I. Is it possible to recover from a stroke by medication? Due to recent advances in medical technology and modern monitoring methods, the success rate of rescuing patients with severe strokes has become higher and higher. This may give some people the illusion that they can recover from a stroke with medication alone, which is not true. In fact, the harsh truth we see in the clinic is that these rescued patients with severe stroke have much more severe dysfunction than ordinary patients, the quality of survival is poor, the patients are in great pain, and some even have the feeling that life is worse than death. Unfortunately, there is not yet a drug that can bring dead brain nerve cells back to life. In other words, many people’s hope to rely on “expensive drugs, imported drugs” to help their recovery is unrealistic and impossible. It is necessary to minimize functional impairment through strenuous and even painful rehabilitation training, so that one can return to family and society in the best condition. Of course, for stroke patients, in addition to stroke itself disease are accompanied by a variety of diseases such as hypertension, diabetes, heart disease, hyperlipidemia, atherosclerosis, etc., should deal with the relationship between disease treatment and functional rehabilitation according to the specific situation of the patient. Generally speaking, drug therapy should be the main treatment in the acute stage to save the patient’s life; rehabilitation therapy should be the main treatment in the remission stage, supplemented by drug therapy to reduce the patient’s functional impairment and prevent the disease from recurring. The organic combination of the two is the scientific and reasonable treatment method. Second, after a stroke, is “excessive care” for patients conducive to recovery? The author once encountered an interesting incident: an elderly man had a stroke, his wife and children were very nervous, plus the old man was cautious and introverted, although his condition was stable, he did not dare to take the initiative to move around. The wife was responsible for all the major and minor things, including food and living, and her functional recovery had been very poor. When his wife fell ill one day due to strain, the old man felt very guilty and went to do what he could to ease his wife’s burden as much as possible. When his wife recovered a few weeks later, the old man was surprised to find that his mobility was basically normal. As you can see, a moderate amount of basic activities of daily living can lead to physical recovery. The care of family, friends and colleagues is beneficial to the patient’s psychological recovery and is advocated. However, it cannot replace the patient’s active training under the guidance of the rehabilitation doctor. Third, can stroke be rehabilitated? With the gradual arrival of the aging society and the change of modern lifestyle and life rhythm, the incidence of acute cerebrovascular disease (commonly known as stroke, including cerebral hemorrhage, cerebral infarction, etc.) is increasing, and even from the past, mainly in the elderly, began to spread to the young and middle-aged. After a lot of long-term research and practice, medical doctors have found that the human brain is an incredibly sophisticated “machine”. Each part of it has its own specific function and is closely related to each other. In other words, once a part of the brain is diseased, because brain cells cannot be regenerated, the human body is bound to have specific functional disorders. This theory is one of the important basic theories of neurology. However, it also has obvious defects, according to this theory, once a brain disease such as stroke occurs, because brain tissue necrosis can not be regenerated, the specific dysfunction can not be restored, people do not need to carry out special treatment for such diseases. In fact, after a long period of close observation, medical doctors found that the human brain has great plasticity. In the 1980s, a foreign medical doctor reported a case of a patient who had undergone a left-sided cerebral resection for intractable epilepsy, and according to the above theory, the patient would have lost all speech and right side limb functions. However, one week after the operation, the patient was clear, with unimpaired speech and slight movement of the right lower limb. After one year of rehabilitation, the patient’s speech, intelligence, and limb movement were basically normal, while becoming a horticultural worker. In other words, after the patient completely lost the left side of the brain, the right side of the brain basically replaced the function of the left side of the brain, which cannot be explained by the traditional theory. A similar case was reported in China: a patient with brainstem infarction (a severe stroke) resumed full-day work and was able to climb mountains alone after rehabilitation. Three years later, he died of heart disease, and the autopsy found that 93% of the tissues in his brainstem had been destroyed, which proved that the affected person had completed more than 90% of the neurological functions with 7% of the normal brain tissues before he was born, thus showing that the human brain has a huge compensatory and substitution function. Recent studies have found that the human brain has the ability to structurally and functionally reorganize to compensate for lost functions after injury, in addition to the known functions and conduction pathways. This ability manifests itself in different forms at different times and under different conditions. For example, peripheral replacement, contralateral replacement, regenerative germination, reorganizational adjustment, etc. Of course, it is also possible to lose these functions permanently if they are not stimulated and induced at the right time and in the right way. Therefore for stroke, we can say: it is not whether the function can be recovered or not, but the difference between the degree of recovery is big or small, good or bad, fast or slow. Stroke patients should build up confidence, seize the time and choose the right method for rehabilitation. Minimize functional impairment in order to improve their quality of life. D. What are the general signs before a stroke (stroke) occurs? The following conditions indicate the possibility of stroke 1. episodic vertigo 2. episodic one-sided darkness or double vision 3. sudden adverse speech 4. sudden weakness of one limb or limb weakness 5. sudden numbness of one limb The above states last for several minutes or hours, and usually recover completely within 4 hours. V. Why does one limb of hemiplegia have pain? After cerebrovascular disease enters the recovery period, if rehabilitation exercises are not carried out in time, contracture, stiffness and deformity of the hemiplegic side limb will occur and even cause severe pain, which will bring great pain to the patient. The common causes of pain in paralyzed limbs are as follows: 1. Shoulder joint subluxation After complete paralysis of the upper limb, the muscles around the shoulder joint are relaxed, and under the influence of gravity, the shoulder joint is often pulled and subluxed. Patients often feel pain or discomfort, especially when giving passive movement to the affected limb. Why is the shoulder joint prone to subluxation? This is due to the characteristics of the shoulder joint itself. We know that the range of motion of each joint in the body varies greatly. The shoulder joint has the largest range of motion. It can move in almost all directions, allowing us to perform a variety of daily activities with flexibility. This function of the shoulder joint is mainly related to its structure. Because the shoulder fossa is shallow and the joint head is round and large, it is certainly easy to move. However, when the limb is paralyzed, the muscle ligaments around the shoulder joint relax and the function of fixing the joint is weakened. Combined with the effect of gravity, the shoulder joint leaves the joint fossa and slips below, resulting in clinical changes in the shape of the shoulder joint and pain. 2.Shoulder-hand syndrome This syndrome often occurs 1 to 3 months after cerebrovascular disease, and is a common cause of shoulder pain and hand pain after cerebrovascular disease. If left untreated, the consequences are serious and often cause disability. This disease mainly manifests as shoulder pain on the affected side, hand pain, limited abduction, rotation and lifting of the upper limbs, and severe pain with forced passive movement, swelling of the back of the hand and fingers, disappearance of skin wrinkles on the back of the hand, shiny feeling, slight concavity with pressure, gradual redness of the skin, increased skin temperature and painful flexion of the finger and wrist joints. 3. Shoulder joint periarthritis often occurs several months after hemiplegia, with pain in the upper arm during abduction and elevation at the beginning of the clinical period, and then gradually worsens. The patient experiences persistent severe pain in the upper arm and hand, which often makes it difficult for the patient to sleep, while crying hopelessly and pleading with the doctor or others not to move his shoulder and arm. In addition, severe flexion and inversion of the toes, atrophy of the flexors of the elbow and knee joints, and shortening of the Achilles tendon often cause pain in the affected limb when touching the ground or when moving. What are the programs and forms of post-stroke rehabilitation training? The rehabilitation training program is based on the patient’s situation to take the targeted functional training. The specific content is: 1, muscle strength enhancement training: muscle strength enhancement is a basic element of rehabilitation training. Since the muscles that are still innervated by nerves need to compensate for the functions of those paralyzed muscles, there are high requirements for muscle strength. They often have to do movements that they would not normally have to do.2. Muscle flexibility and joint range of motion training: Muscle stretching is another key part of rehabilitation, and many functional activities involving range of motion require a higher level of flexibility than is generally available.3. Functional training: Neither muscle strength strengthening nor muscle stretching alone will improve the patient’s function, so functional training becomes becomes an important part of the hyperactivity training program. Forms of rehabilitation training Muscle strengthening, stretching and functional training can be accomplished through one-on-one training between trainer and patient, group activities and solo activities. 1.”One-on-one” training: one trainer to one patient, i.e., hands-on training to increase stability and strength, as well as simple protection. 2.Group activities: group activities: group training to increase stability and strength, as well as simple protection. 2. group activities: group activities are a good way to motivate patients with the same or similar motor skills to work towards the same goals. 3. individual activities: during the rehabilitation process, the patient should spend some time each day doing individual activities, such as stretching specific muscles and improving some necessary skills. Seven, early stroke to prevent fractures. After stroke, due to long-term bed rest, both lower limbs lose the opportunity to bear weight, which can lead to bone decalcification, i.e. osteoporosis, and can easily cause femoral neck fracture of the affected lower limbs. Fractures of the femoral neck in hemiplegic patients mostly occur in the early stage of moving to the ground, commonly in the process of moving, such as from bed to chair, from wheelchair to toilet, etc. In the early stage of going to the ground, the fracture can occur due to poor support of lower limbs, unstable balance of standing position and unwillingness to trouble family members. The prevention method is very simple: as long as early rehabilitation training, such as weight-bearing and weight-shifting training on the ground, and do not be blindly optimistic when moving, and ask more family members to take care of you, no accident will happen. Do not go down because of the fear of falling. Eight, late autumn stroke prevention. Late autumn, the temperature drops, is the season of stroke. The following points should be noted for stroke prevention: 1. 0 degrees Celsius is a meteorological factor for high blood clotting Statistics show that the most likely season of the year for stroke is late autumn and early spring, and the peak of the incidence is when the weather is 0 degrees Celsius. Therefore, when you hear that the weather is preventing high winds and temperatures drop to 0 degrees Celsius or below, you should add clothes and take anticoagulant drugs such as aspirin early. Second, be wary of small strokes developing into strokes Stroke patients have varying degrees of small stroke symptoms, such as slurred speech, difficulty swallowing, blurred vision, hemianesthesia or weakness, months or days before the onset of the stroke. Most of these symptoms are transient and disappear naturally after 24 hours, and thus are often overlooked. If you are alert to the signs of stroke, you will be able to see the smallest and shortest signs and prevent and treat them early, so that they will not develop into strokes. Third, although the stroke is healed when the recurrence of the stroke is healed in late autumn and easy to take the opportunity to recur, so do not ignore the necessary prevention. Stroke patients are 30% of the recurrence. The first thing you need to do is to take a walk for 3 minutes to an hour every day, which is good for the adaptation to temperature changes. 3. Nine, stroke rehabilitation is important in the early stage. Modern neurological rehabilitation is an emerging medical discipline, which was only gradually introduced and carried out in China in the late 1980s. Due to the late start and insufficient publicity, it has not received the attention and attention of society so far. Most people in the medical field also lack understanding of its specific content, and even mistakenly and automatically equate it with convalescence, physical therapy, massage and exercise training. As a result, many stroke patients lose valuable recovery time and are left with difficult to recover dysfunction, which is a great pity. Many patients, often months or even years after a stroke, remember to undergo rehabilitation only when they have undergone a variety of unsatisfactory treatments. At this time, the possibility of reconstructing the brain function of the patient is already minimal, and moreover, it is accompanied by “misuse, overuse and disuse” syndrome, which makes the treatment twice as hard and half as effective. Theory and practice have proven that the best time for stroke patients to recover is within three months after the onset of stroke, and the earlier the formal rehabilitation is carried out, the better the results. Beyond three months, the speed of recovery will slow down and the effect will be greatly reduced. This is because the higher motor functions governed by the human brain are damaged during a stroke, and the reflexes established after birth, such as balance and turning, as well as the skillful movements acquired through learning, such as walking and hand movement, are inhibited to varying degrees. The spinal cord-controlled high-level movements will replace the brain-controlled high-level movements and become the dominant movement pattern. This is the reason why it is common to see patients after a stroke with the upper limbs inward and internally rotated, the finger, wrist and elbow joints flexed; the lower limbs straightened and externally rotated, the toes trailing on the ground, and the circle-like walking gait. As for the specific time to start rehabilitation treatment, the general principle is to start as early as possible, but it should also be treated differently according to the patient’s condition. For severe stroke, rehabilitation should be started 48 hours after the patient’s consciousness, vital signs are stable and the condition no longer progresses; for patients who have been in coma for a long time and cannot be awake for a short time, attention should be paid to the patient’s limb position, body position, and passive movement of limbs and joints to prevent future The patient should also pay attention to the patient’s limb position, body position, and passive movement of limbs and joints to prevent future disuse atrophy and painful contracture of joints. It can be said that for stroke patients, time is health. We hope that stroke patients and their family members will cherish the precious time and seize the opportunity to carry out rehabilitation treatment, so that the patients’ residual functions can be restored to the maximum and the quality of life can be improved. X. Why do we need passive movement of joints? Passive movement of paralyzed limbs is the main means to prevent joint contracture. If the shoulder joint is inactive for three weeks, soft tissue adhesions around the joint may occur, causing pain and thus limiting future generations, and further development may lead to shoulder contracture. The sooner the passive activity of the joint starts, the better. XI. Why should you leave the bed and get down early after stroke? After a stroke, regardless of the length of time, there is a process of bed rest, and early getting off the ground can make both lower limbs weight-bearing, the affected lower limbs weight-bearing is conducive to hip and knee joint extension, creating conditions for walking. 2. Prevent the occurrence of disuse syndrome. 3. Prevent the appearance of osteoporosis. Due to the structure of the diet, China is generally deficient in calcium, especially the middle-aged and elderly. Weight-bearing training on the ground can prevent the occurrence of osteoporosis, thus avoiding the occurrence of fractures.4. Facilitate the early recovery of daily living ability, such as going to the toilet to urinate and defecate, sitting on a chair to eat, etc.5. Enhance the patient’s confidence and desire to recover from the disease, and carry out rehabilitation training with a good psychological state. Twelve, how to prevent the occurrence of stroke? 1, to prevent stroke, we must minimize the risk factors of stroke as much as possible. Control of hypertension is the focus of stroke prevention. Patients with hypertension should take antihypertensive drugs on time as prescribed by their doctors, and those who are in a position to do so should preferably have their blood pressure measured once a day, especially during the phase of adjusting antihypertensive drugs to keep their blood pressure stable. To maintain emotional stability, do less or do not do things that can easily cause emotional excitement, such as playing cards, mahjong, watching sports broadcasts, etc.; diet must be light and moderate, quit smoking and alcohol, keep bowel movements smooth; moderate activities, such as walking, playing tai chi, etc. To prevent and treat atherosclerosis, the key is to prevent hyperlipidemia and obesity. Establish a healthy diet, eat more fresh vegetables and fruits, and eat less fatty foods such as fatty meat and animal offal; exercise in moderation to increase calorie consumption; and take lipid-lowering drugs. Control diabetes and other diseases such as heart disease, vasculitis, etc. 2, pay attention to the aura signs of stroke: some patients often have aura such as elevated and fluctuating blood pressure, headache and dizziness, numbness and weakness of the hands and feet before stroke attack, which should be controlled by taking measures as early as possible after detection. 3, effectively control transient ischemic attack: when patients have aura of transient ischemic attack, they should be allowed to rest quietly and treated actively to prevent it from developing into cerebral thrombosis. Prevent it from developing into cerebral thrombosis.4. Pay attention to the influence of meteorological factors: seasons and climate change can make hypertensive patients emotionally unstable and their blood pressure fluctuates, which can induce stroke, and it is more important to guard against stroke at such times. XIII. What to do when a stroke comes? Strokes often occur suddenly and take people by surprise. However, after careful observation, there are often some omens before the onset of the stroke. 1, one side of the face or upper and lower extremities suddenly feel numb, weakness, mouth distortion, drooling. This is due to insufficient blood supply to the brain, which damages the neural pathways that innervate the trunk. 2. Sudden difficulty in speaking or understanding other people’s words. This is due to insufficient blood supply to the cerebral cortex, which affects the language center. 3. Sudden vertigo and unsteadiness. This is due to insufficient blood supply to the cerebellum, which affects its balance function. The above auguries may be temporary and disappear after some time, or they may recur or get progressively worse. 4. Transient unconsciousness or drowsiness. 5. An unbearable headache appears. The headache changes from intermittent to persistent, or is accompanied by nausea and vomiting. This is often due to a sudden increase in intra-arterial pressure, which stimulates the nociceptive receptors in the vessel wall. This may be a sign of cerebral hemorrhage and should be paid special attention. For the patient’s family, in case of cerebral hemorrhage, in addition to sending the patient to the doctor urgently, some measures should be taken as follows: 1. Keep the patient quiet and completely bedridden. Try not to move the patient during the acute period and do not perform non-urgent examinations. This is because the change of the patient’s position at this time may prompt continued bleeding in the brain. After 48 hours of onset, the patient can be gradually turned to prevent the occurrence of pneumonic pneumonia and decubitus ulcers. 2. Keep the airway unobstructed. Comatose patients should loosen the top button and belt, and those who have dentures should also take them out, and turn the patient’s head sideways so that the airway can be kept open and vomit is not easily inhaled into the trachea, the head position can be slightly lowered, and the patient should not be given medicine, and the patient should be suctioned diligently. It is best to let the patient inhale oxygen continuously or intermittently. 3. maintain the supply of nutrition. In the first 1 to 2 days of the disease, comatose patients should fast. After the patient is conscious and has no difficulty in swallowing, try to give some liquid diet, such as milk, egg soup and so on. The amount should be smaller each time, and can be fed more times. Once complications occur in patients with cerebral hemorrhage, they often become the direct cause of death. Therefore, it is necessary to do the above work. XIV. When can stroke patients do rehabilitation exercises? After a stroke patient has passed the danger period, he enters the rehabilitation exercise stage. At this time, the patient is mainly through a certain way of exercise to promote the functional recovery of paralyzed limbs, prevent contracture of paralyzed limbs, improve physical health, prevent the occurrence of complications, and make the patient treat the disease with a positive attitude and improve the mental state of the patient. The main methods used are massage, passive exercise with the help of others, and active exercise with the patient’s own participation. Although medical professionals advocate rehabilitation exercises as early as possible, patients and family members are often apprehensive about early exercises, especially for patients with cerebral hemorrhage, who are worried that early activities may cause rebleeding. In fact, the chance of rebleeding caused by rehabilitation exercises is very small. Medical personnel concluded that rehabilitation exercises for patients with cerebral hemorrhage will not cause rebleeding as long as the blood pressure is stable and the movements are not violent, while rehabilitation exercises start too late to prevent sequelae and complications. Others believe that the rehabilitation of stroke patients is meaningless after six months, and the patient’s body function will not recover more from further exercise, which is also wrong. Many patients still have improved physical function 1 year after the stroke, and do not insist on exercise, the function that has been restored often regress. Some patients with other organ pathologies such as hypertension and coronary artery disease worry that exercise will cause blood pressure fluctuations and heart attacks. In fact, stroke rehabilitation exercises are gradual, and as long as overexertion and excessive exertion are avoided, these conditions generally do not occur. Therefore, we advocate that once a stroke patient’s condition is stable, he or she can exercise to promote the recovery of the disease.