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<section data-tools="gulangu" data-label="powered by gulangu"></section><section data-style-type="4" data-tools="新媒体排版" data-id="9052"><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><strong>点击蓝字</strong></p></section></section></section></section><section><section powered-by="gulangu"><section><section><p><img src="image/20200927/7ce4ade09297e6f1e1e5715ccb5b2820_1.gif" /></p></section></section></section></section><section><section powered-by="gulangu"><section><section><p><strong>关注我们</strong></p></section></section></section></section></section></section></section><p><span>脑卒中肢体的偏瘫为上运动神经元性偏瘫，康复治疗不仅要促进肌力的恢复，更重要的是促进肌肉运动高级神经控制的重建。</span></p><section data-role="paragraph"><section data-width="100%"><section><section><section><section data-role="outer" label="Powered by gulangu"><section data-role="outer" label="Powered by gulangu"><p><span>脑卒中三级康复中的“一级康复”指的就是患者早期在医院急诊室或神经内科的常规治疗及早期康复治疗，</span><span><strong>脑卒中偏瘫恢复的理论基础是基于Brunnstrom提出的六阶段过程。</strong></span></p><p><span>1、患肢迟缓性瘫痪，无自主运动；</span></p><p><span>2、肌张力增加，痉挛出现，有基本的共同运动和联合反应，无随意运动；</span></p><p><span><span>3、</span>可随意引起共同运动，痉挛加重；</span></p><p><span><span>4、</span>痉挛不再加重或挛缩减轻，共同运动有所减弱开始出现分离运动及正常模式的运动；</span></p><p><span><span>5、</span>痉挛显著减轻，共同运动失去优势，可完成较难的分离运动及正常模式的主动运动；</span></p><p><span><span>6、</span>痉挛和共同运动消失，协调运动大致恢复。</span></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><span><strong>康复训练的原则与禁忌</strong></span></section></section></section></section></section></section></section><p><span>康复训练的四大原则为：<strong><span>早期干预、功能训练、全面康复、重返社会功能训练</span></strong>的具体原则：</span></p><p><span>①主要是抑制异常的、原始的反射活动，改善运动模式，重建正常的运动模式；</span></p><p><span>②其次才是加强软弱肌肉和力量训练。</span></p><p><span>③患侧功能重建训练为主，健侧代偿训练在后。</span></p><p><span><strong><span>运动和感觉功能障碍的治疗：</span></strong></span></p><p><span>①良肢位摆放；</span></p><p><span>②体位转换训练；</span></p><p><span>③平衡能力训练；</span></p><p><span>④躯干控制能力训练；</span></p><p><span>⑤保持关节活动度治疗；</span></p><p><span>⑥感觉功能训练；</span></p><p><span>⑦其他治疗。</span></p><p><span>住院期间为患者进行良肢位的摆放非常重要，一般三甲医院护士要求掌握。</span></p><p><span><strong><span>康复干预禁忌：</span></strong><span>合并严重脑水肿、神经功能恶化、颅内压增高、频发癫痫、严重心肺功能不全者。</span></span></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><span><strong>偏瘫卧位姿势</strong></span></section></section></section></section></section></section></section><p><span>保持良好的瘫肢功能位置是防治患肢拘紧挛缩及肌萎缩的重要康复手段。患者病后，经过一点时间，即有软瘫逐渐进入硬朗期。</span></p><p><span>上肢发生肩、肘、腕、指关节的屈曲挛缩，下肢发生髋、膝、踝关节的过伸及屈曲困难。故应采取早期拮抗卧位姿势，以避免或减轻肌张力的增高。</span></p><p><span><strong><span>健侧卧位姿势</span></strong></span></p><p><span>健侧卧位姿势是偏瘫病人最佳卧床体位。</span></p><p><span>其正确的姿势是瘫侧肩关节前伸，肘、腕、指关节保持伸直位，可在胸前放置枕头或衣物，垫起患侧上肢，保持良好体位。</span></p><p><span>患侧下肢髋、膝关节应自然屈曲，骨盆取内旋位。</span></p><p><p><img src="image/20200927/41fb4c252750ed0efcb095e7bd97c6b9_2.jpg" /></p></p><p><span><strong><span>患侧卧位姿势</span></strong></span></p><p><span>患侧上肢应保持伸展位，下肢应保持半屈曲位置，患侧在后，健侧在前，为患侧卧位的良好体位。</span></p><p><span>患者患侧的肩胛带要向前伸，肩关节屈曲，肘关节伸展，前臂旋后，腕关节被伸，手指是伸展的。</span></p><p><span>患侧下肢伸展 ，膝关节轻度屈曲，患侧下肢的髋关节与膝关节屈曲，有时候可以在下边垫一个软枕，背部再放一个枕头，给患者依靠。</span></p><p><p><img src="image/20200927/a39da8147cb0cb627e98afa1a620b206_3.jpg" /></p></p><p><span><strong><span>仰卧位姿势</span></strong></span></p><p><span>患侧肩关节外旋，上肢各关节伸展，下肢髋关节内收，内旋，膝关节屈曲，足掌平踏床铺，为患者仰卧位时的最好体位。</span></p><p><span>面朝上，头部下方可以垫一个枕头，枕头高度一定要适当，同时强调胸椎不能出现屈曲，往往患侧臀部下方可以垫一个枕头，让患侧的骨盆向前凸一些，防止髋关节的屈曲和外旋。</span></p><p><span>患侧肩关节下方可以垫一个方软枕，让肩胛骨向前凸，上肢的肘关节伸展放在枕头上，腕关节被伸，手指伸展。</span></p><p><p><img src="image/20200927/438e063a122a07e6e1e1ab26d0fcbfd1_4.jpg" /></p></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><span><strong>偏瘫翻身运动</strong></span></section></section></section></section></section></section></section><p><span>患者卧床之后，建议患者 2 ~ 3 小时翻身一次，翻身运动分为主动和被动运动。</span></p><p><span><strong><span>被动翻身运动：</span></strong></span></p><p><span>为患者翻身时，需要指导看护者，要对肩关节和髋关节同时用力，防止因为用力不当导致患者损伤。</span></p><p><p><img src="image/20200927/4b8141110c39fcb78bb73957fcf61b1a_5.jpg" /></p></p><p><span><strong><span>助力翻身运动：</span></strong></span></p><p><span>当患者本身有一定力量的时候可以使用。助力翻身要以患者自身用力为主，家人少许用力进行辅助。</span></p><p><p><img src="image/20200927/40bc1079b8fabe4364b8b96549272e90_6.jpg" /></p></p><p><span><strong><span>自主健侧翻身运动：</span></strong></span></p><p><span>患者完全依靠自己的力量进行翻身，翻身前患者健侧下肢插到瘫侧下肢下面，将瘫侧上肢放到腹部，在转颅及肩的同时，健足用力蹬床铺，瘫侧肢体随之翻向侧上方，呈健侧卧位姿势。</span></p><p><p><img src="image/20200927/05a908d43a225a514954ec4d615f50fe_7.jpg" /></p></p><p><span><strong><span>自主患侧翻身运动：</span></strong></span></p><p><span>当患者自主向瘫侧翻身时，健侧下肢伸向外侧并立膝，健足蹬着床铺。患者在抬头、颈前屈、叉开腿的同时转上半身。</span></p><p><p><img src="image/20200927/18ab1972633d77503dca5414669c0fd0_8.jpg" /></p></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><span><strong>床上坐位/坐起训练</strong></span></section></section></section></section></section></section></section><p><span><strong>床上被动坐起靠背训练</strong></span></p><p><span>患者靠家人外力被动坐起后，患者背后放棉被、枕头、衣物或家人在患者背后用双手扶住病人肩部等，以使上身保持正直舒适位置。</span></p><p><span>下肢伸直，两手相握，伸肘放于身前桌子上，保持被动坐位平衡。需要患者反复训练。</span></p><p><p><img src="image/20200927/f4e2db70edba128b0b89cb11839b2f8e_9.jpg" /></p></p><p><span><strong><span>床上助力坐起训练</span></strong></span></p><p><span>患者取健侧卧位姿势，健侧肘及前臂尺侧支撑上半身，并在抬头抬身的同时，肘及前臂随抬身动作向下移动，以便使上半身抬的更高。家人用手扶助患者健侧肩部或肘部，并给予适当助力，即可坐起。</span></p><p><p><img src="image/20200927/a6c36848ae7ad0d3de4a033653863ea3_10.jpg" /></p></p><p><span><strong><span>床上自主坐起训练</span></strong></span></p><p><p><img src="image/20200927/7e50130385e300e17ced3c5a31dfeb68_11.jpg" /></p></p><p><span><strong><span>床上坐位平衡训练</span></strong></span></p><p><span>患者坐位时容易向患侧倾斜，需要给予一个助力；患者如果坐不稳，可以在患侧垫一个软垫以维持平衡。</span></p><p><span>床上坐位的平衡训练要早期进行，患者只有在坐稳以后，才能进一步进行站立的平衡训练。</span></p><p><p><img src="image/20200927/ec40cf9e44020741c14c37de7028be58_12.jpg" /></p></p><p><span><strong><span>床上横、纵向移行训练</span></strong></span></p><p><span>依靠健侧的肢体力量，逐渐带动患侧进行纵、横向的平移。</span></p><p><p><img src="image/20200927/dd3708e1711ba973fcbeb790270f04b0_13.jpg" /></p></p><p><span><strong><span>但是，如果能坐起、却没回到脑梗前的样子，又该如何是好呢？</span></strong><strong><span>那么还需动起患者的手脚来！具体方法如下：</span></strong></span></p><p><br /></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><span><strong>上肢被动运动训练</strong></span></section></section></section></section></section></section></section><p><span><strong><span>仰卧位上肢被动运动</span></strong></span></p><p><span>肩关节可内收、外展、旋前、旋后等。需要注意的是，保护好肩关节和肘关节。</span></p><p><p><img src="image/20200927/593f09427d6900cb326cece4864e9593_14.jpg" /></p></p><p><span><strong><span>仰卧位肘关节及小臂被动运动</span></strong></span></p><p><span>同样要注意关节的保护。</span></p><p><p><img src="image/20200927/4789808985de0eded9f8537105aad225_15.jpg" /></p></p><p><span><strong>腕及手指被动运动</strong></span></p><p><span>同样需要注意关节的保护。</span></p><p><p><img src="image/20200927/b9ee712bba67aa183e8b5ab152216860_16.jpg" /></p></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><span><strong>上肢助力运动训练</strong></span></section></section></section></section></section></section></section><p><span><strong><span>肩肘关节助力运动</span></strong></span></p><p><span>如果上肢瘫痪比较严重，可以给予一个助力，进行上臂的前后运动。</span></p><p><p><img src="image/20200927/d4e7a94d91c4456a381cc786140be39f_17.jpg" /></p></p><p><span><strong><span>肘关节屈曲拮抗运动</span></strong></span></p><p><span>患者坐位，手掌心朝下，家人站于患肢前外方，一手握住者手腕或手掌，一手扶于上臂1／2外上侧。</span></p><p><span>在嘱病人用力向上平抬的同时，握于患者的手用助力促其患肢上抬，扶于上臂的手做相方向的下按，抬到一定高度，使患肢保持伸直位，重新回到原位。</span></p><p><p><img src="image/20200927/6a9eb3b74bc6e5ff55cf609fb2600fa3_18.jpg" /></p></p><p><span><strong><span>下臂肌张力增高助力拮抗运动：</span></strong></span></p><p><span>患者仰卧位或坐位，用衣物或薄枕放于患肘下，家人一手于患侧肘关节上方，一手与患手相握，在嘱病人用力做前臂的外旋，内旋运动的同时，家人给予助力，促进动作的完成。</span></p><p><p><img src="image/20200927/4637c594ca89fbf640ef7315ed503278_19.jpg" /></p></p><p><span><strong><span>健上肢带动患肢助力运动训练</span></strong></span></p><p><span>屈肘回收：建议在患者早期卧床的时候就进行这些运动。患者两手相握，十指交叉。</span></p><p><span>注意正确的手指交叉方式是患侧手的大拇指握在健侧手大拇指的外面，肘关节伸直，伸过头顶，可以屈肘回收。</span></p><p><p><img src="image/20200927/f6e387897cc970d602b39d06f32df62e_20.jpg" /></p></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><strong>上肢自主运动</strong></section></section></section></section></section></section></section><p><span><strong><span>床上上肢自主运动：</span></strong><span>患者上肢的肌力如果能够平移的话，说明患者有2级肌力，必须强调，患者每次上肢平移外展的距离每次要大于40cm。</span></span></p><p><p><img src="image/20200927/ca33279bc3cfd46daa3a410de638f603_21.jpg" /></p></p><p><span><strong><span>坐位上肢自主运动：</span></strong><span>患者肢体缓慢地从大腿内侧移动到外侧，反复进行；</span></span><span>或者让患者的上肢进行一个上举，摸到后脑，做梳头动作。</span></p><p><p><img src="image/20200927/9b7184d4aa6c32eeeeddeee96ce8a18e_22.jpg" /></p></p><p><span><strong><span>站位上肢自主运动：</span></strong><span>患者力量再好一些的时候，可以进行摸墙运动。</span></span><span>一般以5cm为高度，一周时间为单位，让患者慢慢进行摸高训练。</span></p><p><p><img src="image/20200927/d0c632bdd6fd3824cb8cb8f794a63a83_23.jpg" /></p></p><p><span><strong><span>手指自主运动</span></strong></span></p><p><span>瘫手的屈伸训练。</span></p><p><p><img src="image/20200927/ed2db5ffbfa56afe53f5c8f01549c138_24.jpg" /></p></p><p><span>瘫手指的分并训练，瘫手的对指训练。</span></p><p><p><img src="image/20200927/f1f6bf31fce4b6e87d46cfb89130dd3f_25.jpg" /></p></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><strong>下肢被动运动康复</strong></section></section></section></section></section></section></section><p><span><strong><span>床上髋、膝、踝关节被动运动</span></strong></span></p><p><p><img src="image/20200927/d1137485a3db56ab2ac66337851eaa91_26.jpg" /></p></p><p><span><strong><span>床边下肢垂位被动运动</span></strong></span></p><p><span>患侧肢体搭在床沿上，根据患者的力量情况进行训练，可以进行大腿的上下抬和踝关节的前后屈伸动作。</span></p><p><p><img src="image/20200927/17b3ba8bda146950675c1a6881236581_27.jpg" /></p></p><p><span><strong><span>踝关节被动运动</span></strong></span></p><p><span>如果患者的远端力量比较差。</span></p><p><p><img src="image/20200927/6e7f752ba52835a5edafd29653ae0843_28.jpg" /></p></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><span><strong>瘫下肢助力运动</strong></span></section></section></section></section></section></section></section><p><span><strong><span>床上下肢助力运动</span></strong></span></p><p><br /></p><p><span>患者取仰卧位，家人用手给予助力，使瘫侧下肢处于屈曲位，然后令患者用力下蹬，伸直下肢。</span></p><p><p><img src="image/20200927/8c06b02aa33ff8bcc90ef92c36df6fa4_29.jpg" /></p></p><p><span><strong><span>床上下肢桥式运动</span></strong></span></p><p><span>患者取仰卧位，家人帮助患者将两腿屈曲，双足在臀下平踏在床铺面上，嘱患者伸髋，家人在两臂部间断给予助力抬离床面。</span></p><p><span>患肢髋外旋、外展不能支持时，家人可帮助稳住双膝。能完成双桥式运动后，令病人伸展健肢，嘱患者做单桥式动作，以加强髋内外旋的能力。</span></p><p><p><img src="image/20200927/98410aae55950cc0fdd60c0393e8fdd5_30.jpg" /></p></p><p><span><strong><span>下肢助力站立训练</span></strong></span></p><p><span>根据患者具体情况决定是单人搀扶还是双人搀扶。</span></p><p><p><img src="image/20200927/e9dbdb40241a8459cc832143213c9567_31.jpg" /></p></p><p><span>一人扶站时，其上身稍向前倾，两膝略弯曲，用膝盖支撑患者膝部。一手扶于患者腰骶部。并用力上托，另一手扶于病侧肘部。患者健臂手搭在家人肩背部，然后两人同时直腰并伸直膝部即可站立。</span></p><p><p><img src="image/20200927/9d0a88b8a91fe3717c5160d21806cbf8_32.jpg" /></p></p><p><span><strong><span>下肢助力步行训练</span></strong></span></p><p><span>直腰、挺胸，目视前方，迈患腿时躯体略向健侧倾斜，防病足蹭地。两足迈出间距相等。</span></p><p><p><img src="image/20200927/45fbbfdbe260a1f960efd19293482ddb_33.jpg" /></p></p><p><span><strong><span>下肢重瘫助力步行运动</span></strong></span></p><p><span>蹲位助力运动训练</span></p><p><p><img src="image/20200927/1cd77fac3b35ef7799ad28dff0ca42f0_34.jpg" /></p></p><p><span><strong><span>膝、踝关节助力运动训练</span></strong></span></p><p><span>患者坐在椅子上，家人将制备的脚蹬式圆木放在两足下，两腿同时做伸屈活动，用健肢带动患肢活动。</span></p><p><span>如患腿运动时仍有困难，家人可用手略给予助力，帮助前后运动。</span></p><p><p><img src="image/20200927/51ded6d4662ffe652e0321154006b136_35.jpg" /></p></p><p><span><strong><span>拄杖助力步行训练</span></strong></span></p><p><span>令患者将手杖向健足一脚长的外前方着地，两脚并拢站稳，伸出手杖，迈出病足，然后再伸出健足，即：手杖点出-患足迈出-健足迈出。</span></p><p><span>当迈出健足时，由手杖和患足两点支撑，其稳定性高，比较安全。</span></p><p><p><img src="image/20200927/7fb930092e13f4b0ce993b949fd38379_36.jpg" /></p></p><p><span><strong><span>拄杖上下楼梯训练</span></strong></span></p><p><span>上楼时先健足，后患足。</span></p><p><p><img src="image/20200927/07f022d17f6a53c6c3a9d74b5952e552_37.jpg" /></p></p><p><span><strong><span>拄杖上下楼梯训练</span></strong></span></p><p><span>下楼时先患足，后健足。</span></p><p><p><img src="image/20200927/6fedee0ac1d31b66d5da44141fc1f639_38.jpg" /></p></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><span><strong>床上运动训练</strong></span></section></section></section></section></section></section></section><p><span><strong><span>床上自主左右摆腿运动训练</span></strong></span></p><p><span>患者取仰卧位，肌力达2级时，令患者将健下肢伸直，患腿沿床铺面左右运动达最大程度；反复自主练习内收与外展后，瘫肢肌力可在3-5天内达到自主抬离床面的程度。</span></p><p><p><img src="image/20200927/decbf2f9593822259c4fa972f2ee2459_39.jpg" /></p></p><p><span><strong><span>床上自主抬腿运功</span></strong></span></p><p><span>患者取仰卧位，健腿保持伸直位或稍屈曲位。在令患者向上平抬患腿的过程中，家人将手掌放于患足以上适当高度，令患者用力抬腿，使足尖触及家人手掌或接近手掌。</span></p><p><span>可有计划的反复训练。</span></p><p><p><img src="image/20200927/f17ebe70c0138a1981879287da8ac10a_40.jpg" /></p></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><strong>自主站立训练</strong></section></section></section></section></section></section></section><p><span>患者在脱离助力站立后即进入自主站立阶段，在自主站立初期，要有家人在旁边监护，以防跌倒。</span></p><p><span>站立时间要由短到长，嘱患者平视，两肩放平，头要摆正，身子正直位。</span></p><p><p><img src="image/20200927/ac2e4a698c6d0cfb1945704e77380d04_41.jpg" /></p></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><span><strong>自主坐起训练</strong></span></section></section></section></section></section></section></section><p><span><strong><span>自主坐起运动训练</span></strong></span></p><p><span>患者上身呈前屈状，双足跟位于椅子腿根部，边屈髋、膝，双手边扶住膝盖部，缓慢坐下，然后保持上身坐直。</span></p><p><p><img src="image/20200927/37e356b9f13439505363366763ed56e8_42.jpg" /></p></p><p><span><strong><span>自主坐起运动训练</span></strong></span></p><p><span>患者坐在椅子上，将双足缩到椅子腿跟部，然后身子前屈，两手扶于膝盖。用双手支撑再伸展髋膝即可站起。</span></p><p><p><img src="image/20200927/277763cb89c9b8ef550de4a9bbb4d5af_43.jpg" /></p></p><section data-tools="gulangu" data-id="93436" data-color="#1e9be8" data-custom="#1e9be8"><section><section><section><section><section><section><section data-width="100%"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 56.2 47.4" width="100%"><g><path d="M56.2,47.4V24.5H44.5c-1.2-10.9,6.1-20,6.1-20L44.7,0C34.3,7.9,33.3,24.5,33.3,24.5v22.9H56.2z" fill="#1e9be8"></path><path d="M22.9,47.4V24.5H11.2c-1.2-10.9,6.1-20,6.1-20L11.5,0C1,7.9,0,24.5,0,24.5v22.9H22.9z" fill="#1e9be8"></path></g></svg></section></section></section></section><section><section><section data-brushtype="text"><strong>步行训练</strong></section></section></section></section></section></section></section><p><span><strong><span>主动步行训练</span></strong></span></p><p><span>抬头、挺胸、目视前方。纠正前脚掌蹭地，足内翻及行走步态异常、步间距大小不等。</span></p><p><p><img src="image/20200927/ad6d3920aa175d29fb76f41a25937ddb_44.jpg" /></p></p></section></section></section></section></section></section></section><section data-role="paragraph"><section><section data-role="paragraph"><section><p><span>本文供大家交流参考，以各自临床情况为准。</span></p><section data-style-type="7" data-tools="新媒体排版" data-id="9182"><p><p><img src="image/20200927/eab6ecc32a0ffaaa0b29df9516d67e4c_45.png" /></p></p></section></section></section></section></section><p>本文素材转自：康复汇<br /></p>
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发表于 2020-9-27 07:26:03