I. Definition
Cerebrovascular disease (CVD) refers to brain lesions caused by various cerebrovascular pathologies. The former is also known as cerebral infarction, including cerebral thrombosis and cerebral thrombosis; the latter includes cerebral hemorrhage and subarachnoid hemorrhage. Cerebrovascular disease (CVD) is one of the common and prevalent diseases in the elderly. The annual incidence rate in China is 217/100,000, which is similar to that of Japan and higher than that of the West. Cerebrovascular disease has a high mortality rate, often accounting for the first and second causes of death in China’s cities, while its prevalence is 719/100,000. According to the rough calculation of population, the total number of patients suffering from cerebrovascular disease in China will reach 6-7 million. Cerebrovascular disease is often followed by a series of disorders such as limb paralysis, speech, memory and thinking, and sometimes mental and behavioral abnormalities. If the treatment and rehabilitation are not appropriate, hemiplegia and unfavorable speech will be left behind, and the disability rate is extremely high. About 3/4 of the survivors in China are left with disabilities. Gao Zhenmei, Department of Rehabilitation, Affiliated Hospital of Shandong University of Traditional Chinese Medicine
II. Clinical manifestations
The nature of limb paralysis after CVD is of upper motor neuron nature. At this time, the lesion in the brain produces inhibition, while the brainstem and spinal cord below the lesion are in the inhibitory release stage. The recovery of motor function of the paralyzed limb starts only with the activities of the released brainstem and spinal cord, such as postural reflexes, joint responses and co-movement. They are primitive, low-level activities that remain in the pathological mode. Only when the brain function is restored, the movement of the limbs can be restored to normal.
Third, rehabilitation assessment
Staging of limb movement recovery after cerebrovascular disease.
Motor recovery after CVD, Brunnstrom divides it into six processes, which are briefly described as
Phase I Flaccid paralysis with no movement
Phase II Movement in common form with spasticity
Phase III Presence of active movement seen only during common form of limb movement with increased spasticity
Phase IV Presence of voluntary movements outside of the common form of activity with reduced spasticity
Fifth stage: control of individual or separate activities can occur
Stage 6: Recovery to near normal activity control
The duration of the first stage is generally said to be 7 to 10 days and not more than 2 weeks. The second and third phases last from 2 weeks to the end of 1 month. The so-called early rehabilitation should only include this stage in bed, i.e. rehabilitation within 2 weeks after the disease.
IV. Clinical rehabilitation
(I) Principles of rehabilitation treatment
(1) Rehabilitation treatment group – centered on rehabilitation physicians, there are rehabilitation therapists, rehabilitation nurses and other components. Through a collaborative approach to jointly develop rehabilitation treatment plans and organize their implementation.
(2) Good environment – the ward treatment and training place for people with difficulties, family and community are all there to achieve spacious and bright with, comfortable, suitable environment is conducive to rehabilitation treatment and functional recovery of people with difficulties.
(3) Early rehabilitation intervention – Under the premise that the patient’s condition is stable, rehabilitation treatment should be carried out as early as possible. Corresponding treatment methods and treatment intensity can be selected according to the patient’s general condition, and bedside treatment, bedside activities, indoor activities and outdoor activities can be used. Early rehabilitation can help reduce the degree of disability and improve the quality of life of patients with this disease.
(4) Comprehensive rehabilitation therapy – The comprehensive use of relevant rehabilitation therapy can help improve the clinical treatment effect and shorten the average hospital stay.
(5) Prevention and treatment of complications – Active prevention and treatment of complications related to cerebrovascular disease (such as shoulder pain, shoulder-hand syndrome, decubitus ulcer, pneumonia, urinary tract infection, deep static thrombosis of the lower extremities, etc.) is beneficial to the functional training and functional recovery of patients.
(6) Community rehabilitation – carrying out various forms of community rehabilitation treatment and activities can enrich the content of patients’ community life, promote the improvement of the function of seriously ill patients and further improve their quality of life.
(2) Rehabilitation treatment methods
There are many rehabilitation therapies related to cerebrovascular disease, mainly physical therapy, occupational therapy, speech therapy, psychotherapy, rehabilitation medicine engineering and community rehabilitation as well as traditional therapy.
(1) Physiotherapy (PT)
PT commonly used in cerebrovascular disease rehabilitation mainly includes electrotherapy and exercise therapy, of which the former commonly includes myoelectric biofeedback and functional electrical stimulation, and the latter includes Rood method, Bobath method, Brunnstrom method, PNF and MRP, etc.
(2) Occupational therapy (OT)
Selected, purposeful occupational activities are used for functional training of patients with cerebrovascular disease according to their needs (including daily life, family life and social life).
(3) Speech therapy (ST)
Used for cerebrovascular disease rehabilitation mainly for the treatment of aphasia, in order to improve patients’ language comprehension and expression to restore their communication function and create conditions for social reintegration. Domestic and international literature reports that ST can significantly improve the language function of aphasic patients. The earlier treatment is started, the better the results. Commonly used ST methods include: Stimulation facilitation – stimulation provokes a corresponding response from the patient to promote improvement and recovery of language comprehension and expressive functions. Communication facilitation – the use of close to actual communication, so that information is transmitted in both directions between the therapist and the patient, so that the patient’s residual capacity can be mobilized as much as possible, so that he or she can acquire communication skills.
(4) Psychotherapy (PST)
A treatment method that corrects abnormal behaviors (e.g., emotional disorders, incorrect cognitive activities) through words and actions, or by combining other special means (e.g., music, biofeedback, etc.). The purpose of psychotherapy is to make patients give full play to their subjective initiative and actively participate in relevant therapeutic activities in order to obtain better therapeutic results.