I. Initial or floppy phase
Treatment goals for this period
1.Improve respiratory swallowing and feeding, improve body perception
2.Improve the control of trunk and proximal joints
3.Maintain the movement of scapula, elbow, wrist, hand and hip, knee and ankle
4.Improve muscle tone and balance as soon as possible
5.Improve functional mobility
1.Pay attention to maintain the correct position in bed
2.Massage and passive activities
3.Use of nerve promotion techniques
The right upper limb extensor weakness is used to illustrate the excitatory promotion technique.
Contents of the technique
1.All kinds of reflexes
Combined reflexes of the upper limb on the healthy side to resist elbow extension, pulling the bow reflex to turn the head to the right, right arm extensor excitation, left arm flexor excitation, rotating waist reflex to rotate to the left, inclined plate reflex to tilt to the left.
2.Sensory stimulation
Tactile stimulation: quick brushing and light touching of the skin on the extensor side of the upper limb, light tapping of the extensor tendon or muscle belly, temperature stimulation: quick brushing with ice or local placement for 3~5 seconds, squeezing to strengthen the shoulder, elbow joint and extensor muscle belly, pulling the muscle to quickly and slightly stretch the extensor muscle group, special receptor stimulation: placing the affected upper limb in a visible place, upper limb activity pattern: stretching the affected limb from the side of the body up over the head, fingers spread, palm The fingers are spread and the palm is turned outward.
3.Medical gymnastics
Section 1 combing hair with a healthy hand
Turn the head to the affected side, use the healthy hand to comb from the healthy side of the forehead to the back of the head and neck, requiring the fingers to press the scalp, slowly push backward, repeat 20 times.
Section 2 squeeze the affected hand
Use the healthy hand to turn the affected arm in front of the chest, with the healthy thumb. Squeeze each finger along the affected side from distal to proximal, and press firmly at the root of the proximal finger for 20 seconds, repeating each finger 5 times.
Section 3: Healthy hand
Place the affected arm in front of the chest and use the palm of the healthy hand to beat from the affected shoulder along the lateral side of the upper limb to the hand, and perform 20 round-trips.
Section 4 finger lift
Cross the affected hand with the healthy hand in front of the chest, press the thumb of the affected hand on the thumb of the healthy hand, then the healthy hand drives the affected hand to lift forward or up over the head until both elbow joints are completely straight, hold for 10 seconds and then recover, repeat 20 times.
Section 5 Wrap around face wash
Grasp the affected hand with the healthy hand to make it stretch, and then drive the healthy hand in the face in the forward and reverse direction to imitate the action of washing the face, repeat 10 times.
Section 6 half bridge exercise
Both upper limbs are stretched out on the side of the body, both lower limbs take the flexed hip and knee position, fix the affected lower limb or cock the affected leg on the healthy knee, then lift the hip off the bed as much as possible, hold it for 10 seconds, repeat 5~10 times, there should be no breath-holding action.
Section 7 resistance leg clamping
Both lower limbs flex the hip and knee, both feet are supported on the bed, the affected leg is fixed by others, then the healthy leg is internally rotated towards the affected leg, while others exert some resistance on the inner side of the healthy knee to enhance the strength to complete the resistance leg clamping, repeat 20 times.
Section 8 cross-legged swing
The affected leg is passively supported by flexing the hip and knee, fixed at the foot by others, the healthy leg is crossed over the affected knee, swinging the hip to the left and right driven by the healthy leg, the healthy leg is required to play a fixed role on the affected leg during the activity, repeat 20 times.
Section 9 straight leg raise
The lower limb on the healthy side is raised 30 degrees in the straight position, hold for 10 seconds, also can hold the healthy leg on the affected leg to do straight leg raise, repeat 5 times.
Section 10 hand-foot touch
Use the hand on the healthy side to touch the back of the foot of the healthy leg, repeat 10 times.
Section 11: Knock on the knee with the healthy foot
Tap the affected knee with the heel of the healthy foot, from below the knee along the front and outside of the calf from above down to the outside of the foot and back 10 times.
Section 12 breathing exercises
Make slow deep exhalation and deep inhalation exercises in the supine position.
4.Passive activities use diagonal diagonal activities of multi-muscle groups and multi-joints in PNF.
5.Position change and balance training
6.Limb control training
7.Strengthen the strength training of the affected upper limb extensors and lower limb tibialis anterior muscles.
Intermediate or spastic stage brunnstrom grade 3~4
Treatment goals for this stage.
1, further balance muscle tone including inhibition of spastic muscles and easing of antagonistic muscle activity.
2, to promote the emergence of more dissociative movements
3, to strengthen the ability to control the activities of the proximal large muscle groups and to accomplish more complex life activities.
4.Strengthen the control of intermediate joints (elbow, knee).
1.Adopt inhibitory postures to break the muscle spasm pattern.
2.Adopt the inhibitory technique in the neural facilitation technique to reduce muscle tone (right lower limb)
Manipulation content
1.Various reflexes
Joint reflex resisted knee extension of the lower limb on the healthy side
Pulling bow reflex head to the left, pulling the bow to the left
Rotate waist reflex to the left
Lower limb flexor reflex to stimulate the right plantar
2.Control the key point knee joint, [toe
3.Stimulate the receptors
Squeeze slight continuous (3~5 seconds) squeeze extensor tendon and hip, knee joint
Deep cold stimulation fast brief deep cold stimulation on the toes
Tension continuous slow stimulation of lower extremity extensor muscles
Lower extremity movement pattern to make cross-legged shoeing movements
3.Muscle traction technique
Traction of the quadriceps in prone position with a hand towel under the thigh and passive flexion of the knee to maximum range; traction of the calf triceps by having the patient stand against a wall with a slanting plate placed on the bottom of the foot.
4.Medical gymnastics
Section 1 shoulder lift
The upper limb of the affected side is lifted forward, requiring the elbow joint to be fully extended, if the strength is poor, the affected elbow can be fixed with the healthy hand and then
This action can also be done by holding the upper limb of the healthy side forward, so that the affected side of the palm along the healthy side of the shoulder to the hand back and forth conversion, each action repeated 10 times.
Section 2 diagonal palm strike
The affected upper limb is held up on the abducted side, with the palm facing upward, and the healthy upper limb is held forward, so that the affected upper limb is gradually brought closer to the healthy limb, and at the same time, the palm is struck with force, repeated 10 times.
Section 3 shrugging exercise
Shrug both shoulders upward and around at the same time, repeat 20 times.
Section 4 palms together with elbows
Hands together in front of the forehead, and then do the two elbows clenched and separated movement, repeat 10 times.
Section 5 cross-legged movement
The healthy leg is supported on the bed by flexing the hip and knee, the affected leg is crossed over the knee of the healthy leg, if the tension of the affected leg extensor is high, (with muscle spasm) let the affected leg take the bending state on the knee and put it down. If you have difficulty in completing the above actions, you can straighten the healthy leg, then place the affected leg on the healthy knee or calf and put it down, repeat 10 times.
Section 6 hip swing
Bend the legs together to support the bed, swing the hips to the left and right respectively, repeat 10 times.
Section 7 leg bending
Straighten the legs together and then bend the hips and knees at the same time, requiring the heels to move close to the bed, and after sufficient bending, lift both feet and bring both knees closer to the abdomen. If the affected leg strength is insufficient, the affected foot will be placed on the healthy foot to complete this action, repeat 10 times.
Section 8 single leg half bridge
Both upper limbs are extended on the side of the body, the affected leg is flexed at the hip and knee, the foot is supported on the bed, the healthy leg is straightened and lifted 30-40 degrees, or cocked on the affected knee, the hip is lifted and extended with force, and held for 10 seconds, repeat 10 times.
Section 9 resistance elbow extension
The upper limb on the healthy side is bent in front of the chest, and the affected hand is pushed forward with the healthy hand against the palm and with force to achieve full extension of the elbow joint on the affected side, requiring the healthy hand to give resistance in the opposite direction, repeat for 10 times.
5.Physiotherapy
6.Antispasmodic
7.Balance exercise
8.Gait training
9.Operational therapy
10.Daily living ability training
11.Slow muscle tensioning with the help of muscle or splint
Recovery period brunnstrom grade 5~6
The goals of treatment in this period
1.To strengthen the control of motor ability
2.Improve gait
3.Improve ADL ability
4.Improve repetitive activities and increase the speed of movements so that the movements are performed at a normal frequency
5.Improve the control of eccentric contraction
1.Further strengthen the active, power and coordinated control movement of the affected limb and promote further improvement of the eccentric contraction
2.Strengthen the ADL training of the affected side
3.Pay attention to the prevention and control of various hemiplegic complications such as painful shoulder subluxation misuse syndrome
4.Medical gymnastics
Section 1: Left and right hammering
One side of the upper limb is lifted forward, and the fist is clenched with the heart upward.
Section 2 hands and knees beat each other
Double upper limbs placed on the side of the body, lower limbs for hip flexion knee stepping activities, with one side of the hand raised to pat the opposite side of the knee, and then the other side of the hand to repeat the above actions, alternately 20 times.
Section 3 hand and foot beat
Two upper limbs straight in the side of the body, palms facing down, both wrists close to the bed, hands alternately beat on the bed, then the two lower limbs bent, the heel close to the bed, for the left and right feet alternately beat action, also in a sitting or standing position under the hands, feet alternately beat the desktop or the ground, can be repeated to fatigue.
Section 4 lower limb circles
Sitting in the supine position, standing position, both sides of the lower limb heel close to the bed or the ground, alternating circling action, repeat 10 times.
Section 5 half bridge stepping
Take the supine position, on the basis of the previous half-bridge movement, both lower limbs bent to support the lifting of the hip position, alternately lifting the feet for stepping action, repeat 10 times.
Section 6 side stepping
Take the healthy side of the lying position, the affected leg for the front to back circle pedal bicycle movement or in the sitting position under the pedal bicycle, repeat 20 times.
Section 7: Heel and knee
In the lying or sitting position, the healthy leg is fully extended and the affected heel is tapped back and forth from the healthy knee along the anterolateral side of the calf to the lateral side of the foot, 10 times round trip.
Section 8 rotation and extension
Take the lying position, bend the lower limb on the affected side by flexing the hip and knee, support the bed with the foot, put the hip external rotation down to the knee, the outside of the leg against the bed, then make the hip internal rotation back to the support position at the beginning, then straighten the lower limb and repeat for 20 times.
Section 9 bedside leg swing
Take the lying position, take the affected leg out of the booth, place the lower leg on the edge of the bed to hang naturally in the 90 degree position of the bent knee, then make the knee flexion and extension of the lower leg swing activity, repeat 20 times.
5.Practical walking training
6.Strengthen dynamic balance training