Specific rehabilitation treatment methods for different periods of cerebrovascular accidents

  (1) Early or delayed paralysis 1) Correct position placement: adopt an anti-spastic position and turn regularly.  (2) Maintain joint range of motion: For patients with limb paralysis, the joints of the limbs should gradually transition from passive motion, active and auxiliary motion to active motion. In the early stage, the passive movement of the limb can be 10–15 min/time, 2.–3 times/d. The conscious patient can use the healthy hand to hold the affected hand to drive the affected limb to complete the active aided movement; the active movement should be completed by avoiding inducing the pathological pattern of the limb or by using synergistic movement.  (3) Induced random movement of the limb: Brunnstrom technique, Bobath technique, Rood technique, PNF technique and motor relearning technique with methods of inducing random movement of the limb can be used.  (4) Bed exercise: If the condition allows, bridge exercise (from double bridge to single bridge), bed turning training (healthy side to affected side, affected side to healthy side), bed sitting up and sitting balance training (from static balance to dynamic balance) can be performed.  (5) Postural transfer training: If the condition permits and the ability to sit up and balance in bed has been mastered, bed and chair transfer, sit and stand transfer and standing training (from standing on a sloping bed, supporting standing to standing alone) can be performed.  (6) Other physical factor therapy: ①Neuromuscular electrical stimulation.  ② Functional electrical stimulation therapy.  ③Transcranial electrical stimulation therapy.  ④ Transcranial magnetic stimulation therapy.  (7) Hyperbaric oxygen therapy: Patients who cannot sit alone can enter the single cabin, and patients who can sit alone for 1.5h can enter the multi-person cabin.  (8) Chinese medicine treatment: acupuncture, massage and other methods can be used.  (2) Recovery period or spasticity period In addition to continuing the treatment of the delayed paralysis period, the following treatments are focused on implementation: 1) Inhibition of muscle tone of spastic muscle groups: anti-spasticity positions, series of splints, Bobath technique, therapy balls, etc. are used.  2) Training to enhance the motor function of the affected limb: Rood technique, PNF and motor relearning techniques can be used. The focus of training is on trunk flexion and extension and rotation function, upper limb is the activity of scapular girdle and shoulder joint, elbow flexion and extension control; lower limb is flexion and extension knee activity, ankle dorsiflexion control, hip extension and knee flexion activity and hip extension and knee flexion and ankle dorsiflexion control.  (3) Balance control training: including static and dynamic balance in sitting position, dynamic balance from sitting to standing position, static and dynamic balance control training in standing position. The specific method can use balance training board, therapy ball (Bobath ball), parallel bar in training. If possible, you can also train with the help of balance training apparatus.  (4) Gait training: including in situ single-leg support, alternating single-leg support, in situ striding, walking within the parallel bars, indoor and outdoor walking, up and down stairs training. Weight reduction walking training system can be utilized when available.  5) Other physical factor therapy: including hydrotherapy, thermotherapy, electrical stimulation of spastic muscles, etc., which can be selected appropriately according to the specific situation when applied.  6)Operational therapy: focus on the training of upper limb function, training of daily living activities, and training of perception and cognitive function.  (1) The training method of upper limb function includes the control of shoulder and elbow joint activities, the training of forearm rotation forward and backward, and the training of fine hand movements and coordination and dexterity.  ②The training of activities of daily living includes instruction and training for dressing and undressing, toileting and bathing, and the application of self-help tools (such as cutlery, grooming, dressing, bathing and other self-help tools).  ③For some patients who have not fully recovered the function of wrist, hand and ankle and foot after active rehabilitation treatment, appropriate braces can be worn, such as fixed resting position cryogenic thermoplastic wrist and hand splints, functional position cryogenic thermoplastic wrist and hand splints, resting position cryogenic thermoplastic ankle and foot splints and movable forearm splints.  ④For patients with partial blindness, first let the patients understand their defects, and then carry out training of bilateral activities, for example, put objects on both sides and let the patients make horizontal scans of the effective part of the visual field by turning their heads to make up for their deficiencies, or use a puzzle board to put together patterns of left and right structures, and train the patients several times with the text deletion method to make them recognize the part of the text that is missed due to the visual field deficiency.  7) Speech therapy: including treatment of aphasia and dysarthria.  ①Individualized training: Patients are trained one-on-one by therapists.  ②Group therapy: Patients with similar speech disorders are divided into groups and trained by therapists.  ③Autonomous training: After patients have received treatment for a period of time and have acquired some communication skills, tasks are assigned for patients to train themselves.  ④Family therapy: The therapist designs the treatment plan and instructs the family members to treat the patients and review them regularly.  ⑤ Communication aids: For patients with severe speech disorders who cannot improve their speech function even after systematic speech training, they can communicate through aided communication tools, such as communication boards.  8) Psychotherapy: Patients with depression or anxiety disorders are given targeted psychological counseling or consultation.  9) Traditional Chinese medicine rehabilitation: including traditional Chinese medicine, acupuncture, Chinese massage and other methods.