Department of physiotherapy, xuanwu hospital, Capital Medical University

Stroke is a localized nervous system disease caused by a group of acute cerebrovascular diseases. Three basic cerebrovascular diseases of stroke: thrombosis, embolism and bleeding.

I. Etiology and main risk factors

The main causes of stroke are atherosclerosis and hypertension, while heart disease, abnormal hemorheology, hematological diseases, cerebral hemangioma and diabetes are also risk factors.

Second, the health education behavior guidance program

1, the main points of diagnosis of this disease:

(1) Sudden nervous system movement limitation, sensory and language disorders, and deep coma, disturbance of consciousness and other different signs.

(2) Often accompanied by headache, vomiting or convulsions.

2. Treatment of patients:

Once a stroke occurs, no matter where, the patient should first lie down quietly, unbutton his collar, raise his head, raise his chin and keep the respiratory tract unobstructed. Don't move and change the patient's position at will, so as not to give the patient all kinds of bad stimulation and wait for the arrival of the ambulance.

3. Stroke patients should be rescued urgently, diagnosed and treated early, and once the life disease is stable, rehabilitation training should be carried out as soon as possible.

4. The rehabilitation treatment of hemiplegia after stroke is to apply neurophysiology and exercise methods to enhance muscle strength, including the recovery of the affected side and the compensation of the healthy side, prevent complications, reduce sequelae, adjust mental state, promote functional recovery, give full play to residual functions, and strive to achieve self-care and return to society.

5, acute rehabilitation treatment:

Under the premise of not affecting the clinical rescue, measures such as nursing, massage, passive exercise (avoid being rude) and keeping limbs in spasmodic position while lying in bed are mainly taken to prevent bedsore, respiratory infection, urinary infection, joint spasm and deformation (such as shoulder subluxation, shoulder-hand syndrome, foot drop, etc.). ) and other complications and secondary injuries, to prepare for the next functional training.

6. Rehabilitation treatment in recovery period:

Generally, rehabilitation training can be carried out 3 days -3 weeks after illness (2-3 weeks after cerebral hemorrhage and 3 days -0 weeks after cerebral thrombosis), that is, the patient is conscious, has no progressive stroke and is in a stable biological state. We should follow the law of human sports development, from simple to complex, from easy to difficult, in order. The exercise time is from short to long, the exercise intensity is from low to high, and the exercise mode is from passive, auxiliary to autonomous. The order is as follows:

Move and turn over in bed → sit → sit and balance → stand and balance on both knees → stand and balance on one knee → sit → stand and balance → walk → go up and down stairs. In the process of rehabilitation training, we should emphasize the reconstruction of normal exercise patterns, followed by strengthening the training of weak muscle groups. Training should include the recovery of the affected side and the compensation of the healthy side.

(1) Bed training:

Including turning over, up and down, left and right activities, training of back muscles, abdominal muscles and respiratory muscles, activities of upper and lower limbs (such as doing unilateral and bilateral bridge exercises in bed to straighten pelvis), training of daily life activities such as washing, dressing, eating and going to the toilet.

2 sit-ups balance training:

First, from semi-sitting position (30 -40 degree angle) to sitting on the bed, sitting by the bed and sitting in a chair or wheelchair, gradually increase the angle, frequency and time.

Because patients can't control when sitting, they tend to lean to the affected side. At this time, it is necessary to train the balance of sitting, from unstable sitting without support to swinging the trunk in different directions to being able to sit steadily under the impetus of some external force from others.

(3) Standing and standing balance training:

Prepare for standing activities (such as sitting cross-legged and stepping, muscle strength training of the affected lower limbs, etc.). ), and then support standing → balance standing between bars → unarmed standing → standing balance training, so as to keep standing balance under the impetus of certain external forces of others.

(4) Walking training:

Walking is an important part of self-care for hemiplegic patients. Prepare activities before walking (such as supporting the affected limb to swing back and forth, step, load, etc.) ) → Walking with support or between parallel bars → Walking with crutches → Walking with bare hands. In walking training, it is important to pay attention to improving gait training.

There are three kinds of walking gait:

(1) Turn your hands before landing, feet outward, and then strengthen your heels.

(2) The crutches reach out to the ground, step out with healthy feet, and suffer from heel.

(3) The affected foot and hand turn forward at the same time, and then keep up with the healthy foot) → Walk with bare hands.

5] Step-by-step training: At the beginning, we should train according to the principle that healthy legs go first and sick legs go first.

[6] Complex gait training: such as walking in circles, changing direction, walking over obstacles, etc.

At one time, the function of upper limbs and hands was very important for patients to take care of themselves and return to society. Generally, joint activities recover well, but fine hand movements recover slowly, which requires intensive training.

Training content:

① Joint range of motion training: functional activity training of each joint, all-round intensive activity training of metacarpophalangeal joint and interphalangeal joint, flexibility, coordination and fine movements training of hands.

② Daily living ability training: training in dressing, washing, combing hair, eating, writing and taking things.

③ Return to social vocational training.

7. Prevention:

(1) a healthy lifestyle, a reasonable diet, smoking and drinking.

② Prevention and treatment of hypertension and obesity.

③ Keep blood pressure, blood sugar and blood lipid in the normal range.