Planning Treatment Program

Abstract

The main points of a treatment program for hemiplegic patients are: (1) prevention of disuse syndrome (strengthening muscles on the unaffected side, inducing frequent joint movement, providing strong sensory stimulation and walking training in the early stages); (2) treatment of paralysis and sensory impairment as well as higher brain dysfunctions (such as aphasia, hemi-spatial neglect); (3) training that includes gait training and ADL training. The actual components of treatment will differ depending on the patient’s age, duration after onset, severity of paralysis, severity of sensory disorder, muscle strength on the unaffected side and level of higher brain dysfunctions (Table 3.1). Physical therapy should place emphasis on the activities related to daily living and independent walking; therefore, it is essential to promote muscle strength in the unaffected limbs and trunk first. It will also be necessary to devote time to treatments that improve paralysis. Under the current medical insurance system in Japan, the time allotted for physical therapy and occupational therapy is about 20–60 min each. In order to provide an effective treatment that improves the patient’s paralysis, it is necessary to realize the intended movement within the limited treatment time and provide Repetitive Facilitative Exercise. Therefore, the technique for inducing excitement of the nerve tract should be completed within a few minutes. Instead of a conventional passive range of motion exercises, it (the range of motion exercises) is performed as a self-passive exercises with electrical and vibratory stimulation. This can be efficient as long as electrical and vibratory stimulation are not contraindicated, as described in the section on promotion methods in this book. (※ in Table 3.1).