Pay attention to prevent muscle atrophy after fracture
The sudden Lushan Earthquake in Sichuan brought a serious disaster to the people in the disaster area.
Professor Li Jianjun, director of the China Rehabilitation Research Center and director of the Beijing Pok Oi Hospital, has been stationed in the earthquake-stricken area.Disabled.
The basic principles of rehabilitation for earthquake victims are early intervention, reduction of disability, prevention of complications, and the development and application of all their residual functions.
In the rescue of the injured in the earthquake, the earlier the intervention should be, the sooner the better.
“After the Lushan earthquake in Sichuan, a rehabilitation expert at the Beijing Bo’ai Hospital of the China Rehabilitation Research Center wrote the first rehabilitation and nursing articles about the common injuries such as spinal cord injuries, limb fractures, and brain trauma in the earthquake, helping the injured to recover from the injury as soon as possible.Recover from the pain, improve their confidence in life and self-care ability, and provide a good foundation for them to return to the family and society in the future.
Pay attention to prevent muscle atrophy after fracture. Limb fractures are the most common wounds in disasters such as earthquakes and landslides.
Functional exercise after fracture is very important. Patients undergoing conservative treatment and surgery should perform early functional exercise. This can promote fracture healing, prolong fracture healing time, prevent joint adhesion, muscle atrophy, and reduce disability.
Early, middle, and late exercises for fractures. Focus on early and early fractures (within 1-2 weeks after injury). The injured limb is more swollen and painful. The main exercises are muscle relaxation and contraction. In principle, except for the upper and lower joints of the fracture, the other joints are temporarily inactive.Should be appropriate.
Exercises for upper limb muscles are repeated with fists and flexion and extension.
Exercises for lower limb muscles are to contract and relax thigh muscles, fractures of hooked feet and active toes, which can help reduce swelling.
In the middle stage of the fracture (after 2 weeks), the swelling of the injured limb subsides, and the local pain gradually disappears. The muscles should continue to relax and contract at the same time. At the same time, the upper and lower joints of the fracture should be moved gradually.The scope, special attention should be paid to the joints not to move up and down, and at the same time should ask the doctor certain activities can not be done.
In the late stage of fracture (after fracture healing), it is mainly to strengthen the active exercise of the joints of the injured limb, so that the joint can quickly return to the normal range of motion.
Specially strengthen the joints at the top of the activity.
Functional exercise method for common fractures 1. After the fracture of the upper arm (fracture of the diaphysis), fix the fracture, start to practice finger, palm, and wrist movements, and contract the upper arm muscles. Do not rotate the upper arm and do not lift things.
After 2-3 weeks, exercise the shoulder and elbow joints. Fully exercise the shoulder and elbow joints at the later stage of the fracture: such as touching the contralateral shoulder with the injured limb, touching the back of the brain, and rowing.
2. Forearm fractures (ulnar and radius fractures) can be used to exercise the muscles of the arm in the early stage, make strong fists, and open fingers.
After 2-3 weeks, start to exercise shoulder, elbow, and other joint activities, and the range and strength gradually increase. Do not do forearm rotation activities, and then practice forearm rotation activities to fully practice all joint activities.
3, lower limb fractures (femoral fractures, fractured bone fractures) after surgical fixation, early raise the injured limb, do thigh muscle contraction activities, follow the doctor’s instructions to move the knee joints and other joints, when to follow the doctor’s instructions.
You cannot use full force after landing, you should use a double or single turn, and when you use a single turn, put it on the side of a good leg.
After the fracture is completely healed, it can be fully applied.
In short, functional exercise is mainly based on active muscle and joint activities, supplemented by passive activities. Active muscle and joint activities can prevent muscle atrophy and increase the range of joint activity.
When strengthening the key joints, do not overlap the surrounding joints, such as fractures of the wrist joints. You must move both the wrist joints and the finger joints and shoulder and elbow joints.
Functional exercise should be performed under the guidance of a doctor, because each patient’s injury, age, physical condition, and nutritional status are different.
Functional training should be continuous from surgery to full recovery. This is a long-term process and cannot be abandoned halfway.
If you have obvious discomfort, you should seek medical advice.
Younger patients with brain trauma are more likely to recover. The clinical symptoms of head trauma are determined by the severity of the injury. Slight head trauma is only a scalp hematoma, while severe head trauma can cause headaches, nausea, vomiting, lethargy, and lethargy, Coma and so on.
Other manifestations such as dizziness, tinnitus, memory loss, fatigue, and insomnia are also common.
Many years of experience in rehabilitation treatment tell us that the rehabilitation value of young patients with brain trauma often has some unexpected effects through effective rehabilitation treatment through distance.
Rehabilitation of traumatic brain injury includes positioning of good limbs during bed rest, joint mobility training, turning over, sitting up, balance training, orientation training, walking training, language training, cognitive training, psychological counseling, and eating, dressing, sizeDaily ability training such as toilet care, breathing and skin management.
Correct bed rest position is important. Early bed trauma often requires a certain bed rest time. Long-term bed rest will cause certain muscle atrophy, joint stiffness, osteoporosis, dizziness and other symptoms when sitting up, which will seriously affect future functional recovery.
When the condition is stable, bed time should be minimized to prevent functional waste.
It is very important to stay in the correct posture while lying in bed. It is recommended to lie on the side, turn over regularly, and pat your back.
In the early stage of the onset, turning over once every two hours will cause a variety of complications. The main purpose of turning over in time is to prevent wound sores.
In the early stages of the disease, patients with limbs who are unable to move must turn over every 2 hours.
Patients who have been bedridden for a long time should also turn over in time.
When sitting up after long-term bedridden, it is necessary to slowly start the disease. When sitting up for the first time or to stay in bed for a long time, in order to avoid orthostatic hypotension, a passive sitting-up method with an increasing angle should be used.
You can shake the head of the bed 15 degrees to 30 degrees, rest for 3-5 minutes, gradually increase the angle, increase 10-15 degrees each time, increase the sitting time for 5-10 minutes, perform exercises for more than 2-3 days, on the bedSit straight up to 90 degrees.
After the patient can sit up to 90 degrees and hold for 30 minutes, they can begin to practice independent sitting and transfer movements. Do joint mobility training twice a day. For bedridden patients, exercises to maintain and improve the range of joint motion should be performed.
Joint range exercises can be done twice a day, about 10 times per joint, with gentle and slow techniques.
Calling for affection can help awakening. Patients with traumatic brain injury often have conscious disturbances, unconsciousness, poor active movement and other conditions. Giving appropriate sensory stimulation can promote awakening and induce movement.
Sensory stimuli include touch, vision, hearing, smell, and taste.
You can use the bath, turn over, exercise, massage, etc. to give the patient tactile sensation and deep stimulus; talking with the patient, calling for affection, listening to the radio, watching TV, watching photos and other stimuli have a certain wake-up effect.
Do not rush to walk on the ground, including walking exercises, walking with walking sticks and walking aids, orthopedic walking.
Patients with traumatic brain injury must first be mentally prepared for walking. They must be able to sit still, stand up and stand firmly. At the same time, the affected leg can take a step, shift the focus to the affected leg, support the affected leg, and keep up.
Otherwise don’t rush to walk prematurely.
You should walk in the balance bar early and gradually transition to flat walking training.
Hearing damage that cannot be ignored Because most of the hearing organs are buried in the skull, in the disability caused by the earthquake, hearing damage often coexists with craniocerebral trauma.
The early stages of this type of injury are often masked by other symptoms of brain trauma and are not easily detected.
After the traumatic period of brain trauma, the corresponding symptoms, such as tinnitus, deafness, dizziness, and some patients with fractured bones will appear complete or incomplete paralysis of facial muscles.
Damage to the outer ear generally does not cause hearing loss.
Middle ear damage is mainly a ruptured tympanic membrane and an interrupted ossicular chain. Hearing loss will not exceed 60 decibels. Loud speech can be heard, can be heard clearly, and can be understood.
When nursing, pay attention to put a sterile cotton ball in the ear canal to prevent dust and shampoo and face wash from entering the ear. As long as no infection occurs, most of the tympanic membrane perforation can heal automatically.
The interruption of the ossicular chain can be repaired by surgery in the future, and hearing will be restored without leaving permanent hearing damage.
Injury to the inner ear, auditory nerve, and auditory center is the main feature of hearing damage. The ability to distinguish speech is reduced. The injured can hear the voice of someone, but they cannot distinguish the meaning.
The type of hearing loss rehabilitation measures is to compensate for the hearing loss through hearing aids or cochlear implantation after hearing loss is stabilized.
For children whose speech is not fully developed, speech rehabilitation training should be conducted in time to prevent the occurrence of language barriers.
Spinal and spinal cord rehabilitation begins immediately after spinal cord and spinal cord injury is also one of the most common diseases in earthquake injuries. Rehabilitation treatment should begin on the first day after injury.
Contents include: reconstruction of spinal stability, external fixation, internal fixation during surgery, spinal dehydration treatment, etc.
Also pay attention to the management of the whole body, to prevent multiple system dysfunction, to prevent complications such as pressure ulcers, ptosis, and urinary tract infections.
Rehabilitation treatment includes three periods: 1. Acute attack period (about 2-4 weeks after injury or spine displacement): During the acute attack period, rehabilitation training should be performed 1-2 times a day, and the training intensity should not be excessive.
The main contents of rehabilitation training during this period include: joint mobility training, muscle training, respiratory function training, exercise training, bladder function training.
2. Acute stabilization period (from acute instability period to about 8 weeks after injury): Rehabilitation training content should be strengthened during this period. The total daily rehabilitation training time should be about 2 hours.
The main clinical treatment in this period has basically ended, and the spine and the condition of the wounded are stable. Rehabilitation has become the first or only task.
3. Chronic period (two months after the injury): After the early rehabilitation period, a period of post-rehabilitation training can be carried out according to the situation of the injured person. The purpose is to guide the injured person to return to the family and society.