What is home rehabilitation nursing?
Family rehabilitation nursing is guided by the theory of rehabilitation medicine, focusing on the goal of comprehensive rehabilitation, applying the theory of rehabilitation nursing and rehabilitation nursing skills to guide the care and training of children and their families at home, so that the training of children’s daily living ability and daily living care can be carried out in daily life, and finally achieve the purpose of improving the self-care ability of life.
I. Daily correct posture care
1.Correct holding posture
(1) Spastic cerebral palsy: Let the child’s arms stretch out towards the mother’s back or around the mother’s neck, bend the hips and knees and place the legs apart on both sides of the mother’s waist. Keep the body close to the mother’s body.
In addition, the child can be moved to the side of the mother’s hip bone, which saves effort and can achieve the purpose of correcting the stiffness of the legs, and at the same time, the child can expand the field of vision.
(2) Hand-legged cerebral palsy: The child’s legs are brought together, the joints are flexed as close to the chest as possible, and the hands and together, so that the child is held on the mother’s chest or side.
(3) For flaccid cerebral palsy, the most important thing is to give the child a good reliance. You can use the hand-foot-excitation type of holding method or pass the right armpit of the child with one hand and hold the child’s hip with the other hand.
2, the correct sitting position.
The child takes a long sitting position, legs apart, knee joints remain extended position, induce the trunk straight, such as Figure 5; or the child sits on a chair, keep the hip, knee, ankle three joints are flexed 90 °.
3. Correct sleeping position.
The child lies on his side and spreads his legs apart. A cylindrical pillow can be placed between the legs or the child can sleep in a boat-shaped hammock.
Second, the training and care of daily living ability
What is the ability of daily living?
The ability of daily living is the most basic and common body movements that people must perform repeatedly every day in order to live independently, that is, the basic movements and skills for moving, eating, living, walking and personal hygiene.
1.Dressing training and care
Dressing is a complex skill. First of all, choose wide clothes for the child, preferably with zippers or buttons, with different patterns on the clothes, teach the child to recognize the names and purposes of the front, back, left and right, and all parts of the clothes, and take a large toy baby to teach the child to dress and undress for him, and then dress and undress for himself. When dressing, the child should take a sitting position, with the affected limb first and the healthy limb first, the order is to wear the sleeve → pocket back → then wear another sleeve → button.
Pants should be loose, with an elastic band for easy donning and doffing, and open crotch pants can be worn by severely disabled children. Shoes should be elastic or Velcro style, and socks should not be too tight with elasticity. Keep the hip and knee joints flexed when wearing pants, shoes and socks.
2.Eating training and care
In children with cerebral palsy, there are many feeding disorders, chewing difficulties, sucking and swallowing difficulties, so feeding training is the basic training of daily living ability. The selection and placement of feeding position must inhibit abnormal posture and avoid unnecessary involuntary movements and actions; and bilateral symmetry of the body is the basis of all movements. The child should be placed in a half position with bilateral shoulders tucked inward, legs apart on the floor or on a pedal, hips and knees bent, and the upper body in a natural arch.
For children with sucking and swallowing difficulties, the jaw control technique is used, i.e., a gentle and sedate upward thrust is applied to the jaw with the fingers, while the opening and closing of the mouth and forward bending of the head are induced to improve the sucking and swallowing reflexes of the child. Do not let the child lie on his back or tilt his head backward during feeding to avoid postural rigidity and choking and asphyxiation. For children with high generalized muscle tone and flexion, they can be fed in prone position. When eating, pay attention to the selection of appropriate tables, chairs and tableware, such as bowls with suction cups and binaural cups. Food selection should be paste first, then semi-liquid, soup, followed by solid food, mainly brain-healthy food supplement, such as pig brain, pig heart, pig bone marrow, sesame, silver fungus, banana, etc.
3.Use and bowel training and care
Urination and defecation training should not be too early, and it is appropriate to train after 2 years old. When training, master the defecation position and the appropriate bucket. Defecation position: sit with your buttocks on the potty, bend and separate your knees, and step flat on the ground with both feet. Appropriate toilet: preferably a toilet with a handle in front, so that the child can sit with both feet on the ground. Training should be done in accordance with daytime training first, then nighttime training; urine training first, then stool training; training to use the spittoon first, then sitting side, squatting toilet training. Choose the training time according to the regularity of the child’s defecation time, and let the child sit on the toilet regularly to develop the habit of regular defecation. Teach the child to tell others in time when he/she needs to defecate and learn to control defecation to keep his/her body clean and dry. This is very important to build up the child’s self-esteem and independence.
Psychological care
The results of many surveys show that children with cerebral palsy have the tendency of internal questioning and emotional instability, and have obvious anxiety, fear, strange behavior and other psychological disorders.
1. Psychological characteristics of children
(1) They do not seek psychological help on their own because they feel emotional problems
(2) Lack of communication skills and inability to express their feelings verbally
(3) Deeply influenced by parents or educators
(4) In the psychological stage of continuous development and transformation
(5) Rich in potential
2.Psychological guidance principles
(1) Carefully establish a good therapeutic relationship
(2) Consider the developmental level of the child at all times
(3) Use of non-verbal and indirect methods of communication: parent-child interaction, peer interaction.
(4) The principle of good learning and attention to emotional treatment: learning and play combined.
(5) Include parental involvement and cooperation
IV. Safety care
1.Strengthen the safety awareness education for children and their families, especially in feeding and walking, to prevent choking and bruises.
2.Popularize the awareness and basic means of resuscitation in case of accidental injury.
3.Properly guide rehabilitation training and establish basic knowledge to avoid dislocations and fractures.
4.Keep the indoor environment neat and clean, fresh air, and prevent cross infection.
V. Simple rehabilitation apparatus care
1.Hanging bed.
A piece of canvas with strong structure is fixed on the four sides of the bed frame around the child’s bed, so that the middle of the canvas sags in a bag shape.
Its role: ① inhibit the original back seal
②It is conducive to the child’s hands to reach the midline position
③ easy to torso side turn and turn over
2.Trolley and trolley.
There are pulleys under the trolley box, put some weights in the box to increase the stability of the body, its role to make the child bend over, bending, hip flexion, can correct the Achilles tendon spasm.
3, roller.
It is a cylindrical solid object that can be rolled on the ground. Suitable for children with spasticity.
Its role: ① supine on the roller can promote the spine and hip joint extension
② lying prone on the roller, arms straight in front of the roller, can promote head lifting
③Sitting across the roller can reduce the spasm of lower limb adductor muscles.
④ lying on the roller can practice crawling action.