I. Initial or flaccid phase The goal of treatment in this period is to improve respiration, swallowing and feeding, and body perception.2 Improve control of the trunk and proximal joints.3 Maintain movement of the scapula, elbow, wrist, hand, hip, knee and ankle.4 Improve muscle tone and balance as soon as possible.5 Improve functional mobility. 1, pay attention to maintain the correct position in bed 2, massage and passive activities 3, the use of nerve promotion techniques to the right upper limb extensor muscle weakness, to illustrate the excitatory promotion techniques Zhang Jiankui, Department of Pediatrics, The First Affiliated Hospital of Henan Medical College of Traditional Chinese Medicine Manipulation Contents 1 various reflexes joint reflexes healthy side of the upper limb resistance to elbow extension pull bow reflex head turned to the right, right arm extensor muscle excitement, left arm flexor muscle excitement rotation waist reflex waist to the left rotation inclined plate reflex tilt to the left 2 sensory Tactile stimulation Quick brushing and light touching of the skin on the extensor side of the upper limb, light tapping of the extensor tendon or muscle belly Temperature stimulation Quick brushing with ice or local placement for 3-5 seconds Squeeze Strengthening of the shoulder, elbow and extensor belly Squeeze Pulling the muscle Quick light stretching of the extensor muscle group Special receptor stimulation Place the affected upper limb in a visible place Upper limb movement pattern Extend the affected limb from the side of the body up over the head, fingers spread, palm outward up 4, medical gymnastics section 1 healthy hand hair combing head turned to the affected side, using the healthy hand from the healthy side of the forehead to the back of the head and neck combing, requiring fingers tight pressure on the scalp, slowly push backward, repeat 20 times. Section 2 squeeze the affected hand with the healthy hand to turn the affected arm in front of the chest, with the healthy hand thumb. Squeeze each finger along the affected side from the distal end to the proximal end, and press the root of the proximal end of the finger for 20 seconds, repeating each finger 5 times. Section 3: Healthy hand beat Put the affected arm in front of the chest and use the palm of the healthy hand to beat from the affected shoulder to the hand along the lateral side of the upper limb, 20 times round trip. Section 4 group finger lift with the healthy hand and the affected hand crossed in front of the chest, the affected hand thumb pressed on the healthy hand thumb, and then the healthy hand drive the affected hand to lift forward or up over the head until the two elbow joints are completely straight, hold for 10 seconds and then recover, repeat 20 times. Section 5 wash around the face Grab the affected hand with the healthy hand to make it stretch, and then drive the affected hand in the face in the forward and reverse direction to imitate the action of washing the face, repeat 10 times. Section 6 half bridge exercise Two upper limbs are stretched out on the side of the body, two lower limbs to bend the hip and knee position, the affected lower limb fixed or the affected leg on the healthy knee, and then try to lift the hip out of the bed, hold for 10 seconds, repeat 5-10 times, there should be no breath-holding action. Section 7 resistance leg clamping Both lower limbs are flexed at the hip and knee, both feet are supported on the bed, the affected leg is fixed by others, then the healthy leg is rotated inwardly to the affected leg, while others exert some resistance on the inner side of the healthy knee to enhance the strength to complete the resistance leg clamping, repeat 20 times. Section 8 leg crossover swing The affected leg is passively supported by flexing the hip and knee, fixed by others at the foot, the healthy leg is crossed over the affected knee, and the hip is swung to the left and right driven by the healthy leg, the healthy leg is required to play a fixed role on the affected leg during the activity, repeat 20 times. Section 9 straight leg raise The lower limb on the healthy side is raised 30 degrees in the straight position, hold for 10 seconds, also the healthy leg can hold the affected leg to do straight leg raise, repeat 5 times. Section 10 hand-foot touch Touch the dorsum of the foot of the healthy leg with the hand on the healthy side, repeat 10 times. Section 11 healthy foot knocking knee with the healthy side of the heel knocking the affected knee, from below the knee along the front of the outer side of the calf from the top down to the outside of the foot back and forth 10 times. Section 12 breathing exercises Slow deep exhalation and inhalation exercises in the supine position. 5,Passive activity Use the diagonal diagonal activity of multi-muscle group and multi-joint in PNF. 6,Position change and balance training 7,Limb control training 8,Strength training of upper limb extensor and lower limb tibialis anterior muscle. Intermediate or spastic stage brunnstrom grade 3~4 The goals of treatment in this stage are 1,to further balance muscle tone including inhibiting spastic muscles and facilitating antagonistic muscle activities; 2,to promote more separation movements; 3,to strengthen the ability to control the activities of proximal large muscle groups and to complete more complex life activities; 4,to strengthen the control of intermediate joints (elbow and knee). 1,Adopt inhibitory posture to break the muscle spasm pattern. 2,Use inhibitory techniques in neural facilitation techniques to reduce muscle tone (right lower limb) Manipulation Contents 1 Various reflexes Joint reflexes Resisted knee extension in the able-bodied lower limb Pulled bow reflex Head turned to the left, pulled bow to the left Rotated waist reflex Rotated waist to the left Lower limb flexor reflex Stimulation of the right plantar 2 Control key points Knee, [toe 3 Stimulation receptors Squeeze Light continuous (3-5 seconds) squeeze of extensor tendons and hip and knee joints Deep cold stimulation Quick brief Continuous slow stimulation of the lower extremity extensors Lower extremity mobility pattern Make cross-legged shoeing movements 3, Muscle distraction technique Traction of the quadriceps in a prone position with a hand towel under the thigh and passive flexion of the knee to maximum range; traction of the calf triceps by having the patient stand against a wall with a slanting plate placed on the bottom of the foot. 4,Medical gymnastics Section 1 shoulder lift Lift the upper limb of the affected side forward, requiring full extension of the elbow joint, if the strength is poor, you can fix the affected elbow with the healthy hand and then do this action, you can also lift the upper limb of the healthy side forward and let the palm of the affected side switch back and forth along the healthy side of the shoulder to the hand, repeat each action 10 times. Section 2 diagonal palm strike The affected upper extremity is held up on the abducted side with the palm facing upward, the healthy upper extremity is held forward in a flat position, so that the affected upper extremity is gradually brought closer to the healthy one, and at the same time, the palm is struck with force, repeat 10 times. Section 3 shrugging movement Both shoulders are shrugged upward and around at the same time, repeat 20 times. Section 4 palms together elbows hands together in front of the forehead, then do two elbows clenched and separate movement, repeat 10 times. Section 5 cross-legged movement The healthy leg is supported on the bed by flexing the hip and knee, the affected leg is crossed over the knee of the healthy leg, if the tension of the affected leg extensor is high, (with muscle spasm) let the affected leg take the bending state on the knee and put it down. If you have difficulty in completing the above actions, you can put the healthy leg in a straight position, then put the affected leg on the healthy knee or calf and put it down, repeat 10 times. Section 6 hip swinging Bend the legs together to support the bed, swing the hips to the left and right respectively, repeat 10 times. Section 7 pinch leg flexion Straighten the legs together then bend the hips and knees at the same time, ask the heels to move close to the bed, after sufficient bending, lift both feet and bring both knees closer to the abdomen. If the affected leg strength is insufficient, the affected foot will be placed on the healthy foot to complete this action, repeat 10 times. Section 8 single-legged half bridge Double upper limbs are extended on the side of the body, the affected leg is flexed at the hip and knee, the foot is supported on the bed, the healthy leg is straightened and raised 30 to 40 degrees, or cocked on the affected knee, the hip is lifted and extended with force, and held for 10 seconds, repeat 10 times. Section 9 resistance elbow extension The upper limb of the healthy side is bent in front of the chest, and the affected hand is pushed forward with the healthy hand against the palm to achieve full extension of the elbow joint on the affected side, requiring the healthy hand to give resistance in the opposite direction, repeat 10 times. 5,physical therapy 6,antispasmodic 7,balance exercise 8,gait training 9,occupational therapy 10,daily living ability training 11,slow muscle tension with the help of muscle or splint Recovery period brunnstrom grade 5~6 The goals of this treatment period 1,strengthen the control of motor ability, 2,improve gait, 3,improve ADL ability 4,improve repetitive activities and increase the speed of movement so that the movement is performed according to the normal frequency 5,improve the control of eccentric contraction 1,further strengthen the active, power and coordinated control movement of the affected limb and promote the further improvement of the detachment movement 2,strengthen the ADL training of the affected side 3,pay attention to the prevention and control of various hemiplegic complications such as painful shoulder, subluxation, misuse syndrome 4,medical gymnastics Section 1 left and right hammering One side of the upper limb is held forward and flat with the hand clenched in a fist with the fist upward, the other side The other side of the hand holds a fist and makes a circular hammering motion on the side of the body, and holds a fist to strike the other side of the fist, then exchange the action, alternating between the two sides for 10 times. Section 2 hands and knees beat double upper limbs on the side of the body, lower limbs for hip flexion knee stepping activities, with one hand raised to pat the opposite side of the knee, and then change the other hand to repeat the above actions, alternating 20 times. Section 3 hands and feet beat two upper limbs straight in the body side, palms facing down, both wrists close to the bed, hands alternately beat on the bed, and then the two lower limbs bent, the heel close to the bed, for the left and right feet alternately beat action, but also in a sitting or standing position under the hands, feet alternately beat the table or the ground, can be repeated to fatigue. Section 4 lower limb circles Take supine sitting, standing position, both sides of the lower limb heel close to the bed or the ground, alternating circling action, repeat 10 times. Section 5 half bridge stepping Take the supine position, on the basis of the previous half bridge movement, double lower limbs bent to support the lifting of the hip position, alternately lifting the feet for stepping action, repeat 10 times. Section 6 lateral pedaling Take the healthy side lying down, the affected leg for the front to back circle pedaling bicycle movement or in the sitting position under the pedal bicycle, repeat 20 times. Section 7 knocking heel knee Take the lying or sitting position, the healthy leg is fully extended, the affected heel is knocked back and forth from the healthy knee along the anterolateral side of the calf to the lateral side of the foot, 10 times round trip. Section 8 rotation and flexion Take the lying position, bend the lower limb on the affected side, bend the hip and knee, support the foot on the bed, put the hip outwardly rotated down to the knee, the outside of the leg against the bed, then make the hip inwardly rotated back to the support position at the beginning, then straighten the lower limb and repeat 20 times. Section 9 bedside leg swing Take the lying position, take the affected leg out of the booth, place the lower leg on the edge of the bed and hang it naturally in the 90 degree position of knee flexion and extension, then carry out the lower leg swing activity of knee flexion and extension, repeat 20 times. 5,Practical walking training 6,Strengthening dynamic balance training