The typical patterns of hemiplegic patients are: upper limb flexor spasm and lower limb extensor spasm. Therefore, "fingers can't be stretched out" is a normal developmental state.
When exercising the shoulder joint, please pay attention to moving the scapula first, otherwise it will easily cause shoulder pain, which will lead to "shoulder-hand syndrome". The activities of shoulder joint include adduction and abduction, horizontal adduction and abduction, flexion and extension; The movement of elbow joint includes flexion and extension; The movement of wrist joint includes flexion and extension of ruler and radial deviation; Forearm movement also includes pronation and supination (the pencil is rotated clockwise and then counterclockwise).
If the patient is in a slow stage and has no voluntary movement, then we can only passively move him according to the above joint movements, and at the same time beat the muscles to stimulate him. If some movements of patients have certain strength but are weak, it is suggested to carry out resistance training to enhance muscle strength. Hemiplegic patients have difficulties in adduction and abduction of shoulder joint, elbow flexion, forearm pronation, wrist flexion, wrist extension and finger grip. We can train according to the specific conditions of patients.
Please pay attention to avoid long bed rest, try to avoid blood transfusion on the affected side, or suggest seeing a doctor in a regular rehabilitation medical institution.
Early rehabilitation:
At this stage, patients generally show delayed paralysis, no voluntary muscle contraction, no joint reaction, and the body is basically in a completely relaxed state; Equivalent to Brunnstrom recovery phase 1-2.
(1) Basic purpose: The basic purpose of early rehabilitation is to prevent complications that seriously affect the rehabilitation process in the future, such as swelling, muscle atrophy, limited joint activity, etc. Improve the function as soon as possible and prevent complications.
(2) Early rehabilitation methods:
1, correct posture: teach family members and nursing staff to adopt correct posture, including supine position, healthy side position and affected side position, and ask them to turn over every 2 hours and pat their backs.
2. Turn over exercise: raise your hands horizontally before crossing, rotate to both sides respectively, and support the bed with your feet.
Self-help exercise in bed: raise your hands horizontally, raise your head, raise your nose sideways, bend your legs to support your bed and lift your hips, and move your feet sideways with your hands crossed.
4, bedside passive movement-upper limbs: shoulder straps, shoulder joints, elbow joints, wrist joints.
5, bedside passive movement-trunk traction, back muscle compression stimulation.
6, bedside passive movement-lower limbs: hip joint, knee joint, ankle-toe joint.
7. Ways to promote muscle contraction: Use sudden stretching of muscles to cause muscle contraction.
8, expectoration
9. Bedside elevation sitting training: The bedside is gradually elevated, and the patient can maintain each position for 30 minutes, and then gradually increase 10 degrees to retrain until he can sit up at the bedside without relying on balance exercises.
10, facial and muscle stimulation: mouth opening, cheek bulging, tooth tapping, stretching, palatal roof, etc. , frozen cotton (or ice) and taste stimulation.
1 1. Breathing control exercise: let the patient take a deep breath-exhale slowly and relax.
12. Sitting training: Before the bedside elevation is less than 90 degrees, train the patient to raise his head and lift his shoulders with one hand on his back until he can support sitting up.
13, sitting posture balance: correct sitting posture, bedside sitting posture balance, including front, back, left and right directions.
14. Sitting exercise: strengthen balance training, including horizontal and lateral carbuncle before crossing hands, with hands crossed and pointing to nose and hands crossed and pointing forward; Healthy lower limb muscle strength training. You can teach family members and nursing staff, and then urge patients to practice many times a day.
15. Transfer from bed to wheelchair.
16. Standing exercise: If conditions permit, patients can be given early standing in bed to help them recover their sense of verticality, control their anti-gravity muscles, restore their self-regulation of blood pressure, improve their standing balance and overcome orthostatic hypotension. Under normal circumstances, patients with cerebral infarction are required to sit by the bed 3-4 days after being selected into the treatment group, and they can be trained to stand within two weeks. The strength of assistance depends on the condition. Patients with cerebral hemorrhage should try to sit by the bed for two weeks and stand around as much as possible.
17, healthy hands do activities of daily life: eating, dressing, washing, etc.
18. applied electrical stimulation: low-frequency DC stimulation, TENS, etc.
19, using EMG feedback technology.
20, the application of massage acupuncture treatment.
2 1, using cerebral circulation therapy to promote cerebral blood circulation.
22. Speech therapy.
23. psychotherapy.
(3) Rehabilitation arrangements:
Instruct patients and their families to complete 1, 2, 3, 8, 9, 10,1,17 several times a day; 4, 5, 6, 7, 12, 13, 14, 15 must be completed by the therapist once a day for 45 minutes each time; 18, 19, 20, 2 1, 22 can be decided by each unit; 23, 24 Without professional training, therapists should carry out simple language training including simple vocal exercises in the process of functional training; And be responsible for the psychological counseling of patients, so that patients can cooperate as much as possible and carry out rehabilitation treatment in the best state.
Second, medium-term rehabilitation.
At this stage, patients can obviously show the coordinated movement of upper limb flexor and lower limb extensor, and gradually realize the independent movement of some muscle joints, which is equivalent to 3-5 cycles of B recovery.
(1) Mid-term rehabilitation Objective: Restrain cooperative exercise mode, train muscle joints to move freely and independently as much as possible, improve the coordination of each joint, and gradually restore the patient's exercise ability.
(2) Mid-term rehabilitation methods:
From passive to active.
24, inhibit the upper limb spasm mode.
25. Stretching the trunk promotes and changes trunk activities, and inhibits trunk tension and spasm.
26. Put your arms around your knees to control upper and lower limb spasms.
27. Shoulder flexion: Touch the patient's hand, then touch his forehead, then touch his opposite shoulder, and train the elbow joint to bend and stretch at will.
28. Limb placement and maintenance activities: During the activities of the affected hand, instruct it to stop at any angle and stop for a minute at this position to improve the spatial control ability of the affected upper limb.
29. All-round independent movement of shoulder joint: shoulder lifting forward, shoulder abduction and shoulder external rotation.
30. The elbow joint moves autonomously in all directions: elbow, extension and forearm supination.
3 1, voluntary movement of wrist and finger: wrist dorsiflexion, lateral deviation, thumb abduction, finger pointing, etc.
32. Shoulder strap movement: upward, outward and downward.
33. Hip extension control in bridge training.
34, hip joint internal and external, abduction control training: healthy side neutral position in the affected side, the affected side neutral position in the healthy side.
35, knee flexion and extension control training.
36, hip and knee flexion and extension control training.
37, patients with hanging posture training lower limbs, to prepare for weight-bearing exercise.
38. Kneeling training in prone position.
Seats:
39, the affected upper limb support training.
40. Do a small range of elbow flexion and extension below the affected upper limb.
4 1, the affected hand pushes things forward or hands cross to take things.
42. Push the object with the back of your hand.
43. The forearm rotates and presses plasticine.
44. Hip flexion of the affected lower extremity.
45. Pick up small objects with your fingers (across the center line).
46. Muscle strength training of healthy lower limbs.
47. Knee flexion and extension of the affected lower limbs.
Standing position:
48, standing balance training: move the center of gravity left and right.
49. Standing balance exercise: cross your hands (depending on the situation), raise your head horizontally before lifting, and rotate your torso left and right after lifting horizontally.
50, sitting control training, and decomposition exercises.
5 1. Holding the wall with both hands for elbow flexion and extension promotes elbow extension or supports the affected hand independently.
52. Stand with your legs back and forth, and move your center of gravity to bend and stretch the affected knee in a small range.
53. Bend your knees where your hips are extended.
54. Bend your hips and knees and get ready to step.
55, adduction, abduction and pelvic descent training of the affected lower limbs.
56. Stand with one leg apart.
57. Low-step training controls pelvic stepping up and down.
58. What's the point?
59. parallel bars walking training (three points): the healthy upper limb moves forward-> then the affected lower limb follows-then the healthy lower limb moves forward.
60. Walking training on crutches (at three o'clock and two o'clock): Turn the healthy hand forward-move the affected lower limb forward-strengthen the heel.
6 1, going up and down stairs: going up/down-healthy lower limb-affected lower limb
Lower limbs/healthy walking-affected lower limbs-healthy lower limbs
62, bedside ADL training: washing, dressing, defecation, etc.
(3) Rehabilitation arrangement: The above items basically need the help and guidance of therapists, usually 1-2 times a day, 45 minutes each time, 4-5 days a week, once a day at home and once in the afternoon.
(4) Precautions
Each joint should maintain the maximum range of motion of the joint, and the treatment should be painless or within the range that the patient can tolerate, avoiding violence and gentle manipulation is appropriate; Therapists should give appropriate protection, and the auxiliary power should be from big to small, encouraging patients to complete independently.
Third, late rehabilitation.
(1) Rehabilitation purpose: Patients at this stage can use the affected limb to a great extent, which is equivalent to the 5-6 grade of Brunnstorm recovery. The purpose of rehabilitation training is how to use the affected side more freely, how to better use the skills mastered through training in daily life, improve various ADL abilities, improve the speed on the basis of ensuring the quality of exercise, and maximize the quality of life.
(2) Rehabilitation methods:
Continue the previous training, further consolidate, improve and apply it to daily life.
63, finger fine movements to strengthen training.
64, lateral walking training 7 first healthy side and then back side.
65. Improve gait training: relax the pelvis and bend your knees to strengthen training.
66, improve gait training: ankle back stretching and drafting.
67. Promote the support ability of the affected lower limb: stand, with the healthy leg in front and the affected leg behind, indicating that the center of gravity moves forward and the patient cannot leave the ground.
68. Promote the support ability of the affected lower limbs, carry out weight bearing on the affected limbs, and step forward and backward on the healthy limbs.
69. Stand and cross your feet in turn.
70. Family ADL guidance.
7 1, bedroom decoration.
(3) Rehabilitation arrangements are the same as the previous stage.
This kind of training is mainly assisted by community rehabilitation doctors, their families and volunteers, 3-4 times a week. Biweekly family or outpatient follow-up.
(4) About the use of assistive devices.
72. Footrest-Foot drooping
73, wrist back extension splint-wrist flexion spasm.
74, crutches, help to walk.
75. Wheelchairs.
In addition, for the problem that the patient can't stretch his hand, in addition to passive activities or sitting on the bed to support his hand, we can use splint (orthosis) to help him stretch for 20 minutes, 5-6 times a day.