to prevent secondary disabilities (z. B. contractures) and to prevent depression, rehabilitation should begin as soon as possible. Measures to prevent decubitus ulcers must begin before the patient is medically stable. Once they are fully conscious and does not progress to neurological symptoms, patients can begin erecting in the seated position, usually ? 48 hours after the insult. In the early rehabilitation phase when the affected extremities are still slack, each joint is 3-4 times a day in the normal range of motion moved passively (Normal values ??for the range of motion of joints *).

Rehabilitation is intended to maintain or range of motion, muscle strength, bowel and bladder function, and functional and cognitive abilities after a stroke to improve. Special programs are based on the social situation of the patient, eg. B. prospect of returning home or re-entering the workforce, in the ability to participate in a rehabilitation program under the supervision of nurses or therapists on the learning ability, motivation and skill. A stroke affects the cognitive abilities, which can make rehabilitation very difficult. to prevent secondary disabilities (z. B. contractures) and to prevent depression, rehabilitation should begin as soon as possible. Measures to prevent decubitus ulcers must begin before the patient is medically stable. Once they are fully conscious and does not progress to neurological symptoms, patients can begin erecting in the seated position, usually ? 48 hours after the insult. In the early rehabilitation phase when the affected extremities are still slack, each joint is 3-4 times a day in the normal range of motion moved passively (Normal values ??for the range of motion of joints *). The recovery of the ability to transfer from the bed to a chair or a wheelchair safely and independently, is important for the psychological and physical well-being of the patient. Problems walking, spasticity, visual field defects (eg. As hemianopia), incoordination and aphasia require specific therapy. Hemiplegia patients with hemiplegia can help prevent dislocation of the shoulder placement of one or two pillows under the affected arm. When the arm is limp, a well-designed loop can prevent the weight of the arm and hand stretched the deltoid muscle and the shoulder too much stress. A posterior foot rail, which is mounted at a 90 ° angle at the ankle, foot drop and a drop foot can prevent. Resistance exercises in the field of hemiplegic extremities can increase the spasticity and are controversial. However, exercises to re-educate and coordination of the affected extremities are added to the training program as soon as it is possible, often within the first week. Active and active-supporting exercises involving the full range of motion follow shortly thereafter to maintain flexibility. Active exercises with the unaffected limb must also be encouraged, as long as they do not lead to fatigue. Various activities of daily living (eg. As movement in bed, turning, changing the position, sitting up) should be practiced. For hemiplegic patients, the most important muscle for ambulation of the non-affected quadriceps. If this muscle is weak, it must be strengthened in order to support the affected side. Gait disorders in hemiplegic patients are multifactorial, such. As by muscle weakness, spasticity or distorted body image, and therefore difficult to treat. The functional prognosis of hemiplegic patients with a hip fracture is very bad. increase also attempts to correct the gait often spasticity and can lead to muscle weakness and also further increase the already high risk of falls resulting in a hip fracture. Accordingly, no attempt to correct the gait should be started as long as hemiplegic patient can walk safely and enjoyable for them. are new treatments for hemiplegia: “Constraint-induced movement therapy”: The limb is not affected during the day fixed (except for certain activities), with which the patients are forced to exercise all movements, especially with the affected limb. Robotic Therapy: robotic devices are used to provide intensive repetitions of therapeutic movements to guide the affected limb in the execution of the movement, and to give feedback (eg on a computer screen.) And the patient’s progress to eat. Controlled mobilization and part load: An apparatus (. Eg treadmill) which supports part of the weight of a patient is used during walking. The proportion of the weight to be supported and the speed of movement can be set. This approach is often combined with the robotic therapy that helps to mobilize the patient and provides as much support as necessary. Whole-body vibration: Patients stand on a Trainigsgerät with a platform that vibrates with rapid shifting of weight from one foot to the other. This movement stimulates reflexive muscle contractions. Trouble walking, before you can start walking exercises, patients must be able to stand. Patients must learn to come from the seating position in the state only. The height of the seat must be adjusted if necessary. Patients must be sure straight, slightly prone, and toward the affected side. Using a bullion for holding standing can be practiced safest. The goal of therapy is to develop a safe journey and maintain, not wiederherzustelllen a normal gait. Most hemiplegic patients have a gait abnormality, which is caused by multiple factors, such. As by muscle weakness, spasticity, or a distorted body image, which is difficult to treat. Attempts to correct the gait, often increase spasticity and can lead to muscle fatigue, which in turn increases the risk of falls. During the walking exercises the patient’s feet are placed> 15 cm (> 6 in) apart, while the patient holds with the unaffected hand firmly on the ingot. Patients take a shorter step with the affected leg and a longer step with the unaffected leg. Patients who are trying to go without bars, initially need any physical support by the therapist. Later, it is sufficient if the therapist is watching. In general, patients use a cane or walker if they practice walking without bars. The diameter of the cane should be large enough to provide an arthritic hand grip. Climbing stairs the climb begins with the unaffected leg and begins the descent with the affected leg (good leads up, the poor down). If possible, patients get up and down the railing on the healthy side, so they can embrace it. can look up the stairs cause dizziness and should be avoided. During the descent, patients should use a cane. The pole should be placed on top of each lower level just before the affected leg is verchoben there. Patients must learn to prevent falls. Falls are the most common injuries suffered by stroke patients and often lead to hip fractures. Usually tell patients the case, saying that her knees gave out. For hemiplegic patients almost always fall on her paralyzed side, lean on the parties concerned against a railing when climbing stairs is a prevention of falls. Strengthening exercises for weak muscles, especially in the short and in the legs, can also help. For patients with symptomatic orthostatic hypotension treatment support stockings, medicines and exercises includes a stability exercise equipment. Because hemiplegic prone to dizziness, they should change their posture slowly and take a moment after getting up to find her balance before walking. It should comfortable, supportive shoes with rubber soles and heels ? 2 cm be worn. Spasticity in some stroke patients, spasticity develops. Spasticity can be painful and debilitating. Spastic knee extensors easily can fix or on standing stretch (Genu recurvatum), which requires a knee brace with a hyperextension lock the knee. Resistance at the plantar causes ankle clonus; a short leg brace without spring mechanism minimizes this problem. Flexor spasticity develops in most paralyzed hands and wrists. If patients do not do with flexor spasticity several times a day exercises with the complete range of motion, a flexion contracture may develop, which can lead to pain and difficulty in maintaining personal hygiene. Patients and their families are instructed that these exercises are important and welcome. A hand or wrist splint can also be useful, especially at night. The best is one that simple to apply and must be cleaned. Heat or cold therapy can temporarily reduce spasticity and allow the muscle stretching. Hemiplegic patients can be given benzodiazepine to minimize fear and anxiety, especially in the early stages of rehabilitation, but has no effect on spasticity. The effectiveness of long-term benzodiazepine therapy to reduce spasticity is questionable. Methocarbamol has a limited value in relieving spasticity and causes sedation. Hemianopia patients with hemianopia (defective vision or blindness in the half of the field of one or both sides) should be taught to move their heads in the direction of the affected side, when they fix something. Family members can help by placing important objects on the unaffected side of the patient and approach from this side to the patient. A repositioning of the bed can be useful so that patients can see each person the same that comes into the room. When walking patients tend with hemianopia to be abut the door frame or obstacles on the affected side, which requires a special training in order to avoid this problem. When reading to patients who have difficulty to see on the left side, draw a red line on the left side of the newspaper column. When they reach the end of a line of text, they can then be recognized by the red line where the next line starts. A ruler, which is placed under each line can also help to find the right line. Occupational therapy after a stroke fine motor skills is often compromised or missing, what the patient can be very frustrating. Occupational therapists may need to modify the operations and movements of patients and assistive devices recommend (auxiliary equipment). Occupational therapists should also check the patient’s home for safety and identify the need for social support. You can help all the necessary equipment and facilities (eg. As bathtub bench, grab bars in the tub or the toilet) to order and install. Occupational therapists can also recommend changes that allow patients to perform the necessary activities of daily living (ADL) as safely and independently as possible, for. For example, by a change of furniture or disposal of unnecessary and cumbersome objects. Patients and caregivers learn how the transfer between the various seats (z. B. shower, toilet, bed, chair) is best achieved and, if necessary, how to modify daily activities. For example, patients can learn how they can attract or shave with one hand and any unnecessary movement can be avoided like cooking or shopping. Occupational therapists can suggest to prefer clothing and shoes with Velcro fasteners or to get plates with rubber grips. Patients with impairments in cognition and perception are shown ways to compensate for this. For example, they can use Arzneimittelbehäter who have a compartment for each day of the week.

Health Life Media Team

Leave a Reply