Professor Wang Ninghua, Director of Physical Medicine Rehabilitation Department of Peking University First Clinical Medical College, has rich clinical experience in physical therapy of pain, rehabilitation of bone and joint diseases, and rehabilitation of nervous system, and published a monograph 10. (Left)
Huang Zhen, deputy chief physician of physical medicine rehabilitation department of Peking University First Clinical Medical College, has been engaged in clinical work of rehabilitation medicine for more than 0 years, and has rich clinical experience in mental system diseases, bone and joint diseases, cardiopulmonary dysfunction and so on. (right)
Hello, audience friends! This is CCTV's live program "The Road to Health", and today we are going to talk about the problem of learning sports for stroke patients.
Moderator: Has the problem of physical disability after stroke been cured?
Wang Ninghua: Stroke, also known as cerebrovascular accident, is the infarction or rupture of some blood vessels in the brain, which causes damage, destruction or necrosis of brain cells, thus affecting the functions of various parts of the body. Stroke patients may have one limb motionless in the early stage, the upper limb flexes in the late stage, the lower limb is straight, and they walk in circles. Because the destruction or death of brain cells is usually irreversible, it is impossible to recover completely on its own. So we emphasize here that rehabilitation training is very important. It is proved that rehabilitation training can make normal brain cells around the injury replace the function lost by brain cells in the injury site. It is also emphasized that rehabilitation training should be carried out as soon as possible.
Huang Zhen: The so-called rehabilitation training as soon as possible means that only when the condition is relatively stable, the vital signs are relatively stable, and the symptoms and signs are no longer progressing can we intervene in rehabilitation treatment. Some data show that the earlier the rehabilitation treatment, the better the rehabilitation effect. Two weeks to three months after onset is the best period of rehabilitation treatment, and early rehabilitation treatment is safe and effective.
Moderator: Can rehabilitation training reduce the occurrence of disability?
Wang Ninghua: Absolutely. There are two principles of rehabilitation training, 1, which should be carried out as soon as possible to avoid disuse syndrome. 2. Scientific rehabilitation exercise to avoid misuse syndrome. It should be emphasized here that family members can participate in learning some simple rehabilitation exercise methods. With more encouragement, family members can play a supporting and auxiliary role, rather than a compensatory role.
Huang Zhen: The so-called disuse syndrome means that if you don't move your limbs or reduce your activities, it will lead to further dysfunction. For example, if your joint stays motionless for 65,438+0-2 weeks, it is likely that joint contracture or stiffness will occur, and it will take 65,438+0-2 months to recover. If the stroke patient can't move his joints in the early stage, he will move his joints with the help of others, thus avoiding disuse syndrome.
Moderator: How to help patients recover their exercise when they can't move in the early stage?
Wang Ninghua: Early lying posture is very important for patients' rehabilitation. Let's watch a video. First, put a pillow around your neck to give the patient enough support. In order to prevent the scapula from retracting, put a pillow under the right scapula, keep the elbow joint and forearm extended, and put a cushion under the knees of both legs. This is to avoid lower limb muscle spasm. We should also keep our feet vertical to avoid foot sagging. Correct lying posture has different requirements for upper and lower limbs. The upper limbs should be stretched as far as possible and the lower limbs should be flexed.
Huang Zhen: If the patient's lying posture is contrary to the above requirements, it will aggravate the pattern of abnormal spasms in the future, that is, misuse syndrome.
Moderator: Can patients lie flat and turn over for a long time?
Huang Zhen: It is ok to change posture, but we should pay attention to several points. Watch a video, the patient is in a healthy lateral position, and the position of upper and lower limbs and back is the key. Then look at the lateral position of the affected side, pay attention to the affected knee joint, and don't stretch too straight.
Wang Ninghua: You should pay attention to the above points when lying in bed for a long time. The patient's sitting posture is also very particular. Let's watch a video. Put a pillow on his back, keep his back upright, keep his shoulder and scapula extended, keep his upper limbs extended on the table, and keep his lower limbs flexed.
Huang Zhen: When the patient first arrived at the hospital, his upper limbs were very painful and basically had no function. After rehabilitation training, the upper limb function recovered and life was able to take care of itself.
Moderator: When the patient's condition gradually improves and he can go to the fields, what aspects should he pay attention to?
Huang Zhen: It is a very important process for a patient to lie down and sit by the bed. Let's watch a video. The patient first grasps the affected hand with the healthy hand, and then hooks the affected leg with the healthy leg. After taking a healthy lying position, the nurse can help the patient sit up. If the patient has a certain activity ability, he can also sit up by himself according to the above method, which is a very labor-saving and safe way to get up.
Wang Ninghua: Family members should be careful not to use too much force when helping patients sit up, so as not to cause joint dislocation or even more serious consequences.
Moderator: How should patients exercise in bed?
Wang Ninghua: Let's watch a video. First, medical staff help patients to move their shoulder blades passively, and their feet should also do some passive activities. Then, exercise the upper limb control ability. You can stretch your elbow in different directions to exercise the patient's elbow orientation ability. When the lower limbs move, you can do bridge movement, that is, lift away from the bed. When doing this exercise, your hip joint is stretched, which is conducive to walking in the future. In addition, you can also do the rotation of the trunk, and the doctor will give oral guidance when the patient is exercising, which is conducive to the recovery of the patient. Family members of these sports can help patients complete as long as they master the essentials of sports.
Moderator: How do patients move from bedside to wheelchair?
Wang Ninghua: Let's watch a video. First of all, the doctor's knee is pressed on the patient's affected knee, and the chair is placed next to the healthy side. The doctor helps him get into the wheelchair. In addition, pay attention when you get up. Let's watch another video. When you get up, your feet will retreat slightly, so that the patient's center of gravity will move forward slightly and stand up relatively symmetrically. If the patient is hemiplegic, you can hook the affected foot with the good foot and stand.
Moderator: If we can pay attention to the above aspects in the early stage, we can avoid the occurrence of hemiplegia syndrome.
Huang Zhen: Basically, this can be avoided. Rehabilitation treatment can minimize disability or sequelae. We have many professional techniques to reduce spasms, suppress abnormal patterns and promote normal patterns. Let's watch a movie. If the foot has turned gait, it is necessary to pay attention to the bending of the knee joint. The patient steps on a wooden board to make the hip joint stand up. According to the correct exercise method, the patient's gait in circles can be relieved. Let's watch another movie. According to the flexion state of the upper limb, put something on the extension side to exercise the patient's extension ability purposefully. You can also use the bottle to touch the object to exercise the patient's upper limb rotation ability. In addition, it also includes wrist extension and shoulder extension. Remind patients that when doing the above exercises, their feet should bend their instep 90 degrees to avoid foot sagging.
Moderator: What should I do if I walk a little wobbly after exercise?
Huang Zhen: You can make some orthopedic devices, such as shoulder straps and foot pads. You can also exercise daily life skills such as washing, eating and dressing.
Moderator: What role should patients play in rehabilitation exercise? Should we give priority to active exercise or passive training?
Wang Ninghua: Rehabilitation training requires patients' active participation, which can enhance the reorganization function of the brain. Let's watch a movie. When wearing a sweater, the patient first aims the left sleeve at the left hand (the affected limb), pulls it up to the shoulder joint with the right hand, and then puts the sleeve into the healthy arm. When wearing pants, you also wear the affected side first and then the healthy side, and pull up the pants with the help of the healthy side's hands. The principle of wearing shoes is to wear the affected side first, and some shoe buckles can be made to facilitate fastening.
Moderator: Mr. Changchun Jin is 63 years old. I had a cerebral hemorrhage three years ago and recovered well. When I do rehabilitation training alone, my arms can bend, but I can't walk. What's going on here?
Huang Zhen: Maybe the patient didn't participate in rehabilitation treatment in time. Generally speaking, it should be good if he intervenes in rehabilitation treatment in time. Correct exercise methods can make patients recover. The key depends on the specific situation of the patient's spasm. If it is serious, he should reduce the degree of spasm and train.
Moderator: Ms. Zheng, a 32-year-old native of Hunan, whose mother was paralyzed for five months. She stays in bed at home, eating and urinating. We helped her move her arms and legs, and she said it hurt. What should we do?
Wang Ninghua: This is disuse syndrome caused by long-term immobility. Long-term immobility can cause soft tissue contracture and pain. Family members can learn some passive exercise skills from the film we just made. They must be mild and not exceed the patient's pain range. Remind patients to exercise quickly and lie still for a long time, so that the pain will not disappear and the symptoms will not improve.
Huang Zhen: If the pain is obvious, the usual method is ice compress. Wrap the ice cubes with a wet towel and apply them to the pain area for 5- 10 minutes, which can obviously relieve the pain.