Principles of hemiplegia treatment in stroke

In the past decade, rehabilitation medicine has been rapidly developing in China and has been increasingly emphasized by the society. Foreign studies have reported that, like stroke (cerebrovascular accident), such a serious disabling disease, active rehabilitation treatment can make 90% of patients regain the ability to walk and take care of their own life, and 30% of them can also resume some light work. On the contrary, for those who did not undergo rehabilitation, the percentage of recovery in the above two aspects was only 60% and 5% correspondingly. In terms of mortality, the rehabilitation group was also 12% lower than the non-rehabilitation group. Therefore, rehabilitation is important for stroke patients. However, hemiplegic stroke patients often take a wrong way or are misled in the treatment. Anyone who walks with the hemiplegic side of the upper limb hooked tightly to the chest and the same side of the lower limb on the ground in a "circle" is the result of the lack of rehabilitation treatment. So, what are the misconceptions that patients and their families should avoid?

Misconception 1: patients have medication, as long as rest, good nutrition, can gradually recover, do not need rehabilitation.

"Rehabilitation" is rumored to be the earliest word in China in about 900 AD in the "Old Book of Tang", the book has "Wu Zetian after the disease to get well" record, in fact, Wu Zetian after the disease did not leave a disability, but from the disease to fully recover! In fact, Wu Zetian was not disabled after her illness, but fully recovered from her illness. Therefore, China has always used rehabilitation as a synonym for complete "recovery" from illness, which makes the understanding of rehabilitation in China quite different from that in the international arena.The WHO Expert Committee on Medical Rehabilitation defines rehabilitation as "Rehabilitation refers to the application of various useful measures to alleviate the effects of disability and reintegrate persons with disabilities into society". Rehabilitation refers to the application of useful measures to alleviate the effects of disability and to reintegrate persons with disabilities into society." From this definition, we can see that there is a fundamental difference between rehabilitation and medication. The aim of rehabilitation is not to cure the disease, but to find ways to restore the function of the patient or disabled person. That is to say, patients who can recover 100% after the disease, there is no problem of rehabilitation, only after the disease can not reach 100% recovery, such as after a stroke left different degrees of hemiplegia, there is the problem of rehabilitation treatment. The method of rehabilitation is not drugs and surgery, but a variety of functional recovery training methods represented by exercise therapy. It is precisely because the purpose and method of treatment are different from clinical medicine that a unique medical specialty with distinctive features has been formed.

Our experts have made some controlled observations on hemiplegia in stroke, for example: the walking recovery rate of hemiplegia patients: 89.7% in the rehabilitation group and 65.2% in the neurological treatment group alone; the average hospitalization days: 74.4 days in the rehabilitation group and 106.1 days in the neurological treatment group alone. It can be seen that stroke hemiplegia is not a disease that can be gradually recovered by medication, rest and nutrition, but must be treated with rehabilitation as early as possible in order to have the hope of maximizing functional recovery.

Myth 2: Rehabilitation for hemiplegic stroke is acupuncture and massage.

Rehabilitation is a systematic project, which mainly includes:

(1) Kinesiotherapy:

Used to restore the motor function of hemiplegic patients, it is mainly a one-to-one (i.e., one rehabilitation therapist to one patient) manipulative therapy. The treatment method is based on the principle of central nervous development, restoring the patient's motor and sensory functions and inhibiting abnormal movements and reflexes through the techniques of facilitation and facilitation. It is also combined with the use of some exercise equipment to promote the patient's motor ability.

(2) Occupational therapy:

It is a rehabilitation therapy for upper limb motor ability, coordination and fine hand movement, aiming at restoring the patient's ability of daily life activities.

(3) Physical therapy:

such as functional electrical stimulation, biofeedback therapy and corresponding physical therapy to improve the muscle and circulation problems of hemiplegic limbs.

(4) Speech therapy:

Patients with speech dysfunction are treated to improve their verbal communication ability.

(5) Psychotherapy:

Stroke hemiplegic patients are often accompanied by depression and anxiety, and need to be given appropriate psychological intervention.

(6) Rehabilitation engineering:

The hemiplegic limbs can be equipped with appropriate orthopedic braces to stop limb deformation and assist functional activities.

(7) Rehabilitation nursing:

Functional position placement and passive activities of the limbs in the early stage of the onset of the disease or bedridden period of the patient, prevention of respiratory, urinary and gastrointestinal complications, etc..

According to the theory of Chinese medicine, hemiplegia belongs to "loss of support for tendons and blockage of meridians", and the use of acupuncture and massage therapy can open the meridians. Acupuncture and massage do play an important role in the rehabilitation of hemiplegia in stroke, which makes the rehabilitation treatment more Chinese. However, acupuncture and massage cannot replace rehabilitation.

Myth 3: The more care and support the family provides to the patient, the faster the patient recovers.

In 2003, a very interesting observation was reported by Jiang Zhongli and Reed Jianan in China that family size became a hindering factor for patients' recovery of daily living ability. In families with a large population, patients' recovery of daily living ability was poorer, on the contrary, in families with a smaller population, patients' recovery of daily living ability was better. This phenomenon suggests that the sense of "raising children to prevent old age" is y rooted among the people in our country. Due to the large number of family members, the children compete for filial piety for fear of getting a bad reputation as unfilial sons. Even if the patients could do many daily activities, they were not allowed to do it, and they did it instead. Therefore, although the patients also received rehabilitation treatment during hospitalization, they did not have a strong sense of rehabilitation in daily life activities, and the recovery of motor function of hemiplegic limbs and the ability of self-care in life were poor. On the other hand, in families with small number of members, the patients could only do many things by themselves, and their awareness of self-care was quite strong, and the recovery of motor function of hemiplegic limbs and ability of daily life activities was higher. Therefore, family members of the patients should establish the awareness of rehabilitation and actively cooperate with the medical staff to carry out rehabilitation treatment for the patients.

Myth 4: Rehabilitation has no effect on the post-stroke period.

Rehabilitation for hemiplegic stroke should be started as early as possible, usually about one week after the onset of the disease. The best rehabilitation period is 3 months after the onset of the disease. For more than 3 months and then rehabilitation treatment of patients (post-stroke period) also have a certain effect, the key lies in the correct method. It has been reported abroad that there is no end to the recovery process of brain injury, only a gradual slowing down of the recovery process. Recovery of motor function can last up to 1 or 2 years after the injury, and some studies have even confirmed that it can last more than 5 years after the formation of fixed damage. It has also been reported in China that a group of patients with an average duration of 11 months of recovery and sequelae, who had never received rehabilitation guidance and were plagued by "disuse syndrome" and "misuse syndrome", had their motor functions corrected through therapeutic rehabilitation. Correction", so that the motor function is partially restored. In our country, due to the development of rehabilitation medicine in various regions and medical cost and other problems, there are many hemiplegic stroke patients who have not received rehabilitation therapy, but they still have "rehabilitation potential", and rehabilitation therapy can also improve their motor function and daily life activities. Happily, with the development of rehabilitation medicine in China, community-based rehabilitation has also gained the attention of society as a whole. The Community Rehabilitation Implementation Program has been incorporated into the Outline of China's Eighth Five-Year Plan for Persons with Disabilities, and is being gradually implemented. In the future, many patients can continue to receive rehabilitation treatment in the community after discharge.