Cerebral infarction and cerebral hemorrhage is one of the most common diseases with high morbidity, mortality, and disability.
At present, the mortality rate of stroke is the highest among all kinds of diseases. In terms of disability, about 70% of stroke patients have different degrees of functional impairment, including limb paralysis, speech and communication difficulties, limb numbness, cognitive impairment, swallowing difficulties, among which hemiplegia is the most common, causing great pain to the patient and a heavy burden to the family and society.
Modern concept of rehabilitation
WHO definition of disability.
Disabling (injury) organ dysfunction.
Disability (loss of ability to work) difficulty in working.
Disability, social difficulties.
Rehabilitation is a restorative and learning process that helps patients to regain their motor skills, independence and the greatest possible return to social life through training in the three areas of post-stroke disabling, disability and handicap.
The definition of rehabilitation given by the WHO in 1981 is
Rehabilitation is the application of all useful measures to reduce the effects of disability and to reintegrate the disabled person into society.
Rehabilitation involves not only training the disabled person to adapt to his or her surroundings, but also adjusting the conditions of the surroundings and society to facilitate his or her reintegration into society.
Rehabilitation services should be designed with the participation of the person with a disability, their family and the community in which they live.
Requirements and objectives of stroke rehabilitation
In 1989, the WHO stated the following for stroke rehabilitation
To improve motor, speech, cognitive and other impaired functions
To enable the patient to achieve spiritual, psychological and social readaptation
To enable the patient to resume autonomous activities, social activities and interpersonal interaction, and to restore the patient’s ability to perform daily living activities to the extent possible.
Rehabilitation principles
Early rehabilitation and gradual progress Rehabilitation should be started simultaneously with emergency rescue, and preventive rehabilitation should be done. Through preventive measures, it can not only promote the recovery of damaged functions as soon as possible, but also prevent the occurrence of various complications, and at the same time, early training should be gradual, measured and persistent according to the condition to prevent muscle atrophy and functional degeneration. The advantages of early rehabilitation also include shortening the course of treatment, reducing the patient’s hospitalization days, and reducing the patient’s economic burden and psychological pressure. According to the data published by the World Health Organization in 1989, 60% of stroke patients can achieve self-care in daily life after early rehabilitation, which shows that the earlier the start of rehabilitation, the better the rehabilitation effect.
There are various rehabilitation measures, including physical therapy (ultrasound therapy, square wave, spinal cord energization therapy, hydrotherapy, magnetic therapy, etc.), as well as psychological, acupuncture, massage, Chinese medicine, and qigong therapy.
Systematic management and social participation Stroke rehabilitation is a long and difficult process, and the implementation of rehabilitation should be systematic and phased. Professionals working in rehabilitation are required to work with patients and their families individually and in small groups to develop rehabilitation plans, and to motivate patients to cooperate with treatment and rehabilitation training. At the same time, rehabilitation centers should be set up in primary hospitals, community clinics, and health care stations to provide regular guidance and follow-up for the early recovery of patients.
Rehabilitation measures
Emotional therapy: psychotherapy. Stroke patients cannot take care of themselves completely because of the sequelae such as, aphasia, etc. Many patients will have different manifestations of psychological disorders such as pessimism, irritability, irritability, depression and anxiety. In this case, we should actively carry out psychological guidance to stabilize the patient’s mind and emotion, and establish the patient’s confidence in recovery and release the psychological barriers through various psychotherapy methods such as communication, reasoning, education, suggestion, psychoanalysis, music, exercise, and relaxation and silence.
When the disease is stable and entering the recovery period, Western medicine mainly focuses on stabilizing blood pressure and promoting the recovery of brain metabolism and neurological function, using brain circulation promoter and brain metabolism activator. methods.
Briefly described as follows.
(1) Hemiplegia: In cases of Qi deficiency and blood stagnation and stagnant veins, the symptoms include hemiplegia, weakness of the limbs, swelling of the affected side of the hands and feet, language-jaggedness, atrophy of the face, thin white coating, and thin and weak pulse. The treatment is to tonify the Qi and activate the Blood, and to open the meridians and activate the channels. Formulation: Tonifying Yang and Returning the Five Elements with Addition and Reduction. The symptoms include stiffness and contracture of the affected limbs, headache and dizziness, redness of the face, thin yellow tongue coating and strong string pulse. The treatment is to pacify the liver and submerge the yang, extinguish the wind and ventilate the ligaments. Formula: Tianma Hooked Vine Drink plus or minus or Liver Quenching Wind Soup plus or minus.
(2) Unfavorable language: wind and phlegm blocking the ligaments, with strong tongue and lame speech, numbness of limbs and slippery pulse. The treatment is to dispel wind and phlegm, to promote the orifice and clear the ligament. The formula is based on the addition and subtraction of Xieyue Dan. In cases of kidney deficiency and essence deficiency, the symptoms include mute speech, palpitations, shortness of breath and weakness of the waist and knees. The treatment is to nourish Yin, tonify the kidney and benefit the orifices. The formula includes removing cinnamon and sophora from Gehuang Drink and adding almonds, orris and mucuna pruriens to open the tone and facilitate the orifice.
(3) Distortion of the mouth and eyes: mostly caused by wind and phlegm yin in the luo channel. The formula is based on the formula of “Zhuanzheng San”. All the above drugs are taken orally in soup twice a day, and can be changed to pills or tablets after 1 month.
Acupuncture and massage treatment Patients with stroke often show two major dysfunctions, mainly speech and hemiplegia, which can be significantly improved by acupuncture and massage treatment.
The above symptoms can be significantly improved.
(1) Acupuncture and moxibustion therapy: head and face acupuncture points such as Baihui, Shangxing, Yin Tang, Ying Xiang, Sun, Xia Guan, Di Cang, Ren Zhong, Feng Chi, etc., and upper limbs acupuncture points such as Shoulder, Qu Chi, Waiguan, Heping, etc. The upper limbs are mainly shoulder, Quchi, Waiguan and Heguan, and the lower limbs are mainly Huanjiao, Yanglingquan, Feisanli, Kunlun and Taichong, each time the needles are left for 20 minutes, once a day, 10 days as a course of treatment, after 3 days of rest, the second course can be performed.
(2) massage therapy: the order can start from the head with gentle as the main, with the thumb to rub the patient’s head 5 times, with the hand to rub the patient’s upper limbs 5 times, and then use the fingers in the tendon area to do the finger method 1 to 2 times, while pressing the kneading and activity of the joints, lower limb flexion several times, and thumb kneading the back of the foot between the toes several times, each massage 30min, once a day, 15 days for a course of treatment, the length of massage and power The length of time and power of massage should vary from person to person.
Functional exercise Due to paralysis, the blockage of qi and blood flow, easy to lead to limb atrophy and complications. Functional exercise can not only improve the tension of the central nervous system and prevent the decline of the physiological functions of the whole body, but also promote blood circulation and stimulate neurotrophic functions to prevent disuse atrophy of muscles, bones and joints and deformity of joints. When the disease stabilizes and enters the recovery period, the patient can leave the bed, first of all, stand training, family-assisted standing, practice left and right turn, front and back tilt activities, followed by walking training, first step in place, then family-assisted stepping, to the healthy limb with the affected limb, gradually transition to support their own objects walking, until walking on foot, and finally is the training of daily activities, such as: eating, bathing, dressing, grooming, cooking, shopping and Finally, the training of daily activities, such as eating, bathing, dressing, grooming, cooking, shopping, and reading and writing, will eventually achieve the goal of self-care.
The above rehabilitation measures have been effective in treating stroke, indicating that rehabilitation plays an important role in the overall treatment of stroke. Because of the late start of rehabilitation medicine in China, there is still a need for further systematic standardization of stroke rehabilitation procedures, and individualized treatment plans should be emphasized for specific patients to achieve the goal of comprehensive rehabilitation.