A scientific approach to rehabilitation in three stages of neurological training

1. The three-stage rehabilitation technique of neurological training is philosophical and in accordance with the laws of nature.  Philosophy is the fundamental principle and wisdom that guides people’s life and work. Darwin’s theory of evolution, the concept of “using in and out”, and what people often call “the fire of a star can start a prairie fire” and “overkill” are all concepts that can make people’s spirit new. They are the fundamental principles that guide life.  In the three-stage rehabilitation method of neurological training, although the method was developed over a long period of time, it was not realized that the method was developed gradually under the guidance of the philosophy, but that the method was gradually added and the equipment was developed according to the needs of functional rehabilitation, and after the development was basically mature, it was realized through analysis. We found that all the rehabilitation methods of neurological training are guided by philosophical ideas, which are mainly reflected in the following aspects: (1) The principle of “the use of progress and waste”: In the three-stage method, we insist on the principle of “finding the method of using the brain to dominate the active movement of the limbs as early as possible in order to restore the function of the brain. “The guiding idea of “find a way to use the brain to dominate the active movement of the limbs as early as possible in order to restore the function of the brain” is in line with the principle of Darwin’s theory of evolution, and the patient is guided to use the brain to dominate the active movement of the limbs, so the effect should be better.  (2) The principle of “transcendental goals – power source”: “Goals” are widely used in daily life, such as the national “five-year plan goals”. The principle of “goals” is widely used in daily life, such as the national “five-year plan goals”, “the plan of the day lies in the morning, the plan of the year lies in the spring”, etc., which fully reflects the philosophy of life that without goals, there is no motivation. In the three stages of neurological training, the patient is guided and encouraged to develop potential, rebuild procedures and reshape movement patterns by continuously surpassing gradually increasing goals, based on the establishment of transcendent goals and the application of the six-step TCM guidance technique. Therefore, the neurological training and rehabilitation method is not simply active motor training, but is more conducive to the development and utilization of neurological potential by creating a critical state without danger, verbal motivation and inspiration, and resistance to the reinforcement of active movement by constantly surpassing the goal.  (3) The “no break, no gain” principle: It is very difficult to establish a new pattern without removing the original pattern (or habit). If an old habit is not corrected, there is no way to talk about the establishment of good habits. In the process of correcting abnormal motor patterns, the patient is trained in brain potential development and motor program reconstruction based on the prohibition and restriction of walking, i.e., on the basis of breaking the old patterns. At the stage of movement pattern remodeling, the patient is trained to remodel normal gait with the assistance of a device that can effectively limit abnormal joint movements in limb movements, and gradually transition to independent walking. The training process of “new” normal gait is gradually established from the foundation while “breaking” is realized, thus achieving better clinical results.  (4) The principle of “Yin and Yang are secret and harmony is precious”: Chinese medicine uses the unity of opposites of “Yin and Yang”, emphasizes the balance and coordination of the functional activities of various tissues and organs, summarizes the laws of various vital activities of the human body, and elaborates the principle of “Yin and Yang are secret and the spirit is healing. If yin and yang are separated from each other, the essence will be extinct”, which is important for maintaining normal life activities.  After injury to the central nervous system, the original “homeostasis” is broken, so a series of disorders of movement and other functions occur. The six-step method of Chinese medicine guiding technique in the three-stage method has the function of “opening the meridians, harmonizing the qi and blood, developing the potential of the brain and internal organs, and restoring the balance of yin and yang of the body. Some scholars believe that the effect of the neurological training and rehabilitation method may be related to the increase of the “negative entropy flow” in the body after the training of “opening the meridians and activating the channels and developing the potential of the brain and internal organs”, which restores the “internal homeostatic mechanism” of the body.  2, the three-stage method is in line with the natural law of “subject – knowledge subject – functional subject” functional transformation.  The law of nature, also called the law of nature, is the law that exists inside the objective things in nature, which is the inherent nature of natural phenomena and has the objectivity that does not depend on human will.  People as the subject of the use of methods, through learning to learn the method, but this is not the same as the actual function, still need to be applied through the actual application, in order to use the method to better solve practical problems. Just as the process of martial arts masters learning to apply martial arts is mentioned above, so is the process of an army with 100,000 soldiers, who have trained physically, learned gun operation and knowledge of formation, but also need practical training, i.e., military exercises, in order to turn what they have learned into actual technical combat ability.  In this process, all three follow the process of functional transformation: “the subject person – the person who has learned the method – the person who actually applies the method”, and all three are indispensable.  The neurological training and rehabilitation method is a process of “transformation of method into function” that takes place inside the human body. The main body is the brain cells, the main target of the first stage of training in the three-stage method. Through the potential development method, new brain cells are mobilized and alternate conduction pathways are activated. The second stage of the three-stage approach is to use motor program reconstruction techniques to establish close connections between these newly mobilized brain cells and the non-dead brain cells, so that they can learn to work in a coordinated and orderly manner. In the third phase, the motor pattern remodeling training, i.e., the practical application training, translates the results of the previous training into the actual ability to govern the movement of the body. Following the internal law of the process from “cellular activation, method learning to practical application”, as long as the method is appropriate, the indications are chosen appropriately, and the training time meets the requirements, good clinical results should be obtained.  On the other hand, although the law of nature itself does not depend on human will, human beings can use their wisdom and methods to trigger, regulate and control the physical, energy and information processes in nature to make them change or stabilize in favor of the human body, that is, “subjective initiative based on objective law”. In the three-stage neurological training method, the rehabilitation principle of “early standing and walking recovery” for patients with severe illness, severe cognitive impairment and low consciousness is in line with this principle, and through potential development, standing and walking training, patients with severe illness can learn methods and develop their potential through use. Through potential development, standing and walking training, patients with severe diseases can learn the method and develop their potential through the use of it, so that some patients who cannot do active movement training by ordinary methods and have difficulty in recovering their functions can do the required training and facilitate functional recovery.  3.Dialectical treatment, the formation of individual rehabilitation principles around the three-stage approach.  In order to improve the clinical effectiveness of the neurological training rehabilitation method, highly targeted individualized treatment principles and programs have been formed around the three-stage approach. Through an exhaustive functional assessment, the main points of impairment are identified (e.g., the cause of the circling gait, sometimes simply due to the denervation of the peroneus longus longus muscle), and the final rehabilitation goals, rehabilitation principles, treatment plan, and implementation process (physician, therapist, location, and time) are determined. In terms of rehabilitation principles, for patients who have not yet gotten out of bed after the disease or who have developed abnormal movement patterns but are evaluated and expected to recover function better with neurological training rehabilitation techniques, the typical three-stage rehabilitation principles are used, and the training is carried out strictly in accordance with the requirements of each stage; for patients who only have dysfunction in individual areas and are evaluated and expected to recover function faster, the atypical three-stage For patients with severe dysfunction, old age and frailty or obvious cognitive impairment, the rehabilitation principle of “early standing and walking recovery” was adopted. In the case of pediatric cerebral palsy, the rehabilitation principle of “early standing and walking development” is used, which means that along with the training of lower limb potential development, abnormal gait correction and weight reduction walking training devices are used to assist in walking training, so as to develop brain potential as soon as possible and to have a better recovery of the brain’s ability to govern the voluntary movement of the limbs.  In addition, for elderly patients with severe diseases, according to the principle of “choosing the lesser of two evils”, the treatment of some parts of the function that are difficult to recover should be abandoned, and the function that is important for the ability of daily life should be restored. For example, if the upper limb and the lower limb are dysfunctional, because the upper limb is more difficult to recover, the upper limb can be protected in a functional position and the rehabilitation of the lower limb can be carried out first. Moreover, one upper limb function is normal and can still complete daily living activities. However, if the function of only one lower extremity is normal, the ability to take care of oneself in daily life will be seriously affected. Compared with the functional recovery of one lower limb and the functional recovery of foot valgus, the functional recovery of foot valgus is relatively difficult, and foot braces can be worn to correct foot valgus so that it does not affect the recovery of the overall walking function of the lower limbs. Because, the ability of both lower limbs to stand and walk is essential to improve the patient’s ability to take care of himself.  4. The course of treatment of the three-stage rehabilitation method should be adjusted appropriately according to the situation.  In more than ten years of clinical practice, one month of treatment time for each stage can basically meet the treatment needs of patients with stage rehabilitation goals. However, for patients with severe illness or long duration of illness, it should be extended appropriately according to the actual situation. In fact, a 3-month course of treatment does not yet meet the time requirements for recovery of injured brain functions. This is because the time required to establish function in the brain of an animal is positively correlated with the evolutionary level of the animal. The higher the evolutionary level of the animal, the longer the time required to establish function, and vice versa, the shorter the time required. Humans are higher evolved animals and can walk only about 1 year after birth. A 3-month course of rehabilitation training is determined according to the principle of “hospital-community-family” rehabilitation, as well as various factors such as hospital beds, family financial burden and human resource constraints. Patients who have developed abnormal movement patterns during the acute or recovery period should first be treated in a hospital rehabilitation center for one course of treatment to solve most of their problems. At this point, the patient’s functional recovery will mostly enter a slower plateau phase. After teaching the patient the basic rehabilitation methods of self-training, the patient is discharged back to the community and continues training at the community health center, while returning to home for self-exercise. After six months or one year, return to the hospital rehabilitation center for the next course of treatment. This makes the rehabilitation process relatively economical for the patient, less burdensome for the family, shorter bed occupancy time, and conducive to the patient’s functional recovery.  5. The equipment applied with the method is an effective tool to ensure the efficacy of the method.  Equipment is an effective tool to ensure the standardized application of the method, broaden the scope of application of the method, increase the effect of the method, and reduce labor intensity. At present, the rehabilitation methods widely used at home and abroad and invented in the middle of the last century, such as Bobath, Rood, Brunnstrom, PNF (Proprioceptive Neuromuscular Facilitation), MRP (Motor Relearning Program), etc., require equipment other than the equipment. Program), etc. The equipment required is manual except for PT bed, balance bar and Bobath ball, and no other equipment is needed.  Most of the existing rehabilitation equipment for clinical applications are designed by engineers mainly for symptoms. For example, standing beds designed for foot drop, CPM devices designed for muscle and joint adhesions, lower extremity rehabilitation training robots designed for patients without the ability to walk, and so on. Obviously, although these devices are useful in some aspects, from the perspective of restoring brain function, they are of little use because they do not conform to the mechanism of active movement to promote changes in brain plasticity, but they can play the role of preparatory training before restoring brain function to rehabilitation training.  Neurological training devices, whether they are potential development, motor program reconstruction and motor pattern remodeling training devices, or meridian-guided neurological training robots and meridian-guided one-to-many automatic training systems, are designed for clinical application of the method. For example, the potential development equipment, under the effect of the weight reduction and protection function of the equipment, can enable patients with heavy weight, heavy symptoms, cognitive impairment, and low consciousness state to carry out training of voluntary, assisted or forced active movement, which obviously broadens the scope of application of the method, facilitates the standardized application of the method and the improvement of the effect, and can effectively reduce the labor intensity of the therapist, especially the automated neurological training equipment, which is more In particular, automated neurological training equipment has the advantage of this aspect.  6, the rehabilitation process of restoring motor function after CNS injury is a systematic project.  Restoration of motor function after brain injury, I think, is different from the process of treatment of body part injuries and lesions, because the treatment of body part lesions, is the process of repair or replacement of individual parts of the whole. Just like a car with a broken battery or tire, after replacing a new battery or repairing a broken tire, the car can run as good as new again. Another example is a ruptured liver, which is surgically repaired to stop the bleeding or part of the liver lobe is removed, and after healing, function is restored and the person can return to work. A kidney with cancer on one side can be surgically removed, and after the wound heals, it will naturally regain its ability to perform daily life. When a person has a fracture, it can be fixed by surgical repositioning, rest for a period of time, and after the fracture heals, a little exercise can generally restore the original function. Early rehabilitation interventions can effectively prevent complications and promote healing and shorten the course of the disease.  However, restoring the lost motor function after brain injury is different, not only to repair the damaged brain, but also to restore the brain’s ability to dominate the body and organs. Therefore, compared with the restoration of body organs and local functions, the restoration of brain function after injury is a relationship between “using” and “being used” based on the restoration of its own functions. The brain uses its own functions to dominate body parts and organs, and body parts and organs work under the domination of the brain. In the process of restoring brain function, it is necessary to restore both the brain’s own function and the function of the body parts it dominates. Therefore, the restoration of brain function is a systematic project. Moreover, as far as brain function is concerned, it is necessary to restore both the function of individual cells and the ability of intercellular synergy. For example, for the functional recovery of a patient with hemiplegia of cerebral infarction on one side, it is necessary to first restore the function of damaged brain cells or train other brain tissues to compensate for their functions, and then restore the coordinated function between old and new cells. And on this basis, their ability to actually innervate the movement of the limb is restored. In addition, the functions of the limbs themselves need to be restored, such as adhesions of muscles and joints, deformities (e.g. foot drop, inversion), etc., before the body can finally be restored to do what the brain wants to do under its domination. Therefore, the rehabilitation process of brain function is to apply many methods including rehabilitation methods and medical engineering techniques to restore a disabled person to a person with the ability to take care of himself or herself and work, which can be said to be a human shaping project and a medical discipline with high technology content, when surgery and medicine are difficult to solve.  In conclusion, the three-stage neurological rehabilitation method is a philosophical and scientific method that conforms to the laws of nature, and it is also a concrete manifestation of the cross-fertilization and integrated application of various neurological rehabilitation techniques. I think that as the clinical application of this method increases, the research continues to deepen, the method continues to improve, and the types and quality of equipment continue to innovate and improve, it will eventually be perfected and develop and play a role in promoting the development of rehabilitation.