Walking training for stroke patients Walking training for stroke patients

Introduction: Stroke is a common disease in my country, with the characteristics of "high incidence, high disability rate, high recurrence rate and high mortality rate". It is the leading cause of death in the Chinese population. The first incidence rate in China increases by 8.3% on average each year, and the recurrence rate one year after the first stroke is as high as 12.4%.

Stroke can lead to a series of functional disorders such as movement, balance and cognition, which seriously affect the patient's quality of life and bring a heavy burden to the family and society. Therefore, it is very important to help patients recover related functions through various rehabilitation methods. The recovery of balance and independent walking ability is the basis for improving the quality of life of stroke patients and is also the focus of the patient's rehabilitation training plan.

Walking dysfunction is one of the main problems encountered by stroke patients during rehabilitation, and whether walking can be restored is the main indicator for evaluating the motor function of hemiplegic patients. Therefore, one of the basic tasks of hemiplegic rehabilitation is walking training.

Before stroke patients undergo walking training, they must first confirm the safety of various movements, take precautions against potential hazards, and improve their movements and skills in a timely manner. Patients and their families must follow the health guidance and safety education of medical staff. It is critical and important to be able to perform limb exercises in a scientific manner.

The most critical and fundamental measure for walking training after stroke is to strengthen the strength and coordination of the lower limbs. Only when you are strong can you be fearless of any environment. Only when you can control your body flexibly and powerfully can you accomplish anything you want to accomplish.

Walking training

Restoring walking is one of the basic goals of rehabilitation therapy. Generally, walking training can be started after the patient has achieved dynamic standing balance, the affected leg can bear more than half of the body weight, and can step forward. However, since the elderly are prone to disuse syndrome, some patients are slow to improve their weight-bearing ability by static standing. Therefore, walking training can be started earlier for some patients, and lower limb assistive devices can be used when necessary.

However, the amount of walking training should be small in the early stage, so as not to cause excessive effort on the patient, resulting in inversion and spur foot deformity and aggravation of systemic spasm. For most patients, it is not advisable to use a cane too early, so as not to affect the training of the affected side.

Before walking training, first train the legs to alternate forward and backward steps and the shift of the center of gravity. First, perform supported walking or walking in parallel bars, and then perform independent freehand walking. However, some patients do not need to go through the parallel bar walking training period and can directly perform walking training under supervision or with a little support.

In the early stages of walking training, knee hyperextension and knee weakness (sudden knee flexion) are common, and targeted knee control training should be performed. If a circular gait with the affected side's pelvis lifted occurs, it indicates poor knee flexion and ankle dorsiflexion.

After being able to walk independently, further training is provided in going up and down stairs (the healthy leg goes up first when going up, and the affected leg goes down first when going down), walking in a straight line, walking in circles, crossing obstacles, going up and down slopes, and practical walking training in real life environments.

The training to improve gait focuses on correcting the circular gait. Targeted training should be implemented for patients. For example, during the standing phase, the affected leg has poor weight-bearing capacity. During the weight transfer process, the affected leg lacks the ability to balance and react. The weight-bearing capacity of the affected leg should be trained. For example, during the swing phase, the affected leg cannot flex well. Smaller flexion and extension should be trained. Independent training of the affected knee joint should be performed alternately. During the swing phase, the affected knee can complete flexion and step forward.

1. Shifting the center of gravity left and right

method:

1. The patient stands naturally in front of the mirror with his feet shoulder-width apart and his eyes looking straight ahead.

2. The trainer stands behind the patient, places his hands on the patient's hips, and helps the patient shift his center of gravity left and right, first to the healthy side and then to the affected side.

Note: During training, the patient's upper body should be kept upright to prevent the torso from bending sideways and the heels from leaving the ground.

(II) Shifting the center of gravity forward and backward

method:

1. The patient should stand naturally in front of the mirror with the affected foot in front and the healthy foot behind and both eyes looking straight ahead.

2. The trainer stands behind the patient, with one hand on the affected hip and the other hand on the affected shoulder, to help the patient shift his center of gravity forward and backward.

During the training, the patient's upper body should be kept straight to prevent the trunk from swinging back and forth; when the center of gravity moves forward, the affected leg should not suddenly become weak or the knee should be hyperextended; when the center of gravity moves backward, the affected foot should not be dragged. Afterwards, the patient can train the forward and backward center of gravity transfer with the healthy foot in front and the affected foot behind.

3. Low step training

method:

1. The patient stands naturally in front of the mirror with his feet parallel and his eyes looking straight ahead.

2. The trainer squats on the patient's affected side, places one hand on the affected hip and the other hand on the toes of the affected foot, and helps the patient step forward.

Note: When training the patient, the upper body should be kept upright. When taking a step forward, the trainer should control the skull with one hand to prevent the patient from over-tilting the hip, and control the toes with the other hand to prevent the toes from landing first.

4. Stepping with the healthy side supported

method:

1. The patient should stand naturally in front of the mirror with the healthy foot in front and the affected foot behind and both eyes looking straight ahead.

2. The trainer stands behind the patient, places his hands on the patient's hips, and asks the patient to take steps forward and backward.

Note: During training, the patient's upper body should remain upright, and the trainer should control the patient's hips to avoid excessive hip lifting and excessive side tilt of the body.

5. Stepping with the affected side supported

method:

1. The patient should stand naturally in front of the mirror with the affected foot in front and the healthy foot behind and both eyes looking straight ahead.

2. The trainer stands behind the patient, places his hands on the patient's hips, and asks the patient to take steps forward and backward.

Note: During training, the patient's upper body should be kept upright and avoid sudden bending or overextension.

6. Rear support walking training

method:

In the standardized gait training area, the trainer stands behind the patient, holds the patient's hips with both hands, and asks him to take continuous steps forward.

Note: During training, the patient's upper body should be kept upright, the stride should be even, not large or small, and circular gait and walking with the head down should be avoided.

7. Lateral support walking training

method:

For patients with high upper limb muscle tone, lateral support walking training can be used. That is, the trainer stands on the affected side of the patient, supports the patient's shoulder with one hand, and controls the affected hand with the other hand, so that the patient's affected upper limb is in the extended elbow, wrist, and fingers position, allowing the patient to take continuous steps forward.

Note: During training, the patient's upper body should be kept upright, the stride should be even, not large or small, and circular gait and walking with the head down should be avoided.

Stair training

method:

1. The patient stands facing the training stairs, holding the handrail with the healthy hand. The trainer squats behind the patient's affected side, fixes and controls the patient's affected knee joint with the right hand to prevent sudden flexion, and controls the patient's healthy torso with the left hand to transfer the patient's body center of gravity to the affected side.

2. The patient steps up one flight of stairs with the healthy lower limb and places the entire sole of the foot firmly on the ground.

Note: If the patient has poor weight-bearing capacity on the affected lower limb or is unable to complete the transfer of center of gravity to the affected side due to fear, the trainer must assist the patient in transferring the trunk with his left hand and provide stable support with his right hand.

3. The trainer assists the patient to move the center of gravity forward, and the healthy lower limb bears the weight. At the same time, both hands fix and support the healthy trunk and the affected knee joint of the patient. The trainer's right hand moves from above the knee joint to the inside, and uses the fingers to hook and assist the patient's affected lower limb to flex the hip and knee, and move the affected lower limb up one step, with the whole sole of the foot firmly on the ground. Repeat.

Note: The trainer must provide stable support for the patient's trunk behind him to prevent him from falling backwards.

Stair training

method:

1. The patient stands on the training stairs and holds the handrail of the stairs with the healthy hand. The trainer stands on the affected side of the patient, fixes and controls the patient's affected knee joint with the right hand to prevent sudden flexion, and controls the patient's healthy torso with the left hand to transfer the center of gravity of the trainer's body to the healthy side.

2. The trainee moves his right hand from above the patient's affected knee joint to the inner side, hooks his fingers and assists the patient in flexing the hip and knee of the affected lower limb, steps the affected lower limb down one step, and keeps the entire sole of the foot stable on the ground.

Note: During the stair descent training of the patient's affected lower limb, the trainer must always observe the abnormal movement of the patient's affected lower limb: such as knee abduction and external rotation caused by abnormally high tension of the lower limb extensor muscles, foot drop caused by distal muscle weakness, etc., to assist the patient to place the affected lower limb stably and safely on the next level of stairs.

3. The trainer stands on the patient's affected side, with the right hand fixedly controlling the patient's affected knee joint to prevent sudden flexion, and the left hand controlling the patient's healthy torso to transfer the patient's body center of gravity to the affected side. At the same time, the patient's healthy lower limb steps down one step, with the whole sole of the foot firmly on the ground. Repeat.

Note: When the patient's affected lower limb is bearing weight, the trainer must support and fix the patient's affected knee joint with his right hand at all times to prevent sudden flexion and forward tilting.