(1) Rehabilitation goal

(2) Principles of making rehabilitation plan

There are various functional disorders caused by craniocerebral injury, and there are great differences among patients, so the treatment plan should be different from person to person. The rehabilitation of craniocerebral injury is long-term. Most of the physical obstacles after injury have stabilized within one year, but the cognitive, behavioral and social psychological problems often last for a long time. Therefore, the goal of long-term rehabilitation should be set. If there are behavioral, emotional and cognitive obstacles at the same time, they must be dealt with first, otherwise patients may resist, resist and treat rehabilitation negatively, or many retraining methods cannot take effect because of poor attention and memory. Cognitive rehabilitation is long-term, so it is necessary to teach patients' families some practical methods that can be trained at home for a long time.

(3) Treatment of common dysfunction

1. Treatment of acute phase, necessary drugs and surgical treatment, and strengthening nutrition; Passive activities to prevent joint stiffness; Prevent pressure ulcers and deep vein thrombosis; Correcting abnormal posture by reflex inhibition mode.

2. Rehabilitation treatment of cognitive impairment has been widely used in cognitive rehabilitation abroad, but it has not been popularized in China. Here are some simple and practical rehabilitation methods that can be carried out in the hospital or after the patient returns home.

(1) training of attention and concentration

(1) shell game: take two transparent glasses and a pinball, let the patient watch the surgeon cover a cup on the pinball and point out the cup with the pinball, and repeat it several times. When it is correct, use two opaque cups. The operation is the same as above. Repeatedly several times, after success, switch to more cups or more balls of different colors. After buckling, ask the patient to point out the cups with various colors of marbles, and then ask again after moving the cups.

② cancellation task: write a few capitalized Chinese pinyin letters such as KBLRBPYO (numbers and figures can also be used) on a piece of white paper, and ask the patient to delete the letters designated by the artist, such as B.. Then rewrite the order of letters and specify the letters to be deleted, and repeat it several times. Increase the number of lines and difficulty of letters after success.

③ time sense: Ask the patient to start the stopwatch according to the operator's order, stop it at 1 seconds, and then gradually extend the time to 1 minute. When the error is less than 1~2 seconds, stop it by letting him mentally calculate it at 1 seconds after starting, and then extend the time to stop at 2 minutes, with the error of no more than 1.5 seconds every 1 seconds. After meeting the requirements, talk to the patient and let the patient carry out the above training, so that the patient can try to control himself not to be distracted by the conversation.

④ occupational therapy: knitting, carpentry, jigsaw puzzles, etc.

(2) memory training

(1) visual memory: first, put 3-5 picture cards with daily necessities in front of the patient, tell the patient that each card can be read for 5 seconds, then take away the cards, and let the patient write down the names of the items he sees with a pen, and repeat it several times, and then increase the number of cards after success.

② Story-making method: It is helpful to make a short story according to your own habits and hobbies.

③ Occupational therapy: carpentry, clay work, inlay, throwing arrows, etc.

The following methods should be adopted in daily life:

① Establish a constant daily activity routine for patients to repeat and practice constantly;

② Ask questions and give orders to patients patiently and quietly;

③ Practice from simple to complex, and divide the whole exercise into several small parts, first train small parts, and then combine them gradually after success;

④ Use various sensory inputs such as sight, hearing, touch, smell and movement to cooperate with training;

⑤ The training time should be short each time, and rewards should be given promptly and frequently when the memory is correct;

⑥ let the patients distinguish the key points, remember the most necessary things first, and don't remember some irrelevant things.

(3) Training of thinking

Thinking includes many processes, such as reasoning, analysis, synthesis, comparison, abstraction and generalization, and these processes are often manifested in human solving problems. Here are some training methods of reasoning and problem-solving ability.

① Point out the news in the newspaper: Take a local newspaper, first ask the patient the information about the front page of the newspaper, such as headline, date, name of the newspaper, etc. If the answer is correct, then ask him to point out the columns in the newspaper, such as sports, business, classified advertisements, etc. After the answer is correct, train him to look for special news, such as asking him what the score of the two teams is. What about the movies shown in a cinema? After the answer is correct, train him to find some news that needs his decision.

② arranging numbers: give the patient three digital cards, and let him arrange them from small to large, and then give him another card at a time, so that he can insert them among the three arranged cards according to the size of the numbers. After it is correct, give him some digital cards and ask him what * * * is in common, such as those that are odd or even, and those that can be multiples of each other.

③ classification: ask patients to classify and pair multiple item names according to their purposes.

④ occupational therapy: picture synthesis, carpentry, etc. Training is varied, and not all the steps in a training are completed in one day. Training does not need special supplies, and it can be continued at home after discharge. Therefore, patients' families should also be trained so that they can master the training methods.

(4) Improvement of environment

If patients still have cognitive impairment after leaving the hospital or returning to work, improvement of environment may be the most effective rehabilitation strategy. In attention training, patients should be kept in a quiet environment, such as turning off the radio and TV to reduce noise interference. If this is not possible, you can use earplugs. Short and clear instructions also help patients. The best way to damage memory is to use assistive devices that can compensate its memory. For example, patients can be taught to rely on calendars, alarm clocks and timers on the wall to arrange their work schedules. Post a work list in the workplace. Put commonly used tools in the place where they are most easy to see and get.

3. Rehabilitation of behavior disorder

For paroxysmal out-of-control and frontal lobe attack, drug therapy and positive punishment behavior therapy can be used. For negative behavioral disorders, behavioral therapy is adopted, such as negative punishment method, shaping method, token method and so on. You can also carry out occupational therapy to eliminate aggressive emotions.

4. Rehabilitation of speech disorder and motor disorder.