Walking self-help traction exercise method for hemiplegic patient
By using a lifting device in walking exercises for hemiplegia patients, ensuring that the knee joints on both lower limbs are flexed and the ankle joints are in dorsal extension, the problem of abnormal gait in early walking exercises is solved and the normal function recovery of the calf muscles is promoted.
Patent Information
- Application Number
- CN202411930238.4
- Authority / Receiving Office
- CN · China
- Patent Type
- Applications(China)
- Current Assignee / Owner
- Filing Date
- 2024-12-26
- Publication Date
- 2025-03-28
AI Technical Summary
Patients with hemiplegia tend to cause abnormal gait during early walking exercises, and it is difficult to reverse abnormal gait due to the lack of muscle tone and muscle strength of tendons and ligaments around the knee joint.
By setting up a lifting device, the patient can perform walking exercises, ensuring that the knee joints on both sides of the lower limbs are flexed at the same time, and the center of gravity is transferred evenly and alternately between the two lower limbs, avoiding the occurrence of abnormal gaits, and keeping the ankle joint at the dorsal angle during the exercise, and continuously drawing the calf triceps.
It effectively avoids the occurrence of abnormal gait, promotes the stretching of the calf triceps, reduces the foot tilt and foot tilt caused by spasm, and creates conditions for other means to treat ankle dorsal extension.
Smart Images
Figure CN119700486A_ABST
Abstract
Description
Technical Field
[0001] The invention relates to the technical field of hemiplegia rehabilitation, and in particular to a self-help traction walking training method for hemiplegic patients. Background Art
[0002] Hemiplegia refers to symptoms such as weakness, paralysis, and numbness of one side of the limbs. It is one of the common sequelae of cerebral stroke, and the ability to walk of the lower limbs is the most basic ability for normal people to participate in social work and family life. About 85% of patients have various functional disorders left over from a stroke and their primary rehabilitation goal is to restore the ability to walk. Restoring and improving the ability to walk is the most urgent need of patients and their families.
[0003] Most patients choose to walk by themselves or with the help of their family members due to the economic burden, and this forced walking will inevitably lead to abnormal gait. In the early stage of stroke, the affected limb is paralyzed. Due to the loss of muscle tone and strength of the tendons and ligaments around the knee joint, even when the affected lower limb is briefly loaded, it is completely dependent on the bony support of the femur and tibia. In addition to showing morphological changes of knee hyperextension, it will further change the local anatomical structure in the knee joint; morphology determines function, and normal anatomical morphology will have normal motor function. Abnormal gait accompanied by morphological changes is difficult to reverse. Based on the above background, there is a need for an exercise method that can not only meet the needs of post-stroke patients for early walking exercises, but also avoid gait abnormalities caused by premature walking. Summary of the invention
[0004] In view of the above problems, the purpose of the present invention is to provide a self-help traction training method for walking for hemiplegic patients. A lifting device is set to assist the patient in walking exercise. The knee joints of both lower limbs are flexed at the same time, ensuring that the center of gravity is always transferred alternately and evenly between the two lower limbs, thereby avoiding the occurrence of abnormal gait. During the training process, the ankle joint is at a dorsiflexion angle, which continuously stretches the triceps surae, avoiding the occurrence of plantar inversion and inversion of the foot caused by spasm, and creating conditions for other means of treating ankle dorsiflexion.
[0005] The embodiments of the present invention are implemented by the following technical solutions:
[0006] A self-help traction walking training method for hemiplegic patients comprises the following steps:
[0007] S1. Preparation: A lifting device is fixed on the front part of the sole of the affected lower limb of the patient, wherein the lifting device comprises a fixing part fixed on the sole and a lifting part connected to the fixing part, and the connection point between the fixing part and the lifting part is located on the outside of the sole;
[0008] S2. Exercise inspiration posture: The patient keeps the trunk straight, pelvis tilted forward, hips in neutral position and knees flexed, while the patient's healthy hand holds the lifting device;
[0009] S3. Exercise process: The healthy hand uses the lifting device to lift the forefoot of the affected side so that the forefoot is out of contact with the ground. The iliopsoas muscle at the hip of the affected lower limb exerts force to make the affected lower limb move forward with the knee flexed and the heel touching the ground. Then the affected lower limb enters the supporting period. The affected knee remains in a flexed state during the entire supporting period to complete the forward movement of the healthy lower limb. This alternating movement is performed to complete the exercise.
[0010] Preferably, in step S1, the connection point between the fixing portion and the lifting portion is located at the outer third of the sole of the foot.
[0011] Preferably, in step S2, the lifting portion is a flexible structure, and the lifting portion is moved along the inner side of the calf toward the popliteal fossa, and finally moved upward from the popliteal fossa to the front of the patient.
[0012] Preferably, in step S2, the affected upper limb is suspended from the neck and fixed in flexion in front of the chest.
[0013] Preferably, in step S2, the angle of flexion of both knees is 10°-15°.
[0014] Preferably, in step S3, the movement stride of the affected lower limb and the healthy lower limb is half the length of the patient's foot.
[0015] Preferably, in step S1, the thickness of the fixing portion located at the bottom of the sole is less than 0.1 cm.
[0016] Preferably, in step S1, after the connection point between the lifting part and the fixing part is fixed, the length of the lifting part is determined based on the elbow of the healthy upper limb being straight and the force direction being toward the head.
[0017] Preferably, in step S3, the patient needs to look forward while walking.
[0018] Preferably, in step S1, before the lifting device is fixed, stability training is performed on the functional muscles of the scapula, chest, waist and pelvis, with emphasis on the training of the functions of the iliopsoas, hamstrings and tibialis anterior muscles. After the movement of hip flexion or knee flexion or knee flexion and hip flexion occurs, input training of lower limb hip flexion, knee flexion and ankle dorsiflexion that simulates a normal movement pattern should be performed regardless of whether there is ankle dorsiflexion at the same time; the functional muscles of the scapula, chest, waist and pelvis are connected with the lower limbs. The connection training includes: sitting and standing training and posture maintenance training with the trunk straight, the pelvis slightly tilted forward, the hips in neutral position, the knees flexed, the feet shoulder-width apart and the toes level, weight-bearing training of the affected lower limb in this posture, and weight transfer training on the coronal plane / lower limb left and right.
[0019] The technical solution of the embodiment of the present invention has at least the following advantages and beneficial effects:
[0020] By setting up a lifting device to assist the patient in walking exercises, the knee joints of both lower limbs are flexed at the same time, ensuring that the center of gravity is always transferred alternately and evenly between the two lower limbs, thus avoiding the occurrence of abnormal gait; during the exercise process, the ankle joint is at a dorsiflexion angle, which continuously stretches the triceps surae, avoiding the occurrence of plantar inversion and inversion of the foot caused by spasms, and creating conditions for other means of treating ankle dorsiflexion. BRIEF DESCRIPTION OF THE DRAWINGS
[0021] In order to more clearly illustrate the technical solutions of the embodiments of the present invention, the drawings required for use in the embodiments are briefly introduced below. It should be understood that the following drawings only show certain embodiments of the present invention and therefore should not be regarded as limiting the scope. For ordinary technicians in this field, other related drawings can be obtained based on these drawings without creative work.
[0022] Figure 1 A schematic diagram of the use status provided by an embodiment of the present invention;
[0023] Figure 2 A schematic diagram of the use status of another embodiment of the present invention is provided.
[0024] Icons: 1- sole of the foot; 2- calf; 3- fixed part; 4- lifting part; 5- popliteal fossa. DETAILED DESCRIPTION
[0025] In order to make the purpose, technical solutions and advantages of the embodiments of the present invention clearer, the technical solutions in the embodiments of the present invention will be clearly and completely described below in conjunction with the drawings in the embodiments of the present invention. Obviously, the described embodiments are part of the embodiments of the present invention, not all of the embodiments. Generally, the components of the embodiments of the present invention described and shown in the drawings here can be arranged and designed in various different configurations.
[0026] Therefore, the following detailed description of the embodiments of the present invention provided in the accompanying drawings is not intended to limit the scope of the invention claimed for protection, but merely represents selected embodiments of the present invention. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without creative work are within the scope of protection of the present invention.
[0027] Combine the following Figure 1 , Figure 2 The present invention is described in detail.
[0028] Example
[0029] A self-help traction walking training method for hemiplegic patients comprises the following steps:
[0030] S1. Preparation: A lifting device is fixed to the front of the sole 1 of the affected lower limb of the patient, the lifting device comprising a fixing portion 3 fixed to the sole 1 and a lifting portion 4 connected to the fixing portion 3, and the connection point between the fixing portion 3 and the lifting portion 4 is located on the outer side of the sole 1;
[0031] S2. Exercise inspiration posture: The patient keeps the trunk straight, pelvis tilted forward, hips in neutral position and knees flexed, while the patient's healthy hand holds the lifting device;
[0032] S3. Exercise process: The healthy hand uses the lifting device to lift the forefoot of the affected side so that the forefoot is out of contact with the ground. The iliopsoas muscle at the hip of the affected lower limb exerts force to make the affected lower limb move forward with the knee flexed and the heel touching the ground. Then the affected lower limb enters the supporting period. The affected knee remains in a flexed state during the entire supporting period to complete the forward movement of the healthy lower limb. This alternating movement is performed to complete the exercise.
[0033] Figure 1 and Figure 2 The right leg is used as the affected lower limb, and the left hand is used to pull the lifting device for exercise. The lifting device can replace the crutches to increase the exercise effect. Traditional crutches are a tool that transmits force from top to bottom and compensates for the weight of the affected lower limb through the healthy upper limb. They are equivalent to the third lower limb of a person, which will cause the patient's center of gravity to shift rapidly toward the healthy lower limb. Once used, early stroke patients will quickly become dependent on them, which is an important inducement for the formation of a circular gait. The lifting device is only a tool that uses the healthy upper limb to self-help the ankle dorsiflexion function that is lacking in the tibialis anterior muscle after a stroke. Its use itself is also a rehabilitation treatment for the ankle dorsiflexion function, which does not involve the distribution of the center of gravity of the human body. The patient's lower limbs on both sides always bear the weight of the upper body, and there is no center of gravity shift.
[0034] In step S1, the connection point between the fixing part 3 and the lifting part 4 is located at the outer third of the sole 1 to prevent the foot from being inverted when the healthy hand exerts force to lift up.
[0035] In step S2, the lifting part 4 is a flexible structure, and the lifting part 4 is wound along the inner side of the calf 2 to the popliteal fossa 5, and finally wound upward from the popliteal fossa 5 to the front of the patient. Figure 2 As shown, this method can help patients complete the normal movement pattern of hip flexion, knee flexion, and ankle dorsiflexion during the swing phase.
[0036] In step S2, the affected upper limb is suspended from the neck and flexed and fixed in front of the chest to prevent shoulder subluxation and shoulder-hand syndrome.
[0037] In step S2, the angle of flexion of both knees is 10°-15°. Both knees should be in a state of flexion of 10°-15° in the entire walking cycle, whether in the support phase or the swing phase. This is the main action point of gait therapy specified in this application, which lowers the center of gravity and increases the stability of balance.
[0038] In step S3, the movement stride of the affected lower limb and the healthy lower limb is half of the patient's foot length, which is conducive to the forward and backward transfer of the body's center of gravity on the sagittal plane.
[0039] In step S1 , the thickness of the fixing portion 3 located at the bottom of the sole 1 is less than 0.1 cm to avoid the fixing portion 3 being too thick to cause a change in the sole pressure and affect the walking function.
[0040] In step S1, after the connection point between the lifting part 4 and the fixing part 3 is fixed, the length of the lifting part 4 is made based on the elbow of the healthy upper limb being straightened and the force direction being toward the head. The lifting device can be made using a gauze bandage according to the patient's height. After the length is fixed with the force point, it is appropriate to straighten the elbow of the healthy upper limb and exert force toward the head; the lifting device only slightly exerts force upward on the healthy upper limb of the patient to lift the front foot of the affected lower limb and clear the obstacles of the foot clearance for the affected lower limb to walk forward. The power source for finally completing the walking forward must come from the iliopsoas muscle. Double-sided tape can be pasted on the sole to stick and fix the gauze bandage, which can further increase the friction between the gauze bandage and the shoe to prevent the gauze bandage from slipping.
[0041] In step S3, the patient needs to look forward while walking and cannot use the visual system (lowering the head to look at the feet) to compensate for the lack of proprioception caused by the stroke, because the head is the key point of human posture control during walking, and the displacement of the head space will cause changes in posture.
[0042] In step S1, preparatory training is required before the lifting device is fixed. For example, stability training is performed on the functional muscles of the core muscles (scapula, chest, waist and pelvis); core stability refers to the ability of the trunk and pelvis of the human body to be in a stable posture during exercise, so that the muscles can complete the best work and the muscle force can be effectively transmitted and controlled in each link of the movement chain until the end of the limbs; the body core control ability is the basis of human limb movement and all functional activities. Patients after stroke may not only have paralysis of one limb, but also paralysis of the ipsilateral trunk. Core muscle stability training is a necessary stage of rehabilitation. According to the discussion in the article "Prognosis of motor function of lower limbs in stroke hemiplegia based on the "three three three one" evaluation principle", the function of the iliopsoas, hamstrings and tibialis anterior muscles is focused on. After the movement of hip flexion or knee flexion or knee flexion and hip flexion occurs, regardless of whether there is ankle dorsiflexion at the same time, input training of lower limb hip flexion, knee flexion and ankle dorsiflexion should be performed to simulate the normal movement pattern. The functional muscles of the core muscles are connected with the lower limbs. The connection training includes: sit-and-stand training and training with the trunk straight, pelvis slightly tilted forward, hips in neutral position, knees flexed 10°-15°, feet shoulder-width apart and toes level. In this posture, there is weight-bearing training for the affected lower limb and weight transfer training on the coronal plane / left and right lower limbs.
[0043] This application is only applicable to patients who are conscious after a stroke and have no obvious cognitive dysfunction. Only when the patients actively cooperate can the desired therapeutic effect be achieved. During the initial walking training, the therapist should try to get close to the patient without physical contact with the patient, to give the patient a sense of psychological security and overcome the physical tension caused by the fear of falling. When a person is in a tense state, the muscles of the whole body will produce involuntary coordinated contractions and cannot complete the movement requirements set by the gait. If the patient needs to walk at home, he must also use the gait specified in this application, in order to form dynamic stereotypes and develop behavioral habits as soon as possible; in this way, he can establish a subconscious walking movement pattern without thinking through the brain when walking, and avoid the occurrence of abnormal gait.
[0044] The posture and gait specified in this application are aimed at establishing a normal posture and a normal gait when walking. Through the plasticity of the brain, the various elements of a normal gait when walking are taken as the starting point, and the characteristics and causes of the typical circling gait of hemiplegia are taken as the avoidance points. The various components involved in walking (trunk, pelvis, hip, knee, ankle and foot) and movement patterns are designed, and finally integrated into an exercise method that not only allows early independent walking, but also leaves sufficient time and space for the recovery of knee and ankle function and the establishment of a normal gait in the future.
[0045] The therapeutic principle and mechanism of this application:
[0046] ① The waist, pelvis and hip joints are the core parts of the human body, where the center of gravity is located and where walking begins. The gait specified in this application sets the trunk straight, the pelvis slightly tilted forward, and the hip in a neutral position, so that the starting posture of early walking after a stroke is in the posture control required for normal walking. This ensures that the human body posture can meet the requirements of a normal gait at the source, lays the foundation for the establishment and stabilization of a normal posture in the later stage, and eliminates the adverse effects of abnormal posture on walking.
[0047] ② The lower limbs of stroke hemiplegia are extensor-dominant, and the inability or limitation of knee flexion caused by extensor spasm is one of the main causes of abnormal gait. Simultaneous flexion of the hip and knee joints, and flexion of the knee joint when the hip joint is fully extended are two basic actions to prevent circling gait; and the design of the hip and knee joints for the gait specified in this application makes the hip and knee joints flexed at the same time during the support period of the affected lower limb, and can meet the requirements of hip extension and knee flexion when the affected lower limb is in the early and middle stages of the step.
[0048] ③Spasm of the triceps surae is an important cause of inversion of the foot, foot drop and spastic gait of hemiplegic patients. In the recovery of motor function of the hip, knee and ankle joints, foot drop or inversion of the foot caused by ankle dorsiflexion disorder accounts for 20% of limb motor function disorders. The rehabilitation treatment ability of the ankle joint is also an important criterion for measuring the treatment technology level of a rehabilitation department. When walking with the gait of the present application, the ankle joint is in a dorsiflexion angle throughout the entire walking cycle, which has a continuous stretching effect on the triceps surae, avoiding the occurrence of foot inversion and inversion caused by spasm, and creating conditions for other means of treating ankle dorsiflexion. The gait of the present application itself is also a rehabilitation treatment method that induces ankle dorsiflexion function in its movement pattern, which may prevent patients from being able to dorsiflex the ankle joint alone in a standing or sitting position, but during walking, the ankle joint can meet the requirements for ankle dorsiflexion angle during normal gait.
[0049] ④ The paralysis of the affected lower limb of the stroke patient affects the weight bearing of the affected leg. When standing and walking, the weight bearing of the healthy limb increases, the center of gravity of the body is biased to the healthy side, and an abnormal gait pattern with asymmetry between the healthy and affected sides occurs. This asymmetry includes not only the imbalance of the center of gravity distribution, but also the shortening of the stance phase and the prolongation of the swing phase of the affected lower limb, and the prolongation of the stance phase and the shortening of the swing phase of the healthy lower limb. The gait regulated by this application is to use a lifting device and set the knee joints of both lower limbs to bend 10°-15° at the same time, so as to always ensure that the center of gravity is evenly and alternately transferred between the two lower limbs, and not give the "asymmetry" the opportunity to cause abnormal gait.
[0050] ⑤Balance function refers to the ability to immediately return the body's center of gravity to a stable support surface through active or reflex activities when the body's center of gravity deviates from a stable support surface. After a stroke, the central nervous system is damaged, resulting in partial loss of its control function over the lower centers, affecting standing balance and increasing low-level reflexes, which leads to abnormal gait when patients and their families are forced to walk. The setting of the gait of the present application in which both sides of the lower limbs are flexed 10°-15° at the same time lowers the center of gravity, and the setting of a stride of 1 / 2 the length of the patient's own foot per step means that the body's center of gravity swings less; the lower the center of gravity when standing and walking, the smaller the swing, the stronger the posture stability and balance control ability, which reduces the causes of abnormal gait and increases the chance of restoring a normal gait.
[0051] The above are only preferred embodiments of the present invention and are not intended to limit the present invention. For those skilled in the art, the present invention may have various modifications and variations. Any modification, equivalent replacement, improvement, etc. made within the spirit and principle of the present invention shall be included in the protection scope of the present invention.
Claims
1. A self-help traction walking training method for hemiplegic patients, characterized in that: The steps include: S1. Preparation: a lifting device is fixed to the front of the sole (1) of the affected lower limb of the patient, the lifting device comprising a fixing portion (3) fixed to the sole (1) and a lifting portion (4) connected to the fixing portion (3), wherein the connection point between the fixing portion (3) and the lifting portion (4) is located on the outside of the sole (1); S2. Exercise inspiration posture: The patient keeps the trunk straight, pelvis tilted forward, hips in neutral position and knees flexed, while the patient's healthy hand holds the lifting device; S3. Exercise process: The healthy hand uses the lifting device to lift the forefoot of the affected side so that the forefoot is out of contact with the ground. The iliopsoas muscle at the hip of the affected lower limb exerts force to make the affected lower limb move forward with the knee flexed and the heel touching the ground. Then the affected lower limb enters the supporting period. The affected knee remains in a flexed state during the entire supporting period to complete the forward movement of the healthy lower limb. This alternating movement is performed to complete the exercise.
2. The method for self-help traction walking training for hemiplegic patients according to claim 1, characterized in that: In step S1, the connection point between the fixing portion (3) and the lifting portion (4) is located at the outer third of the sole (1).
3. The self-help traction walking training method for hemiplegic patients according to claim 1, characterized in that: In step S2, the lifting portion (4) is a flexible structure, and the lifting portion (4) is wound along the inner side of the calf (2) toward the popliteal fossa (5), and finally wound upward from the popliteal fossa (5) to the front of the patient.
4. The method for self-help traction walking training for hemiplegic patients according to claim 1, characterized in that: In step S2, the affected upper limb is suspended from the neck and fixed in flexion in front of the chest.
5. The method for self-help traction walking training for hemiplegic patients according to claim 1, characterized in that: In step S2, the angle of flexion of both knees is 10°-15°.
6. The method for self-help traction walking training for hemiplegic patients according to claim 1, characterized in that: In step S3, the movement stride of the affected lower limb and the healthy lower limb is half of the patient's foot length.
7. The self-help traction walking training method for hemiplegic patients according to claim 1, characterized in that: In step S1, the thickness of the fixing portion (3) located at the bottom of the sole (1) is less than 0.1 cm.
8. The method for self-help traction walking training for hemiplegic patients according to claim 1, characterized in that: In the step S1, after the connection point between the lifting portion (4) and the fixing portion (3) is fixed, the length of the lifting portion (4) is determined based on the elbow of the healthy upper limb being straightened and the force direction being toward the head.
9. The method for self-help traction walking training for hemiplegic patients according to claim 1, characterized in that: In step S3, the patient needs to look forward while walking.
10. The method for self-help traction walking training for hemiplegic patients according to claim 1, characterized in that: In step S1, before the lifting device is fixed, stability training is performed on the functional muscle groups of the scapula, chest, waist and pelvis, with emphasis on the training of the functions of the iliopsoas, hamstrings and tibialis anterior muscles. After the action of hip flexion or knee flexion or knee flexion and hip flexion occurs, regardless of whether there is an ankle dorsiflexion action at the same time, input training of lower limb hip flexion, knee flexion and ankle dorsiflexion should be performed to simulate the normal movement pattern; The functional muscles of the scapula, chest, waist and pelvis are connected with the lower limbs. The connection training includes: sit-and-stand training and posture maintenance training with the trunk straight, pelvis slightly tilted forward, hips in neutral position, knees bent, feet shoulder-width apart and toes level, weight-bearing training of the affected lower limb in this posture, and weight transfer training on the coronal plane / left and right lower limbs.