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Tang Ying
Physical Medicine and Rehabilitation
About me
Shenzhen Longgang Central Hospital, Department of Rehabilitation Medicine, Associate Chief Physician, has been engaged in clinical rehabilitation work for many years and has rich clinical experience in rehabilitation treatment.
Proficient in diseases
Specializes in common diseases in rehabilitation medicine such as limb numbness, weakness, ataxia, paraplegia, muscle atrophy, etc.
Voices
Principles of Stroke Rehabilitation Treatment
Principles of stroke rehabilitation treatment. First is the issue of timing; it is crucial to choose the appropriate time for rehabilitation intervention. Rehabilitation treatment should start as early as possible when the patient's condition is stable. Secondly, rehabilitation assessment, also known as rehabilitation evaluation, should be performed throughout the treatment process. This allows for comparability before and after treatment, clarifying the treatment results for the patient and determining if there is a need to modify the treatment plan during the process. Thirdly, it is essential to have rehabilitation treatment goals and plans. Based on assessments, short-term and long-term rehabilitation plans must be developed for the patient to achieve certain rehabilitation objectives. Fourth, the principle of gradual progression must be adhered to in rehabilitation treatment. It should not be rushed, and active participation from both the patient and their family members is crucial, incorporating daily life and exercise opportunities. Fifth, rehabilitation treatment primarily involves comprehensive therapy, which includes physical exercise, speech therapy, occupational therapy, physiotherapy, and traditional rehabilitation treatments such as acupuncture and moxibustion, as well as psychological therapy, rehabilitation engineering, and assistive devices. Sixth, conventional pharmacological treatments and necessary surgical interventions are involved. These include essential medications that must be used, and when rehabilitation methods alone cannot restore function, appropriate medical advice from relevant departments should be considered, and surgical treatment may be needed to assist the patient in better recovery.
How to exercise swallowing after a brainstem hemorrhage
Patients with brainstem hemorrhage often have critical conditions. Therefore, after stabilizing their condition, their swallowing function is usually severely impaired. During swallowing training, besides the common use of medications and acupuncture treatment, professional swallowing therapists in a formal rehabilitation medicine department conduct training on swallowing functions. Before starting swallowing training, an accurate assessment of swallowing function is typically conducted first. Swallowing disorders are divided into four stages: the preparatory stage, the oral stage, the pharyngeal stage, and the esophageal stage. In the preparatory stage, coordinating the consistency of the food can aid the patient's swallowing. Proper stimulation of the oral and pharyngeal muscles, including stimulation of the tongue and pharyngeal wall muscles, cold therapy, tongue pressure training, and training of the muscles around the mouth, are used to help restore swallowing function. During the esophageal stage, when the patient's condition has stabilized, videofluoroscopic swallow study can be carried out to assess specific issues in the esophageal stage, which are often related to cricopharyngeal dysfunction. Esophageal dilation with a balloon may also be used. With these accurate assessments and appropriate training, the swallowing function of patients generally shows significant improvement. Therefore, when patients experience these swallowing dysfunctions, it is best to seek treatment from a formal rehabilitation medicine department for better care.
What is the goal of rehabilitation during the acute phase of a stroke?
Rehabilitation goals during the acute phase of stroke. In the acute phase, we usually can intervene with rehabilitation treatment 48 hours after the patient’s vital signs have stabilized. The main goals of rehabilitation during the acute phase are to prevent complications such as pressure ulcers, atelectasis pneumonia, urinary tract infections, deep vein thrombosis, and muscle atrophy. Additionally, it aims to improve impaired neurological functions such as sensory, motor, and speech therapies, and to enhance the patient’s ability for self-care and mobility.
Rehabilitation Treatment Plan for Stroke
The rehabilitation treatment plan for stroke involves rehabilitation physicians and therapists who, through comprehensive assessment of the patient's overall medical condition and functional impairments, develop individualized plans. These plans focus primarily on the patient's functional impairments, and accordingly, design treatments for movement, speech, swallowing, and attention to promote the patient's overall rehabilitation and improve their ability to perform daily activities independently. Common rehabilitation treatment options include not only medication but also occupational therapy, speech therapy, physical therapy, psychological support, and traditional rehabilitation methods. Through these personalized and comprehensive rehabilitation treatments, the aim is to facilitate the patient's early recovery, allowing them to return to their family and work environment sooner.
How long is the edema period for brainstem hemorrhage?
The edema phase of the brain stem generally lasts for two to three weeks, with the peak of swelling occurring around seven to ten days. For some patients, the swelling completely subsides nearly a month later. Only after the peak of the swelling has passed can patients be out of life-threatening danger. As the swelling gradually subsides, the patient's consciousness, vital signs, limb movements, eating, and other symptoms will also gradually improve. Once patients get through the swelling phase, we can start early bedside rehabilitation as soon as possible. In addition to using some drugs that nourish brain nerves, passive limb movements, proper limb positioning, early exercise, and acupuncture can all be started early to accelerate the patient's early rehabilitation and prevent complications such as muscle atrophy, relaxation, and dependent pneumonia, which can be improved early on.
Rehabilitation nursing for stroke patients
For the rehabilitation and nursing care of stroke patients, first and foremost, we need to monitor the patient's vital signs, food intake, sleep, as well as bowel and bladder function. Secondly, we should pay attention to their psychological state, checking for signs of tension, anxiety, and depressive emotional reactions. Thirdly, we encourage patients to overcome their illness and to establish confidence in their recovery. Fourthly, we guide patients to actively engage in physical function exercises, as well as daily activities such as eating and dressing to practice their daily living skills. Fifthly, we manage proper limb positioning and patient turning, prevent pressure sores, and also prevent a series of complications such as venous thrombosis and urinary tract infections.
Stroke Rehabilitation Treatment Plan
In the rehabilitation treatment of stroke patients, we first need to conduct a comprehensive rehabilitation assessment, evaluating the patient's current primary clinical symptoms, nutritional status, and rehabilitation functional impairments. Based on the results of the assessment, we determine the patient's main functional impairments, targeting a series of functional impairments such as mobility, hand function, as well as speech and swallowing disorders. We adopt a series of therapeutic interventions including exercise therapy, occupational therapy, physical therapy, swallowing therapy, speech therapy, psychological therapy, rehabilitation engineering, and rehabilitation nursing. Generally speaking, through evaluation, we develop a personalized rehabilitation treatment plan for the patient, comprehensively promoting the patient's overall recovery, improving the patient’s ability to live independently, and helping them return to their families, society, and work positions as soon as possible.
The soft paralysis phase of a stroke refers to a few weeks after the onset.
The recovery of stroke patients is generally divided into four phases: the flaccid phase, also known as the hypotonic phase, the spastic phase, the recovery phase, and the sequelae phase. The symptoms of the flaccid phase mainly include muscle relaxation, low muscle tone, and lack of autonomous movement. The majority of patients maintain the flaccid phase for about one to three weeks, and depending on the individual's condition, they generally begin to enter the spastic phase after one to three weeks. A small portion of patients with severe conditions and poor initiative, who have not undergone formal rehabilitation training, may extend their flaccid phase to more than a month or even longer. Therefore, receiving early formal rehabilitation training to improve muscle strength and spasticity treatment can allow patients to smoothly transition through the flaccid phase and gradually enter the spastic phase. Good management of spasticity is even more beneficial for the patient’s recovery. Rehabilitation training can help stroke patients recover sooner and faster.
Treatment of urinary retention in stroke patients
In cases of urinary retention after a stroke, some patients experience this due to psychological factors, concerns, and the sudden need to remain in bed, making it difficult to urinate in bed since they cannot stand or squat. Therefore, the first step is to alleviate psychological factors, provide patient communication and counseling, and perform massages around the navel and abdomen, along with heat treatments, to help patients urinate on their own. In a second scenario, where the patient's condition is severe or even comatose, and they have difficulty urinating, a catheter can be placed. It's important to first try to rule out a urinary tract infection, collect a midstream urine sample for analysis, and ensure the catheter is not left in longer than necessary. Once the patient's condition improves or they regain consciousness, the catheter should be removed promptly to avoid any urinary tract infections.
Can facial neuritis heal by itself?
If it's a case of facial neuritis, generally very mild facial neuritis tends to heal on its own, but it takes time. Common symptoms of facial neuritis include incomplete eyelid closure and deviation of the mouth. More severe cases may even experience reduced taste and hearing. Under such circumstances, it is recommended that patients seek medical attention at a formal hospital as soon as possible to avoid delaying treatment. The best recovery period for facial neuritis is within three weeks; therefore, as time delays, the difficulty of recovery increases. Thus, we advise patients with particularly evident symptoms to seek medical care promptly.