Rehabilitation guidance program for patients with brain injury

  At this stage of China’s medical resources are scarce, and clinical health care workers are often too busy to take care of the post-surgical rehabilitation of patients with brain injury due to various reasons because they are already physically and mentally exhausted from the rescue treatment of acute patients. I have collected and prepared this article in order to help patients and their families.  Acute and chronic cranial lesions caused by functional disorders are mainly motor disorders, language disorders, emotional disorders. Among them, motor disorders are the most common, manifested as central hemiparesis of the limb on the opposite side of the lesion.  (The functional recovery after brain injury (after trauma, hemorrhage, inflammation, tumor resection) is the fastest in the first 3 months after injury (especially the first 2~3 weeks), and the maximum recovery is basically reached at 6 months, and there is usually no significant change after 2 years. The early functional exercise after the cause is removed, especially within 6 weeks after the onset of the functional exercise is appropriate, directly affect the patient’s long-term results and quality of life.  General precautions: 1. Absolute bed rest (2~3 weeks) should be given during the acute period, long-distance transportation and excessive moving are not recommended, the head should be protected when turning over, and the movements should be gentle and decent to avoid aggravating intracranial hemorrhage.  2.For those who are unconscious, agitated or combined with psychiatric symptoms, guardrails should be added and properly restrained to prevent bruises.  3.Elevate the head of the bed 15~30 degrees, which is conducive to cerebral venous reflux, intracranial pressure decrease and reduce cerebral edema.  4.Leave the comatose patient’s head to one side, remove the movable denture, and keep the airway open to prevent misaspiration.  5.A conscious patient, after the vital signs are stable (mostly in 2~3 days after injury), start to do active limb function exercise in bed, bedside or out of bed, starting from 5~10 minutes/time, gradually to 30~45 minutes/time, if there is no obvious discomfort, at least 2~3 times a day, avoid excessive force to hold the breath.  Second, dietary guidance: guide the patient to carry out the necessary dietary therapy, which can improve the body’s resistance to disease and improve brain circulation.  1. Acute phase: Recommend the patient’s gastrointestinal nutrition intake of high protein, high vitamin, high calorie (2300~2800 calories/day) and low fat food. High protein food with meat (lean meat, poultry, etc.) is preferred, and more fresh soy products. To keep the patient’s bowels open, eat more fresh green vegetables, sweet potatoes, pears, bananas, honey and other fruit products and coarse fiber foods. Avoid pungent, spicy and other stimulating foods, smoking and alcohol, fatty meat, pork, egg yolk, fish, animal offal and other high-fat foods.  Patients with combined diabetes should limit the intake of carbohydrates and sweet fruits! Patients of advanced age or with combined cardiac dysfunction should limit sodium intake (no more than 3g/day) to prevent deterioration of cardiac function, sodium and water retention aggravating cerebral edema.  Food temperature is appropriate (36~40 degrees), too hot may scald the oral mucosa, too cold may cause diarrhea, erratic, and affect digestion and absorption. For those who can still eat, feeding food should not be too fast, and should be suspended when vomiting or belching to prevent food from choking into the trachea and causing asphyxia or aspiration pneumonia. For those who are still in a coma for 24 hours and cannot eat, and those who are not suffering from upper gastrointestinal bleeding from combined stress ulcers, start nasal feeding of liquid diet as soon as possible, 4~5 times/day, 200~300 ml/time, such as milk, soybean milk, lotus root powder, steamed egg or mixed homogenate, etc. The liquid should be boiled and sterilized and cooled before feeding.  2, recovery patients give light, low salt, low fat, moderate amount of protein, high vitamin, high fiber food, eat more vegetables and fruits, avoid spicy food, quit smoking and alcohol, keep the bowel movement smooth. Fat people should reduce their body weight, reduce calorie intake, and avoid pure sugar.  Functional exercise and exercise guidance: For the sequelae of hemiplegia and unfavorable language after cerebral hemorrhage, it is necessary to improve the circulation and metabolism of the body through functional exercise and appropriate exercise to promote the recovery of the disease body. It is necessary to strengthen the active and passive activities of the paralyzed limbs in a planned, regular and quantitative manner.  The patient can start to assist in functional exercise when the condition is stable, and the patient should progress step by step from lying to sitting to standing to walking, together with massage and acupuncture. Limb massage should start from the distal joints and passive movement first. At first, the patient is reluctant to move because of pain, then should be comforted, encouraged and slightly forced. Activities start with a short period of small movements and gradually increase the amount. Help and encourage the patient to resume voluntary movement as soon as possible. After 2 weeks of surgery, acupuncture treatment can be considered. In general, patients can recover the function of paralyzed limbs within a few months or even longer, as long as they can insist on exercise.  For patients with aphasia, the principle of starting from easy to difficult, step by step, repeated exercises, and perseverance is adhered to. The patient should start with the least damaged speech function first, and then train with specific objects, single words, words and short sentences, and start pronunciation and intelligence training as early as possible. (1) Motor aphasia: words~phrases; (2) Sensory aphasia: use gestures and expressions to express intention; (3) Naming aphasia: use objects to repeatedly teach the patient to say their names. In addition, the patient may be asked to follow a pre-recorded standard phrase for word-by-word language retraining. Pay attention to prevent the patient from being overworked.  Do psychological guidance: 1, the acute phase of the patient’s life is critical, the family is very anxious, should take the initiative to explain to the family in detail the condition and prognosis, eliminate their tension and anxiety, correct view of the changes in the condition, and ask them to arrange reasonable escort and visitation, keep the room environment quiet, reduce all adverse stimuli, so that they establish confidence and actively cooperate with rescue and treatment.  2, recovery period patients due to long-term bed-ridden, life can not take care of themselves and appear pessimistic, depressed, in the functional exercise, there is often eager to achieve the psychological, medical and nursing staff should be patient and meticulous psychological guidance, more persuasive explanation work, care for the patient, and cite typical rehabilitation cases, encourage patients to enhance the confidence of recovery, so that they cooperate with doctors to carry out the necessary treatment and rehabilitation exercise, to avoid mental stimulation, especially too happy, too angry and so on. In particular, emotional changes such as excessive joy and anger. Ask family members to avoid causing mental stimulation to the patient, so that the patient is in an optimistic, peaceful and comfortable environment.  V. Discharge guidance: Patients with traumatic brain injury are more likely to have sequelae of intellectual disability. Attention should be paid to the early start of various functional training and rehabilitation treatment. To strengthen daily life, personal hygiene, diet, sleep and other basic care and training. Especially for those who cannot take care of themselves, they should be trained in living habits to prevent progressive decline of mental status. As long as the patient is not severely demented, he/she should be guided to defecate regularly and develop the habit of regular defecation.  Patients should avoid emotional excitement, remove the unfavorable factors such as anxiety, fear, anger and worry, and maintain a comfortable mood. Eat a light diet, more watery and fibrous food, more vegetables and fruits, avoid smoking, alcohol and spicy stimulating food. Avoid heavy physical labor, insist on doing health care gymnastics, such as tai chi and other appropriate exercises, and pay attention to the combination of work and rest.  The rehabilitation process is hard and long ( usually takes 1~3 years, or even a lifetime!!!) It requires the confidence, patience and persistence of the patient, family members and medical staff, and is carried out gradually and persistently under the guidance of the doctor. Pay attention to regular blood pressure measurement, review of the condition, timely treatment of possible coexisting hypertension, atherosclerosis, hyperlipidemia, hyperviscosity, coronary heart disease, diabetes, etc.