I. Early recovery:
Patients in this stage generally show delayed paralysis, no random muscle contraction, and no joint reaction, the body is basically in a fully relaxed state; equivalent to Brunnstrom recovery stage 1-2.
(a) Basic purpose: The basic purpose of early rehabilitation is to prevent future complications that may seriously affect the rehabilitation process, such as swelling, muscle atrophy, joint movement limitation, etc.; to strive for early functional improvement and to prevent complications.
(2) Early rehabilitation methods:
1, correct position: teach the family and nursing staff to use the correct position, including supine, healthy side lying and affected side lying methods, require turning once every 2 hours, and pat the back several times.
2, turning exercises: hands crossed in front of the flat, respectively, to both sides of the rotation, feet propped up in bed.
3, bed self-assisted exercises: hands crossed in front of the planks, overhead, side lifts, finger nose, legs bent to support the bed to lift the buttocks, feet crossed lateral shift, etc..
4.Bedside passive exercises – upper limbs: scapular belt, shoulder joint, elbow joint, wrist and finger joints.
5.Bedside passive exercise – trunk pulling, back muscle squeezing stimulation.
6.Bedside passive exercise – lower limbs: hip, knee and ankle toe joints.
7.Promote muscle contraction methods: the use of sudden muscle tension, causing muscle contraction.
8.Expectoration
9, bed head elevation sitting training: the head of the bed gradually elevated, each position the patient can maintain 30 minutes, then gradually add 10 degrees of retraining, until you can sit up on the edge of the bed, without relying on sitting balance exercises.
10, facial, muscle stimulation: open mouth, cheek, knocking teeth, stretching, top palate, etc., frozen cotton (or ice cubes containing clothing) and taste stimulation.
11, breathing control exercises: require patients to inhale deeply – slow exhalation, relaxation.
12.Sitting training: Before the head of the bed is raised to 90 degrees, first train the patient to lift the head and shoulders with one hand behind the side, until they can support sitting up.
13.Sitting balance: correct sitting posture, bedside sitting balance, including front and back, left and right.
14.Sitting exercise: to strengthen the balance training, including crossed hands in front of the flat, side, crossed hands pointing to the nose, crossed hands pointing to the object; the lower limb muscle strength training on the healthy side, etc., can teach the family and nursing staff, and then supervise the patient to practice several times a day.
15, bed to wheelchair (or chair) transfer.
16.Sitting and standing exercises: if available, patients can be given bed standing at an early stage to help patients regain a sense of verticality, regain control of anti-gravity muscles, regain self-regulation of blood pressure, improve standing balance and overcome upright hypotension. In general, patients with cerebral infarction are required to achieve bedside sitting after 3-4 days of enrollment in the treatment group, and can be trained to stand within two weeks, and the auxiliary strength depends on the condition; patients with cerebral hemorrhage should try to achieve bedside sitting within two weeks, and stand within four weeks.
17.Do the activities of daily living with healthy hands: eating, dressing, washing, etc.
18.Application of electrical stimulation: low frequency direct current stimulation, TENS, etc.
19.Application of myoelectric feedback technology.
20.Application of acupuncture and tui na treatment.
21, the application of cerebral circulation therapy to promote cerebral blood circulation.
22.Speech therapy.
23.Psychotherapy.
(C) Rehabilitation arrangements:
Instruct patients and family members to complete 1,2,3,8,9,10,11,17 several times a day; 4,5,6,7,12,13,14,15 must be completed by the therapist once a day for 45 minutes each time; 18,19,20,21,22 can be determined by each unit to carry out or not; 23,24 if there is no professional this training, the therapist in the process of functional training In the process of functional training, the therapist should conduct simple language training, including simple vocal exercises, and be responsible for the psychological guidance of the patient so that the patient can cooperate as much as possible and carry out the rehabilitation treatment in the best condition.
II. Mid-term rehabilitation
At this stage, the patient can obviously show the flexor synergistic movement of the upper limbs and extensor synergistic movement of the lower limbs, and can gradually achieve independent movement of some muscles and joints, which is equivalent to B recovery stage 3-5.
(A) The purpose of mid-term rehabilitation is to suppress the synergistic movement pattern, train the muscles and joints to move independently at will as much as possible, improve the coordination of each joint, and gradually restore the patient’s motor ability.
(B) Medium-term rehabilitation methods:
From passive to assisted to active
24.Suppress the spasticity pattern of the upper limbs.
25.Stretching the trunk to promote and improve trunk mobility, inhibit trunk tension and spasm.
26.Hold the knees with both hands and lightly move the body from side to side to control the spasm of upper and lower limbs.
27.Flexion of the shoulder joint with the affected hand touching the therapist’s hand and then touching his forehead, and then touching his opposite shoulder to train the elbow joint to flex and extend at will.
28.Limb placement and holding activity: During the activity of the affected hand, instruct to stop at any angle and hold it in this position for a moment to improve the spatial control of the affected upper limb.
29.Autonomous movements of the shoulder joint in all directions: forward shoulder raise, shoulder abduction, shoulder external rotation.
30.Autonomous movements of the elbow joint in all directions: elbow extension, forearm rotation back.
31.Autonomous movements of the wrist and fingers: wrist dorsiflexion, lateral deviation, thumb abduction, finger pairs, etc.
32.Activities of the shoulder belt: up, outward, down.
33.Bridge movement training hip extension control.
34.Control training of hip extension and abduction: do it on the affected side in the healthy neutral position and on the healthy side in the affected neutral position.
35.Knee flexion and extension control training.
36.Flexion-extension control training of the knee joint in hip extension position.
37.Patient draped position training lower limb preparation for weight-bearing exercise.
38.Flexion of the affected knee in the prone position.
Sitting position:
39.Support training of the upper extremity on the affected side.
40.Small range of flexion and extension of the elbow joint under the affected upper limb.
41.Pushing objects forward with the affected hand or picking up objects with crossed hands.
42.Pushing objects with the back of the hand.
43.Rotating the forearm to press the play-doh.
44.Flexion of the lower limb on the affected side.
45.Pick up small objects with fingers (over the midline).
46.Muscle strength training of the lower limb on the healthy side.
47.Flexion and extension of the knee of the affected lower limb.
Standing position:
48.Standing balance training: left and right forward and backward to move the center of gravity.
49.Standing balance exercises: crossed hands (depending on the situation) before the flat overhead, after the front flat torso rotation, etc..
50, sitting and standing control training, and decomposition exercises.
51, hands supporting the wall to do elbow flexion and extension exercises to promote elbow extension or independent support of the affected hand.
52.Standing with the legs in front and behind, shifting the weight to a small range of knee flexion and extension.
53.Bend the knee in hip extension position.
54, Hip flexion and knee flexion in preparation for stepping.
55.Internal abduction, adduction and lowering pelvis training of the affected lower limb.
56.Stand on one leg separately with support.
57.Low stride training to control the pelvis up and down for stride.
58.Foot to the ground training.
59.Walking training within the double bar (three points): the healthy side of the upper limb to hold the bar forward and then the affected side of the lower limb to follow up and then the healthy side of the lower limb to step forward.
60, walking training with crutches (three points, two points): able to hold the crutches forward affected lower limb forward to take the heel of the healthy foot.
61, up and down the stairs: up/healthy hand to support the affected lower limb of the healthy side of the lower limb
Down/healthy hand to support the affected lower limb of the healthy side of the lower limb
62.Bedside ADL training: washing, dressing and undressing, and bowel handling, etc.
(C) rehabilitation arrangements: the above items basically need the therapist’s help and guidance to complete, generally 1-2 times a day, 45 minutes each time, 4-5 days a week, once a day in the family, and once in the afternoon to guide the family practice.
(D) Precautions
All joints should be kept within the maximum range of motion, and the treatment should be painless or tolerated by the patient, avoiding violence and using gentle techniques; the therapist should give appropriate protection, and the force of assistance should be large to small, encouraging the patient to complete independently.
III. Post-rehabilitation
(a) Rehabilitation purpose: Patients at this stage can use the affected limb to a large extent, which is comparable to Brunnstorm recovery stage 5-6. The purpose of rehabilitation training is how to use the affected side more freely, how to better apply the skills acquired through training in daily life, to improve various ADL abilities, to improve speed on the basis of ensuring the quality of movement, and to maximize the quality of life.
(B) Rehabilitation methods:
Continue the previous phase of training, further consolidate, improve and apply to daily life
63.Strengthening of fine finger movements
64.Lateral walking training, first to the healthy side and then to the back side
65.Gait improvement training: pelvic relaxation, knee flexion strengthening training
66.Gait improvement training: ankle dorsiflexion and stretching.
67.Promote the lower limb support ability of the affected side: standing position, the healthy leg in front, the affected leg in the back, instructions to shift the weight forward, the affected foot heel can not leave the ground.
68.Promote the ability of the affected lower limb support, the affected limb weight-bearing, the healthy limb back and forth stride.
69.Doing standing position cross-legged exercise in turn.
70.Family ADL guidance.
71.Modification of living room.
(C) The rehabilitation arrangement is the same as the previous stage.
This period is mainly assisted by community rehabilitation doctors, family members and volunteers, 3-4 times a week. Biweekly home visits or outpatient visits.
(d) About the use of assistive devices.
72.Foot brace – foot drop
73.Wrist dorsiflexion splint–flexion of wrist spasm.
74.Crutches, walking aids.
75.Wheelchair.
(E) about the training of family members and volunteers:
The training is conducted by rehabilitation therapists at home or by family members at the hospital once every 2 weeks, and the training content is the patient’s home training program method, and the patient’s family members and volunteers are required to record the training content once every 2 weeks.
(f) Record of rehabilitation treatment.
The therapist is required to record once a week in the early stage, and once every 2 weeks after the second month of the disease. The content of the record is: the patient’s functional status, the current stage of the problem; the current stage of rehabilitation purposes; the current stage of treatment content, the aforementioned content can be filled in the number, if there is additional can be filled in other columns.