The main training items for rehabilitation of typical stroke patients during hospitalization include:
Basic training of ROM; Basic movement training such as sitting, standing and walking; Functional training of paralyzed upper limbs; Daily life activities training; The corresponding treatment of advanced brain dysfunction; Preparatory training for returning to family, etc.
The content of occupational therapy involves many aspects. One is to use specific work activities to improve the upper limb function, and to treat the surrounding movements as the center (including posture control and intellectual activities necessary to complete these movements, etc.). Secondly, it is necessary to predict the degree of residual dysfunction and movement disorder, and start various activities aimed at improving ADL's self-care ability from the early stage. At first, you can break down a series of movements for training. At the same time, you can also use self-help tools to guide and help the change of family environment. In addition, you need to cooperate with the necessary treatment, aiming at pre-job evaluation and training of psychological and social skills.
1. therapeutic purpose
The main purpose of occupational therapy for stroke patients is to improve and maintain their physiological and psychological functions by participating in occupational therapy activities, so that patients can take care of themselves to the maximum extent, and finally return to their families and society and enjoy a high-quality life.
Second, the treatment method
In order to achieve the above goals, occupational therapy must be based on patients' own characteristics, and the following factors must be considered when formulating specific treatment plans and measures: the onset time of patients, the current recovery stage, patients' age, motor sensory cognitive function, complications, family social economy and so on. It should include the contents of promoting patients' normal posture reflex, abnormal movement inhibition reflex and abnormal movement pattern. After encouraging patients to use the affected hand to determine the treatment measures, we should let the patients' families and other professionals, especially nurses, know the contents in time, and introduce and guide them to take correct methods to effectively supervise and guide patients and apply them to daily life as much as possible.
At different stages of stroke rehabilitation, the main goals of treatment will be different and the treatment methods will have different characteristics. Therapists must make timely assessment and adjust treatment plans and measures at any time according to the changes and progress of patients' condition.
(A) treatment measures in acute phase
A large number of clinical rehabilitation practices show that early rehabilitation is helpful to improve the impaired function of stroke patients, reduce the degree of obstacles and improve their quality of life. Therefore, it is generally advocated that once the vital signs of patients are stable for 48 hours, rehabilitation measures should be implemented in time without further progress. The treatment in this period is mainly to prevent the occurrence of complications and secondary obstacles, laying the foundation for future rehabilitation training. The goal of acute occupational therapy is to improve the basic movement of getting out of bed early, restore the cognitive function of upper limbs and improve the psychological support of patients after onset.
In the early stage of the disease, all patients' nonspecific functions declined, so when designing work activities, we should not only consider the recovery of individual functions, but also consider carrying out treatment activities around improving the overall activity ability of patients.
The main purposes and methods of acute treatment are: ① to prevent the swelling and pain of the affected upper limb caused by the loss of limb movement, to prevent muscle shortening, to pay special attention to the affected upper limb, to prevent the immobility of the limb pattern caused by ignoring the affected limb, to promote the recovery of voluntary movement, and to input the correct movement pattern to the patient as a sense of movement.
④ Specific treatment measures to improve patients' central awakening level include:
1. Prevent joint contracture and deformation.
After stroke, the limbs will be inactive for a long time, leading to joint contracture and adhesion, even causing pain and even affecting functional recovery. Once joint contracture occurs, it is not easy to recover. It takes time to improve joint contracture and it will be accompanied by pain. If there are some special circumstances that require orthosis or surgery, it will bring greater pain and burden to patients. Therefore, it is very important to prevent contracture. Preventive measures include posture placement, regular posture change and joint range of motion training, as follows:
(1) Posture placement: When the patient is in bed rest, whether he is unconscious or not, he must keep his limbs in the correct position, otherwise the muscle tension may increase, which may also lead to secondary dysfunction such as muscle contraction and joint contracture. In order to prevent these secondary disorders, patients must maintain correct posture and change posture in time to minimize functional damage and lay a good foundation for future functional training. For patients with severe disturbance of consciousness, it should be avoided.
1) Sick lateral position (Figure 4-4- 1): Sick lateral position is the most important position among all positions. Because the patient's weight is pressed on the sick lateral position, it is beneficial to increase the sensory stimulation input to the sick lateral position, so it can be used from the early stage; Because the whole affected body is passively stretched, it is beneficial to relieve spasm; In addition, when the healthy hand is liberated and can move and use freely, the following points should be paid attention to when taking this posture:
Head: the head should be fully supported by pillows.
Trunk: Turn back slightly and fully support your back with a pillow.
Upper limb: the scapula of the affected upper limb extends forward, and the included angle between shoulder flexion and trunk is not less than 90. Elbow straight, forearm supination, wrist on the edge of the bed, keep passive back extension. Healthy upper limbs can be placed on pillows above or behind the body.
Lower limb: The lower limb is in a step position, the hip joint of the affected lower limb is straight and the knee joint is slightly flexed. The healthy hip and knee joints of lower limbs are flexed and supported under the pillow.
Figure 4-4- 1 Correct posture of patient lying on his side.
2) Healthy lateral position (Figure 4-4-2): Head: The head is supported by a pillow.
Trunk: the trunk lies on its side, at right angles to the bed surface.
Upper limb: support the affected upper limb in front of the patient with a pillow, with the scapula extending forward, the shoulder joint flexed forward by about 90 ~ 100, the wrist joint and fingers of the elbow joint straight, the palm down, and the healthy upper limb placed in any position where the patient feels comfortable.
Lower limbs: The hips and knees of the affected lower limbs lean forward slightly and are completely supported by pillows. Pay attention to avoid varus caused by hanging your feet on the edge of the pillow. Healthy lower limbs lie flat on the bed, stretching hips and slightly bending knees.
Figure 4-4-2 Correct posture when lying on the healthy side.
3) Supine position (Figure 4-4-3): Supine position is only used as an alternation or transition with other supine positions, because this position will be affected by neurocervical reflex and neurolabyrinthine reflex, and abnormal reflex activity is the strongest, and long-term adoption of this position is likely to cause pressure sores on the lateral heel and lateral ankle of sacrococcygeal region, so it is necessary to avoid long-term adoption of supine position: the head is supported by a pillow and the face is turned to the affected side.
Affected upper limb: put a pillow under the affected scapula and upper limb to prevent the affected scapula from retreating. Keep the upper limb above the level of the heart, straighten the elbow joint, supinate the forearm, extend the wrist joint backwards and straighten the fingers.
Lower limbs: place pillows under the affected pelvis and outside the affected thigh to move the pelvis forward and prevent external rotation of the hip joint.
Figure 4-4-3 Correct posture in supine position
4) Precautions when placing posture: ① The mattress should not be too soft, the bed should be flat, and the head of the bed should not be raised.
(2) Correct bed posture is a part of treatment measures, which must be implemented, checked and adjusted at any time, and some special measures should be taken according to the patient's specific situation, such as letting the patient hold a small roll of towel in the palm of his hand to prevent finger flexion and contracture. At this time, we should pay attention to whether the towel roll will stimulate his palm and cause grasping reflex, so it is not advisable to put anything in the affected hand when it appears; Don't put anything on the soles of your feet to make them naturally placed, but for patients who need to stay in bed for a long time or be slowly paralyzed, you need to use the soles of your feet to keep your ankle in a 90 flexion position to prevent toe deformation; In supine position, the lower limbs naturally extend, but for patients with genu varus, a small pillow can be placed under the knee joint to make the knee joint slightly flex.
(3) If you need to wear a rest brace to maintain wrist extension, you must always check it to avoid the brace interfering with sensory input and limiting active movement, which will lead to shortening of extensor tendon.
4 pillows of different sizes and shapes should be prepared to support different parts of the body.
⑤ In order to prevent foot drop, a metal frame can be made at the end of the bed, placed above the patient's foot, and covered with a quilt to avoid foot drop caused by direct oppression of the affected foot.
⑥ In the process of posture placement, the proximal and distal ends of the upper limbs should be fully supported to avoid only controlling the distal ends of the upper limbs and ignoring the proximal ends.
(2) Changing posture regularly: Because a person who keeps a posture for a long time will cause secondary obstacles, it is necessary to change the patient's posture regularly, especially in the acute phase, which is mainly the responsibility of nurses and the cooperation of occupational therapists.
In principle, it is required to change positions every 2~3 hours. When the patient can turn over and move on the bed, the interval can be appropriately extended until the patient is awake or feels uncomfortable.
(3) Training of joint range of motion: While maintaining correct posture, we should actively take training to maintain and expand joint range of motion, which can effectively prevent joint contracture caused by contraction of muscles and ligaments of limbs. Moreover, in the early stage of functional recovery training, the training of joint range of motion is very important for learning motor sensation and inducing voluntary movement.
Long-term bed rest is easy to cause joint contracture. The prone joints and movement directions of upper limbs are as follows:
Shoulder joint: adduction and pronation
Elbow joint: flexion
Forearm: pronation
Wrist joint: flexion
Fingers: bending
In the early stage of illness, when the patient has not taken the initiative to exercise, the therapist should take the initiative to do passive movements in all directions for the patient, and when necessary, go to the patient's bedside to carry out joint activities with passive movements as the main part and active movements as the supplement. This kind of joint exercise is generally carried out twice a day, each time 15 minutes. When instructing patients to move according to the direction of movement, it should be noted that all-round joint activities should be carried out. In order to avoid the gradual decrease of joint range of motion, the therapist must make clear the angle of full range of joint range of motion of each patient, and observe its changes at any time, paying special attention to the following joint range of motion:
① Pay attention to the movement of the scapula on the chest wall, especially the upward rotation of the scapula. When the scapula movement is not obvious, the therapist can hold the patient's forearm under his arm, hold the patient's upper arm with his hand, induce the elbow joint of the upper limb to extend and rotate the shoulder joint outward, and hold the patient's scapula spine edge with the other hand, and then slowly and rhythmically move the patient's scapula up and down.
② The premise of complete abduction of shoulder joint is external rotation of humerus, because external rotation of humerus makes greater tubercle of humerus pass behind acromion.
Joint mobile training should follow the following principles:
Activities should be carried out slowly and gently, because rapid exercise increases the risk of joint stiffness, and excessive force can easily lead to joint dislocation or other injuries, and may also cause pain.
Activities start from the proximal joints, and each joint moves in all directions for 3~5 times, training twice a day.
When moving, the proximal joint should be fixed, the distal joint should be moved, and the distal end of the limb should not be fixed across several joints.
After passive activity, pay attention to keep the patient in good posture.
Pay attention to encourage and guide patients to use correct methods for self-joint activity training, such as lying in bed, hands folded, thumb above the affected side, elbow straight, shoulder flexion and extension (Figure 4-4-4);
Figure 4-4-4 Flexion and Extension of Shoulder Joint
In addition, the shoulder joint can be horizontally adducted in the direction of the healthy side at the 90 flexion position of the shoulder joint, so as to drive the affected scapula to fully extend forward. 2. Skin care: About 65,438+04.5% of stroke patients have skin tenderness and squeezing, especially those with unconsciousness, malnutrition, obesity, or severe paralysis or muscle spasm, which are easy to occur. OT can help patients keep their skin healthy through the following points:
(1) Prompt patients to keep correct bed posture at any time and change their posture regularly.
(2) Apply correct transfer and exercise techniques to reduce skin irritation and avoid excessive skin friction.
(3) Put forward reasonable suggestions on wheelchair selection and transformation for patients.
(4) Instruct patients and nursing staff to protect their skin.
(5) Pay attention to the signs of skin compression (such as squashed red blisters, abrasions and ulcers), pay special attention to prominent bones, and remind nurses and medical staff to give appropriate treatment at any time.
3. Prevention and correction of unilateral neglect and visual field defect. Clinically, we can often see the phenomenon of neglect of stroke patients. For example, throwing the affected upper limb aside like it is not a part of your body will easily cause damage to the affected limb and joint, which is also extremely unfavorable for future functional recovery. Therefore, the therapist should always remind the patient to pay attention to the body of the affected side. In addition, the following measures are also effective for preventing and improving side view.
(1) Encourage patients to turn their heads and scan their surroundings with their eyes.
(2) When treating or caring for patients, therapists or their families should try their best to approach patients from the affected side, so as to increase the chances for patients to pay attention to and know their affected side.
(3) In daily life, always keep the affected upper limb within the patient's own field of vision, and try to keep the same limb position as the healthy side. For example, when eating, even if you can't use the affected hand, you should put the affected upper limb on the table and sit in the chair. The affected hand should be placed on your thigh. The therapist must always remind the patient to put the affected hand back on the thigh with his healthy hand when it falls off the leg.
(4) Do more self-rescue activities with healthy hands to drive the affected hands and upper limbs.
4. Sitting training When the patient's vital signs are stable for 48 hours and he can communicate with others, he can start sitting training under the guidance of the attending doctor, and take sitting position repeatedly within the patient's tolerable time, starting from sitting in bed for a long time and gradually transitioning to sitting in bed and wheelchair.
Correct sitting posture requires stable support from the pelvis. Keeping the back straight can free the upper limbs and allow the patient to observe the surrounding environment in a horizontal position. Due to the uneven distribution of muscle tension in various parts of the patient's body, the patient often shows a posture in which the head, neck and trunk bend to the affected pelvis. This posture is easy to cause some muscles to be overtired, and will gradually lose balance or even fall. The therapist must correct the patient's bad sitting posture at any time. The principle of correct sitting posture is symmetry on both sides.
(1) Long bed sitting posture (Figure 4-4-5): When taking a long bed sitting posture, the hip joint must keep 90 degrees flexion, the lower limbs naturally extend and the back is straight. If necessary, a pillow or quilt can be placed on the back of the patient, and the head does not need to be supported.
Put your upper limbs on the small table in front.
Avoid leaning against clothes. When leaning, the back will often bend, the pelvis will lean backwards, and the hip joint will be in a semi-extended state. This posture is easy to induce or aggravate lower limb extensor spasm and hinder the recovery of lower limb motor function.
The number and duration of sitting up every day should be determined according to the patient's needs and tolerance. For example, washing face, brushing teeth and combing hair after getting up every morning can be done in a long sitting position, and three meals a day can also be eaten in a long sitting position. If the patient feels tired at first, he can adjust his posture at any time during eating. After sitting in bed for a long time can be maintained stably and permanently, he can gradually adopt bedside sitting posture (both lower limbs hang down from his knees to the edge of the bed) and wheelchair sitting posture.
Figure 4-4-5 The correct posture of long sitting posture in bed
(2) Wheelchair seating: First, choose a wheelchair suitable for the patient's figure. If necessary, the height and width of the wheelchair can be adjusted by using the sponge pad, so that when the patient sits in the wheelchair, the hip, knee and ankle keep 90 flexion position, and the back extends to the back of the chair. If the wheelchair backrest is too soft and the torso is excessively flexed, a backboard should be placed at the back. Help the patient to sit with his back straight, and place a sponge block outside the affected thigh to prevent abduction and external rotation of the hip joint (Figure 4-4-7). When taking this posture, patients rarely tend to slide down to a sitting position and lie in a wheelchair (Figure 4-4-8). In order to maintain a good posture of upper limbs, patients are advised to use a wheelchair table (Figure 4-4-9) and put both upper limbs on the table.
Figure 4-4-7~9
The main functions of wheelchair table are:
1) can give enough support to the affected upper limb, and can also eat at the wheelchair table and do other simple work activities.
2) It can make the scapula of the affected side move forward fully, and inhibit the flexor spasm of the affected upper limb.
3) prevent hand edema
4) Put both upper limbs on the wheelchair platform, so that the affected upper limbs are in the patient's field of vision, which is beneficial to avoid the phenomenon that the affected side is neglected.
Can be simply assembled and disassembled, and does not hinder wheelchair driving, so that upper limbs can be placed on the table top to keep sitting posture, hand edema can be prevented, and simple work activities can be carried out on the table top.
(3) Correct chair sitting posture: the left and right shoulders and trunk are symmetrical, the back is straight, and the hips, knees and ankles keep 90 flexion. In order to avoid abduction and external rotation of hip joint, feet should be shoulder width apart, knees should be close together, and upper limbs should be placed on the table in front (Figure 4-4- 10).
Figure 4-4- 10 Correct chair seating position
5. The surrounding movement training requires patients to complete their movements as soon as possible, such as eating and grooming with healthy hands. Eating is a highly self-reliant ADL action. OT teachers can improve the independence of patients' eating actions by transforming eating utensils, such as thickening the spoon handle, increasing the non-slip pad of the dish, or adjusting the height of the table. If you can sit on the bed, you can use the portable toilet to complete defecation; At this stage, patients can also be instructed to put on and take off their clothes. In short, patients should be allowed to do actions that can be done independently as much as possible. 6. Therapeutic work activities are aimed at improving patients' mobility, preventing swelling and neglect of the affected upper limbs, fixing body posture, and carrying out activities that require the joint participation of patients' limbs and spirit, such as simple intelligence test, wooden nail placement exercise, upper limb lifting exercise with folded hands, etc.
Hands with fingers crossed, thumb of the affected hand facing upward, hands raised together in an elbow straight posture (Figure 4-4- 1 1).
Figure 4-4- 1 1 Upper limb lifting
Repeated training of this movement can promote the perception and sitting balance of the affected limb, while maintaining the range of joint motion without pain.
(2) Treatment measures in recovery period
All nonspecific functions decline after onset, but after recovery, individual functions such as exercise or cognition are more common. The treatment objectives in this period are: ① improving hypofunction; ② Based on compensatory function, patients can acquire corresponding abilities. Goal ① and goal ② are generally in chronological order, but in most cases they are carried out at the same time.
To improve the low function, it is necessary to carry out the structure of activities through homework activities. The sensory perception, motor cognition, psychology and social functions required by different levels of activities are different. Occupational therapists need to analyze the process of work activities, grasp the degree of patients' low function and consider what measures should be taken. When selecting homework activities, it should be considered that it is best to use homework activities that are slightly more difficult to complete than the patient's existing functional level. Such activities are more conducive to improving patients' low function.
1. Sensory motor function (movement of upper limbs and hands) The functional recovery of hemiplegic upper limbs generally starts from the proximal end of the upper limbs, but due to the lesion site, some patients start to recover from the distal end, and usually experience: delayed paralysis after onset; Have convulsions; Spasm is aggravated, with * * * synchronous movement; Spasm relief, separation exercise and other rehabilitation processes can improve the control ability of patients' upper limbs and hands through specific work activities, exercises in homework and work scenes. The goal of treatment is to make patients get the coordination of sensorimotor system, which is motor learning in a broad sense and also refers to the development order of upper limbs.
General training principles of upper limb and hand movements;
The main purpose of training is not to enhance muscle strength, but to improve exercise patterns.
The key points of training: ① Form (sequence, way); ② Accuracy; 3 speed; ④ Adaptability (scene change, etc. ); ⑤ Durability
The movement of upper limbs necessary to complete work activities is to transfer from proximal joints to distal joints, and various limb positions of limbs need to be maintained during the movement.
When your fingers can't move, you can use a training orthosis.
Homework activities should be selected according to the order of sports development.
The difficulty and complexity of the movement should be from simple to complex: ① the movement mode of the element movement is from simple to complex (from joint movement to separation movement); ② From continuous action to simultaneous action; (3) the time required to complete the action is from short to long; ④ From plane action to space action; ⑤ The moving distance is from short to long; 6. Never need hand-eye coordination to need hand-eye coordination.
(1) Joint range of motion training: It is very important to maintain joint range of motion in both acute and recovery periods.
In particular, it is necessary to start joint mobility training from the early stage of onset, actively prevent the limited joint mobility when the affected hand is still at the level of disused hand in voluntary movement, and prevent the health management difficulties of changing hands in the future, and also carry out joint mobility training.
Operating activities that can achieve the purpose of maintaining and expanding the range of joint motion include table cleaning, sand grinding and gymnastics bar training (Figure 4-4- 12~ 17).
Fix the affected hand on the fingerboard, so that the thumb abduction finger can be straightened. At the same time, put the healthy hand on the back of the affected hand, and push both hands up and down at the same time.
4-4- 12 desktop wiping movement (auxiliary active movement)
You can wipe the table with a fingerboard or a folding towel. To promote the active movement of shoulders and elbows, we should pay attention to the compensatory movement and abnormal movement mode of trunk.
Figure 4-4- 13 desktop wiping movement (active movement)
Holding the handle of the sand table with one hand requires forearm pronation or forearm neutral position. Generally, forearm pronation is adopted in the initial stage, and attention should be paid to avoid excessive compensatory movement of trunk in the process of gradual transition to forearm neutral position.
Fig. 4-4- 14 grinding movement of one-handed sand table
Pay attention to the symmetry of both upper limbs when grinding your hands with sand table. The angle of the inclined plate is generally within the range of 0 ~ 55. If possible, the sand table polished by both hands can be divided into horizontal and vertical positions. According to the different rehabilitation stages of patients, different actions are designed. Desktop wiping action is not only the change of forearm from pronation position to neutral position and then to supination position, but also can change the inclination angle of sand table grinding.
Figure 4-4- 15 Two-handed sand table grinding movement
In order to promote the separation of forearm and hand, there are many kinds of grasping forms of sand table grinding that can be used.
Fig. 4-4- 16 Various sand table abrasives
(2) Basic exercise training: As the patient's condition enters the recovery period, most patients will have different degrees of spasms and joint reactions. If it is not restrained in time, pathological body posture and abnormal movement pattern will appear one after another, which will greatly affect the recovery of physical function. The following aspects should be paid attention to when treating patients who have entered a spastic state: ① During the training process, patients should be paid attention to relaxation and rest. Avoid excessive exertion. (2) Avoid actions that require high grasping function of the opponent during the obvious spasm stage of the affected upper limb. ③ Avoid excessive use of healthy hands. Excessive use of healthy hands or excessive exertion will aggravate the spasm of the affected limb and affect the functional recovery of the affected limb. For spasms, traction, squeezing, rapid friction and other methods can be used to reduce the tension of the affected upper limb. For example, the use of weight-bearing exercises or work activities under weight can effectively reduce the spasm of the affected upper limb.
Paralytic upper limb dyskinesia is characterized by: when the patient wants to use the affected hand, all the strength of the upper limb will be mobilized, so that the muscle tension will increase and a * * * synchronous movement mode will appear. Therefore, occupational therapists must try to break this * * synchronous movement pattern, input the correct movement pattern as sensory information into the patient's brain from the early stage before the abnormal movement pattern is fixed, and gradually establish the separation movement of each joint for separation exercise training. It should be noted that: avoid choosing too complicated actions. According to the training sequence from the proximal joint to the distal joint, the function of the distal joint cannot be exerted without good separation and control ability of the proximal joint-shoulder joint, and even if the manipulation ability of the distal joint-hand is strong, it cannot be fully applied to the ultimate goal of simultaneous movement, that is, the distal joint can operate and move freely without being affected by the movement and position of the proximal joint.
Many activities in life are composed of a series of actions. At first, it was difficult for patients to complete a series of continuous movements. Therefore, in the initial treatment, the therapist needs to break down the activities and guide the patients to practice one by one, and finally realize the moving operation of the target object that completes the continuous action. It is a multi-joint and multi-combination of shoulder, elbow and wrist. Complex exercise training, including the use of trunk and lower limb movements at the same time, is to guide patients to complete their movements in the right way, and to obtain practicality through specific operations. The movements of upper limbs and hands contain many action elements, among which five basic elements are: ① reach); Hand; 2 grab; ③ moving
(4) location; ⑤ release.
1) Upper limb movements: There are many kinds of operation activities to choose from in upper limb functional training, such as roller movement, hoop movement, wooden nail placement, weight training on the affected side, etc. Therapists must choose the most suitable surgical activities and carry out targeted training according to the recovery stage of patients (Figure 4-4- 18~30).
The patient's hands are crossed, the thumb of the affected side is above, and the wrist joint is placed above the roller. Driven by the healthy upper limb, the flexion and extension of shoulder joint and elbow joint are alternately completed.
Fig. 4-4- 18 drum movement (left hemiplegia)
Driven by the healthy hand, the affected hand pushes the big therapeutic ball to the healthy side to increase the rotation of the trunk, promote the movement of the scapula of the affected side and pull the affected trunk.
Fig. 4-4- 19 bedside push therapy ball (left hemiplegia)
Use a fingerboard with a towel at the bottom to give some support to the forearm and hand, and fix the movement direction and joint as an axis at the beginning to help keep the elbow straight.
Figure 4-4-20 Fingerboard (left hemiplegia)
The downward fetching mode in which the patient sits and places the object on the floor in front of the patient promotes the flexion of the shoulder joint and the extension of the elbow joint. With the improvement of the patient's motor control ability, the position of the object gradually rises.
Figure 4-4-2 1 Item Placement Movement (Left Hemiplegia)
The patient's hands are crossed, the thumb of the affected side is on it, and the wooden nails are held in the palms of both hands for carrying and moving, so as to promote the lifting of the upper limbs and the balance of the trunk.
Figure 4-4-22 Wooden Nail Placement Action (Left Hemiplegia)
The patient's hands are crossed, and the affected thumb is on it. Grasp the mousetrap with the thumb and forefinger of the healthy hand and put it on the pole.
Figure 4-4-23 Cyclic Exercise (Left Hemiplegia)
In order not to cause scapula adduction, shoulder abduction and elbow flexion, the therapist assists the patient's shoulders and elbows, and the amount of assistance decreases gradually according to the exercise mode, which promotes the learning of correct exercise mode.
Figure 4-4-24 Cyclic exercise (assisted by therapist)
Reduce the amount of assistance until the patient can independently change the position and height of the bar to improve the adaptability of the shoulder joint, and change from the elbow extension forearm pronation mode to the elbow extension forearm supination mode.
Figure 4