This was covered in today’s lecture, just in time to post it and share it with you. It is recommended that a copy be posted at the bedside of stroke patients, so that they can be placed and read at any time.
For post-stroke hemiplegic patients, a good position of the limb in bed at an early stage can play a role in preventing and relieving spasticity, shoulder subluxation, shoulder pain, shoulder-hand syndrome, posterior pelvic tilt, hip abduction, external rotation and early induction of detachment movement, which is a very important part of rehabilitation treatment. Please refer to the diagram for the specific operation method. If you are not sure about the operation method, please ask the health care personnel in time to avoid any operation error, which may adversely affect the functional recovery.
Attention.
1. The diagram shows a simulated right hemiplegic patient (i.e. the right side is the affected side and the left side is the healthy side).
2. The good limb position is a temporary position designed from the therapeutic point of view. To avoid complications such as pressure sores and contractures, the position should be changed regularly (change 1 time/1～2h).
3.The supine position strengthens the extensor advantage, the healthy side lying position strengthens the flexor advantage on the affected side, and the affected side lying position strengthens the extensor advantage on the affected side, so the position should be correctly selected according to the patient’s condition and under the guidance of the doctor.
Supine position
Key points.
1.The bed should be as flat as possible.
2. head fixed on pillows, avoiding hyperextension, hyperflexion and lateral flexion, with the face facing the affected side.
3. Upper limb on the affected side: a small pillow under the affected shoulder, so that it is the same height as the healthy shoulder; the upper limb on the affected side is fixed outward on the pillow, and the trunk is at an angle of 90° or more than 90°; the elbow and wrist are straightened as much as possible; the palm of the hand is upward, and the fingers are extended and separated.
4. Affected lower extremity: place a wedge-shaped pillow from the affected hip to the outer lower thigh to prevent external rotation of the lower extremity; knee joint padded and slightly flexed inward; ankle in neutral position, i.e., toe up.
Common errors.
Head to the healthy side, with the affected shoulder too high.
Holding a towel roll in the hand and placing it on the stomach
Lower limb pillow not in wedge shape
Turning the toes to the outside
Reclining on the healthy side (hemiplegic side on top)
Key points.
1. the bed is made as flat as possible
2.Head fixed on a pillow to avoid twisting backwards.
3.Place a pillow behind the back to relax the body.
4. Tilt the trunk slightly forward.
5, the affected upper limb: forward flat, placed on the pillow in front of the chest, and the torso is 90 ~ 130 ° angle, elbow straight, wrist, knuckle extension on the pillow, avoid wrist and hand suspension.
6, the affected side of the lower limb: hip, knee joint natural bending, placed on the pillow in front of the body seems to step out a step away, ankle joint as far as possible to maintain a neutral position, to avoid foot overhang.
7, the healthy side of the upper limb: natural placement.
8, the healthy side of the lower limb: hip joint straight, knee joint natural slight flexion.
Common errors.
Insufficient angle between the affected limb and trunk, hand overhang
Foot dangling
Reclining on the affected side (hemiplegic side in the lower)
Points to remember.
1. the bed is as flat as possible.
2.Head fixed on a pillow.
3.Torso slightly backward, with a pillow fixed behind the back to relax the body.
4, the affected upper limb: the affected shoulder is stretched forward (can be gently stretched forward by family members), the affected upper limb and trunk at an angle of 80-90 °, put a small table at the side of the bed, so that the elbow joint as straight as possible, fingers open, palms up.
5. lower limb on the affected side: hip extension, knee slightly flexed.
6.Healthy side upper limb: naturally placed on the body or pillow
7, the healthy side of the lower limb: maintain the stepping position, placed on a pillow in front of the body; knee and ankle natural slightly flexed
Common errors.
The affected shoulder is not pulled out, the affected shoulder is under pressure
The position of the pillow under the healthy leg is too far forward, the affected hip is not posteriorly extended
Sitting position
Points to remember
1, the bed is as flat as possible, and the patient’s lower back is padded with pillows.
2, trunk: straighten.
3, the hip: flexion 90 °, so that the upper body is straight, the weight is evenly distributed on both sides of the hip.
4.A soft pad can be placed under both knees, so that the knees are slightly flexed.
5, upper limbs: placed on an adjustable table, the table put a pillow
Common errors.
Swing up the head of the bed into a semi-recumbent position, which is detrimental to the patient’s recovery
Unless drinking and eating, do not use this position at other times
Application props
Pillow
Requirements.
1, preferably buckwheat leather pillow, with a certain degree of breathability, and can be shaped arbitrarily.
2, the pillow should be high enough, large, about 1500px × 1000px × 500px size.
Thin cushion
Requirements.
1, can be sewn with towels themselves, the surface should be flat.
2, the height of ≤ 125px is appropriate.