With the improvement of people’s living standard, the acceleration of the pace of life and the relative reduction of exercise, the incidence of stroke is increasing cut younger year by year. Despite the increasing success rate of resuscitation, the disability rate has also increased significantly, especially the disability of limb motor function, due to many factors such as the cognitive level of rehabilitation treatment and economic conditions of doctors and patients. Hemiplegia is a significant proportion of the sequelae.
It not only affects the self-care of elderly patients and the reintegration of young adults into society, but also affects the function of other parts of the body, causing a vicious circle in the organism. Therefore, the ADL training of daily living movements for hemiplegic patients is very important. The focus of ADL training is not on the “ADLs that can be performed”, which are evaluated and trained, but on the ADLs that are performed, i.e., the activities that are performed in real life, and the training and instruction procedures should be improved accordingly.
The basic idea of practical walking training: the most important thing of walking training for hemiplegic patients in the rehabilitation process is not to improve the ability to not work in the ideal bad situation they wish to be in, but aims to improve their ability to not work in the actual life situation, in order to motivate patients to obtain the walking ability necessary in the process of returning to I society later. Therefore, walking and other ADLs have a close interrelationship. The use of transportation, for example, is of great significance for their social range of activities.
Methods of conducting practical walking training.
The most basic is determined by the patient’s condition, age, economic status, and the range of deep gray activities after discharge from the hospital. The individual training programs are launched in a certain order of priority. For example, for a patient who is scheduled to be discharged early and comes to the hospital for rehabilitation training on a regular basis, the training content should not be aimed at simply extending the continuous walking distance, but should be arranged according to the actual situation such as whether the ADL exercise is performed after going home and whether the ground is flat, with or without slopes and steps on the way from the residence to the hospital. For example, the purpose of rehabilitation for some patients is to return to work, which should take into account the distance to work and walking distance at work as well as environmental conditions. Through these arrange training procedures and programs to achieve the best condition for reinstatement.
The focus of practical walking training.
1. Practical walking training and evaluation in practical settings: Early rehabilitation training is often conducted in hospitals, and the biggest difference between “ability walking” in the training room and “practical walking” in living settings is the difference in the corresponding environment. The walking in the training room is in a wide and five-obstacle space, so there are two main differences between the training in the training room and the training in real-life situations.
First, inpatients due to the narrow space around the ward, and bedside tables, tables and chairs and other obstacles. Therefore, crutches and turn direction have great space limitations, must guide and train patients to adapt to the hospital environment of crutches and direction change.
Second, the patient is unfortunately in the training room, the surface does seem to be able to walk independently, often because the medical staff is concerned about the patient next to the patient, even if no one is concerned, in fact, people around the patient are paying attention to not hit the patient or not quickly approach the patient, so as not to make it frightened. Second, in reality, even if walking in a spacious and flat corridor, from time to time from the room or around the corner there are sudden appearances of passers-by or wheelchair rubbing and sudden conversations with people, which can interfere with the patient’s attention and make his or her walk unstable. Therefore, the “ability to walk” in the hospital training room does not represent the patient’s ability to walk in ADL. Therefore, it is necessary to provide patients with more “practical” training so that they can walk steadily without accidents even under the conditions of interference.
2. Training and evaluation at different times in real life: the inability and posture are often unstable when you first wake up, and often change throughout the day due to the disease and treatment, so there are not only the patient’s own factors, but also objective factors such as time, environment and others. For example, washing the face and brushing the teeth are done after waking up and before going to bed. During the agreed time in the ice rink, the people going to the bathing room are more concentrated and chaotic, which makes it difficult to walk smoothly and makes the patient nervous, thus increasing the difficulty of the patient’s movements. If the walk before going to the bathing room is counted outside the evaluated time period, it is found that although practical ADLs can be performed independently, ADLs at specific time periods cannot be performed independently in a few cases. Therefore, extending the time period of life and rest forward or backward, and evaluating the training performance in the actual life period of the patient is the basic means to improve the level of ADL.
3. Walking in a series of continuous movements of ADL: As mentioned before, walking activity is not in itself, but walking only for the purpose of performing certain behaviors. Therefore, instead of just training walking alone, training other continuous movements other than walking should be added, which is very important for the practicalization of walking in real life.
For example, in order to enable patients to walk to the toilet independently as early as possible, before walking independently from the ward to the toilet, patients should also be trained to be able to complete the continuous movement of defecation in the toilet independently before completing ADL. continuous movement is a relatively difficult training subject, so medical and nursing staff are required to be patient and personally demonstrate the movement for the patient to encourage the patient’s confidence in self-care, and the disease can be extended through this training to Washing room washing, brushing teeth, dining room eating not independent, link these ADL and walking range, expand the range of contact, increase walking opportunities, to achieve the patient can independently carry out the ADL of the places to the purpose.
(1) Use of walking aids during training: The rehabilitation program should actively extend the walking distance and range to make walking as stable as possible. Therefore, stability during training alone does not determine the ability to walk in real life when walking increases. For this reason, it is necessary to consider appropriate cane appliances and to give specific instructions. For example, different canes and tools can be used for inpatient rehabilitation in different situations such as walking in the ward and walking outdoors. The more severe the dysfunction and the slower the improvement, the more important it is to use each tool separately. As long as the patient does not have a severe high central disorder, there is no difficulty in using each tool separately. The early use of appliances and walking aids is important as a treatment tool.
The use of appliances ensures the support and stability of the lower extremity, enables the patient to walk safely as early as possible, makes walking practical at an early stage, and also promotes the improvement of the dysfunction itself. The application of lower extremity appliances is determined by the position in the rehabilitation program as a whole and is importantly predicated on the use in real-life settings and the increase in walking volume. In order to use the lower extremity appliance in real life, it is necessary to train the patient to be able to fit the appliance independently. It is necessary to train the patient to install the appliance in a real-life situation and in a place where the appliance is actually installed, just like any other ADL training, and this action is more important for the patient who has difficulties.
(2) Walking training on different ground and in various environments: The stability of the patient’s walking varies in different spaces and ground states. Therefore, this training is indispensable, especially for the improvement of ADL level and adaptation to various living environments in the future. Unlike a training room with wide space, in the living environment during hospitalization or in one’s own home, patients are closer to furniture and walls, and can often walk stably without canes or appliances with the help of furniture and walls.
Therefore, patients should be trained to walk holding onto furniture and walls as early as possible. While in the hospital, medical staff can gradually help patients to carry out early walking training by holding onto beds, bed rails, corridor railings and walls, and set up effective methods suitable for patients to train them to carry out stable walking and living movements in irregular spaces and on different floors, (such as furniture arrangement, carpets, baseboards and floor tiles at home), so as to lay a good foundation for patients’ home life after discharge from the hospital. foundation.
(3) Walking training with objects: It is not enough that hemiplegic patients can only walk independently, and the relevant movement in actual life is often walking with weighted objects. Therefore, special training should be provided for walking with weighted objects, so that the patient can walk steadily for at least a short distance, such as moving with food and tableware during meals and taking out clothes from the closet, etc. Gradually, the training will be extended to outdoor areas, such as going to buy small items and being able to take them back steadily. In addition, such as wipe wipe wipe furniture and other cleaning work, hold things when moving stable in real life is very meaningful.
(4) Discharge training and expansion of practical walking range: Improving practical ADL after discharge is not negligible. Therefore, early and effective discharge training of patients is a must program.
The following two points should be noted for practical walking training as discharge training:
One is for indoor walking. The home environment is different from the ward environment, and even if walking training such as bed holding, walls, and railings is performed during hospitalization, it is difficult to imitate an exactly similar environment at home, so independent discharge training will play a big role.
Second, for outdoor walking. In order to improve ADL function after discharge, it is necessary to train in actual settings to ensure safety within the walking range. Walking is one of the effective activities after discharge, but walking with a purpose is more acceptable to the patient. For example, going shopping in a safe place nearby increases the interest in walking and promotes walking training.
Rehabilitation is a long-term training process, but the patient’s time in the hospital is often limited, and receiving outside rehabilitation treatment assumes that the patient can afford to come to the hospital. Therefore, early home to hospital process training is necessary. The home to hospital process training must include the patient’s journey and experience from the home to the hospital. The health care provider should predict the appropriate walking route to be used for future hospital visits based on the actual situation, carefully instruct the patient, obtain and use this to develop targeted training subjects to enable the patient to make a smooth transition to future rehabilitation as early as possible, and achieve the ability to adapt comfortably to ADLs in various settings and time periods in order to achieve practical walking training In order to achieve the ultimate goal of practical walking training.