In China if there is a paralyzed mother-in-law in the family, and the daughter-in-law is virtuous and feeds water, food, poop and urine every day, this is a good daughter-in-law. But if you look at this matter from the perspective of a rehabilitation doctor, especially a rehabilitation doctor in the United States, you may ask 3 questions: First, has this mother-in-law gone through regular rehabilitation treatment. Second, has she independently recovered her disability, and if not completely, can the remaining part be replaced with appliances, for example, if the patient has difficulty walking, then has she been given a walking frame or wheelchair so that she can walk on her own for a while. Third, is the family overprotective of the patient, meaning that the patient is not allowed to do what she can do. If there is overprotection, it is totally wrong. Doing things independently is the best way to live a long life and to feel that one’s life is worthwhile. We must remember that nothing is more valuable to a patient who is going to recover than his ability to do things and act independently on his own. The following is a discussion of the management of the surviving patient after a stroke from a rehabilitation perspective. About muscle and joint contractures. Muscle and joint contractures are one of the main causes of disability after a stroke, so in the United States, when a patient has a stroke, a doctor and therapist specializing in rehabilitation medicine will consult with the patient on the same day or the second day. For example, if the patient is hemiplegic on one side and cannot move his left arm and leg after the stroke, the rehabilitation physician will order the patient’s left arm and leg to be exercised by the therapist on a daily basis. There are two main aspects of exercise, one is joint, to move each joint to the maximum extent to prevent joint ankylosis; the second is muscle strength, passive movement of the muscle can maintain muscle strength to prevent disuse atrophy. The emphasis here is to be early and timely. Osteoporosis. When the bones are not under pressure in the normal activity state, osteoporosis starts to appear as early as 30 hours. A hemiplegic patient who does not pay attention to osteoporosis is likely to develop a fracture of the hip femur. The first treatment for osteoporosis is to move the limbs as early as possible, even if it is a passive activity. Secondly, vitamin D and calcium should be given. Heterotopic ossification. The concept of heterotopic ossification is that when the patient is paralyzed in bed and cannot move, the soft tissues next to the bones will have calcium deposits, and the main symptom is pain. It can be treated with antipyretic and analgesic drugs, strengthening the movement of the limbs and preventing falls. Among the various types of paralysis, right-sided hemiplegia is the most prone to falls. To prevent falls, the first step is for the rehabilitation doctor and therapist to determine the patient’s mobility. When the patient does not need help from others, the first step is for him to use a walking frame, which is a very common rehabilitation tool in the U.S. The biggest difference between it and a cane is that the walking frame itself is stable, with four feet on the ground, and the person can entrust his or her weight to it, which neither a cane nor a crutch can do. Weakness. Prevent the debilitation of the body caused by bed rest. Scientific studies have pointed out that if a normal person is bedridden for 7 days, the debilitation brought about needs to be restored to a normal state with another 7 days. Therefore, a chair should be placed next to the bed, and when the patient is seen to be in a little remission, the patient should be asked to sit in the chair at least 3 times a day to avoid the debilitation brought about by prolonged bed rest. Difficulty urinating or urinary incontinence. About 50 to 60 percent of patients who have a stroke will have difficulty urinating or become incontinent. However, they usually recover on their own within 6 months to 2 years, and some patients recover completely within 1 month, or as late as 4 years. After the patient has passed the risk period, indwelling catheters are no longer used in the United States because prolonged indwelling catheters can cause urinary tract infections, commonly with Pseudomonas aeruginosa. Urinary tract infections mostly refer to bladder infections, which can travel to the renal pelvis and cause kidney failure as a consequence of serious kidney infections. After removing the long-retained catheter, a disposable catheter is used, four times a day, and the urethral opening should be well disinfected. Decubitus ulcers. Decubitus ulcers often occur in the sacral area and heel. The prevention of bedsores in the sacral area is to turn the patient, and the patient should be turned regularly. To prevent bedsores on the heel, in the United States a foot brace is used, which holds the entire foot up so that the heel hangs in the air to avoid bedsores. In the past, the U.S. also used rubber bands and tire belts to hold the patient’s buttocks up. This is no longer used in the United States because it has been found that the ring itself can withstand a lot of pressure, and it is now common to change the patient’s mattress to a very soft one. Swallowing difficulties. About 25% to 45% of elderly people who have a stroke will have difficulty swallowing. Treatment for dysphagia begins with a gastric tube or gastrostomy, followed by a speech therapist to treat the dysphagia. The speech therapist is responsible for two things, one is speech difficulties and the other is swallowing difficulties. When treating a patient for dysphagia, the first step is to determine the patient’s muscle paralysis through various tests and try to adjust the dryness of the food for the patient. In the United States, there are many different levels of dryness of food. To give you an example, there is a grade called honey spoon, where a spoon is placed in the honey and then the spoon is slowly poured down as a standard of consistency. As you can see here, the United States has done a very fine job with the diet of stroke patients.