The hemiplegia of a stroke limb is upper motor neuron hemiplegia, and rehabilitation should not only promote the recovery of muscle strength, but more importantly, the reconstruction of higher neural control of muscle movement. The theoretical basis of stroke hemiplegia recovery is based on the six-stage process proposed by Brunnstrom.
The basic theory of rehabilitation department
1. delayed paralysis of the affected limb with no voluntary movements.
2. increased muscle tone and the appearance of spasticity, with basic co-movement and joint responses and no voluntary movements.
3, spasticity may be aggravated by inducing co-movement at will.
4, spasticity is no longer aggravated or contracture is reduced, co-movement is diminished beginning to appear as dissociated movement and normal pattern of movement.
5, the spasticity is significantly reduced, the co-movement loses its dominance, the more difficult detached movements and normal pattern of active movements can be accomplished
6.The spasticity and common movement disappear, and the coordinated movement is generally restored.
I. Principles and contraindications of rehabilitation training
The four principles of rehabilitation training are: early intervention, functional training, comprehensive rehabilitation, and reintegration Specific principles of functional training.
1, mainly to suppress abnormal and primitive reflex activities, improve motor patterns, and rebuild normal motor patterns.
2, followed by strengthening of weak muscles and strength training.
3, the affected side of the functional reconstruction training is the main, the healthy side of the compensatory training in the latter.
Treatment of motor and sensory dysfunction.
1, good limb position placement.
2.Position change training.
3.Balance training.
4.Trunk control training.
5.Maintenance of joint mobility treatment.
6.Sensory function training.
7.Other treatments.
The placement of good limbs for patients during hospitalization is very important and is generally required to be mastered by nurses in tertiary care hospitals.
Contraindications to rehabilitation intervention: combined with severe cerebral edema, deterioration of neurological function, increased intracranial pressure, frequent epilepsy, and severe cardiopulmonary insufficiency.
Reclining posture of hemiplegia
Maintaining a good functional position of the paralyzed limb is an important rehabilitation tool to prevent and control the constrictive contracture and myasthenia gravis of the affected limb. After the patient’s illness, after a little time, that is, there is soft paralysis gradually into the hard phase. Flexion contracture of the shoulder, elbow, wrist and finger joints occurs in the upper limbs, and hyperextension and flexion difficulties of the hip, knee and ankle joints occur in the lower limbs. Therefore, early antagonistic lying posture should be adopted to avoid or reduce the increase of muscle tone.
The correct posture is to keep the shoulder joint on the paralyzed side in forward extension and the elbow, wrist and finger joints in straight position, and to place pillows or clothes in front of the chest and pad the upper limb on the affected side to maintain good posture. The hip and knee joints of the affected lower limb should be naturally flexed, and the pelvis should be in an internally rotated position.
2. Reclining position on the affected side: the upper limb on the affected side should be kept in an extended position, and the lower limb should be kept in a semi-flexed position, with the affected side in the back and the healthy side in the front, which is a good position for reclining on the affected side. The scapular band of the affected side of the patient should be extended forward, the shoulder joint is flexed, the elbow joint is extended, the forearm is rotated back, the wrist joint is extended, and the fingers are extended. The lower limb on the affected side is extended , the knee joint is mildly flexed, the hip and knee joint of the affected lower limb are flexed, sometimes a soft pillow can be placed underneath and a pillow is placed on the back to give the patient something to lean on.
3, supine position: the affected shoulder joint is externally rotated, the joints of the upper limb are extended, the hip joint of the lower limb is internally retracted and internally rotated, the knee joint is flexed, and the palm of the foot is flat on the bed, which is the best position for the patient in supine position. Face up, a pillow can be placed under the head, and the height of the pillow must be appropriate, while emphasizing that the thoracic spine should not be flexed. Often, a pillow can be placed under the hip of the affected side, so that the pelvis of the affected side can be convexed forward to prevent the flexion and external rotation of the hip joint. A square soft pillow can be placed under the shoulder joint of the affected side to make the scapula convex forward, the elbow joint of the upper limb is extended on the pillow, the wrist joint is stretched, and the fingers are extended.
Third, hemiplegic turning exercise
After the patient is bedridden, it is recommended that the patient should turn over once every 2~3 hours.
1.Passive turning exercise: When turning the patient, the caregiver should be instructed to exert force on the shoulder joint and hip joint at the same time to prevent the patient from being injured due to improper force.
2.Assisted turning exercise: can be used when the patient himself has some strength. Assisted turning should be based on the patient’s own force, with a little force from the family to assist.
3.Autonomous healthy side turning exercise: the patient completely relies on his own strength to turn over, before turning over the patient’s healthy side lower limb inserted under the lower limb of the paralyzed side, put the upper limb of the paralyzed side to the abdomen, while turning the skull and shoulders, the healthy foot stomps hard on the bed, the paralyzed side limb then turns over to the side, in the healthy side lying position.
4.Autonomous affected side turning movement: When the patient turns over to the paralyzed side independently, the lower limb on the healthy side extends to the outside and stands on the knee, and the healthy foot stomps on the bed. The patient turns the upper body while raising the head, flexing the neck forward and forked the legs.
IV. Bed sitting/sitting up training
1.Passive sitting up back training in bed: After the patient sits up passively with the external force of family members, put quilts, pillows, clothes behind the patient’s back or family members hold the patient’s shoulders with both hands behind the patient’s back to keep the upper body in an upright and comfortable position. The lower limbs are straightened, the hands are held together, and the elbows are extended and placed on the table in front of the body to maintain balance in the passive sitting position. The patient needs to be trained repeatedly.
2.Bed-assisted sit-up training: The patient takes the healthy side lying position, the healthy side elbow and forearm ulnar side support the upper body, and while lifting the head and body, the elbow and forearm move down with the lifting action in order to make the upper body lift higher. The family members support the patient’s healthy side shoulder or elbow with their hands and give appropriate assistance to sit up.
3.Autonomous sitting up training in bed
4.Bed sitting balance training: Patients are prone to tilt to the affected side when sitting, so they need to be given a boost; if the patient is unstable, a soft cushion can be placed on the affected side to maintain balance. The balance training of sitting in bed should be carried out at an early stage, and only after the patient sits steadily can he further carry out the balance training of standing.
5.Transverse and longitudinal transfer training in bed: rely on the strength of the limb on the healthy side and gradually drive the affected side to perform longitudinal and transverse translation.