#益阳头条##益阳市中心医院#
A few months ago, Uncle Li was sent to Yiyang Central Hospital because of cerebral infarction, after a series of treatments by doctors, Uncle Li was out of danger, but after the onset of the disease, there was a limb movement disorder on one side, and the doctor instructed him to go to the rehabilitation medicine department for rehabilitation training and treatment.
Uncle Li felt that it would get better with the passage of time, and there was no need to do rehabilitation training, but it didn't get better for a long time, leaving sequelae.
When it comes to rehabilitation treatment, many people have a misunderstanding, thinking that it is acupuncture, massage, and massage, but in fact, rehabilitation therapy is the comprehensive application of various rehabilitation treatment techniques to maximize the patient's function, so as to improve the patient's ability to take care of himself in daily life, improve the patient's quality of life, reduce the burden on the family, and enable the patient to return to the family and society.
In reality, there are many patients and their families who focus on treatment rather than rehabilitation, and regard rehabilitation as the same as recuperation and physiotherapy, believing that rehabilitation is dispensable. Many patients do not receive rehabilitation treatment as soon as possible after surgery and stroke, resulting in a variety of sequelae and seriously affecting their quality of life.
So, what are the misunderstandings in rehabilitation?
Myth 1: Everything is fine after the surgery
The function of the limbs is mainly manifested in the movement of the limbs, their tissue structure is fine, tendons, internal and extrinsic muscles, joint capsule, ligaments, bones and other tissues are located in the middle, the position is relatively superficial and precise compared to other parts of the human body, and it is easy to be damaged. However, surgery can only carry out anatomical relative repair of the injury, and only the comprehensive use of systematic rehabilitation treatment can achieve better results.
Myth 2: Rest more will get better
In order to help patients with stroke and accidental injury have certain difficulties in completing daily behavioral activities because of functional impairment, family members feed patients who could have eaten by themselves and do not let patients move on their own. Over time, the patient develops a strong sense of dependence. Suffering from disuse syndrome.
There are also many patients who feel that with medication, they can recover gradually and do not need rehabilitation, so they are also prone to disuse syndrome.
Disuse syndrome refers to patients who are bedridden for a long time after stroke or accidental injury, or have insufficient activity and reduced various stimuli, due to the decline of systemic or local physiological functions, resulting in muscle atrophy, joint contractures, lung infection, osteoporosis, and sequelae.
Myth 3: Rush to progress
Patients and their companions often think that the harder the exercise, the better the effect, so they continue to strengthen the muscle contraction of the hemiplegic limb to carry out strong flexor movements, resulting in strengthening the flexor movement, but inhibiting the extensor movement, so that the hemiplegic upper limb often presents flexor spasm.
Some patients are anxious, the affected limb can move slightly, they are in a hurry, and they do not have the conditions to sit and stand independently, so they can't wait to ask someone to pull and start intensive training such as walking or climbing stairs, resulting in the patient walking in circles, tremors, etc.
These premature or drastic rehabilitation sessions can lead to misuse syndrome.
Misuse syndrome refers to the damage to ligaments, tendons, and muscles, deformation of bones and joints, increased spasticity, habituation of abnormal gait, and fractures caused by falls.
Exercise training for post-trauma and stroke patients must be supervised by rehabilitation physicians or rehabilitation therapists, and different exercise training time, training intensity and frequency should be determined according to the different degrees of movement disorders and the surgical conditions of patients. Some people exercise too early or excessively, or even violently move the affected limb, resulting in rerupture of repaired tendons or nerves, or other injuries.
Myth 4: Ignoring psychological adjustment
Trauma and stroke occur suddenly, causing severe psychological trauma to the patient. Patients are often anxious about not being able to return to normal work, life and their own future, and they are depressed, have low self-esteem and even commit suicide. Therefore, psychological rehabilitation plays a very important role in the rehabilitation of limb function, and only when the psychological rehabilitation is completely rehabilitated, can the functional rehabilitation get the desired effect.
Myth 5: Rehabilitation = exercise
Rehabilitation is a medical exercise, not physical exercise. The clients of rehabilitation are not strictly normal people, and their conditions will change at any time, and they cannot be treated according to physical training. Training a patient by someone with no medical knowledge can cause undue harm to the patient. Formal and effective rehabilitation training should be under the professional guidance of a rehabilitation team composed of rehabilitation physicians and therapists to help patients recover as soon as possible.
Myth 6: Rehabilitation treatment = acupuncture, massage, massage......
Acupuncture, massage, and massage are just some of the components of rehabilitation treatment, which is called traditional Chinese rehabilitation treatment. The main treatment methods of modern rehabilitation medicine are the use of modern anatomy, kinematics, neurodevelopmental theory, functional compensation theory and motor relearning theory, etc., which are various functional recovery training based on exercise therapy.
There are many modern rehabilitation treatment methods, including physical therapy (exercise therapy and physiotherapy), occupational therapy, speech therapy, psychotherapy, rehabilitation bioengineering, etc. Modern rehabilitation treatment and traditional rehabilitation treatment should be combined with each other and learn from each other's strengths.
Myth 7: Rehabilitation = late stage
Recovery is not the same as good care. Rehabilitation should be carried out in tandem with clinical treatment to minimize disability and help patients regain function and return to daily life as soon as possible.
At present, most patients with cerebrovascular accidents are still unable to take care of themselves due to the lack of rehabilitation. For patients with cerebrovascular accidents, the best recovery period is within one month after the onset of the disease, the golden recovery period is within three months, and even early recovery can be achieved in the acute stage. We must pay attention to early rehabilitation intervention.
Myth 8: Rehabilitation treatment = exclusive treatment for the disabled
In addition to the disabled, rehabilitation targets also include chronic patients, elderly patients, as well as hemiplegia, amputation, cognitive impairment and other functional disorders caused by chronic cardiovascular and cerebrovascular diseases, tumors, head trauma, spinal cord injuries and other diseases.
The purpose of rehabilitation medicine is not only to cure patients, but also to restore the physical functions of patients, so the service objects of rehabilitation medicine are not only various injured and sick patients, but also various functional disorders who still have self-care impairment or partial/complete loss of employability after general medical treatment in various clinical departments.
Resources:
[1] Wang Longde, Peng Bin, Zhang Hongqi, et al. Summary of the report on stroke prevention and treatment in China 2020[J].China Cerebrovascular Miscellaneous,2022
[2] Li Yuwei. Clinical significance of early rehabilitation exercise training on patients with cerebral infarction[J].Application of Modern Medicine in China,2023
Hunan Medical Chat Special Author: Wen Dongsen, Yiyang Central Hospital
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(Editor YH)