Ten common misunderstandings about stroke rehabilitation

01Stroke is all around us

In 2019, there were 3.94 million new cases of stroke in my country.

There are currently 28.76 million stroke patients.

In our country, 2 out of 5 people may suffer from stroke in their lifetime.

02Harm caused by stroke

Stroke causes 2.19 million deaths each year.

In our country, at least 1 in every 5 people dies from stroke.

Stroke is the leading cause of disability among adults in my country.

70% to 80% of stroke patients cannot live independently due to disability.

Stroke rehabilitation is the most effective way to reduce disability rate.

Effective rehabilitation training can bring the following benefits:

1. Reduce the functional disability of patients;

2. Accelerate the recovery process of stroke;

3. Improve patient satisfaction;

4. Reduce potential care costs;

5. Save social resources.

However, since some stroke patients and their families still have some misunderstandings about rehabilitation, this may affect the rehabilitation effect!

Myth 1:

Physically weak and unable to move, almost completely dependent on family members for daily life×

After some patients suffer a stroke, their family members believe that the patients are in a relatively weak state, so they provide them with meticulous and comprehensive care. Even after the condition stabilizes, the family members or the patients themselves still do not engage in physical activities and continue to rest for fear of recurrence or worsening of the disease.

√In fact, the organs and functions of the human body are "use it or lose it". Frequent use will make them more developed, while infrequent use will gradually degenerate. If the patient does not actively carry out rehabilitation training, it may lead to contracture and deformation of the paralyzed limb joints, muscle atrophy, decreased cardiopulmonary function, osteoporosis and other problems. In severe cases, the affected limb will lose its motor function. Post-stroke rehabilitation treatment should be actively participated in and started as early as possible. For mild to moderate strokes, patients can undergo bedside rehabilitation and early rehabilitation training in the out-of-bed period 24 hours after onset. It is safe and feasible to take short-term, multiple activities in the early stage. It should be carried out in a step-by-step manner. The earlier the rehabilitation training is started, the better the effect.

Myth 2:

After a stroke, just keep taking medicine.

Some patients believe that they will recover as long as they adhere to medication after becoming ill.

√ This is true for some diseases, but for those with stroke and functional impairment, this idea is harmful. Functional recovery still requires long-term and arduous training. If you only focus on drug treatment and ignore functional training, you will not get full recovery, which will affect the patient's quality of life.

01Drug treatment

Antiplatelet drugs

l Lipid-lowering drugs

l Antihypertensive drugs

l Antidiabetic drugs

Anticoagulant drugs

l ···

02Rehabilitation

l Movement disorder rehabilitation

l Rehabilitation of sensory impairment

l Rehabilitation of dysphagia

l Rehabilitation for cognitive impairment

l Rehabilitation of mental disorders

l ···

Medication and rehabilitation treatment, neither can be missing!

Myth 3:

Rehabilitation training is difficult, acupuncture and physical therapy are enough×

Patients think that these rehabilitation trainings are too tiring and prefer passive trainings such as acupuncture, massage and physical therapy, but are not very cooperative with active trainings.

√ Rehabilitation treatment is very different from our traditional acupuncture and physical therapy massage. Systematic rehabilitation training is required under the guidance of professionals. Only doing acupuncture and physical therapy may delay the best time for rehabilitation. Active rehabilitation training is more effective. Functional reconstruction after nerve damage requires active practice by the patient. Low treatment cooperation will affect the progress of rehabilitation. Patients should focus on active exercise and supplement it with passive exercise in rehabilitation training. Studies have shown that compared with patients with passive training, patients with active rehabilitation training have significantly improved quality of life and sensory motor function of the affected limb.

Myth 4:

Be impatient and get out of bed and walk as soon as possible ×

Stroke patients and their families are often eager to recover and want to walk when they are paralyzed in bed. Therefore, many times, when the patients' functions are not yet up to the standard of walking, their family members drag them and force them to practice walking, or even climb stairs. Such behavior is very detrimental to the patient's recovery process and may cause joint swelling and dislocation, resulting in symptoms of "carrying hands on a basket and legs in circles". Once an abnormal gait is formed, it is very difficult to correct.

√ Rehabilitation treatment should be gradual and requires a scientific training plan. From the perspective of the recovery of motor function after stroke, rehabilitation training should be gradual and should start from the most basic functions. Taking walking function rehabilitation as an example, the training stages should include sitting balance → standing balance → assisted walking → independent walking → walking in complex environments. No one should be impatient for quick results at each stage.

Myth 5:

Only focusing on physical rehabilitation, but ignoring psychological rehabilitation

Some family members only focus on the patient's daily life care and functional training, ignoring the patient's anxiety or pessimism and disappointment caused by the daily life difficulties brought about by functional disorders and the long and arduous rehabilitation process.

√ Stroke is a great mental blow to a person, especially men, who often become depressed due to stroke. According to statistics, 40%-70% of stroke patients will have cognitive impairment, anxiety, depression, personality changes and other problems to varying degrees. Stroke rehabilitation is a protracted battle shared by patients and their families. Psychological dysfunction after stroke is very common, and family companionship and psychological comfort are crucial. We should pay attention to the mental health of patients. During the rehabilitation training, family members should not blame the patients, but should be patient and cooperate with the patients' training. At the same time, they should promptly feedback the patients' mental state to the medical team, adjust the rehabilitation plan, and help patients make progress together, build confidence, and return to health.

Myth 6:

Reject speech training, thinking it is too simple and will be learned naturally after recovery.

Some patients and their families believe that speech training is just following the therapist to make sounds, read words, and recognize pictures. They think that these treatment contents are very simple and do not require training. Therefore, they are relatively resistant to the corresponding training plans developed by rehabilitation therapists.

√Speech therapy is a treatment for patients with speech dysfunction, which repeatedly uses strong auditory stimulation and multi-channel language stimulation to improve the patient's verbal communication ability.

Myth 7:

The training results are not consolidated in daily life ×

Some patients practice very hard under the guidance of rehabilitation therapists and can already complete some daily activities. Doctors and therapists are also very satisfied with their recovery and believe that they can return to their families. However, after returning to their daily lives, they begin to slack off and no longer perform basic exercises, which causes the functions they have learned to gradually weaken.

√ The purpose of occupational therapy is to help patients restore their normal living and working abilities as much as possible. It is an important way for patients to return to their families and society, and requires more practice and consolidation in daily life.

Myth 8:

Giving up rehabilitation training too early when no results are seen ×

After training for a period of time and persisting for a period of time, many patients give up when they find that they have not recovered to normal.

√ Rehabilitation is a process of repeated training. Only repeated stimulation can restore the patient's function to a considerable degree. Rehabilitation training must be persistent and avoid "fishing for three days and drying the net for two days".

Stroke rehabilitation is a long-term battle, and persistence is the key

Myth 9:

Prefer intravenous infusion in the affected upper limb ×

The patient and his family believed that the affected limb would not move, so it was just right to use it for intravenous infusion.

√ Little do people know that this will affect the recovery of the affected limb. The blood return of the affected limb is already poor, and coupled with exudation and limited movement, it is easy to cause edema and adhesion on the back of the hand, thereby increasing the probability of shoulder-hand syndrome.

Myth 10:

Rehabilitation is only a doctor's job×

Some patients tend to become sensitive and fragile after the onset of the disease, showing excessive dependence on doctors and lack of initiative in rehabilitation training. They believe that the doctor's rehabilitation techniques and acupuncture are the only treatments and that their own active training is useless.

√ In fact, for stroke patients, active training is more important than passive treatment. One of the five principles of rehabilitation is to require patients to "actively participate".

Early start: After the stroke patient's condition stabilizes, rehabilitation interventions such as leaving bed should be initiated as soon as possible.

Gradual progress: The content, duration and intensity of treatment should be gradually increased according to the assessment results.

Comprehensive: Comprehensive treatment methods such as physical therapy, occupational therapy, speech therapy, psychotherapy, rehabilitation care, etc. should be adopted according to the characteristics of functional disorders in order to achieve the best effect of returning to family and society.

Perseverance: Persistence is victory. You must continue to maintain the habit of training and comprehensive rehabilitation management.

Author: Wu Fang, Gao Caiping Shanghai Tongji University Affiliated Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)

Chief Judge: Zhai Hua, Yangzhi Rehabilitation Hospital Affiliated to Tongji University, Shanghai, Vice Chairman of the Science Popularization Working Committee of the Chinese Rehabilitation Medicine Association

Editor: Jia Jing (Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine)