According to World Health Organization statistics:
1 in 6 people worldwide may suffer from a stroke;
1 in 6 seconds Dies from a stroke;
1 person is permanently disabled by a stroke every 6 seconds.
stroke A group of diseases that cause brain tissue damage to the brain, usually divided into two categories: ischemic and hemorrhagic.
In recent years, the incidence of stroke in my country has shown an upward trend. and a huge burden on society.
How can a stroke be quickly identified?
China has launched a rapid identification method for acute stroke suitable for Chinese people, namely “Stroke 120”, which is a rapid identification of stroke suitable for Chinese people. and strategies for immediate action:
“1” stands for “seeing 1 asymmetrical face”;
” 2″ stands for “check whether there is unilateral weakness in both arms”;
“0” stands for “listen (zero) to hear whether the speech is clear”.
If you suspect a stroke through these three-step observations, you can immediately call the emergency number 120.
Once a family member has a stroke, remember to actively and standardize the rehabilitation treatment of stroke in the early stage. Rehabilitation treatment is a long process. Adopting all effective measures in different periods can improve the impaired dysfunction, effectively prevent complications, reduce the recurrence rate, disability rate and mortality rate, and improve the quality of life of stroke patients.
Stroke Practical Rehabilitation Strategy
011. Good limb placement
What is “good limb placement”?
In layman’s terms, a good limb position is a temporary position that is beneficial for restoring limb function.
The correct placement of the limbs will help protect the shoulder joint, trunk, and lower limbs and prevent the appearance of spasticity. Incorrect lying posture can induce aggravated spasticity, which in turn can cause joint contractures and lead to severe functional impairment in patients.
When should I start placing the healthy limbs after I am sick?
It can be performed 48 hours after the patient’s vital signs are stable and neurological symptoms are no longer developing. The sooner rehabilitation begins, the better the recovery of limb function.
Because limb function recovers the fastest within 3 months after stroke, it is best to give intensive training during the peak period of neurological recovery. That is, when the patient is admitted to the hospital for flaccid paralysis, he or she needs to place a good limb position while giving treatment, and insist on the whole cycle of rehabilitation.
How to adjust posture for good limb placement?
1. Supine position
Put a soft pillow under the patient’s head, which can be up to a punch high according to the size of the patient’s fist.
Put a soft pillow under the scapula, and it is required to stretch the scapula as far as possible to avoid retraction, so that the shoulder is raised forward and the upper arm is externally rotated Slight abduction, elbows and wrists should be straight, palms up, fingers straight and separated, and the entire upper limbs are placed on the pillow.
Put a soft pillow on the hips and outside of the thighs to slightly rotate the hips inward.
Place a soft pillow under the knee joint so that it is slightly flexed.
However, due to the risk of pressure ulcers and exacerbation of extensor spasms in the supine position for extended periods of time, this exercise is only intended as a position change Do not maintain this position for a long time.
2. Lying position on the affected side
Put a punch on the head and a soft pillow, and lean back slightly.
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Place a pillow on the back to relax the body.
The upper scapula on the affected side is forward Extend flat, the upper limb on the affected side and the trunk are at an angle of 80-90 degrees, the elbow joint is as straight as possible, the fingers are open, the palm is upward, the healthy limb is in front, the affected limb is behind, the hip and knee joints on the affected side are flexed, and passive Dorsiflex the ankle.
Flex the hip and knee of the unaffected leg, and use a soft pillow to support from the knee to the foot to avoid compressing the affected leg Limb.
This posture increases the sensory input to the affected side without affecting the normal use of the unaffected hand. p>
3.
Put your head with a punch and a soft pillow, and try to avoid twisting backwards.
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Put a pillow behind your back to relax your body and lean forward slightly.
the upper limb on the affected side , The shoulder blades are stretched forward and placed on the pillow in front of the chest at a 90-130 degree angle with the torso, and the elbows are straight. The wrists and knuckles are stretched on the pillow to avoid hanging the wrists and hands.
Lower limbs on the affected side: Bend the hips and knees naturally, put them on the pillow in front of you, and keep the ankles in a neutral position as much as possible to avoid the feet hanging in the air. The upper limb of the unaffected side is placed naturally, the hip joint of the unaffected lower extremity is straightened, and the knee joint is naturally flexed. Separate your legs with a pillow.
or more It is necessary to turn the patient over once every hour, and it is recommended that the patient adopt a lateral position!
4. Bed Seating
Keep the patient’s torso upright, in order to prevent the body from leaning back, you can use a large pillow behind the patient, flex the hip joint 90 degrees, and place both upper limbs on an adjustable table On top, cushion the elbows and under the forearms to prevent pressure on the elbows.
Early good limb placement can effectively prevent muscle atrophy, joint contracture, foot inversion, shoulder subluxation, shoulder-hand syndrome It is beneficial to prevent complications and reduce the occurrence of disability, promote the recovery of motor function, and improve the quality of life of patients.
The placement of good limbs in the early stage can lay a good foundation for later rehabilitation treatment, reduce the disability efficiency of patients to varying degrees, and relieve the family and society. burden.
The key to stroke rehabilitation is to hurry up and move the active parts in the early stage of the disease, and learn how to turn over, move and sit up and lie down.
02 Posture Transfer
Bed Rollover Training
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1. Turn over to the affected side
< /img>▲The right side is the healthy side, and the left side is the affected side (the same as the picture below)
The patient’s healthy side holds the affected side The hand is on the side, the thumb of the affected side is on the top, and the hip and knee are flexed, and the upper limb is extended and the elbow is raised more than 90 degrees. The upper limb on the healthy side drives the upper limb on the affected side to swing. When swinging to the affected side, bend the neck and turn the head to the affected side, and use the inertia of the swing to rotate the trunk to complete the movement of the shoulder girdle and pelvis. Cross the unaffected side with the unaffected leg and turn over to the affected side.
2. Roll over to the healthy side
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The patient’s healthy hand holds the affected hand, the upper limb is extended and the elbow is raised more than 90 degrees, the unaffected lower limb is flexed, and the affected leg is inserted Bottom. The upper limb on the healthy side drives the upper limb on the affected side to swing back and forth, while the upper limb swings, bend the neck and turn the head to the healthy side, relying on the rotation of the trunk to drive the pelvis to turn, and at the same time use the power of the unaffected side to extend the knee to drive the affected side to complete the healthy side.
Precautions for turning over in bed
① When a hemiplegic patient turns over to the affected side, the upper limbs on the affected side should be placed in front of the body and slightly abducted to prevent The side limb is compressed.
② The therapist stands on the affected side of the patient to protect the patient and take safety measures.
③ When the patient cannot turn over independently on the unaffected side for the first time, the therapist It can assist the patient to complete the action that the patient cannot or has not completed. It can help the patient to complete it more standardly and safely.
④ When the patient turns over to the unaffected side, the patient should try to stretch the shoulder of the affected side forward, and the limb of the affected side should be placed on the opposite side. The front of the body can prevent the affected side from being neglected to cause the shoulder dislocation and pain on the affected side.
⑤At the same time, there are many kinds of courses and resources, which are available in all walks of life, and there are always people who need them.
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Bed movement training
1. Bed lateral movement
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The lower limb of the unaffected side flexes, inserts the lower limb of the unaffected side, and moves the lower limb of the unaffected side toward the unaffected side. Using the body and arms as support, move the trunk to the unaffected side to complete the entire process of activity.
2. Longitudinal movement on the bed span>
> Bend the hips and knees of the unaffected leg, and place the feet flat on the bed. Using your feet and elbows as support, lift your hips and move your body up to complete the movement.
Bed Sit Up
1. Assist the patient to sit up
from the knee to the healthy patient with the foot>
2. The patient sits up from the unaffected side independently
This type of activity is easier and safer for patients to complete, but it can cause the patient to develop a joint movement pattern, and it is easy for the patient to ignore the affected side. Follow the steps of turning over on the healthy side and turn into a lying position on the healthy side. The unaffected hand holds the affected hand in front of the pillow, crosses the legs, and uses the unaffected leg to move the patient’s lower extremity to the bedside.
Bend the healthy elbow to the side of the body, pronate the forearm, and support the body with the elbow and hand to sit up. Adjust your posture and stay seated.
Precautions for sitting up in bed
Although sitting up on the unaffected side is easier than sitting up on the affected side, sitting up on the affected side encourages the patient to use the upper body on the affected side. lower limbs.
Sit-up training requires patients to have a certain ability of sitting balance and posture control. During training, attention should be paid to prevent excessive force and induce limb spasm.
Seated Lay Down
< span>1. The patient lies down from the affected side independently
the patient’s hand on the side of the bed, with the patient’s hand on the side of the bed, The healthy leg is crossed behind the affected leg, and the unaffected hand crosses the body from the chest and is supported on the bed next to the affected hip. The affected leg is lifted to the bed with the help of the healthy leg. After the legs are placed on the bed, the patient gradually lowers the affected side until he is lying on the bed, keeping the legs flexed while the body is lying down.
2. The patient lays down independently from the unaffected side
The patient sits on the edge of the bed, the affected hand is placed on the thigh, the healthy leg is crossed behind the affected leg, the body is inclined to the unaffected side, and the unaffected side is supported on the bed by the elbow of the unaffected side. The legs are lifted to the bed with the help of the unaffected leg. When the legs are placed on the bed, the patient gradually lowers the body and gets closer to the torso, and finally lies on the bed, supporting the buttocks with the unaffected foot and the unaffected elbow and moving back to the bed. center of the bed.
3. Assist the patient to lie down< /p>
The patient sits on the edge of the bed with the affected hand on the thigh, the unaffected leg is crossed behind the affected leg, and the assistant stands on the affected side , drag the patient’s neck and shoulders with one upper limb. The assistant slightly bends the knees, puts the other hand under the patient’s leg, and helps lift the patient’s legs to the bed when the patient lies down from the affected side.
The assistant turns to the other side of the bed and places both forearms under the patient’s waist and thighs. Support the bed surface with the side hand, while the assistant pulls the patient’s hip to the center of the bed, adjust the posture, and take a comfortable lying position on the affected side.
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When the patient learns to simply sit up and turn over on the bed, they can try sitting movement, sitting up, transfer training, and wheelchair driving training with the assistance of their family members to improve the patient’s self-care ability , reduce the degree of dependence on family members, and return to family and society as soon as possible.
Sit up training
1. Sit up with assistance
The assistant supports the affected shoulder while the patient supports the upper body with the unaffected elbow.
The patient places both lower extremities under the bed and extends the elbow.
Sit up and stay seated.
2. Sit up alone
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The patient’s legs are crossed, and the affected leg is placed on the side of the bed with the unaffected leg. Turn to the unaffected side and place your legs under the bed.
Keep your healthy elbow on your side and raise your head.
Sit up with your elbows straight, to the edge of the bed.
Seated Balance Exercise
▲10 degrees
▲30 degrees
▲full sit up
Sit-up training aided by objects, elderly hemiplegic and severely injured patients are bedridden for a long time, when sitting or standing Orthostatic hypotension is prone to occur. Therefore, you should sit up with a stand or a shaker in the early stage, and you can generally sit up completely in about 2 weeks.
Sit up at 30 degrees on the first day, 5 minutes in the morning and afternoon A towel roll can be placed under the knee for hamstring pain.
After being able to sit up for 20 minutes, you can sit and eat.
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Seated Movement Training
Place the unaffected hand in front of (or behind) the body to support the body.
The unaffected lower limb flexes and moves toward the unaffected hand.
Using the knee as a fulcrum, move the hip.
Seated Stand Up
Auxiliary standing: the patient lays his feet flat on the ground, With the affected foot in front of the patient, the assistant supports the patient’s knee with the knee, and hugs the waist with both hands.
Stand up independently: touch the ground with both feet, the heel of the affected foot should be flat on the ground, the hands should be crossed, the upper limbs should be fully stretched forward, and the body should be pour. When your shoulders are forward over your knees, immediately raise your hips, extend your knees, and stand up.
Transfer Training
Place the wheelchair obliquely with the patient’s healthy side facing the bed, at an angle between 30-45 degrees, brake brake.
Stand up with the unaffected hand, and then use the healthy hand to hold the bed.
turned and sat down.
Wheelchair Drive Training
Place the patient’s foot on the wheelchair footrest and the healthy foot on the ground.
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Use the healthy hands and feet to drive the wheelchair, the feet control the direction, and the healthy hands help to drive. Carry out exercises such as walking forward, backward, and turning on the flat ground.
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Let’s demonstrate the training methods of passive joint movement, balance function and walking.
Passive joint movement
01Upper extremity joints1. Shoulder forward flexion : The patient is in a supine position, the therapist stands on the affected side, holds the wrist joint of the affected side with one hand and the elbow joint with the other hand slightly above, and slowly raises the upper limbs along the sagittal plane over the head.
2. >: The patient is placed in a lying position on the healthy side, the therapist stands on the affected side, holds the elbow slightly above with one hand, and fixes the scapula with the other hand, and slowly stretches the patient’s upper limbs back along the sagittal plane.
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3. Shoulder joint abduction: The patient is in a supine position, the therapist stands on the affected side and holds the wrist joint with one hand and the other with the other. Hold slightly above the elbow joint, and slowly abduct the upper limb of the affected side along the frontal plane. When the patient’s upper limb is moved to 90 degrees of abduction, the upper limb is externally rotated and continued to move until it approaches the patient’s ipsilateral ear.
4. Horizontal abduction and adduction of shoulder joint strong>: The patient is in a supine position, the therapist stands between the affected side body and the abducted upper limb, holds the affected wrist joint with one hand, and holds the elbow joint slightly above with the other hand, and slowly moves the affected upper limb along the affected side. The horizontal plane is abducted first and then adductioned.
5. Internal and external rotation of the shoulder >: The patient is in a supine position, the affected side shoulder joint is abducted 90 degrees, and the elbow joint is flexed 90 degrees. The therapist is on the affected side, fixing the elbow joint with one hand and holding the wrist joint with the other hand. Using the elbow joint as the axis, the patient’s forearm is moved along the The axis of the humeral shaft moves in the direction of the head and the foot, so that the shoulder joint passively rotates internally and externally.
6.
7. Forearm rotation The patient is in a supine position, the therapist stands on the affected side, the shoulder joint of the affected side is abducted, and the elbow joint is flexed 90 degrees. , the supination action.
8. Wrist flexion, extension and ulnar and radial deviation: The patient is in a supine position with the elbow joint in the flexed position. The therapist holds the distal forearm of the affected side with one hand and the fingers of the affected side with the other hand to perform flexion, extension, ulnar deviation, and radial deviation of the wrist joint.
9. Activity of the palm and knuckle joints : The patient is in the supine position, the therapist holds the palm of the affected side with one hand, and moves the fingers with the other hand to perform flexion, extension, abduction and adduction of the metacarpophalangeal joint respectively.
10. Interphalangeal joint mobility: The patient is in a supine position, and the therapist holds the patient in one hand Flexion and extension of the proximal and distal interphalangeal joints with the palm of the side and the fingers of the other hand.
2Lower extremity joints
1. Anterior hip joint Flexion: The patient is in a supine position, the therapist stands on the affected side, supports the affected calf near the knee joint with one hand, and supports the affected heel with the palm of the other hand. The lateral thigh is bent up in the sagittal plane so that the front of the thigh is as close to the patient’s abdomen as possible.
2. Hip extension: The patient is in a prone position, the therapist is on the affected side, one hand holds the upper part of the affected side ankle, the other hand grabs the front of the affected side knee joint from below, supports the affected side calf and knee joint with the forearm, and lifts it upwards forcefully , passively extend the hips.
3. Hip adduction and abduction >: The patient is placed in a supine position, the therapist is on the affected side, one hand supports the back of the knee joint, the forearm supports the distal thigh, and the other hand holds the heel, and the hip joint is slightly flexed to complete the hip joint. Outreach, and then return to the original position.
4. Internal and external rotation of the hip joint >: The patient is in the supine position and the lower limb is extended. The therapist fixes the patient above the knee joint with one hand and the ankle joint with the other hand to complete the axial transfer of the lower limb. Internal rotation of the hip.
5. Knee flexion, extension span>: The patient is in the supine position, and the treatmentThe teacher supports the back of the knee joint with one hand and the heel with the other hand, and completes the flexion and extension of the knee joint under the flexion of the hip joint.
6. Ankle dorsiflexion >: The patient is in a supine position, and the lower limbs are stretched. The therapist fixes the top of the ankle joint with one hand and holds the heel with the other hand. While pulling the Achilles tendon, the therapist’s forearm is used to push the sole of the foot.
7. Ankle plantar flexion: The patient is in a supine position, and the lower limbs are stretched. The therapist fixes the upper part of the ankle joint and moves it to the dorsum of the foot. While pressing the dorsum of the foot, the other hand lifts the heel.
8. Ankle Varus, Valgus >: The patient lies on his back and the lower limbs are stretched. The therapist fixes the ankle joint with one hand and performs varus and valgus movements with the other hand.
03< /span>torso
The patient lies on their side, with the upper leg flexed and the lower leg straight. The therapist immobilizes the upper shoulder joint with one hand and the other hand on the pelvis on the same side, so that the shoulder Rotate in the opposite direction to the pelvis and hold for a few seconds to fully stretch the torso.
The above set of movements is completed by external help. When you help the patient to perform full range of motion in all directions of the joint, avoid rough movements, and the time and intensity of the activity should also be controlled according to the patient’s tolerance and vital signs.
Balance dysfunction is also one of the main obstacles for stroke patients, so balance training must not be neglected. To train the balance function, it is necessary to focus on trunk rehabilitation and standing balance training.
Balance function training
Trunk rehabilitation
According to the degree of hemiplegia of different patients, the following will demonstrate Training methods of different periods and levels of difficulty, if dizziness, headache or nausea occur during training, it is recommended to suspend training first.
01Early Torso Rehabilitation
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1. Bridge Exercise
The patient lies on the back with the legs flexed, then the hip is extended, raised and held . Bridge movement is one of the important contents of early bed position transformation training, which can improve posture and improve the ability to control movement.
2. Rollover training
Turn over training strengthens the trunk strength, promotes limb flexion and extension, and can promote proprioception, thereby improving the patient’s balance function and motor function.
3. Upright Bed Training
An upright bed is a transition from bed rest to standing, preventing orthostatic hypotension and improving lower extremity weight bearing, balance, and trunk control.
4. Four-point kneeling, three-point kneeling, two-point kneeling training
four Point kneeling increases muscle control around the trunk, hips, upper extremities, and shoulders.
three-point kneeling
< p>Two-point kneeling position
In the beginning, you can use the kneeling position with both hands and knees. The four-point kneeling position can be gradually increased in the later stage to perform three-point kneeling and two-point kneeling training.
02Trunk rehabilitation in the middle and late stages
1. Flat bed training
The patient straightens the lower limbs, Put your feet on the yoga ball, use your torso strength to lift your hips off the bed, and keep your lower limbs in a straight line with your torso, keeping your elbows straight and the ball stable.
2. >
Patients place their feet on the ball, straighten their knees, support the bed with both hands and straighten their elbows so that the lower limbs are in a straight line with the trunk.
3. Ball sitting training >
The patient sits on the ball, and with the help of the therapist or family members, keeps the thoracic spine stable, and moves the ball back and forth or from side to side to flex, extend or laterally flex the waist sports.
Balance ability training
Balance training should follow the principle of increasing the support surface from large to small and the stability limit from large to small, and gradually from static balance to dynamic balance Balance, and gradually increase the complexity of training. When the patient’s condition is stable, and there is no dizziness or headache in the sitting position, the rehabilitation training for balance dysfunction can be started.
01Static standing balance
Head, shoulders and hips are balanced and vertical, and the torso remains Straight, knees slightly bent and facing forward, feet shoulder-width apart, ankles steady and weight bearing on the soles of the feet, hands resting at the sides of the body in a relaxed state to maintain balance.
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02Dynamic standing balance
1. Ankle coordination and stable weight-bearing exercises:
2. Hip-knee coordination, keeping both feet supported and torso balanced:
3. The patient can maintain a stable balance from sitting to standing and from standing to sitting:< /span>
4. Balanced:
5 The affected limb can respond or change to changes in the surrounding environment to maintain its own balance:
1Knee abnormalities
1. Knee flexion when the foot touches the ground
Training method: hamstring stretching, knee joint control training
Training method: Correct foot drop, controlled flexion and extension of the knee in the range of 5-10 degrees in the standing position .
3. Inability to flex or underflex the knee when the foot is off the ground span>
Training method: strengthening the control exercise of knee flexion and extension in the supine position
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02Hip/pelvis/trunk abnormalities
< p>1. Body leaning toward the supporting leg
< span>Hip abductor weakness training: hip abductor strength training
2. Lower body adducts when feet are off the ground
< p>Training methods: hip adductor stretching, hip flexor strength training
03Foot drop correction< p>
04 Elastic band correction of lower extremity external rotation
Rehabilitation treatment is a long process. Taking all effective measures in different periods can improve the damaged dysfunction, effectively prevent complications, and reduce the recurrence rate, disability rate and death. Rate. Therefore, after a stroke, we must actively and standardized rehabilitation treatment.
Source: Comprehensively compiled from Beijing United Family Rehabilitation Hospital
Author: Physiotherapist Zhou Jian< /p>