wrist with one hand and holding the patient’s fingers with the other hand, and doing flexion and extension of the wrist joint and flexion and extension of each finger.
The passive movement of the lower extremity also starts from the proximal end, that is, the passive movement of the hip joint, by flexing the knee joint of the affected limb, and then the family member holds the knee joint on the affected side with one hand, and holds the hip with the other hand, doing left and right rotation movements. The calf movement is done by the family holding the ankle with one hand and holding the knee with the other hand, doing the knee extension and flexion movement. The foot movement is done by holding the ankle with one hand and squeezing the toes with the other hand to make the foot do dorsiflexion and rotation to the left and right. It is worth mentioning that passive exercises should be combined with massage at the same time. It helps to restore the function of the limbs.
What are the main factors causing stroke hemiplegia
(1) Hypertension and cerebral arteriosclerosis: It is the most common and main cause of stroke. It is more common in older patients.
(2) Cerebral aneurysm and cerebrovascular malformation: common in younger patients.
(3) Metabolic disorders: such as diabetes mellitus, acidosis, alkalosis, uremia, etc.
(4) Various heart diseases: such as rheumatic heart disease, congenital heart disease, heart failure, myocardial infarction, atrial fibrillation, etc.
(5) Blood diseases: such as leukemia, thrombocytopenic purpura, erythrocytosis, hemophilia, etc.
(6) Various vasculitis: including tuberculous and rheumatic arteritis, nodular and lupus arteritis, parasitic arteritis and leptospirosis, etc.
(7) Others: such as intracranial infection, traumatic brain injury, lead and carbon monoxide poisoning, etc.
Dietary contraindications for stroke patients
I. Limit fat intake: Reduce the total amount of fat in the daily diet, increase polyunsaturated fatty acids and reduce animal fat so that the P/S ratio reaches more than 1.8 to reduce the synthesis of endogenous cholesterol by the liver. Instead of using animal oil in cooking, use vegetable oil, such as soybean oil, peanut oil, corn oil, etc. The dosage should be 25 grams per person per day, and within 750 grams per month is appropriate. To limit food cholesterol, it should be within 300 mg per person per day, that is, you can eat 3 egg yolks per week.
Second, control the total calories: If the total fat intake in the diet is controlled, blood lipids will drop, and the weight of obese or overweight patients will also drop, and it is better to reach or maintain the ideal weight, which is beneficial to the physiological functions of all internal organs of the body.
Third, an appropriate amount of increased protein: due to the amount of fat in the diet decreased, it is necessary to properly increase protein. Can be provided by lean meat, skinless poultry, can use more fish, especially sea fish, daily to eat a certain amount of soy products, such as tofu, dried beans, to reduce blood cholesterol and blood viscosity is beneficial.
Fourth, limit the intake of refined sugar and sweet food containing sugar: including snacks, candy and drinks.
Five, scientific diet: some patients with cerebral thrombosis have combined hypertension disease, the amount of salt should be small, to adopt a low salt diet, 3 grams of salt per day, you can add salt after cooking and mix it well. If salt is added in the cooking, the cooked dish will still be very light and difficult to eat. In order to increase appetite, you can add some vinegar, tomato sauce, sesame sauce when stir-frying. Steam, boil, stew, boil, stir-fry, blanch, stir-fry, warm and other cooking methods, not suitable for frying, deep-frying, stir-fry, oil dripping, baking and other methods.
Drink more water: Patients with cerebral thrombosis should drink water frequently, especially in the early morning and evening. Evening activity is small, the biggest benefit of drinking water before sleep is that it can dilute the blood and prevent thromboembolism.
Seven, increase dietary fiber and vitamin C food: which includes coarse grains, vegetables and fruits. Some foods such as onions, garlic, mushrooms, fungus, kelp, hawthorn, nori, light tea, konjac and other foods have a lipid-lowering effect.
Language rehabilitation for post-stroke sequelae
(a) Sensory aphasia: the patient can speak, but cannot understand the meaning of his own words and those of others, and the patient must use visual stimulation in conversation to help understanding.
1.Visual logic method: For example, give the patient a basin of water, and take out a towel and soap, and then say “wash your face”, the patient can follow the instructions to wash his face, so repeatedly make the visual and verbal combination, and train the patient’s ability to understand language.
2. Gesture method: If you say “wash your face”, the patient cannot understand it, but if you combine it with the gesture of using a towel to wash your face, the patient can soon understand it and may take the towel to wash his face.
(ii) Motor aphasia.
1. Complete motor aphasia: The patient is completely unable to speak. Rehabilitation training should start with learning pronunciation, then speaking the most familiar single sounds commonly used, then learning double sounds, and then learning phrases, short sentences and long sentences. It is best to combine visual and auditory stimulation when training speech. The auditory speech stimulation method is administered to the patient by the speech therapist. The components are.
(1) training of the articulatory muscles, making the patient pronounce “ah” sounds or lip-sound training, or inducing articulation by coughing, blowing paper, blowing out matches, etc. The lip-sounds of aphasic patients are most easily recovered.
(2) Mirror training, let the aphasic patient first pronounce or speak the vocabulary with the next person, and with the help of visual observation, observe the position of the organ of speech or mouth shape during the training, from easy to difficult, from short to long.
(3) Articulatory training, let the patient listen to the first half of a common sentence and make him/her say the second half.
(4) Repetition training, in which the patient repeats numbers, words or phrases.
(5) Listening to pictures, objects, and words, where the patient performs oral commands to look at pictures and objects and say their names.
(6) Reading and writing training, let the patient with aphasia read words, let the patient with aphasia dictate, copy and mime.
2. Incomplete aphasia: Patients can speak, but their vocabulary is poor, they often make mistakes, their words do not make sense, and they are not grammatically logical. The treatment patiently teaches them to learn more vocabulary and exercise the skill of using speech muscles and practice tongue flexibility. A procedural learning method is available, which is a speech therapy using indirect informal dialogue. The main ones are.
(1) Fractional method: The patient is asked to say as many homophones as possible, to form different words or phrases with the same word, etc., in order to expand and strengthen the ability to respond with word reproduction and semantics, for light aphasics.
(2) Central content discussion method: The training content is focused on a certain topic with the aim of improving verbal expression.
(3) Mixed aphasia.
The patient has both comprehension and expression disorders. The patient should be trained to understand language first during treatment, and then trained to speak as comprehension is restored, and attention should be paid to the combination of visual and auditory training.