Rehabilitation care for hemiplegic patients with stroke

Stroke is a group of cerebral blood circulation disorders with sudden onset. It is characterized by focal neurological deficits, even with impaired consciousness and the onset lasts for 24h or more. It is a common and frequent disease with high mortality and disability rates, and constitutes one of the three major killers of human beings together with heart disease and malignant tumors. Among the survivors, 3/4 of the patients have different degrees of incapacity, and the rate of severe disability is more than 40%. In our department, 158 cases of hemiplegic stroke patients admitted from January 2004 to December 2006 received better results in reducing disability, maximizing patients' residual functions, and improving the quality of life through active rehabilitation and nursing care while actively treating and preventing complications, which are now reported as follows.

1. Clinical data

There were 158 cases of hemiplegic stroke patients, 82 male and 76 female, aged 42-88 years old, average 62 years old. Among them, 72 cases of hypertensive cerebral hemorrhage, 34 cases of cerebral thrombosis, 52 cases of cerebral embolism; 28 cases of death (accounting for 17.7%), 38 cases of cure, and 49 cases of limb paralysis left at the time of discharge.

This group of patients after active treatment and planned, step-by-step rehabilitation care, did not occur care complications caused by improper care, most patients can live on their own. It is evident that early, timely and effective rehabilitation training is of great significance in changing the abnormal movement pattern of patients and promoting the recovery of limb function as much as possible.

2. Nursing measures

2.1 Psychological care patients with acute and severe onset of illness, and limb dysfunction, conscious patients are mostly fear and anxiety, showing depression and pessimism. Effective psychological guidance to patients, patients with good cooperation with the treatment and rehabilitation care is of great help. Specific measures are: (1) establish a good nurse-patient relationship, create a good hospitalization environment, warmly receive the patients, and comprehensively assess the patients, understand the patients' social, physiological, and psychological conditions, and communicate with them more to understand the patients' psychological needs. Encourage patients to face reality, eliminate bad moods, and establish confidence in treatment. For patients who need craniotomy, explain to the patients and their families the method of surgery and the importance of surgery to the treatment of the disease, and provide psychological comfort and support. (2) Emphasize the support of the family and society, the patient is a member of the society and the family, especially the spouse, and ask him/her to be more caring and considerate to the patient, talk to the patient and participate in the patient's daily life arrangement. Visiting time to encourage visits, so that patients recognize that they are not alone, but have friends and family around to face the disease together, to overcome the disease, thus reducing the sense of isolation, to establish confidence in overcoming the disease [1].

2.2 Acute rehabilitation nursing can start 24~48h after the onset of the disease, such as thrombotic stroke, the condition can be stabilized to start. This period with clinical treatment can reduce secondary neurological damage, while preparing for the next step of training. Specifically, there are the following points: (1) The placement of good posture is an important part of early hemiplegic rehabilitation care and the most effective way to prevent atrophy. Patients lie on rigid beds to ensure correct bed posture and frequently change the position. Supine position can aggravate the contracture pattern due to the influence of tense cervical reflex and labyrinthine reflex, and the abnormal reflexes are active [2], and at the same time, excessive position should be prevented due to the posterior rotation of the pelvis on the affected side and external rotation of the lower limbs which easily lead to the pressure sores on sacrococcygeal tail, heel and external ankle. And prone position is a prone position to prevent contractures caused by hip flexion exam, large collection of flexion and lumbar flexion, but should prevent the occurrence of asphyxia. In practice, it is also not advocated in the palm of the hand with a towel roll and other physical objects to counteract the finger flexor spasms, and it is also not advocated that the soles of the feet are placed in hard objects to avoid foot metatarsophalangeal deformity, because this will aggravate the spasm. (2) Prevention of contractures. Regularly exercise the paralyzed joints, 3~4 times a day, each time about 10 times for each action, the sequence of activities from top to bottom, from large joints to small joints, gradually, the amplitude from small to large stretching contracture of the muscle tendons and the tissues around the joints, more and more with the contracture of the opposite direction of the movement until the active movement is restored. (3) Massage can promote blood circulation and lymphatic reflux to reduce swelling, and is also a sensory stimulation of the affected limb. For the muscle groups with high muscle tone, push and massage of a soothing nature is adopted to make them relax, and for the muscle groups with low muscle tone, they are rubbed and kneaded.

2.3 Recovery Nursing Generally, 1~3 weeks after the disease (cerebral hemorrhage 2~3 weeks, cerebral thrombosis 1 week or so) vital signs are basically stable, then enter the recovery period. The purpose of rehabilitation nursing in this period is to further restore function through functional training, and to achieve the purpose of walking and self-care. Nursing measures in each stage include: (1) soft paralysis stage: restore and improve muscle tone, and induce active movement of limbs. Encourage patients to start self-help movement as early as possible and gradually return to active movement. Pay attention to the gentle exertion, try to achieve the amplitude, and exertion to the extent of causing tension and mild pain. Cooperate with acupuncture physiotherapy and facial heat therapy once a day for 30 min each time.(2) Spasticity period: control the muscle spasm and abnormal movement patterns, and promote the emergence of detached movement. (3) Improvement period: assess the patient's paralysis, make a motor training plan for the patient according to the principle of from simple to complex, from easy to difficult, and carry out targeted training. If the vital signs are stable and the condition is stabilized, the training of sitting position can be carried out as early as possible, starting from semi-sitting position, then from supine to bedside sitting position, and finally to chair or to wheelchair, and achieve tertiary balance. Following the training of standing and walking, let them receive gait training in different terrains such as flat ground, steps and slopes, and instruct them to use the method of assistive devices to assist the training, and pay attention to the principle of "the healthy leg goes up first, and the sick leg goes down first" when going up and down the steps. In the training, attention should be paid to the training of the upper limbs and hands, the function of the hands is basically the last to be restored, and some of them are difficult to be restored for the rest of their lives. Attention should be paid to the training of the flexibility, coordination and finesse of the hands, such as the training of patting the ball, pitching the ball, and writing. During the training, attention should be paid to the patient's physical condition, so as not to cause recurrence of stroke due to over-training, and encouragement should be given to the patient's every progress, so as to build up his confidence in restoring his function. Self-support training is also an important part of this period, assisting the patient to complete the activities of daily life, such as washing, dressing, eating, etc., to restore his confidence in life.

2.4 Sequelae care Some patients will be left with the sequelae of spasticity, muscle weakness, contracture deformity, or even flaccid paralysis, and they should continue to be trained to utilize the residual functions to prevent functional deterioration and muscular atrophy, and change the environment as much as possible to adapt to the disability.

3. Discussion

Stroke-induced hemiplegia is cerebral hemiparesis, and the essence of motor dysfunction is damage to upper motor neurons, which causes movement to lose control of the nerve center, thus releasing the original inhibited motor reflexes of the subcortical centers, causing abnormal movement patterns [3]. The mechanism of hemiplegia rehabilitation depends on the plasticity of the central nervous system in addition to the process of recovery from brain tissue and vascular lesions. Functional retraining allows afferent nerve impulses received by receptors to promote the development of plasticity in brain function and to regain lost functions, and is therefore the main condition for the reorganization of central nervous function.

The principle of functional retraining for hemiplegia is to inhibit abnormal primitive reflexes, improve motor patterns, rebuild normal motor patterns, and strengthen weak muscles. Functional retraining is a long and arduous process, and nurses should have a high sense of responsibility, strong empathy and enough patience to strive for the formulation of a practical rehabilitation plan for each patient's specific situation, and to strive for the opportunity to intervene as early as possible for the restoration of functional limits. At the same time, it is also necessary to strive for family and social support for the patient's psychological and physical, increase the patient's confidence in treatment and treatment of rich therapeutic effect, so that he or she can return to the family and return to the community as soon as possible. In addition, the motivation to learn is also quite important to the training of rehabilitation, the nurse should mobilize the initiative of the patient.