2. Walking training method with walking stick: (1) Three-point walking stick: When using walking stick, the patient stretches out the walking stick first, then steps on the affected foot, and finally steps on the healthy foot. This walking mode has good stability because it has two points to support the healthy foot and the affected foot. Except for some patients with lower limb dyskinesia, most hemiplegic patients are used to this gait. According to the basic situation of patients and the size of healthy feet, it can be divided into dorsal type, lateral type and anterior type. (2) Walking on crutches at two points: the crutches and the affected foot stretch out the supporting weight at the same time, and then take a healthy foot. Walking at two points is called walking with crutches and affected feet as points and healthy feet as points to alternately support weight. This kind of walking speed is fast and has good practical value. When patients have a certain balance function or have a good grasp of walking at three o'clock, they can practice walking at two o'clock.
3. Functional training of organs related to eating and swallowing activities. (1) Oral muscle training: including oral and lip atresia training, jaw opening and closing training, tongue movement training, etc. (2) Neck relaxation training: relax the neck from front to back, left and right, or rotate the neck from left to right, and lift and sink your shoulders. (3) Cold stimulation: improve the sensitivity of soft palate and pharynx, and reduce salivation. (4) Breath-holding vocal exercise: training glottic atresia function, strengthening soft palate muscle strength, and helping to clear the food left in the pharynx. (5) Cough training: promoting glottic atresia. (6) Breath-holding swallowing: it is beneficial to glottic atresia and prevents food from being swallowed into the airway by mistake.
4. Obesity means that when the human body consumes more calories than it consumes, the excess calories are stored in the body in the form of fat, which leads to overweight malnutrition, which can also be considered as a disorder of energy metabolism. (1) Simple obesity: There is no obvious cause of endocrine and metabolic diseases. ① Body obesity: onset of childhood, overnutrition, fat distribution in the whole body, coexistence of fat cell proliferation and hypertrophy, poor effect of restricting diet and strengthening exercise, and insensitivity to insulin. ② Acquired obesity: Adult onset, overnutrition and decreased physical activity, with fat distributed in trunk and limbs, and fat cells are mainly hypertrophy. Diet control and exercise have good curative effect, and insulin sensitivity can be improved after treatment. (2) Secondary obesity: obesity secondary to neuroendocrine metabolic disorder. It is central, endocrine, hereditary and medicinal.
5. Shallow feeling mainly includes pain, warmth and touch. Shallow sensory conduction pathway: the shallow sensory pathway of the body below the head-the posterior root of spinal nerve-the neurons in the posterior horn of spinal cord-the nerve crosses to the opposite side of spinal cord-the lateral bundle of spinal cord and thalamus (pain and warmth) and the anterior bundle of spinal cord and thalamus (light touch)-thalamus.
6. Physiological significance of muscle glycogen in exercise: (1) is the main energy substance in exercise. (2) Under the premise of the same oxygen consumption during exercise, the oxidation of sugar produces more energy. (3) During endurance exercise, due to the massive emptying of muscle glycogen, bound water can be released, which is of positive significance for maintaining water metabolism during exercise, satisfying some biochemical processes in the body and preventing dehydration.
7. Rehabilitation treatment of coronary heart disease phase I: early rehabilitation treatment of hospitalized patients after acute myocardial infarction. Rehabilitation treatment of acute coronary syndrome can be included in this period. The second stage: patients with myocardial infarction are discharged from hospital for 5-6 weeks until their condition is completely stable. Stage ⅲ: old myocardial infarction, stable condition, course of disease ≥3 months. Rehabilitation after stable angina pectoris, occult coronary heart disease, percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG), heart transplantation and pacemaker installation can also refer to this scheme.
8. The principle of diabetes exercise therapy: ① Increase the number of glucose carriers on muscle cells and adipocyte membranes, enhance the sensitivity of peripheral tissues to insulin, improve abnormal glucose metabolism and lower blood sugar. ② Accelerate the decomposition of adipose tissue, promote the utilization of free fatty acids and cholesterol, and correct the dysfunction of lipid metabolism. ③ Improve glucose metabolism, prevent and reduce chronic complications of diabetes, and reduce the disability rate and mortality rate of diabetes.
9.( 1) Muscle strength training ① After hip replacement: the quadriceps, hamstring and gluteus muscles of the affected side contract, and the active power-assisted exercise began on the fifth day after operation. In the third week, the progressive resistance movement of hip flexion and extension abduction muscle strength began. 2 ~ 3 weeks after operation, you can practice with a fixed bicycle. ② After knee replacement: it mainly includes muscle strength training of quadriceps femoris and hamstring muscles. Early training of corresponding muscle groups. In the training process, especially in the early stage, strength training is mainly isometric contraction, mainly in the form of multi-point isometric contraction. (2) Precautions ① Muscle strength training should adhere to the principle of gradual progress and no pain. ② On the first day after operation, in addition to the muscle strength exercises of surgical limbs, we should also practice healthy limbs and upper limbs according to the overall situation, so as to make necessary preparations for walking and using crutches.
10. Common complications and treatment after amputation: (1) Treatment of skin ulceration, sinus, scar and keratinization of residual limb: ① bandaging by cavity; ② dressing change; ③ Long-term unhealed sinus requires surgical dilation; ④ ultraviolet ray, ultrashort wave, magnetic therapy and other treatments combined with antibiotics have better effects; ⑤ Soft socks made of silicone rubber can be used to cover the residual limb to reduce and avoid skin scar oppression or friction. (2) Residual bone deformation: large bone spurs need to be surgically removed. For severe conical stump, if there is enough length, the protruding bone end can be removed. At the same time, muscle plasty or muscle fixation is performed to make it a columnar stump contracture (3). Functional exercise as early as possible after operation is the most effective way to prevent contracture. Once contracture occurs, its correction methods are as follows: ① strengthening active and passive joint activities; (2) Change the posture and press the joints with sandbags; ③ Severe cases need surgical treatment. (4) Treatment of pain: Treatment of residual limb pain: ① Neuroma resection. ② Symptomatic treatment of analgesics. Treatment of phantom limb pain: ① psychotherapy: hypnosis, relaxation and reasonable emotional therapy. ② Physical therapy: ultrasonic therapy, low-intermediate frequency pulse electrotherapy, etc. Pet-name ruby central sedative: tricyclic diazepam antidepressants are applicable, and amitriptyline, imipramine and carbamazepine can be used for general pain. ④ Acupuncture therapy. ⑤ Others; Such as wearing artificial limbs as soon as possible, exercise therapy, etc. (5) Prompt the residual limb to eliminate swelling and setting as soon as possible: Continuous elastic bandage dressing and wound suture removal after operation are the key steps to prevent or reduce swelling and excessive adipose tissue of the residual limb and promote the maturity and setting of the residual limb. Dressing points: ① Leg width 10cm, thigh width 12.5cm, length 2 ~ 4 m..② ② Winding around the long axis of the residual limb for 2-3 times, and then winding around the diagonal as much as possible to form a spiral. For thigh stump, it should be wrapped around pelvis; The stump of the calf should be wrapped around the thigh. (3) Bandages should be bandaged 24 hours a day, but should be replaced 4 ~ 5 times a day. Pay attention to the hygiene of the stump, wash it with water and soap every night, and then dry it. ④ The tightness of elastic bandage should be wound more tightly towards the stump, so as not to affect the blood circulation of the stump.
1 1. Principles of rehabilitation treatment of coronary heart disease. The rehabilitation of coronary heart disease is to comprehensively adopt active physical, psychological, behavioral and social activities training and retraining to help patients relieve symptoms, improve cardiovascular function and improve quality of life. At the same time, it is emphasized to actively intervene in the risk factors of coronary heart disease and strictly control the indications and contraindications of rehabilitation treatment in each period.
12. Matters needing attention in rehabilitation treatment of chronic congestive heart failure: (1) Strictly master the indications and contraindications of exercise therapy, and pay special attention to excluding patients with unstable heart disease. (2) Detailed cardiopulmonary function evaluation and drug treatment should be carried out before rehabilitation treatment. (3) The rehabilitation plan emphasizes the principle of individualization. (4) Activities should emphasize the combination of static and dynamic, and do what you can. (5) Activities must be carried out step by step, and the influence of environmental factors on activities should be considered. (6) Appropriate medical supervision should be provided during treatment. (7) Exercise therapy can only be used as a part of comprehensive treatment, and other treatment methods are not excluded. (8) Pay attention to medication and exercise response.
13. The toxic effects of hyperglycemia are: ① stimulating insulin secretion, and long-term hyperglycemia will eventually lead to islet B cell failure; ② Increase the resistance of peripheral tissues such as muscle to islandin, inhibit the activity of glucoprotein GLUT4 in muscle cell membrane, and reduce the transport of glucose into muscle cells; ③ Increase the production of oxygen free radicals and induce vascular complications.
1 4. Training methods for COPD patients to enhance their overall physical strength: (1) Lower limb training: Lower limb training can obviously increase the activity tolerance of COPD patients, relieve dyspnea symptoms and improve their mental state. Training programs such as brisk walking, boating, cycling and mountain climbing are usually adopted. (2) Upper limb training: Upper limb training includes upper limb strength car training, upper limb gymnastics stick training and weight lifting training. (3) Respiratory muscle training: Respiratory muscle training can improve respiratory muscle endurance and relieve dyspnea symptoms. ① Strengthen the training of inspiratory muscles: train with resistance respirator for 3 ~ 5ml/ time, 3 ~ 5 times/day, and then the training time can be increased to 20 ~ 30min. ② Strengthening abdominal muscle strength training: The patient takes the supine position and puts sandbags on the abdomen for abdominal lifting training, starting at 65,438+0.5 ~ 2.5 kg, and then gradually increasing to 5 ~ 65,438+00 kg, with abdominal muscle strength training for 5 minutes each time.
15. principle of joint maneuver training: (1) determine the training form according to the function evaluation. (2) Fixing the proximal limb to control the movement. (3) Support parts with poor structural integrity, such as joint relaxation, recent fracture or limb paralysis. (4) exertion should not cause obvious pain. (5) Training state: ① Anatomical plane (frontal plane, sagittal plane, coronal plane); ② the extent of muscle elongation; ③ Combination mode (combination of several plane movements); ④ Function mode, etc.
16. principles of rehabilitation treatment after cerebrovascular accident: (1) early start: for patients with stable vital signs and no progress in symptoms, treatment can be started within 48 hours after onset; For coma patients or patients living in intensive care unit, as long as they have no fever, paralysis and stable blood pressure, they can also start passive physical activities or intervene through physical factors. (2) Comprehensive treatment: In addition to drug treatment, physical therapy (including exercise therapy), occupational therapy, speech training, psychological counseling, rehabilitation nursing, rehabilitation bioengineering and traditional Chinese medicine (including acupuncture and Chinese medicine) are mainly used. (3) Step by step: from less to more treatment items, the treatment time is gradually increased, and the treatment intensity is gradually increased; In the process of treatment, the external help to patients gradually decreases, and the active participation of patients gradually increases. (4) Perseverance: From the onset, rehabilitation means intervention until the patient's function is fully restored.
17. The main dysfunction after brain injury is as follows: (1) Cognitive dysfunction: distraction, inattention, memory loss, learning difficulties, decreased inductive and deductive reasoning ability, etc. (2) Behavioral dysfunction: Patients are suffering from various behavioral and emotional problems. Memories of injured scenes, discomfort caused by headaches, fear of life and other negative emotions can lead to denial, depression, burnout, irritability, aggression and anxiety. In severe cases, there will be personality changes, neurotic reactions, behavior out of control and so on. (3) Speech dysfunction: common dysarthria and aphasia. (4) Dyskinesia: common high muscle tone. Spasm, abnormal posture, hemiplegia, paraplegia or quadriplegia, ataxia, limb peristalsis, etc. The symptoms are that the upper limb of the affected side is not functional, unable to put on clothes, the lower limb is disabled, the movement is poor, the standing balance is poor, and it is impossible to go to the toilet, take a bath and go up and down the stairs. (5) Delayed epilepsy: half of the patients can have seizures within six months to one year after onset, and the general seizures are characterized by loss of consciousness for 5 ~ 15 min and generalized convulsions; Localized seizures are characterized by short-term disturbance or loss of consciousness, which generally lasts for several seconds without general convulsions. (6) Dysfunction of daily life: due to lack of cognitive ability and limited exercise, self-care, housework and entertainment in daily life are restricted. (7) Obstacles to employability: persistent lack of attention, poor memory, poor behavior control and poor judgment make it impossible for them to participate in competitive work.
18. Standing balance training method: (1) First-level balance training: support the body weight with lower limbs and keep standing posture. When necessary, the therapist can control the patient's lower limbs with both knees, or help fix the knee joint with a bracket. At the beginning, the foot spacing is large, which improves stability; After you can stand independently, gradually narrow the distance between your feet to reduce the supporting surface and increase the difficulty. (2) Level II balance training: independently complete the training of body center of gravity transfer, trunk flexion and extension, left and right tilt and rotation to maintain balance. At first, the therapist fixed the patient's buttocks with both hands to help complete the center of gravity shift and physical activity, and gradually transitioned to the patient's independent action. (Level III Balance Training: Resist external forces to maintain body balance in standing posture. Patients can use balance board training, standing training, etc.
19. First-level balance training: support the weight with lower limbs and maintain a static posture. Level II balance training: independently complete the training of body center of gravity transfer, trunk flexion and extension, left and right tilt and rotation to maintain balance. Three-level balance training: resist external forces and maintain body balance by standing.
20. The basic rehabilitation techniques of cerebral palsy are: (1) neuromuscular promotion techniques: Bobath technique, proprioception and skin sensation promotion techniques. (2) Voita method: It is a method to induce the whole body reflex movement by stimulating the body to a certain extent. Its principle is to induce normal posture and movements through the sensory system, such as proprioception, kinesthetic or tactile stimulation to inhibit abnormal movements. This method is an effective method to suppress abnormal movement at an early stage. (3) Functional electrical stimulation, computer intermediate frequency therapy, biofeedback therapy, hydrotherapy, etc. (4) Occupational therapy: gross motor ability training of upper limbs; Trunk control ability training; Advanced fine hand function training; Sensory integration therapy; ADL training; Recreational activities. (5) Guided education: it is an all-round, multi-channel and multi-means treatment for children with neurological disorders such as cerebral palsy. (6) Speech correction: including early language development stimulation, speech training, speech organ training, communication methods instead of speech, etc. (7) braces and AIDS for treatment. (8) Clinical treatment of traditional Chinese and western medicine: improving cranial nerve metabolism and functional recovery; Muscle spasm was blocked by botulinum toxin or anhydrous alcohol; Symptomatic treatment of complications such as pain, swelling and pressure sore; Surgical treatment of some severe muscle spasms, muscle contractures and deformities. (9) Reconstruction of environment and appliances: The environment and appliances should be reconstructed accordingly to facilitate children's activities and life. (10) Education and vocational training.
2 1. The principles of rehabilitation treatment for obesity: ① reducing energy intake through diet control; (2) Increase energy consumption through exercise and maintain negative energy balance; ③ Correct unhealthy eating behaviors and living habits through behavioral therapy, so as to consolidate and maintain the therapeutic effects of diet therapy and exercise therapy and prevent obesity from recurring; ④ According to the patient's condition, choose appropriate medication to increase the curative effect and enhance the confidence of patients to lose weight.
22. The basic way of rehabilitation treatment: (1) Improvement: Improve physiological function through training and other measures. (2) Compensation: The weakened function is amplified or enhanced by various orthoses and assistive devices. (3) Substitution: replacing the lost physiological function with some instruments.
23. Indications of cervical traction therapy: painful spasm of cervical muscles, degenerative disc disease of cervical vertebrae, protrusion (swelling) of cervical vertebrae, stimulation or compression of cervical spinal nerve roots, degenerative osteoarthritis of cervical vertebrae, cystitis of intervertebral joints, and pathological changes of anterior and posterior longitudinal ligaments of cervical vertebrae.
24. Choose the appropriate muscle strength training method according to the patient's muscle strength level. Muscle strength 1: electrical stimulation therapy and electromyographic biofeedback electrical stimulation therapy were used; Muscle strength level 2: auxiliary sports training; Muscle strength level 3: active exercise training; Muscle strength level 4: resistance training; Muscle groups with poor endurance emphasize muscle endurance training.
25. The main contents of rehabilitation treatment: physical therapy, occupational therapy, speech therapy, rehabilitation engineering and traditional rehabilitation treatment in China.
26. Characteristics of lower extremity orthosis: The main function of lower extremity is to bear weight and walk, so the main function of lower extremity orthosis is to support weight, assist or replace limb function, limit unnecessary activities of lower extremity joints, maintain the stability of lower extremity, improve posture when standing and walking, and prevent and correct deformity. Some lower limb orthoses can also reduce or exempt the load of weight on lower limb bones, promote the formation of callus at fracture sites and accelerate fracture healing.
27. Neurolysis refers to the treatment of injecting phenol or ethanol into nerve trunk or muscle movement point, which leads to degeneration of nerve sheath or axon cell membrane, or coagulation and denaturation of muscle protein, thus reducing local muscle-nerve activity. It has been widely used in the rehabilitation treatment of spasticity in patients with upper motor neuron syndrome.
28. The basic principle of postoperative rehabilitation in thoracic surgery: under the premise of not affecting the healing of surgical incision and not increasing the tension of incision, take active training to improve breathing, avoid adhesion, contracture and muscle atrophy, and prevent scoliosis.
29. Clinical classification of NYHA cardiac function: Grade I: unrestricted physical activity. General physical activity will not lead to fatigue, palpitation, dyspnea or angina pectoris. Level 2: Physical activity is slightly limited. It is normal at rest, but general physical activity can cause fatigue, palpitation, dyspnea or angina pectoris. Level 3: Physical activity is obviously limited. Rest is normal, but slight physical activity can cause fatigue, palpitation, dyspnea or angina pectoris. Grade ⅳ: total loss of physical activity. There are still symptoms of heart failure or angina pectoris at rest. Any physical activity will aggravate the symptoms.
30. The purpose of amputation is to cut off the limb that has lost its viability, endangered life safety or lost its physiological function, so as to save the patient's life, and make up for the loss of limb function through residual limb training and prosthesis installation. The focus of rehabilitation after amputation is the assembly and use of prosthetic limbs, rebuilding the function of lost limbs, preventing or alleviating the adverse effects of amputation on patients' body and mind, and making them return to society as soon as possible.
3 1. Rehabilitation treatment for Parkinson's disease: (1) Maintain or increase the active and passive range of joint activities, especially the extension range of joint activities. (2) Stretching tense muscles to prevent contracture; (3) Training to maintain muscle strength. (4) Improve the coordination and control ability of body movements, improve the flexibility of hands, and control and reduce hand tremors. (5) Balance training. (6) Walking exercise: emphasize increasing stride length and supporting surface, increasing hip flexion, reducing flustered gait, promoting upper limbs to swing alternately, and improving the starting, stopping and turning of movements. (7) neuromuscular promotion technology. (8) Relax training. (9)ADL training: focus on activities such as putting on and taking off clothes, changing from sitting to standing, going in and out of the toilet, taking a shower or bathing, walking with things, getting on and off the bus, etc. As training content. (10) homework activities to improve advanced brain function. (1 1) Improve communication ability, maintain patients' recreational activity ability and employment ability. (12) Application of auxiliary equipment and environmental transformation.
32. The main dysfunction of cerebral palsy is: (1) limitation of active movement: loss of randomness and control ability of movement, involuntary and non-functional peristalsis, and rough and abnormal movement patterns instead of coordinated and fine separation activities. Sports development is lagging behind, such as not turning over, crawling, standing and walking. (2) Abnormal muscle tone: ① Muscle tone continues to increase, mainly manifested as muscle spasm; ② Muscle tension is persistently low, mainly manifested as muscle weakness and weakness; ③ Muscle tension often changes, and muscle spasm and hypotonia appear alternately. (3) Abnormal reflexes: the existence of primitive reflexes, abnormal postural reflexes, imperfect righting and balance reflexes make normal body reflexes abnormal, and postural reflexes are lost during exercise, which hinders the completion of functional movements. (4) Abnormal operation activities: ① Loss of basic hand skills; ② Unable to complete more complicated hand techniques; ③ hand-eye coordination is difficult; (4) unable to use upper limbs under load. (5) Advanced brain dysfunction: ① ontological technical obstacles that need to understand spatial concepts; ② Sensory formation function is poor, and sensory information cannot be accepted and explained. ③ Poor sensory integration. (6) Poor ability of daily activities: Children's ability of daily activities is hindered by obstacles such as movement, feeling, language and intelligence. (7) Secondary damage: mainly limited joint activity caused by joint and muscle contracture deformation, dislocation of shoulder, hip and radius capitulum, osteoporosis, fracture, pelvic inclination and scoliosis caused by long-term no-load braking. (8) Others: Common perceptual and intellectual disabilities. Visual, hearing and language disorders. Some children have emotional and behavioral disorders, learning disabilities, epilepsy and growth retardation.
33. The basic part of motor relearning method: ① Upper limb function; ② Oral and facial functions; ③ Sit up from supine position to bedside; ④ Sitting posture is balanced; ⑤ Stand up and sit down; ⑥ Stand and balance; 7. Walk.
34.( 1) Principle of exercise therapy: Exercise load is one of the important factors to promote bone growth, development and maturity. Exercise mainly increases the bone load through the direct and indirect effects of muscles. Different loads determine the adaptive changes of bones and affect the increase or decrease of bone mass. (2) Exercise prescription principle: ① Exercise mode: Aerobic exercise, strength exercise and tendon stretching are the three pillars of exercise therapy for osteoporosis. From the perspective of safety, the elderly mainly take aerobic exercise, supplemented by exercise, to enhance explosive power. If physical conditions permit, you can run with load or fast. ③ Exercise intensity: within a certain range, the greater the exercise intensity, the more beneficial it is to maintain and improve bone mineral density. ④ Exercise time: Depending on the intensity of exercise, the intensity is higher and the time is shorter; The intensity of exercise is small and the time can be slightly longer. ⑤ Exercise frequency: generally 3-5 days a week is appropriate, and there is no fatigue the next day. Adhere to long-term planned and regular exercise and establish good living habits.
35. Physiological significance of ketone body formation: (1) ketone body is a special transport form of FFA. (2) Participate in energy metabolism of brain and muscle. (3) Participate in the regulation of fat mobilization. (4) Blood and urine ketone bodies are the evaluation indexes of sugar reserve in the body.
36. Speech therapy principle: (1) Start early: The earlier speech therapy starts, the better the effect, and early detection is the key to treatment. (2) Timely evaluation: Before speech therapy, a comprehensive speech function evaluation should be conducted to understand the types and degrees of speech disorders and formulate targeted treatment programs. In the process of treatment, it is necessary to evaluate regularly to understand the treatment effect, or adjust the treatment plan according to the evaluation results. After the treatment, the therapeutic effect should also be evaluated. (3) Step by step: The process of speech training should follow the principle of step by step, from simple to complex. (4) Timely feedback: According to the patient's response to the treatment, give timely feedback, strengthen the correct response and correct the wrong response. (5) Active participation: Speech therapy itself is a communication process, which requires the active participation of patients. Two-way communication between therapists and patients and between patients and their families is an important part of treatment.
37. Functions of self-service equipment: including compensation for lost limb functions to complete functional activities; Compensate the range of joint motion, making the motion simple, time-saving and labor-saving; Convenient for one-handed activities, overcoming the difficulty of two-handed operation; Support limbs and joints to maintain their functions; Compensate visual and auditory functions and enhance visual and auditory abilities.
38. Motor relearning refers to the training to restore motor function after central nervous system injury, as a therapeutic method of relearning. Basic principles: including the mechanism of functional recovery after brain injury and five basic factors of learning motor skills: functional recovery after brain injury, limiting unnecessary muscle movement, feedback is extremely important for motor control, adjusting center of gravity and environmental control. Composition: the motor relearning method consists of seven parts, including the basic motor functions in daily life: ① upper limb functions; ② Oral and facial functions; ③ Sit up from supine position to bedside; ④ Sitting posture is balanced; ⑤ Stand up and sit down; ⑥ Stand and balance; 7. Walk, etc.
39. The assessment of motor function after cerebrovascular accident includes the following aspects. We can choose (1) muscle tension and spasm according to the patient's physical condition: We use the improved Ashworth Spasm Scale to evaluate. (2) Muscle strength: Muscle strength can be tested by hand, and if possible, it can also be tested in isokinetic exercises (such as Cybex or Biodex). (3) Balance: use a balance scale (such as Berg balance scale and Tinnetti capacity scale) to evaluate, and use a balance tester if possible. (4) Walking ability: mainly through clinical observation of patients' performance in different stages of gait cycle, and also through "standing up and walking" timing test, 6-minute or 10-minute walking test; Conditional can use gait analysis system to test. ⑤ Overall motor function: such as Brunnstrom's limb function recovery staging and Fugl-Meyer motor function evaluation.
40. The essentials of abdominal breathing training: take a lying position or a sitting position (lean forward). When breathing, relax your abdomen and inhale slowly and deeply through your nose. When exhaling, the lips contract to blow out the gas slowly, and at the same time contract the abdominal muscles to increase the intra-abdominal pressure, promote the lifting of the diaphragm, and exhale the gas as much as possible. When inhaling in supine position, put your hands on your abdomen, inhale with your hands, and expand outward with the expansion of your abdomen. When exhaling, the abdomen collapses, and at the same time, the hands gradually press the abdomen to promote the diaphragm to move up. The time ratio of exhaling to inhaling is roughly 1: 1, which emphasizes proper deep breathing, slows down breathing frequency and improves ventilation efficiency. It is not advisable to practice abdominal breathing too many times each time, that is, practice 3 ~ 4 times, take a break and practice again, and gradually get used to abdominal breathing in activities.
4 1. indications of joint mobilization: any joint dysfunction caused by mechanical factors (non-neurological factors), including: joint pain, muscle tension and spasm; Reversible joint activity decreased; Progressive joint activity limitation; Functional joint fixation. Contraindications of joint loosening: joint relaxation or habitual dislocation; Joint swelling (increased exudation) caused by trauma or disease; Acute inflammation of joints; Malignant tumor or tuberculosis at joints; An unhealed intra-articular fracture.
42. Simple standard of reasonable exercise: (1) Exercise intensity index: The following conditions suggest that the exercise intensity is too high: ① The exercise cannot be completed. ② You can't talk freely because of asthma during activities. ③ Weakness or nausea after exercise. (2) Exercise index: The following conditions suggest excessive exercise: ① Persistent fatigue. ② Insomnia on the day of exercise. ③ Continuous joint pain after exercise. ④ In the morning after exercise, the quiet heart rate obviously becomes faster or slower, or you feel unwell.
43. Botulinum toxin injection principle: Botulinum toxin combines with motor nerve endplate to inhibit the release of acetylcholine, thus blocking the transmission of excitement in neuromuscular joints, thus weakening muscle tension or spasm.
44.( 1) bed transfer: lateral transfer: sit up first, then move your lower limbs to one side with your hands, then support the bed surface with your hands and move your hips to that side. Patients who can't sit up because of paraplegia can raise their hands, first swing in the opposite direction of transfer, then suddenly swing in the direction of transfer, so that the trunk turns sideways first, and then the nursing staff moves the lower limbs to the predetermined position. (2) Lying and sitting transfer: When the strength of abdominal muscles is insufficient, you can lift the upper body by pulling the suspension belt or the traction belt tied at the end of the bed and sit up. You can also lean sideways, support the upper body with one hand, and sit up from the side; Support the bed surface with the other hand to maintain stability and balance. (3) Sit for one stop and turn around: practice sitting up and standing with orthoses. First, support the chair with both hands, and extend the knee joint backward, locking the knee joint and keeping the standing stable. Those who use knee-ankle-foot orthosis can start walking after locking their knees. (4) Bed-wheelchair transfer: ① The wheelchair leans on the bed, and the two wheels stop, making an angle of 45 with the long axis of the bed. The patient first sits up on the bed, moves the paralyzed lower limbs to the bed with his hands, moves his hips to the bed, lowers his legs, supports the wheelchair with one hand and swings his hips to the wheelchair with the other. ② When going to bed, push the front of the wheelchair to the front of the bed, brake, move the paralyzed lower limbs to the bed surface one by one by hand, and then support the armrest of the wheelchair by hand, and gradually push the hips and legs to the bed to complete the transfer. When getting out of bed, use the opposite method, that is, move your hips to the bed with your back to the wheelchair, then support the bed surface with your hands and gradually move to the wheelchair. (3) Auxiliary transfer means that the patient needs the help of instruments, and some or all of them need the help of others to complete the transfer action. A. Skateboard: When the quadriplegic patient's upper limb muscle strength is insufficient, it is difficult to support the body and move and transfer, a skateboard (solid plastic board or wooden board) can be used under the hip to slide the body from the skateboard to the wheelchair or bed. B. Power assist: If the elbow flexion strength of the patient's upper limb is 3 ~ 4, but the wrist cannot be transferred by skateboard, put your hand on the head and neck or back of the power assist person and lean forward; The helper puts his head under the armpit on one side of the patient, supports the patient's buttocks with both hands, and fixes the patient's knees with double knee joints at the same time, and pulls the patient's buttocks to his trunk by using the strength of reclining waist, so that the patient's knee joints are straight and stable, and then sideways transfers the patient to the bed or from the bed to the wheelchair.
45.COPD shortness of breath symptom classification: Grade 0: Although there are different degrees of emphysema, activities are like ordinary people, daily life is as usual, and there is no shortness of breath during activities. 1 grade: shortness of breath during normal labor. Grade 2: when walking on the flat ground without shortness of breath, the speed is faster, or when going upstairs or uphill, healthy people of the same age feel short of breath but they are short of breath. Level 3: If you walk slowly, you will be short of breath. Level 4: speaking or dressing is slightly urgent. Level 5: when quiet, you are short of breath and can't lie flat.
46. Treatment principle of dysarthria: (1) Focus on training abnormal speech performance: consider neuromuscular, posture, muscle tension, muscle strength and motor coordination that affect speech, and finally improve the quality of patients' speech expression. (2) Choose the treatment order according to the evaluation results: analyze the relationship between the phonetic structure and speech production, and work out the initial link and order of treatment. Generally speaking, it is trained one by one according to the movements of breathing, throat, palate, tongue body, tip of tongue, lips and jaw.
47. Physiological significance of gluconeogenesis during exercise: (1) Maintain the stability of blood sugar during exercise. (2) It is beneficial to the utilization of lactic acid and prevents lactic acid poisoning. (3) Promoting the oxidative decomposition of fat for energy supply and amino acid metabolism.
48. Training points of coordinated training: (1) Regardless of the severity of symptoms, patients should start with the training of lying position, and then conduct the training of sitting, standing and walking after proficiency. (2) Start with simple unilateral actions and gradually transition to more complex actions. (3) You can do quick and easy-to-complete movements first, and then do slow and small movements training after you are proficient. (4) The coordinated training of upper limbs and hands should be carried out from the aspects of correctness, reaction speed and movement rhythm. The coordinated training of lower limbs mainly adopts the movements of lower limbs in all directions and various correct walking gait training. (5) Open your eyes first and then close them. (6) Disabled people with different weights on both sides should start from the lighter side; Both sides of the same degree of disability, in principle, starting from the right side. (7) Repeat each action for 3-4 times.
49. Principles of exercise prescription for diabetic patients: ① Exercise intensity: 40% ~ 60% of the maximum oxygen uptake is appropriate. ② Exercise type: Aerobic exercise combined with strength exercise. ③ Exercise time: from 10min to 30 ~ 40 min. Exercise after meals 1h is appropriate. ④ Exercise frequency: It is reasonable to exercise 3-4 times a week, depending on the amount of exercise each time. Patients who don't feel tired after each exercise can insist on exercising once a day.
50. The dysfunction caused by spinal cord injury includes: (1) direct dysfunction: ① motor dysfunction: spasm and paralysis; ② Sensory disorders: sensory loss, hypoesthesia and allergy (paresthesia, pain); ③ Bladder control disorder; ④ Disorder of rectal control; ⑤ the embodiment of independent thinking; ⑥ Sexual and reproductive dysfunction; ⑦ Thermoregulation disorder. (2) Indirect obstacles: ① heterotopic ossification; ② Pressure ulcer; ③ Joint movement disorder/contracture; ④ Pneumonia and respiratory disorder; ⑤ Urinary tract infection; ⑥ Osteoporosis; ⑦ thrombosis; ⑧ Psychological disorder.