Hypertensive cerebral hemorrhage (cerebral hemorrhage, also known as stroke), is a disease with high morbidity, mortality and disability rates. With the progress of society and the accelerated pace of life, there is a trend of increasing year by year. According to incomplete statistics, the incidence rate in China is 110/100,000, and its mortality rate varies with the different sites of bleeding (about 35%), and the disability rate is almost 100%, which seriously affects the health of the people. Therefore, for patients who have passed the acute stage, rehabilitation training is the main method for patients to live independently or even go back to work. However, there are various rehabilitation methods and programs, resulting in some patients’ families being overwhelmed and even missing the best rehabilitation period. Brain hemorrhage is divided into acute, recovery and sequelae treatment according to the course of the disease, and appropriate rehabilitation treatment programs can be selected in different periods, taking into account the patient’s condition.
Acute phase rehabilitation treatment
For patients who are 2-3 days postoperative or conservatively treated, regardless of whether they are conscious or not, as long as their vital signs are stable, their blood pressure is satisfactorily controlled, their intracranial hematoma is no longer enlarged on review of cranial CT, and their neurological signs do not continue to deteriorate, early bedside rehabilitation can be actively carried out. The purpose of rehabilitation is to prevent bed sores, respiratory and urinary tract infections, deep phlebitis and joint contracture and deformation, as well as to prepare for functional training during the recovery period.
(1) Local massage: mainly for the hemiplegic side of the limb, massage and muscle massage are performed to counteract muscle spasm, 3-6 times a day for 30 minutes each time.
(2) Bedside passive joint exercises: both sides should be performed, with gentle techniques, 2-3 times a day, and all directions of movement of each joint should be trained, 3-5 times in each direction. This is especially important for the prevention of deep vein thrombosis.
(3) Postural treatment: correct postural placement in bed is helpful to inhibit spasm, prevent shoulder subluxation, and induce separation movement early.
(4) Application of electromyographic feedback techniques and electrical stimulation: acupuncture and low and medium frequency electrical therapy can be used to stimulate the recovery of nerve pathways in the limbs.
(5) Vocal music stimulation: wear headphones for the patient and choose music with different rhythms (preferably music that the patient liked before the disease) for stimulation to promote the establishment of auditory nerve reflexes, which also has a certain wake-up-promoting effect.
(6) Turn and pat the back regularly to promote sputum excretion and control lung infection.
(7) For awake patients, a little warm water can be given for swallowing training at this time, from little to much, step by step, taking care not to give paste diet hastily to avoid choking.
(8) For patients with mild condition, self-assisted exercises of facial, tongue and lip muscle stimulation can be performed in bed: mouth opening, cheek puffing, tooth knocking, tongue extension, tongue on palate and articulation training; ice cubes and taste stimulation can be given. Turning exercises and sitting training can also be performed.
Recovery period rehabilitation treatment
Patients in this period can obviously show the flexor synergistic movement of upper limbs and extensor synergistic movement of lower limbs, and gradually can achieve independent movement of some muscles and joints, which is equivalent to Brunstrom’s recovery stage 3-5; the purpose of rehabilitation is to improve the patient’s cognition, language comprehension and expression ability, 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 movement. Coordination, and gradually restore the patient’s motor ability.
(1) Rehabilitation treatment for motor disorders: support shoes (hard-soled high-top shoes) can be used to correct poor posture; through recumbent training (from passive → assisted → active), crawl training, kneeling and sitting balance training, gradually transition to standing balance training and walking training.
(2) Training of rectal and bladder function: At this time, the catheter can be removed and regular bowel control training can be performed.
(3) Psychological treatment: Focus on adjusting the values and methods of thinking of the disabled, so that patients can realize the limitations of disability and their remaining functions, abilities and intrinsic values, and thus find their own direction of effort, and put themselves into rehabilitation training as soon as possible to achieve the purpose of self-care and social reintegration; the main treatment methods include: supportive psychotherapy (including guidance, persuasion, explanation, training, adjustment, environment The main treatment methods include: supportive psychotherapy (including guidance, persuasion, explanation, training, adjustment, environment, cultivation of interest, etc.), rational/emotional therapy and humanistic treatment methods. Psychotherapy is particularly important for patients with simple hemiplegia, who are prone to negative emotions and confront training during the rehabilitation process, which is also the basis for further rehabilitation training later.
(4) Speech disorder therapy: For dysarthria and swallowing disorder, speech ability can be improved by targeted adoption of vocalization and discrimination exercises. In patients with post-brain hemorrhage waking aphasia, most of them can understand other people’s speech, but cannot reply in an imperative manner. But the usual phrases (especially curse words) can be fluently and clearly said (explosive language), at this time should not give up, should follow the patient’s thinking to induce, help patients gradually restore language function.
(5) Rehabilitation training of attention and concentration: training through graphic cards, guessing games, deleting homework, sense of time, and homework therapy.
(6) Rehabilitation training of thinking ability: trained by building blocks, arranging numbers, sorting, and occupational therapy. Increase the patient’s awareness of hemiplegia, reduce disability due to neuropsychological and motor disorders, and enable the patient to actively participate in meaningful daily activities and maximize independence.
(7) Rehabilitation of behavioral disorders: mainly to help patients establish conditioned reflexes and operant conditioned reflexes. It includes reinforcement therapy, systematic desensitization method, relaxation therapy, etc.
(8) Hyperbaric oxygen therapy: theoretically, the earlier the hyperbaric oxygen therapy, the better, but in the early stage, the patient’s vital signs are unstable, blood pressure control is not ideal, there are still obvious signs of cranial hypertension, or combined with serious complications, tracheotomy with pneumonia, at this time, hyperbaric oxygen therapy is easy to aggravate the disease, half the effort. Therefore, it is more appropriate to carry out hyperbaric oxygen therapy when the condition is stabilized after cerebral hemorrhage and there are no serious complications (about 2-4 weeks after hemorrhage).
(9) General physiotherapy: It is the application of the physical energy of nature (air, sunlight, climate, seawater, mud and sand, etc.) to stimulate the recovery of sensorimotor function.
(10) Other facilitation techniques: application of artificial physical energy (electrotherapy, phototherapy, ultrasound, magnetic therapy, heat and cold therapy, hydrotherapy, etc.). At present, each hospital rehabilitation department has corresponding rehabilitation training equipment, such as medium and high frequency electrical stimulation, magnetic therapy instrument, infrared irradiation and various types of orthopedic support, training bed, etc., according to the patient’s specific situation to choose the appropriate method. Do not overdo and overspend on training, which may lead to rebellious psychology, shoulder dislocation, or even induce elevated blood pressure and lead to cerebral hemorrhage again.
(11) Traditional Chinese medicine rehabilitation treatment: mainly plays the role of regulation, rectification, loosening and strengthening. It includes massage, acupuncture, cupping, qigong, medicinal bath, medicinal fumigation, and traditional exercises (Five Animal Play, Eight Duan Jin, Taijiquan, etc.).
Post-acute rehabilitation
Patients in this stage have improved cognitive ability and poor memory, and can use the affected limb to a large extent, which is equivalent to Brunstrom recovery stage 5-6. Severely ill patients are mostly left with serious neurological deficits such as limb movement and language. 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, improve various daily living abilities, increase speed on the basis of ensuring movement quality, and maximize the patient’s quality of life. With the right approach and perseverance, most can achieve considerable improvement. In addition, attention must be paid to treatments that address the causes and prevent relapse.
(1) Increased rehabilitation of cognitive impairment.
(2) Training of concentration ability and language ability
(3) Training in perception, memory, and spatial recognition
(4) Maintenance training to use residual functions to prevent functional deterioration
(5) Enhancement of limb coordination and fine motor skills; improvement of gait and restoration of walking ability
(6) Use of assistive devices (canes, walkers, wheelchairs) when appropriate to compensate for the function of the affected limb.
(7) compensatory problems on the healthy side.
(8) Emphasis on psychological, social and family environment modification to enable patients to return to society
(9) Improving and restoring the ability of daily living activities.
In conclusion, the treatment of cerebral hemorrhage cannot be limited to a fixed pattern, but must be individualized according to the clinical specifics of the patient. In addition to paying attention to the staging of pathological stages, staging according to brain lesions at an early stage and adopting highly targeted therapies can continuously improve the efficacy and reduce the morbidity, mortality and disability rates.