What is a stroke

　　1.What is a stroke?
　　Stroke is also known as stroke and cerebrovascular accident. It is a general term for a group of acute cerebrovascular circulatory disorders (spasm, occlusion or rupture) caused by different etiologies. The main clinical manifestations are sudden coma, unconsciousness, hemiplegia, hemianesthesia, partially numbness, obliqueness of the mouth and eyes, and speech impairment, which are various dysfunctions of motor, sensory, speech, and cognition in modern medicine. The disease mostly occurs in middle-aged and elderly people, with the characteristics of high morbidity, high mortality, high disability rate, high recurrence rate and many complications, but stroke is not an incurable disease. Zhu Qianwei, Department of Rehabilitation, Bozhou People’s Hospital, Anhui Province
　　2. What are the types of strokes?
　　Strokes are generally divided into two main categories.
　　(1) Hemorrhagic stroke: also known as hemorrhagic cerebrovascular disease, is when a blood vessel in the brain ruptures and blood enters the brain tissue, compressing and destroying the brain tissue in that area. It includes cerebral hemorrhage and subarachnoid hemorrhage, and is the most vicious of strokes, with the highest mortality and disability rates. It occurs mostly in patients over 40 years old with hypertension and arteriosclerosis, and is characterized by rapid onset and fierce onset. It starts with severe headache and frequent vomiting, and then quickly turns into slurred speech, confusion, lethargy and even coma. At the same time, paralysis of one limb may occur.
　　(2) Ischemic stroke: also known as ischemic cerebrovascular disease, refers to the blockage of the blood vessels supplying a certain part of the brain, resulting in the death of brain cells and necrosis of brain tissue in that part. It includes transient ischemic attack (also called transient ischemic attack), cerebral thrombosis, cerebral embolism and lacunar cerebral infarction. It is more common clinically, accounting for about 70% to 80% of all cerebrovascular patients.
　　3.What are the ischemic strokes?
　　(1) Cerebral thrombosis: It accounts for more than half of all stroke cases. It is caused by cerebral arteriosclerosis and other reasons, which narrow the lumen of cerebral blood vessels, reduce blood flow or completely block the brain, resulting in impaired blood circulation in the brain, leading to brain tissue damage. The disease occurs mostly in middle-aged and elderly people aged 55-65 years old, and is more common in men than women. It mostly develops in a quiet state, progresses slowly, and gradually develops paralysis of one limb, but with a clear consciousness. The prognosis of cerebral thrombosis is better than that of cerebral hemorrhage, and the mortality rate is lower, but some patients will have sequelae such as hemiparesis. Good recurrence is a characteristic of this disease.
　　(2) Cerebral embolism: It is caused by the “embolus” formed in other parts of the body (mostly heart and limb vessels), which flows into the brain with the blood and blocks the cerebral vessels, causing local ischemia in a part of the brain tissue. Most of the patients suffering from this disease have a history of heart disease, surgery and obstetrics and gynecology (especially rheumatic heart disease patients). Patients mostly present with rapid onset, headache, vomiting, unconsciousness, and in some cases, hemiparesis. The age of onset is relatively young, with more young and middle-aged people aged 20 to 40.
　　(3) Cavernous cerebral infarction: It is characterized by many lesions and small and deep lesions, with small lesions less than the size of a small grain of rice, which are difficult to be detected by general medical equipment. Therefore, before the introduction of CT, it was difficult to confirm the diagnosis of it. Due to the small extent of lesions, their clinical manifestations are not obvious or quite mild, and most patients even “feel normal”. Most of the patients even “feel normal”. In general, people may have symptoms that are easily ignored, such as poor concentration and memory loss. Therefore, the detection of this disease mainly relies on the CT examination of the brain.
　　4.Who is prone to stroke?
　　(1) Age: The incidence, prevalence and mortality of stroke increase with age. In particular, the increase is more pronounced in the age groups from 55 to 75 years old. Statistics show that the prevalence of stroke in the age group of 45-54 years old is 60-180/100,000; in the age group of 65-74 years old, it increases to 200-600/100,000; and in the age group of 85 years old and above, it increases dramatically to 4000/100,000. Therefore, stroke is a priority disease for people over 55 years old. The older the age, the higher the prevalence of stroke.
　　(2) Obesity: obesity can cause elevated blood lipids, but also prone to hypertension, hyperglycemia and coronary heart disease, is a relative risk factor. The majority of stroke patients are obese.
　　(3) family history of cerebrovascular disease: cerebrovascular disease has a family genetic factors, China’s survey shows that immediate family members with a history of cerebrovascular disease increased the chance of stroke.
　　5, which life factors are related to stroke?
　　(1) smoking: statistics show that the incidence of stroke in smokers aged 30 to 40 is almost five times that of nonsmokers, and the risk of stroke in smokers aged 50 to 60 is three times greater than that of nonsmokers. In particular, young women who smoke while taking oral contraceptives have a 7 or 5 times higher chance of having an ischemic stroke than the general population.
　　(2) Alcohol consumption: 43% of young adults who have a stroke have a history of alcoholism before the onset of stroke, and this is 4 times more common in women than in men, and 5 times more common in men. Heavy alcohol consumption is an absolute risk factor, but small amounts of occasional alcohol consumption is not yet a definite risk factor.
　　(3) Dietary factors: mainly refers to salt, meat and animal fat. High salt, meat and animal fat intake are factors that promote the formation of hypertension, hyperlipidemia and hyperglycemia, and are therefore detrimental to people at high risk of stroke. Some people like to eat saltier food, so that the body has an excess of sodium, easy to store water, causing hypertension.
　　6, which diseases are prone to induce stroke?
　　(1) hypertension: medical research has proven that hypertension is an absolute risk factor for stroke, especially cerebral hemorrhage. 80% of strokes are due to hypertension, and the risk of stroke is usually three times higher in hypertensive patients than in those with normal blood pressure. Clinical data indicate that sustained elevation of high blood pressure increases the risk of stroke by 4 to 6 times. Clinical stroke patients are often accompanied by significant hypertension, control of hypertension can significantly reduce the occurrence of stroke.
　　(2) diabetes mellitus: the risk of stroke in diabetic patients is 2,5 to 3,7 times higher than in those without diabetes mellitus, about 10% of male stroke patients and 14% of female stroke patients are directly caused by diabetes mellitus; and 50% of diabetic patients and combined with hypertension, more likely to have a stroke. Clinical recurrent stroke patients, there are 10-30% have diabetes.
　　(3) heart disease: stroke and coronary heart disease (coronary atherosclerotic heart disease) these two diseases often affect each other. Seventy-five percent of stroke patients have a combination of heart disease, with coronary heart disease predominating abroad and rheumatic heart disease predominating in China. Heart patients often have heart enlargement, abnormal heart rhythm and other comorbidities, which can easily cause cerebral embolism.
　　(4) Transient ischemic attack: Some patients have sudden half weakness, speech loss, dizziness or visual and hearing loss, but the symptoms improve quickly, so they do not care, but in fact, it is likely to be transient ischemic attack. People who have transient ischemic attack have 30% possibility of ischemic stroke after one year, so it is also an absolute risk factor.
　　(5) Hyperlipidemia: Hyperlipidemia is a risk factor for stroke, mainly elevated cholesterol, triglycerides and LDL indicators. Especially in people over 50 years old, increased lipids are often associated with stroke. Therefore, it is very important for middle-aged and elderly people to have regular blood lipid checks.
　　7.Does stroke recur?
　　Clinical observation shows that even for transient ischemic attack, generally within 2 to 3 years, about half of the people have another attack. And the general rule is that the symptoms of another attack are heavier than one at a time, and the interval is shorter than one at a time; recurrence after a minor stroke also leaves serious sequelae; the death rate of the third attack is over 50%. The recurrence rate of stroke disease is high within 5 years, and many patients have multiple attacks within 5 years to the point of death. Therefore, whether it is ischemic or hemorrhagic stroke, one attack should be especially alert to recurrence.
　　8.How to prevent the recurrence of stroke?
　　(1) Treatment of the primary disease: The reason why stroke disease is prone to recurrence is that although symptomatic treatment is given during the first attack, the underlying causes of its development are not removed, such as hypertension, atherosclerosis and other pathological factors still exist. Moreover, there are many precipitating factors for the occurrence of stroke disease. If the precipitating factors are not taken seriously and eliminated in time, or if hypertension and atherosclerosis are not controlled, it is easy to recur. Every stroke patient, whether hospitalized or not, should be treated for the primary disease that led to the stroke, and the doctor should identify and treat the primary disease. For example, hypertensive patients should take antihypertensive drugs on time as prescribed by the doctor, and those who are able to do so should have their blood pressure measured once a day, especially during the stage of adjusting antihypertensive drugs to keep their blood pressure stable.
　　(2) Regular review: this is very important, not based on self-perception alone, because many stroke patients are unaware of the recurrence. Since the prevention and control principles of multiple diseases that cause stroke are different, after having a stroke attack, it is important to use modern technology such as CT and MRI to find out the cause in a timely manner, whether it is an ischemic or hemorrhagic or mixed type of stroke, and then develop a systematic program to prevent another attack under the guidance of a doctor. In addition, blood pressure, blood glucose and blood lipids should be checked regularly and in a targeted manner. If you experience a short period of “transient” hemiplegia or paralysis of one limb, loss of fluency in speech, dizziness or loss of vision and hearing, or continuous yawning, you should go to the hospital immediately for treatment.
　　(3) Regularity of life and living: For every stroke patient, it is important to have a regular life and living. The so-called regularity is to regulate the living activities in line with the biological clock in the body. Wake up in the morning without rushing to get up, you can first lie on your back in bed, move your limbs and head and neck, so that the limb muscles and vascular smooth muscle to restore tension, in order to adapt to the change of position after getting up, to avoid dizziness. Take a nap at noon, and even if you can’t sleep, close your eyes or meditate. Go to bed on time at night, wash your feet with warm water before going to bed and massage the Yongquan point in your feet. If the condition allows, you can also exercise as appropriate, choose walking, gymnastics, taijiquan and other items, should not participate in strenuous activities, running, hiking, etc.. When you go out, be more careful to prevent falls; get up, head down and tie your shoes and other daily movements should be slow; bath time should not be too long. In addition, the row of cheap with a sitting position, avoid impatience, discard gas force, so as not to induce cerebral hemorrhage.
　　(4) Pay attention to the regulation of diet: low salt, low fat, low cholesterol is appropriate, appropriate to eat more soy products, vegetables and fruits. Smoking should be avoided and alcohol should be consumed sparingly, and the daily consumption of alcohol should not exceed 100 ml (white wine). It is also best to avoid strong tea and coffee, and to strictly quit smoking. Those with habitual constipation should eat more fresh vegetables, fruits and other fiber-rich foods, and if necessary, use some laxatives.
　　(5) Pay attention to the influence of meteorological factors: seasons and climate change can make hypertensive patients emotionally unstable, blood pressure fluctuations, triggering strokes. At such times more to the occurrence of stroke, should pay attention to keep warm, prevent colds.
　　(6) pay attention to psychological prevention: keep emotional stability, do not overuse the brain, do less or do not do things that are likely to cause emotional excitement, such as playing cards, mahjong, watching sports, etc.
　　9.Is stroke “incurable”?
　　In recent years, due to the improvement of the level of treatment, the mortality and disability rate of stroke have been reduced. A large number of statistical data show that 70% to 90% of patients who receive early formal rehabilitation training or treatment can walk within 6 months after the onset of stroke, 30% can resume partial work, and 24% of patients have basic recovery of upper and lower limb functions. Rehabilitation can make the patient’s survival and quality of life much better. Therefore, in addition to comprehensive measures such as medication, acupuncture, massage therapy and rehabilitation training, stroke patients should also cheer up their spirits, maintain a positive and optimistic attitude, firmly believe in life, take the initiative to work closely with doctors and strengthen functional exercises in order to speed up the speed of functional recovery and maximize the degree of functional recovery.
　　10.Why should rehabilitation treatment be carried out after stroke?
　　A large number of clinical practice has proved that early, scientific and reasonable rehabilitation training can improve the plasticity of the central nervous system of patients with cerebrovascular accidents, which can better exploit the repair potential of the injury and promote regeneration. On the contrary, if the disuse syndrome and the misuse syndrome caused by the failure to receive timely rehabilitation treatment, patients with great recovery potential may become disabled for life due to irreversible dysfunction. Therefore, rehabilitation medicine occupies a very important position in the treatment of patients with cerebrovascular accidents. After decades of efforts and on the basis of a large number of applied studies, rehabilitation medicine has formed a more complete system in the modern evaluation and treatment of stroke. The effectiveness and reliability of a series of methods such as exercise therapy and physiotherapy have been definitely proved, and the research on the theory has been generally recognized by the medical profession.
　　11.Does stroke rehabilitation mean convalescence?
　　Rehabilitation is probably the most confusing term, such as leisure rehabilitation, tourism rehabilitation, sauna rehabilitation, recreational rehabilitation, etc. Many leisure retreats are related to rehabilitation. Many local sanatoriums have been transformed into rehabilitation hospitals, so some people think that rehabilitation is convalescence, but it is not.
　　Rehabilitation is used in modern medicine to restore physical and mental functions, occupational ability and social life. Rehabilitation for stroke focuses on the preservation and restoration of the patient’s functions. The aim is not only to cure the disease, but also to preserve and restore its residual functions and potential abilities to the maximum extent. Convalescence, on the other hand, is a conscious health care activity aimed at delaying aging, fitness and longevity, and is mainly applicable to healthy people and people in a subhealthy state. There is an essential difference between the two.
　　Modern rehabilitation therapy mainly applies physiotherapy, occupational therapy, speech therapy, swallowing disorder treatment, psychotherapy and orthopedic application, combined with measures such as tui na, boxing exercises and acupuncture in Chinese traditional medicine, so that stroke patients can be fully rehabilitated in terms of physical, psychological, social and occupational abilities, which can improve patients’ ability to live, study and work independently to the greatest extent, so that they can better This can improve the patient’s ability to live, learn and work independently, so that he or she can better adapt to the environment, improve the quality of life and eventually return to society.
　　Therefore, rehabilitation therapy not only targets the stroke itself, but also attaches more importance to the recovery of functional disorders caused by stroke, while convalescence in the general sense does not play an actual role in the treatment and functional recovery of stroke patients.
　　12.What are the contents of stroke rehabilitation treatment?
　　Stroke patients usually have different degrees of limb paralysis, aphasia and mental disorders, so the rehabilitation of stroke patients includes rehabilitation of paralyzed limb functions, rehabilitation of speech disorders, and rehabilitation of mental and psychological disorders. Through rehabilitation training and treatment, the sequelae of stroke patients can be reduced or fully recovered, and the patients can regain the ability to take care of themselves and return to work.
　　The content of stroke rehabilitation treatment includes: ① various physiotherapy: including electrotherapy, phototherapy, hydrotherapy, wax therapy, as well as the combination of Chinese and Western medicine electroacupuncture therapy, ultrasound therapy, acupuncture point magnetic therapy, Chinese and Western medicine direct current introduction therapy, etc. ②Exercise therapy: including joint activities, muscle strength training, balance training, standing training, walking training, etc. ③Operational therapy: including the basic movements of daily life of clothing, food, housing and transportation, occupational labor movements and craft labor movements training, etc. The purpose is to let patients gradually adapt to the various needs of personal, family and social life. Swallowing and language training: Swallowing training is provided to patients with swallowing disorders to restore their swallowing function to a certain extent; speech training is provided to patients with aphasia to restore their speech ability to a certain extent. (5) Psychological rehabilitation: study the psychological state and intellectual status of patients, and use psychotherapy to promote the psychological rehabilitation of patients. (6) Rehabilitation engineering: including the selection and use of various orthopedic devices, etc. ⑦ Traditional Chinese medicine rehabilitation therapy: including acupuncture, tui-na, Chinese medicine and food therapy. According to the symptom characteristics of stroke patients in different courses of illness, planned and purposeful rehabilitation treatment can reduce the disability rate of stroke patients and improve their quality of life.
　　13.When to start rehabilitation after stroke?
　　The disability rate of stroke survivors is about 70% to 80%. In order to reduce the disability rate, many scholars advocate that rehabilitation should be carried out as early as possible and believe that early rehabilitation has good effect. Most doctors in China agree that early rehabilitation should be started within 1 month after the disease. Many physicians may not allow patients to be active early or delay activity for several weeks because activity within two weeks after illness, especially sitting, can cause blood pressure fluctuations and may aggravate the condition. However, some studies have concluded that the proportion of patients with recurrence and progressive exacerbation does not increase in patients who are active early, and that inactivity can cause a series of disuse syndromes and affect the prognosis, so the timing of rehabilitation should be started as early as possible depending on the patient’s specific situation. It is generally believed that anti-spasticity limb position, position change and passive limb movement have no significant effect on blood pressure and can be started immediately after the disease, provided that clinical resuscitation is not affected. Active activities require the patient’s active completion or cooperation and have a certain effect on blood pressure and pulse rate, so it is appropriate to start when the patient is clear, the vital signs are stable and there is no progressive aggravation. In the first sitting (or standing) position, the sitting method should be used one by one in order to observe the presence of postural hypotension and to prevent the possible adverse effects of blood pressure fluctuations.
　　14.Can rehabilitation be started in the acute stage of stroke?
　　In principle, rehabilitation treatment should be started as early as possible. Internationally, the concept of “ultra-early rehabilitation” has been proposed, and rehabilitation should be started in the intensive care stage. For example, the correct prevention and treatment of hand dysfunction in stroke patients will directly affect the recovery of upper limb function and the ability to perform activities of daily living, and the recovery of hand function is closely related to the time of rehabilitation intervention. If the rehabilitation training starts with the shoulder joint according to the law of neurodevelopment and gradually transitions to the elbow joint, wrist joint and finger function exercises, ignoring the early hand function exercises and missing the best rehabilitation treatment time, the rehabilitation effect and the speed of the patient’s limb function recovery will be reduced. will be reduced. Thus, the earlier the rehabilitation intervention, the greater the possibility of hand function recovery, and the better the prognosis.
　　Therefore, the acute rehabilitation of stroke patients is very important, but it is often neglected by doctors and family members, who emphasize sedentary rest and focus only on drug therapy. In fact, even for comatose patients with massive cerebral hemorrhage, severe cerebral infarction and hemiplegia combined with severe lung infection, rehabilitation treatment such as limb massage, correct placement of hemiplegic limbs, passive position change and passive joint movement can be carried out when their vital signs are stable.
　　Emphasis on early rehabilitation can not only avoid the emergence of “disuse syndrome” such as deep vein thrombosis, gastrointestinal reflux, aspiration pneumonia, decubitus ulcers, spasticity, and degeneration of nerve and muscle function and cardiopulmonary function caused by long-term bed rest, but also improve the sensory deprivation and psychosocial deprivation, as well as anxiety and depression that arise after long-term braking. emotions, laying a good foundation for later comprehensive functional rehabilitation. The preliminary conclusion of our “Ninth Five-Year Plan” research project also shows that the earlier the rehabilitation training of stroke patients is carried out, the better the functional recovery, and the fewer the comorbidities such as foot drop and shoulder subluxation.
　　However, it must be remembered: when the patient’s condition is unstable, rehabilitation training must not be carried out blindly. If there are obvious manifestations of infection, serious heart rate arrhythmia, etc., rehabilitation training must be postponed, and rehabilitation medical activities can only be carried out after 24 to 48 hours of stabilization.
　　15.Does only the post-stroke period need rehabilitation treatment?
　　With the development of medical treatment, the mortality rate in the acute stage of cerebrovascular disease has dropped significantly, but the disability rate is increasing. Among the 5 to 6 million stroke patients in China, about 3/4 of them have different degrees of limb paralysis, speech, memory, thinking and other dysfunctions, which seriously affect the patients’ ability to live their daily lives and reduce their quality of life, causing great pain to the patients and a heavy burden to their families and society. The reasons for this are related to the neglect of early rehabilitation training. Some doctors and patients do not know enough about rehabilitation and think that rehabilitation is a late stage work, which is optional; or they think that rehabilitation training can be started only after the patient is awake and able to sit up and eat.
　　In recent years, through a large number of clinical observation and research, it is believed that long-term bed rest itself is a common cause of dysfunction, which can aggravate disability, and sometimes its consequences are much more serious than the effects of the original disease, even involving the function of multiple systems. The adverse consequences of prolonged bed rest can be causal to each other, forming a vicious circle that leads to poor patient outcomes. Therefore, clinical drug therapy and rehabilitation therapy for acute stroke patients should be carried out simultaneously, i.e., rehabilitation therapy should be started 48 hours after the patient’s vital signs (such as respiration, blood pressure, pulse, pupil changes, etc.) are stable and neurological symptoms no longer develop. Generally speaking, 2 to 3 days after the onset of cerebral infarction (cerebral hemorrhage can be slightly postponed to about 7 to 10 days), early, scientific and reasonable bedside rehabilitation treatment should be provided to patients in a gradual manner while drug treatment is carried out in neurological and surgical wards, which can also prevent complications such as decubitus ulcers, respiratory and urinary tract infections, deep phlebitis and joint contracture and deformation, and prepare for the next step of functional training.
　　Many clinical practices have proved that early active rehabilitation can promote functional reorganization of tissues around brain injury, enhance brain plasticity, restore its motor function to the maximum, significantly improve self-care ability, reduce complications and help patients return to society. Some data show that if a stroke patient starts rehabilitation training within 1 month, it only takes an average of 86 days for his or her function to reach self-care, while it takes more than 100 days to start rehabilitation training only after a month, and sometimes the effect is not satisfactory. If rehabilitation training is started only after one year of disease, the effect of rehabilitation and the speed of recovery of the patient’s limb function will be greatly reduced.
　　16. Is there no possibility of recovery if the hemiplegia is more than six months old?
　　Most scholars believe that the recovery time from stroke is basically within 3 months, with the fastest recovery in the first few weeks, and that further recovery of motor and walking functions of the paralyzed limb is less likely after 6 months. Some patients and their families accordingly believe that recovery of stroke patients is meaningless after six months, and that even if they exercise again, the patient will not recover more physical function. As a result, many patients who have been ill for more than 6 months give up the opportunity to continue rehabilitation exercises.
　　In fact, with the advancement of rehabilitation theory and technology, the patient’s self-care ability and physical function can still be greatly improved by continuing rehabilitation training after 6 months. This is because brain plasticity exists for life. As long as the correct rehabilitation training is adhered to, the function of the limbs can still be restored, but the recovery is relatively slow after 6 months. It is clinically proven that speech, cognition, balance, household and work skills can be further improved within 2 years after stroke, and the recovery period is longer than that of motor function. For those patients who cannot fully recover after more than half a year or even one year, their ability to take care of themselves can still be improved with the help of compensatory training of the healthy limb or wearing a brace to achieve maximum self-care. In view of this, hemiplegic patients and their families should firmly believe in the effect of rehabilitation training and should not miss the opportunity to continue rehabilitation.
　　17. Is rehabilitation only possible if I live in a hospital?
　　The rehabilitation of stroke is a long-term process. Patients in the acute stage should be hospitalized for emergency and early medical treatment and rehabilitated as early as possible, so that the occurrence of disuse syndrome and misuse syndrome can be avoided and the patient’s neurological deficit can be maximized. When stroke patients are stable and have recovered function to a certain extent, they should return to their families and communities to continue home rehabilitation and community rehabilitation.
　　This is because, on the one hand, the cost of inpatient rehabilitation is high and many families cannot afford the high cost of medical care in the long run; on the other hand, if patients are confined to a medical institution for a long time and cannot participate in normal family life and social activities, they may feel emotionally “isolated” from their families and society. This is not conducive to the patient’s future reintegration into the family and society. On the other hand, if patients can live in a familiar and comfortable environment, with the care of family members, neighbors and friends, they will feel the joy of life, enhance self-confidence and the initiative of rehabilitation exercises, which is conducive to the functional rehabilitation of limbs.
　　18. Is rehabilitation only the doctor’s job?
　　Many patients’ families mistakenly believe that rehabilitation is only the doctor’s job, and as long as the patient receives treatment in the hospital, everything will be fine, and it has little to do with them. In fact, family members play a very important role in the rehabilitation process of hemiplegic patients. On the one hand, the warm atmosphere of the family, the affection of the family and the supervision of the training are the most powerful support for the hemiplegic patient to overcome the disability; on the other hand, the training of the hemiplegic patient’s daily living ability, such as dressing, eating and toileting, is not only feasible but also very effective in the family. It can be said that whether a hemiplegic can live a normal life and return to society depends largely on the quality of the family’s continued rehabilitation for the hemiplegic.
　　19. Can function be restored by passively receiving rehabilitation treatment?
　　The rehabilitation treatment for stroke patients should be passive first and then active. Since the paralyzed limb of a stroke patient cannot move by itself, initially the family or the patient can use the healthy limb to assist the affected side in movement. However, the patient should be instructed early to perform some active activities in bed, including turning over, bed mobility, sitting up at the bedside, and bridge movement. Because although early intervention of passive exercise can prevent or reduce disuse atrophy of muscles, bones and skin, active exercise is an important factor in increasing central nervous system tension, activating physiological functions of various systems and organs, preventing complications and improving general health status. Only by starting active rehabilitation as early as possible and developing an appropriate training program as physical and cardiopulmonary functions recover, it is possible for patients to achieve maximum functional recovery at all three levels (physical level, individual activity level and social participation level). Studies have shown that the higher the level of active training, the better the quality of life of the patient and the recovery of sensory-motor function of the affected limb. Therefore, passive training cannot replace active training, and active training must be used as the main means of rehabilitation. Stroke patients should actively and positively cooperate with their therapists to carry out various active rehabilitation trainings suitable for them.
　　20.Can physiotherapy be used instead of functional training?
　　Physical therapy is the use of physical factors and physical methods such as heat, cold, water, electricity, light, gymnastics, traction, massage, manipulation and equipment. Physiotherapy in the narrow sense of the word refers to physical therapy, including electrotherapy, light therapy, magnet therapy, ultrasound therapy, heat therapy, cold therapy, water therapy, biofeedback therapy, etc. It is a passive stimulation therapy. Functional training is to relieve symptoms or improve the function of the whole body or local exercise with bare hands and the application of equipment and instruments to achieve the purpose of treatment, its purpose is the recovery of limb function, emphasizing active training is the main, can not be replaced by only passive stimulation of physical therapy.
　　21.What is the difference between exercise therapy and occupational therapy?
　　Kinesitherapy is a training method that uses equipment, bare hands or the patient’s own strength, through functional exercise, through certain movement methods (active or passive movement, etc.), so that the patient obtains whole body or local motor function and sensory function recovery.
　　The theoretical principles of occupational therapy and exercise therapy are the same, but the difference is that it designs the movement needed for the limbs as an occupational activity, for example, using checkers, games, painting, pottery making, etc. to train the fine movements of the fingers, allowing the patient to actively participate. This not only increases the patient’s interest, but also improves the patient’s ability and quality of life.
　　The most common problem that stroke hemiplegics have to address is motor dysfunction, so exercise therapy has become an indispensable and crucial part of the rehabilitation process for hemiplegics. Many people tend to focus only on functional exercise, but neglect occupational therapy, which enables stroke patients to gain self-care.
　　During treatment, we often find that patients are still unable to use the affected limb for functional activities even though they may have regained functional activity in the affected limb. For example, although the patient is able to selectively move his hemiplegic arm with guidance, he does not do anything in his daily life, including eating, dressing, or pushing his wheelchair, let alone returning to work. Many therapists also find that in many cases, patients have difficulty with activities of daily living, not only because of physical dysfunction, but also because of cognitive problems. For example, when pushing a wheelchair, a stroke patient often knocks over objects on the affected side of the body; or when dressing, he often neglects to put the sleeve on the affected side of the body because the cognitive function of the brain responsible for the affected side of the body is impaired and the concept of the existence of the affected side of the body is no longer present in the patient’s brain. Therefore, pure functional exercise cannot really achieve the rehabilitation goal of hemiplegic patients.
　　22.What does occupational therapy include?
　　Occupational therapy mainly includes daily life movement training for food, clothing, housing and transportation and occupational labor movement training. The ultimate goal of occupational therapy for stroke patients is to give them maximum independence in their home, work and life. When a stroke patient is admitted to the hospital, the occupational therapist will immediately conduct a functional assessment, including self-care skills such as eating, grooming and dressing. If the patient is unable to perform these activities with both hands, the occupational therapist will provide training to enable the patient to perform these activities with one hand and assistive devices such as a long-handled brush, dressing stick, bathtub board, etc. The patient will also be offered and trained to use notepads, timetables, calendars, alarm clocks, and daily living schedules to assist in remembering activities to facilitate independent living. In addition, the occupational therapist will take into account the patient’s role and needs in life and encourage him/her to return to the old life. If the patient is a housewife, the therapist will provide training on household tasks such as cleaning and cooking that the patient is capable of doing. For a patient who is of working age, the therapist’s main goal is to help the patient return to his or her previous job. To do this, the therapist will analyze the patient’s work routine, assess the patient’s ability to work, and provide simulated work training such as clerical work, typing, desktop publishing, carpentry, machine operation, etc.
　　The road to recovery is a long one, and although a stroke patient may not recover completely, the occupational therapist will try to help him/her adapt to a new lifestyle and reintegrate into family and society. Therefore, occupational therapy is not just a continuation of functional exercise, but serves as an important part of the stroke patient’s rehabilitation and a bridge to connect the individual patient with his family and society.