Illustrated Explanation Of Correct Body Positions

The patient needs to change the body position after a period of treatment to prevent secondary dysfunction due to long-term lying on the bed. The body can be changed gradually from a lying position to a sitting position, and from a sitting position to a standing position and from a standing position to a walking position. In this way, the patient is eventually able to walk and go up and down stairs with ease.

The change of body position is not simply a matter of sitting or standing up. Such a change should be scientific. Changing the body position too early or too late will increase the possibility and degree of disablement. Besides, a premature change of the body position may lead to wind stroke and death.

Generally speaking, the change from a lying to a sitting position can be done after the acute stage (two weeks after ischemic wind stroke, 3-4 weeks after hemorrhagic wind stroke). If the patient is conscious and the myodynamia of the affected lower limbs is two to three grades, he or she may do sitting exercises from angles of 300, 450, 600 and 800, and reaching the highest sitting position (800) within two weeks. Each time, the patient sits 30 minutes and once or twice a day. Before, after and during the exercise, the blood pressure and pulse should be examined. The exercise should be stopped if the blood pressure increases over 4kPa or falls below 1.3kPa, and the pulse increases 30% or is 120 times a minute, or if postural hypotension appears (such as vertigo, nausea, vomiting and cold sweat).

When the myodynamia of the affected lower limb has attained three to four grades and the patient's hip and knee joints can bend and extend freely, it means the patient is now able to get out of bed, and he or she should do standing exercises, each time 10 to 30 minutes, three to four times daily. The patient should begin the exercises with standing with support and then standing all on his or her own. At the same time, the patient should make sure that the sole touch the ground steadily and the foot is not inverted, so as to prevent deformity of the foot. Meanwhile, functional exercises of the affected lower limb should be intensified to prevent spasm of the lower limb, especially foot droop.

With improvement of the dyodynamia, the patient may try to walk with support, meanwhile taking care to constantly correct foot droop, knee joint stiffness and spasm of the hip and elbow joints and prevent semi-dislocation and adhesion of the shoulder joint.

The exercises of change from a sitting position to a standing position and then to a walking position should be done step by step. Be sure to guard against rashness to avoid the deformity of the joints resulting from excessive traction of the weak muscles and ligaments.

Functional Sitting Position (Fig. 5-1 )

[Method] The patient sits straight on the chair (without leaning against the back). The upper part of the body stretches as much as possible. The head is not deviated to the healthy side. The hips and knees are bent at an angle of 90~. The feet are placed in a stable position on the ground with the same width of the shoulders. In doing functional exercise, the hands are placed on the thighs to keep a balanced sitting position. The affected upper limb is usually suspended with a triangular bandage in front of the chest.

[Effect] To exercise muscles responsible for extension of the spine; to prevent anterior bending of the body, stiffness of the hip and knee joints and droop and inversion of the foot; and to improve cardiocerebrovascular functions.

Passive Change From A Lying Position To A Sitting Position (Fig. 5-2)

[Method] The patient lies face up. The hand on the healthy side grasps the hand on the affected side and is laid on the abdomen. The foot on the healthy side is placed beneath the foot on the affected side in a crossover position. The doctor or nurse stands on the healthy side of the patient with both hands on the patient's shoulders, turning the body slowly to the healthy side and pulling the shoulders upward. At the same time, the patient bends the elbow on the healthy side to support the body and then, with the palms resting on the bed, extends the elbow on the healthy side as the upper part of the body is being pulled up. The foot on the healthy side moves the affected lower limb to a lower place of the bed and both feet are placed evenly on the ground. Then, the patient stays in a functional posture.

[Effect] To exercise the muscles responsible for extending  the shoulder and elbow joint and stretching the hip joint on the healthy side, as well as the neck, back, waist and abdominal muscles; and to prevent atrophy due to disuse. The other effects are the same as those of the functional sitting.

The TCM approach is fundamentally different from that of Western medicine. In TCM, the understanding of the human body is based on the holistic understanding of the universe as described in Daoism, and the treatment of illness is based primarily on the diagnosis and differentiation of syndromes.