How exactly to rehabilitate a stroke

  The functional recovery of stroke patients mainly occurs within 6 months after the disease, especially within the first 3 months. It has been proved that stroke is the best period for limb function recovery within 6 months after the onset of stroke, which should not be neglected, and reasonable rehabilitation treatment should be emphasized and carried out as early as possible. Rehabilitation of stroke should be done as early as possible according to the condition. In general, patients with ischemic stroke can be rehabilitated after 48 hours as long as they are clear, their vital signs are stable and their condition is no longer developing, while patients with cerebral hemorrhage are relatively late (2-3 weeks after the disease).  Rehabilitation is most effective in the first 3 months after stroke onset. Without early rehabilitation, the movement of the limbs may show abnormal walking patterns, i.e. the formation of misuse syndrome or disuse syndrome, and rehabilitation after discharge is often half-hearted and fails to achieve the desired goal, while early rehabilitation of stroke can minimize the impact of disability on normal life.  Many patients and their families do not know how they should carry out stroke rehabilitation. In fact, active training can be started after the onset of stroke by preventing or reducing limb spasms and sequelae through postural placement and passive movements, etc. Once the condition is stabilized, active training can be started. Since turning and passive joint exercises can only prevent bed sores, pneumonia and joint contractures, and cannot prevent other sequelae such as disuse muscle atrophy, and have no significant effect on functional recovery, patients should also start the next phase of active training as early as possible.  In order to achieve better results, stroke patients should pay attention to the following issues in the rehabilitation process: ① Pay attention to the normal limb placement. It is important to place the body in a good position and pay attention to the protection of the affected limb. Do not let the affected limb stay in one position for a long time, which may lead to joint stiffness and prolonged compression of the affected limb and obstruct the blood circulation of the affected limb. From the day of onset, if the patient’s vital signs are stable, the patient should try to move the affected limb as much as possible, such as lifting the hand and stretching the leg. If the patient is unable to exercise, family members should help the patient to do passive activities of the limb joints in bed to prevent joint contracture and muscle atrophy.  When moving the affected limb, the movement must be gentle to avoid excessive stretching of the limb leading to joint dislocation or injury. The mattress should be reasonably chosen. A bed that is too hard is prone to pressure sores, while a bed that is too soft makes it difficult for the body to sink and change position. Should turn over every 2 hours. Each practice a movement, be sure to achieve the correct posture, focus on. For each muscle exercise, the muscle should be stimulated with a certain intensity several times in a row to complete a certain amount of work load, and gradually increase. In the acute stage, rehabilitation exercises are mainly to suppress the abnormal primitive reflex activity and rebuild the normal movement pattern, followed by the training to strengthen the muscle strength.  ② Once the patient’s condition is stabilized, the training of transferring from the prone position to the sitting position can be carried out. Sitting training should be carried out when the trunk has the ability to balance. As the patient is bedridden for many days to have an adaptation process, sitting training can be carried out by first elevating the head of the bed 30° and sitting for 10 minutes without dizziness and panic, and then gradually increasing from 45° to 9 0° for 30 minutes to 1 hour to prevent the occurrence of upright hypotension. If the patient can sit smoothly in bed, then feet down and further practice sitting at the bedside, a chair can be placed at the bedside, and the patient is required to sit in the chair at least 3 times a day to avoid the debilitation brought by long-term bed rest.  ③After the patient can sit independently, he/she can start training to stand. The rehabilitation training method from sitting to standing is: support the bed with the healthy hand, transfer to the bedside with the feet in the right position, cross the fingers of both hands (the thumb of the affected limb is at the top) and bend the waist, lean the body forward, use the forward shift of the center of gravity, lift the hips and make the body upright.  ④Practice walking. After the patient can stand alone, let the patient gradually shift the weight to the affected leg and train the weight-bearing ability of the affected leg. Walk training can be started only when the patient can stand independently and balance, hold more than 75% of the weight of the affected leg, and can take steps forward. For most patients, it is not advisable to use a cane prematurely as it may interfere with the training of the affected side.  Before walking training, practice alternate forward and backward steps and weight transfer of the legs, instruct and correct the incorrect posture and gait of the patient, and ask the patient to look forward with the head up to maintain body balance during walking training. In recent years, some hospitals have used some of the weight loss support devices to carry out early walking training, so that patients have received better results in terms of walking ability and walking speed recovery.  ⑤ Conduct training of activities of daily living ability. Once the patient has a good recovery of the muscle strength of the limbs, we should train the ability of daily living, such as the ability to eat and drink independently, how to dress and undress by themselves, how to perform personal hygiene and cleanliness, self-reliance of bowel movements, bathing, doing housework, etc., so that the patient can try to achieve self-care, in order to reduce the burden on the family and society, find self-esteem and return to society and family.  (6) In addition to motor rehabilitation, attention should be paid to speech, cognitive, psychological, occupational and social rehabilitation.  (7) Patients with stroke cannot take care of themselves completely due to hemiplegia and aphasia, and many of them may have different degrees of anxiety and depression, and have different manifestations of psychological disorders such as pessimism, irritability, irritability or depression and anxiety. Medical staff should actively carry out psychological guidance, stabilize the patient’s mind and emotion, and establish the patient’s confidence in recovery and release psychological barriers through communication, reasoning, education, suggestion, psychoanalysis, music, exercise, relaxation and silence, and other psychotherapy methods.  ⑧ The essence of stroke rehabilitation is learning, exercising, exercising again and learning again, which is to mobilize the remaining brain tissue functions to reorganize and strengthen the residual functions and enhance the compensatory capacity, requiring the patient to understand and actively participate in order to achieve good rehabilitation results. Rehabilitation is an ongoing process and should be integrated into daily life.  It is best to conduct rehabilitation training under the guidance of a professional rehabilitation physician, develop a rehabilitation plan, conduct regular assessments, and instruct the patient’s family or caregivers to collaborate in training. The amount of exercise should be moderately controlled and the intensity of training should range from small to large. If the patient still feels fatigue after a day of training and a night of rest, the amount of exercise is too much and should be reduced as appropriate. Do not overexercise to avoid overexertion affecting the rehabilitation process. Exercise must be carried out according to the prescribed time, avoid favoring one part of the exercise and neglecting other parts. Avoid the phenomenon of “overprotection” and allow the patient to do things and act independently within the limits of his ability. The frequency of training should be kept at least 2 to 3 days per week, 1 to 2 times per day, for about 30 to 40 minutes each time. The training should be integrated into the activities of daily living and combined with training.