Wenru Zhao - Rehabilitation Therapeutics of The Neurological Training (2019, Springer Singapore) PDF

Rehabilitation
Therapeutics of the
Neurological Training
Daoyin Technique in Chinese

Medicine
Wenru Zhao
123 123
Rehabilitation Therapeutics of the
Wenru Zhao
Rehabilitation
Therapeutics of the
Daoyin Technique in Chinese
Medicine
Wenru Zhao
Neurological Training Rehabilitation
Research Room of Beijing Daxing
District Chinese and Western Medicine
Combined Hospital
Beijing
China
ISBN 978-981-13-0811-6 ISBN 978-981-13-0812-3 (eBook)

https://doi.org/10.1007/978-981-13-0812-3
Library of Congress Control Number: 2018956445
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189721, Singapore
I spent 4 years’ day and night on this book. I spent three Spring
Festivals and many weekends in my office. Rehabilitation
Therapeutics of the Neurological Training : Daoyin Technique
in Chinese Medicine is finally completed. I enjoy myself for a
while and am anxious about this book. Although this book is
my painstaking effort for almost 20 years and is completed by
my group, will it withstand the ordeal of time and tide? Is there
any major regret and careless omission? In any case, who is
coming will come. Rehabilitation Therapeutics of the
Neurological Training: Daoyin Technique:in Chinese Medicine
should be presented to the author sooner or later. This book
should go through the test of time and tide, should be applied
in clinic and should be discussed by the rehabilitation doctors.
More than 10 years’ clinical application proved that the
therapeutic effect is good and the method is accepted by many
patients, which make me feel comfortable. All these results give
me courage. At least, this book serves as a modest spur to
induce someone to come forward with his valuable. My purpose
is to revive the old rehabilitation technique of Chinese nation to
improve life quality of the disabled. I want to devote myself to
rehabilitation medicine service. This book should receive the
inspection and judgement of specialists, rehabilitation doctors,
all sectors of society and the successors. This book may be only
a start. After practice, modification, supplement and perfection,
this book can be used to serve the disabled and benefit all
mankind. That’s what I want to and am happy to see.
When this book is going to be published, the most urgent thing I
want to do is to thank the hospitals, companies and people that
support and help me in the development of rehabilitation
technique of neurological training and in the days of book
writing. Since 2001, I came back to China and Xuanwu Hospital,
vi
Beijing Municipal Rehabilitation Center, Tongren Hospital and

National Research Center for Rehabilitation Technical Aids
Affiliated Rehabilitation Hospital provide affordable conditions
for the development of this technique, which play an important
role in the early incubation and development of rehabilitation
technique of neurological training. I want to thank the groups in
different phases who don’t give me up in the difficulties and who
follow me and give up good pay and working condition
regardless of hardship. They contribute to the development and
progress of rehabilitation technique of neurological training and
the development and application of rehabilitation enterprise.
It is estimable that Beijing Xingchengwanyou Science and
Technology Ltd is the rehabilitation technological achievement
transformation of neurological training. Since 2003, the
company is leaded by general manager, senior engineer
Hongquan Su, to raise money, prepare place, buy equipment and
turn my thoughts into corollary equipment at any cost, because
they are willing to try their best to develop corollary equipment
of our own rehabilitation technique of functional training with
proprietary intellectual property rights and contribute to the
formation and industrialization development of this technique.
I want to thank the hospitals that recruit this technique. They take
risks to recruit rehabilitation technique of neurological training for
the local patients at first, broaden the clinical application range of
this technique, and accelerate the pace of clinical verification and
improved development. I want to thank the rehabilitation doctors,
news media, all sectors of society, the patients and their family
who accept and support rehabilitation technique of neurological
training. They give me the courage and power to do further
research on the rehabilitation technique of neurological training.
I want to thank my family as well who support and understand
me in these years.
With this, I realize that if neurological training has a little
effect and contribution on the development and progress of
rehabilitation medicine, it is the results of everyone’s effort.
Perhaps, the publishment of this book is only the start of the
research work. My group and I will devote ourselves to the
renaissance of rehabilitation technique in traditional Chinese
medicine and progress of rehabilitation enterprise.
Beijing, China
28 July 2013
Preface
During the years I worked as an orthopedist specializing in the treatment and

functional rehabilitation of spinal cord injury, I had the honor of studying in
the department of physics and biophysics at the University of Salzburg for
three years and then in the orthopedics and rehabilitation department of
Jackson Memorial Medical Center at the University of Miami for three years.
When I studied in the USA under the guidance of Professor Bernard S
Brucker, I was brought into contact with the rehabilitation technique of
electromyographic biofeedback and was immediately impressed. Since I
returned to China in 2001, I have been dedicating myself to clinical practice,
teaching, and research in the field of rehabilitation.
During the process of undertaking clinical rehabilitation, teaching, and
research work, I truly realized the value and importance of rehabilitation
work and recognized that rehabilitation medicine requires advanced technol-
ogy and a wide breadth of knowledge. I realized that rehabilitation is a sub-
ject with practical value. When medicines, surgery, and other methods cannot
recover lost motor function after an injury to the central nervous system, the
method of rehabilitation training and rehabilitation medical engineering can
remodel the disabled who have lost their self-help ability into those who have
physical autonomy and are capable of taking care of themselves and return-
ing to society. Rehabilitation medicine is a complicated and difficult cross-
discipline subject, but it is a great way to help remodel people. All these
aspects of rehabilitation medicine give me the passion and confidence to
undertake rehabilitation medicine work.
I spent nineteen years, including six years in an elementary stage abroad
and thirteen years’ exploration at home, to develop a new rehabilitation tech-
nique that combines traditional Chinese and Western medicine. This tech-
nique’s theoretical bases are CNS plasticity and functional reorganization and
its training methods are neural potential development, motor program rees-
tablishment, and motor pattern remodeling. The basic technique applied in
these methods is a six-step Daoyin technique in traditional Chinese medicine
of guiding collaterals through meridians to improve neural potential and
recover functions of the nervous system; this process is also referred to as
neurological training. Nine anatomical systems are controlled by nerves.
Therefore, this technique can be widely applied. At present, using the six-step
Daoyin technique, a series of therapeutic methods and corollary equipment
have been in gradual development, which is called the rehabilitation therapy
system of neurological training.
vii
viii Preface
In the process of writing this book, I was supported by rehabilitation

groups of neurological training and all sectors of society. I deliberated over
the content of this book, simplified it by cutting out the superfluous, and
strove for accuracy. However, my knowledge is limited and there may be
some mistakes, so that I hope the reader will help me rectify them.
I hope this book can serve as a modest motivator to spur someone to come
forward with their valuable contributions, so they can then activate the enthu-
siasm of medical workers for further exploration in this technique in order to
improve it. In this way, the Daoyin technique from traditional Chinese medi-
cine can then be spread worldwide.
Beijing, China Wenru Zhao

August 2013
Acknowledgments
I spent four years, day and night, on this book. I spent three Spring Festivals
and many weekends in my office. Now, Rehabilitation Therapeutics of the
Neurological Training: Daoyin Technique in Chinese Medicine is finally
completed. I enjoyed myself for a while and am anxious about this book.
Although this book is the result of my painstaking effort for almost twenty
years and is completed by my group, will it withstand the ordeal of time? Are
there any mistakes or careless omissions? In any case, whatever happens,
happens. Rehabilitation Therapeutics of the Neurological Training: Daoyin
Technique in Chinese Medicine should be presented to the reader sooner or
later. This book should go through the test of time, should be applied in clinic,
and should be discussed by the rehabilitation doctors.
More than ten years’ clinical application has proved that the therapeutic
effect is good and the method is accepted by many patients, which made me
feel comfortable. All these results gave me courage. At least, this book will
serve as a modest motivation to encourage someone to come forward with
their valuable ideas. My purpose is to revive an old rehabilitation technique
of Chinese origin to improve the life quality of the disabled. I want to devote
myself to rehabilitation medicine service. This book should receive the
inspection and judgment of specialists, rehabilitation doctors, all sectors of
society and their successors. This book may be only a start. After practice,
modification, supplement, and perfection, this technique can hopefully be
used to serve the disabled and benefit all mankind. That’s what I want and
would be happy to see.
When this book is published, the most important thing I want to do is to
thank the hospitals, companies, and people that supported and helped me
while I was developing this technique and during my days of book writing. In
2001, I returned to China. Xuanwu Hospital, Beijing Municipal Rehabilitation
Center, Tongren Hospital, and the National Research Center for Rehabilitation
Technical Aids Affiliated Rehabilitation Hospital provided affordable condi-
tions for the development of this technique, which played an important role
in the early incubation and development of rehabilitation technique of neuro-
logical training. I want to thank the groups in different phases who didn’t give
up on me despite the difficulties and who followed me and gave up good pay
and working conditions regardless of hardship. They contributed to the devel-
opment and progress of this rehabilitation technique.
My special thanks go to Beijing Xingchengwanyou Science and
Technology Ltd., the transformation base for our technical achievement in
ix
x Acknowledgments
neurological training and rehabilitation. Since 2003, the company has been
led by general manager and senior engineer Hongquan Su. This company
helped to raise money, prepare places, buy equipment, and turn my thoughts
into corollary equipment at any cost, because they are willing to try their best
to develop equipment for rehabilitation technique of functional training with
proprietary intellectual property rights and contribute to the formation and
industrialization development of this technique.
I want to thank the hospitals that adopted this technique. They took risks
to adopt this technique for local patients at first, broaden the clinical applica-
tion range of this technique, accelerate the pace of clinical verification, and
contribute improvements and developments. I want to thank the rehabilitation
doctors, news media, all sectors of society, the patients and their families who
accepted and supported this technique. They gave me the courage and power
to do further research on this rehabilitation technique of neurological
training.
I want to thank my family as well, who has supported and understood me
all these years.
With this, I realized that if neurological training has some impact or con-
tribution to the development and progress of rehabilitation medicine, it is the
result of everyone’s effort.
Perhaps, the publication of this book is only the start of this research. My
group and I will devote ourselves to the renaissance of rehabilitation tech-
nique in traditional Chinese medicine and progress of rehabilitation
enterprise.
Contents
1 Basic Theory of Neurological Training Rehabilitation�� 1

1.1 Abstract �� 1
1.1.1 The Mechanism of Recovering the Lost
Motor Functions After CNS Injuries�� 1
1.1.2 The State of Applied Rehabilitation
Techniques at Domestic and Overseas at Present �� 6
1.2 Theoretical Basis of Neurological Training Rehabilitation�� 13
1.2.1 CNS Potential Development �� 13
1.2.2 Motor Program Reconstruction�� 15
1.2.3 Motor Pattern Remodeling�� 18
1.3 The Principle and History of Daoyin Technique
in Traditional Chinese Medicine (TCM)�� 20
1.3.1 The Principle of Daoyin Technique
in Traditional Chinese Medicine�� 20
1.3.2 The History of Daoyin Technique
1.3.3 The Reason of Endangered Daoyin Technique
1.3.4 Basic Ideas of Renaissance of Daoyin Technique
1.4 Electromyographic Biofeedback�� 25
1.4.1 The Development History of Electromyographic
Biofeedback Technique�� 25
1.4.2 The Principle and Clinical Application
of Electromyographic Biofeedback Technique�� 25
1.4.3 Equipment Types of Myoelectric Biofeedback�� 29
1.4.4 Advantages and Shortages of Myoelectric
Biofeedback Technology�� 30
References�� 31
2 The Formation of Neurological Training
Rehabilitation System�� 33
2.1 The Modernization of Daoyin Technique
2.1.1 Theoretical Foundation of the Modernization
of Daoyin Technique in Traditional
Chinese Medicine�� 33
xi
xii Contents
2.1.2 The Formation and Specific Operational Approach

of Six-Step Daoyin Technique�� 34
2.1.3 Controlled Clinical Trial of Six-Step
Daoyin Technique �� 44
2.1.4 Clinical Indications and Cautions
of Six-Step Daoyin Technique�� 47
2.1.5 The Application of Six-Step Daoyin Technique
in Physical Therapy and Occupational Therapy �� 48
2.1.6 The Application of Six-Step Daoyin Technique
in Other Trainings �� 53
2.2 Therapeutic Methods of Neurological Training
Rehabilitation�� 54
2.2.1 Acquisition of Motor Program Signal:
Experimental Study on the Source of Surface
Electromyogram Signal�� 56
2.2.2 The Role of “Objective and Motive” Mechanism
in the Development of Human Potentials �� 63
2.2.3 The Display of Effect of Objective Indicators
in Six-Step Daoyin Technique�� 64
2.2.4 The Origin and Definition of Neurological
Training�� 66
2.2.5 Rectification of Abnormal Motor Program
and Consolidation of Normal Motor Program�� 67
2.2.6 Indications, Contraindications and Cautions
of Rehabilitation Therapeutics Methods
of Neurological Training�� 76
2.3 The Type and Methods of Establishing Coordinated
Movement Procedure�� 77
2.3.1 The Significance of Establishing the Coordinated
Movement Procedure in Recovering Coordinated
Movement �� 77
2.3.2 The Type and Methods of Reestablishing
Coordinated Movement Procedure �� 78
2.3.3 Indications, Contraindications and Cautions
of Reestablishing Multi-joint Coordinated
Motor Program�� 80
2.3.4 Clinical Application Study on Mechanism
of Rehabilitation Therapeutics of Neurological
Training�� 81
References�� 87
3 Neurological Training Methods of Developing
Neural Potential�� 89
3.1 The Basis of Neural Potential �� 89
3.1.1 Theoretical Basis of Developing Potential�� 90
3.1.2 The Condition of Developing Potential�� 92
3.2 The Application of Six-Step Daoyin Technique
in Potential Development�� 95
3.2.1 Clearing and Activating the Channels
and Collaterals of Daoyin Technique�� 95
Contents xiii
3.2.2 Classification of Potential Development Training�� 98

3.3 Clinical Indications and Cautions of Potential
Development �� 100
3.3.1 Clinical Indications and Cautions
of Upper Limbs Potential Development Training�� 100
3.3.2 Clinical Indications and Cautions of Potential
Development Training in Trunk�� 101
3.3.3 Clinical Indications and Cautions of Potential
Development Training in Lower Limbs�� 102
3.4 Clinical Experiment of Potential Development�� 102
3.4.1 The Development and Clinical Application
of Potential Development Training Equipment
of Upper Limbs �� 102
3.4.2 The Development and Clinical Application
of Potential Development Training Equipments
of Lower Limbs�� 105
References�� 109
4 Comprehensive Application of Rehabilitation Technique
4.1 The Formation and Prevention Mechanism
of Abnormal Motor Pattern�� 112
4.1.1 The Formation Mechanism of Abnormal
Motor Pattern�� 112
4.1.2 The Effect of Abnormal Motor Pattern on Physical
Function�� 113
4.1.3 Common Classification of Abnormal Motor Pattern�� 114
4.1.4 The Mechanism of Prevention and Rectification
of Abnormal Motor Pattern�� 118
4.1.5 Rehabilitation Method Used for Rectifying
Abnormal Motor Pattern at Home and Abroad
at Present�� 121
4.2 Three Stages of Rehabilitation Training Method
in Neurological Training �� 122
4.2.1 The Division, Principal Method and Mechanism
of Three Stages in Neurological Training�� 122
4.2.2 Basic Methods and Clinical Indications
in All Stages of Neurological Training �� 128
4.2.3 The Training Time and Therapy Course
of Three-Stage of Neurological Training Therapy�� 131
4.2.4 Flexible Use of Three-Stage Neurological
Training Therapy�� 131
4.2.5 Clinical Verifications of Three-Stage Neurological
Training Therapy�� 132
4.2.6 Clinical Application Experiences in Three-Stage
Rehabilitation Method of Neurological Training:
A Philosophical Method with Dialectics
and Natural Law�� 136
4.3 Three-Stage Associated Equipment and Clinical
Verification of Neurological Training �� 140
xiv Contents
4.3.1 Abnormal Gait Rectification Weight Support

Treadmill Training Device and Clinical Verification�� 140
4.3.2 Clinical Verification of Lower Limbs Motor Pattern
Remodeling Trainer�� 146
4.3.3 The Design Principle and Clinical Verification
of Limb Multifunctional Training Box �� 152
4.3.4 Development and Clinical Verifications
of Controlled-Release Force Ankle-Foot Orthosis�� 156
5 Training Method and Equipment of Virtual
Neurological Training�� 161
5.1 The Mechanism and Significance of Virtual
Training Methods�� 161
5.1.1 The Generation of Ideas of Virtual Neurological
Training�� 161
5.1.2 Background of Related Techniques: Virtual Reality�� 163
5.1.3 Research Purpose and Meaning of Virtual
Neurological Training System�� 166
5.2 Composition and Training Method of Virtual Neurological
Training System�� 167
5.2.1 The Composition of Virtual Neurological
5.2.2 Training Method of Virtual Neurological
5.3 The Mechanism and Function of Virtual Neurological
5.3.1 The Mechanism of Virtual Neurological
5.3.2 The Function of Virtual Neurological
5.4 Clinical Experiment of Virtual Neurological
5.4.1 Clinical Data �� 175
Reference �� 181
6 Rehabilitation Methods of Neurological Training
in Special Diseases�� 183
6.1 Rehabilitation Methods of Neurological Training
of Recovering Motor Function in the Patients with Severe
Unconsciousness �� 183
6.1.1 Theoretical Foundation of Motor Function
Recovery Training in the Patients with Severe
Unconsciousness �� 183
6.1.2 The Introduction of Severe Unconsciousness�� 185
6.1.3 Compulsive Active Movement Method
of Neurological Training of Recovering
Motor Function of the Patients
with Severe Disturbance of Consciousness�� 187
Contents xv
6.2 Rehabilitation Methods of Neurological Training

of Muscle with Zero Myodynamia �� 191
6.2.1 The Mechanism of Rehabilitation Training of
Neurological Training of Zero Myodynamia�� 191
6.2.2 Training Methods of Zero Myodynamia�� 192
6.2.3 Clinical Research of Neurological Training
Therapy of Zero Myodynamia�� 194
6.3 Beauty Method of Neurological Training �� 198
6.3.1 Active Movement of Facial Muscle Training
Method of Neurological Training �� 199
6.3.2 Active Movement Training Method of Facial
Muscle of Virtual Neurological Training�� 200
6.3.3 Manual Active Movement Training Method
of Facial Muscle of Neurological Training�� 200
6.3.4 Self-Training Method of Facial Muscle
6.3.5 Facial Physiotherapy �� 201
6.4 Active Movement Conceptions and Methods
of Aged Care: New Concept of Modern Aged Healthcare�� 201
6.4.1 Active Movement�� 202
6.4.2 Assisted Active Movement Training�� 204
6.4.3 Passive Active Movement Training�� 204
6.4.4 Compulsive Active Movement Training �� 206
6.4.5 Self-Exercise Method of Neurological Training�� 207
6.4.6 Cautions�� 207
7 Function Assessment and Therapeutic Schedule
of Neurological Training Rehabilitation�� 209
7.1 The Main Methods of Rehabilitation Functional
Assessment�� 209
7.1.1 The Principle of Neurological Training
Rehabilitation Evaluation�� 209
7.1.2 The Main Content and Assessment Stages
of Rehabilitation Evaluation �� 211
7.1.3 Assessment Method�� 212
7.2 The Formulation of Rehabilitation Therapy
of Neurological Training Schedule �� 218
7.2.1 The Composition of Combination Therapy Group �� 218
7.2.2 Basic Principle of Formulating Therapy Schedule �� 219
7.2.3 The Implementation and Adjustment
of Therapeutic Schedule �� 225
7.2.4 The Role of the Patients and Their Family
in Rehabilitation�� 228
xvi Contents
8 Integrated Method of “Physiotherapy-Physical Exercise

and Self-Exercise”�� 233
8.1 The Reason Why Bony Joint and Muscular Painful
Diseases Are Difficult to Be Cured and Easy to Relapse�� 233
8.1.1 Soft Tissue Adhesion After Damages
Is Not Lessened Effectively�� 233
8.1.2 The Factors That Induce Soft Tissue Inflammation
of Joint and Muscle Aren’t Rectified�� 234
8.1.3 Single Therapeutic Method Without
Comprehensive Therapeutic Method
for Pathogenesis and Complication�� 235
8.2 Neurological Training Rehabilitation for Osteoarthritis �� 236
8.2.1 Early Stage�� 236
8.2.2 Middle Stage �� 236
8.2.3 Late Stage�� 236
8.2.4 Physiotherapy�� 237
8.2.5 Method and Mechanism of Physical Exercise
Therapy �� 243
8.2.6 The Method and Effect of Self-Exercise�� 251
9 The Application of Rehabilitation Medical Engineering
in Neurological Training�� 265
9.1 The Research and Development of Preventive Orthotics �� 265
9.1.1 Semi-Finished Product Macromolecule
Orthotics Material �� 265
9.1.2 Former of Orthopedic Brace �� 269
9.1.3 Retainer of Joint in Functional Position �� 272
9.1.4 Convenient Turning–Over Device
to Prevent Pressure Sores�� 277
9.2 The Development of Orthopedic Orthotics�� 283
9.2.1 Ankle Orthotics of Controlled-Release Force�� 284
9.2.2 Antispasmodic Dynamic Joint Position Retainer �� 286
9.3 The Development of Functional Assistive Device�� 290
9.3.1 Elastic Band Orthosis of Lower Limbs�� 290
9.3.2 Assistive Walking Device of Complete
High Paraplegia�� 291
10 Rehabilitation Therapy of Neurological Training
of Hemiplegia�� 301
10.1 Dysfunction Type and Rehabilitation Stage
of Hemiplegia�� 302
10.1.1 Dysfunction Type of Hemiplegia �� 302
10.1.2 Rehabilitation Stage of Hemiplegia �� 303
10.2 Rehabilitation Therapy of Hemiplegia�� 305
10.2.1 Rehabilitation Therapy in Bed�� 305
10.2.2 Rehabilitation Therapy Out of Bed�� 312
10.3 Solutions to Some Common Problems �� 320
Contents xvii
10.3.1 Rehabilitation Method of Neurological

Training of Zero Myodynamia �� 320
10.3.2 The Therapy of Myospasm�� 320
of Facial Paralysis�� 327
11.1 Main Dysfunctions of Facial Paralysis �� 327
11.1.1 Pathogenesis and Dysfunction Characteristics
11.1.2 Functional Assessment Method
11.2 The Mechanism and Method of Rehabilitation
Therapy of Facial Neuritis�� 329
11.2.1 The Mechanism of Rehabilitation Therapy
of Facial Neuritis�� 329
11.2.2 The Method of Rehabilitation Therapy
of Facial Neuritis�� 332
11.3 Rehabilitation therapy in sequelae phase.�� 344
11.3.1 Clinical Therapeutic Effect Observation
of Peripheral Facial Paralysis Treated
by Rehabilitation of Neurological Training �� 349
of Cerebral Palsy in Children �� 357
12.1 The Characteristics of Cerebral Palsy�� 357
12.1.1 Characteristics and Types of Cerebral Palsy
in Children�� 357
12.1.2 Complications and Secondary Diseases �� 358
12.2 Assessment Method of Cerebral Palsy in Children�� 358
12.3 The Formulation of Therapeutic Schedule�� 362
12.3.1 Rehabilitation Therapy Principle of the Baby
and Infant with Cerebral Palsy �� 362
12.3.2 Rehabilitation Therapy Schedule and Specific
Method of the Baby and Infant
with Cerebral Palsy�� 363
12.3.3 Amount of Training of Children
with Cerebral Palsy�� 378
12.3.4 Training and Therapy in Other Aspects�� 379
12.4 Case Report: The Rehabilitation Process
of an Elder Child with Cerebral Palsy�� 382
of Paraplegia�� 387
13.1 The Main Dysfunctions of Spinal Cord Injury �� 387
13.1.1 Classification and Diagnosis of Spinal
Cord Injury �� 387
xviii Contents
13.1.2 The Common Clinical Syndrome After Spinal

13.1.3 The Main Dysfunctions Induced by Spinal
13.1.4 Functional Assessment of Spinal Cord Injury�� 391
13.2 Spinal Cord Injury Rehabilitation Therapy
13.2.1 Early Rehabilitation Therapy of Spinal
13.2.2 Rehabilitation Therapy of Neurological Training
of the Patients with Spinal Cord Injury
in Convalescence�� 398
13.3 The Prevention and Treatment of Common
Complications of Paraplegia �� 406
13.3.1 Dysfunction of Urine and Stool
and Rehabilitation Therapy�� 406
13.3.2 Treatment of Pressure Sores�� 406
13.3.3 The Common Cardiovascular Problem
and Rehabilitation After Spinal Cord Injury�� 408
13.3.4 Deep Vein Thrombosis of Lower Limbs�� 409
13.3.5 Rehabilitation of Thermoregulation Disorder�� 411
13.3.6 Tardive Neurological Deterioration�� 412
13.4 Clinical Application of Neurological Training
for Paraplegia�� 412
13.4.1 Observation of Therapeutic Effects
of Chronic Cervical Cord Injury�� 412
13.4.2 Multiple-Course Observation of Curative Effect
of Treating Obsolete Cervical Cord Injury�� 415
13.4.3 Therapeutic Effect Analysis of Muscles
with Zero Myodynamia in the Patients
with Obsolete Cervical Cord Injury �� 421
of Pulmonary Dysfunction�� 427
14.1 Respiratory Movement and Pulmonary Function �� 427
14.1.1 Pulmonary Ventilation Function�� 427
14.1.2 Evaluation of Pulmonary Ventilation Function�� 430
14.2 Pulmonary Motor Dysfunction and Rehabilitation
Therapy of Neurological Training�� 431
14.2.1 Assessment of Pulmonary Motor Dysfunction�� 431
14.2.2 Rehabilitation Therapy of Neurological Training�� 432
14.3 Rehabilitation Methods of Keeping Fluency
of Respiratory Tract�� 438
14.3.1 The Control and Adjustment of Cough�� 438
14.3.2 Postural Drainage �� 438
14.3.3 Patting and Chattering to Excrete Sputum �� 439
14.3.4 Aerosol Inhalation Therapy�� 439
Contents xix
14.3.5 Mucus Lytic Agent �� 439

14.4 Development and Clinical Application of Pulmonary
Function Exercise Device �� 439
14.4.1 Design Principle of FG-01 Pulmonary
Function Exercise Device�� 439
14.4.2 The Therapeutic Effect of FG-01 Pulmonary
Function Exercise Device on Pulmonary
Function Rehabilitation of the Patients
with Pulmonary Fibrosis�� 442
of Cognitive Disorder�� 447
15.1 The Concept of Cognitive Disorder
and the Mechanism of Memory Formation�� 447
15.1.1 Basic Concept of Cognitive Disorder�� 447
15.1.2 The Mechanism of Memory Formation �� 448
15.2 Rehabilitation Therapy of Neurological Training
of Cognitive Disorder�� 450
15.2.1 Assessment of Cognitive Disorder �� 450
15.2.2 Rehabilitation Therapy of Cognitive Disorder �� 453
15.2.3 Cognitive Training Device Development
of Swallowing Dysfunction�� 467
16.1 The Mechanism of Swallow and Dysphagia�� 467
16.1.1 The Mechanism of Swallow�� 467
16.1.2 Dysphagia�� 471
16.2 Rehabilitation Therapy of Swallowing Disorder�� 472
16.2.1 Principle and Method of Rehabilitation
of Neurological Training of Swallowing
Disorder�� 472
16.2.2 Other Common Rehabilitation Training
Methods�� 476
of Sphincter Dysfunction�� 481
17.1 Micturition Dysfunction�� 481
17.1.1 Innervation of Micturition�� 481
17.1.2 Classification of Micturition Dysfunction�� 483
17.1.3 Assessment Method of Micturition Dysfunction �� 484
17.1.4 Rehabilitation Therapy of Micturition
Dysfunction�� 484
17.2 The Mechanism of Defecation Dysfunctions �� 492
17.2.1 The Process of Forming Defecation Reflex�� 492
xx Contents
17.2.2 Pathogenesis and Classification of Defecation

Dysfunctions�� 492
17.2.3 Rehabilitation Therapy of Defecation
Dysfunctions�� 495
of Visual Impairment �� 503
18.1 Visual Structure and the Mechanism of Visual
Formation�� 503
18.1.1 Visual Structure�� 503
18.1.2 The Mechanism of Visual Formation �� 505
18.2 Visual Impairment�� 507
18.2.1 Ocular Abnormal Refraction�� 507
18.2.2 Myopic Eye�� 508
18.2.3 Presbyopia�� 515
18.2.4 Presbyopia�� 519
18.3 Clinical Application of Rehabilitation Training
of Ciliaris in Pupil with Early Myopia�� 522
18.3.1 Materials and Methods �� 522
18.3.2 Observational Index�� 522
18.3.3 Results�� 523
18.3.4 Discussion�� 524
19 Corollary Equipment of Rehabilitation Training
19.1 The Guiding Ideology of Developing Corollary
Equipment of Rehabilitation Training�� 527
19.1.1 The Implication of Rehabilitation
Training Equipment�� 527
19.1.2 Development Mechanism of Corollary
Equipment of Rehabilitation Training
19.2 The Major Function and Classification of Corollary
Equipment of Neurological Training�� 530
19.2.1 Major Function �� 530
19.2.2 The Classification of Rehabilitation Corollary
Equipment of Neurological Training�� 532
19.3 Introduction of Partial Corollary Equipment
of Rehabilitation of Neurological Training�� 535
19.3.1 Training Appliance �� 535
19.3.2 Training Device�� 548
19.3.3 Training Device�� 559
19.3.4 Training Robot�� 571
About the Author
Wenru Zhao was born in November

1951 in the village of North
Guanzhuang, located in Royang
County of Hebei Province. He gradu-
ated from the medicine department of
North China Coal Medical University
in 1976. After graduation, he worked
in the surgery department of his uni-
versity’s affiliated hospital. In 1986,
he became a graduate student at
Beijing Tuberculosis and Thoracic
Neoplasms Institute, earning a mas-
ter’s degree in surgery. From 1995 to
2001, he went to Europe and America
as a senior visiting scholar, which started his journey in the fields of clinical
rehabilitation, teaching, and research.
He was the first president of the National Research Center for Rehabilitation
Technical Aids Affiliated Rehabilitation Hospital. After being relieved of his
office, he became the President Emeritus of this hospital and Chief Physician
in rehabilitation. He was head of the department of functional therapy (reha-
bilitation) at Capital Medical University Xuanwu Hospital, vice president
and director of the Rehabilitation Center of Neurological Training at Beijing
Xishan Hospital, and the director of the Rehabilitation Center of Neurological
Training of Capital Medical University Tongren Hospital. He worked in clini-
cal practice, rehabilitation diagnosis and therapy, medical teaching, and
research for 37 years. He founded the rehabilitation therapy system of neuro-
logical training. He is the chairman of a specialized committee called the
Rehabilitation Medicine of Beijing Combination Society of Traditional
Chinese and Western Medicine. He was a winner of a Prominent Achievement
Award for master’s degree recipients by the State Education Commission and
Academic Degrees Committee of the State Council. Currently, he is involved
in the National Key Technology R&D Program’s “Three-stage Method and
Corollary Equipment Research of Rehabilitation of Neurological Training of
Motor Functions of Hemiplegic Lower Limbs.”
xxi
Introduction
Traditional rehabilitation methods developed in the middle period of last cen-

tury such as Bobath, Rood, Brunnstrom, PNF and motor relearning program
(MRP), played an enlightened and foundation effect on rehabilitation in the
long history of rehabilitation. However, the therapeutic effect is influenced
because these methods are mainly passive movements, primary reflex and
afferent stimulus. Therefore, it is extremely urgent to study the rehabilitation
method that is better in accordance with the mechanism of motor functional
recovery after CNS injury.
Neural potential development is the basis of promoting plasticity and
functional reorganization of central nervous system. Six-step Daoyin tech-
nique in traditional Chinese medicine of guiding collaterals through meridi-
ans of complete active movement is accordance with rehabilitation method to
develop brain potential. Daoyin feedback technique is an important method
to reestablish motor program with a purpose through goal and motive mecha-
nism and guided motor program signal real-timely detected and displayed.
Effective restriction of unnecessary joint motion in limbs movements is the
important segment to remodel motor pattern and is an essential process of
transforming developed potential and reestablished motor program into
actual motor function and life ability. The three-stage rehabilitation method
of neurological training is the specific manifestation of clinical standard
application of technique. A series of corollary equipment developed accord-
ing to the methods is the important measures to implement the method cor-
rectly and realize the therapeutic effect. Accurate rehabilitation assessment,
confirmation of main obstacles, formulation and selection of overall goal of
rehabilitation, principle and specific method are essential rehabilitation strat-
egy and tactics to obtain anticipated training effect.
This book is mainly used for clinical application and is to introduce basic
mechanism, specific method and development of rehabilitation technique of
neurological training. This book emphasizes on clinical indications, contrain-
dications, announcements and rehabilitation dedicated device of neurological
training. This book use easy, practical, understandable and simple description
and illustration to analyze rehabilitation therapeutic technique of neurologi-
cal training from the angle of integrated Chinese and Western medicines in
order to make it practical. It is not only suitable for rehabilitation doctors and
therapists in big hospitals, but also suitable for the doctors in community and
village. For the teachers and students in medical school and physicians in
other departments, the book has certain reference value. Therefore,
xxiii
xxiv Introduction
r ehabilitation medicine should run through therapy of all clinical departments

and diseases.
We hope this book can serve as a modest spur to induce someone to come
forward with his valuable contributions to encourage medical staffs, espe-
cially staffs in rehabilitation medicine to dig and learn the old rehabilitation
technique in traditional Chinese medicine and its modern development in
order to promote the renaissance of old rehabilitation technique and contrib-
ute to the development of rehabilitation medicine in worldwide.
Beijing, China
August 2013
Basic Theory of Neurological
Training Rehabilitation 1
1.1 Abstract through exercise. However, many medical scien-

tists explained that the functions recovery was not
1.1.1 T
he Mechanism of Recovering due to brain cell regeneration and functions reor-
the Lost Motor Functions ganizing on account of rehabilitation training, but
After CNS Injuries due to the residual motor functions were improved
by rehabilitation training.
Central nervous system (CNS) includes brain and For more than decade, both in animal experi-
spinal cord, which is the headquarters of somatic ments and in clinical practice, accumulating
motor functions. Therefore, recovery of the cen- evidences showed that both in CNS of non-mam-
tral nervous system is prior to recovering the lost malian animals and mammalian animals, even
motor functions after central lesion. in CNS of adult, there were structural plasticity
Some experiments demonstrated that cells in change and functional reorganizing ability after
CNS are not capable of regeneration, which is central lesion. On the other hand, clinical and
an unbridgeable obstacle for the mechanism of experimental study demonstrated that some parts
recovering the lost motor functions after central of CNS were regenerative under certain circum-
lesion. For a long time, it is widely believed in stance. The regenerative ability was not good,
medical world that motor dysfunctions after real but the regenerative parts could bine with targets
central lesion are unrecoverable and permanent properly. Therefore, the functions recovery after
motor function loss that due to degree and posi- central lesion was possible. In the study of CNS,
tion of the injury is reasonable. regeneration was widely accepted in the past few
But the reality is not the case. For example, some years and some related key factors were found.
patients and their family did not give up the treat- In the hypothesis of the functions recovery after
ment including rehabilitation training after central central lesion, plasticity theory was the most
lesion. Some of them did not know the thesis that widely focused and accepted.
motor dysfunctions after central lesion are unre- Even the study about CNS regeneration and
coverable. Some of them were willing to receive plasticity are under preliminary and insufficiency
treatment and keep doing exercise even they knew period, these results would shed light on the func-
the thesis. It was beyond all expectations that a tions recovery after central lesion. At least these
large number of them got improvements to vary- studies have proved irrecoverable functions after
ing degrees in motor function recovery. Thereafter, central lesion wrong and let the doctors and patients
some researchers found that the lost motor func- to understand the CNS function and the possibil-
tions after central lesion were partly recoverable ity of motor functions recovery after central lesion.
© Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House 2019 1
W. Zhao, Rehabilitation Therapeutics of the Neurological Training,
https://doi.org/10.1007/978-981-13-0812-3_1
2 1 Basic Theory of Neurological Training Rehabilitation
1.1.1.1 Several Hypotheses without receiving normal afferent impulse from

of Functions Recovery After the injured parts. Thereby, the functions and the
CNS Injuries morphology would be detached and this condi-
In the end of nineteenth century and 1930s, some tion was called diaschisis. The intact brain tissues
researchers explained why the function was were in dysfunction and the symptoms would be
recoverable after central lesion. These hypoth- watched. When the “shock” phenomenon disap-
eses are as follows. peared, the functions of the intact brain tissues
would be recovered. Later, the symptoms of par-
Hierarchical Re-representation Theory tial brain tissues injury would be watched. The
Hierarchical re-representation theory was first mechanism of the theory could be explained by
proposed by Jackson in 1884 or so. He thought the functional inhibition of metabolic remote area.
that the structures of nervous system were
divided into different hierarchies from highest to 1.1.1.2 Brain Plasticity Theory
lowest. Functions were not peculiar to one of the The mechanism of brain plasticity was related to
hierarchies, but one kind of functions could be many factors such as neurotomy, neurophysiol-
represented repeatedly in different hierarchies. ogy, neuropathology, neuroimmunology, neuro-
Superior hierarchy of the nervous system devel- chemistry and neuroelectricity.
oped relatively late, was prone to be activated, In 1930, the students of Bltz firstly proposed
regulated the functions fine and had inhibiting the conception “plasticity of CNS”. He thought
effect on inferior hierarchy of the nervous sys- that plasticity was an ability that could adapt to
tem. When the Superior hierarchies of the ner- sudden change and deal with some kind of dan-
vous system were injured, the inferior hierarchies ger. The ability was the basis that CNS could
of the nervous system were disinhibited and reorganize to maintain proper functions structur-
could accomplish or compensate the lost func- ally and functionally after central lesion. In the
tions. Jackson’s theory was the basis of neuro- experiment, he observed the functional recovery
logical function compensatory principle. of the amphibian without 1–2 limbs. He found
that the animals could readjust to keep moving in
Substitution or Vicarious Theory a new way. However, he thought that the move-
Substitution or vicarious theory was first pro- ments in a new way were the results of dynamic
posed by Mumk in 1881 or so. He thought that functional reorganization or adaption of CNS but
intact cortex could undertake the lost functions not the regeneration. He thought that the func-
due to injury. The intact cortex should satisfy tions recovery after central lesion was the results
the following conditions. Firstly, the intact cor- of functional reorganization of residual normal
tex was capable to accomplish the functions. nervous tissues.
Secondly, the intact cortex was under resting In 1969, the CNS functional reorganization
state. Thirdly, the intact cortex did nothing but theory was proposed and completed by Luria,
undertaking the lost functions. These conditions Naydin, Tsvel, Kova and Vinarskaya. They real-
seem not correct at present. However, Mumk’s ized that the residual parts of brain after injury
hypothesis became the forerunner of functional could replace the lost functions in a new way
reorganization theory. through functional reorganization and thought
that the functional reorganization was divided
Diaschisis Theory into two types, intra-system and inter-system.
Diaschisis theory was first proposed by Monakow The intra-system mean that the compensation
in 1914. He thought that partial brain tissues injury took place in the identical level or different level
damaged the ability of other intact brain tissues of the same system. For example, the lost func-
that could receive normal afferent impulse from tions were compensated by adjacent tissues of
the injured parts. The other intact brain tissues nidus or upper or lower tissues of nidus structur-
would be into a specific “shock” phenomenon ally. The inter-system mean that the lost functions
1.1 Abstract 3
were compensated by an entirely different sys- Contralateral Transfer

tem. For example, vision could be replaced by The lost functions could transfer to the corre-
skin touch. Meanwhile, the compensation must sponding parts of contralateral hemisphere. The
be accomplished through specific rehabilitation functions of the two parts were replaced and com-
training, which was also called retraining theory. pensated each other.
There are many ways to accomplish the func-
tional reorganization after central lesion such as Ipsilateral Functional Compensation
training, adjacent tissue compensation or offside It is thought that cortical cells were not the same-
tissue compensation, denervation supersensitiv- size ratio with their dominant movements. It is a
ity, the axon collateral sprouting, latent pathway many-to-many way. The functions would not be
and enabled synapse and behavioral compensa- totally lost even if the CNS cells were damaged.
tion. All these ways were known as the results of There were still a considerable amount of nerve
CNS functional reorganization. cells in the periphery of the injured parts. The
Functional reorganization after compensation residual cells could reorganize through the intrin-
becomes the basis of the physiology, biochemis- sic factor or the external interference to recover
try or morphological changes of brain plasticity. the lost functions.
After more than 40 years’ experiments and clini-
cal studies, brain plasticity theory was widely Enabled Minor Pathway
accepted by most researchers. Every nerve cell in CNS can communicate with
other cells through synapses, which become
1.1.1.3 The Main Types and Mechanism the pathway for neural information conduction.
of Brain Plasticity However, most of the pathways are inhibited,
CNS plasticity is that the nerve cells possessed dormant or activated alternatively. When the
with one kind of function can obtain other func- main neural pathway is damaged, the minor path-
tions because of body functional requirements way will be enabled, but the functional differen-
and the nervous system can adapt to new demands tiation is not elaborated.
structurally and functionally through modify-
ing itself. The higher the CNS plasticity is, the Nerve Sprouting
stronger the adaptability of the nerve cells is. The The soma or proximal synapses that are dam-
higher the CNS plasticity is, the easier the func- aged can lead to soma death. The proximal intact
tional recovery after injury is. The experiments neuronal axons can communicate with targeted
demonstrated that brain functional reorganization, nervous tissues through nerve sprouting in order
enabled minor pathway and synapse sprouting to replace the neuronal axons that lost functions.
were the significant manifestations of brain plas- Nerve sprouting includes regeneration sprout-
ticity, which play important role in the recovery ing and synapse sprouting. Regeneration sprouting
of the lost motor functions after central lesion [1]. means that disappeared synapse can be regenera-
tive, but this kind is seldom. Synapse sprouting is
Functional Reorganization of Cortex common, which means dendrite or axon of nor-
When partial tissues responsible for the func- mal neuron sprout to communicate with residual
tional position were injured, the lost functions dendrite or axon of injured neurons and replace
can transfer to the corresponding parts of contra- the lost functions. This is the morphological basis
lateral hemisphere. In fact, nerve tissues of con- of functional recovery of central lesion, which
tralateral hemisphere replaced the injured nerve indicates the functional compensation.
tissues because of the intrinsic factor (biological The subtypes of synapse sprouting.
factor) or the external interference (treatment or
rehabilitation training). Adjacent nerve tissues of Lateral Sprouting
injured parts replaced the injured nerve tissues to Lateral sprouting means that there is lateral
recover the lost functions. sprouting in nerve fiber, and then new axon
sprouting is formed. Besides, there are new syn- provided a new approach for treatment of nerve
aptic connection between the terminal and sur- injury and retrogression.
vival neurons or neurons surrounding injured
region (see Fig. 1.1a). Lateral sprouting in nerve 1.1.1.5 Long-Term Potentiation (LTP)
fiber can replace injured neurons to play roles. Long-term potentiation means that synapses are
in excitatory state for a long time after nervous
Terminal Sprouting centralis receive some kind of stimulus, which
Terminal sprouting means that there are some belongs to functional synaptic plasticity.
extensions in synaptic terminals of dead neurons. The mechanism of LTP may be related to
There are new synaptic connections between the increased presynaptic membrane neurotransmit-
extensions and normal neurons (see Fig. 1.1b). ter. Because LTP can influence synaptic plasticity
Terminal sprouting in nerve fiber can replace and transmission efficiency, it is the basis of sen-
injured neurons to play roles. sory memory. In addition to normal physiological
conditions, LTP changes identically in patho-
Synapse Sprouting logic conditions. Therefore, it is crucial for reha-
Synapse sprouting means contact surface of bilitation treatment, such as “objective-motive”
synaptic terminals in dead neurons enlarge to active exercise training under the guidance of
increase the contact points. There are new syn- Daoyin technique in traditional Chinese medi-
aptic connections between the contact surface cine according to Meridian. It may be involved
and normal neurons. Neural information con- in inducing synaptic plasticity of LTP, which pro-
duction pathway are built and synapse sprouting vides theoretical foundation for recovering motor
can replace injured neurons to play roles (see functions.
Fig. 1.1c).
In short, in all these three sprouting, there 1.1.1.6 Long-Term Depression (LTD)
are new synaptic connections between dendrites Depression means the excitability of resting mus-
and axons of dead neurons and normal neurons cle is inhibited in one kind of movement, which
to replace injured neurons to play roles. Recent guarantees the completion of the movement.
research indicated that the phenomenon exten- The functional nuclei that regulate muscu-
sively existed in CNS such as spinal cord, mid- lar tension or coordinate voluntary movement
brain, cerebrum, epencephalon and thalamus. It are located in cerebellar cortex. This region is
is one of the mechanisms that underlie repair- involved in united movement, motor plan and
ing injured neural networks. However, there are motor program compilation between this region
still some unsolved questions, such as the factors and motor area, sensory area and association
inducing sprouting and how to control the local area of cerebrum. Through learning exquisite
condition of sprouting in order to facilitate the movements, a whole set of motor programs are
functional recovery. It is said that correct func- formed in cerebellar cortex, which are based on
tional training (exercise stimulus) can induce local neuronal circuit of epencephalon and can
sprouting to right direction. Conversely, incorrect combined with LTD of Purkinje cells. The axons
functional training will mislead sprouting and of Purkinje cells are the only efferent fibers in
hinder functional recovery. cerebellar cortex, which can inhibit neuronal
tonic firing of deep cerebellar nuclei such as roof
1.1.1.4 Regeneration nucleus, inter nuclei and dental nucleus. Purkinje
and Transplantation cells can receive afferent signals simultaneously
of Neural Cells from climbing fibers and parallel fibers. Because
It is stated that neural cells are not regenerative the sensitivity of dendritic side to neurotransmit-
after degeneration. Recent research demonstrated ters is low, the time of the signal from parallel
that neural stem cells in CNS had potential abil- fibers is long. The conduction efficiency is low,
ity to differentiate into neurons and neuroglio- which manifests as LTD. This is the characteris-
cytes, which was found in culture in vitro. This tic synaptic plasticity of cerebellum.
1.1 Abstract 5
a
Necrotic neuron
the side of germination
b
necrotic neuron
information flow
Terminal Bud
c
necrotic neuron
synaptic germination
Fig. 1.1 (a) Lateral sprouting: new connection between sions and normal axons. (c) Synaptic sprouting: increased
new axons and normal neurons. (b) Terminal sprouting: contact points in synaptic terminals
new synaptic connection between new terminal exten-
The cause of this phenomenon is related to the technical specialty. Its objectives are to promote
low sensitivity of dendritic side to neurotransmit- patients to recover the abilities of daily life,
ters. The reason why the functions of CNS are learning, work, labor and social life as much as
normal and are not disturbed by hyperexitation is possible and improve living quality. Therefore,
related to LTD of Purkinje cells. This may be the it can alleviate the burden of family and soci-
theoretical basis of voluntary exercise therapy for ety and help the patients integrate into society.
myospasm. Rehabilitation therapy includes many contents
In short, compensation and functional reor- such as medical, professional, educational and
ganization become the basis of physiology, bio- social details. The scope of rehabilitation therapy
chemistry or morphological changes of brain includes naturopathy, occupational therapy, logo-
plasticity. The mechanism of brain plasticity is therapy, psychotherapy, rehabilitation engineer-
related to neurotomy, neurophysiology, neuro- ing and traditional Chinese medicine therapy [2].
pathology, neuroimmunology, neurochemistry In tradition, rehabilitation medicine includes
and neural electrical activities. For more than two naturopathy and rehabilitation medicine.
decades, both in animal experiments and in clini- Physical medicine (physiotherapy) means that
cal researches, brain plasticity is widely accepted physical factors such as sound, light, electric-
by most researchers. Recently, some research- ity, magnetism, water, wax and thermodynamics
ers pointed that the CNS plasticity conformed to act on human body to play a role in prevention
“technical employ and dependence” principle, and treatment of diseases through nerves, body
which meant voluntary exercise that had never fluids and endocrine. We do not discuss physical
been done could promote CNS plasticity. The medicine in this book. Rehabilitation medicine is
voluntary exercise could be solidified through dependent on functional training to recover the
repeated training, which could lead to the redistri- lost functions maximally such as movements,
bution and orientation of brain function division. speech, swallow, cognition, vision, defecation
Therefore, Whether or not rehabilitation tech- control and cardiopulmonary functions.
niques to recover the lost functions after central At present, rehabilitation techniques that were
lesion are effective, depend on whether or not invented in the middle period of last century such
the techniques could promote plasticity changes as Bobath, Rood, Brunnstrom and so on, were
and functional reorganization of CNS and be still the main techniques of rehabilitation training
employed in the voluntary exercise training of at domestic and overseas and played important
limbs dominated by brain. Although simple vol- role in the foundation of medical rehabilitation
untary exercise training is merely to promote cells philosophy and its clinical application. I think
surrounding CNS injured area to play roles and that the role of these rehabilitation techniques in
replace the lost functions, the new activated cells promoting CNS plasticity remains unclear. Here
can transform into cells with practical functions are some characteristics and defects of these
through further complicated training. However, rehabilitation techniques.
this is the essential and important basis for the
motor function recovery. 1.1.2.1 Bobath Technique
Bobath technique is a rehabilitation training
technique for child cerebral palsy and adult
1.1.2 T
he State of Applied hemiplegia.
Rehabilitation Techniques
at Domestic and Overseas Mechanism
at Present Bobath therapy was founded from the study
of child cerebral palsy treatment, which based
Rehabilitation therapy is a new treatment that on neurodevelopment principle of exercise.
can facilitate functional rehabilitation in mind Movement development is dynamic, sequential,
and body of patients and the disabled. It is a new from the head end to the tail end and from the
1.1 Abstract 7
proximal to the remote. Before children have means that the patients are instructed to lie on or
consciousness, the movements are voluntary and sit on the treatment ball and the whole body is
then become adaptive and responsive. moved by the therapeutic staff.
Limbs loads and compressing joints have a
Operational Approach good effect on the patients.
Through detailed assessment, the blastocoly- Motor function recovery after CNS diseases
sis level could be found in sick child by Bobath should follow the principle of motor development
therapy. In the next moment, the abnormal move- sequence and the recovery is not mechanical.
ments are inhibited and normal movements are It is groundless that the primary cause of the
promoted according to development sequence lost functions is low-level reflex release con-
in order to recover motor functions ultimately. trolled by brainstem and spinal cord.
Therefore, Bobath therapy is also called neural Some treatment theories proposed by Bobath
development therapy (NDT). The specific meth- according to Magnus’ study. Magnus’ concepts
ods are as follows: are dominant at that time, but not accepted by
neurophysiologists these days. At present, it is
Bobath Handshake thought that sensory afferent has no effect on
The patients are instructed to put the centre of motor control and the motor control is not depen-
the palm together with fingers crossed. Affected dent on reflex.
thumb is above unaffected thumb. The spasm after CNS diseases is not the con-
tinuation of primitive reflex but the pathological
Reflex Inhibition Pattern irradiation of excitation.
Hemiplegic paralytic upper limb of adult is pas- It is groundless that head movements can
sively in different positions such as abduction, dominate the movements of limbs. The experi-
extorsion, elbows extension, forearms supina- ments demonstrated that head movements cannot
tion, wrists and fingers stretch. induce the movements of limbs.
In the treatment, both the passive inhibition
Key Points of Control and promotion exerted by the therapeutic staffs
The patients are instructed to focus on the move- and the voluntary participation of the patients
ments of these parts that include proximal parts should be advocated.
such as neck, vertebral column, shoulder, pelvis, It is difficulty to recover the motor coordi-
manubrium and scapula and distal parts such nation because of lacking the training without
as toes, ankle, fingers and wrist. The abnormal movements in active constrained movements.
motor pattern and muscle spasm can be changed
by the movements of these parts. 1.1.2.2 Brunnstrom Technique
Brunnstrom technique is applied for assess-
Facilitation Technique ment of paralysis after stroke and rehabilitation
The voluntary movements can be induced by training.
reflexes such as righting reflex, Protective reflec-
tion, and balance reflex and so on. Mechanism
Brunnstrom deemed that synergic movements
Proprioception and Skin Stimulus and associative reaction are the inevitable
The therapists use pat and load bearing to pro- process before normal voluntary movements
mote muscular tension and motion control. recovery. This process is a part of the normal
processes of functional recovery after stroke. In
The Evaluation of Bobath Therapy the early stage of recovery (Stage I to Stage III),
at Present the therapeutic staffs should help the patients
Vestibular stimulation method has a good effect to control and employ these patterns to acquire
on paralysis with sensory deprivation, which some movements. Once the synergic movements
can be proceeded voluntarily, through corrective that there was no significant difference between
training, the wrong pattern can be got rid of and Bobath therapy and Brunnstrom therapy in treat-
the normal pattern can be recovered. ing adult hemiplegic paralysis.
The Main Methods of Brunnstrom 1.1.2.3 Rood Technique

Technique
Associative reaction, skin and noumenon stimu- Mechanism
lus can lead to mechanical synergic movements. The basic viewpoint of Rood therapy is that motor
In the basis of that, through the endeavor of exer- pattern is developed from inherent basic reflex
cise therapist and patients, semi-autonomous pattern. These patterns are constantly modified in
synergic movements will be accelerated and then usage and sensory stimulus until these patterns
the corrective and artificial training should be has ultimate control in conscious level of cere-
proceeded to separation movements. bral cortex. If proper stimulus is exerted to appro-
In Brunnstrom therapy, limbs are used to com- priate receptor, motor response will be induced
plete myotatic reflex such as synergic movements, reflectively and correct motor pattern will be
associative reaction, tonic neck reflex, asymmet- achieved through repeated correct stimulus.
rical tonic neck reflex, tonic labyrinthine reflex
Principal Methods of Rood Technique
and tonic lumbar reflex with bridge type move-
ments and passive movements. Rehabilitation
Stimulus
methods are divided into six stages to induce
Skin and noumenon stimulus are used to facili-
autokinetic movements.
tate or inhibit muscle contraction.
Assessment of Brunnstrom Therapy Load
at Present When bearing load, pressure is given to the joint
CNS promotion, peripheral and noumenon stim- from two sides of the joint in order to promote
ulus are comprehensively applied in Brunstrom deep postural muscle and inhibit muscle spasm.
method. From synergic movements to separate
from synergic movements, it is useful for recov- Exercise
ering the functions of limbs, wrists and fingers. The proximity of burdened limbs is made to do
Bridge type movements can help the patients some movements after bearing load.
diagnosed of Cerebral Vascular Accident (CVA)
Motor Control Training
to get rid of synergism of lower limbs, which is in
Motor control training is completed according
favour of recovering the motor functions of lower
to motor control development sequence in Rood
limbs.
therapy.
The six stages recovery assessment method
of Brunnstrom is used extensively. Fugl—Meyer The Assessment of Rood Therapy
assessment method in the western world and at Present
Ueda Min method in the eastern world evolved • The facilitation is conducted through skin
from this. stimulus, which is based on neurophysiology.
Although Brunnstrom therapy is accepted by • The facilitation of freezing and brushing is
neurophysiologists, most rehabilitation therapists effective during treatment process and 45–60 s
do not use it. after treatment. The effect of the brushing is
Brunnstrom therapy has no active restric- better.
tion on unnecessary movements in the exercise. • In order to get the satisfying effect, the stimu-
Therefore, it is unsatisfactory in recovering coor- lus time should be long enough, but the effect
dinative movements. does not last long after treatment.
Although most rehabilitation therapists prefer • Proprioceptive Neuromuscular Facilitation
Bobath therapy to Brunnstrom therapy, precise (PNF) is further developed because of this
and long-term research done in 1990s showed technique.
1.1 Abstract 9
• Skin stimulus is given first, and muscle con- tion more rapidly and effectively than passive
traction is given to facilitate the effect. It is movements.
wrong that the time interval is 30 min, because • Promotive motor pattern definitely accelerates
it is invalid when the time interval is more muscles response.
than 5 min. • “Contraction-relax” and “Control-relax” both
• Unnecessary movements are not inhibited in can enlarge ipsilateral joint range of motion.
this therapy. Therefore, the good coordinate However, “Contraction-relax” training also
exercise cannot be recovered. can enlarge contralateral joint range of motion
in case of contralateral amyotrophy.
1.1.2.4 Proprioceptive Neuromuscular • PNF can definitely increases the flexibility of
Facilitation (PNF) shoulder, trunk and hamstring muscles.
• PNF can increase the excitability of spinal
Mechanism cord.
Research achievements are concluded from neu- • Knees stretching may promote the excitability
rophysiology, motor learning and motor behavior. of vastus lateralis muscles.
• Joint compress transiently enhance the excit-
Methods ability of α spinal cord motor neurons.
Proprioceptive stimulus such as stretching, joint
compress and traction and imposing resistance, Negative Assessments
spiral motor pattern and diagonal motor pattern are • Overflow theory is groundless because strong
employed to facilitate motor functions recovery. contraction of healthy muscles promotes con-
The detailed are as follows: traction of badly injured muscles through
excitation diffusion.
• Spiral and diagonal motor patterns includes • Diagonal motor has no promotive effect on
91 kinds of basic motor patterns. Most focus quadriceps femoris.
on the training mode that uninjured side move- • The theories of Magnus are no longer accepted
ments induce injured side movements. by neurophysiologists nowadays.
• Manipulative therapy technique: After stretch- • Similarly, this method cannot inhibit the
ing, resistance and synergic muscles contrac- unnecessary movements in the exercise.
tion, antagonistic muscle contraction and motor Therefore, it is difficult to achieve motor
neuron excitation threshold enhanced by stimu- coordination.
lus are employed for suppressive therapy.
• Noumenon and skin stimulus: In PNF, only 1.1.2.5 Motor Relearning Program
proper stimulus can induce correct motor (MRP)
direction. Noumenon sensory stimulus is MRP means that motor functions recovery after
given mainly through right palm. The second- central lesion is a relearning process, which takes
ary are skin stimulus such as hairbrush and advantage of learning and motive theory and
temperature stimulus. In addition, moderate the results from the research of human move-
sound is prone to induce the activity of motor ment science and motor skills. On the premise
neuron. Soft sound can facilitate stabilization of patients’ subjective involvement and cognitive
and big sound can facilitate movements. significance, according to information processing
theory of motor learning and the method of mod-
The Assessments of PNF at Present ern motor learning, the patients are educated in
order to recover the motor functions.
Positive Assessments CNS is capable of reorganization and adap-
• True proprioception stimulus is finely used in tion. The therapy is a relearning process. Motor
this method. learning should be instructed using comprehen-
• “Control-relax” training can enlarge joint sive scientific achievements and it is very impor-
range of motion confined by muscles contrac- tant to master learn opportunity.
Mechanism Information Processing 6. Therapy is not to strengthen the muscle but

of Modern Motor Learning Should Be Fully to enhance the motor control ability.
Utilized in Motor Relearning 7. The patients should learn the meaningful
1. There are three elements in learning that may daily functional movements but not the
be used in relearning of stroke patients such motor pattern.
as eliminating unnecessary muscle activity, 8. Through motor analysis, therapists find the
using feedback to modify the movement out- lost key movements of the patients, train the
put and obtaining improvements from patients pertinently and practice the com-
practice. pleted movements. According to the view-
2. There are two key components that must be points of behavioral psychology, the
considered when learning complicated motor therapists should not expect sudden turn up
skills such as what to learn and how to orga- of complicated behaviors. Until all the
nize information correctly in order to com- details are correct, the final objective can be
plete assignments. achieved through a series of staged half steps
3. The importance of cognition should be to move on.
emphasized. The reasons are as follows: 9. The therapists should make full use of feed-
(a) Two key components need cognition to back, especially vision and verbal feedback,
be involved. which can make the patients know the results
(b) In order to recover as soon as possible, of their behaviors, what is correct and what
the patients should be instructed to recall is incorrect.
the exercise and movements before 10. Open loop training should be promoted,

injury in cognition in order to trigger the which means exercise should adapt to differ-
former and familiar motor program. ent circumstances but not confined in certain
(c) In the relearning, cognition is needed to condition.
control the unnecessary muscle move-
ments in case of excessive movements. Training Methods and Techniques
(d) In acquiring complicated motor skills, 1. The principles of training: According to the
the cognition process is inevitable. former theories and viewpoints, the principles
(e) Memory is the storage and maintenance of training are summarized as follows:
of post-learning experience. Learning is (a) Even in the stage of totally unable volun-
the premise of memory and memory is tary movements, the patients should be
one of the important cognitive functions. instructed to do spiritual training accord-
Without bad cognition, learned experi- ing to the principles of MRP.
ence and habits are hard to acquire and (b) Before the training or at the beginning of
store. the training, the patients are asked to
4. In the early stage of motor skills learning, the recall the movements and activity they are
patients should be instructed to be highly able to do before injury in order to trigger
concentrated to acquire the message needed the motor program that they mastered
in processing behavior. before.
5. Because of the injury, information process- (c) The training should be started immedi-
ing ability is limited. If the amount of ately after the patients in stable condition
information exceeds the ability of the in case of extinction of acquired exercise
patients, the behavior will break down. habit and experience without repeated
Therefore, therapists must control the bal- training and the learning of incorrect
ance between the mount of the information mode of activity.
processing and the processing ability of the (d) Before training, sports science is used to
patients in order to move to the target step analyze the detained exercise in order to
by step. find the mainly lost movements of the
1.1 Abstract 11
patients, train them specifically and no strict efficacy comparison between MRP and
combine them to the whole functional proprioceptive sensory neuromuscular promotion
activities. therapy or traditional exercise therapy. In addi-
(e) The control of the movements should be tion, there is no active restriction on unnecessary
emphasized but not strengthening the movements in this method.
muscle. The patients ought to practice Although these therapies have already been
daily functional activities objectively and accepted by most therapy centers at home and
practically to avoid the designed pattern overseas, which are more and more widely used.
or impractical training. However, the different perspectives are present
(f) In all the trainings, the patients are in rehabilitation medicine at home and abroad.
instructed to suppress unnecessary and Scientists recognized that there were a lot of
excessive movements subjectively. reserve of CNS cells and synapses and proper
(g) Verbal tips and vision feedback are
training could promote CNS plasticity in order
enhanced in the training to let the patients to achieve functional reorganization. Scientists
to know the results of their behaviors. The also found that the CNS plasticity and functional
patients should be given feedback and reorganization conformed to “skillful use and
encourage because of the correct behav- dependence” principle. At present, these theories
iors. The incorrect behaviors should be are used to explain the mechanism of functional
modified subjectively and objectively. recovery of limbs movements after central lesion,
Therefore, PT technique is brought in. but there is no obvious improvement in rehabilita-
(h) The training is transferred from subcortex tion methods. Many scholars tried new rehabilita-
to cortex. In the learning theory, the cog- tion treatment methods such as motor relearning
nition stage with many mistakes is trans- program and constraint-induced movement ther-
ferred to associative stage that is apy. Constraint-induced movement therapy is
connected between external guidance and that uninjured side upper limb of the patients are
internal sensation. Finally, it will be trans- tied up and are instructed to use injured upper
ferred to auto-completed autonomous limb to complete a certain movement. Because
stage subconsciously. The mastered objective indicator of this method is not precisely
movements can be used in daily life. quantified movement, exercise therapists can
2. Four steps of training only tell the patients to use injured limbs to com-
–– Analyzing the movements to find the plete designed movements. When the patients
mainly lost movements. fail to complete the movements because of the
–– Practicing the lost movements. nonfunctional injured limbs, exercise therapists
–– Practicing the functional activities. have no other choice. In addition, the patients try
–– Transferring learned movements to the many times but still cannot complete the move-
functional activities required for daily life. ment, which is thought that this part of functions
3. The content of training includes seven aspects. cannot be recovered and the patients will lose
–– Functional training of upper limbs. confidence on rehabilitation training. When the
–– Functional training of mouth and face. patients are able to partly complete the move-
–– Training of sitting up at bedside. ments and are instructed to complete designed
–– Sitting balance training. movements required for multi-joint coordination
–– Standing and sitting up training. exercise, functions of some paralyzed muscles
–– Standing balance training. are required to be compensated by other muscles,
–– Walking training. which will easily lead to abnormal motor pattern.
Because the therapy is lack of pertinent strategy
The Assessments of MRP at Present in motor program reconstruction and there is no
At present, therapists find that the effect of motor way to actively confine the unnecessary move-
relearning program is good. However, there is ments in exercise, abnormal motor pattern will
be intensified and will be difficulty to rectify after it is hard to obtain good achievements and will
repeated trainings. Because of these defects, the influence the development from now on.
therapy failed to be applied until now, which was Rehabilitation methods are based on theory of
developed in 1920s. traditional Chinese medicine, such as acupunc-
In recent years, some scientists proposed ture and moxibustion, massage, cord embed-
early, voluntary and intensified new rehabili- ding, main and collateral channels stimulus and
tation theory and highlight the importance of Chinese herbal medicine. Modern medicine dem-
voluntary movements. However, there was no onstrated that there were some certain regulating
improvement in the methods, which still are lack effects and rehabilitation efficacy in Chinese
of the functions of promoting CNS plasticity medicine rehabilitation therapy. Doctors of all
and reorganization, the consciousness of motor dynasties summarized predecessor’s experi-
program reconstruction and pertinent methods. ence and replenished and developed it in many
Simple strengthening the muscle is the mainly different ways. There are a lot of content which
training method, which is totally different from are worth learning and promotion. It is closely
the training of CNS functional reorganization related to modern psychotherapy, physical exer-
facilitated by motor program reconstruction and cise therapy, naturopathy and information ther-
motor pattern remodeling. Muscular strength apy and there is similarity between them, which
training is one kind of effect trainings and the is regarded as the comprehensive application of
results weakens or even disappear after stopping these therapies. From the origination, Chinese
the training. For example, one was trained to lift medicine rehabilitation therapy has close connec-
100 kg, but he did not lift it 1 year or more after tion with Chinese traditional culture. Especially
stopping the training. On the contrary, motor pro- in the inheritance, the various factions summa-
gram reconstruction training is one kind of estab- rized, replenished and developed it. The theory
lished methodologies and its results will keep a is extensive and profound, but inescapably mys-
long time after stopping the training. For exam- terious, which is lack of definite concept. The
ple, once one learned cycling or swimming, he principles are subjective abstract. Therefore, the
could not forget it 10 years after stopping cycling application of Chinese medicine rehabilitation
or swimming, which indicated the importance therapy is under restrictions. In addition, there
of CNS functional recovery and motor program is no objective indicator in the therapy and it is
reconstruction in rehabilitation therapy. difficulty to be proved in basic research for appli-
Motor relearning program was improved and cation. Therefore, it is hard to be promoted in
advanced in theory. For example, Motor relearn- clinical rehabilitation.
ing program did not focus on strengthening In conclusion, it has been recognized that
muscles, but on motor control. It is necessary to applied rehabilitation methods has no effect on
learn the daily functional movements with practi- promoting CNS functions recovery. Therefore,
cal significance and unnecessary movements in the scientists started to study the rehabilitation
verbal and vision feedback and designed exercise methods that can promote CNS functions reor-
but not the motor pattern. For example, without ganization. Although there is no improvement in
solid basis, there is no good effect when doing specific methods and there are lack of ideas and
motor control and it is difficulty to exert func- specific methods to correct abnormal motor pro-
tional movements with practical significance gram and reconstruct normal motor program, the
in the condition that it is unable to confine the new “early, voluntary and intensified” rehabilita-
unnecessary movements. In addition, it is scien- tion is proposed. The importance of the rehabili-
tific to learn motor pattern, because normal motor tation is from voluntary movements to promoting
pattern is the basis of the daily functional move- CNS functions reorganization. Consequently,
ments with practical significance. For example, motor program reconstruction and CNS func-
if the positions of hitting the ball when playing tions reorganization are important research direc-
Ping-Pong game or swimming are not correct, tions of rehabilitation methods in the future.
1.2 Theoretical Basis of Neurological Training Rehabilitation 13
Moreover, in the research and development of injured are and are replaced by reserved signal-
rehabilitation training equipment, there are many ing pathways, which mean that CNS plasticity
kinds of equipment, which is a general tendency is induced to achieve functional reorganization.
to automation, large-size, complication and Large CNS cells reserves are the basis of CNS
expensiveness. However, the equipment major in plasticity and functional reorganization. The
passive movements that means equipment helps plasticity changes conform to the “skillful use
people to do some movements and the move- and dependence” principle. Individually, only
ments substitution effect is strong, which go new voluntary movements (undone movements
against the theory that CNS plasticity is based on and unlearned movements) can lead to CNS plas-
the mechanism of skillful use and dependence. ticity and functional reorganization.
The equipment not only cannot actively recover The training to recover lost motor functions
the lost functions, but also bring out movements after central lesion was divided in two stages
substitution effect, which will lead to muscle (acute stage and chronic stage) and three steps.
disuse and function decline, exactly as the case The principle is in order of difficulty and pro-
that special troops are capable of developing their gressive. The first is to achieve CNS plasticity,
potential and extraordinary abilities through sci- which means inducing the activities of reserved
entific and tough training in specified conditions. nerve cells adjacent to injured area and starting to
The more automatic the rehabilitation equip- use reserved neural signaling pathway to replace
ment is, the stronger the movements substitution the functions of injured nerve cells. During this
effect is and the weaker the effect of promoting process, “objective and motive”, encourage and
CNS functions reorganization is. Therefore, it is voluntary movements in imminent danger with
more and more hopeless to recover the lost motor protection play important roles, which are good
functions. methods and process to develop CNS potential.
The motor program of joint motion dominated
by brain is in real-time display when the patients
1.2 Theoretical Basis do some joint movements. Subsequently disor-
of Neurological Training dered motor program can be corrected and nor-
Rehabilitation mal motor program can be reconstructed through
“objective and motive” mechanism, which are
The process of human movements is that the mus- the essential part for the coordination of new
cles orderly dominated by lower nerve center that activated neurons. Realizing coordinative move-
is controlled by motor program of cortex motor ments of motor functions is based on recon-
center involved in joint motion contract and relax structing the motor program of joint movements.
successively to generate coordination exercise Proper exercise, constraining the model exercise
and then complete specific functions. Motor pat- without active movements and “objective and
tern is the fundamental form for achieving the motive” mechanism are the effective methods for
abilities of daily life. It can dominate muscles to remodeling of motor pattern. The correct motor
complete multi-joint coordination exercise under pattern is the premise and basis of activity of
the joint coordination of many axoneures. Motor daily living and life quality improvement.
program in the cortex motor center is the basis of
motor pattern. High quality of human functional
activities is dependent on the correct motor pat- 1.2.1 CNS Potential Development
tern. The formation of motor program is partly
related to inherited development tendency, but The fundamental method to recover the lost
most of them are acquired through learning. functions after central lesion is to promote CNS
Under the limitation of CNS cells regen- plasticity in order to achieve functional reorgani-
eration, the lost motor functions after injury zation through rehabilitation methods. The CNS
are mainly dependent on cells surrounding the plasticity conform to the principle “skillful use
and dependence”, which means voluntary limbs hemisphere replace the removed brain region to
movements dominated by brain are able to pro- function, which was called contralateral transfer
mote CNS plasticity. The nature of rehabilita- of brain functions.
tion methods is dependent on this. Rehabilitation Large CNS cells and signaling pathways
training methods that conform to this principle reserves are the histological basis of CNS plas-
are effective methods. Conversely, rehabilitation ticity and potential ability. Inducing the functions
training methods that do not conform to this prin- of reserved CNS cells and signaling pathways is
ciple may have poor effect on therapeutic effect the basis of CNS functional reorganization. This
such as the training method major in passive training method can be used to develop CNS
movements. potentials.
Some experiments showed that there were CNS potentials should be developed under
plasticity changes in CNS. After craniotomy, specific circumstance and using particular meth-
electrostimulation was used to find the region ods. The development of CNS potentials under
responsible for the thumb flexion in the motor natural conditions is limited. It is crucial that
cortex of monkey and the region was removed. which kind of methods can induce the potential
After the surgery, the ability of the thumb flex- of human body to compensate the lost functions.
ion was lost. However, 10 days after surgery, the At present, the development of human body
power of gripping recovered to 90% of normal potential focused on athletics, aerospace, work
functions through training, which indicated that abilities and child intelligence development,
the functions of brain region responsible for the which was seldom applied in medicine. English
thumb flexion were replaced by that of other medical scientists in 1920s used constraint-
region. After the second craniotomy, the new induced movement therapy to promote the func-
cortex region responsible for the thumb flex- tions of paralyzed upper limbs in stroke patients.
ion was found, which was located around the Uninjured side limbs were tied up and the patients
removed brain region in last surgery. The new were instructed to complete the designed move-
cortex region responsible for the thumb flexion ments using injured limbs. After a period of time,
was removed and the ability of the thumb flex- there was certain improvement in the functions
ion was lost again. The power of gripping recov- of the injured limbs. If the patients are instructed
ered through training, which indicated that the to complete successive and complicated whole
functions of new brain region responsible for movements such as holding teacup, combing,
the thumb flexion were replaced by that of other fastening buttons and seating belt, which means
region. In order to exclude the possibility that the the objective indicator of these movements is
functional recovery is due to contralateral cor- not exactly quantified, the physical therapists
tex compensation, after the surgery and before can only ask the patients to complete designed
functional recovery, contralateral cortex region movements using injured limbs. However, if the
responsible for the thumb flexion was removed patients cannot complete the movements because
and the functions recovery of the thumb flexion of the injured limbs, the physical therapists have
dominated by original removed brain region was no other therapies. In addition, the patients try
not influenced. These results further indicated many times but still cannot complete the move-
that the functions of the original removed brain ments. They will lose confidence and think that
region were replaced by the adjacent brain region the functions cannot be recovered. If the patients
but not the contralateral cortex compensation. are able to partly complete designed movements
Some scientists confirmed that one hemisphere and are instructed to complete a designed move-
can be compensated by the other hemisphere. One ment required multi-joint coordination exercise,
hemisphere of the monkey was removed, contra- abnormal motor pattern will be induced because
lateral limbs were paralyzed, but the functions of the replacement of paralyzed muscles by
of contralateral paralyzed limbs were recovered other muscles. There is no pertinent method to
again. These results indicated that uninjured side reconstruct normal motor program. Therefore,
abnormal motor pattern can be intensified and imminent danger condition without real threat
is difficulty to correct after repeated trainings. will be constructed to develop CNS potential
Because of these defects, the therapy has not and recover the lost functions of the patients. In
been widely promoted and applied up to now. imminent danger, the patients are instructed to do
The question is that which kind of methods goal-oriented voluntary movement, which is the
can quickly induce the potential of human body good method for recovering the lost functions.
to compensate the lost functions. In normal life, Repeated trainings can transfer the functions in
people can overcome difficulties and hardships imminent danger into daily life abilities at ordi-
using willpower. In dangerous condition, people nary times.
can get through the difficulties through bursting Regulation of movements based on regulation
into extraordinary ability. In specified condi- of mind and regulation of breathing is the basic
tions, tough training can lead a person to be a technique of Daoyin technique in traditional
superman, such as the training of special troops Chinese medicine. The speech in Daoyin tech-
of liberation army. These examples showed that nique is able to enlighten and motivate human
human potentials can be induced through danger- willpower commendably, which construct a safe
ous conditions such as willpower, goal, stimulus, “imminent danger” condition for functional reha-
misfortune, disaster and accident. These factors bilitation. In modern opinion, the patients are
can promote the development of human poten- instructed to concentrate to complete a designed
tials. The human potentials mainly are CNS movement and during this the therapists use
potentials, because all the muscles are dominated Daoyin speech to create a condition of imminent
by CNS. However, patients with hemiplegia and danger, such as “Stand up, or you will fall down”,
brain paralysis always have serious protopathy, “Hold up your body or you will crash” and so
such as hypertension, diabetes and heart disease. on. The therapists should encourage the patients
Therefore, under imminent danger, train may maximally to complete the designed movements.
worsen the condition. Obviously, under immi- When the movement is in the peak or holding
nent danger, the potentials development training weights, the patients should use willpower to
cannot simply be employed in the rehabilitation hang on several seconds, such as “Hold on, 1, 2
of patients with central lesion. and 3, you did great”, “Hold on, 4, 5 and 6” and
Traditional rehabilitation methods mainly so on. In this process, the brain potential will be
focus on passive movements. In training, there is fully developed and utilized.
no specific target of competition. Lack of “objec- It must be emphasized that potential develop-
tive and motive” mechanism influences the effect ment is not muscular strength training but mus-
of neuronal potentials development. For exam- cles capability training involved in joint motion
ple, a high jumper practices high jump without dominated by CNS, which means that the func-
cross-bar elevation. It is hard for him to increase tions of injured area are replaced by the ner-
the altitude of the jump. The cross-bar is the indi- vous tissue surrounding the injured area through
cator of new jump altitude on the basis of training training. There is significant difference between
achievement in last jump. In order to jump over recovering CNS functions and strengthening
the new altitude, the high jumper needs to adjust muscles.
mood, run-up speed, take-off distance, ground
force and throw-over gesture to develop jump
potential adequately. Then the jump altitude will 1.2.2 Motor Program
be increased gradually. Passive movements are Reconstruction
unable to develop potential.
Therefore, the patients should be enlightened Every movement of human body is dependent on
and motivated to complete goal-oriented single the electrical signal from brain cells to muscles
movement, which is worth studying and look- to drive and control. The signals are sent succes-
ing for. In the process of movement completion, sively according to a certain proportion, such as
Fig. 1.2 The new babies factory-fresh computers

differences between
human brain and training and learning software installing
computer
program construction program installing
Chinese English Chinese English
Chinese,creeping, sitting, running, Chinese editing, picture, playing
jumping and English videos and English
large memory space (the basis of potential) memory space(set by human)
motor program. Motor program makes the human center with computer, it is easy to understand
movements coordinative and orderly and makes what is motor program (Fig. 1.2). We found
it able to complete some certain movements. that there were many similarities between new
After central lesion, motor program will be dam- born babies and factory-fresh computers. The
aged to varying degrees, because the formation factory-fresh computers have no functions but
of motor program is based on cells and signaling software installing. Unless you installed all kinds
pathways. Damage of motor program can lead to of software, you will not use the functions of the
motor dysfunction and abnormal motor pattern, computer such as editing, reading pictures and
which has a strong impact on life quality of the playing videos. If the software is in English ver-
patients. In the process that CNS plasticity pro- sion, you can only edit English. If the software is
motes functional reorganization and motor func- in Chinese version, you can only edit Chinese. If
tions recovery, it is far from enough to develop the software is in Chinese-English version, you
CNS potential. It is essential to use methodology can switch the languages smoothly.
to make these new activated nerve cells function New born babies have nothing to do but suck-
coordinately and orderly, which is the process of ing the breast, crying and screaming, defecating
reconstructing motor program. Therefore, devel- and flapping and kicking aimlessly, but the com-
opment of brain potential and reconstruction of puter is able to learn and memorize just like the
normal motor program is the key of functional brain of babies. In the growing process of babies,
recovery after central lesion. it is easy to learn to sit up, creep and stand up.
The motor programs of human cortex motor One year after birth, babies can learn to walk,
center are from two ways. The first is congeni- run and jump. This is a process that a series of
tal, which is inherited from ancestors. Although motor programs are constructed and perfected in
it contributes seldom to the motor program, it can the cortex motor center. Therefore, every volun-
be used to obtain functions such as daily essen- tary movement should be dominated by motor
tial motor program including standing, walking, program in cortex motor center. Voluntary motor
running and jumping. The second is acquired. pattern is dependent on the motor program is per-
Most of the motor programs are acquired through fect or not.
training. These motor programs must be con- Another example of daily motor program is
structed through learning and training after birth robot. Robot is made from imitating human. In
such as the specialized motor programs including short, robot is composed of mechanical device,
swimming, cycling and somersault. electromotor, power and Central Processing
The nature of motor program is electrical sig- Unit (CPU). The software in CPU is the motor
nal orderly from cortex motor center to muscles program of robot. The power turns the electro-
involved in joint motion or multi-joint associated motor rotate and the rotation of the electromo-
movement. If we compare human cortex motor tor makes mechanical device function regularly.
And then the robot can be able to complete the ple, people are able to run, but there are signifi-
designed movements. The key of this process is cant differences of speed, duration and distance
the motor program in CPU. Robot is less flexible among individuals. This may be related to accu-
than human and don’t do some movements like racy degree of running pattern. The formation of
human, because the software in robot is not the motor pattern is dominated by motor program in
same perfect and precise as the motor program cortex motor center. The walking pattern of most
in human cortex motor center. However, this is a people may be incorrect, because the degree of
good example to demonstrate that there is motor wear indicates the abnormal motor pattern. For
program in human cortex motor center. example, someone’s outside shoes wear out more
From above, we can conclude that what is quickly than others. Someone’s inside shoes wear
motor program. Motor program in human cortex out more quickly than others. Moreover, heels
motor center is the same as computer program, of someone’s shoes wear out more quickly than
which is a process that numerous motor neurons others. In addition, pigeon-toed and out-toeing
are instructed optionally or involuntarily to work walking pattern are abnormal motor pattern. If
coordinately and the electric signals are sent suc- the abnormal motor patterns of these people can
cessively to muscles (initiative muscle, antago- be corrected through scientific training, the ath-
nistic muscle, synergistic muscle and neutralized letic ability and performance will be increased.
muscle) involved in joint motion to varying Long-term abnormal motor patterns are
degrees in order to complete muscle contraction, caused by some reason such as restricted or com-
joint motion or multi-joint synergic movement pensatory abnormal motor patterns induced by
essential for individual functions appropriately muscle paralysis, joint damage or skeletal abnor-
and opportunely. mality and related lesions. Long-term abnormal
After central lesion, the damage of motor motor patterns can lead to formation of abnormal
program will lead to functions loss to varying motor program in cortex motor center, which is
degrees. Entire damage of motor program will the construction of abnormal motor pattern in
lead to total functions loss. Some motor functions rehabilitation medicine. Therefore, motor func-
will be retained in part damage of motor pro- tions loss or abnormal motor functions induced
gram. Because the reserved signaling pathways by central lesion should be corrected through
between nerve cells are absent and the decreased constructing normal motor programs on the basis
synergistic effects of nerve cells lead to dyskine- of reconstructing or correcting disordered motor
sia or abnormal motor pattern to varying degrees, programs.
the motor functions can be recovered through If the motor program has been constructed in
normal motor program reconstruction. cortex motor center and the cortex is damaged,
CNS of new born babies may be influenced there are differences between motor program
by evolution of species, but has a tendency to reconstruction and the construction of motor pro-
develop naturally, which means that the abili- gram of new born babies. The brain of new born
ties required for the survival of the species can babies likes a blank sheet with natural develop-
be obtained through normal training. This is not ment tendency, so the motor program is easy to
always the case in reality, because the obtained be constructed. If the motor program has been
functions tend to have a certain defect when it constructed in cortex motor center and the cor-
is not trained scientifically. In general conditions, tex is damaged, it is difficulty to reconstruct the
human know nothing about whether their motor motor program, which is related to that the origi-
program is correct or incorrect. People may do nal signaling pathway is damaged. Like driving a
not realize or understand why normal people nail into a plank, if the nail is driven slantingly,
have defects of motor pattern, because there it is difficulty to be driven into the plank again
are no tests and comparisons. The defects of after the nail is pulled out. Moreover, non-via-
motor pattern will lead to significant difference ble and non-apoptotic cells will influence the
of motor abilities among individuals. For exam- new intercellular signaling pathways. Therefore,
reconstruction of normal motor program should After repeated training, the speed and accuracy
be based on actual condition of abnormal motor of the movements are controlled precisely by the
program and be completed through targeted and brain so that the speed and accuracy of the move-
repeated training. ments will be increased. During this process,
The time spent in reconstructing motor pro- arrow target is the subjective indicator for illus-
gram is related to evolution extent of species. tration and feedback, which make the brain know
The higher the evolution extent of species is, the the mistake, rectify it timely and set clear objec-
longer reconstructing motor program takes, and tive. Therefore, arrow target is essential external
the vice versa. For example, sheep can learn to conditions for increasing the degree of accuracy
walk and run several hours after birth, meanwhile in archery and constructing archery motor pro-
people take a year or more to learn to walk and gram. After repeated training, the motor program
run. Therefore, reconstruction of human motor is consolidated.
program is a relative long process. The patients The archery example showed that before
are instructed on purpose to be trained in order reconstructing motor program, the motor pro-
to promote reconstruction of normal motor program signals are transmitted real-timely from
gram. Ultimately, through repeated practical brain to muscles involved in joint motion during
applied training, the motor program can be con- the process of voluntary movements. According
solidated. Based on the fact, the course of reha- to the practical condition of motor program,
bilitation training should take a lifelong time. abnormal motor program can be rectified and
If the patients want to be recovered within few normal motor program can be reconstructed.
days in hospital, it will have a strong impact
on the therapy effect and destroy the patients’
confidence. 1.2.3 Motor Pattern Remodeling
However, how to construct the motor program
in human brain? The development of CNS potential and recon-
In daily life, there is a truth that archery struction of motor program are not equal to prac-
athlete aims at arrow target to practice archery tical motor functions. Through practical applied
so that degree of accuracy in archery can be training, the motor functions can be transformed
increased. Otherwise, the degree of accuracy to daily life abilities. Just like a martial artist, the
in archery cannot be increased without target. actual combat ability cannot be obtained merely
This is because archery is a motor program that through basic skills such as standing exercise,
is constructed in cortex motor center. Through strength and speed training and martial arts rep-
repeated practice, the archery skill will be pro- ertoire such as shaolin boxing and Hung Ga.
moted continuously. When archery athlete aims Only after basic skills and martial arts repertoire
at arrow target to practice archery, the first arrow training, practical skill and tactic capability can
may be shoot in the above of the bull’s-eye. The be increased through exchanging experiences or
archery result is sent to the brain and the brain fighting.
will analyze numerous factors (altitude of arrow In the motor relearning program technique, the
target, distance, wind direction, bow weight, training of daily life practical functional activi-
arrow weight, arm strength and emotion) com- ties should be emphasized, but not the designed
prehensively. After calculation, the gesture of patterns or impractical training. However, nor-
the second arrow can be decided such as low- mal motor pattern is the best form for human
ering the arrowhead. The second arrow may be to function. Abnormal motor pattern will influ-
shoot in the below of the bull’s-eye. The archery ence the functions to varying degrees. Besides,
result is sent to the brain and the brain will know the movements under long-term abnormal motor
the arrowhead is too low. The gesture of the third pattern can lead to complications. For example,
arrow can be decided such as raising the arrow- the patients with hemiplegic circle gait have
head. The third arrow is shot in the bull’s-eye. walking limitation, slow speed, increased energy
consumption and falling injuries. Besides, walk- and the gait training instructed by the speech
ing under long-term hemiplegic circle gait may of exercise therapists [3]. Some reports showed
lead to disuse of hip flexors, bone and joint dis- that these methods have improvement effect
ease, pelvic obliquity and postural malformation, on recovering walking abilities of hemiplegic
which have a strong impact on walking abilities patient and gait symmetry. There is no specific
and functions. indication for these methods. Besides, corrective
Normal motor patterns provide important function of abnormal gait is decreased because
guarantee for efficient functions and improve- the unnecessary movements in exercise cannot
ment of life quality. For example, in table tennis, be constrained effectively. In addition, there is no
method of holding tennis racket and posture of constraint of exercise after training in all these
hitting the ball can directly decide the accuracy methods. Out of training room, most patients still
and quality of hitting the ball. The key points walk as original motor pattern, which is bad for
of deciding the accuracy are covering the ball decreasing the excitability of cortex abnormal
using racket in 400 and swing of the racket to the motor center that means abnormal motor pro-
direction of apex nasi. The waist drives the upper gram cannot be rectified and there is no way to
limbs to hit the ball, which is the key point of rectify the abnormal motor pattern. For example,
deciding the quality. Therefore, we can conclude a tobacco addict wants to quit smoking. In smok-
the importance of normal motor pattern. ing cessation room, some methods are used to
Motor program and motor pattern inter- explain the smoking perniciousness to the smok-
act with each other and supplement each other. ers, but the tobacco addiction cannot be cut out
Motor pattern is the external manifestation of the after treatment, just as smoking habit and smok-
motor program in cortex motor center. Motor pat- ing desire.
tern is dependent on motor program. Abnormal In addition, there are short of dedicated
motor program definitely leads to abnormal device for gait training at home and abroad.
motor pattern. On the contrary, abnormal motor Some scientists deemed that gait analysis sys-
pattern may lead to abnormal motor program tem was an ideal gait assessment and training
through CNS plasticity. Therefore, after the con- mode, but gait analysis system was only used
struction of motor program, normal motor must for detecting gait, which provided scientific
be constructed in order to guarantee the normal basis for clinical diagnosis and therapeutic
function of motor program. regimen making. Gait analysis system was an
During the construction of motor program equipment to assess the effect of gait training.
or after that, the keys of normal motor pattern When it was used for gait training, it had an
remodeling are seizing the moment of motor pat- impact on therapeutic effect because the unnec-
tern training and limiting the unnecessary move- essary movements in exercise cannot be con-
ments in exercise. strained effectively.
The modes of abnormal motor pattern can Training methods of preventing and rectify-
be divided into three classes, such as abnormal ing abnormal gait at home and abroad at present
motor pattern of upper limbs, abnormal motor are summarized, but the therapeutic effect is not
pattern of trunk and abnormal motor pattern of entirely satisfactory. The reason is related to sev-
lower limbs. Abnormal motor pattern of lower eral factors:
limbs indicates abnormal gait. At present, there
are few methods to prevent and correct abnormal • There is no systematic rehabilitation method
gait. The common methods include placing in for preventing and rectifying abnormal gait.
good limbs position at early stage, constraint of • The unnecessary movements in exercise can-
walking out of bed, standing on correction board not be constrained effectively, which is bad for
for foot drop, strephenopodia and strephexopo- reconstructing normal gait.
dia, adorning orthotics, Bobath technique, Body • There are no specific indications and contrain-
Weight Support Treadmill Training (BWSTT) dication of existing gait training methods.
• It is short of training equipment for rectifying 1.3.2 T

he History of Daoyin
abnormal gait and reconstructing normal gait. Technique in Traditional
• After training, the patients walk as original Chinese Medicine
motor pattern and the excitability of abnormal
motor center cannot be decreased, which is The history of Daoyin technique in Chinese tradi-
bad for constructing normal motor pattern. tional medicine is very long, which can date back
to the Spring and Autumn Period and the Warring
The defects mentioned above have a strong States Period or even earlier time. Since the mod-
impact on preventing and rectifying abnormal ern times, Daoyin technique in Chinese traditional
gait. Moreover, there are the same defects and medicine was seldom applied to clinic, but it was
deficiencies in preventing and rectifying abnor- widely used in health maintenance such as five-
mal motor pattern of upper limbs and trunk. animal boxing, eight trigrams boxing and Qigong,
Considering that there is close connection a system of deep breathing exercises. The ancient
between motor pattern and motor program, on Daoyin technique in Chinese traditional medi-
the basis of rectifying abnormal motor pattern, it cine was able to spread in the world permanently,
is an essential step to do the training of normal which had their reasons and practical application
motor pattern remodeling. It is a step and target value. It is worth further researching and develop-
for rehabilitation training that must be taken seri- ing. Especially, there is a possibility that it can be
ously. During this process, except the designed used for modern rehabilitation clinic and benefit-
restrictive targeted functional movements, func- ing the disabled and should be discussed deeply.
tional movements training required for daily life Some scientists deemed that Daoyin tech-
should still be done and the unnecessary move- nique in Chinese traditional medicine originated
ments in exercise should be constrained effec- from dance, which referred to the Old Stone Age
tively. After training, the patients should practice at the earliest. It was closely related to later tra-
the movements maintained for a long time in ditional therapies such as Daoyin, massage with
daily life and restraint the unnecessary move- hands and foots and traditional Chinese manipu-
ments themselves. lation. The chapter of ancient music in Mister
Lv’s Spring and Autumn Annals was written in
239 A.D. The book recorded the dance with per-
1.3 The Principle and History tinent movements designed by tribal chiefs. The
of Daoyin Technique dance can regulate qi and blood, move muscles
in Traditional Chinese in exercise or work and resist lower limbs swell-
Medicine (TCM) ing, hindered joint motion and abasia induced by
moisture. Therefore, in order to treat some rheu-
1.3.1 The Principle of Daoyin matism sore pain disease, the dance was used
Technique in Traditional to regulate qi and blood to alleviate the disease.
Chinese Medicine Daoyin was to move muscles and joints in exer-
cise or work, which derived from dance move-
Daoyin technique in traditional Chinese medi- ment. The early explanation of Daoyin was made
cine is an entirely voluntary movement on the by Wang Bing in Tang Dynasty who said “regu-
basis of regulation of the mind and breathing, late qi in order to make your body peaceful and
which integrate mind guidance, breath adjust- stretch your body in order to make it flexible”.
ment and body movement. It can regulate qi Daoyin technique in the chapter of intention in
and blood, unblock the channel, coordinate vis- Zhuangzi was called Taoyin. The ancient people
cera and recover body function, which is health thought it could free spirits and qi, keep fit and
maintenance and rehabilitation method of self- even prolong life. “exhale and inhale, exhale the
training. It was widely used in health mainte- old and inhale the new, stretch body like bears
nance and rehabilitation. and birds. The people who did Daoyin and kept
1.3 The Principle and History of Daoyin Technique in Traditional Chinese Medicine (TCM) 21
fit loved this, so did Peng Zu (The god of longev- On the basis of hot compress and oral admin-
ity in the ancient). This sentence depicted people istration of medicine, if Daoyin technique was
who kept in good health liked to exhale the old assisted with limbs exercise that can promote the
and inhale the new with abdominal respiration circulation of qi, it can alleviate joints, soften lig-
and stretch body like bears and birds. aments and regulate heart and blood, which indi-
Because of the important effect of Daoyin in cate the role of Daoyin technique in joint motion.
health care, after many weary centuries, Daoyin The book Synopsis of Golden Chamber written
technique was developed slowly and was spread by Zhang Zhongjing in the Eastern Han Dynasty
up to now with indomitable vitality. It got a great showed that Daoyin technique could promote the
development and was applied to rehabilitation. In circulation of qi and blood and open the nine ori-
different dynasties, medical practitioners compre- fices in order to prevent diseases. When the limbs
hended and applied Daoyin technique differently. cannot be moved smoothly, Daoyin technique,
However, in overall, it was upward developed expiration and inspiration, acupuncture and
slowly. moxibustion and massage with paste preparation
In the classics of traditional Chinese medicine were used to open the nine orifices.
Huangdi’s Internal Classics during Qin and Han So far, the earliest book about Daoyin tech-
dynasty, several therapeutic methods are summa- nique was Yinshu unearthed from Han dynasty
rized, which derived from the ancient times and tombs in Zhangjiashan Hubei province in 1983,
were effective. Daoyin was on the top of these which was written in the middle and late period
methods. Daoyin technique was described as of Warring States before 221 B.C. So far, the
moving bones and joints in exercise or work in earliest book about illustration of Daoyin tech-
the book Suwen. Daoyin technique was used to nique was Daoyintu unearthed from Mawangdui
treat callousness (symptoms of some diseases) in Han Dynasty Tomb in Changsha Hubei province
the book Lingshujing. If Daoyin technique was in 1973 (Fig. 1.3). There is close connection
assisted with fire needle stimulation of ashi acu- between Yinshu and Daoyintu. Daoyintu illus-
puncture point, it could recover sensory function. trated Daoyin technique in the book Yinshu.
Fig. 1.3 Daoyintu unearthed from Mawangdui Han Dynasty Tomb in Changsha Hubei province in 1973
Operational methods include 68 kinds of something. The five sense organs (ears, eyes,
Daoyin technique modes and 41 kinds of Daoyin lips, nose and tongue) should be often practiced
therapeutic methods. Daoyintu illustrated Daoyin in order to prevent diseases. This type of Daoyin
technique, which included 44 pictures. The pic- technique can be used for rehabilitation training
tures are different, which are divided into empty- of the patients with conscious mind and stable
handed and instrument-handed pictures. All of condition. This is the precedent that early reha-
the pictures show whole movements with erect bilitation was used for preventing complications
position. and promoting functional recovery.
In the clinic, the applications of Daoyin tech- During Song-Jin-Yuan Dynasty, Daoyin tech-
nique in different dynasties were not the same. nique was developed for practice. One of the
For example, Daoyin technique to recover upper characteristics was that various kinds of Chinese
limbs functions in Yinshu is that uninjured side meditations were developed on the basis of prec-
hands are used to grasp the injured side hands to edent Daoyin techniques. The book twenty-four
stretch it towards the head. It can improve joint Chinese meditations Daoyin techniques healing
motion of injured side upper limbs and allevi- pictures wrote by Chen Tuan in Song Dynasty
ate adhesion between muscles and joints to pro- (A.D. 989), divided Chinese meditation into 24
mote functional recovery. However, in the view kinds of movements and named them separately
of operation mode, it is a passive movement for according to the 24 solar terms on the basis of
the injured limbs. In fact, this is one part of the correspondence between man and universe, five
Daoyin technique. There are many operation elements’ motion and six kinds of natural factors
modes in Daoyin technique, which are all volun- and main and collateral channels theory. Every
tary movements good for functional recovery of kind of methods based on viscera used Daoyin
lower limbs. techniques to circulate main and collateral chan-
General Treatise on the Cause and Symptoms nels in order to prevent the diseases dominated by
of Diseases [4] was written in 610 B.C. (Sui 12 meridians. Chinese meditations Daoyin tech-
Dynasty), Daoyin technique was recorded to treat niques were definitely based on main and col-
hemiplegia. Standing against the wall, holding lateral channels theory for the first time, which
the breathing and promoting the circulation of had a great promoting effect on the development
qi from head to foot are the specific procedures, and enhancement of Chinese ancient Daoyin
which can be used to treat subcutaneous ulcer, techniques.
hemia, stroke, hemiplegia and wandering arthri- Daoyin techniques included Slight heat
tis. This type of technique can be divided into method, Great heat method and the methods in the
several subtypes. One subtype is that keeping the book Zhu Xian Daoyin pictures according to the
back straight, stretching foots and fingers, keep- 24 solar terms. The most representative method
ing mind calm, and entraining qi from head to ten was immortal guiding method. The procedures
toes of foot and soles. Qi can be confined in the of this specific method are as follows: pointing to
center of the palm. Qi can be entrained from head the left using the hand, looking on the right and
to plantar Yongquan acupoint. This is Daoyin circulating Qi in 24 breaths; pointing to the right
technique in standing position. Promoting the using the hand, looking on the left and circulating
circulation of qi, inspire and expire slightly, Qi in 24 breaths. This method was used to treat
inspire more and expire less with silent breath- paralysis. The procedures of this specific method
ing are the main procedures. The circulation of are as follows: standing, left foot forward, point-
qi is called that Qi can be entrained from head to ing to the right using the right hand, looking on
plantar Yongquan acupoint. In addition, there is the left and circulating Qi in 24 breaths; stand-
Daoyin technique in lying position. The specific ing, right foot forward, pointing to the left using
method is making the toes upward and holding the left hand, looking on the right and circulating
breathing, which can treat pain or numbness of Qi in 24 breaths. This method was employed to
waist and back, hemiplegia and make the ear hear circulate main and collateral channels and ease
1.3 The Principle and History of Daoyin Technique in Traditional Chinese Medicine (TCM) 23
joint movement, which was known as one of the homeostasis and have favorable influence on
most effective methods for treating hemiplegia in body metabolism to recover motor functions.
ancient times. Modern medicine demonstrated that Daoyin
Daoyin techniques in Qing Dynasty were sim- technique was good for the regulation and reha-
ple and practical. The most representative Daoyin bilitation of cardiovascular diseases, respiratory
technique “Fen Xing Wai Gong Jue” was intro- diseases, nervous system diseases, digestive
duced in the book Shou Shi Chuan Zhen wrote system diseases and so on [5]. On the basis
in 1771. The procedures of this method are as of precedent experience, doctors of all dynas-
follows: stand up, walk slowly, hold firmly with ties supplemented and developed it, which was
two hands; left foot forward, left hand swing worth considering and popularized. There are
forward and right hand swing back; right foot many relationships and similarities between
forward, right hand swing forward and left hand Daoyin technique and modern psychotherapy,
swing back; two foots cross forward, move for- physical exercise therapy, naturopathy, informa-
ward dozens of steps and then move back dozens tion therapy and physiotherapy. Daoyin tech-
of steps; sit high and stretch the foots, twist the nique is the comprehensive application of all
heels inward and then outside for 24 times. these therapies.
The book dynamic exercise massage recipe
was written in 1696 in Qing Dynasty, which
combined Daoyin technique and massage to treat 1.3.3 T
he Reason of Endangered
diseases. There were many methods such as acu- Daoyin Technique
point selection, massage and Daoyin in this book, in Traditional Chinese
which were simple to use and had a unique cura- Medicine
tive effect on paralysis and chronic low back and
leg pain. The correspondent static exercises were From the birth of Daoyin technique, there was
sedation, concentration, breathing modulation, a close relationship between Daoyin techniques
licking the palate using tongue tip, omphalo- with Chinese traditional culture, especially dur-
skepsis, breathing slowly, rising the stomach and ing the development process. After the addi-
breathing rhythmically under resting state. tions and deletions of doctors of all dynasties,
After the combination of dynamic exercise the content of the theory was extensive and pro-
and static exercise, Daoyin techniques were found, but was with mystery inevitably, which
developed to health maintenance and rehabilita- were lack of definite concept and subjective and
tion exercise method that could combine associa- abstract. In addition, there are several defects and
tion of activity and inertia, association of insides deficiencies.
and outsides, regulation of the mind and breath- From the documents of Daoyin technique in
ing and body movements. all dynasties, it was a self-exercise method to
In the view of modern medicine, Daoyin preserve one’s health, which was appropriate for
technique in Chinese is an important method healthy person or sub-health person. It was dif-
to enlighten and arouse people to complete ficulty to be applied for rehabilitation training of
designed movements. The technique included the disabled.
static exercise with the breathing controlled by Although it could be applied for rehabilitation
OBEs and dynamic exercise with OBEs, breath- training of the diseases, the self-exercise way was
ing and movements (imitation of various kinds its main method. The methods were all the bulk
of animals). Through regulation of the mind, movements with complicated multi-joint move-
regulation of breathing and regulation of movements, especially the 44 Daoyin pictures that
ments, Daoyin technique could circulate main were all bulk movements in standing position. It
and collateral channels, regulate qi and blood, was not suitable for the disabled or the patients
harmonize viscera, and strengthen the body resis- with more severe dyskinesia and the range of
tance to eliminate pathogenic factors, strengthen application was confined.
In the long development of Daoyin technique, mind, breathing and movements, single multi-
there was no special equipment that cooper- joint movement was transformed to the reha-
ated with the application of Daoyin technique bilitation training technique from simple joint
except some simple appliances such as sticks movement to multi-joint movement, which
and swords. Without systematic basic theory and are applied to rehabilitation therapy of the
controlled clinical trial, even lack of clinical indi- patients with dyskinesia after central lesion.
vidual cases and specific objective indicator in 2. According to the conditions required for

treatment, the reliability of therapeutic effect of clearing and activating the channels and col-
Daoyin technique was influenced. laterals and developing potential, Daoyin
In all ages, there were small changes in theo- speeches are studied, which can inspire the
ries and methods of Daoyin techniques. Daoyin patients, induce and create endangered cir-
technique was developed slowly even stagnated cumstance. It is convenient for the therapists
without the promotion of modern theory of medi- to instruct the patients to do rehabilitation
cine. For these reasons, Daoyin technique was training through Daoyin technique.
used for life cultivation and health preservation 3. According to objective and motive, biofeed-
instead of clinical rehabilitation from Ming-Qing back and motor program theory, combined
dynasty to modern times. with advanced rehabilitation methods over-
seas and modern electronic technique, objec-
tive indicator of therapeutic effect of Daoyin
1.3.4 B
asic Ideas of Renaissance technique are made to be in digital display and
of Daoyin Technique new rehabilitation therapy of traditional and
in Traditional Chinese western medicine is developed with the core
Medicine technology of Daoyin technique. It is widely
applied to rehabilitation training, which not
Daoyin technique in traditional Chinese medi- only can reconstruct or enhance single muscle
cine is a basic technique of regulation of move- control signal, but also can be involved in
ment on the basis of regulation of mind and reconstruction training of motor program of
breathing, which were all voluntary movement associated movements participated with sev-
dominated by brain through using all the vigor. eral muscles.
It was completely in conformity with “skill- 4. Except for the motor functional rehabilitation,
ful use and dependence” principle. It was an Daoyin technique in traditional Chinese medi-
important method instructed by modern medical cine can be used in rehabilitation training
theory to promote CNS plasticity and functional method of other functions such as speech,
reorganization. Therefore, modernization and
swallow sphincter, cardio-pulmonary func-
renaissance of Daoyin technique in traditional tion, and vision, which becomes a series of
Chinese medicine should combine with modern rehabilitation treatment methods with the core
medical theory form the aspects as follows. On technology of Daoyin technique.
the basis of inheritance of the precedent experi- 5. A series of controlled clinical trial should be
ence, it would contribute to the development of proceeded to demonstrate the therapeutic effect
rehabilitation medicine in our country and even and study the mechanism. The indications and
the world. contraindications of Daoyin technique should
be investigated to form a normalized and stan-
1. According to the rehabilitation principle from dard instruction, which lay the foundation of
simple to complex, simplified and practical long-term development of Daoyin technique.
rehabilitation principle, and comprehensive 6. The characteristics of traditional Chinese
rehabilitation principle, on the basis of inheri- medicine should be emphasized. We stud-
tance of Daoyin technique in traditional ied Daoyin technique throughout main and
Chinese medicine, through regulation of collateral channels and Daoyin methods with
1.4 Electromyographic Biofeedback 25
virtual simulation through main and collateral tromyographic biofeedback of the vision and
channels pictures that are easy to be under- audition signal to enhanced the patient control
stood by the patients and to be popularized ability of tibialis anterior; Basmajian exhibited
and applied. We also would verify the thera- the clinical application of electromyographic
peutic effect. technique in the recovery of neuromuscular
7. We will develop the equipment applied for system, the control of pain and the treatment of
Daoyin technique in traditional Chinese medi- headache and so forth. In 1983, Wolf integrated
cine, because the equipment is important mea- electromyographic biofeedback technique into
sure to ensure the correct methods and physical therapy, and used in the treatment of
therapeutic effect. There are some kinds of patients with hemiplegia and achieved a land-
training equipment used for developing poten- mark result in the research of clinical effect. In
tials, reconstructing motor program and the following 1990s and twenty-first century,
remodeling motor pattern of Daoyin tech- electromyographic biofeedback technique was
nique. There are also some kinds of equipment widely used in hemiplegia, paraplegia, cerebral
used for gait training with unnecessary move- palsy, disturbance of sphincter, headache, low
ments in balance training and active restriction back pain, and various wrist-hand functional dis-
movements. orders following the widely use of computer, it
has become one of the effective treatments in the
Following the further study and the develop- field of modern rehabilitation medicine.
ment of Daoyin technique, the application value
will become increasingly higher and the applica-
tion range will become more and more extensive, 1.4.2 T
he Principle and Clinical
which will advance the development of rehabili- Application
tation medicine service. of Electromyographic
Biofeedback Technique
1.4 Electromyographic 1.4.2.1 Basic Concepts

Biofeedback
The Definition of Biofeedback
1.4.1 T
he Development History In 2008, three internationally professional bio-
of Electromyographic feedback organizations defined biofeedback
Biofeedback Technique together as follows: biofeedback is a process for
the purpose of improving health conditions and
The prototype of electromyographic biofeed- functions, which urged individuals to learn how
back technique can be traced back to 1930, when to change physiological activity. It uses delicate
Jacobson developed an instrument which could instruments to examine a variety of physiological
continuously detect the electromyographic sig- activities including electroencephalogram, car-
nal, he found that the level of electromyographic diac function, respiration, muscular activity, skin
signal could be influenced by cognitive activity, temperature, etc. These instruments can feedback
and therefore proposed progressive relaxation this information to users accurately and quickly.
therapy based on this finding, which could be The expression of the information often related
used for treatment of various mental and physi- to the change of thought, emotion, behavior
cal diseases such as hypertension etc. The mod- promoted the change of physiological functions
ern sense of electromyographic biofeedback towards to the hopeful direction. After a period of
appeared in 1960s, Marinacci used electromyo- training, these changes can be achieved without
graphic biofeedback technique to treat peripheral rely on instruments.
facial paralysis, sequela of polio paralysis and In brief, biofeedback is a method which can
hemiplegia; Harrison and Mortensen used elec- transform internal function changes which is
unawareness by human beings under normal con- the recorded EMG through amplification, filtra-
ditions, such as electromyographic, skin temper- tion, bidirectional rectification, integral, then
ature, heart rate, blood pressure and so on, into use integrator voltage to drive display devices
audio-visual signals which can be awareness, and including voice, light, electric, digital, etc. Due
make patients to learn to control their involun- to the proportional relationship between integra-
tary functions according to these signals through tor voltage and muscular tension, people are able
guidance and self-training, and therefore used for to directly observe the level of muscular tension
prevention and treatment of diseases or rehabili- or relaxation. Since skeletal muscle is under the
tation training. To date, it has been reported in the control of voluntary nervous system, so the self-
literature that biofeedback has been used in the modulation of electromyographic is easy to learn,
treatment of dozens of diseases such as tension- the therapeutic method is also easy to be accepted
type headache, migraine, bronchial asthma, by patients, and the treatment effect is reliable,
upper digestive tract ulcer, allergic colitis, hyper- so electrographic biofeedback is one of the most
tension, arrhythmia, etc. In the field of modern widely used in clinical and the most successful
rehabilitation medicine, it is used in the treatment feedback therapies.
of cerebrovascular accident, spinal cord injury,
cerebral palsy, spasm, flaccid paralysis, muscle 1.4.2.2 Myoelectric Biofeedback
disuse atrophy, pain syndrome, restricted joint Technique Principle
range of motion, prosthetic function training, The feedback information of myoelectric bio-
peripheral nerve injury, poisoning-induced nerve feedback is illustrated by electromyography
system diseases, etc. (EMG). Through amplification, filtering, bi-
directional rectification and integration, inte-
Electromyographic Signal grator voltage driven display devices such as
It is traditionally believed that electromyographic sound, light, electricity and digital to form
signal is an electric signal which is produced by EMG. Because of the direct ration relationship
neuromuscular system activity under the quiet between integrator voltage and muscle tonus,
and contraction state of muscle, although this the level of muscle tonus or relaxation can be
electric signal mainly derives from nerve or directly observed. Because skeletal muscle is
muscle requires further research to identity, in controlled by voluntary nervous system, myo-
clinical, however, it is often regards the both as electric autogenous regulation is easy to learn.
a whole, and is depicted various simple electro- The therapeutic methods are easily accepted by
myographic signal as electromyography (EMG), the patients and the therapeutic effect is reliable.
EMG is also represents electromyographic sig- It is one of the most widely used and successful
nal. EMG is closely related with the functional feedback therapies.
status of neuromuscular system, it is an objective In a broad sense, the reason why the biofeed-
indicator which is used for clinical differential back technology is effective is that it is closely
diagnosis of neurogenic and myogenic disorders, connected with the targeted training process
learning the location, degree and the status of under the mechanism of “objective and motive”
functional repair, make rehabilitation treatment and the study of “knowing defects and correct
plan and evaluate the effect of rehabilitation it”. The study of “knowing defects and correct
training. In recent years, EMG is widely used in it” is similar with the archery training. The target
the fields of athletic training, biofeedback, gait can feed the results of archery back to the archer
analysis and artificial limb driving. and the archer can ultimately increase the accu-
racy and reaction speed through correcting his
Principle of Electromyographic own posture. The mechanism of “objective and
Biofeedback Technique motive” is a process of exceeding stated objec-
Electrographic biofeedback use EMG as its feed- tive and developing own potential. Just like high
back information. The principle of which is take jump, the cross-bar is the sign of altitude. If the
jumper can jump over 1.4 m and the altitude of myoelectricity level absorbedly in accordance
the cross-bar is 1.5 m, the jumper should exert with the vision and sound signals transformed
run-up distance, speed, force, varied direction from EMG in order to enhance muscle force and
running during the way, take-off position, throw- recover motor function.
over posture, mental state and courage to a cer- Sports coordination training.
tain extent in order to jump over the cross-bar.
The exceeding 0.1 m is the result of developing 1.4.2.3 Clinical Application
potential. If there is no cross-bar, the jumping of Myoelectric Biofeedback
altitude may not be increased, because the poten-
tial of jumping cannot be developed. Indications Myoelectric Biofeedback Can
In physiological mechanism, biofeedback Be Widely Used to Treat Diseases
technology can promote brain functions, because of Different System
voluntary body movements are generated by ner-
vous impulse signals from motor center in cortex Tension Headache
to neuromuscular junction through nervous con- Tension headache was induced by long-lasting
duction pathway. The membrane permeability muscular tension or blood vessel shrink in head,
of nerve fiber can be changed and the internal neck and shoulders. In clinic, mental factor usu-
flow of calcium ion will trigger exocytosis of ally induced muscular tension or blood vessel
synaptic vesicles. Therefore, acetyl choline is shrink in head, neck and shoulders that lead to
released from prejunctional membrane of neu- local circulation disturbances and ischemia. The
romuscular junction and binds with receptor in therapists not only instruct the patients to listen
endplate membrane through synaptic cleft to to themself and watch the abnormal EMG during
trigger endplate potential. Electrotonic potential treatment, but also let the patients to experience
can stimulate peripheral myolemma to gener- the normal EMG recorded before without head-
ate action potential and muscle contraction will ache and to compare the difference. The patients
be induced. The normal physiological process were encouraged to decrease the abnormal signal
originates from the transformation and transduc- displayed by the biofeedback equipment through
tion of primary electrical signal from brain cells, willpower.
chemical signal and electrical signal. Primary
electrical signal from brain cells in motor center Hemiplegia
of cortex can be transduced to stimulate muscle Feedback training of muscular excitation can
contraction and EMG. Therefore, EMG is the enhance muscle force and motor function.
drive signal from brain to muscle, which can Similarly, feedback training of muscular flaccid-
be consciously enhanced or attenuated by train- ity can be used to inhibit spasm as the circum-
ing. This is the basis of myoelectric biofeedback stances may require.
technique.
As for medical purposes, myoelectric biofeed- Stammer
back can be divided into three methods. When speaking, masseter is in a relaxed state.
Feedback training of muscular flaccidity However, the masseter is in a tension state when
During treatment, according to the state of an ill- the patients with stammer start to say something,
ness, the therapists select the muscle, place the which is the reason of stammer. Myoelectric
electrode, test EMG and instruct the patients to biofeedback can be used to treat stammer.
relax muscles absorbedly in accordance with the When keeping silent, the patients should try to
vision and sound signals transformed from EMG decrease the EMG of facial muscles, and then
in order to achieve treatment goal. use this experience to control the EMG during
Feedback training of muscular excitation the speaking, and employ self-control behaviors to
therapists place the electrode on the body surface maintain the decreased physiologic electrical
of the muscle and instruct the patients to increase activity.
Bronchial Asthma close their eyes so that the patients can receive
Mental stimulus is the important factor to induce information from EMG when closing their eyes.
asthma and aggravate it. Myoelectric biofeed-
back is combined with progressive relaxation Contraindications
training. The therapists place surface electrode
on the forehead of the patients and read some Absolute Contraindications
warm and happy words silently in order to relax Because myoelectricity myoelectric biofeed-
the patients’ body and make their breath peaceful. back has no effect on the patients’ health and the
patients do active training, there is no evident
Emphysema absolute contraindications.
In patients with emphysema, diaphragm decreases,
Relative Contraindications
the movements are confined, residual volume
Skeleton and muscle diseases that can severely
increases and ventilation function declines. The
affect joint motion.
electrode is placed on the body surface of rec-
The patients with severe cognitive deficit or
tus abdominis and musculus obliquus externus
long-term administration of sedative, antide-
abdominis in order to train the patients’ abdomi-
pressant and so on, or the patients who ignore
nal respiration and enlarge the range of motion of
instructions.
diaphragm.
The patients are with skin damage, lesion and
infection in the surface of training part so that the
Dysfunction of Oddi’s Sphincter
electrode cannot be placed.
The patients are trained to contract anal sphinc-
ter, urethral sphincter and pelvic floor muscle in Preparation Before Training
order to control defecation and urination.
Understanding the Illness
Hyperactivity Before training, the therapists should talk to the
According to the EMG, once there is muscular patients, know the mental and physiological sta-
tension signal, the children patients are trained to tus of them and do complete inspection of them.
eliminate the tension signals. The therapists should know the disease char-
acteristics, invalidism and recoverable extent.
Torticollis The therapists should evaluate the intelligence,
The patients are instructed to enhance the muscle audio-visual ability, attention and self-control
force of sternocleidomastoid in uninjured side. The comprehensively.
therapists place the electrode on the body surface
of sternocleidomastoid in uninjured side and let the Training Environment
patients flex the head to the shoulder in uninjured The training circumstance should be quiet, com-
side and let the neck turn to offside. According to fortable, air freshening and the room temperature
the feedback information from EMG, the patients should be 18–25 °C. The light should be dim and
know the enhancement extent of muscle force and the furnishings should be clean and tidy. The
will be more confident about the treatment. The therapists should reduce conversation and walk-
therapists can decrease the tension of spasmodic ing in the room. If possible, the training should
muscle to relax spasmodic muscle. be proceeded in a separate room in case of envi-
ronmental disturbance.
Facial Paralysis
According to the dysfunction point, the thera- Psychological Preparation
pists train frontalis, musculus risorius, orbicu- The therapists should specifically eliminate the
laris oculi muscle and orbicular muscle of mouth patients’ scrupulosity and explain the basic prin-
separately. The therapists train the patients to use ciple of myoelectric biofeedback, training meth-
sound to feedback information when the patients ods, precautions and the purpose to the patients in
order to achieve self-control and self-regulation. Operating Conditions

The patients will be more confident about the • Environment temperature is 5–40 °C.
treatment and place their hope on the therapeutic • Relative humidity is not more than 80%.
outcome. • Power supply should conform to the regula-
tions as follows:
Training Methods • alternating current supply: 220 ± 22 V (Volt),
The patients should be evaluated first. According 50 ± 1 Hz.
to the dysfunction point, the therapists select • direct current supply: The voltage is no more
the targeted muscles for training. The patients than 60 V.
lie in a comfortable position. The therapist use
75% made of medicinal alcohol to disinfect the Property
skin and put the electrodes on the surface skin • Range of measurement: 1 V to 999 μV.
of the training muscles with two main electrodes • Maximum resolution (sensitivity): The mini-
on both ends of the muscle belly and grounding mum signal change detected by the equipment
electrode between the two main electrodes. The is less than 0.2 μV.
therapists let the patients to contract or relax the • Input noise: Less than 1 μV.
muscles actively and then instruct the patients to • Transmission bands: 120–1000 Hz (−3 dB).
do feedback training of muscular excitation or • Differential-mode input impedance: More
feedback training of muscular flaccidity accord- than 5 MΩ.
ing to the feedback information from EMG. • Common mode rejection ratio: More than
For example, the problem of the patients with 100 dB.
hemiplegia and pendency foot is pendency foot • In the instruction book, the type of feedback
in injured side and weak muscle force of tibialis signal should be described.
anterior muscle. Therefore, the therapists select • When the EMG changes reach 0.2 μV, the
tibialis anterior muscle as the targeted muscle. feedback signal will change simultaneously.
During training, the therapists place the elec-
trodes on the surface skin of tibialis anterior In the myoelectric biofeedback equipment
muscle and ask the patients to do dorsiflexion with computer, myoelectric measurement part
of foot. The EMG will be showed on the fluo- should be isolated from computer and the com-
rescent screen when active contraction of tibialis puter should conform to relevant safety standards.
anterior muscle and the patients will know their
shortcomings. In the next training, they will con- 1.4.3.2 Electrode
centrate on the dorsiflexion of foot consciously The electrodes are used to measure and record the
and obtain lasting effect after repeated training. electrostatic phenomena of living body, which
include microelectrode, surface electrode and
needle electrode. Surface electrodes are usually
1.4.3 Equipment Types used in myoelectric biofeedback. Biopotential is
of Myoelectric Biofeedback the potential difference between two electrodes,
which can be conducted through the skin sur-
1.4.3.1 Government Standard face with one or two recording electrodes and a
of Myoelectric Biofeedback grounding electrode.
The Definition of Myoelectric Biofeedback 1.4.3.3 Neuroeducator III

Equipment 1. Principle Neuroeducator III is one kind of

Myoelectricity is used as physiological informa- myoelectric biofeedback equipment used for
tion that can feed back to the patients for treating neurological training rehabilitation. The sig-
psychosomatic disorder and equipment of reha- nal is extracted through root mean square of
bilitation therapy through vision or audio. potential that is less than 0.2 μV noise level
and the bandwidth are 10–1000 Hz, which is 1.4.3.5 Other Equipment

obtained from analysis of surface electromyo- of Myoelectric Biofeedback
gram signal that is less than 140 dB. The sig- There are other equipments of myoelectric bio-
nals are combined in order to exceed 0.1 s and feedback such as JD-2A myoelectric biofeedback
are measured as μVs. The data of every one- equipment, ABD2100S myoelectric biofeedback
tenth second at present is displayed on the equipment and so on. However, feedback infor-
color display in continuous curve (see mation of most equipment is showed as number
Fig. 1.1). Myoelectric signals are presented to form, which is different from curve display that
the patients in visual form. The equipment is visual and dynamic. The level of training target
includes four signal channels that can be used cannot be set in this equipment.
to display four different myoelectric signals at
the same time. Ag-AgCl surface electrode is
used in this equipment. 1.4.4 Advantages and Shortages
2 . Functions of Myoelectric Biofeedback
–– Neuroeducator III includes many parame- Technology
ters that can be set up manually
–– Patient name and training part Biofeedback technology, especially myoelectric
–– Single screen or double-screen display biofeedback had a prominent therapeutic effect
–– Screen time limit and potential upper on the contraction of voluntary muscles training,
bound which was regarded as one of the new medical
–– Curve color of myoelectric signals; altitude achievements in twentieth century.
value and color of training goal line The advantages of myoelectric biofeedback
–– Sound switch technology are as follows:
–– Switch of electrocardio filtration system In myoelectric biofeedback technology, sur-
–– Data storage and extraction face electrode or needle electrode can be used
to transform imperceptible myoelectric signals
1.4.3.4 AM800 Therapeutic Equipment into visual signal or auditory signal in real time.
of Neural Network The signal can be used for precise judgment
Reconstruction and provide scientific basis for pertinent thera-
AM800 can skillfully combine EMG and neuro- peutic schedule. The patients will be more and
muscular electrical stimulation, which can detect more confident during treatment because of the
the extremely subtle EMG generated by nerve improvement of training.
cells of the patients with stroke. When the EMG Comprehensive indications: Myoelectric bio-
signal reach or exceed the setting domain of feedback technology can be used for various dis-
AM800, the equipment will emit electric stimu- eases such as mental and psychological diseases,
lus and the patients will have a functional muscle neuromuscular system diseases. It also can be
contraction. The main effects are as follows: used for excitation and flaccidity of palsy muscle,
motor coordination training.
• It is widely used for the hemiplegia patients The training content should include mental
after stroke to reconstruct cerebral neural regulation and encouraging words. The therapists
network. should arouse the enthusiasm of the patients to
• Making the paralytic limbs to recover achieve the required target, which is good for
functions. the motor function recovery on the basis of CNS
• Through cognitive re-learning, the residual function recovery.
nerve cells after stroke can regrow and recon- Biofeedback signal (myoelectric signal) is in
struct new neural network. direct proportion to myodynamia within limits.
• Detecting the feedback of EMG and proceed- Therefore, it can be used as the indicator of func-
ing automatic electrical stimulation therapy. tional assessment.
References 31
Painless. struction equipment. Because of the movement

No time limit after injury. facilitation and movement substitution effect
Although some reports showed that biofeed- of electric stimulus, active movements will be
back had good therapeutic effect, up to this day reduced, which is adverse to neural potential
this technology was not widely popularized and development. In addition, the therapists don’t
applied, which was still not the main rehabilita- realize reconstruction of motor program in the
tion technology. The reasons are as follows: application of biofeedback therapy, which has a
The mechanism of biofeedback therapy is still strong impact on therapeutic effects.
unclear. That the feedback signal of the training Limited training part: Myoelectric biofeed-
is myoelectricity showed that myoelectric sig- back therapy is dependent on surface electrode
nals are generated from muscle contraction and that receives the drive signal from brain to mus-
the signal enhancement represent myodynamia cle. The electrode should be placed on the surface
strengthen. Because the therapists don’t know that of trained muscle and it is difficult to treat the fine
only recovery of CNS function can recover motor part such as hand, foot, rim of the eye and so on.
function, the training methods and time are unable Patients’ selectivity: the therapy required good
to satisfy the demand of CNS plasticity and func- compliance of patients and the patients should
tional organization. The biofeedback therapy was take part in the therapy actively. Therefore, it is
applied incorrectly, which had a bad effect on the not applied for the patients with severe dysgnosia
therapeutic effect. For example, some therapists or coma.
used the equipment merely as electrical stimula- Even so, myoelectric biofeedback can pro-
tion instrument and there were no mental regula- vide real-time visual and audio feedback signals.
tion and encouraging words during treatment. Therefore, the patients can do the training with
The therapeutic effect of biofeedback is exag- a purpose. When the signals are in comovement
gerated. For example, in Brucker myoelectric relationship with the drive signal from CNS to
biofeedback therapy, there are 15 therapeutic the joint muscle in the active joint motion, if the
times (one time a day) in one course of treatment therapists use motor program to analyze the sig-
and there are 50 min in every time. The total time nals and use the method of abnormal motor pro-
in one course of treatment are 12.5 h, which go gram correction to reconstruct motor program,
against the reality that reconstruction of motor these will improve the CNS plasticity, func-
function in higher evolved species take a long tional reorganization and motor function recov-
time. It is difficulty to improve lost motor func- ery. These procedures are combined with other
tions after central lesion in this therapy. Even if rehabilitation methods, which can be used for
there are therapeutic effects, it is hard to be con- rehabilitation training, increase practical applica-
solidated in 15 therapeutic times (one time a day) tion and value of biofeedback and promote the
in one course of treatment. The effects of this development of rehabilitation medicine.
therapy were deemed to be not good over time.
Biofeedback technology failed to combine
with other rehabilitation techniques. As an inde- References
pendent treatment item, the application of bio-
1. Bin G. Adams and Victor’s principles of neurology.
feedback technology cannot satisfy the demand
Beijing: People’s Medical Publishing House; 2002.
of motor function recovery. Because recovering p. 53–5.
motor functions requires all-around training, only 2. Hong D, editor. Rehabilitation medicine. Beijing:
the muscle training is far from enough. In addi- Peking University Medical Press; 2004. p. 26.
3. Duus P. Duus’ Neurologisch-topische Diagnostik
tion, there are no specific indications and contra-
Anatomic Funktion Klinik. Beijing: Navy Press; 2000.
dictions in the application of biofeedback therapy. Translated by Liu Zonghui, Hu Weiyi, Duan Guosheng
Recently, myoelectric biofeedback tends to 4. Guangdi D. Various pathogenic designate theory.
functional electric stimulus. Therefore, some bio- Beijing: People’s Medical Publishing House; 1993.
p. 12.
feedback therapeutic equipments are with elec-
5. Keji C. Traditional Chinese rehabilitation medicine.
tric stimulus functions such as AM800 made in Beijing: People’s Medical Publishing House; 1988.
Denmark and homemade neural network recon- p. 170–1.
The Formation of Neurological
Training Rehabilitation System 2
2.1 The Modernization 2.1.1 Theoretical Foundation

of Daoyin Technique of the Modernization
in Traditional Chinese of Daoyin Technique
Medicine in Traditional Chinese
Medicine
Although Daoyin technique has been developed
for thousands of years and it contributed to the The meaning of rehabilitation is a process to
development of rehabilitation medicine of tradi- recover original functions through various mea-
tional Chinese medicine, ancient Daoyin tech- sures and means such as recreation, medical
nique in traditional Chinese medicine was short treatment, functional training and rehabilitation
of vigor and substantial changes in the long medicine engineering. In clinical rehabilitation,
development process. Especially, Daoyin tech- rehabilitation include exercise, cognition, speech
nique does not combine with new medical the- and mentality, but usually point to motor func-
ory and not advance with times. From orchestic tion recovery. Motor function recovery includes
Daoyin technique that focused on longevity to nervous system dyskinesia, bone and joint dys-
whole self-training way that focused on health kinesia and muscle injury dyskinesia. All tissues
maintenance and included eight trigrams boxing, and organs of human body are possessed with
five-animal boxing, shadowboxing and Qi gong, huge functional reserve. It not only satisfies the
the progress of Daoyin technique is stuck and it is demand of daily life, but also deals with contin-
not applied for clinical rehabilitation. gencies. The basis of functional reserve is tissues
Therefore, we should enlarge the application and cells. For example, people can strengthen
range and use value of Daoyin technique and muscle force and endurance obviously through
should not stand still and refuse to make prog- training. After training, people can complete
ress. We must combine Daoyin technique with unaccomplished movements before training and
modern medical theory and methods, improve improve athletic performance, etc. Therefore, for
it on the basis of inheritance and make Daoyin the patients with hemiplegia or cerebral palsy
technique promote motor function recovery on after central damages, the lost functions can be
the basis of CNS function recovery. Meanwhile, recovered to varying degrees through proper
we start therapeutic effect validation and mecha- rehabilitation training [1].
nism research, which will provide theoretical However, in the process of recovering and
basis and clinic trial basis for long-term develop- improving human functions, there is a com-
ment and renaissance of Daoyin technique. mon phenomenon that only active movements
https://doi.org/10.1007/978-981-13-0812-3_2
34 2 The Formation of Neurological Training Rehabilitation System
(especially the concentrated active movements) them is that in western medicine brain dominates
can recover and improve human functions. This the muscles responsible for body movements
is an undeniable fact in daily life. The reason why through neural electrical signal and in traditional
the active movements can improve functions is Chinese medicine the house of mentality domi-
that active exercise conform to the “skillful use nates body movements through Qi in main and
and dependence” principle that can promote CNS collateral channels. Both the electric signals in
plasticity. western medicine and Qi in traditional Chinese
Not all the people that do active exercise medicine are one kind of messenger that trans-
are instructed by Daoyin technique. However, mits the signal from brain to muscles and are one
they all know they should concentrate on train- kind of energy forms. If the house of mentality
ing, which is possessed with regulation of mind or brain is damaged, the cradle of messenger is
and breathing to a certain extent. Perhaps under damaged. Because the messenger is decreased or
correct Daoyin technique, active exercise can disappear, body movement may be lost to vary-
have better effect and the time spent is shorter. ing degrees. Now that both the electric signals
Basic technique that the regulation of movement and Qi are one kind of energy forms, they can
is based on the regulation of mind and breath- be detected and received in real time, analyzed
ing is a completed method of concentration and and demonstrated in a visual form. It provides
active exercise training. Besides, the regulation theoretical basis and feasibility for realization of
of movement in Daoyin technique is in accor- objective indicator of Daoyin technique.
dance to main and collateral channels. Therefore,
Daoyin technique is a completed method of con-
centration and active exercise training with of 2.1.2 T
he Formation and Specific
traditional Chinese medicine characteristic. It is Operational Approach of Six-
a scientific method that is completely in confor- Step Daoyin Technique
mity with modern CNS plasticity and functional
reorganization theory, which provides solid prac- Although entirely active exercise guided by
tice foundation and theoretical basis for modern- Daoyin technique can better promote motor
ization of Daoyin technique. function recovery after brain function reorgani-
Short of the objective indicator of therapeu- zation. However, limited by the ancients’ medi-
tic effect is one of the key factors that influence cal knowledge, the operating methods of Daoyin
the development of Daoyin technique. If there technique are whole movements such as immor-
are objective indicators that can demonstrate the tal guiding and the zoomimic movements, which
therapeutic effect of Daoyin technique, the thera- don’t conform to the “from easy to difficulty and
pists can set a target for the patients to catch up step by step” principle of rehabilitation training.
with and surpass and let the patients do targeted It can influence the clinical use.
training. The objective indicator can improve the According to development of CNS potential
effect of Daoyin technique and make it become and clearing and activating the channels and col-
a training method that can be used in clinical laterals, ancient Daoyin technique was modified
rehabilitation. to six-step Daoyin technique, which was applied
In traditional Chinese medicine, brain is the for rehabilitation training of single muscle con-
house of mental activity, and in western medicine, traction and single joint motion. Six-step Daoyin
brain is the advanced central nervous system that technique was not only used for patients with
control general movements. Whether nerve in slight symptom, but also the patients with severe
western or main and collateral channels in tra- diseases. According to the pathway difference
ditional Chinese medicine, the common point of the regulation of mind, Six-step Daoyin tech-
is that brain has a close relationship with body nique was divided into normal technique and
movements and brain is the highest center that six-step Daoyin technique guided by main and
control body movements. The difference between collateral channels. The two methods can be used
2.1 The Modernization of Daoyin Technique in Traditional Chinese Medicine 35
separately or be used in combination in order to “Qi” concentrate on the muscle of joint motion
satisfy different clinical demands of the patients through main and collateral channels. The thera-
and avoid vanpidity of singular method in the pists instructed the patients to be in a “Lock and
training. Load” state. According to the main and collateral
channels, this method is divided into the common
2.1.2.1 The Specific Procedures of Six- method and the method of main and collateral
Step Daoyin Technique channels.
The formation of six-step Daoyin technique is
dependent on the basis of regulation of mind, 1. The common method “vigor” assembly of six-
breathing and movements. Motor imagery and step Daoyin technique
imitation, concentration on one point, clearing On the basis of breathing regulation, rid-
and activating the channels and collaterals with ding distraction and mental relaxation, the
sudden release of Qi, resistance exercise and therapists instructed the patients (or the
speech inspirations, exploring the neural poten- patients trained themselves) to concentrate and
tials are used in this technique. The rehabilitation assemble “vigor” and “Qi” from the uninjured
principle is step by step and the specific proce- side limbs to injured side brain or to contralat-
dures are as follows: eral brain of the mobile joint. For example, if
the patients want to exercise the left hip joint,
Motor Imagery and Imitation they will assemble “vigor” to right brain. On
The therapists explained the patients in detail and the contrary, the patients will assemble “vigor”
straightaway that electric signal were released to left brain. Assembly of the “vigor” to the
by brain to control body movements and CNS injured side brain can stimulate the injured
functions recovery should be followed by lost side brain through the energy flow carried by
motor functions after central damages. In the “vigor” in order to promote resurgence of
basis of characteristics of CNS function recovery, brain cells in penumbral area in which there
the therapists instructed the patients to do joint are surviving cells around damage zone. The
motion of uninjured side limbs (dorsiflexion of patients can actively concentrate on using
foot). Afterwards, the therapists let the patients injured side brain in order to promote the CNS
to do the same joint motion of injured side limbs plasticity and functional reorganization.
imitating the uninjured sides. The therapists 2. “Vigor” assembly of six-step Daoyin tech-

should guide the patients to image the normal nique through main and collateral channels
joint motion mode in injured side. Therefore, This method is divided into the dredging
the correct motor imagery is constructed and the meridians through collaterals method and the
training content and the target are clear. dredging collaterals through meridians, which
highlight the traditional Chinese medicine
Setting Target characteristics of six-step Daoyin technique.
The therapists advised the patients to use “vigor” Dredging the main and collateral channels is
on the targeted muscles such as the tibialis ante- similar with dredging a river. The water in the
rior muscle in dorsiflexion of foot and triceps river likes the “Qi” in the main and collateral
muscle of arm in elbow extension. One joint channels. Qi is the information flow between
motion is done for each time and the target is one brain and viscera. If the river is stagnated,
muscle. The principle should be from easy to dif- people cannot live without water. If the main
ficulty and training the muscle one by one. and collateral channels are stagnated, the
information cannot be exchanged and the vis-
“Vigor” Assembly cera cannot work correctly. If the river can be
In a warm, lucifugal and quiet room, through dredged from two sides, the blockage will be
relaxing meditation, breathing regulation, the loosened easily and be removed. The river is
patients used mind to make the “vigor” and clear and can deliver water. The obstructed
main and collateral channels can be dredged instructed to guide Qi from ulnar side of the
easily from two sides and recover the infor- third finger to the muscle belly of triceps
mation conduction and exchange between muscle of arm through the reverse side of
brain and viscera. wrist and the space between radius and ulna
According to the orientation of Qi in the of forearm. Qi is in a “Lock and Load” state
main and collateral channels, Daoyin tech- and then into a cocking state. The conduction
nique is divided into the dredging meridians flow of joint motion through main and col-
through collaterals method and the dredging lateral channels is showed in Table 2.1
collaterals through meridians method. The (Figs. 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9,
dredging collaterals through meridians are 2.10, and 2.11).
based on the regulation mind and breathing.
The patients are instructed to guide Qi to the Trigger
targeted muscle and do joint motion. The patients are instructed to regulate their breath
Afterwards, the patients guide Qi through and take a deep breath. Afterwards, the patients
meridians until the Qi is scattered in collater- are guided to give out “vigor” to the targeted
als. On the contrary, the dredging meridians muscle suddenly. Contraction of the targeted
through collaterals method are based on the muscle leads to corresponding joint motion such
regulation of mind and breathing. The patients as dorsiflexion of foot and elbow extension. The
are instructed to guide Qi from the end of the patients concentrate on one muscle. There is a
collaterals to the targeted muscles and then do sentence in art of war that the army should attack
corresponding joint motion. Afterwards, the one point with superior force in order to develop
patients guide Qi through collaterals until the the function of Daoyin technique and achieve
Qi is scattered in meridians. good effect.
However, whether the dredging meridians Trigger is the important procedure of Daoyin
through collaterals method or the dredging technique. The patients are guided to release
collaterals through meridians method, they accumulative energy flow (Qi) to targeted muscle
both are the process of clearing and activating suddenly, which is vital for the CNS plasticity.
the channels and collaterals dominated by Just as the process of pulling the trigger, the bul-
brain. Through training, it can promote the lets are ejected from the bore with high energy
ability of the brain to dominate the process of and high initial velocity in order to hit the ulterior
clearing and activating the channels and col- target easily.
laterals. This is similar with the process that The common Daoyin speeches are as follows:
training can promote CNS plasticity and func-
tional reorganization in western medicine. • The therapists asked the patients: “Are you
The two methods can be used alternatively ready?”
in the training. Comparing the beginning of • The patients say “Yes” or nodding.
the meridians or the end of collaterals with • The therapists say “good, pay attention” and
the movable joint, if the distance between the raise their voice suddenly (a powerful low
movable joint and the beginning of meridians voice) “Get up”.
is shorter, the dredging collaterals through • The patients concentrate on the contraction of
meridians method are used. If the distance targeted muscle and lead the joint to the
between the movable joint and the end of col- designed orientation.
laterals is shorter, the dredging collaterals • If the therapists instruct the patients torpidly
through meridians method are used. For and say “Get up” in a powerless low voice, the
example, in the training of elbow extension, patients’ enthusiasm and passion cannot be
the target is triceps muscle of arm, which enlightened and the contraction of the targeted
belongs to the Tri-energizer Meridian of muscle and corresponding joint motion cannot
Hand-Shaoyang. Using mind, the patients are be induced.
Table 2.1 The conduction flow of joint motion through main and collateral channels
The name of main and
Joint motion collateral channels The beginning and the end
Shrug The Small intestine Contraction: outside of little finger (Shaoze)–ulnar side of palm (Qiangu)–
Meridian of capitulum ulnae (Yanglao)–elbow (Xiaohai)–shoulder joint (Jianzhen)–
Hand-Taiyang musculus levator scapulae
Relaxation: musculus levator scapulae—the seventh cervical vertebra
(Dazhui)–heart meridian—stomach (Zhongwan)–small intestine
Shoulder The Large Intestine Contraction: the end of index finger (Shangyang)–radialis index finger
abduction Meridian of (Erjian)–the space between the first metacarpal and the second metacarpal
Hand-yangming (hegu)–radialis forearm (Pianli)–outside of the elbow (Quchi)–outside of the
upper arm (Binao)–deltoideus triangularis
Relaxation: deltoideus triangularis—the seventh cervical vertebra (Dazhui)–
supraclavicular fossa (Quepen)–lung meridians—large intestine
Elbow extension The Tri-energizer Contraction: the end of the third finger (Guanchong)–the reverse side of wrist
Meridian of (Yangchi)–forearm (Waiguan)–the upper arm (triceps muscle of arm)
Hand-Shaoyang Relaxation: triceps muscle of arm—shoulder (Jianliao)–the central region of
mediastinum (Danzhong)–pericardium
Elbow flexion Lung channel of hand Contraction: middle burner–stomach–lung–throat–oxter (Yunmen)–the upper
restoration taiyin arm (bicipital muscle of arm)
Relaxation: bicipital muscle of arm—chelidon (Chize)–Yuji—the end of
thumb (Shaoshang)
Wrist extension The Tri-energizer Contraction: the end of the third finger (Guanchong)–the reverse side of wrist
Meridian of (Yangchi)–forearm (extensor carpi)
Hand-Shaoyang Relaxation: extensor carpi—forearm (Waiguan)–shoulder (Jianliao)–the
central region of mediastinum (Danzhong)–pericardium
Wrist flexion Pericardium channel Contraction: thorax cavity and pericardium—axilla (Tianchi)–the upper arm
restoration of hand jueyin (Tianquan)–elbow center (Quze)–forearm (flexor muscle of wrist)
Relaxation: flexor muscle of wrist—the centre of the palm (Laogong)–the end
of the middle finger (Zhongchong)
Hip flection The Stomach Contraction: the side of ala nasi (Yingxiang)–inner canthus (Jingming)–upper
Meridian of teeth and ring lip (philtrum)–supraclavicular fossa (Quepen)–2.6 in. outside
Foot-yangming of ventrimeson (Guanmen)–groin (Qichong)–hip flexor
Relaxation: Hip flexor—outside of tibia (Zusanli)–acrotarsium (Chongyang)–
the inside of middle toe (Neiting)–outside of the second toe (Lidui)
Knee extension The Stomach Contraction: the side of ala nasi (Yingxiang)–inner canthus (Jingming)–upper
Meridian of teeth and ring lip (philtrum)–supraclavicular fossa (Quepen)–2.6 in. outside
Foot-yangming of ventrimeson (Guanmen)–groin (Qichong)–hip joint (Biguan)–the front of
the thigh (quadriceps femoris)
Relaxation: quadriceps femoris—outside of tibia (Zusanli)–acrotarsium
(Chongyang)–the inside of middle toe (Neiting)–outside of the second toe
(Lidui)
Strephexopodia The Gallbladder Contraction: outer canthus (tongziliao)–post aurem (Tianchong)–the seventh
Meridian of cervical vertebra (Dazhui)–oxter (Yuanye)–hip joint (Huantiao)–the outside
foot-Shaoyang of knee (Xiyangguan)–the outside of crus (peroneus longus and brevis
muscles)
Relaxation: peroneus longus and brevis muscles–lateral malleolus (Qiuxu)–
acrotarsium—the outside of the fourth toe (Diwuhui)
Dorsiflexion of The Stomach Contraction: the side of ala nasi (Yingxiang)–inner canthus (Jingming)–upper
foot Meridian of teeth and ring lip (philtrum)–supraclavicular fossa (Quepen)–2.6 in. outside
Foot-yangming of ventrimeson (Guanmen)–groin (Qichong)–hip joint (Biguan)–the outside
of tibia (Zusanli)–the front of crus (tibialis anterior muscle)
Relaxation: tibialis anterior muscle—acrotarsium (Chongyang)–the inside of
middle toe (Neiting)–outside of the second toe (Lidui)
Lumbodorsal The Urinary Bladder Contraction: inner canthus (Jingming)–the top of the head (Tongtian)–Brain
muscle Meridian of collaterals (Yuzhen)–the side of the seventh cervical vertebra (Dashu)–around
Foot-Taiyang the inside of the scapula–lumbodorsal muscle (Shenshu)
Relaxation: lumbodorsal muscle (Shenshu)–kidney collateral
Taiyang Small Intestine Channel of Hand
Contract Relax
musculus levator scapulae

the ulnar aspect of the little finger (Shàozé SI 1)
(Dàzhui GV14)
^
the palmar ulnar end of the wrist(Qiángu SI 2) the cervical vertebra
shoulder(Jianzhen SI9) (Dàzhui GV14)
heart
^ ^
capitulum ulnae(Yanglao SI 6)
^ ^
elbow(Xiaohai SI8)
heart
^ ^
intestine
elbow(Xiaohai SI 8)
^ ^
captitulum ulnae(Yanglao SI 6)
^
stomach(Zhongwan CV12)
shoulder(Jianzhen SI 9) the ulnar aspect of the little finger(Shàozé SI1)
intestine
musculus levator scapulae
Fig. 2.1 Shrug of six-step of the dredging collaterals through meridians
Yangming Large Intestine Channel of Hand

Contract
Relax
the end of index finger(Shangyáng LI 1)

deltoid muscle
the cervical vertebra

(Dàzhui GV14)
the radial side of the index finger end(Erjian LI 2)
the cervical vertebra
(Dàzhui GV14)
^ lung
between the 1st and 2nd metacarpal bones(Hégu LI 4)
the radial side of the forearm(Pianlì LI 6) supraclavicular fossa

lateral of the elbow(Quchi LI 11)
(Quepén ST 12)
lateral of the elbow(Quchí LI 11) large intestine
lung
^
(Hégu LI 4)
lateral of the upper arm(Bìnào LI 14)
large intestine
the end of index finger(Shangyáng LI 1)
deltoid muscle
Fig. 2.2 Shoulder abduction of six-step of the dredging collaterals through meridians
Shaoyang Sanjiao Channel of Hand
Contract Relax
triceps muscle of arm
the end of the ring finger

(Guanchong TE1)
Jianliáo TE14
shoulders
Dànzhong CV17
the back of the wrist
(Yángchí TE4)
^
Tianjing TE10
mediastinum(Dànzhong CV17)
forearm(Wàiguan TE5)
Wàiguan TE5
the upper arm(triceps muscle of arm) Yángchí TE4
pericardial membrane
pericardium
Guanchong TE1
Fig. 2.3 Elbow extension of six-step of the dredging collaterals through meridians
Taiyin Lung Channel of Hand
Relax
Contract
middle-jiao Biceps brachii
throat
Yúnmén Lu2
stomach ^
chelidon (Chizé LU5)

lung
lung
middle-jiao ^
Chizé LU5 Yújì LU10
throat
oxter (Yúnmén Lu2) Lièque LU7

end of the thumb
(Shàoshang LU11)
the upper arm (Biceps brachii) (Shàoshang LU11)
Fig. 2.4 Elbow flexion restoration six-step of the dredging collaterals through meridians
Shaoyang Sanjiao Channel of Hand

Contract Relax
extensor carpi
end of ring finger

(Guanchong TE1)
forearm (Wàiguan TE5)
Jianliáo TE14
Danzhong CV 17
shoulders (Jianliáo TE14)
the back of the wrist ^
(Yángchí TE4) Tianging TE10
middle mediastinum
(Danzhong CV 17)
Yángchí TE4
forearm (extensor carpi)

pericardium
Fig. 2.5 Wrist extension of six-step of the dredging collaterals through meridians
Jueyin Pericardium Channel of Hand

Contract
Relax
pericardium flexor muscle of wrist
armpit (Tianchí PC1)
the centre of the palm

(Láogong PC8)
the upper arm Tianchí PC1
(Tianquán PC2) Quzé PC3
elbow (Quzé PC3)
end of middle finger

(Zhongchong PC9)
forearm (flexor muscle of wrist)
Zhongchong PC9
Fig. 2.6 Wrist flexion of restoration six-step of the dredging collaterals through meridians
Yangming Stomach Channel of Foot

Contract Relax
nose (Yíngxiang LI20) Jingmíng BL1 hip flexor
Yíngxiang LI20
Quepén ST 12
inner canthus ^
the lateral tibia (Zúsanli ST36)
(Jingmíng BL1)
upper teeth (Renzhong)

Guanmén ST22
acrotarsium (Chongyáng ST42)
supraclavicular fossa (Quepén ST 12)

Qìchong ST30
beside the belly line (Guanmén ST22) in the medial plantar (Nèitíng ST44)
inguen (Qìchong ST30)
^ the outside of second toe(Lìduì ST45)

Zúsanli ST36
hip flexor
Chongyáng ST42
Lìduì ST45
Fig. 2.7 Hip flection of six-step of the dredging collaterals through meridians

Contract Relax
nose (Yíngxiang LI20) Jingming BL1 hip flexor

Yingxiang LI20
Quepén ST 12
inner canthus ^
(Jingmíng BL1)

Guanmén ST22
acrotarsium (Chongyáng ST42)
supraclavicular fossa (Quepén ST 12)

Qìchong ST30
beside the belly line (Guanmén ST22) in the medial plantar (Nèitíng ST44)
^ the outside of second toe(Lìduì ST45)

Zúsanli ST36
hip (Bìguan ST30)
Chongyáng ST42
at the front of the thigh (quadriceps)
Lìduì ST45
Fig. 2.8 Knee extension of six-step of the dredging collaterals through meridians
Shaoyang Gallbladder Channel of Foot
Contract
Relax
^
^
Tóngziliáo GB1
outer canthus (Tóngziliáo GB1)
fibula
post aurem (Tianchong GB9)

Dàzhui GV14
lateral malleolus (Qiuxu GB40)
the cervical vertebra (Dàzhui GV14)
Yuanyè GB22
armpit (Yuanyè GB22)
along
hip (Huántiào GB30) Huántiào GB30 the
foot
back
the outside of knee(Xiyángguan

GB33) Xiyángguan
Yánglíngquán GB34
the outside of the fourth toe
^
Wàiqiu GB36 (Diwuhuì GB42)
the lateral crus(fibula)

^
(Dìwuhuì GB42)
Fig. 2.9 Strephexopodia of six-step of the dredging collaterals through meridians
Insistence you did great, four, five, six.” When encourag-

The patients are instructed to induce muscle con- ing the patients, the therapists use words to cre-
traction and corresponding joint motion through ate state of emergency such as “hold on or you
trigger. Meanwhile, the therapists use hands to will fall down” and “lift up or you will crash”.
provide resistance on the orientation of the joint The therapists encourage and urge the patients to
motion such as the metatarsophalangeal joints in complete the required joint motion. This process
dorsiflexion of foot and the rear side of forearm, is essential for developing the neural potential.
even if the myodynamia is zero. The therapists State of emergency can stimulate the patients
let the patients to find the target and orientation into proximal response state. Under proximal
of the released signal easily. The opportunity response state, the strength of muscle power
of exerting resistance is that the patients flex is six times of that in normal state. Proximal
or extend the joint to the maximum angle. The response state can improve myodynamia in dif-
strength of the exerted resistance is dependent on ferent degree. The increase in the muscle power
the intensity of the patients’ myodynamia. The is related to the development of CNS potential.
patients can resist the resistance and the joint In addition, under the anti-resistance condition,
motion angle cannot be reduced. When exerting the patients hold on one more second that is a
resistance, the therapists encourage the patients process to develop a little more potential, activate
to hold on for 6 s. This procedure can be com- more new brain cells and promote a little more
pleted using counting such as “one, two, three, recovery of motor function.
Contract Relax
nose (YingxiangLI20)
Jingmíng BL1
inner canthus Yíngxiang LI20

Quepén ST 12
(Jingmíng BL1)
^
Guanmén ST22
supraclavicular fossa (Quepén ST 12) acrotarsium (Chongyáng ST42)
Qìchong ST30
beside the belly line (Guanmén ST22)
in the medial plantar (Nèitíng ST44)

hip (Bìguan ST30)

^ the ouside of second toe(Lìduì ST45)
Zúsanli ST36
Chongyáng ST42
the lateral crus(fibula)
Lìduì ST45
Fig. 2.10 Dorsiflexion of foot of six-step of the dredging collaterals through meridians
Taiyang Bladder Channel of Foot
Contract Relax
^
Baihuì GV20
inner canthus
(Jingming BL1)
Tongtian BL7 Jingmíng BL1 waist and back muscle (Shènshu BL23)
the top of the head

(Tongtian BL7) Dàzhù BL11
^
brain (Yúzhen BL9)
the cervical vertebra (Dàzhù BL11)

Huántiào GB30
along inner shoulder blades
kidney
waist and back muscle (Shènshu BL23)
Fig. 2.11 Lumbodorsal muscle of six-step of the dredging collaterals through meridians.
Relaxation tory is from 1 to 5 years. The patients are divided

Relaxation method is divided into the normal into six step group and control group. There are
method and relaxation method of dredging col- 30 patients in each group.
laterals through meridians.
1. Six-step group: There are 18 males and 12
1. The normal relaxation method females. The age range is from 35 to 76 years
After the end of movements, the therapists old. The mean age is 48.4 years old. The med-
guide the patients to take a deep breath and ical history is from 19 to 59 months. The mean
breathe out quietly. The ratio of expiration medical history is 40 months.
time to inspiration time is 1:2. The patients 2. Control group: There are 16 males and 14
keep relaxed wholeheartedly in order to allay females. The age range is from 34 to 71 years
tiredness and be beneficial to next movement. old. The mean age is 47.8 years old. The med-
2. After one time of Daoyin technique training, ical history is from 12 to 60 months. The mean
therapists are instructed to do joint motion medical history is 42 months.
passively and muscle massage in order to alle-
viate synarthrophysis and promote blood cir- Therapeutic Method
culation of muscles. And then the patients will In six-step group, the six-step Daoyin technique
do the second training. The frequency of train- is used to instruct the patients to do dorsiflex-
ing is dependent on the patients’ ability and ion of foot actively once a day. Every time takes
6–8 times per 15 min is appropriate. 45 min and the total times are 30 times. In control
The relaxation method of dredging collat- group, dorsiflexion of foot promotion method of
erals through meridians. Brunnstrom is used in this training, which includes:
After the anti-resistance movements, the
therapists guide the patients to take a deep 1. Bechterev/Marie-Foix reflection: The thera-

breath and during the slow expiration the pists press the patients’ toes for plantar flexion
patients can make Qi circulate in residual merid- in order to drag muscle spindle of plantar dor-
ians. The ratio of expiration time to inspiration siflexor. This reflection can induce dorsiflex-
time is 1:2. The patients guide Qi to circulate in ion of toe, dorsiflexion of foot, kneebend and
residual meridians and finally disperse in col- body bent at hips. The time of during is
laterals. For example, in the movement of elbow 15 min.
extension, after completion of anti-resistance, 2. Finger percussion: The therapist use finger to
the patients are instructed to guide Qi along the rap lateral dorsum of foot quickly in order to
shoulder to disperse in pericardium through facilitate ankle dorsiflexion. The time of dur-
Tanzhong. Qi in the relaxation method of dredging is 15 min.
ing meridians through collaterals finally dis- 3. Hairbrush stimulation: The therapist use hair-
perse in the beginning of the meridians. brush to stimulate lateral dorsum of foot. It
takes 30 s once. It is enough to induce foot
dorsiflexion reflex. The time of during is
2.1.3 Controlled Clinical Trial 15 min. Three kinds of treatments take 45 min
of Six-Step Daoyin Technique (once a day, 30 days).
2.1.3.1 Methods and Data Functional Assessment

International universal Lovett MMT, ankle ROM
General Data and Grouping and Fugl-Meyer are used for ankle dorsiflexion
From June 2006 to June 2008, in neurological functional assessment method (zero: incapable of
training rehabilitation center of Beijing Tongren dorsiflexion actively; one point: partial dorsiflexion;
Hospital, we selected 60 stroke patients with two points: full dorsiflexion) and detection of elec-
hemiplegia and pendency foot. The medical his- tromyographic signal (Neuroeducator III produced
by Therapeutic Alliances in America, 3 M Ag-AgCl Discussion

surface electrode) in tibialis anterior muscle. Necrocytosis of axoneuron can lead to dyskine-
The assessment should be proceeded before treat- sia of limbs. The key point of treatment is the
ment and at the end of treatment. functional recovery of axoneuron. Because the
axoneuron is unable to regenerate itself, the lost
Statistical Analysis functions after central damages should be com-
After the completion of all the experiments, pensated by the normal cells around the injured
Epidata 3.02 software is used to create database area. The standby conduction pathway is acti-
and all the data requires double entry and vali- vated to replace the functions (development
dation. SPSS 12.0 is used as statistical software and utilization of neural potentials) of injured
for the comparison of functional assessment cells. The CNS contains great potentials that
score within group before and after treatment and originate from numerous cells and synapses and
T-Test analysis of comparison between groups in is the basis of recovery of limbs motor func-
control group and six-step group. tions through training after central damages.
Therefore, development of neural potentials is
Results the key of recovery of motor functions after cen-
Statistical analysis of four assessment indicators tral damages [2].
in six-step group demonstrated that there was sig- CNS potentials are the results of CNS plas-
nificant difference between the data after treat- ticity and functional reorganization. However,
ment and that before treatment (P < 0.01). There the plasticity of nervous system is based on the
was significant difference between the data of “skillful use and dependence” principle, which
electromyographic signal after treatment and means only active limbs movements can induce
that before treatment in control group (P < 0.05). plasticity of motor cortex function and then
There was no significant difference in the data of improve the motor functions of limbs [3].
other three indicators in control group (P > 0.05). Traditional rehabilitation techniques that
Before treatment, there was no significant differ- include Bobath, Rood and Brunnstrom are based
ence in comparison among groups of four indi- on passive movement, primitive reflex and affer-
cators. There was significant difference of four ent stimulus. Reflex of lower nerve center such
indicators between control group and six-step as myotatic reflex and tonic neck reflex are used
group after treatment (P < 0.01, see Table 2.2). to induce reflex movement of limbs, which is not
in accordance with the “skillful use and depen-
Conclusion dence” principle required for plasticity of CNS
Six-step Daoyin technique is an effective reha- functional reorganization. This may be the rea-
bilitation method that is in accordance with son why the therapeutic effects of these rehabili-
motor functions recovery mechanism after CNS tation methods are not satisfying. For example,
damages. foot drop of stroke patients with hemiplegia is
Table 2.2 Functional assessment comparison table of within group and between group before and after training
( x ± s)
Assessment item Group Before training After training Within group p Between group p
Myodynamia Six-step group 1.32 ± 0.65 3.62 ± 1.21 <0.01 <0.01
Control group 1.31 ± 0.47 2.13 ± 101 >0.05
Myoelectric signal (μV) Six-step group 26.18 ± 8.36 87.31 ± 23.66 <0.001 <0.05
Control group 27.32 ± 10.54 43.18 ± 8.36 <0.05
Joint range of motion (°) Six-step group 9.23 ± 2.36 18.43 ± 2.68 <0.001 <0.01
Control group 10.12 ± 2.36 13.47 ± 4.36 >0.05
Fugl-Meyer Six-step group 0.43 ± 0.50 1.7 ± 0.47 <0.001 <0.01
Control group 0.50 ± 0.50 0.7 ± 0.47 >0.05
due to the loss of voluntary movement functions It has close relationship with modern psycho-
of tibialis anterior muscle dominated by brain, therapy, motorpathy, naturopathy and information
myoparesis of tibialis anterior muscle and plantar therapy, which is the comprehensive application
flexion of shin and foot after contralateral motor of all these therapies. From the birth of Daoyin
center damages or conduction pathway damage. technique, it is closely related to Chinese tradi-
Therefore, the autokinetic movement of tibi- tional culture, especially in the development.
alis anterior muscle can be recovered only after After additions, deletions and modifications by
recovery of functions of cortex motor center and doctors of all dynasties, although the theory is
conduction pathway. Afterwards, the dorsiflexion extensive and profound, it is shrouded in mystery.
of foot can be recovered. Brunnstrom can induce Because it is short of definite concept, subjective
dorsiflexion of toe, dorsiflexion of foot, knee- and abstract, Daoyin technique is mainly used in
bend and body bent at hips through reflex. The life cultivation and health preservation but not in
reflex center is located in spinal cord. Just like clinic from Ming and Qing Dynasties to modern
knee jerk reflex through rapping patellar tendon, times, which is endangered.
the effect on the cortex motor center is little. The Daoyin technique can be used to instruct the
unsatisfactory therapeutic effect of control group patients to actively complete designed movement
is due to lack of CNS plasticity and functional on the basis of regulation of mind and breathing.
reorganization. This process is in accordance with “skillful use
Daoyin technique in China is an important and dependence” principle that can promote CNS
method to enlighten and motivate human will- plasticity. Therefore, Daoyin technique can bet-
power to complete designed movements in order ter promote CNS functional reorganization and
to achieve functional rehabilitation. It has a long recovery of motor functions. However, the main
history. For the rehabilitation of apoplexy hemi- training method of ancient Daoyin technique is to
plegia, the first volume of General Treatise on the complete an integral movement such as immor-
Cause and Symptoms of Diseases written in Sui tal guiding and animal form, which is against the
dynasty (B.C. 610) described four syndromes such rehabilitation training principle of from the easy
as hemiplegia, disability of flexion and extension to the difficult and step by step. The patients can-
because of contracture of arms and legs, imbal- not complete the movements because of the dif-
ance of hands and feet and phemilateral wind in ficulty movements. After repeated failed training,
wind disease that was related to sequela of apo- the patients will lose confidence in rehabilitation.
plexy. There are more than 20 Daoyin techniques Six-step Daoyin technique is based on the
in this book include static exercise (breathing basic techniques of ancient Daoyin technique and
guided by spirit) and dynamic exercise supple- is modified according to modern medical theory.
mented by spirit, breathing and movements (imi- After central damages, the functions training
tation of all kinds of animals), which have good should focus on functional recovery of voluntary
effect on dredging the channel, regulation of Qi movements. In executing goal-directed compli-
and blood, balancing viscera, strengthening the cated work, compilation of motor program and
body resistance to eliminate pathogenic factors, motor start are closely related to motor associated
body steady state and metabolism through regula- area. When the cortex motor center is damaged,
tion of mind, breathing and movements. Modern this function can be destroyed to varying degrees
medical research demonstrated that Daoyin and the recovery of the lost functions require
technique has good regulative and rehabilitation reconstruction of this function. When starting a
effect on cardiovascular disease, respiratory dis- voluntary movement, the sporter should judge
ease, nervous system disease, digestive disease. the primary objective and the position, decide the
Doctors of all dynasties supplemented and devel- movement mode, time and speed, and then enter
oped Daoyin technique from different aspects on into critical state. Hereby, the first step of six-step
the basis of experience of the predecessors. Many Daoyin technique is motor imagery and imitation.
contents are worthy for reference and spreading. The purpose of this step is to help the patients to
construct the idea of voluntary movement, basic muscle or one joint motion, it can be done lying
motor mode and orientation. Through regulation in bed, sitting on a chair or wheelchair, or stand-
of mind and breathing, the patients get into criti- ing on the ground. Therefore, this method can be
cal state of exercise. On the basis of the targeted applied for the rehabilitation training of all motor
muscle, the patients are guided to send signal to dysfunctions, cognitive dysfunctions, visual dys-
the targeted muscle suddenly. The purpose of this functions, breathing dysfunctions, swallow dys-
method is to focus on one point with all power functions and gatism. It can also be used in the
in order to achieve good effect. The purpose of rehabilitation training of scapulohumeral periar-
holding on the counting method resistance is thritis, pain in waist and lower extremities, and
to let the patients find the target in brain. The muscles of bone and joint.
counting method is used to instruct the patients
to complete the training quantitatively in order 2.1.4.2 Contraindications
to develop the neural potential of the patients. 1. The patients with unstable vital signs.
During the process, the therapists can encourage 2. This method should be used with caution in
the patients and say “Stand up, or you will fall the patients with bone, joint and muscle injury
down” or “hold up, or you will crash” to create and bad healing after surgery.
the dangerous atmosphere. The therapist should 3. The patients with severe disturbance of con-
encourage the patients furthest to complete the sciousness or coma. (This method can be used
designed movements by themselves. During this with the help of equipment in the patients with
process, the neural potential of CNS and the stable vital signs.)
functional reorganization can be developed well.
The electrical signal to activate and control 2.1.4.3 Cautions
muscle from brain is one kind of energy forms. 1. Abiding by the principle of from the easy to
Therefore, the process can motivate the energy the difficulty and step by step: The treatment
flow of human body to promote CNS functional should be started from single muscle and joint
reorganization through CNS plasticity. motion and then transited gradually to united
On the basis of regulation of mind and breath- movements with multiple muscles and joints.
ing, the regulation of movements in Daoyin 2. Exerted resistance should be from weak to
technique can develop CNS neural potential strong, especially in the patients with bone,
and promote functional reorganization in order joint and muscle injury and bad healing after
to recover paralyzed muscles dominated by surgery. The isometric muscular contraction
autonomic nerve. The modernization develop-
should be done first in case of the wrong-
ment of Daoyin technique not only improve the orientation movement for bone, joint and
therapeutic effect of rehabilitation, but also show muscle healing.
the charm of ancient rehabilitation technique and 3. The application of Daoyin speeches. The ther-
contribute to rehabilitation medicine all over the apists should use encouraging, inspiring
world. words to create dangerous atmosphere. The
critical words such as command and scold
should be strictly prohibited. The therapists
2.1.4 Clinical Indications can only say how to do some movements bet-
and Cautions of Six-Step ter, but not say the patients do bad. The thera-
Daoyin Technique pist must not show dissatisfied, impatient and
disdainful expressions.
2.1.4.1 Indications 4. Special attention should be paid to the fact
Six-step Daoyin technique is a rehabilitation that Daoyin technique can guide Qi and
training mode during that the patients can do it recover CNS functions, but not strengthen the
themselves with guidance and instruction of the myodynamia. There is significant difference
therapists. Because the method can focus on one between the two.
2.1.5 T
he Application of Six-Step For the patients lying in bed with severe condi-
Daoyin Technique in Physical tion, the isometric contraction training without
Therapy and Occupational resistance to muscles dominated by CNS can be
Therapy given to the patients in order that rehabilitation
training that includes cognitive disorder training
Six-step Daoyin technique can be employed for and the training for coma patients can be given at
various kinds of rehabilitation training such as early stage. The training forms free-hand six-step
the development of neural potential, reconstruc- Daoyin techniques are as follows:
tion of motor program and remodeling of motor
pattern, whether using the normal method or the Active Range of Motion (ROM) Exercises
main and collateral channels method. According This training is appropriate for the patients in
to free-hand training, equipment training and stable state of an illness and clear consciousness
with or without therapists, six-step Daoyin tech- who can do voluntary joint motion completely
nique can be divided into free-hand training, or partially. In exerting resistance condition, the
equipment training and self-training. therapists employ six-step Daoyin technique
to give voluntary joint motion training to the
2.1.5.1 Non-instrumental Method patients in proper position. The training should
of Six-Step Daoyin Technique be given to the patients step by step and gradually
Non-instrumental method of six-step Daoyin increase the level of challenge.
technique is free-hand operational approach with-
out any apparatus when the therapists treat the Auxiliary Active Movements
patients. The main contents include therapeutic This training is appropriate for the patients in
schedule, mechanism explanation, six-step oper- stable state of an illness and clear consciousness
ating steps, Daoyin speeches and anti-resistance. who have active motor consciousness but cannot
The patients try not to use apparatus and the do voluntary joint motion. The therapists guide
training should be done in a quiet, noiseless, luci- the patients to do joint motion with tooth and nail
fuge and warm room. It is also used in bedside and help the patients to complete full-range joint
rehabilitation training. The patients may lie in the motion. With the recovery of CNS functions and
bed, sit on a chair or stand on the ground, mostly improvement of active movements ability, the
sit on a chair. therapists should reduce assistance gradually.
Before training, according to the exercise pre-
scription of the doctor, the therapists should do “Passive” ROM Exercises
simple assessment and further understand the This training is appropriate for the patients with
main dysfunction point. According to the prin- stable vital signs, consciousness but not clear,
ciple of integrated planning, adjustment at any cognitive dysfunction and without voluntary
moment, supplementing the weak and attenuat- movements. This training should be carried out
ing the excited, the therapists determine the ther- by two or more therapists. In special position,
apeutic schedule and objective of this treatment. such as erect position, two therapists stand on the
The therapists usually stand in the paralyzed side two sides of the patients. The two therapists help
of patients’ limbs. The methods should be in the patients to squat with protective belt for any
accordance with the principle of from the easy to contingency and the depth of squat (flexion angle
the difficulty and step by step. According to the of knee) is dependent on the step by step prin-
different states of the patients’ illness, there are ciple and the specific condition of the patients.
difference in training method and training inten- When encouraging the patients with Daoyin
sity. For the patients in convalescence with stable speeches, the therapists help the patients to stand
state and voluntary joint motion, the isotonic up. In the process of standing, the therapists can
contraction training with resistance to muscles reduce auxiliary intensity suddenly. The patients
dominated by CNS can be given to the patients. are falling down non-autonomously. Meanwhile
the therapists use Daoyin speeches to create dan- therapists don’t deem that the coma patients
gerous atmosphere and help the patients to stand have no response to the training and should real-
up again. Through repeated training, voluntary ize that no surface response don’t equal to no
movements are induced in most patients. It is deep response. It is a method to awake the coma
safer to do this training with electrocardiograph patients and to prevent osteoporosis, myopha-
monitoring. gism and other complications.
The specific operational approaches of six-
“Compulsive” ROM Exercises step Daoyin technique are introduced in the fol-
In the condition of imperceptions and unwilling- lowing pictures.
ness, voluntary movements are induced in the
patients in order to recover the patients’ con- 1. Six-step navigation physical therapy (SSNPT)
sciousness. It is appropriate for the coma patients –– The normal method of NPT refers to
with stable vital signs and good cardiovascular Figs. 2.12, 2.13, 2.14, and 2.15.
response. Before training, the patients should be –– The main and collateral channels method of
trained to stand with the standing bed. When the NPT refers to Figs. 2.16, 2.17, 2.18, and 2.19.
patients can stand in 90° position for half an hour 2. Six-step navigation occupational therapy

and the vital signs are stable, the training can be (NOT)
given to the patients. In addition, the training –– The normal method of NOT refers to
should be conducted with vital sign monitoring. Figs. 2.20, 2.21, 2.22, 2.23, 2.24, 2.25,
“Compulsive” ROM Exercises 2.26, 2.27, 2.28, and 2.29.
During standing and squat training, there –– The main and collateral channels method
should be two or more therapists. The two thera- of NOT refers to Figs. 2.30, 2.31, 2.32,
pists stand on the two sides of the patients and 2.33, 2.34, 2.35, and 2.36.
use protective belt to keep the patients safe. The
training intensity should be in accordance with 2.1.5.2 The Corollary Equipment
step by step principle and the specific condition Method
of the patients. The procedures of the stand- Corollary equipment is dedicated appliance and
ing training are as follows: The depth of squat equipment for rehabilitation techniques, which
begins at 15° of the flexion angle of knee. On the
basis of this, the depth of squat increases gradu-
ally. When encouraging the patients with Daoyin
speeches, the therapists help the patients to stand
up. In the process of standing, the therapists can
reduce auxiliary intensity suddenly. The patients
are falling down non-autonomously. Meanwhile
the therapists use Daoyin speeches to create dan-
gerous atmosphere and help the patients to stand
up again. The procedures of the squat training
are as follows: the therapist help the patients to
squat slowly form the standing position. During
the squat process, the therapists suddenly reduce
the auxiliary power and encourage the patients
to keep the body position in case to continue to
squat.
Through repeated “compulsive” active move-
ment training, the patients’ motor responses are
induced and the consciousness recovery of the
patients is promoted. During this process, the Fig. 2.12 Hip flection of the normal method
Fig. 2.15 Strephexopodia of the normal method

Fig. 2.13 Knee flection of the normal method
Fig. 2.14 Foot dorsiflexion of the normal method Fig. 2.16 Hip flection of the main and collateral chan-
nels method
are suitable for six-step Daoyin technique and equipment. The equipment plays a supporting
neurological training (effect feedback technol- role. We don’t overemphasize the role of the
ogy of six-step Daoyin technique). The corollary equipment and should not chase the high-grade,
equipment method is that the six-step Daoyin precision and advanced equipment. The valuable
technique is carried out with corollary equip- rehabilitation training equipment is simple and is
ment. The objective of this method is to assure the with good therapeutic effect, not the high degree
correct application of this method and its effect. of automation, expensiveness and large size.
What calls for special attention is that the method The therapist or rehabilitation therapists with
plays a leading role in the process of rehabilita- exquisite craft who understand six-step Daoyin
tion training in spite of the important role of the technique and neurological training can achieve
Fig. 2.17 Knee flection of the main and collateral chan- Fig. 2.19 Strephexopodia of the main and collateral
nels method channels method
Fig. 2.18 Foot dorsiflexion of the main and collateral Fig. 2.20 Shrug of the normal method
channels method
wonderful therapeutic effect without the cor- 2.1.5.3 Self-Training

ollary equipment. As a superb gongfu master Self-training is appropriate for the patients who
without blade in hand can still beat the man with received six-step Daoyin technique training or
blade. In the contrary, a rehabilitation physician the self-training plan designed by rehabilitation
or therapist who doesn’t understand six-step physician of neurological training. The patients
Daoyin technique well and doesn’t apply the should be instructed by doctors or therapists.
techniques appropriately cannot get good train- Self-training can be carried out in ward, parker
ing effect, even they have many appliances. or at home. The training can be carried out with
Fig. 2.21 Shoulder abduction of the normal method Fig. 2.23 Elbow flexion of the normal method
Fig. 2.24 Wrist extension of the normal method

Fig. 2.22 Elbow extension of the normal method
multifunction training box guided by voice or premise of keep training is the self-cognition of
video. The correctness and effect of self-training rehabilitation, perseverance and family monitor-
can be guaranteed by multifunction training box. ing. Quantitative index and training record are
The common problems of self-training are the effective measure to guarantee exercise. The
that the patients cannot keep training frequently bases of improving exercise effect are regular
or the training method is wrong. Keep train- reexamination or contacting the training doctors,
ing is the important guarantee for maintaining adjustment or modification of exercise project,
functions and achieving therapeutic effects. The and the correct application of the method.
Fig. 2.25 Wrist flexion of the normal method
Fig. 2.28 Hallux flexion of the normal method
Fig. 2.26 Finger stretching of the normal method
Fig. 2.29 Lumbus stretching of the normal method
2.1.6 T
he Application of Six-Step
Daoyin Technique in Other
Trainings
The basic techniques of six-step Daoyin tech-

nique are regulation of mind, breathing and
movements. Six-step Daoyin technique not only
can be used in motor function training such as
hemiplegia, cerebral palsy, paraplegia, facial
Fig. 2.27 Thumb abduction of the normal method
Fig. 2.31 Shoulder abduction of the main and collateral

channels method
Fig. 2.30 Shrug of the main and collateral channels

method
paralysis, monoplegia induced by peripheral

nerve injury and dyskinesia after muscle injury
of bone and joint, and also can be used in vari-
ous aspects such as cognition, vision, audition,
beauty, snore, swallow, diaphragm, sphincter
and sub-health. The specific methods should be
referred to individual chapters.
2.2 Therapeutic Methods

of Neurological Training
Rehabilitation
As previously mentioned, there is no regenera-

tive ability in CNS cells. The lost functions after Fig. 2.32 Elbow extension of the main and collateral
central damages are mainly dependent on nor- channels method
2.2 Therapeutic Methods of Neurological Training Rehabilitation 55
Fig. 2.35 Wrist flexion of the main and collateral chan-

nels method
Fig. 2.33 Elbow flexion of the main and collateral chan-

nels method
Fig. 2.36 Lumbus stretching of the main and collateral

channels method
Fig. 2.34 Wrist extension of the main and collateral
channels method
technique can develop the CNS neural potential
better. However, developing neural potential
mal cells around the injured area or activation of is not enough. If the new activated cells should
spare conduction pathway to replace the func- work coordinated and orderly, the motor func-
tions of injured cells (development and utiliza- tions can be recovered. The completion of one
tion of CNS neural potential). Six-step Daoyin joint motion is the result of cooperation of many
cells. One cell or one conduction pathway cannot whether the functions of cortex motor center can
complete the joint motion. The cells are trained to be recovered or the limbs motor functions can be
work coordinated and orderly so that the normal recovered through reconstructing normal motor
motor program can be constructed. program. If the EMG is generated by muscle con-
However, we should know the fact of abnor- traction, signal amplification will lead to myody-
mal motor program before the reconstruction of namia enhancement. If the signal is from CNS,
motor program an then we can reconstruct the signal amplification will lead to CNS functions
normal motor program on the basis of correcting enhancement. There is significant difference
abnormal motor program. To do this, we must see between the training of simple enhancing muscle
the motor program (the acquisition and display strength and the training of reconstructing motor
of motor program signals) that control the joint program. Myodynamia training is a process of
motion in the cortex. effect training. The effect will attenuate or disap-
pear after training ceases. For example, a person
who could lift 60 kg now can lift 100 kg through
2.2.1 A
cquisition of Motor Program hard training, but cannot lift the same weight
Signal: Experimental Study without training for one year or more. However,
on the Source of Surface constructing motor program training is a process
Electromyogram Signal of established methodology. Unless the CNS is
damaged severely, the effect will last a long time
After the injury of brain, spinal cord and nerve, it after training ceases. For example, once a per-
is known that the motor functions of limbs would son learned to ride a bike or swim, he can ride a
be lost. Therefore, there is a close relationship bike or swim without training for 10 years. The
between nervous system and body movements. example demonstrates that rehabilitation train-
In nervous system, the main function of central ing should focus on brain functions recovery and
nerve is to control contraction and relaxation of reconstruction of motor program.
muscles. Moreover, the main function of conduc- In order to clarify the question, we used ani-
tion tract and peripheral nerve is to transmit infor- mals in waken state to do mechanical stimulus
mation from central nerve to muscles, which are experiment, which can rest the source and type
recognized research result in modern medicine. of sEMG.
From the above mentioned, we can infer that In previous studies, the researches on the
the source of the signal detected in the muscle source of sEMG are carried out through electri-
contraction by instrument is from cortex motor cal stimulation. Some studies indicated that there
center, which is motor program signal. If the cor- was difference between sEMG signal detected
tex motor center is damaged or the conduction through electrical stimulation of peripheral nerve
pathway is blocked, the motor center cannot gen- and normal sEMG, which due to the interference
erate electrical signal even the muscle is intact. of stimulative current that can hinder the analysis
However, the hypothesis is not testified by the of signal resource. We used mechanical stimulus
experiment. to induce voluntary contraction and reflex con-
Up to this day, the source of intramuscular traction of muscles in animals in waken state to
electromyographic signal or surface electromy- exclude the interference of external stimulative
ography signal (sEMG) still isn’t identified. The current, which is good for the analysis of sEMG
sources of the two signals are mixed up and are signal resource.
controversial, but it is widely believed that the Thirty adult New Zealand rabbits (half males
signal is due to electrical activity in muscle con- and half females) are used in our experiment. The
traction. Therefore, it is called electromyography. rats were provided by Department of Laboratory
The source of EMG is a problem that must Animal Science in Capital Medical University.
be clarified, because it is involved in the ques- The body weight is 2.15–2.60 kg and the aver-
tion that whether the motor program is existed, age weight is 2.35 kg. We used Neuroeducator
whether the motor program can be displayed and III, 3 M Ag-AgCl surface electrode that was
produced by Therapeutic Alliances in America. and the intensity and form of sEMG are detected
Neuroeducator III was used to detect sEMG sig- in real-time. (2) Ischiadic nerve is detached.
nal and record it. The signal is obtained from anal- Midpoint of the line segment between ischial
ysis of sEMG signal that is less than 140 dB. The tuberosity and greater trochanter of femur is the
root mean square of potential is less than 0.2 μV mark. We cut open the back of the right thigh in
noise level and bandwidth is 10–l000 Hz. We length wise. One percentage lidocaine used for
combined during of sEMG signal to exceed 0.l s local infiltration, we cut open every layers below
and standard it as μVs. Meanwhile, the data in the skin, detach the tissues, find the ischiadic
every one-tenth second is displayed in color dis- nerve and cut it off, put the distal end out of the
play with continuous curve. The scan time limit incision and suture the incision. Achilles’s ten-
of every screen is 20 s. The receive mode is ECG don, distal ischiadic nerve stump, the right mus-
shielding signal. The data are stored for analysis. culus gastrocnemius are separately stimulated.
We used hwato-med (0.35 mm × 13 mm) pro- The contraction of musculus gastrocnemius is
duced by Suzhou medical supplies limited com- observed and the intensity and form of sEMG are
pany. We choose 1 cm above the trailing edge of detected in real-time. When the right ankle is pas-
heel with Achilles’s tendon as the stimulating sively moved, the contraction of musculus gas-
point. Acupuncture pin is inserted from 10 cm trocnemius is observed and the intensity and form
above the stimulating point until the acupuncture of sEMG are detected in real-time. (3) The spinal
pin penetrates the tendon below the entry point. cord is transected. The electrodes are placed in the
We observed whether the acupuncture pin can skin surface of left musculus gastrocnemius and
induce the contraction of musculus gastrocne- then are linked to the first lead of Neuroeducator
mius and recorded the electrical signal. III. 2 cm above the intercrestal line of pelvis, 1%
The rabbit is fixed on the operation table. The lidocaine used for local anaesthesia, we cut open
surface skin is unhaired and the electrodes are the middle of the back in length wise, detach
placed around muscle belly. The first electrode is the tissues layer by layer, expose the spine, cut
placed on the skin surface above the middle of the off L2–L4 spinous process and vertebral plate,
muscle belly that is 1 cm away from the muscle expose spinal cord, cut off spinal cord in L3 plane
starting point. The second electrode is placed on and suture the incision layer by layer. The left
the skin surface above the middle of the muscle Achilles’s tendon is stimulated to test the contrac-
belly that is 1 cm away from the muscle stopping tion of musculus gastrocnemius. The intensity
point. Grounding electrode is placed between the and form of sEMG are detected in real-time. The
two surface electrodes. The surface electrodes rabbits are sacrificed using air embolism through
are linked to the first lead of Neuroeducator III rabbit’s auricular vein.
the through wire. The procedures of the experi- The results: Thirty experiment animals were
ments are as follows: (1) In the waking state, the included in this experiment and the wave form,
right Achilles’s tendon is acupunctured to induce intensity and duration of the sEMG were detected
voluntary contraction of musculus gastrocnemius for 180 times (Table 2.3).
Table 2.3 The detection result of electromyography signal of musculus gastrocnemius ( x ± s)
Transected spinal
Normal state Interruption of ischiadic nerve cord
Stimulation
Stimulation of of Achilles’s Stimulation of Stimulation of Passive Stimulation of
Items Achilles’s tendon tendon nerve muscle movement Achilles’s tendon
Signal 353.3 ± 96.1 0.3 ± 0.8 0.2 ± 0.4 5.0 ± 3.5 0.0 ± 0.0 27.9 ± 55.0
strength (μV)
Wave form Wide base Interference Interference Interference No wave Narrow base
random wave wave wave wave reflex wave
Wave length (s) 4 <0.5 <0.5 <0.5 0 <1
Our experiments demonstrated that the wave the electrical signal received from skin surface of
form of sEMG was high-strength wide base ran- the muscle in voluntary contraction derived from
dom wave when Achilles’s tendon was stimu- high level motor center.
lated and the voluntary contraction of musculus The cortex motor center generates nervous
gastrocnemius was induced (Fig. 2.37). The wave impulse signal. The signal reaches neuromuscu-
length is 4 s. The joint is moved passively in order lar junction through neural conduction pathway
to pull the musculus gastrocnemius but cannot step by step. The membrane permeability of neu-
induce the muscle contraction. There is no sEMG ral fiber is changed, which induces inward flow
signal received by the apparatus (Fig. 2.38). After of calcium ion. And then the exocytosis of synap-
transection of spinal cord, stimulating Achilles’s tic vesicles is triggered and the acetyl choline are
tendon can induce reflex contraction of mus- released from frontal membrane of neuromus-
culus gastrocnemius. At this moment, the low- cular junction. This is the process of the genera-
intensity narrow base reflex wave can be received tion of voluntary movements. The acetyl choline
(Fig. 2.39) and the wave length is less than 1 s. can bind endplate receptors through synaptic
After transection of ischiadic nerve, we stimu- cleft and induce endplate potential. Electrotonic
lated Achilles’s tendon, muscle and the distal end potential can stimulate peripheral myolemma
of transected nerve and cannot induce muscle to produce action potential and induce muscle
contraction. However, we can receive weak irreg- contraction. This is the process of the genera-
ular interference wave (Fig. 2.40, 2.41, and 2.42) tion of voluntary movements. The physiologi-
and the wave length is less than 0.5 s. cal process is composed of the transformation
The intensity of electrical signal and transduction of primary electrical signal to
(353.3 ± 96.1 μV) in voluntary contraction of chemical signal and then to electrical signal.
musculus gastrocnemius is 12.7 times of that Conway and his colleagues detected the elec-
(27.9 ± 55.0 μV) in reflex contraction of mus- trical signal of offside cortex motor center and
culus gastrocnemius after transection of spinal EMG of extensor or flexor muscle of wrist and
cord. The duration time is four times of that in found that there were short-time low-frequency
reflex contraction. These evidences proved that coherence between electrical signal and EMG in
Fig. 2.37 The wave

form of sEMG was
high-strength wide base
random wave when
Achilles’s tendon was
stimulated and the
voluntary contraction of
musculus gastrocnemius
was induced
Fig. 2.38 The joint is

moved passively in order
to pull the musculus
gastrocnemius but
cannot induce the
muscle contraction.
There is no sEMG signal
received by the
apparatus
Fig. 2.39 After
transection of spinal
cord, stimulating
Achilles’s tendon can
induce reflex contraction
of musculus
gastrocnemius. At this
moment, the low-
intensity narrow base
reflex wave can be
received
rapid active movement. According to the results, trical signals from cortex motor center of non-
they inferred that low-frequency electrical signal human primates to control the movements of
of cortex motor center had some effects on the mechanical arms successfully. In 1982, Graupe
generation of EMG in rapid point-to-point wrist and his colleagues applied EMG for functional
movements. EMG and brain electrical signal neuromuscular stimulation for the first time. He
are used for controlling mechanical prosthesis mapped the EMG obtained from upper trunk to
and functional stimulation of paralytic limbs. functional neuromuscular stimulation signal and
Carmena and his colleagues used the brain elec- made the patients with paraplegia to walk.
Fig. 2.40 After
transection of ischiadic
nerve, we stimulated
Achilles’s tendon and
cannot induce muscle
contraction. However,
we can receive weak
irregular interference
wave
Fig. 2.41 After
nerve, we stimulated
muscle and cannot
induce muscle
contraction. However,
we can receive weak
irregular interference
wave
Dyskinesia induced by central damages such ferent under the same electrical signal intensity.
as stroke, cerebral trauma and child cerebral This phenomenon may be caused by the different
palsy is due to irreversible damage to brain cells. volume and quality of child and adult. It is the
There is no damage in the peripheral nerves and difference between effectors but not the signal dif-
muscles of the patients and there are damages in ference from motor cortex that drive the effectors.
the brain. We found in the clinic that the signal We inferred that the signal is form CNS to muscle
intensity from the skin surface of adult muscle is but not generated by the muscle contraction.
the same as that from the corresponding part in In fact, the electrical signal received from
the child, but the myodynamia is significant dif- muscle skin surface is generated before muscle
Fig. 2.42 After
nerve, we stimulated the
distal end of transected
nerve and cannot induce
muscle contraction.
However, we can receive
weak irregular
interference wave
contraction, which is the control and drive signal On the other hand, the relationship between
from CNS to muscle. The intensity of this signal CNS and limbs movements can be explained
is not equal to myodynamia, but there is propor- using principle of automobilism. The “heart” of
tionality between the signal and myodynamia the automobile is the engine. The main compo-
within limits. nent of the engine is internal combustion engine.
We deem that there are two examples to prove Pulverization gasoline is combusted in the engine.
the EMG is not directly from muscle contraction. The electric spark can light pulverization gaso-
The first is the generation of electrocardiosig- line, which comes from automobile accumulator.
nal. The electrocardiosignal is from the atrio- Under the control of microcomputer, the drivers
nector located at the above of atrium dextrum. activate the ignitor and the power of ignition plug
Atrionector can generate autorhythmic electri- is on. When the ignition plug ejects electric spark,
cal excitation (electrical signal). This signal is fuel injection nozzle in internal combustion engine
conducted to atria myocardium and ventricular start to eject gasoline and make it into spray pat-
myocardium through atrioventricular bundle and tern appropriate for burning. The heat from gaso-
ventricular Purkinje fibers and then induces the line burning can move up the piston. The lifted
contraction of atria myocardium and ventricu- piston can drive wheel move through conduction
lar myocardium. Electrocardiogram shows the system and the car can move forward or backward.
conduction of autorhythmic electrical current Compared the relationship between CNS and
in normal or abnormal atrial and ventricular tis- limbs movements with principle of automobil-
sue generated from atrionector but not from the ism, the power is equal to human CNS and the
contraction of atria myocardium and ventricular electric wire is equal to nerve. Ignition plug is
myocardium. When there is some kind of dam- the same as neuromuscular junction. Burning of
ages in atrioventricular tissue, autorhythmic pulverization gasoline is the same as consump-
electrical current may be influenced to varying tion of adenosine triphosphate (ATP) in muscle.
degrees and the conduction is blocked, which The upward movement of cylinder plug is equal
can lead to systolic dysfunction of atria myocar- to muscle contraction. The conduction system is
dium and ventricular myocardium. In clinic, the equal to joint motion. The axle drives the wheel
assessment and diagnosis of cardiac function can to make the vehicle move forward, which is equal
be detected with electrocardiogram. to the human movements driven by limbs.
One of the most important parts is piston trode on the skin surface and the signal was
movement after gasoline burning, which is the called interference wave by the author, which
same as the process that electrical signals from indicated that peripheral nerve and muscle are
CNS induce muscle contraction. It is an domino not the source of sEMG.
effect process that spark drives the cylinder plug In the case the innervation of limbs were
move after gasoline burning. High heat energy intact, Achilles’s tendon was stimulated to induce
make the cylinder plug move. During this process, the contraction of musculus gastrocnemius and
the movement of cylinder plug is to make the the signal intensity was high (400 μV). The
wheel rotate but not to generate electricity. Unless duration time is long (4 s). Although the reflex
the movement of cylinder plug drives specific center that induced contraction reflex of mus-
power generation assembly such as thermoelectric culus gastrocnemius was located in spinal cord,
generators, the electricity cannot be generated. In pain stimulation can induce avoidance reflex and
that case, the vehicles don’t have power to move brain dominated limbs to avoid pain stimulation.
forward or backward. The result of consuming The voluntary contraction of musculus gastroc-
ATP is muscle contraction. The objective of mus- nemius could be induced so that the wave form
cle contraction is joint motion in order to make was wide base random wave. After transection of
human body complete movements such as walk- spinal cord, we stimulated Achilles’s tendon and
ing, running and jumping. It is a domino effect detected low-intensity (less than 100 μV), short
process but not the power generation process. duration time (less than 1 s) electrical signal.
sEMG is one kind of quantitative index, This is because higher nerve center lost control
which has clinical application value in the of lower nerve center. In that case, the reflex was
assessment of functional recovery of motor induced in spinal cord and the signals are only
movements in the patients with CNS damages. from motor neurons of anterior horn of the spinal
There was no evidence to prove that the increase cord. Therefore, the wave form was narrow base
of sEMG can reflect the brain function recov- reflex wave. Just like the knee jerk reflex whose
ery. We analyzed the source and type of sEMG reflex center was in spinal cord, patellar tendon
through animal experiment and found that there was knocked to induce involuntary and rapid
was no sEMG in the process of the muscle knee jerk reflex.
traction by joint in passive movements. If the We analyzed the experiment results and some
muscle is without innervation of peripheral phenomenon in life and deemed that electrical
nerve, the intensity of electrical signal induced signals of muscle contraction received from skin
by mechanical stimulation of peripheral nerve surface mainly originated from cortex motor cen-
or muscle is low (less than 10 μV). The dura- ter. Simple peripheral nerve innervation, passive
tion time is very short (less than 1 s). The weak contraction of muscles and spinal reflex cannot
electrical signals come from two ways. Firstly, induce electrical signals of voluntary contraction
the cell membrane permeability change after of muscles. Only the signals from brain to move-
mechanical stimulation of nerve fiber or myo- ments muscles through cascade conduction can
fiber induces transfer of ions inside and outside induce electrical signals of voluntary contraction
of cell membrane. However, the potential dif- of muscles. Therefore, electrical signals received
ference generated by transfer of ions inside and from skin surface on the part of muscles are the
outside of cell membrane cannot induce action integrated electrical signal from higher nerve
potential and cannot induce voluntary contrac- center and lower nerve center to muscles, mainly
tion of muscle. Secondly, the sensitivity of sig- are electrical signals from higher nerve center.
nal receiving equipment is very high and it can Many muscles such as agonistic muscle,
receive cardiac electrical activity from the body antagonistic muscle, synergic muscle and neutral-
surface. Although the ECG shielding system of ized muscle are involved in the completion of a
the equipment was activated, it can received the joint motion. Many joint motions are involved in
low-intensity signal from the wire of the elec- a coordinate exercise of the limbs with practical
functions. All the muscle that take part in the limbs before the myodynamia recovery in the motor
movements are controlled by the electrical signals function recovery after CNS damages. This pro-
from CNS. These signals are released sequentially cess took about 3 months or more. Long time
and proportionally in order to complete coor- muscle disuse induced amyotrophy. Although
dinated limbs movements. For the single joint the signal was high, the effect of muscle contrac-
motion, motor program means the ratio of signal tion was weak. These results were published in
intensity of agonistic muscle to the signal intensity Chinese Journal of Tissue Engineering Research
of antagonistic muscle. The ratio of signal inten- [2011;15(46):8693–7].
sity of agonistic muscle to the signal intensity of
antagonistic muscle is 10–1 in motor program of
a normal joint motion. For the multi-joint coor- 2.2.2 T
he Role of “Objective
dinate exercise, motor program means the speci- and Motive” Mechanism
fied order of seniority of motor program in single in the Development of Human
joint motion. For example, in the motor program Potentials
of walking, hip flexor of the “step forward” leg
receive signals from cortex motor center firstly Comfort and enjoyment are good intension and
and the lower limbs step forward. Hamstring pursue in human life. Laziness many be the
muscles receive signals from cortex motor center humanity, but the base of comfort and enjoy-
secondly to induce knee flexion. Tibialis anterior ment is giving. You can get what you want only
muscle receives signals from cortex motor center through giving. If a person has no plan, he idles
finally to induce foot dorsiflexion. These sequen- away his time and does nothing day by day.
tial and proportional signals from CNS are called Setting a goal can promote people to try their
motor program signals. Therefore, electrical sig- best. Setting a goal with some rewards and pun-
nals of muscle contraction in joint motion and ishment can increase the work efficiency so that it
limbs movements are the motor program signals can provide material basis for the people. Goal is
from CNS to muscles. This is different from the the orientation and the motive of working. It can
meaning of traditional EMG. Traditional EMG make people to complete the almost impossible
is the current generated by muscle contraction. task. Setting a goal promotes people to achieve or
However, motor program signals mean the electri- overfulfil the expectant indicator, which is called
cal signals controlling or driving muscle contrac- “objective and motive” mechanism and can pro-
tion involved in joint motion but not the electrical mote human potentials effectively. The specific
signals generated by muscle contraction. goal can be expressed by quantity, altitude, task
The relationship between myodynamia and and ability. In order to stimulate people’s motive,
motor program signals are mentioned before. The the goal should be more clear and easier. The
signal is in proportion to myodynamia within closer the relationship between the goal and the
limits. The stronger the motor program signal is, effect is, the more important the effect of poten-
the stronger the myodynamia is. Along with the tial development is.
increase of the motor program signal, the myo- “Objective and motive” mechanism can be
dynamia is not increased proportional. The sig- applied for any area. It is said that the whole
nal intensity of motor program in children and year’s work depends on a good start in spring and
adults is 640–800 μV. The highest motor program the whole day’s work depends on a good start
signal of the person with strong myodynamia is in the morning, which demonstrates the impor-
less than 800 μV, but there is significant differ- tance of plan and goal. Our country sets Five-
ence of myodynamia between the people with year Plan for development and lets the whole
strong myodynamia and the people with weak nation and various sectors step towards this goal.
myodynamia. After eleven Five-year Plans, there were earth-
In clinical rehabilitation training, we found shaking changes in China. If a primary school
that the recovery of motor program signal is student can set a study goal very early by him-
self not by his parents, he may study very well. through international assessment methods, but
If he wants to enter into the top two schools these indicators can only assess the effects of
(Tsinghua University and Peking University) in rehabilitation training. Although the therapeutic
China and he does work hard, the chance to enter schedule can be modified by this, these methods
into Tsinghua University and Peking University cannot be applied for direct adjuvant therapy.
is good. The second is that these indicators can be used as
“Objective and motive” mechanism was real-time display of objective indicators of direct
widely and necessarily applied for competitive adjuvant therapy. The effect of real-time dis-
sports training. For example, the cross-bar of play of effect of objective indicators is the same
jumper, the target of archery, target of shoot- as target of the archery and cross-bar of jump-
ing, weight of weightlifting and degrees of free ing. These indicators can provide specific goals
exercises are all the goals of sports training. for the people who are trained and are good for
With these targets, the athletes can surpass them timely adjustment of training scheme in order to
one by one through training and improve their do targeted training and promote training effect.
competitiveness. Six-step Daoyin technique can regulate the
The training of recovery of motor function brain or the ability of muscle contraction domi-
after CNS damages is a process of develop- nated by CNS. This ability can be transmitted
ment of CNS potentials. Therefore, the training through motor program electrical signals sequen-
goals that are in accordance with “Objective and tially and proportionally. This signal can be
motive” mechanism, visualized, effective and received from skin surface on the part of muscles
practical can assure the effects of rehabilitation through receiving equipment of electronic signal
training. in real-time. The received signal is showed as
waveform or sound in real-time, which is result
feedback.
2.2.3 The Display of Effect Feedback regulation is an important mecha-
of Objective Indicators in Six- nism to achieve control and balance. This mecha-
Step Daoyin Technique nism not only exists in human body, but also in
daily life. The regulation of human endocrine,
Daoyin technique was invented 2000 years ago. blood pressure and temperature are realized
Daoyin technique in modern times is seldom through feedback mechanism. The normal tem-
used in clinic, which may be due to lack of objec- perature of human body is around 37 °C. When the
tive indicators in Daoyin technique. Therefore, body temperature is less than 37 °C, excitability
the display and effect of objective indicators in of thermogenic center in metathalamus increases,
Daoyin technique, especially the objective indi- heat production increases, heat dissipation
cators in the application of Daoyin technique decreases, and the body temperature increases.
as adjuvant therapy, is the important symbol of On the contrary, when the body temperature is
development and renaissance of ancient Daoyin more than 37 °C, excitability of thermolytic cen-
technique. ter in anterior thalamus increases, heat produc-
The display of effect of objective indicators in tion decreases, heat dissipation increases, and
Daoyin technique is divided into different sub- the body temperature decreases. On this account,
types. The first is the objective indicator of long- body temperature can be maintained around
term effect. At present, assessment methods of 37 °C, which is good for the normal process of
effect of rehabilitation therapy used at home and metabolism in vivo. The feedback mechanism is
abroad are all the objective indicators of long- used in the equipment of maintaining environ-
term effect. During the training process or after ment temperature. If the room temperature is set
the training, the objective indicators of long-term to 24 °C, when the room temperature is lower
effect such as myodynamia, ability of daily liv- than the setting temperature, the thermorecep-
ing, walking and balance ability can be obtained tor of air-conditioner can detect the temperature
change and the heating system of air-conditioner muscle of arm was 20 μV in last training and the
is activated to increase the temperature. When the setting goal required the patients to exceed this
room temperature reaches 24 °C, the heating sys- signal intensity in this training. Through the sys-
tem of air-conditioner stops. When the room tem- tem settings of the equipment, when the signal
perature is higher than the setting temperature, exceeds 20 μV, the equipment makes a noise in
the thermoreceptor of air-conditioner can detect order to let the patients know their progresses
the temperature change and the cooling system of through hard work. However, the sound feedback
air-conditioner is activated to decrease the tem- is not precise and the sound is constant whether
perature. Through repeated regulation, the room the value surpassing a goal is big or small. There
temperature is maintained around 24 °C. is no visible and mobile curve surpassing the
It is observed from this process that feedback targeted horizontal line, which can motivate
is the base of regulation. Without feedback, we the patients to do their best. In addition, sound
cannot know the real-time situation and can- feedback is not appropriate for the training of
not analyze the correctness of the situation. regulation of proportion and intensity of motor
Regulating system cannot adapt to the situation. program. For the patients with poor eyesight or
Therefore, feedback and regulation are the pro- blind person, compared with the training with
cess that we know what is correct and take steps no feedback, sound feedback is a more effective
to correct it with a purpose to achieve goals. training method.
The real-time monitoring and display of motor For correcting abnormal motor program and
program signal can be realized in six-step Daoyin reconstructing normal motor program, visual
technique, which is the combination of result feedback is a better method. When the patients
feedback and regulation method. Through differ- are guided to do a joint motion, the equipment can
ent lead receiving electrodes of signal monitoring detect motor program signal from CNS to ago-
equipment (four-lead in general), motor program nistic muscles or antagonistic muscles and dis-
signals from CNS to agonistic muscles or antago- play it real-timely on fluorescent screen through
nistic muscles can be received separately when curve form. According to the practical situation
the patients are guided to do a joint motion and of motor program, the therapists can do various
the signals from CNS to agonistic muscles of kinds of trainings such as the training of promot-
joint motion can be received in coordinated exer- ing agonistic muscle signal. Through the operat-
cise for multiple joints. These two signals can be ing system of the equipment, the guided agonistic
displayed real-timely in the fluorescent screen muscle signal last time is set as the baseline that
separately through curve form. Under the instruc- should surpassed in this time. The guided antag-
tion of the therapists, the patients can be guided onistic muscle signal last time is set as bottom
to do the training with a purpose. Real-time result line that should surpassed in this time (Fig. 2.43).
feedback demonstrated that feedback not only let During training process, the therapists use six-
the therapists and the patients know existence, step Daoyin technique to guide the patients to
strength, right or wrong of motor program signals surpass the baseline of agonistic muscle signal
precisely to design correct therapeutic schedule and bottom line of antagonistic muscle signal
and do targeted training, but also design different under the linear signal curve. Through motivated
degree targets for the patients through software and targeted training, in the process of promoting
program of the equipment to use “objective and motion signal gradually, the proportional motor
motive” mechanism to do the training of develop- program can be established.
ment of CNS potential. The author combines six-step Daoyin tech-
For the patients who merely know whether the nique with biological feedback technology to
training can achieve the required goal, the sound form rehabilitation method, which is called
feedback can be applied for meeting require- “Daoyin feedback technique in traditional
ments. For example, in the training of elbow Chinese medicine”. Motor program signal is the
extension, signal intensity from CNS to triceps objective feedback index of the effect of Daoyin
Fig. 2.43 Baseline
setting in the training of
reestablishing motor
program
technique. Because continuous dynamic detec- logical training. This technique is widely applied
tion and real-time display in curve form are because every cell of nine anatomy systems is
realized, the feedback effect of motor program innervated by nerves. At present, on the basis of
signal is superior to that of target. Therefore, it basic techniques of neurological training reha-
is possible for targeted training of rehabilitation bilitation, the therapeutic methods are developed
functional assessment, development of therapeu- for motor function, cognition, vision, audition,
tic schedule, establishment of surpassing and swallow, sphincter, scapulohumeral periarthritis
lowering target, development of CNS potential and Lumbago-leg pain. A series of techniques
and reconstruction of motor program. It plays an are formed to be used for almost all rehabilitation
indispensable role in development of CNS poten- therapies. Therefore, it is called rehabilitation
tial, implementation of reconstruction method of therapeutics system of neurological training. In
motor program and recovery of lost motor func- this system, there are not only independent the-
tion. It can also open up a new way for modern- ory and rehabilitation method, but also a series
ization development and renaissance of Daoyin of specific corollary equipment, which will be
technique, establishment of new rehabilitation introduced in the following chapters.
method. The definition of rehabilitation technology of
neurological training is that neurological training
focus on rehabilitation techniques in traditional
2.2.4 T
he Origin and Definition Chinese medicine with supplement of biologi-
of Neurological Training cal feedback technology and includes a series of
new technologies in rehabilitation therapy that
Six-step Daoyin technique is applied in Daoyin integrates traditional Chinese and western medi-
feedback technique in traditional Chinese medicine. The basic theories of it are neural plasticity
cine. Qi is guided in this method and is used to and motor program. The basic technique of it is
dredge the channel and develop brain function, Daoyin technique in order to clear and activate
and then the brain or central nervous system is the channels and collaterals, develop brain func-
recovered. Therefore, the author called it neuro- tions. Modern electronic equipment are used to
monitor the signal of potentials and the effect of 2.2.5 Rectification of Abnormal
Daoyin technique is displayed real-timely on flu- Motor Program
orescent screen in curve form. Through feedback and Consolidation of Normal
mechanism, the patients are instructed to regulate Motor Program
signal intensity with a purpose, adjust disorga-
nized motor program and consolidate it, enhance As what are mentioned before, muscles involved
myodynamia, remodel motor pattern with whole in single joint motion include agonistic muscle,
training, recover independent coordinated motor antagonistic muscle, neutral muscle and synergic
function and increase ability in daily life. muscle. For the extension and flexion of joint,
Daoyin technique is used in this therapy to the movement muscles include simply agonistic
develop neural potential, reconstruct motor pro- muscle and antagonistic muscle. In elbow exten-
gram and remodel motor pattern, which plays an sion, triceps muscle of arm is the agonistic mus-
important therapeutic role. Motor program signal cle and in elbow flexion bicipital muscle of arm
monitoring and real-time display of the effect is the agonistic muscle. Agonistic muscle is the
of Daoyin technique provide the target required main muscle to complete joint motion. The func-
for promoting the effect of Daoyin technique tions of antagonistic muscle are to maintain the
through feedback mechanism, which plays a sup- stability of joint motion and prevent damage of
portive therapeutic role. excessive movement of joint.
Compared with traditional rehabilitation tech- The effect of agonistic muscle and antagonis-
niques, rehabilitation methods of neurological tic muscle on joint motion is the same as learning
training focus on active movements and mainly to ride a bike. The bikers are equal to agonistic
act on CNS, but traditional rehabilitation tech- muscles of joint. The people who uphold the
niques focus on lower nerve center and muscles. bike are equal to antagonistic muscle. When rid-
The comparison of the effect of the two methods ing, the bigger the difference between the force
is referred to Fig. 2.44. of pedaling and the force of upholding the bike
Fig. 2.44 Comparison
Human body
of the effects of
neurological training
and traditional
rehabilitation therapy
Heart Blood Muscle Joint
Motor center
(lower) in spinal
Neurological Traditional
training rehabilitation
therapy therapy
Motor center
(higher)
in cortex
Subjective will
Voluntary movement of limbs

with backward traction is, the bigger the force muscle keeps stable, the stronger the antagonis-
of pedaling is and the faster the speed is. On the tic muscle signal is, the more difficulty the joint
contrary, if the force of upholding the bike with motion is. When the proportion of motor program
backward traction is too big, the force of pedal- signal is inverted, the signal intensity of antago-
ing is becoming small and it is difficulty to ride nistic muscle is stronger than the signal intensity
a bike forward. Therefore, the proper proportion of agonistic muscle. If the patients try to extend
between the two forces is required to make the their elbows, because the signal form CNS to
riding flexible and stable. bicipital muscle of arm is stronger than the sig-
Joint motion is also the case. For the single nal form CNS to triceps muscle of arm, the elbow
joint motion, motor program center of single joint extension cannot be completed, even there will be
located in Brodmann 4 area gives out properly elbow flexion in the process of elbow extension.
proportional motor program signal to be involved Abnormal motor programs of single joint
in the agonistic muscle and antagonistic muscle motion include following subtypes:
of joint motion, which is the important guaran-
tee for flexibility and stability of joint motion. 2.2.5.1 Subtype Accordance
Through preliminary measurement, in joint to the Signal Proportion
motion of human body, the proper proportion of and Intensity of Agonistic
signal between agonistic muscle and antagonis- Muscle and Antagonistic
tic muscle is about 10–1. Motor program signal Muscle
without this proportion is called disorganized 1. The type of no motor program signal: In

motor program. severe CNS damages, neural cells that gener-
Accordance to the normal range of human ate motor program signals or neural conduc-
motor program signal intensity (640–800 μV), tion pathways that conduct signals are
when the signal intensity of agonistic muscle is destroyed severely and the muscles are com-
640 μV, the signal intensity of antagonistic muscle pletely paralyzed without motor program sig-
is 64 μV. On the basis of this, the more severely nals from the area of CNS damage to the
the proportion of motor program signal loses bal- muscles of joint motion in offside body part
ance, the more difficulty the joint motion is. In dominated by the area of CNS damage. There
the condition that the signal intensity of agonistic is no joint motion at last (Fig. 2.45). The type
Fig. 2.45 The type of

no motor program signal
of no motor program signal demonstrates that method of neurological training introduced in

the CNS of the patients is damaged severely. It this book, the patients with this type of signal
takes longer time to recover functions through can recover functions ideally and the abnor-
rehabilitation training and there will be dyski- mal motor pattern cannot be formed.
nesia to some extent left. 3. Disproportionality of motor program signal
2. The type of normal proportion of motor pro- with low intensity: This type of signal is com-
gram signal with low intensity: This type of monly detected in the early recovery period
signal is commonly detected in the early and medium recovery period of the patients
period of CNS damages of the patients with with CNS damages (Fig. 2.47). Compensatory
paralyzed limbs who force themselves to do mechanism is activated and undead neural tis-
exercise such as the patients who don’t walk sue in injured CNS area and around injured
out of bed without muscle spasm in upper CNS area can replace the functions of injured
limbs (Fig. 2.46). At this time, the patients are neural tissue. However, because the time is
guided to do joint motion, when the joint of not appropriate and the functions are not
paralyzed side limbs can move, not only the replaced completely, the signal intensity from
motor program signal can be detected, but CNS to the muscle of joint motion is weak.
also the signal intensity proportion of agonis- Moreover, there is no compatible ability of
tic muscle and antagonistic muscle usually is the compensated neural tissue. Therefore, the
in a normal range, but the signal intensity will proportion of motor program signal to agonis-
be decreased to some extent. This type of sig- tic muscle and antagonistic muscle is disor-
nal demonstrated that there were CNS dam- dered. There is more severe dyskinesia in the
ages, but there were still some normal neural patients with this type of signal who has
tissue with functions. Because the patients abnormal motor pattern. The therapy usually
don’t force themselves to do joint motion too takes a long time. On the basis of developing
early, abnormal motor program is induced by neural potential, reestablishing motor pro-
that the function of paralyzed muscle is com- gram, restricting motor pattern training in
pensated by peripheral muscle. Through stan- unnecessary movements in exercise, there will
dard rehabilitation training such as three-stage be good functional recovery.
Fig. 2.46 The type of

normal proportion of
motor program signal
with low intensity
Fig. 2.47
Disproportionality of
with low intensity
4. Disproportionality of motor program signal joint motion, the muscle relaxes. At this time,
with normal intensity: This type of signal is there is no motor program signal. Therefore,
commonly detected in the late recovery period during resting stage (the muscle relax), the sig-
and sequelae period of the patients with CNS nal baseline of normal motor program is zero.
damages and without standard rehabilitation
training (Fig. 2.48). Because of long medical This type of signal is commonly detected in the
history, the functions of neural tissues in recovery period of the patients with higher CNS
injured penumbra are recovered. The functions damages (brain damages, Fig. 2.49). The func-
can be replaced by the neural tissue around the tions of higher nerve center are not recovered,
injured area and distal area. Through neural whose inhibitory effect on the lower nerve center
plasticity, functional reorganization is realized, is weak. Therefore, the excitability of lower nerve
but the neural tissue and cells of functional center is activated and continuous or frequent
reorganization without training are lack of weak electrical signal can be released. Irregular
compatible ability. Although the signal inten- signal curve constantly above zero baselines is
sity of motor program is not low, the propor- generated. This type of signal may decrease the
tion is disordered. Therefore, the dyskinesia is stimulus threshold of muscle excitability evi-
still obvious. In allusion to these patients, the dently and the muscles are always in tension state.
training of rectifying disordered motor pro- With slight stimulus, the long-term contraction or
gram, reestablishing normal motor program spasm of the muscle can be induced and it is dif-
and remodeling motor pattern can result in bet- ficulty to recover to relaxed state.
ter effect. The rehabilitation training principle of these
5. Irregular proportionality of motor program sig- patients should be put on the recovery of higher
nal with high baseline delay form: Normal nerve center functions. Through the training of
motor program signals are in accordance with developing neural potential and reestablishing
the law of “all or none” in action potential gen- motor program, motor function can be better
eration and conduction. The signal is conducted recovered. In addition, the training of relaxed
to corresponding muscle and induces the con- muscle is essential. The prompt relaxation after
traction of the muscle. After the completion of muscle contraction is a process that higher nerve
Fig. 2.48
Disproportionality of
with normal intensity
Fig. 2.49 Irregular
proportionality of motor
program signal with
high baseline delay form
center controls lower nerve center and the recov- 2.2.5.2 Classification of Signal
ery of higher nerve center functions. Intensity of Agonistic Muscle
Under the continuous detection and real-time 1. Abundant incremental type: This type of wave
display of motor program signal in neurological form is observed in the recovery period of the
training equipment, the patients are guided to patients with lighter CNS damages. In every
strengthen the agonistic muscle signal and atten- training, the signal intensity of agonistic mus-
uate antagonistic muscle signal in order to restore cle increases little by little (Fig. 2.50, 2.51,
the normal proportion of 10–1. The abnormal and 2.52). When the patients are guided to
motor program can be rectified gradually and complete joint motion, the signal intensity of
will be consolidated through repeated training. agonistic muscle can surpass the baseline last
Fig. 2.50 Abundant
incremental type I
Fig. 2.51 Abundant
incremental type II
time easily. The times can be reach five times with this type of signal was ideal after training
or more, which make people think that the sig- and its prognosis is good.
nal resource of motor program is abundant 2. Exhausted decay type: The characteristic of
and inexhaustible. This type of signal demon- this wave form is that motor program signal of
strated that the CNS damages were slight or agonistic muscle is strong in the first training
the injuries were repaired even though the and the signal intensity don’t increase, but
CNS damages were severe. The functional decrease in the following training. There is
reorganization was realized, which indicated lacking in strength of agonistic muscle and
that the motor function recovery of the patients make the people think that the signal resource
Fig. 2.52 Abundant
incremental type III
is limited cannot be supplemented in time, There is difficulty in single joint motion

which is called gradually exhausted decay and snail pace of the patients with this type of
type (Figs. 2.53, 2.54, and 2.55). This type of signal. The key point of training is the starting
signal is commonly detected in the patients speed training of motor program. Under no
with motor neuron degeneration, complete earth gravity circumstances, the patients are
peripheral nervous injury or incomplete guided to give out motor program signal and
peripheral nervous injury, which declared that induce corresponding joint motion. The time
the neural injury is severe or there is progres- from giving out instruction to the appearance
sive neuropathy. The effect of rehabilitation of motor program signal is defined as objec-
therapy is not ideal and its prognosis is bad. tive indicator. The patients are guided to try to
3. Initiating delay type: When the therapists
shorten the starting time gradually.
guided the patients to do joint motion, the 4. Zero slow type: Under normal circumstances,
patients try to move joint with subjective con- after completion of active contraction, motor
sciousness after the instructions, but the signal program signal should disappear immediately.
from CNS to agonistic muscle is delayed and The curve should return to Zero baseline
the corresponding joint motion is delayed (Fig. 2.57). When the patients complete joint
accordingly (Fig. 2.56). Under normal cir- motion, the therapists guided the patients to
cumstances, movements instructions are given relax and the motor program signal stops, but
to the patients and they try to move joint. Then the signal curve cannot decrease to zero
there will be signal and joint motion soon. immediately, but the process is slow (several
The reason of slow start of joint motion is minutes in some situation), which is called
due to the selection of motor program and dis- Zero slow type curve.
order in the starting process, which is the
result of cortex motor center damages. The The generation of this type of signal is due
other situation includes hypertonia of antago- to incompatible work of CNS cells. When the
nistic muscle and severe disorder of motor movements idea is formed, there are only par-
program. The agonistic muscle can hardly tial cells that are activated and give out electrical
drive joint motion. signal in the corresponding cortex motor center,
Fig. 2.53 Exhausted
decay type I
Fig. 2.54 Exhausted
decay type II
whereas the other cells are not activated. When The training for this type of signal is relax-
the previous cells gave out the signal, the other ing training, whose objective is to develop CNS
cells are activated. Therefore, in muscular flac- potentials and recover the ability that higher
cidity period, there are still signals from nerve nerve center controls lower nerve center. The
cells to the muscles and the muscles are excited, time of the process that the signal returns to zero
even tension increasing and spasm. In other situ- is defined as objective indicator. Time limit in
ation, after higher CNS damages, the excitability every screen is 40–60 s or the scan is continuous.
of lower CNS is released and the continuous sig- The patients are guided to relax continuously
nal can induce muscle spasm. until the signal returns to zero.
Fig. 2.55 Exhausted
decay type III
Fig. 2.56 Initiating
delay type
The time of establishing or consolidating motor established in the motor center and the motor cor-
program is related to evolution extent of species. tex is damaged, the process of motor program is
The higher the evolution extent is, the longer the complicated and takes more time.
time of establishing motor program takes. On the Therefore, the process of reestablishing human
contrary, the time is shorter. For example, several motor program is relatively chronic. Repeated
hours after the birth of sheep, it can walk and run, training is needed to reestablish motor program.
whereas people need 1 year or more to learn to After repeated basic training (3–6 months), the
walk and run. When the motor program is already motor program is consolidated and the therapeu-
Fig. 2.57 Zero slow

type
tic effects can be consolidated. After this, the The indications and contradictions of all kinds of
functions can be maintained through continuous diseases are slightly different, but they are basi-
exercise. cally similar.
Many patients and their relatives, even the
doctors and the therapists, cannot understand 2.2.6.1 Indications
the same training. There are examples that some 1. All kinds of diseases include hemiplegia,

skills are mastered through repeated training in paraplegia, cerebral palsy, facial paralysis,
daily life such as shooting and archery athletes. peripheral nerve injury, visual impairment,
The shooters or archery athletes can enhance swallow disorder, respiratory dysfunction,
and keep the good score through shooting the cognitive disorder, speech disorder, sphincter
target every day. This is a perfection, refinement of Oddi dysfunction, scapulohumeral periar-
and consolidation process of archery or shooting thritis, pain in waist and lower extremities and
program. osteoarticular diseases.
2. The consciousness of the patients is clear.
3. There is no obvious disorder in cognitive

2.2.6 Indications, Contraindications function.
and Cautions of Rehabilitation
Therapeutics Methods 2.2.6.2 Contraindications
of Neurological Training 1. The patients with unstable vital signs in the
early period of diseases, severe weakness or
Neurological training is composed of a series of cachexia.
methods, which includes the training of dyskine- 2. Subjective consciousness or active movement
sia induced by hemiplegia, paraplegia, cerebral training may endanger the patients’ life or
palsy, facial paralysis, visual impairment, swal- worsen the condition of the patients, such as
low, throat muscles, diaphragm and sphincter and unstable state of hypertension or unhealed frac-
training methods of cognition, speeches, beauty, ture in the early period of fracture fixation.
scapulohumeral periarthritis, pain in waist and 3. The patients with psychiatric disorders and
lower extremities and osteoarticular diseases. incompatible with treatment.
2.3 The Type and Methods of Establishing Coordinated Movement Procedure 77
4. In the patients with deep venous thrombosis jeopardize the patients’ self-respect during
and limbs swelling, active movement may training, especially order speeches and scold
make the embolus fall off. speeches. The therapists should use negotia-
5. The patients are in coma or serious cognitive tion, conciliation and induction to let the
disorders, who are not appropriate for reestab- patients cooperate with the therapists.
lishing training through directly using motor 4. The therapists should emphasize on the com-
program and need to develop training in munication with the patients. Mission com-
advance. pleted training should be avoided. At the end
of the training, in allusion to the patients’
2.2.6.3 Cautions problems, the therapists give the patients self-
1. Choosing appropriate method according to training tasks and inspect the tasks results the
different situations. In the therapeutic meth- next day.
ods of neurological training, the therapy
points in different stages are different. We
should choose different methods according 2.3 The Type and Methods
to different situations. For the patients with of Establishing Coordinated
weak signals. The development of neural Movement Procedure
potential should be emphasized. The propor-
tion of agonistic muscle signal and antago- 2.3.1 The Significance
nistic muscle signal should not be of Establishing
overemphasized. Otherwise, the patients the Coordinated Movement
may feel depressed and then lose the confi- Procedure in Recovering
dence in the therapy because they cannot Coordinated Movement
Meet the requirements. Meanwhile, these
have an important effect on the development As mentioned above, the movement procedure of
of neural potential. Just as in the difficulty the single joint is located in the area 4th of cortical
times, it is unpractical to overemphasize motor, while the movement procedure of multi-
nutrition structure. It is essential to eat full in joint coordinated movement is located in the area
order to save people’s life. Under the suffi- 6th of cortical motor [4]. Single joint activity is
cient life supply, it is able to lay emphasis on the basis of associated movement of limbs; single
nutrition structure of eating. In the first stage joint activity disorder can severely influence the
of training, the reserved neural cells and con- coordinated movement of the multi-joint, and can
duction pathways should be activated firstly. even make the coordinated movement unable to
Afterwards, the cells and pathway are coop- be completed. Multi-joint coordinated move-
erated to work together to reestablish motor ment is the complex form of the movement of
program. If the new cells are not activated, limbs, while the flexible single joint activity is
the cooperative work will fail. the highest movement form of the human body.
2. During training, the therapists should empha- For instance, it is hard for an ordinary people who
size on the therapy methods and mechanisms, have not been improved through training to carry
which include the relationship of brain and out single activity of auricular and little finger, yet
body movements, what’s motor program sig- only may be achieved by special training.
nal and the functions of training. All these can However, a functional action which has a real
motivate the patients and let the patients take meaning, such as walking, running, jumping, and
part in the training and know their progress in picking up a cup and drinking and so on, must
the training. be the results of the coordinated movement of
3. The attitude of the training it is forbidden to multi-joint, most of the single joint activities do
show during dissatisfaction, impatience, the not have practical function which can be used
expressions, speeches and behaviors that can in daily life. Without the activity of single joint,
however, the coordinated movement which is the means and progresses of training, it is a prog-
formed by multi-joint activity and has practical ress of training the practical ability of the brain
function is impossible. Therefore, both of them to discover, analyze and solve problems, but not
are essential and supplement each other, and they what has learnt. Similarly, through the training of
are one of the questions which must be putting a the movement procedure of designed multi-joint
high value during rehabilitation training. coordinated movement, training the brain’s abil-
Multi-joint coordinated movement is the ity of integrated management and coordinate the
movement which is often referred to the involve- movement of each joint, instead of trained to be an
ment of whole limbs (such as upper limb or lower fixed, rigid single movement pattern.
limb) or more joints, it is this movement which Establishing a movement procedure of multi-
is governed by the most complex movement. joint coordinated movement needs based on the
Therefore, establish the movement procedure of practical functional defects and daily life of the
multi-joint movement, must be based on the basis patients, for instance, upper limbs can take the
of established single joint movement procedure. training of procedural reestablish such as pick up
a cup, drink water, brush teeth, tie a belt, fasten a
button and so on; lower limbs can take the train-
2.3.2 The Type and Methods ing of procedural reestablish such as squat, stand
of Reestablishing Coordinated up, walk and reach a stage and so on (Table 2.4).
Movement Procedure
2.3.2.1 The Training of Reestablishing
Multi-joint coordinated movement is an activity the Movement Procedure
which referred to two or more practical func- for Picking Up a Cup Multi-joint
tional meaning joints. In the activities of practi- Coordinated Movement
cal daily life, the form of associated movement This program can control the movements that
is produced by the need of practical work, it require multi-joint to pick up a cup and grasp
included many types, and without bounds. Such something through upper limbs. It is one of
as back somersault, people without training may the essential basic movements in daily life.
not be completed, while through training they This movement can be divided into three joint
can somersault 360, when through science and motions, which include anteflexion of shoulder
diligent long time training, they will have the joint, extension of elbow joint and grabbing.
ability to somersault 720 or more. Excessive dividing causes chaos and induces
From the point of rehabilitation training, it is difficulty in analyzation and memorizing in the
puts particular emphasis on the ability of restore patients, and then the training effects can be influ-
the need of original daily life of patients. This enced. During the motor program, anteflexion of
ability can be roughly divided into multi-joint shoulder joint, flexor digitorum after extension
coordinated movement of upper limbs and lower of elbow joint and finger and grasping should be
limbs. Therefore, it can be trained by designed done sequentially.
multi-joint coordinated movement. This is not The therapists place the reception electrode of
request patients to movement which must be use motor program signal on the skin surface of ago-
this pattern in their future life, but the process nistic muscles in three groups separately, which
which is training cortex motor center to coordinate include three electrodes of the first lead in ante-
each joint to take the coordinated movement for rior deltoideus triangularis, three electrodes of
the need of daily life by different ways. Just as we the second lead in triceps muscle of arm and three
have studied Advanced Mathematics in school, but electrodes of the third lead in flexor digitorum.
we may not engage in the work which is related to Every lead includes three electrodes. The first
mathematics after graduated. Maybe some people surface electrode is placed on the proximal end
will think that that period of time is wasted, but of muscle belly, the second electrode is placed on
this is not the case. Since learning is only one of the distal end of muscle belly and the grounding
Table 2.4 Reestablishing multi-joint coordinated movement procedure, examples of the sequence of sent out signals
Name of the Sequence of sent out Onset position of
movements Joint movement Agonist signals limbs
Pick up a cup Shoulders extend forward Anterior deltoid 1 Upper anatomic
Stretch the elbow Triceps muscle 2 position
Bend fingers to grasp Flexor of fingers 3
Drink water Bend fingers to grasp Flexor of fingers 1 Sitting position
Bend elbow Bicipital muscle 2 Table plane
Shoulders abduction Middle deltoid 3 Grasp the cup
Comb hair Bend elbow Bicipital muscle 1 Sitting position
Shoulders abduction Levator scapulae 2 Table plane
upward
Shoulders downward Pectoralis Major 3 Grasp the comb
muscle
Squat Bend hips Hip flexors 1 Standing position
Bend knees Hamstrings 2
Body bend forward Abdominal muscle 3
Stand up Extend knees Quadriceps femoris 1 Sitting position
muscle
Extend hips Gluteus maximus 2
muscle
Body straighten Psoas 3
Walk Move the centre of gravity Hip abductors 1 Standing position
to offside
Bend hips Hip flexors 2
Foot flexed Tibialis anterior 3
electrode is placed on the distal end of muscle The therapists place the reception electrode of
belly (Fig. 2.58). Under real-time display of the motor program signal on the skin surface of ago-
signal circumstances, the therapists use Daoyin nistic muscles in three groups separately, which
technique to guide the patients to give out the include three electrodes of the first lead in offside
signals sequentially and do joint motion orderly. hip abductors (contraction when the lower limbs
This training should be done slowly at first, and bear load), three electrodes of the second lead
after proficiency it can be accelerated. The trainin hip flection and three electrodes of the third
ing can be done through picking up a teacup or lead in skin surface of tibialis anterior muscle.
grasping something. Every lead includes three electrodes. The first
surface electrode is placed on the proximal end
2.3.2.2 The Training of Reestablishing of muscle belly, the second electrode is placed
Walking Motor Program on the distal end of muscle belly and the ground-
Walking is an important guarantee of the daily ing electrode is placed between the first and
life quality. Abnormal walking is the resource of the second (Fig. 2.59). Under real-time display
abnormal motor pattern of lower limbs such as cir- of the signal circumstances, the therapists use
cle gait, dragging gait and swaying gait. Therefore, Daoyin technique to guide the patients to give
walking training is the basic training to rectify the out the signals sequentially and do joint motion
abnormal motor pattern of power limbs. orderly. This training should be done slowly at
This movement can be simply divided into first, and after proficiency it can be accelerated.
three joint motions, which include load bearing The training can be done through walking train-
of offside lower limbs, hip flection and dorsi- ing, but it should be monitored continuously
flexion of foot. During the motor program, load under the neurological training equipment. The
bearing of offside lower limbs, hip flection and patients should do every joint motion under the
dorsiflexion of foot should be done sequentially. signal program.
Fig. 2.58 The training

of reestablishing motor
program of multi-joint
coordinated movement
of picking teacup
2.3.3 Indications, Contraindications

and Cautions
of Reestablishing Multi-joint
Coordinated Motor Program
2.3.3.1 Indications
1. The training can be done in the third period of
rehabilitation therapeutics of neurological
training.
2. Single joint motor program that control para-
lytic limbs is already established.
3. The patients are capable to complete full

range joint motion autonomously.
4. Myodynamia of agonistic muscle is no less
than III level (Lovett manual muscle test).
5. The patients with stable vital signs
2.3.3.2 Contraindications
1. The patients with infirmity and unstable vital
signs.
2. The autonomous movements of joint are still
not recovered. Motor program of single joint
is still in chaos.
3. The range of whole joint motion that the

patients can complete is less than 50%.
4. Myodynamia of agonistic muscle is less than
III level (Lovett manual muscle test).
5. It is difficulty to recover normal motor pattern
or it takes a long time. In the short term it is
difficulty to be realized in the patients with
Fig. 2.59 The training of reestablishing walking motor
program severe syndromes.
2.3.3.3 Cautions tion. The course of disease is about 1–5 years and

1. The training should be step by step. If it is dif- the average is 3.62 years.
ficulty for the patients to complete the motion Patients’ inclusion criteria are as follows: (1)
require three joints, it is obliged to do united It is in accordance with the diagnostic criteria
motor program training require two joints. of national cerebrovascular disease conference
With ability improvement, the patients can do in 1995. The cerebral hemorrhage and cerebral
the training that can reestablish motor pro- infarction are confirmed by CT or MRI in the
gram and require three or more joints. patients with restricted extension of knee joint
2. Focus on preventing unnecessary joint motion due to hemiplegia. (2) There is no significant
in the early stage of training, in order to rec- dysgnosia (MMSE scores are no less than 20).
tify abnormal motor program and effectively (3) There is no severe adhesion of knee joint and
restrict unnecessary joint motion in the move- the passive movement range is normal. (4) In the
ments, weight reduction training equipment hospital, after traditional rehabilitation methods
and motor pattern molding instrument can be therapy, the patients’ situation was not improved
used to help training. significantly.
3. Flexible adjustment the items of training can Patients’ exclusion criteria are as follows:
be decided according to physical situation of (1) The patients are diagnosed with severe car-
the patients. diac insufficiency, pulmonary insufficiency, liver
4. Improve functional recovery of cortex motor insufficiency and renal insufficiency, severe
center in the training: The therapists should infectious diseases, bone fracture and cachexy
establish multi-joint coordinated motor pro- and they cannot do rehabilitation training. (2)
gram training to recover the functions of cor- The patients are diagnosed with severe cognitive
tex motor center, but not the stiff limbs motor disorder or they take medicine such as sedatives,
pattern. antidepressants and diazepam in long term and
5. Monitoring and preventing excessive agonis- cannot coordinate the treatment and influence
tic muscle involved in joint motion the num- electromyography inspectors. (3) The patients
bers of monitoring parts should be less than with frequent epileptic attack. (4) There are other
three. Otherwise, there are too many curves in diseases that can influence movements such as
the screen, which can lead to visual confusion all kinds of myopathy, bone and joint injury and
and affect the effect of training. peripheral nerve injury. (5) The patients stop
treatments for other reasons and cannot adhere to
treatment for90 times.
2.3.4 C
linical Application Study
on Mechanism 2.3.4.2 Specific Methods
of Rehabilitation Therapeutics of Rehabilitation Therapeutics
of Neurological Training of Neurological Training
In a warm, quiet, soundproof and lucifugal
2.3.4.1 General Data and Inclusion room, the patients sited in front of the screen.
Criteria Neurological training equipment was used.
Form June of 2006 to June of 2008, we picked up 3 M Ag-AgCl surface electrode were placed on
64 inpatients with Apoplexy hemiparalysis and quadriceps femoris separately. The first elec-
restricted extension of the knee joint in rehabili- trode is placed on the skin surface of muscle
tation centre of neurological training of Beijing belly in quadriceps femoris 6 cm above patella.
Tongren Hospital. There is no criterion about sex The second electrode is placed 12 cm verti-
and body side. There were 36 male patients and cally above the first electrode. The grounding
28 female patients. The age is from 30 to 70 years electrode is placed between the first and the
old. The average age is 52.6 years old. In all the second. The surface electrode is linked to the
patients, there were 24 patients with cerebral first lead of neurological training equipment
hemorrhage and 40 patients with cerebral infarc- through wire. 3 M Ag-AgCl surface electrode
were placed on hamstring muscles separately. The training should be done 45 min one time
The first electrode is placed on the skin sur- and one course of treatment includes ninety
face of muscle belly in hamstring muscles 2 cm training.
above popliteal space. The second electrode is
placed 6 cm vertically above the first electrode. 2.3.4.3 Assessment Method
The grounding electrode is placed between the and Statistical Analysis
first and the second. The surface electrode is Lovett manual muscle test (Lovett MMT),
linked to the third lead of neurological training range of motion (ROM) of knee joint, Fugl-
equipment through wire. The therapists use six- Meyer lower extremity motor function assess-
step Daoyin technique to exert resistance in the ment, sEMG intensity and proportion of
orientation of joint motion and encourage the quadriceps femoris and hamstring muscles sig-
patients to try to extend knee for 15 min in sit- nals are used in this experiment. At the begin-
ting position, erect position and walking posi- ning of therapy and at the end of the therapy,
tion actively. The highest signals gathered from the assessment should be carried out and the
motor center to quadriceps femoris and ham- data is collected [5].
string muscles for the first time are defined as The results of data are showed as Mean ± SD
the initial data. Two marked line are based on (x ± s). SPSS 12.0 statistical software is used for
two signals. Daoyin technique is used to guide statistical analysis. T test is used in mean com-
the patients to try to make the signal from CNS parison of two samples.
to quadriceps femoris surpass the baseline and
the signal from CNS to hamstring muscles go 2.3.4.4 Results
below the baseline. During therapy, when the We assess and analyze the myodynamia, active
signal intensity reaches the summit, the thera- ROM of knee joint, Fugl-Meyer lower extremity
pists use words such as “Hold on, or you will motor function score and motor program signal
fall down”, “Hold higher, or your feet will touch before and after therapy of quadriceps femoris
the ground!” and “Climb over, or you will slip” and hamstring muscles in 64 patients. The analy-
to make the patients feel dangerous. The patients sis results are showed in Table 2.5. There are sig-
should make the signal from CNS to quadriceps nificant differences in quadriceps femorismotor
femoris surpass the baseline as much as pos- program signal intensity, myodynamia, Fugl-
sible and decrease the signal intensity from Meyer and active ROM of knee joint before and
CNS to hamstring muscles or don’t increase the after therapy (p < 0.01). After therapy, myody-
signal intensity. Afterwards, the new summit is namia and signal intensity of hamstring muscles
defined ad baseline. The same method is used to are higher than these before therapy, but there is
guide the patients to go against resistance. The no significant difference before therapy and after
patients should try to make quadriceps femoris therapy (p > 0.05). Before therapy, signal inten-
signal surpass new baseline and hamstring mus- sity from cortex motor center to hamstring mus-
cles signal go further below new baseline. The cles is higher than that from cortex motor center
rest can be done in the same manner. to quadriceps femoris. The proportion between
Table 2.5 statistical analysis of function assessment data before and after therapy (‾x ± s)
Assessment items Before therapy After therapy P value
Lovett MMT Quadriceps femoris 2.67 ± 1.62 4.10 ± 0.62 <0.01
Hamstring muscles 2.30 ± 1.17 3.82 ± 280.76 >0.05
Active ROM (°) 4.38 ± 2.36 28.80 ± 7.68 <0.01
Fugl-Meyer 15.71 ± 7.21 25.75 ± 6.30 <0.01
Motor program signal (μV) Quadriceps femoris 42.13 ± 28.24 107.81 ± 50.63 <0.01
Hamstring muscles 57.67 ± 34.17 62.13 ± 28.24 >0.05
Differences 23.94 ± 20.30 56.88 ± 43.35 <0.01
them is 1.4 and 1. There are difficulties in exten- vous cells Because central nervous cells are
sion of knee joint of limbs in hemiplegic side and unable to regenerate, there are seldom regen-
rigidity or recurvatum in walking in the patients erated cells, which have little effect on the
with this proportion. After therapy, signal inten- recovery of motor function. No matter which
sity from cortex motor center to quadriceps kind of cell, the cells should be cooperated to
femoris is increased. There is significant differ- establish new connection in order to recover
ence before therapy and after therapy (p < 0.01). motor function because the relationship
Although signal intensity from cortex motor between cells is changed. Therefore, recover-
center to quadriceps femoris is increased, there ing the coordinated and orderly collaboration
is significant difference before therapy and after of cells is the basis of recovering motor func-
therapy (p > 0.05). After therapy, there is signifi- tion. The training of recovering the coordi-
cant difference between signal of hamstring mus- nated and orderly collaboration of cells is a
cles and signal of quadriceps femoris (p < 0.01). process to reestablish motor program in motor
The proportion between them is 1.4 and 1 before center.
therapy and the proportion is improved to 1 and 2. Human autonomic movements are dominated
4.1 after therapy, which is the main reason of sub- and controlled by motor program in cortex
stantial improvement of autonomic movements motor center. The motor programs in motor
of knee joint. center are from two aspects. (a) The first is
congenital, which is inherited from ancestors
2.3.4.5 Discussion and account for a small fraction of total. (b)
1. The coordinated and orderly collaboration of The second is acquired and account for a large
central nervous cells is the basis of motor fraction of total, which is acquired motor pro-
function recovery. The completion of auto- gram through learning. Motor program is
nomic movement of any joint is the results of electrical signal from cortex motor center to
the coordinated and orderly collaboration of single joint or multi-joint to complete all kinds
central nervous cells. Some research indicated of movements. if we compare cortex motor
that the number of central nervous cells center and computers, we can better under-
required for fine movement is much larger stand the motor program. There are many
than that for gross movement. For example, similarities between new born babies and
the number of motor center cells required for factory-fresh computers. For example, there
controlling a thumb is equal to that required are only recognition and storage of software
for controlling an upper limb. The premise of in factory-fresh computers without any other
numerous cells to complete a joint motion is functions. Only the software are installed, the
the coordinated and orderly collaboration of computers are possessed with various kinds of
them. functions such as editing, mark identification
Although central nervous cells are unable and screening. If the installed software is
to regenerate, central nervous tissue is able to English version, it is able to edit English. If
compensate the lost functions just as other tis- the installed software is Chinese version, it is
sues through CNS plasticity. The lost cells able to edit Chinese. If the English version
after CNS damages can be supplemented by and Chinese version are both installed, it is
the following several aspects in order to able to edit English and Chinese through
recover the original motor functions. (1) The switching. The new born babies cannot do
undead cells in injured area and cells in pen- nothing but sucking the breast, crying and
umbra area can recover functions with the moving without any purpose. However, the
changes of internal environment. (2) The nor- babies’ brain has the same memory function
mal cells around injured area can obtain the with hard disk of computers. During the
same functions as that of the injured cells development, through learning, they can
through training. (3) Regenerated central ner- creep, sit and stand. They learnt to walk and
jump about 1 year after born. This is the pro- If the motor center where motor program
cess of motor program establishment and per- has already established is destroyed, the rees-
fection. It seems that every autonomic tablishment process and difficulty of motor
movement must be dominated by motor pro- program is different from the reestablishment
gram in cortex motor center. The norm of process and difficulty of motor program in
autonomic motor pattern is dependent on the newborn babies. The brain of newborn babies
perfection of motor program or not. The ath- is like a blank paper. With natural tropism,
letes can promote competitiveness through motor program is relatively easy to be estab-
training, which may be related to the fact that lished. In the damaged brain area where motor
the training improves motor program and program has already been established, it is
enhance myodynamia. difficulty to reestablish motor program, which
3. Digital objective display of motor program may be related to the damage of original con-
signal is essential external condition for recti- duction pathway between cells. Like driving a
fying disordered motor program and reestab- nail into a plank, if the nail is driven s lantingly,
lishing normal motor program. After central it is difficulty to be driven into the plank again
nervous cells damages, motor program can be after the nail is pull out. Moreover, non-viable
destroyed to varying degrees. Totally destroy and non-apoptotic cells will influence the new
of motor program leads to completely lost of intercellular signaling pathways. Therefore,
movement, partially destruction of move- reconstruction of normal motor program
ments or abnormal motor pattern due to short should be based on actual condition of abnor-
of cooperation of compensatory cells. In all mal motor program and be completed through
these conditions, normal motor program targeted and repeated training.
should be reestablished. In daily life, there is a truth that archery
Central nervous system of newborn babies athlete aims at arrow target to practice archery
may be influenced by evolution of species and so that degree of accuracy in archery can be
is tend to normal development, which means increased. Otherwise, the degree of accuracy
common training can make the species are in archery cannot be increased without target.
able to survive. This is not always the case. This is because archery is a motor program
There are some defects in the abilities acquired that is constructed in cortex motor center.
without scientific training. Under general cir- Through repeated practice, the archery skill
cumstance, people have no idea about whether will be promoted continuously. When archery
their own motor pattern is normal or not. athlete aims at arrow target to practice archery,
People may not realize or totally understand the first arrow may be shoot in the above of
the defects of motor pattern in normal people. the bull’s-eye. The archery result is sent to the
This is because there is no test and compari- brain and the brain will analyze numerous fac-
son. The defects of motor pattern can lead to tors (altitude of arrow target, distance, wind
difference of human athletic ability. For exam- direction, bow weight, arrow weight, arm
ple, people are able to run, but there is differ- strength and emotion) comprehensively. After
ence in the running speed, running duration calculation, the gesture of the second arrow
time and running distance. This may be related can be decided such as lowering the arrow-
to the accuracy of motor program of individual head. The second arrow may be shoot in the
running. However, the formation of motor pat- below of the bull’s-eye. The archery result is
tern is dominated by motor program in cortex sent to the brain and the brain will know the
motor center. Therefore, central nerve dam- arrowhead is too low. The gesture of the third
ages can lead to motor function lost or abnor- arrow can be decided such as raising the
mal motor function. Rectifying disordered arrowhead. The third arrow is shoot in the
motor program or reestablishing normal motor bull’s-eye. After repeated training, the speed
program is required to recover functions. and accuracy of the movements are controlled
precisely by the brain so that the speed and tablishment. Targeted repeated training is the
accuracy of the movements will be increased. important process to achieve reestablishment.
During this process, arrow target is the subjec- The time spent in reconstructing motor
tive indicator for illustration and feedback, program is related to evolution extent of spe-
which make the brain know the mistake, rec- cies. The higher the evolution extent of spe-
tify it timely and set clear objective. Therefore, cies is, the longer reconstructing motor
arrow target is essential external conditions program takes, and the vice versa. For exam-
for increasing the degree of accuracy in ple, sheep can learn to walk and run several
archery and constructing archery motor pro- hours after birth, meanwhile people take a
gram. After repeated training, the motor pro- year or more to learn to walk and run.
gram is consolidated. Therefore, reconstruction of human motor
In the extension of joint motion in our program is a relative long process. Too short
research, normally strong signal is from brain therapy course can lead to relapse of the dis-
to quadriceps femoris and the result is exten- ease, even futile treatment. If the patients
sion of knee joint. Meanwhile, weak signal is want to be recovered within few days in hos-
from brain to hamstring muscles to maintain pital, it will have a bad impact on rehabilita-
fixed tension and increase stability of knee tion training effect. Through long-term
joint in extension of knee joint. After brain clinical practice, the author found that obvi-
damages, in the abnormal motor program, ous functional recovery of dyskinesia in
except the weak signal intensity, the signal lower limbs caused by central nervous dam-
form brain to quadriceps femoris is the same ages took 3 months. However, for the upper
strong as signal from brain to hamstring mus- limbs, especially hands, obvious functional
cles or there is no significant difference recovery of dyskinesia took 6 months or
between the two signals. Therefore, there is more. Therefore, the author recommended
no extension of knee joint or it is difficulty to that the therapy course of rehabilitation train-
extend knee joint. It is essential to rectify dis- ing is from 3 to 6 months. This is why we use
ordered motor program and reestablish nor- 3 months and 90 times rehabilitation train-
mal motor program in order to observe ings as one therapy course.
practical condition of motor program in exten- 4 . In the Daoyin feedback technique in tradi-
sion of knee joint. tional Chinese medicine, Daoyin technique
Daoyin feedback techniques in traditional plays the main role in therapy. Effect display
Chinese medicine can guide the patients to and signal feedback play an essential support-
extend knee joint actively, the movement ing role. In this therapy, Daoyin technique is
results are detected by signal detection equip- used to develop CNS potential. Signal detec-
ment and displayed on the screening in real- tion equipment display the Daoyin technique
time. The dynamic continuous motor program effect objectively and provide the surpassing
feedback signals are provided to play a role target for the patients. Daoyin technique plays
that is more important than that of the target so the main role in therapy. Effect display and
that the training have a definite object in view signal feedback play an essential supporting
training. Daoyin technique are used repeatedly role. However, without effective digital curve
to encourage the patients to promote signal to display motor program, it can make the
intensity of agonistic muscle and lower signal therapists don’t know the specific circum-
intensity of antagonistic muscle in order to stance of motor program exactly. And then
recover the normal proportion of the two sig- there is no way to rectify and reestablish train-
nals and improve the function of extension of ing. Therefore, training plays an essential role
knee joint. Therefore, objective display of in reestablishment of the training.
motor program signal of extension of knee 5. “Neurological training” is the generalization
joint is important external condition for rees- of Daoyin feedback technique in traditional
Chinese medicine. Six-step Daoyin technique tic muscle and neutralized muscle. Agonistic
training is used for central nervous system, muscle and antagonistic muscle play the main
which means there is CNS plasticity induced role in joint motion. Therefore, we select ago-
by Daoyin training. Finally, functional reor- nistic muscle and antagonistic muscle signals
ganization is achieved and the lost motor as the motor program signals that are from
function is recovered. Therefore, the author cortex and control the joint motion. The
called it “neurological training” in order to appropriate proportion of the two kinds of
emphasize the characteristics of rehabilita- muscles is the basis of autonomous move-
tion in traditional Chinese medicine that are ments of joint. Signal intensity of motor pro-
different from other rehabilitation therapy gram is in direct proportion to individual
methods. myodynamia. Its effect on joint motion is
6. The key component of signal received from similar with pulling a cart. The force of pull-
skin surface of muscle belly is motor pro- ing a cart is 100 N. If the assistant behind the
gram signal. Because of the complexity of cart do not push the cart forward, but pull
neuromuscular system, anatomical and phys- back with 100 N force. The result is that the
iological characteristic of many related elec- cart cannot move forward with the forces
tromyography signal remains unclear. The from two persons. The smaller the drag force
source of signal received from skin surface of of the assistant become, the bigger the differ-
muscle is unknown. Whether it is the control ence between the forces from two persons is,
signal or drive signal form cortex motor cen- the bigger the force of moving forward is.
ter to muscle or it is electrical signal gener- And then the cart can move forward. However,
ated by muscle? It is generally described as human joint motion requires certain tension
biological electrical signal of neuromuscular of antagonistic muscle in order to keep the
activities. Because the signal is received stability of joint motion. Therefore, in the
from skin surface of the muscle, it is called joint motion, certain antagonistic muscle
surface electromyography signal, which is drive signal is from cortex motor center.
composed of action potential of different Appropriate difference in the intensity of
motor unit. Motor unit is composed of a command signal from motor center to agonis-
group of muscle fibers dominated by identi- tic muscle and antagonistic muscle involved in
cal motor nerve. joint motion is the basis of joint flexible
The author detected electromyography motion. Completion of a function requires
signal of the patients with spinal shock and many joints and muscles. It also requires
completely peripheral nerve injury and found motor center to give out command according
that electromyography signal cannot be to the sequence of joint motion, which is
detected in passive muscle movement. called motor program of coordinated move-
Irregular electromyography signal induced by ment. From this, during joint motion, the sig-
heteronomous spasm of muscle in spastic nal received from skin surface of muscle is
period may be from spinal cord motor neu- drive signal from cortex motor center to mus-
rons [6]. In clinic, the author found that the cle, but not generated by muscle contraction.
highest electrical signal received from skin Our results showed that rehabilitation tech-
surface of muscle in children and adults is nology of Daoyin feedback in traditional
less than 800 μV, but there is significant dif- Chinese medicine is an effective method to
ference of myodynamia between children and improve extension of knee joint in the patients
adults with identical signal intensity. It is with hemiplegic stroke, which can develop
showed from one side that signal received CNS potentials and promote reestablishment
from skin surface of muscle may be the drive of motor program. It can provide experiment
signal from central nerves to muscle. The basis and theoretical basis for clinical applica-
muscles involved in joint motion include ago- tion of new therapy and renaissance and mod-
nistic muscle, antagonistic muscle, synergis- ernization of Daoyin technique.
References 87
References 3. Shifang Z. Research and rehabilitation of brain

plasticity after cerebral apoplexy. Chin J Phys Med
Rehabil. 2002;14(7):437–9.
1. Hongshi M, editor. The theory and practice of reha-
4. Linying Z. The research progress and application of
bilitation medicine. Shanghai: Shanghai Scientific &
stroke rehabilitation technology. J Chin Clin Rehabil.
Technical Publishers; 2000.
2004;8(34):7768–9.
2. Shepherd GM. Neurobiology. Shanghai: Fudan
5. Yulong W. Rehabilitation evaluation. Beijing: People’s
University Press; 1992. Translated by Nanshan C. &
Health Publishing House; 2000. p. 88.
Hongzuo A, DAI Hongzuo
6. Wenru Z, Brucker BS, Xiuru W, et al. Application of
myobiofeedback in the injury of old cervical spinal
cord. J Chin Rehabil Med. 2003;18(2):91–3.
Neurological Training Methods
of Developing Neural Potential 3
3.1 The Basis of Neural Potential human can live long is mainly related to three
functions.
Limbs movements are meaningful functional
movements through regular muscle contraction 1. Adaption is an ability that people can change
and relaxation dominated by cortex motor center themselves to adapt the condition changes to
of brain according to human willpower. After survive when the external conditions or cir-
CNS damages, there is motor function lost to cumstance is changed. For example, people
varying degrees. Because of low regeneration who lived in tropic move to cold north and they
capacity of CNS, it is deemed for a long time that can increase their freeze resistance capability
the possibility of recovering the lost motor func- to adapt the cold environments in north.
tions after CNS damages is small, which make 2. Regeneration is an important mechanism of
many patients lose hope on functional recovery. recovering functions after human tissues dam-
With the control study and rise of rehabilita- ages, which is the main route to recovery after
tion method, we found that after CNS damages many tissues damages and is also the measure to
there are significant differences in functional recover original function preferably. For exam-
recovery between the patients with rehabilitation ple, the skin tissue of human body is damaged.
therapy and the patients without rehabilitation Afterwards, new cells are generated through
therapy. The death rate decrease, functional mitosis and regeneration of new vessels can
recovery degree, decreased degree and the rate of recover the original function. However, the
going back to work of the patients with rehabili- recovery ability is different in different tissue
tation therapy are superior to these of the patients types. There is strong regeneration capacity in
without rehabilitation therapy, which indicate epithelial tissue, liver, spleen, skeleton and mus-
that rehabilitation may recover the lost functions cle. Whereas, regeneration capacity of central
to varying degrees. In that way, after CNS dam- nervous tissues include spinal cord and brain tis-
ages, why the training can recover functions sue is very weak. For a long time, it is deemed
under the condition that CNS is lack of regenera- that central nervous tissue is lack of regeneration
tion capacity and function cannot be recovered? capacity. That’s why the lost function is had to be
This question deserves profound thinking and recovered after CNS damages. Some research in
discuss. recent years demonstrated that there is regenera-
Damage is an inevitable thing that is of fre- tion capacity in CNS. However, the lost motor
quent occurrence in daily life. The reason why function after damages is seldom recovered if
https://doi.org/10.1007/978-981-13-0812-3_3
90 3 Neurological Training Methods of Developing Neural Potential
there is no intervention. Therefore, we deemed The basis of potential is tissues and cells in
that regeneration capacity of CNS tissues has reserve and the method of developing potential is
no effect on the functional recovery after CNS that tissues and cells are trained to play their role
damages. In other words, it is far from satisfac- sufficiently or extraordinarily.
tory to recover motor function after CNS dam- The range of potential is wide, which includes
ages only through regeneration of neural motion, thinking, operation, memory, control and
tissues. viscera function. These can be divided into sev-
3. Compensation: When the tissue some part is eral types:
damaged, under the effect of some factor,
homogeneous tissue around the injured area 1. Functional reserved type: This type means

or in distal part replace the functions of the that tissues and cells are already able to play
injured tissue, which is called compensation. roles and they possess abundant functions
This capacity is very important for the tissue after satisfying normal physiological activity
that lases functions and is with bad regenera- and daily life movements. The effects of these
tion capacity. After acute stage, the compensa- functions include two ways. The first is to
tory capacity is high in the early stage of the supplement additional functional require-
disease and become less and less as time goes ments. When people increase activity level
on. Therefore, after damages, the patients suddenly, the reserved functions should be
should begin rehabilitation training as early as activated. For example, there are 303 million
possible. However, from the degree and quan- alveoli and in normal circumstances 180 mil-
tity of compensation, the longer the time lion alveoli are enough. However, when peo-
takes, the higher the compensatory is. ple do strenuous exercise, more alveoli should
be activated, even all alveoli are activated.
However, regardless of what kinds of func- Myodynamia can be adjusted as required.
tions and approaches, it is not practical to recover People can lift 10 kg, and also can lift 50 kg or
lost functions only through natural repair. more without special training when it is nec-
Because there is limitation of repair capacity in essary. The second is that when partial tissues
self-repair ability and it is unable to recover the are damaged and lose functions, the functions
original functions. The repair time is long and it can be supplemented by reserved functions.
is easy to generate some complications such as 2. Efficiency improvement type: This type is

abnormal motor pattern. Therefore, the method based on the original functions that can be
should be used to recover the lost functions. improved through training. The involved tis-
Especially for the CNS tissue with low regenera- sues don’t certainly be increased. For exam-
tion capacity, it is a complicated question to ple, Myodynamia can be adjusted as required.
recover its functions after damages, which is Through weight training, a person can lift
worth further research and investigation. 100 kg or more who can only lift 50 kg before.
It is always the case for pulmonary function.
Through diaphragm training, the contractility
3.1.1 Theoretical Basis can be increased. During inspiration, the tho-
of Developing Potential rax volume increases obviously. Tidal volume
increases obviously with enlargement of pul-
The function ability of human body can be monary alveoli in order to satisfy the demand
improved or enhanced through special scientific for oxygen.
training or under exceptional circumstances. There are potentials in the flexibility of
Under normal circumstances, there is no improve- reaction and movements. Through training,
ment, but under exceptional circumstances, these people can react faster to external stimuli such
functions can be boosted and beyond several as the reaction time of boxing and running
times of original ability, which is called potential. starting, natural hitting reaction speed of
3.1 The Basis of Neural Potential 91
laying ping-pong and the flexibility degree

p flexed, hip abductors can make the hip flex
of human body. Through scientific training, slightly to let the lower limbs move forward in
these functions can be improved obviously. order to complete stepping forward, but the
3. Tissues reserved type: Tissues reserved type circle like abnormal gait pattern is formed. The
means that although some tissues are not pos- patients with amputation of two upper limbs,
sessed with some kind of function, they can through training of lower limbs and toes, can
acquire this kind of function through learning acquire the similar functions of upper limbs
and training. This kind of function is stored in and hands. For example, the feet can be used to
organs and human body in the form of tissues complete the functions of upper limbs and
and cells before training. hands in normal state such as toothbrush,
4. Application form type: Application form is to combing, eating and repairing watch. All these
promote efficiency through technical changes, belong to muscular compensatory potential.
which can be acquired through long-term Neural compensatory potential can be
training such as Taijiquan. The fighting skills developed and utilized through nature and
of the person who practice Taijiquan for a long practice. Nature compensation is a process
time may be increased obviously, but the myo- that tissues reestablish functions through self-
dynamia may not be increased obviously. adjusting ability after damages. The start of
There are some realms such as “Exerting force reestablishing this function may be through
before the opponent and achievement before some kind of tendency induced by lesion area
acting” and “one blow can put someone to or inducing factor. The compensation take
death”. Practice makes perfect, which means place in the early stage after damages and its
the functions can be perfected through repeated effect may be limited. The other way is to pro-
practice. Perfection belongs to one kind of mote central nervous cells to play compensa-
application form potential. A surgeon can tie a tory role through active movement called
knot, 30 knots for the beginner and 60–80 “use” in order to achieve functional organiza-
knots or more for the practician. Although tion and recover the ability of control limbs
there are the same amount of joints and mus- and joint motion. This is the main measure to
cles, the results can be different. recover functions after central nervous dam-
5. Compensatory type: Compensatory type
ages. Its mechanism can be referred to the sec-
potential means that when a part of function is ond section in Chap. 1.
lost, the homogeneous tissue around the 6. Regeneration type: Regeneration potential is
injured area or in distal part replace the func- that after cells damages, homogenous cells
tions of the injured tissue. around injured area generate new cells to
For nervous system and the muscles domi- recover tissues and functions through mitosis,
nated by CNS, compensatory type potential is which is the functions of most tissues and
divided into neural compensatory potential and cells in human body. However, the regenera-
muscular compensatory potential. Neural com- tion capacity is greatly different in different
pensatory potential can recover the function of tissues. For example, after epithelial tissue
its dominated muscles in order to recover the damages, in certain degree and area of dam-
original functions of muscles. Therefore, it is in ages, the original form and function can be
favor of recovering normal motor pattern. recovered. Regeneration capacity of spleen
Muscular compensatory potential can make the and liver is remarkable too. Regeneration
limbs and joints to complete the same motor capacity of muscle is weak. Scar is easy to be
function movement, but it is prone to form formed through fiber tissue connection.
abnormal motor pattern because of the com- Regeneration capacity of central nervous sys-
pensation of other muscles. For example, when tem is weak. Regeneration capacity doesn’t
hip flexors are paralyzed because of neural play a leading role in the recovering motor
injury or muscle injury and the hip cannot be functions of injured area.
In a word, although there is inter-related patients and doctors in order to achieve the
phenomenon in the potentials mentioned objective that the patients take part in the train-
above with different forms, its basis is tissues ing actively and voluntarily.
and cells. Targeted measures should be adopted
to promote development and utilization of 3.1.2.2 Definite Surpassing Target
these potentials in rehabilitation training in Setting a definite surpassing target is the impor-
order to recover more lost motor and cognitive tant measure to develop potential, recover and
functions. improve functions.
“Objective and motive” mechanism can be
applied for any area. It is said that the whole
3.1.2 T
he Condition of Developing year’s work depends on a good start in spring and
Potential the whole day’s work depends on a good start in
the morning, which demonstrates the importance
Development of potential not only requires spe- of plan and goal. Our country sets Five-year Plan
cial condition, but also requires the persons who for development and lets the whole nation and
were trained and were with preparation to apply various sectors step towards this goal. After eleven
and develop potential. The development degree is Five-year Plans, there were earthshaking changes
related to the adopted methods. For example, in China. If a primary school student can set a
under dangerous circumstances, the persons study goal very early by himself not by his par-
without training or preparation lose their head, ents, he may study very well. If he wants to enter
even lose motor and thinking functions. The into the top two schools (Tsinghua University and
result is that the persons not only cannot use Peking University) in China and he does work
development potential to cope with dangerous hard, the chance to enter into Tsinghua University
accident, but also lose the possessed capacity and Peking University is good. “Objective and
under normal circumstances. For the persons motive” mechanism was widely and necessarily
with training or preparation, they can be calm in applied for competitive sports training. For exam-
the hour of peril and use their head in a crisis. The ple, the cross-bar of jumper, the target of archery,
result is that on the basis of the original functions, target of shooting, weight of weightlifting and
they can motivate more functions to cope with an degrees of free exercises are all the goals of sports
emergency and complete the mission or pull training. With these targets, the athletes can sur-
through difficulties. pass them one by one through training and
In conclusion, there are several points in favor improve their competitiveness.
of developing potential. For the patients who want to do rehabilitation
training, the long-term target of rehabilitation can
3.1.2.1 Willingness of Active be set. However, it is practical to set immediate
Participation and definite surpassing targets such as the inten-
Potential development is a chronic and tough sity of motor program signal, myodynamia,
training process. Without the willingness of touching altitude, walking distance and the range
active participation of the patients, it is hard for of joint motion. Immediate target can be modified
the patients to persist and it is easy to be aban- as needed. Exception of the training that the
doned halfway. The patients will never achieve patients do, the patients achieve or surpass the tar-
their objectives. If the patients understand the get through hard work, can see their progress
meaning of developing potential and its impor- timely and is pleasure to receive further therapy.
tant effect and function on their future, the However, the target should be set reasonably. If
patients can take part in the training actively. the target is too high and the patients want to
Not only the patients can persist, but also the achieve it in a short time, it is difficulty for the
development effect is good. This requires the patients to complete. There will be pessimistic
joint effort of the patients, relatives of the mood of the patients that is bad for rehabilitation.
3.1 The Basis of Neural Potential 93
3.1.2.3 Satisfying the Requirements Passive movement is a process that the people

of Active Movement are driven by other people or equipment to move.
Use means that brain controls body movements Because the patients don’t use their brains to
and active use is the most fundamental measure complete or try to complete one limb movement
to develop potential. Unless satisfying the or trunk movement, it has no effect on developing
requirements of active movement, it is hard to potential. Therefore, the main function of passive
promote CNS plasticity and achieve functional movement is to prevent adhesion of joints, mus-
reorganization finally. cles, tissues, contracture of tendon and play a
There is a good example about the training of supportive therapeutic role in recovery of motor
special troops. Special troops are capable of function actively.
developing their potential and extraordinary abil-
ities through scientific and tough training in spec- 3.1.2.4 Methods to Motivate People
ified conditions such as severe cold, the intense into “Reactive State”
heat of summer, extreme climate and conditions In dangerous emergency state, for a person who
with wire entanglement and mire. In competitive is with good psychological quality, deal with
sports, good achievement can be obtained through affairs smoothly and is bridle-wise can enter into
scientific and planned active movement training. full alert, concentrated and competent state
There are also ways to promote competitive immediately in order to deal with dangerous
sports performance through electrical stimulus reactive state. Some research showed that in this
and illegal drugs, which have side effects. state myodynamia of human body is six times of
Electrical stimulus can stimulate the excitability that in normal state. Enormous energy is acti-
of muscles, but the reflex arc is located in spinal vated to cope with dangerous factors and get
cord and it has no effect on recovering higher through the difficulty.
neural center because it is afferent stimulus. The method that is effective to motivate
Therefore, electrical stimulus can maintain mus- human body into reactive state is creating immi-
cle tension, increase blood supply of muscle and nent danger state by all means such as scenario
promote muscle contractility, which belong to simulation and speech intimidation. For the
efficiency training. However, drugs can increase patients with rehabilitation training, if the created
the nutrition supply of muscle and promote the imminent danger state is too severe, the accident
excitability of nervous system abnormally and can be induced, because most patients with limb
temporally just like the patients with manic psy- paralysis due to stroke are associated with hyper-
chosis. Drugs can make the body to exert ability tension and diabetes. Therefore, it is necessary to
abnormally. However, all these cannot recover investigate and find the training method to create
normal active movement completed with muscles imminent danger sate and not to induce accident,
dominated by CNS. Moreover, illegal drugs can which is good for the patients [1–5].
harm human body and it is forbidden in rehabili- The therapists should make the patients to see
tation training. and feel safe when the patients receive training.
For example, in our daily life, if we learn cycling They must exactly know there is no danger such
and swimming, it is practical to use electrical as falling down and bumping in any training to
stimulus, drugs, acupuncture and massage, because what extent, which is the fundamental measure to
these methods are not in accordance with motor eliminate or alleviate the scruple of the patients.
relearning mechanism. Only through practical Additionally, creating strict quantitative
training, we can learn riding and swimming, because imminent danger state has no harm and side

riding and swimming are active movements, effect on the patients in developing potential. The
which conform to the requirements of promoting author called this safe imminent danger state.
CNS potential development. We can increase the In the premise of ensuring safety, creating
technical level of riding and swimming, if we can imminent danger state is an important procedure
do planned scientific training. to guarantee the effect of potential development.
With respect to the effect of potential develop- they can recover their functions through rehabili-
ment, the effect of imminent danger state is better tation training. They even cannot keep training
than that of “Simple endeavor”. The former is for a complete course of treatment. Because of
that the patients without any preparation are this, they usually give up without accomplishing
forced by emergency situation to motivate their anything or halfway. The patients usually think
own potentials to cope with accidents, whereas that there is no treatment value for further reha-
the latter is that the patients consciously try to bilitation and then they give up rehabilitation
complete some kind of unaccomplished mission training. Therefore, it is important to restore their
such as lifting 100 kg. Imminent danger state can confidence to rehabilitation. The most effective
make human body try to motivate itself and over- method to restore confidence is that they can see
come the adverse factors. If human body cannot their progress through training.
overcome the adverse factors, it is possible that In order to increase the confidence of the
there is some kind of result that has adverse patients to rehabilitation, it is necessary to let the
effects on human body or influences human body patients see their own progress in rehabilitation
irreversibly. Afterward, human body enters into training timely. In the process of rehabilitation
“reactive state” immediately in order to moti- training, the therapist should let the patients feel
vate all the powers to cope with dangerous fac- that they have access to functional improvement
tors at the utmost. During this process, the and complete rehabilitation training easily if they
embodied potentials are developed and utilized try. Therefore, on the basis of detailed functional
maximally. In the simple endavour state, the assessment, designed rehabilitation training pro-
patients know exactly mission for fulfillment gram should conform to the principle “from easy
and there is no harm to themselves even com- to difficulty and step by step”, which means sim-
plete it or not. The patients just try to complete pler training method is adopted. The training
it and cannot enter into “reactive state” very should be started from the part where the func-
well, which can influence the effect and degree tions are easy to be improved in and then tran-
of potential development. sited to the part where the functions are hard to be
There are many ways to create imminent dan- improved with high intensity and complicated
ger state. During training, the therapists can use methods. The parts of training are generally from
them flexibly. As mentioned above, scenario sim- trunk to lower limbs, and to upper limbs and
ulation and speech intimidation are used to create hands; from single joint detached movement to
imminent danger state. This method has effect on multi-joint associated movement. In the training
potential development, but the effect is not ideal methods, potential development, reestablishment
in the training without practical movements. For of motor program and remodeling of motor pat-
example, in the process of active movement train- tern are sequentially done during training. For
ing, sudden “zero gravity” or sudden reduction of example, the patients are unable to sit indepen-
assisted force with scenario simulation and dently. Potential development training of lum-
speech stimulation are used to compel the patients bodorsal muscles should be done firstly. Through
to enter into “reactive state” in order to improve the training for 2–3 weeks, the patients can be
the effect of potential development. able to sit independently. The patients see with
their own eyes and be keenly aware of the effect
3.1.2.5 From Easy to Difficulty and Step of training. And then their confidence will be
by Step increase greatly and they want to take part in the
Rehabilitation training is a chronic even life-long subsequent training actively, which can further
process. The problem usually in clinic is that the promote the training effect. Afterward, the train-
patients and relatives of the patients cannot keep ing of lower limbs and upper limbs can be started.
rehabilitation training for some reasons such as Progressive potential development is an
lack of self-confidence or money. They always important guarantee for the smooth training and
doubt, give up or take a negative altitude on that to prevent fear of the patients to difficulty, which
3.2 The Application of Six-Step Daoyin Technique in Potential Development 95
is creating “minor imminent danger state”. The In addition, for the patients with unstable state
therapist let the patients do potential develop- of an illness or severe cardiovascular diseases,
ment training positively and relaxedly and the the training should be done under electrocardio-
training effect will be better. For example, the graph monitoring to know the change of cardiac
author classify the potential development train- function timely in order to find the problem and
ing of lower limbs to six grades (30° per grade) deal with it and make rehabilitation training safe
according to flexion angle of knee joint. From and stable.
low angle, with the help of the therapists and
according to the progress condition of the
patients, the difficulty is increased gradually and 3.2 he Application of Six-Step
T
the assisted force is decreased gradually. Whether Daoyin Technique
the training is in the starting grade or the ending in Potential Development
grade, the therapists can decrease the assisted
force suddenly in the training process and say 3.2.1 Clearing and Activating
“Stand up, or you will fall down” “Hold on, or the Channels and Collaterals
you will bump”, which can motivate the potential of Daoyin Technique
of the patients and they can sit up independently.
The study about Chinese Qigong demonstrated
3.1.2.6 Appropriate Physical State that nervous system can influence human func-
The premise that training can improve motor tions through regular and conscious exercise and
function, cognitive state and memory ability is the practitioners can possess the capacity that
good physical states include stable vital signs, people without exercise cannot have. Some
acid-base balance, fluid balance, electrolyte bal- research indicated that consciousness or idea are
ance in vivo and stable functions of all viscera closely related to the integration of high-grade
that include stability of diet, sleep and defeca- part in nervous system and can control and regu-
tion. Appropriate physical state not only is good late organ activities and turn them into material
for the training safety, but also can have good strength of muscle movement.
effect on training because the patients are with Daoyin technique in traditional Chinese medi-
abundant vigor and physical power and can coor- cine can enlighten and motivate human will-
dinate with the training. power. The regulation of movement is based on
the regulation of mind and breathing, which
3.1.2.7 Secure Safeguard Procedures means the patients use brain to control limbs
Preventing the accident in the training is a special movements and employ Daoyin speeches to cre-
problem that we need to pay attention to. ate state of emergency without risk in order to
According to the specific condition of the achieve functional rehabilitation. However,
patients, feasible safeguard procedures are Daoyin technique in all dynasties attached most
adopted in order to eliminate the hidden danger importance to whole movement of self-exercise
and the fear and panic of the patients. Specific and cannot be directly used for rehabilitation of
corollary equipment neurological training is the patients with obvious dyskinesia of limbs.
equipped with weight loss system. On the one Because it is short of definite concept, subjective
hand, this system can reduce the patients’ weight and abstract, Daoyin technique is mainly used in
to varying degrees through regulating tractive life cultivation and health preservation but not in
force as the patients need in order to make the clinic, which is endangered in modern times.
patients are capable of sitting up and walking. Six-step Daoyin technique in traditional
On the other hand, suspension function of Chinese medicine is the basic technique that
weight loss system can assure the patients not to inherited from ancient Daoyin technique in tradi-
fall down or bump so that it plays a safety pro- tional Chinese medicine and is based on the regu-
tection role. lation of mind, breathing and movements. It is
divided into six steps. The strategy of it is that crash” in order to develop the neural potential as
concentrating superiority in force to attack one much as possible.
spot. The patients are guided to do single joint During training, the signal intensity of agonis-
motion. During this process, there are two char- tic muscle should be increased and the signal
acteristics. The first is the training of one muscle intensity of antagonistic muscle should be
contraction. One muscle plays an important role decreased in order to practice the ability of joint
in single joint motion, which is the contraction of coordinated movement dominated by brain. This
agonistic muscle to complete joint motion. is the training process to reestablish motor pro-
Compared with the whole movement (simultane- gram. Agonistic muscle and antagonistic muscle
ous multi-joint motion with one or more limbs) can switch roles in different joint motion. For
of human body, it is easy to be completed and example, in elbow extension of joint motion,
produce a better effect. The second is the process triceps muscle of arm is agonistic muscle and
of clearing and activating the channels and col- bicipital muscle of arm is antagonistic muscle.
laterals through concentrating superior energy. While in elbow flexion joint motion, bicipital
The process of regulation of mind and breathing muscle of arm is agonistic muscle and triceps
is to concentrate all energy on brain. During this muscle of arm is antagonistic muscle.
process, it not only can clear and activate the The procedure of regulation of mind in normal
channels and collaterals, but also can make the Daoyin technique is not in accordance with the
muscles in stand-by condition. The patients are course of main and collateral channels. Although
guided to use brain to control muscles suddenly, normal Daoyin technique can make the patients
which means the patients use brain to control one to concentrate on the training, the training degree
muscle and concentrate superiority in force to of injured side brain is decreased due to volun-
attack one spot. It is prone to dredge the relation- tary movement, which has a certain effect on
ship between brain and muscle and has a better developing brain potential through Daoyin tech-
effect on developing brain potential and recover- nique. Moreover, the traditional Chinese charac-
ing lost motor function. The procedures of six- teristics of Daoyin technique in traditional
step Daoyin technique are as follows: the Chinese medicine are not prominent in normal
therapists exert resistance properly in the orienta- Daoyin technique.
tion of joint motion of the patients (metatarso- Main and collateral channels are the pathways
phalangeal joints on instep of dorsiflexion of where Qi and blood can circulate. Its functions
foot) in order to let the patients’ brain to find the include connecting visceras in vivo, connecting
target that receive signals and the orientation of limbs in vitro, communicating all the limbs and
exerting. It is also the case when myodynamia is bones, relating the five sense organs and nine ori-
zero. In clinic, that myodynamia is zero is not fices, regulating yin and yang, infiltrating and
equal to that the muscle is out of control. The irrigating Qi and blood, moistening and nourish-
research of the author indicated that the signal ing the whole body, enriching yingqi and weiqi,
from central nerve to muscle is 360 times more defending exogenous pathogenic factors.
sensitive than the muscle contraction assessed in Traditional Chinese medicine deemed that accu-
clinic. Therefore, zero myodynamia is not equal mulated internal injury induce yin-yang dishar-
to zero signals. The therapists encourage and mony, disordered Qi and blood, rise suddenly and
urge the patients to complete the required joint sharply of the liver-yang, swirl of endogenous
motion. When exerting resistance, the therapists wind, exuberance of stagnated heat, phlegm and
encourage the patients to hold on for 6 s. This anger, fleeing in the meridians, impatency of
procedure can be completed using counting such brain and mind. Afterward, the patients suddenly
as “one, two, three, you did great, four, five, six.” faint and are in stroke hemiplegia. Li shizhen
When encouraging the patients, the therapists use pointed out that brain is the headquarters of mind.
words to create state of emergency such as “hold The mind hidden in the five internal organs are all
on or you will fall down” and “lift up or you will the concrete manifestations of mind in brain.
Thereout, we can tell the relationship between collateral channels and found that main and col-
motor function and brain with main and collat- lateral channels are a junction zone located in
eral channels. Main and collateral channels like loose connective tissue. The content of interstitial
nerves. If the main and collateral channels are fluid is high so that the physical property is low-
blocked, the signal of autokinetic movement resistance. And directional flow of interstitial
dominated by brain cannot be conducted fluently, fluid is closely related to propagated sensation
which can induce dyskinesia in corresponding along channel. Some research also indicated that
body part. On the other hand, after brain dam- main and collateral channels may be related to
ages, main and collateral channels are out of con- physiological information conduction system of
trol, which is the fundamental factor to induce stem cells over the entire body. Stem cells are
limbs dyskinesia. activated to release cell active substance, which is
The regulation of mind, breathing and move- related to nervous-endocrine-immune system and
ments of Daoyin technique in traditional Chinese function together. If nervous-endocrine-immune
medicine is to guide the patients to use mind to system is damaged, stem cells system can com-
circulate Qi in main and collateral channels and pensate the lost functions or repair functions.
use brain to control autonomous movement. Dredging collaterals through meridians
Mind is the functional activity of brain. Qi is the method is that mind regulates Qi from the begin-
messenger of brain regulating main and collateral ning of main and collateral channels to agonistic
channels. In brain, the patients use mind to circu- muscle of movable joint. Afterward, brain gives
late Qi to the muscle involved in joint motion out signal to activate joint motion. In the orienta-
through main and collateral channels in order to tion of joint motion, according to the specific
dredge the channels. Therefore, the messenger of condition of the patients, the therapists exert
brain controlling muscle timely and effectively resistance to develop potential fully. After com-
delivers message to the muscle involved in joint pletion of joint motion, the patients are still
motion and autonomous joint motion is induced. guided to relax themselves and use mind to regu-
Afterward, Qi disperse in the main and collateral late Qi along with residual main and collateral
channels, which is a relaxed process and also the channels until Qi disperses in collaterals
process of dredging brain, clearing the heart, gradually.
enlightening the mind and activating collaterals. According to the different orientation of Qi,
The process can promote brain potential develop- dredging collaterals through meridians method is
ment and functional reorganization. On the basis divided into “dredging collaterals through merid-
of the process, motor program can be reestab- ians” and “dredging meridians through
lished and motor function can be recovered. It is collaterals”. Its objective is to bring out clearing
scientific and important for the Daoyin rehabili- and activating the channels and collaterals of six-
tation technique in traditional Chinese medicine step Daoyin technique. Like a blocked pipeline,
to recover the lost motor function after brain if we dredge from one side, plugging matter may
damages. be pushed to one side and become tighter.
Therefore, in a word, regulation of mind is a Therefore, it is uneasy to be loosen and hard to be
process that brain give out movement messenger dredged. If we dredge the pipeline from two
to clear and activate the channels and collaterals. sides, it is easy to be loosen and hard to be
Regulation of breathing is a process that brain is dredged (Fig. 3.1, 3.2, 3.3, and 3.4).
prepared to give out movement messenger.
Regulation of movement is a process that move-
ment messenger induces autonomous movement
of joint from brain to the muscle involved in joint
motion.
Many researchers use modern experiment
methods to investigate the nature of main and Fig. 3.1 Sketch map of stricture site in pipeline
and collateral channels, especially the acupoint.

In clinic, during the circulation of Qi in main and
collateral channels, the muscle micro-contraction
around main and collateral channels can be
induced. Therefore, the process of dredging col-
Fig. 3.2 Dredging along with flow direction
laterals through meridians is also a process that
cortex motor center controls muscle micro-
contraction, which is good for promoting CNS
plasticity.
Therefore, the two methods are used alterna-
tively to clear and activate the channels and col-
laterals. The alternative times and time are mainly
Fig. 3.3 Dredging against flow direction
dependent on dredging collaterals through merid-
ians with subsidiary role of dredging meridians
through collaterals. We place dredging collaterals
through meridians first and dredging meridians
through collaterals second. The alternative ration
of dredging collaterals through meridians and
dredging meridians through collaterals is 3–1 to
Fig. 3.4 Dredging along with flow direction once more 5–1.
Therefore, according to main and collateral
Dredging meridians through collaterals channels, Daoyin feedback rehabilitation tech-
method is used to regulate mind and breathing. nique is implemented to develop neural potential
According to the route lead by animation spot of better, promote compensatory mechanism, repair
meridian points, the patients are guided to use injured brain, improve therapeutic effect of reha-
mind to regulate Qi from the beginning of main bilitation and recover lost motor function.
and collateral channels to agonistic muscle of
movable joint. Afterward, brain gives out signal
to activate joint motion. In the orientation of joint 3.2.2 Classification of Potential
motion, according to the specific condition of the Development Training
patients, the therapists exert resistance to develop
potential fully. (When myodynamia is zero, the According to the rehabilitation training principle
resistance should be exerted because the resis- “from easy to difficulty and step by step”, poten-
tance can increase muscle tone and make it easy tial development training is implemented hierar-
for brain to find the orientation and induce mus- chically in order to prevent the damages of bone,
cle contraction.). After completion of joint joint and muscle. There are postural hypotension
motion, the patients are still guided to relax and collapse due to high-intensity training, even
themselves and use mind to regulate Qi along life-threatening accident.
with residual main and collateral channels until The classification of training refers to the
Qi disperses in meridians gradually. angle of joint motion range change or the training
Both dredging collaterals through meridians time.
and dredging meridians through collaterals are
the process that brain guides Qi to circulate in 3.2.2.1 Classification Method of Joint
main and collateral channels and brain is used to Motion Range
dredge main and collateral channels. If the Classification method refers to the angle of joint
patients concentrate to a certain extent, during motion range change, which is appropriate for
the circulation of Qi in main and collateral chan- potential development training of upper and
nels, the patients can feel slightly hot along main lower limbs.
The objective of upper and lower limbs poten- Similarly, for sitting down with lower limbs and
tial development is to develop CNS potential that pushing down with upper limbs, when the flexion
control muscle contraction of upper and lower range of joint motion is less than 90°, the larger
limbs. However, the development of this potential the range is, the bigger the difficulty is. The littler
can be realized only through active movement the range is, the smaller the difficulty is. When the
training of limbs. For example, six-step of dredg- flexion range of joint motion is more than 90°, the
ing collaterals through meridians is used to lift larger the range is, the smaller the difficulty is.
and lower upper limbs, stand and sit down with The littler the range is, the bigger the difficulty is.
lower limbs. Because the patients with different From the range of whole movement, whether in
dyskinesia and lack of autonomic movement, they standing up, sitting down or pushing up, pushing
need to be helped to do active movement or com- down, the difficulty is in direct proportion to the
pelled to do active movement in order to complete range of joint motion. The larger the range of joint
the designed movement. Therefore, it can promotion is, the bigger the difficulty is. Therefore,
mote the plasticity and functional reorganization according to the angle in the range of joint motion,
of CNS that control upper and lower limbs. we assess the difficulty of the training. Thirty
During the process of potential development, degrees are set as one coefficient of difficulty and
the difficulty is related to the angle of joint flexion there are six coefficient of difficulty, which is
and moment of force. For standing up with lower called six-level classification method of potential
limbs and pushing up with upper limbs, when the development training in lower limbs (Table 3.1).
flexion range of joint motion is less than 90°, the The difficulty classification of potential devel-
larger the range is, the bigger the difficulty is. The opment training in trunk.
littler the range is, the smaller the difficulty is. When doing potential development training
When the flexion range of joint motion is more of trunk, the patients lie on the back and the sunk
than 90°, the larger the range is, the smaller the of lower waist in the training bed is used to regu-
difficulty is. The littler the range is, the bigger the late the difficulty of the training. The sunken
difficulty is. When the flexion range of joint depth of the training bed is training 18 cm, which
motion is equal to 90°, the difficulty is the biggest. is composed of three training stereoplasm sponge
Table 3.1 Six-level classification method of potential development training in lower limbs
The degree of Supplementary measures
knee joint
Coefficient extension or Weight loss
of difficulty flexion (0°) Myodynamia Vital signs (kg) Exerting resistance (kg)
1 0–30° 0 Basically stable with One third to Supplement wanted
weak constitution one fourth of
body weight
2 30–60° I Stable with weak One fourth to Supplement wanted
constitution one sixth of
body weight
3 60–90° I–II Stable with weak One fifth to Supplement wanted
constitution and one eighth of
autonomous joint body weight
motion
4 90–120° II–III Normal with full One eighth to Exerting resistance when
range autonomous one tenth of the range of knee joint is
joint motion body weight more than 90°
5 120–150° III–IV Normal with 5 kg Exerting resistance when
autonomous the range of knee joint is
anti-resistance more than 90°
6 150–180° IV–V Normal with high 5 kg Exerting resistance after
anti-resistance beginning joint motion
Table 3.2 The classification of potential development training in trunk

Coefficient of Cushion Supplementary measures
difficulty number Myodynamia Vital signs Weight loss (kg) Exerting resistance (kg)
1 3 0–II Basically stable with weak One third to Supplement wanted
constitution one fourth of
body weight
2 2 III–IV Stable with autonomous One fourth to Exerting slight
joint motion one sixth of resistance
body weight
3 1 IV–V Normal with full range 5 kg Exerting resistance
autonomous joint motion after beginning joint
and anti-resistance motion
Table 3.3 Classification method of potential development training time

Coefficient Time
of difficulty (min) Vital signs Supplementary measures
1 1–5 Basically stable with weak constitution Supplement wanted
2 6–10 Stable with weak constitution, autonomous joint Supplement wanted
motion ans without anti-resistance
3 11–15 Stable with full range autonomous joint motion, weak Normal, exerting resistance properly
constitution and autonomous anti-resistance
4 16–20 Stable with strong anti-resistance Exerting resistance after beginning
joint motion
cushions that are 6 cm in depth. According to system. According to vital signs of the patients
this depth, they are divided into three levels such as breathing, blood pressure, pulse, body
(Table 3.2). The more the cushion number is, the temperature, electrocardiogram and stamina, the
smaller the difficulty is and the less the cushion therapists set the quantity of weight loss. According
number is, the bigger the difficulty is. to the types of the training, the parts of exerting
resistance are different. The part for exerting resis-
3.2.2.2 Classification Method tance of potential development training in upper
of Training Time limbs is shoulder-back. The therapists use sandbag
According to the training time and time interval or hands to exert resistance. The part for exerting
between trainings, the classification method is resistance of potential development training in
appropriate for potential development training in lower limbs is shoulder of the patients.
all parts.
When the stamina of the patients is good, the
time of potential development training is 30 min 3.3 Clinical Indications
every time. In the middle of the training, the rib and Cautions of Potential
belts should be loosened to let the patients have a Development
break for 1–2 times in case that the rib belts
oppress the chest and influence breathing. The 3.3.1 Clinical Indications
break takes 3–5 min every time and the training and Cautions of Upper Limbs
time is about 20 min. Every 5 min is a training Potential Development
magnitude and there are four levels. According to Training
the specific condition of the patients, the training
time can be adjusted (Table 3.3). 3.3.1.1 Indications
Potential development training requires 1–2 and Contraindications
therapists and potential development training 1. Indications: Potential development training

device is used to do the training. Potential develop- in upper limbs is appropriate for the training
ment training device is equipped with weight loss of dysfunctions in the patients in stable
3.3 Clinical Indications and Cautions of Potential Development 101
condition with acute, chronic and obsolete no restrict requirement for the patients’ constitu-
hemiplegia, cerebral palsy, child cerebral tion. The patients are capable of doing twin bridge
palsy, complete or incomplete paraplegia, training can use this training, but the vital signs of
peripheral nerve injury, bone and joint muscles the patients should be watched carefully.
dysfunction after CNS and bone joint damages
in order to recover autonomous motor function 3.3.2.1 Indications
in upper limbs or prevent myophagism and and Contraindications
osteoporosis. 1. Indications: It is appropriate for the motor
2. Contraindications: Contraindications of poten- function recovery training of dysfunctions in
tial development in upper limbs include the the patients in stable condition with acute,
patients in acute stage with unstable condition, chronic and obsolete hemiplegia, cerebral
the patients in uncontrolled condition with palsy, child cerebral palsy, complete or incom-
severe hypertension and diabetes, the patients plete paraplegia, the patients with lumbodorsa
with severe heart disease, pulmonary dysfunc- injury or spinal postoperation dysfunction
tion and low cardiovascular response capacity after CNS and bone joint damages.
and the patients with subluxation of shoulder 2.
Contraindications: Contraindications of
joint and severe dislocation in upper limbs. potential development in upper limbs include
the patients in acute stage with unstable con-
3.3.1.2 Cautions dition, the patients in uncontrolled condition
It is important for potential development training with severe hypertension and diabetes, the
to keep the training safe. Moreover, there are patients with severe heart disease, pulmonary
other items. For the patients with weak constitu- dysfunction and low cardiovascular response
tion or long-term bedridden patients, the adaptive capacity, the patients with unstable internal
training should be done before this type of the fixation and unhealed centrum after spinal
training in order to increase the stress capability operation and the patients with child cerebral
of the patients’ angiocarpy. When the patients palsy and congenital dislocation of hip joint.
stand erectly for 30 min and blood pressure, pulse
and electrocardiogram are stable, this type of the 3.3.2.2 Cautions
training should be done. The training should be There are several items that should be paid atten-
step by step. The therapists regulate the training tion to in potential development training in trunk.
through changing the weight and training time. For the patients with weak constitution, the adap-
High training intensity should be avoided. During tive training should be done before this type of
training, the enthusiasm of the patients and the the training in order to increase the stress capabil-
training atmosphere should be fully activated. ity of the patients’ angiocarpy. When the patients
The therapists should use encouraging words and lie in bed and do twin bridge training five times
scolding and critical words should be avoided. and blood pressure, pulse and electrocardiogram
Severe patients can do the training by cardiogram are stable, this type of the training should be
monitor and the disease condition should be done. The training should be step by step. The
watched carefully. If there is any problem, the therapists regulate the training through changing
training should be stopped immediately. the weight and training time. High training inten-
sity should be avoided. During training, the
enthusiasm of the patients and the training atmo-
3.3.2 Clinical Indications sphere should be fully activated. The therapists
and Cautions of Potential should use encouraging words and scolding and
Development Training critical words should be avoided. Severe patients
in Trunk can do the training by cardiogram monitor and
the disease condition should be watched care-
Potential development in trunk is the training that fully. If there is any problem, the training should
can be done while the patients lie in bed. There is be stopped immediately.
3.3.3 Clinical Indications training in order to increase the stress capability

and Cautions of Potential of the patients’ angiocarpy. When the patients
Development Training stand erectly for 30 min and blood pressure, pulse
in Lower Limbs and electrocardiogram are stable, this type of the
training should be done. The training should be
Potential development in lower limbs is one of step by step. The therapists regulate the training
the most applied neurological rehabilitation through changing the weight and training time.
training in clinic. Not only there are many indica- High training intensity should be avoided. During
tions of this training, but also there is a good training, the enthusiasm of the patients and the
therapeutic effect. The patients who lose active training atmosphere should be fully activated.
movement completely can recover autonomous The therapists should use encouraging words and
motor function of lower limbs to vary degrees in scolding and critical words should be avoided.
a short time. Severe patients can do the training by cardiogram
monitor and the disease condition should be
3.3.3.1 Indications watched carefully. If there is any problem, the
and Contraindications training should be stopped immediately. The
1. Indications: Potential development training in application of Daoyin technique in the training
lower limbs is appropriate for the training of should be emphasized. Daoyin technique is the
dysfunctions in the patients in stable condi- main training method. Potential development
tion with acute, chronic and obsolete hemiple- training equipment of lower limbs is the assisted
gia, cerebral palsy, child cerebral palsy, corollary equipment of Daoyin technique.
complete or incomplete paraplegia, peripheral
nerve injury, bone and joint muscles dysfunc-
tion after CNS and bone joint damages. It is 3.4 Clinical Experiment
also appropriate for the patients whose lower of Potential Development
limbs functions cannot be improved in tradi-
tional rehabilitation therapy. 3.4.1 T
he Development and Clinical
2.
Contraindications: Contraindications of Application of Potential
potential development in upper limbs include Development Training
the patients in acute stage with unstable con- Equipment of Upper Limbs
dition, the patients in uncontrolled condition
with severe hypertension and diabetes, the The upper limbs dysfunction after central ner-
patients with severe heart disease, pulmonary vous system damages is one of the difficulties in
dysfunction and low cardiovascular response rehabilitation therapy. Although there are many
capacity, the patients with dizziness and drop therapies, the therapeutic effect is not ideal
of blood pressure when standing up, the because of the simple training method and appa-
patients who stand erectly for 30 min but ratus such as occupational therapy. The author
blood pressure, pulse and electrocardiogram develops potential development training equip-
are unstable and the patients with child cere- ment of upper limbs in order to promote upper
bral palsy and congenital dislocation of hip limbs motor function recovery.
joint.
3.4.1.1 Materials and Methods
3.3.3.2 Cautions
1. The constitution of potential development
There are several items that should be paid atten- training equipment of upper limbs: Potential
tion to in potential development training in lower development training equipment of upper limbs
limbs. For the patients with weak constitution or is composed of hand expansion board, pedes-
long-term bedridden patients, the patients should tal, limbs control training system, bearing sup-
do standing bed training before this type of the porting system, hammock and suspension
3.4 Clinical Experiment of Potential Development 103
system, weight loss pulley system, weight loss ceps muscle of arm in paralyzed side.
sandbag or handle. Bearing supporting system During the slow pushing-up process, the
is made of hot drawing welded steel tube whose patients should feel the contraction of tri-
diameter is 36 mm and thickness is 4 mm. The ceps muscle of arm. When the patients
bend frame (120 cm × 180 cm) is connected to cannot push up themselves, the therapists
pedestal. The pedestal is made of the same should help them. When the extension
tube. The superstratum of dual-tier framework angle is more than 90°, the therapists
(180 cm × 150 cm × 20 cm) is covered by alu- reduce assisted force suitably according
minium alloy plate and compressed by spongy to the condition and use the words “push
cushion whose thickness is 3 cm. In the middle up, or you will fall; hold on, or you will
of the top of braced frame, one corner and side bump” to create dangerous atmosphere.
wall, pulley is welding fixed. Steel wire whose The therapist should encourage the
diameter is 3 mm is used to connect hammock patients to push up by themselves.
in frame and handle or weight loss sandbag Pushing-down training is defined as that
hook in side wall. Hammock is fixed to the the patients’ upper is on extension posi-
chest of the patients. The weight of weight loss tion of elbow joint and the patients move
sandbag includes 5, 10 and 20 kg. The quantity their body center to paralyzed side. The
of weight loss can be regulated through chang- patients are guided to take a deep
ing the number and kind of sandbag. The thera- breathing, breathe out and push down

pists can grip the handle during training and slowly. During the slow pushing-down
regulate the quantity of weight loss through process, the patients should feel the con-
assisted force. traction of triceps muscle of arm. When
2. Training methods: The training methods are the patients cannot push up themselves,
as follows: the therapists should help them. When the
(a) Preparation before training: The patients extension angle is less than 90°, the thera-
dress hammock, put on hand expansion pists increase assisted force suitably
board, lie in push-up position, kneel on according to the condition and use the
sponge cushion of pedestal. In this posi- words “push up, or you will fall; hold on,
tion, the patients’ hands are exactly on the or you will bump” to create dangerous
vertical surface weight loss pulley in the atmosphere. The therapist should encour-
middle of the top of braced frame with the age the patients to hold on in this position
width same as shoulder. Hammock is confor 3–5 s.
nected to hook of weight loss system. The (c) Training time is 30 min every time and
therapists stand on the injured side of the one time a day. One course of therapy
patients. According to sandbag in exercise includes 30 times. After one course of
prescription, the therapists can grip the therapy, the therapist should assess the
handle during training and regulate the therapy effect and decide whether to do
quantity of weight loss through assisted the next course of therapy or not.
force.
(b) Training: There are two kinds of training 3.4.1.2 Clinical Application
such as pushing up and down. Pushing-up 1. Clinical data: From April 2006 to October
training is defined as that the patients’ 2007, potential development training equip-
upper is on flexed position of elbow joint ment was used to treat 56 patients with upper
and the patients move their body center to limbs motor dysfunction who are all the inpa-
paralyzed side. The patients are guided to tients and outpatients in neurological rehabili-
take a deep breathing, breathe out slowly, tation training center in Beijing Tongren
concentrate on deep inspiration and hold Hospital affiliated to Beijing’s Capital
the breathing, and then concentrate on tri- Medical University. There are 42 males and
14 females. The age is from 18 to 62 years 4. Discussion: The characteristics of upper limbs
old. The average age is 41.33 years old. The are flexibility, coordination, elaboration and
shortest medical history lasts 6 months and skillful movements. The number of motor neu-
the longest lasts 146 months. The average is rons in the cortex motor area that control upper
37 months. There are 29 patients with hemi- limbs is bigger than that of motor neurons that
plegia after cerebral infarction, 12 patients control lower limbs. The relationship between
with hemiplegia after cerebral hemorrhage, them is complicated. Therefore, the functional
ten patients with hemiplegia after brain compensation not only takes a long time, but
damage and ten patients with spinal cord also is complicated, which is the main reason
injury. There are 26 patients with right hemi- for bad and slow functional recovery of upper
plegia, 25 patients with left hemiplegia and limbs. Some researchers think that more inten-
five patients with dual bilateral limbs sified training is required to promote the func-
dysfunction. tional recovery of upper limbs.
2. Functional assessment and data analysis:

Lovett MMT myodynam assessment, range of Although central nervous cells are lack of
joint motion (ROM) and motor program elec- regeneration capacity, motor neuros are different
trical signal intensity are used as assessment from other tissue cells. Their number is big and
methods. At the beginning of the training and they are the material basis of central nervous tis-
the end of the therapy, the therapists assess sue potential. After partial motor neurons dam-
myodynamia of triceps muscle of arm, auton- ages, cells around the injured area are trained to
omous range of joint motion and electrical replace the functions of the injured cells, which is
signal intensity. SPSS12.0 statistical software functional reorganization. However, cells around
is used for T test analysis. The results are the injured area cannot obtain the functions like
referred to Table 3.4. that of the injured cells unless they are received
3. Results: Statistical analysis of assessment
special repeated training.
data and security of equipment are as At present, in clinic, the method used for func-
follows: tional recovery of upper limbs mainly is occupa-
(a) Statistical analysis: There are significant tional therapy, which includes the training of
differences in the three assessment indica- passive, active and daily life ability. These meth-
tors before and after therapy (p < 0.05). ods are lack of enhancement degree and there is
There are nine patients with zero myody- no training method for the upper limbs without
namia of triceps muscle of arm in all the autonomous movement. There is also no signifi-
patients. After training, myodynamia is cant effect. Upper limbs in uninjured side are
recovered to 2.08 grades. Autonomous bind and upper limbs in injured side are forced to
joint motion is recovered. move. The therapy has a certain therapeutic
(b) Security of equipment: There is no injury effect. However, some kind of whole movement
in all the patients during the training. requires the patients’ autonomous movements to
Equipment design is rational, safe and complete. Meanwhile during the process of com-
reliable. The operation of the equipment pleting the movements, the patients merely try to
is easy and flexible. do it no matter it is completed or not. Therefore,
Table 3.4 Functional assessment comparison table of triceps muscle of arm in paralyzed side before and after training
( x ± s)
Assessment items Before training After training p
Myodynamia 1.32 ± 0.65 2.62 ± 1.21 <0.05
Electromyographic signal 26.18 ± 8.36 87.31 ± 23.66 <0.01
Range of joint motion 19° ± 2.36° 36° ± 7.68° <0.05
exception for lack of sense of urgency, because of In the potential development training of upper
the fixation of upper limbs in injured side, it is limbs, when the patients want to complete some
possible to have an accident. In addition, for the kind of movement and cannot complete it because
patients without autonomous movements or with of limited capacity, the therapists should help
severe obstacle of upper limbs in autonomous them to complete it. Because of the help from the
movements, it is difficulty to do this training and therapists, the movement becomes passive. On
the therapeutic effect is not ideal. That is why this the contrary, in the process that the therapists
technique cannot be widely applied in clinic. help the patients to complete the movement pas-
Therefore, investigation of the method for sively, the therapists guide the patients to com-
development and utilization of brain potential plete the movement actively and make the
plays a key role in functional recovery after cen- movement active. However, the ultimate goal of
tral nervous system damages, which is urgently training is to complete the entire movement in
necessary for clinical rehabilitation. order to develop brain potential that control
There are many examples that people can con- injured limbs and promote brain function
quer difficulties and hardships using willpower reorganization.
and in dangerous condition people can burst into Clinical rehabilitation equipment cannot have
superman condition and tide over difficulties, an effect unless they conform to the rehabilitation
which indicated that the human potential can be method. The equipment cannot be applied unless
better developed in dangerous condition or with they conform to the mechanism of human func-
target and willpower. However, if the patients are tional recovery. Some automatic, complicated
diagnosed with hemiplegia or cerebral palsy, they and large-size equipment that are not based on
may be with some severe protopathies such as rehabilitation theory and method ignore the pro-
hypertension, diabetes and heart disease. In dan- cess that people can do active movement by
gerous condition, the training may exacerbate the themselves because of the strong replacement,
disease state. Obviously, in dangerous condition, which affect clinical effects. People do active
potential development training cannot be used for movement, which is good for human potential
rehabilitation of this kind of patients. development. Some rehabilitation medical engi-
Potential development training equipment can neering specialists believe mistakenly that the
provide safe and reliable protection for upper patients can be recovered if the equipment is
limbs training with the help of bearing frame and developed. If an athlete wants to improve his per-
hammock and can make the training from easy to formance, he can achieve it through hardwork-
difficulty and step by step through changing the ing, scientific and persisted training. Athletes use
quantity of weight loss. On the basis of that, equipment to increase the amount of exercise, not
Daoyin technique in traditional Chinese medi- to replace themselves. If the equipment replace
cine is used to guide the patients to complete the athletes themselves, the equipment are trained,
movements through regulation of mind, breath- but not the athletes. Therefore, how to improve
ing and movement. During the process of com- the performance of the athletes?
pleting the movements, the therapists should use
the words “hold up, or you will fall” “push up, or
you will bump” combined with protective effect 3.4.2 T
he Development and Clinical
to create “safe” dangerous condition that is to the Application of Potential
benefit of brain potential development. The func- Development Training
tional reorganization of central nervous cells that Equipments of Lower Limbs
control the movement of upper limbs is promoted
to recover motor function. During this process, Because of the regeneration capacity of central
Daoyin technique in traditional Chinese medi- nervous cells, functional recovery after damages is
cine plays a leading role and the equipment has a dependent on that normal cells around the injured
supportive therapeutic effect. area replace the injured cells to play a function,
which is potential development. Potential is the 2. Training method

ability that is hidden in the human body and can- (a) Preparation before training: The patients
not be showed. Everyone has great potential and dress hammock. The therapists stand one
its basis is tissues. The key point is how to develop side of or in front or behind the patients.
potential maximally in order to compensate func- According to sandbag in exercise pre-
tional defect after CNS damages. The author scription, the therapists can grip the han-
designed potential development training equip- dle during training and regulate the
ment of lower limbs in order to develop potential quantity of weight loss through assisted
of cortex motor center and promote motor func- force.
tion recovery of lower limbs. (b) There are two kinds of training such as
standing up and sitting down. Standing-up
3.4.2.1 Materials and Methods training is defined as that the patients are
1. The components of potential development
on kneeling-squatting position and the
training equipment of lower limbs: Potential patients move their body center to para-
development training equipment of lower lyzed side. The patients are guided to take
limbs is composed of bearing frame, pedestal, a deep breathing, breathe out slowly, con-
weight loss sandbag and protection system. centrate on deep inspiration and hold the
Bearing supporting system is made of hot breathing, and then concentrate on quad-
drawing welded steel tube whose diameter is riceps femoris in paralyzed side. During
36 mm and thickness is 4 mm. The bend frame the slow standing-up process, the patients
(150 cm × 200 cm) is connected to pedestal. The should feel the contraction of quadriceps
pedestal is made of the same tube, which is dual- femoris. When the patients cannot stand
tier framework (180 cm × 150 cm × 20 cm) and up by themselves, the therapists should
covered by aluminium alloy plate in surface. help them. When the extension angle of
In the middle of the top of braced frame, one knee joint is more than 90°, the therapists
corner and side wall, pulley is welding fixed. reduce assisted force suitably according
Steel wire whose diameter is 3 mm is used to to the condition and use the words “push
connect hammock in frame and handle or up, or you will fall; hold on, or you will
weight loss sandbag hook in side wall. bump” to create dangerous atmosphere.
Hammock is fixed to the chest and abdomen The therapist should encourage the
of the patients. When the quantity of weight patients to stand up by themselves.
loss is big, the hammock can be connected to Sitting-down training is defined as that
huckle part in order to prevent the shift of the patients move their body center to
hammock and compression to chest and abdo- paralyzed side. The patients are guided to
men. The weight of weight loss sandbag take a deep breathing, breathe out and sit
includes 5, 10 and 20 kg. The quantity of down slowly. During the slow sitting-
weight loss can be regulated through changing down process, the patients should feel the
the number and kind of sandbag. Scaleplate is contraction of quadriceps femoris. When
made of transparent soft plastic plate the patients cannot sit down by them-
(30 mm × 50 mm, rectangle). There are three selves, the therapists should help them.
different maps of sole of the foot in facies When the extension angle of knee joint is
medialis. The inner loop is the actual size of less than 90°, the therapists increase
the foot, named 100 score, the middle loop is assisted force suitably according to the
two times of the actual size of the foot, named condition and use the words “push up, po
80 score, and the outer loop is the three times you will fall; hold on, or you will bump”
of the actual size of the foot, named 60 score. to create dangerous atmosphere. The ther-
The higher the foot score is, the more diffi- apist should encourage the patients to
culty the training is. hold on in this position for 3–5 s.
(c) Limbs control ability training: In the ble, this type of the training should be
weight loss and safe protection condition, done. The training should be step by step.
the patients’ two feet are on the inner loop The therapists regulate the training
of the scaleplate and the center of body through changing the weight and training
weight moves to uninjured side. The ther- time. High training intensity should be
apists guide the patients to bends coxa, avoided. During training, the enthusiasm
bend knees, lift injured limbs and then put of the patients and the training atmosphere
injured feet back to the inner loop. The should be fully activated. The therapists
patients should shorten the completed should use encouraging words and scold-
time gradually. ing and critical words should be avoided.
Training time is 30 min every time and 4. Clinical application: From April 2006 to

one time a day. One course of therapy September 2007, potential development train-
includes 30 times. After one course of ing equipment was used to treat 67 patients
therapy, the therapist should assess the with upper limbs motor dysfunction who are
therapy effect and decide whether to do all the inpatients and outpatients in neurologi-
the next course of therapy or not. cal rehabilitation training center in Beijing
3. Clinical indications, contraindications and
Tongren Hospital affiliated to Beijing’s
cautions Capital Medical University. There are 42
(a) Indications: It is appropriate for the acute males and 25 females. The age is from 34 to
or chronic lower limbs dysfunctions train- 76 years old. The average age is 54.3 years
ing and movement coordinated ability old. The shortest medical history lasts
training in the patients in stable condition 15 months and the longest lasts 62 months.
with such as hemiplegia, cerebral palsy, The average is 27 months. There are 39
child cerebral palsy, incomplete paraple- patients with hemiplegia after cerebral infarc-
gia, peripheral nerve injury, bones and tion and 28 patients with hemiplegia after
joint muscles dysfunction after CNS, cerebral hemorrhage. There are 36 patients
bone joint and muscle damages. It is also with right hemiplegia and 31 patients with left
appropriate for the patients whose lower hemiplegia.
limbs functions cannot be improved in At the beginning of the training and the end
traditional rehabilitation therapy. of the therapy, the therapists assess myody-
(b) Contraindications: Contraindications of
namia of quadriceps femoris and autonomous
potential development include the patients range of joint motion. SPSS12.0 statistical
in acute stage with unstable condition, the software is used for T test analysis.
patients in uncontrolled condition with
severe hypertension and diabetes, the 3.4.2.2 Results
patients with severe heart disease, pulmo- 1. Statistical analysis of data: There are signifi-
nary dysfunction and low cardiovascular cant differences in the three assessment indica-
response capacity, the patients with obvi- tors before and after therapy (p < 0.05). There
ous dizziness and drop of blood pressure are six patients with zero myodynamia of quad-
when standing up. riceps femoris in all the patients. After training,
(c) Cautions: For the patients with infirmity myodynamia is recovered to 2.68 grades.
or long-term bedridden patients, the Autonomous joint motion is recovered. The
patients should do standing bed training detailed clinical effects control study refers to
before this type of the training in order to another paper. The results refer to Table 3.5.
increase the stress capability of the 2. Security of equipment: There is no injury in
patients’ angiocarpy. When the patients all the patients during the training. Equipment
stand erectly for 30 min and blood pres- design is rational, safe and reliable. The oper-
sure, pulse and electrocardiogram are sta- ation of the equipment is easy and flexible.
Table 3.5 Functional assessment comparison table of quadriceps femoris in paralyzed side before and after training
Assessment items Before training After training P value
Myodynamia 1.45 ± 0.87 3.62 ± 1.33 <0.01
Range of joint motion 16° ± 3.23° 45° ± 8.37° <0.01
Limbs control ability 67.82 ± 28.73 89.64 ± 21.37 <0.01
3.4.2.3 Discussion tion techniques such as Bobath, Rood,

Many research indicated that there is reorganiza- Brunnstrom, PNF and electrical stimulation are
tion ability of structure and function in CNS, mainly through passive movement, original
which is plasticity. After damages, residual cells reflex, anti-resistance training, daily life ability
or normal cells around the injured area acquire training and afferent stimulus. The effect of reha-
the lost functions through functional reorganiza- bilitation therapy is not satisfying, especially for
tion in a new way. This process is the adaptive the patients with chronic central nervous dam-
and compensatory process after neural tissue ages for more than half a year. Recently, some
damages. The active effect is obvious in the acute researchers started to try new rehabilitation meth-
stage of the damage and become weak after func- ods include new therapy methods and employ-
tional recovery. Concrete realization of plasticity ment of rehabilitation equipment. Some therapy
may be the results of adaption of neural cells to methods such as motor relearning program and
environment. Its manifestations are readaption of constraint-induced movement therapy have some
synaptic connection, long-term potentiation, axo- effects, but these methods still are lack of the
nal extension and establishment of new synaptic consciousness of brain potential development
connection, which are the theoretic basis to pro- and targeted measures and the therapeutic effect
mote functional recovery through rehabilitation is not ideal. Therefore, investigation of the
training after damages. The experimental study method for development and utilization of brain
demonstrated that the plasticity of motor cortex potential is the key point of functional recovery
function is one kind of “skill and dependence” after central nervous damages, which is required
mechanism, but not a simple “use and depen- for clinical rehabilitation at present.
dence” mechanism. Without new skillful move- In real life, there are many examples about
ment, the plasticity change of motor cortex brain plasticity and functions reorganization.
function cannot be induced, which is meaningful There are many examples that people can con-
for the research and application of guiding reha- quer difficulties and hardships using willpower
bilitation training. and in dangerous condition people can burst
The plasticity, functional reorganization abil- into superman condition and tide over difficul-
ity and tissue reserve of brain are the basis of ties, which indicated that the human potential
brain potential. CNS has a large tissue reserve can be better developed in dangerous condition
just as other organs. The research demonstrated or with target and willpower. The ability in dan-
that there are about 1011 motor neurons in brain gerous condition is not the result of immediate
and neurogliocytes that is ten times of motor neu- functional reorganization of brain, but the
rons. Under noram circumstance, there are partial acquired function. The ability can be activated
cells (6%) in using condition and most of them only in dangerous condition. However, target
are under resting state. From this, we can con- and willpower are achieved by functional reor-
clude there are many motor neurons and the ganization of brain through repeated training.
potential is great. From this, repeated training in dangerous condi-
At present, the plasticity theory of brain is tion and repeated training with target and will-
usually used to explain the mechanism of func- power can make the existed functions be used
tional recovery after CNS damages, which is not again in order to promote reorganization of
appropriate for promoting brain plasticity and brain function and generate new functions or
functional reorganization. Traditional rehabilita- functional compensation.
References 109
Daoyin technique in traditional Chinese medi- Potential development training equipment can
cine is capable of inspiring and motivating the provide safe and reliable protection for lower
individual’s stamina, and is an important method limbs training with the help of bearing frame and
to achieve functional rehabilitation by Creating a hammock and can make the training from easy to
“critical state” of no danger with Daoyin speeches difficulty and step by step through changing the
and skillful movement. It has a very long history, quantity of weight loss. On the basis of that,
in terms of rehabilitation of stroke hemiplegia, Daoyin technique in traditional Chinese medi-
the book of “the General Treatise on the Cause cine is used to motivate the patients’ willpower to
and Symptoms of Diseases” in Sui Dynasty in create dangerous condition in order to achieve
610 A.D. Wind disease in the first chapter include “safe” dangerous condition that is to the benefit
“hemiplegia after stroke”, “the patients cannot of brain potential development and the functional
extend or flex the limbs because of stroke”, “the reorganization of central nervous cells. It is pos-
hands and feet cannot move smoothly” and “phe- sible to improve the special skills and war power
milateral wind”, which are related to sequelae of special troops in special hard condition scien-
after stroke. There are more than twenty kinds of tific training.
Daoyin techniques. The technique included static
exercise with the breathing controlled by OBEs
and dynamic exercise with OBEs, breathing and References
movements (imitation of various kinds of ani-
mals). Through regulation of the mind, regulation 1. Xiangyang M, Maoxiang C, Fang X. The effects of
“sports imagine” therapy on upper limb functional
of breathing and regulation of movements, recovery in patients with cerebral trauma. Chin J Prev
Daoyin technique could circulate main and col- Contr Chronic Dis. 2008;16(5):506.
lateral channels, regulate qi and blood, harmo- 2. Xiangdong Z, Hengfang L, Qingcheng Y, et al.
nize viscera, strengthen the body resistance to Research on plasticity of motor function after cerebral
infarction. Chin J Pract Nerv Dis. 2006;9:6):6–8.
eliminate pathogenic factors, strengthen homeo- 3. Jing H, Yuanwu M, Tang T. The plasticity and reha-
stasis and have favorable influence on body bilitation of brain after stroke. Chin J Rehabil.
metabolism to recover motor functions. Modern 2004;19(1):50–2.
medicine research indicated that Daoyin tech- 4. Dewald JP, Beer RF. Abnormal joint torque patterns
in the paretic upper limb of subjects with hemiparesis.
nique has a good regulatory effect on cardiovas- Muscle Nerve. 2001;24(2):273–83.
cular diseases, respiratory diseases, nervous 5. Rice MS, Newell KM. Upper-extremity interlimb
diseases, digestive diseases and rehabilitation coupling inpersons with left hemiplegia due to stroke.
effect. Arch Phys Med Rehabil. 2004;85(4):629–34.
Comprehensive Application
of Rehabilitation Technique 4
Comprehensive application of rehabilitation upper limbs in walking, running and jumping and
technique of neurological training includes three independent operation of upper limbs and hands.
principal aspects such as neural potential devel- Generally, single joint motion is called move-
opment, motor program reestablishment and ment and multi-joint motions are called exercise.
motor pattern remodeling and many other train- Motor pattern means the simultaneous or orderly
ing methods. All these methods should be com- and coordinated associated movement of multi-
bined and applied reasonably in order to obtain joint or multi-limbs.
desired training effects. If these methods are The quality of motor function is dependent on
combined and applied unreasonably or single whether motor pattern is normal or not. It is widely
method is used, it is difficult to obtain ideal effect. believed that the motor pattern of normal people
In that way, how we combine and apply these without malformation is not completely normal
methods reasonably? Before we explain this and there are many imperfections in motor pattern,
question, we must know the ultimate goal of such as pigeon toe, splayed feet, heel friction
rehabilitation training, the effect of various meth- ground, ball of foot friction ground, lateral foot
ods and the mechanism of motor function friction ground and medial foot friction ground.
recovery. These manifestations can be concluded from the
For the motor function of human body, ulti- shoe sole and are induced by abnormal motor pat-
mate goal of rehabilitation training is to recover tern. In addition, in the people with same gender
the voluntary movement ability, and the motor and age, some one run faster and some one run
function that is fast, flexible, with less energy slower. Someone can run for a longer time and
consumption and with more benefit. In order to some one cannot. The phenomenon is related to
achieve this goal, it is far from enough to recover congenital factor, living environment and exercise
the contraction ability of the muscle and volun- methods. The normal motor pattern is somewhat
tary single joint motion. It is necessary to recover irrelevant to this phenomenon. People with normal
coordinated and orderly body movements, which motor pattern can move faster, consume less and
means normal motor pattern. Only normal mus- are more efficient. There people run faster and lon-
cle contraction and voluntary movement of single ger. People with abnormal motor pattern move
joint cannot make motor pattern normal. slower, consume more and are less efficient when
However, abnormal motor pattern cannot have doing the same movement. Therefore, they run
the best movement effect. slower and shorter.
Motor pattern is existed in the movements of Therefore, revering normal motor pattern is
arms and legs, such as coordinated movements of the ultimate goal of rehabilitation training. Based
https://doi.org/10.1007/978-981-13-0812-3_4
112 4 Comprehensive Application of Rehabilitation Technique of Neurological Training
on this, we can set out rehabilitation training can be consolidated through precise training and
scheme. We must use various kinds of rehabilita- become practical motor function—motor pattern
tion therapy of neurological training methods that is necessary for daily life and labor work.
properly. We should first introduce the formation Deliberate normal motor pattern training can
and harm of abnormal motor pattern. On the basis establish motor program that can control the
of prevention and rectification of abnormal motor movement in cortex motor center. The motor pro-
pattern, we investigate how to use various kinds gram can be consolidated through long-term
of rehabilitation therapy of neurological training training and the program can be used uncon-
methods properly and how to reestablish the sciously to control normal motor pattern of mus-
mechanism of normal motor pattern. cle gradually. Similarly, long-term movement in
abnormal motor pattern can modify abnormal
motor program and then induce the formation of
4.1 The Formation abnormal motor program, which can further
and Prevention Mechanism aggravate abnormal motor pattern and make it
of Abnormal Motor Pattern hard to treat. These are the practical problems to
be noticed in rehabilitation training.
4.1.1 T
he Formation Mechanism That whether motor pattern is normal or not
of Abnormal Motor Pattern and its quality can directly affect precision of
movement, difficulty of completing the move-
Motor pattern is a special movement form with ment, movement duration, energy consumption
which people can complete daily life movement, and its manifestations. Before the formation of
productive labor movement or athlete movement motor pattern, during the formation and after it,
in order to achieve movement goal. Motor pattern some joint or muscle involved in motor pattern
is completed with bone, joint and muscle, which are injured for some reason such as motor neuron
is the result of orderly multi-joint movement. necrosis in cortex motor center, neural conduc-
Motor pattern is controlled by motor program of tion pathway damages, neural fiber damages,
brain. Motor program is the result of orderly and skeletal abnormality, dysarthrosis and muscle
coordinated function of many cortex motor neu- paralysis, which can induce abnormal motor pat-
rons, which is the same as the robot made from tern. Central nervous system that generate signal
imitating human functions. Motor pattern of source, conduction system, peripheral nerve and
robot walking is completed by the body move- muscle lesion of joint motion, can induce the
ment of robot driven by gearing. The orderly contraction function lost and joint position abnor-
movement of joint is controlled by the software mity (drop-foot and strephenopodia). In order to
dominated by the Central Processing Unit in complete necessary movement, human body can
robot. The software is compiled by the techni- use other muscles or change the posture to com-
cian, which is motor program of robot. pensate the lost functions of the muscle. However,
From this we can conclude that human motor this compensation can induce abnormal motor
pattern is dominated by motor program of cortex pattern. Motor program destruction due to CNS
motor center. Motor program is the inner form of damages is the important factor of establishing
motor pattern, while motor pattern is the mani- abnormal motor pattern. For example, when the
festation of motor program. A small part of the motor programs that control wrist extension and
formation of motor program is inherited and wrist flexion are destroyed, the joint motion of
increase with age, which can be completed wrist can be totally lost in severe cases and abnor-
through trainings such as walking, running, mal joint motion of wrist can be induced in slight
jumping and speech. Most of them are acquired cases. When the signal intensity of wrist exten-
such as motor programs of cycling, swimming, sion is weaker than that of wrist flexion, a bnormal
driving, somersaulting and wirewalking. The motor pattern of wrist flexion during wrist exten-
motor program is established and used, which sion can be induced.
4.1 The Formation and Prevention Mechanism of Abnormal Motor Pattern 113
Especially after CNS damages, muscles domi- which is slower, involuntary, unskillfully, not
nated by the injured area of CNS may be para- flexible and more energy consumption. In addi-
lyzed. If the patients want to walk before the tion, movement with long-term abnormal motor
function of the paralyzed muscle is recovered, in pattern can induce abnormal body posture or
order to complete the walking, the function of the malformation, which further can damage bone,
paralyzed muscle should be compensated by nor- joint and muscle. Even the malformation of spi-
mal muscle around the paralyzed muscle. This nal cord or thorax can affect viscera function and
compensation can mislead joint motion and do harm to body health.
induce abnormal gesture. For example, the For upper limbs, the function of motor pattern
patients cannot complete hip flexion because of is to complete the motor function that is required
the paralysis of hip flexor when walking. for daily life and technical ability. In the move-
Paralyzed side limbs must lie on uninjured side. ment, upper limbs and lower limbs can coordi-
Meanwhile, the joint swing outside or the patients nate, restrict and affect each other. When walking
abduce the lower limbs because of the contrac- and running, coordinated pendulum motion of
tion of hip abductors. And then the patients upper limbs can balance the human body. When
adduct lower limbs because of the weight of walking and running, the started side upper limbs
limbs when setting foot down. Finally, the circle move backward and the contralateral upper limbs
movement locus is formed because the patients swing forward. The bigger the pace is when run-
abduce lower limbs and then abduct lower limbs, ning, the bigger the amplitude of swing of upper
which is called “circle” gait. Because the para- limbs is. Meanwhile, because upper limbs sway
lyzed muscles are different, the compensatory forward, the trunk rotates slightly to the started
way in walking is different and the abnormal side and elevates which alleviate the bear load of
motor pattern is different too. lower limbs and are beneficial for the increase of
The malformation of bone, joint and spinal stride frequency and stride. All these can acceler-
cord, abnormal body gesture can induce abnor- ate paces and can transfer the swaying power of
mal motor pattern. However, this kind of malfor- upper limbs to lower limbs, which can make the
mation should be rectified through operation. We backward pedal more powerful. Some studies
don’t discuss these cases in this chapter. indicated that if the power of upper and lower
In short, when the motor program is destroyed, limbs cannot keep balanceable, the whole body
the muscle is paralyzed, the contraction ability is cannot exert strength coordinatingly, which can
decreased or the joint position is abnormal, affect the running speed.
abnormal motor pattern is different form normal Because of abnormal motor pattern of upper
motor pattern and can be induced by body pos- limbs, not only some movements cannot be com-
ture change or other muscles compensation in the pleted, but also work and life quality can be
process of completing movement. Therefore, affected to varying degrees such as embroidery,
recovery of normal motor pattern should be playing a ball game and computer, meal, tooth-
started from the above aspects. brush and dressing. The hemiplegic patients with
one side upper limb paralysis lose the balance
between upper limbs or upper and lower limbs,
4.1.2 T
he Effect of Abnormal Motor which can affect the ability of walking and
Pattern on Physical Function running.
Abnormal motor pattern of lower limbs
Motor pattern is scientific voluntary movement includes circle gait, drag gait, swaying gait, glu-
ability through practical application and training teus medius gait, which affect speed and quality
after birth. Abnormal motor pattern is faster, flex- of walking. Because of the different movement
ible, more efficient and less energy consumption locus, it is easy to bump, sprain or fall down,
and don’t do harm to body. Abnormal motor pat- meanwhile it is difficult to achieve the walking
tern (abnormal motor pattern, AMP) is different, goal and the energy consumption is big. Motor
function of lower limbs and life quality are According to the part of abnormal motor pat-
affected severely. Walking with long-term abnor- tern, it is divided into four kinks such as faciocer-
mal motor pattern can modify motor program in vical part, upper limbs, lower limbs and trunk.
the cortex motor center and turn it into abnormal Abnormal motor pattern is normally observed in
motor program. The more the patients take move- lower limbs, which can considerably affect daily
ment with abnormal motor program, the stronger life and work of the patients.
the excitability is. Finally, establishment is
achieved. And abnormal motor pattern is more 4.1.3.1 Abnormal Motor Pattern
severe and is difficult to be rectified, even irre- of Head, Face and Neck
versible. We should pay high attention to it in • Head synkinetic movement: It is observed in
rehabilitation therapy. hemiplegic patient. The head turns to injured
side and the face turns to uninjured side.
• Musculus facialis synkinetic movement: It is
4.1.3 Common Classification usually observed in the patients with facial
of Abnormal Motor Pattern paralysis who is difficult to speak. Palpebral
fissure becomes large in uninjured side. There
The movements of arms and legs, which are con- is blepharoptosis in injured side. There is dis-
trolled by motor program in cortex motor center, tortion of commissure in uninjured side in
are associated movements completed with orderly synkinetic movement.
multi-joint and practical significance. It is an inte- • Twisted neck synkinetic movement: It is usu-
grated functional system. Anyone in this system is ally observed in the patients with athetosis
damaged such as nervous system impairment, child cerebral palsy and mixed type child cere-
deformity of bone and joint and muscle dysfunc- bral palsy, especially the patients with dyspha-
tion, can induce abnormal motor pattern. sia. When the patients use words to explain the
Abnormal motor pattern induced by severe defor- event, they become nervous because of dyspha-
mity of bone and joint can be recovered through sia. And then they wave their upper limbs, turn
rehabilitation training after operative correction, their face to the listeners, twist musculi colli
which is not discussed in this book. and are usually with distortion of commissure.
This book mainly introduces abnormal motor
pattern induced by neuromuscular disorders. 4.1.3.2 Abnormal Motor Pattern of
When some area of nervous system is damaged, Upper Limbs
it can induce paralysis of corresponding muscle • Slow movement of upper limbs: It is usually
or abnormal muscular tension, coordination lost observed in the patients with extrapyramidal
or disorder of muscle group. Normal movement damages who wave upper limbs involuntarily
locus is changed or synkinetic movement is gen- and objectlessly, especially the patients with
erated and different kinds of abnormal motor pat- difficulty in fine movement.
terns are formed. This is the formation process of • Uncoordinated wave of both upper limbs: It is
abnormal motor pattern. usually observed in hemiplegic patients with
Abnormal motor pattern may be formed with upper limbs dysfunction and flexor spasticity.
damages of joint and muscle or anatomic abnor- During walking, the patients’ upper limbs
mality, because joint motion is the basic composi- cannot wave coordinately and the walking
tion of movements. Therefore, abnormal joint speed and body balance are affected (Fig. 4.1).
motion is the basis of forming abnormal motor • Synkinetic movement of upper limbs flexor:
pattern. Prevention of abnormal movements in When the patients want to lift upper limbs in
joint motion is the fundamental measure to pre- injured side, it is difficult to lift it because of
vent and rectify abnormal motor pattern. Certainly, lack of extensor strength. In order to complete
recovery of CNS function that induces abnormal movement, the patients’ trunk inclines to the
joint motion is the first problem to be solved. uninjured side, the patients shrug their shoul-
Fig. 4.1 Uncoordinated wave of both upper limbs

Fig. 4.2 Synkinetic movement of upper limbs flexor
ders and the patients lift their shoulder blade.

Meanwhile, the patients are with flexion of
elbow joint and pronation or supination of the
forearm (Fig. 4.2).
• Synkinetic movement of extensor of upper
limbs: It is observed in the patients who try to
extend elbow joint hemiplegic side with inter-
nal rotation and adduction of shoulder joint,
extend elbow joint and pronate, extend wrist
joint slightly, in synkinetic movement of
extensor of upper limbs with flexion of inter-
phalangeal joint (Fig. 4.3).
4.1.3.3 Abnormal Motor Pattern

of Lower Limbs
The characteristic of abnormal motor pattern in
lower limbs is abnormal gait. Its manifestation of
it is abnormal posture in walking. There are many
kinds of abnormal motor patterns in lower limbs
due to different causes, which affect human func-
tions greatly. Common abnormal motor pattern in Fig. 4.3 Synkinetic movement of extensor of upper
lower limbs are as follows: limbs
• Synkinetic movement of flexor of lower limbs:

The patients try to flex hip, lift pelvis, abduce
and abduct hip joint, flex knee joint, flex ankle
joint plantarly and invert it. It is usually
observed in the patients’ hemiplegic limbs
with foot drop and strephenopodia, which is
called circle gait (Fig. 4.4).
• Synkinetic movement of extensor of lower
limbs: The patients extend and abduce hip
joint, unbend or extend knee joint, flex ankle
joint plantarly and invert it, flex interphalan-
geal joint plantarly and abduce it (Fig. 4.5).
There are hyperextension of knee joint, foot
drop, strephenopodia, stiffness of lower limbs
in injured side, walking difficulty, much
energy consumption and joint injury in the
patients with high muscular tension in hemi-
plegic side.
• Spastic paraplegia gait: It is usually observed
in the patients with adductor muscles spasm in
lower limbs after high level nerve injury, which
induce myodynamia imbalance of adductor
and abductor. When walking, the patients lift
the leg and step forward, spasmodic adductor
Fig. 4.5 Synkinetic movement of extensor of lower

limbs (genu recurvatum)
pull legs to adduct it, both legs cross inwards

like the state that scissor is used to cut off the
cloth, which is called scissors gait. It is usually
observed in the patients with cerebral palsy
such as child cerebral palsy.
• Sensory ataxia gait: It is observed in the
patients with deep sensory disfunction such as
the damages of fasciculus gracilis and
fasciculus cuneatus of funiculus posterior

medullae spinalis that transmit deep sensa-
tion. Its characteristic is big stride in walking,
wide space between legs and high foot lifting.
The patients can walk stably when they watch
two feet and walk unstably when closing their
eyes, even cannot walk.
• Festinating gait: It is slow to start walking.
When the patients begin walking, the pace is
Fig. 4.4 Synkinetic movement of flexor of lower limbs small and random little step is shown up. The
(circle gait) feet rub the ground, both upper limbs don’t
swing, the trunk forerake and center of body lar system lesion such as rickets, Kaschin-
gravity move forward. Therefore, the patients Beck disease, progressive muscular dystrophy
use small paces to rush forward in order to or bilateral congenital dislocation of hip joint.
balance the center of body gravity and cannot • Spinal muscular intermittent claudication:
stop the paces, which is like a flustered man’s When walking after a certain time (1–5 min),
gait and called chasing center of body gravity there are inability, numb or pain in lower
gait or propulsion gait. It is observed in the limbs in one side or two sides. Lower limbs
patients with shaking palsy and the diseases cannot bear weight or load, the body inclines
that can induce shaking palsy syndrome. to injured side, weight bearing time of lower
There is high muscular tension in the whole limbs is short in injured side and the patients
body of the patients with these diseases. limp. However, the right walking can be
• Steppage gait: It is usually observed in the recovered after rest. It is usually observed in
patients with foot drop when they are walking. the patients with endarteritis of spinal cord,
The patients have to lift the injured limbs abnormal spinal cord development and spinal
higher in order to let the toe of foot drop off canal stenosis.
the ground. The posture is like leg lifting when • Gluteus medius paralysis gait: Because of
crossing the threshold, which is called step- dysfunction of gluteus medius and decrease of
page gait. It is observed in the patients with myodynamia, when walking, hip joint cannot
tibialis anterior muscle paralysis induced by fixed in bearing load side and trunk bend to
paralysis of common peroneal nerve. injured side and vacillate to the left and to the
• Dancing gait: When walking, the body is in right. It is usually observed in the patients
involuntary movement state. The pace is big with progressive muscular dystrophy, poly-
and irregular, which make the walking unsta- myositis of gluteus medius and child cerebral
ble, like salutatory gait or dancing gait. It is palsy.
usually observed in the patients with neostria- • Congenital myotonia: There is tetanic spasm
tum lesion. of skeletal muscle when putting forth some-
• Swaying gait: Because of inability of pelvic one’s strength. Therefore, when walking or
girdle muscle and psoas and amyotrophy of running, if the patients want to stop walking or
lower limbs and pelvic muscle, spinal cord is running, they may fall down because the mus-
in a lordosis state in order to keep balance of cle cannot relax immediately.
the body gravity. When walking, because the • Hysteric gait: There are many types in hysteric
pelvis cannot be fixed, hip swings to the left gait such as squatting gait and dragging gait.
and right like duck, which is called duck walk- This kind of patients usually is accompanied
ing gait. It is usually observed in the patients with other functional disease.
with progressive muscular dystrophy. • Star trail gait: When the patients close their
• Drunkard gait: When walking, the body grav- eyes, move forward and move backward to
ity cannot be controlled and the patients can- injured side or to negative direction, after
not stand steadily, the space between the legs repeated moving, the gait is like star. It is usu-
becomes big, the body swing to two sides after ally observed in the patients with vestibular
leg lifting, both upper limbs usually shake in labyrinth lesion.
horizontal direction or back and forth, the
patients cannot walk along straight line, which 4.1.3.4 Abnormal Motor Pattern
is like a drunken man’s gait and is called of Trunk
drunkard gait. Because the patients shake Abnormal motor pattern of trunk is usually due to
back and forth and cannot walk forward, the spine malformation such as abnormal pattern of
gait is called staggering gait. It is usually stoop and walking induced by young type kypho-
observed in the patients with nervous system sis, motor pattern of trunk rigidity induced by
diseases, especially epencephalon or vestibu- ankylosing spondylitis (AS) and abnormal motor
pattern induced by scoliosis. When the patients Fundamental measure to rectify abnormal
are not severe, orthotics is used to prevent the motor pattern is to reestablish normal motor
development of malformation or the malforma- pattern in cortex motor center, which include
tion can be partially rectified. When the patients motor program in cortex motor center IV area
are severe, it is necessary to be treated through that dominates single joint and motor program
operation or there is no effective treatment in cortex motor center IV area that dominates
method. Rehabilitation training can also alleviate associated movement. Motor program of sin-
the development of the diseases. gle joint is the basis of dominating muscle
contraction to complete joint motion. Motor
program of associated movement is to domi-
4.1.4 T
he Mechanism of Prevention nate muscles to complete multi-joint motion
and Rectification of Abnormal orderly and coordinately.
Motor Pattern However, the basis of forming motor pro-
gram is numerous motor neurons, destruction
4.1.4.1 Prevention of Abnormal Motor of motor program and the formation of abnor-
Pattern mal motor program. Except abnormal motor
All aspects of the formation of motor pattern are pattern induced by functional defect of bone,
damaged and lose functions because of some rea- joint and muscle and abnormal motor program
son, which induce the loss of motor function, but induced by long-term abnormal motor pattern,
abnormal motor pattern are still not formed. abnormal motor program is due to damages of
During the process that original functions are CNS cells and conduction system for various
recovered through all kinds of methods such as reasons. Therefore, one of the significant
rehabilitation or before it, the method is used to mechanisms is reestablishing motor program.
prevent the formation of abnormal motor pattern. The significant measure and mechanism of
According to the fact that the formation of reestablishing motor program primarily is that
abnormal motor pattern is usually after muscle reserved CNS cells and conduction system
disability, before trying to complete original around injured area are trained to replace the
movement, the lost functions can be compen- functions of injured CNS cells and conduction
sated by other muscles or body posture. The system. Single joint motion is the movement
mechanism of the formation of abnormal motor without any practical function such as drink-
mode means that the formation of abnormal ing, combing, jumping and running. One sin-
motor pattern can be prevented through avoiding gle joint motion cannot be used to complete
body movement before autonomous innervation the movement mentioned above. However,
and certain myodynamia (three-level) of para- functional recovery of CNS cells to complete
lyzed muscle are recovered. With the measures single joint motion should be firstly achieved,
that prevent abnormal joint motion effectively because single joint motion is the basis of
(training equipment for motor pattern modelling) multi-joint associated movement. Where there
and lose weight, the training of motor pattern is multi-joint associated movement, there is
remodeling can be done. single joint motion. Cortical motor area VI
can give out signal to motivate every single
4.1.4.2 The Mechanism of Rectification joint involved in movement orderly to form
of Abnormal Motor Pattern meaningful and functional movement such as
1. According to the mechanism of “target and drinking with teacup and dressing. Certainly,
motivation”, active anti-resistance joint motion because cells and conduction pathway cortical
induced by six-step Daoyin technique in tradi- motor area VI are damaged, reserved cells and
tional Chinese medicine is the basic method to conduction pathway around injured area are
develop neural potential and promote CNS also required to recover coordinated and
plasticity and functional reorganization. orderly associated motor function.
All these above are the process of neural contraction and relaxation. Muscle contrac-
potential development. According to the tion signal is from CNS cells. These sequen-
mechanism of “target and motivation”, active tial and different proportional electrical
anti-resistance joint motion induced by six- signals are called motor program, which is the
step Daoyin technique in traditional Chinese result of coordinated and orderly cooperation
medicine is the basic method to develop neu- of many central motor neurons.
ral potential and promote CNS plasticity and Because of the degree of injury and differ-
functional reorganization. ent injured area, CNS does not certainly be
2. According to the mechanism of “target and damaged. Therefore, some area can perform
motivation”, active joint motion induced by the functions, but others cannot or seldom per-
six-step Daoyin feedback technique in tradi- form functions. At this moment, CNS would
tional Chinese medicine is the effective have lost normal coordinated work ability, but
method to coordinate new activated CNS cells still with partial function, which can usually
and reestablish motor program. cause abnormal work program and abnormal
Through training, CNS cells around injured motor program is formed.
area replace injured nervous tissue, which Whether motor program is completely lost
means an army recruit young soldiers and the or normal motor program is established on the
young soldiers improves their constitution and basis of abnormal program, we should know
master operation knowledge of firearms motor program that the cells in cortex motor
through drills and learning, but this is not the center dominate muscles to complete joint
case that young soldiers improve their actual motion so that we can judge the actual state of
combat skills. On the basis of theoretical learn- abnormal motor program in order to reestab-
ing, the soldiers must combat actually in order lish normal motor program training through
to turn previous drill achievement into actual rectifying abnormal motor program.
combat skills. New activated CNS cells are Electrical signal and pressure sensing
like this and can possess coordinated ability to device are used to display the tension change
dominate joint motion through further drill. of agonistic muscle and antagonistic muscle
A joint motion requires many pieces of or and the signal intensity of agonistic muscle
many groups of muscle such as agonistic mus- and antagonistic muscle from CNS real-timely
cle, antagonistic muscle, coordinated muscle during joint motion with the form of curve or
and neutral muscle. Moreover, coordinated sound. Transverse line is used to mark the
and orderly contraction and relaxation of the intensity of surpassing and the degree of
involved muscle are required to complete the decreasing. Six-step Daoyin technique in tra-
movement. For example, during elbow exten- ditional Chinese medicine is used to surpass
sion, the contractility of triceps muscle of arm the original target until normal motor program
must be strong and the contractility of bicipi- is established and consolidated.
tal muscle of arm must be weak, which means In the process of establishing motor pro-
that the elbow extension can be completed gram, many patients don’t understand the
with strong contractility of agonistic muscle repeated and the same training even are fed up
and weak contractility of antagonistic muscle. with it. And then they refuse to receive regula-
Meanwhile, neutral muscle plays neutraliza- tion training under the detection of motor pro-
tion role and coordinated muscle plays coordi- gram. Rehabilitation doctors and therapists
nated role to make elbow extension flexible should educate the patients patiently and can
and smoothly. Multi-joint body movement use the example of archery or shooting to
requires sequential joint motion and joint explain how to do long-term training with dis-
motion with specific pattern. However, limbs play of motor program signal in order to make
movement of joint motion and multi-joint the patients understand why they should
movement can be completed through muscle receive the training of reestablishing motor
program. For example, if Chinese Olympic enough that potential development training
shooting champion Hai-Feng Xu shoot to the activates CNS cells around injured area to per-
sky without target, does he can improve shoot- form functions and motor program training
ing accuracy? Why does he shoot to the target makes new activated cells work coordinately
for months and years? And then the doctors and orderly. Practical function required for
should discuss with the patients and explain real life or work requirements is not necessary
the mechanism to the patients. The purpose is to be turned into practical motor function
to use practical example and common phe- through practical applied training, which
nomenon in daily life to make the patients means that training method of remodeling
truly understand the mechanism of important motor pattern can turn reestablishment of
role and repeated training of rehabilitation motor program and development of CNS
methods of neurological training. And then potential into useful practical motor function.
the patients can truly understand, actively par- On the basis of preventing or rectifying
ticipate, positively cooperate the training and abnormal motor pattern, through practical
become one of the members in the therapy but usage and motor pattern remodeling, normal
not the simple training receiver, which can motor pattern can be established. However, in
improve training effect. the process of establishment, how to prevent
3. Practical usage training induced by six-step abnormal motor pattern effective and how to
Daoyin technique in traditional Chinese medi- guarantee the normal of reestablished motor
cine and applied by abnormal joint motion pattern? These are practical problem needed
limiter is the essential procedure of remodel- to be solved in the process of rehabilitation.
ing abnormal motor pattern. Through clinical research and verification
The author use recruiting soldiers, training for more than 10 years, in the motor pattern
them, making them do actual combat and form- remodeling of lower limbs, the author experi-
ing fighting capacity to explain procedure and enced simple restricted walking, abnormal
mechanism of rehabilitation therapy of neuro- gait rectification weight support treadmill
logical training. After recruiting soldiers, with elastic band and motor pattern remodel-
through drill and learning, soldiers master all ing trainer. The author realized the meaning of
kinds of skills including various firearms oper- rectifying abnormal motor pattern and remod-
ation, military strategy of soldier formation and eling normal motor pattern. Independent
physical ability improvement. However, this is developed abnormal gait rectification weight
not equal to actual combat ability. The soldiers support treadmill training equipment and
can turn knowledge and skills into actual com- motor pattern remodeling trainer can make the
bat ability through actual combat. The grow-up patients walk in the early stage and assure the
process of a Gong Fu master with actual com- patients can receive walking training under
bat ability and military accomplishments is also normal motor pattern on the premise of effec-
the case. After the drill of basic skills such as tively restricting joint motion. This method
standing exercise and beating, the master does not only improves the training effect of motor
a series of skills and trick in wushu and combat pattern remodeling, and also turns developed
method such as shaolin quan, wudang quan and potential and reestablished motor program
military strategy of soldier formation. The mas- into actual motor ability to shorten therapy
ter can turn previous drill result into practical course obviously. Developed domestic motor
combat skill through fighting hand to hand or pattern remodeling trainer is portable and can
fighting with each other. assure the self-training of the patients is cor-
On the basis of the mechanism mentioned rect so that recurrence is prevented effectively.
above, the process of rehabilitation therapy of Therefore, abnormal gait rectification weight
neurological training is developed according support trainer and motor pattern remodeling
to the mechanism of autonomous movement trainer play an essential role in normal motor
of body dominated by CNS. It is far from pattern remodeling training.
4.1.5 R
ehabilitation Method Used to cooperate gait training. Some researcher
for Rectifying Abnormal think that gait analysis system is the ideal gait
Motor Pattern at Home assessment and training method, but is only
and Abroad at Present used in detecting the gait condition in order to
provide the basis for clinical diagnosis and
From the mechanism of motor pattern remodel- therapeutic schedule, which is the assessment
ing mentioned above, we measure rehabilitation indicator of gait training effect. There is no
method used for rectifying abnormal motor pat- report about application of gait detection
tern at home and abroad at present such as good device. Body weight-supported treadmill train-
limbs position placing in early stage, restricted ing is the expedite edition of walking training
off-bed walking, talipes varus and valgus in natural state. It not only can decrease the
orthotic board, standing training, wearing field required for walking training, but also can
orthotics, Bobath technique, body weight-sup- regulate the walking speed. However, it still
ported treadmill training (BWSTT) and gait cannot restrict unnecessary joint motion in
training guided by the speeches of the thera- body movement effectively. Robot of rehabili-
pists. These methods have a certain improving tation training is the robot that helps the patients
effect on recovering walking ability and gait to do exercise. The exercise object may be the
symmetry of the patients with abnormal gait. robot, but not human, which has no effect on
However, because these methods cannot effec- rehabilitation.
tively restrict unnecessary joint motion in body There are defects in training methods of pre-
movement, they have no correction effect on venting and rectifying abnormal gait at home and
abnormal gait and there is no specific clinical abroad at present:
indication. Moreover, they cannot restrict the
exercise after training. Most of the patients walk • There is no systematic rehabilitation training
with abnormal motor pattern when they are out method of preventing and rectifying abnormal
of training room or hall, which go against reduc- gait.
ing the excitability of abnormal motor center • Gait training is usually guided by the oral
and make it difficult to rectify abnormal motor instruction, which cannot restrict the
pattern. For example, a person with a craving unnecessary joint motion in movement and go
for tobacco wants to quit smoking. In the smok- against the reestablishment of normal motor
ing cessation room, some methods are used to pattern.
explain the harm of smoking in order to allevi- • Training method of abnormal motor pattern at
ate the tobacco craving, but the patients still present is lack of definite indications and
smoke when they out of smoking cessation contradictions.
room so that it is difficult to quit smoking. • There is no training equipment of rectifying
In addition, these methods are usually in abnormal motor pattern and reestablishing
exclusive use and there is no training basis for normal motor pattern.
pathogenesis of inducing abnormal motor pat- • Most of the patients walk with abnormal
tern such as the training without neural potential motor pattern when they are out of training
development and motor program reestablish- room or hall, which go against reducing the
ment. Gait training is directly done before rees- excitability of abnormal motor center and
tablishing motor program. Like a new recruited make it difficult to establish normal motor
army without operation knowledge of firearms pattern.
and combat skills, it is impossible to obtain
fighting capacity through immediate military These defects severely affect the training
exercise. effects of prevention and rectification of abnor-
In addition, rehabilitation training at home mal motor pattern and reestablishment of normal
and abroad at present is lack of dedicated device motor pattern.
4.2 Three Stages Main therapeutic method: from neural poten-

of Rehabilitation Training tial development, in the early phase of recovery
Method in Neurological of CNS damages, the key point of therapy
Training includes two aspects:
4.2.1 T
he Division, Principal • The first is to enhance muscle tension, prevent
Method and Mechanism joint adhesion and occurrence of bad position,
of Three Stages increase response ability of angiocarpy and
in Neurological Training improve internal environment. The methods
include good limb position placing, electrical
According to rehabilitation techniques of neuro- stimulation, active and passive joint motion,
logical training, three stages are divided in the massage, blood circulation drive, standing bed
whole training process from development of neu- training, regulation of disordered water, elec-
ral potential to recovery of normal motor func- trode and acid-base equilibrium, therapy of
tion. After exploration and clinical verifications dizziness and arthralgia and maintenance of
for many years, the author summarized a com- vital signs such as blood pressure and
prehensive rehabilitation training method through breathing.
repeated adjustment and improvement. It is the • The second is the CNS potential development
high generalization and quintessence of rehabili- training. Active movement with target, will-
tation methods of neurological training and has a power and “safe” dangerous condition is an
good clinical training effect. effective principal method to develop poten-
tial. Six-step Daoyin technique in traditional
4.2.1.1 First Stage: The Stage of Neural Chinese medicine is mainly used for motor
Potential Development program signal enhancement training, a physi-
For dyskinesia induced by CNS damages, the cal exercise therapy of neurological training
key point of therapy is to recover the functions and potential development training of upper
of CNS cells at first, but the regeneration capac- limbs, lower limbs and trunk. This stage
ity of CNS cells is weak and they play limited emphasizes on the enhancement of agonistic
role in or has no effect on recovering lost motor muscle signal, but not decrease of antagonistic
function. Therefore, it is necessary for normal muscle signal, which means the coordinated
cells around injured area to perform functions training of motor program proportion is not
and for reserved conduction pathway to replace emphasized in case that it alleviates the func-
the injured pathway, which means that the lost tion of CNS potential development due to
functions can be compensated through CNS motor program proportion. However, “goal
plasticity and functional reorganization. The and motive” mechanism is the method that we
plasticity and functional reorganization are in should pay attention to constantly, especially
accordance with the principle “skillful use and for the training induced by motor program sig-
dependence”. CNS plasticity can be promoted nal to the muscle with zero myodynamia.
through active movement. A number of reserved
CNS cells and conduction pathways are the Some researches show that the sensitivity of
basis of CNS plasticity. Reserved cells are receiving equipment of motor program signal
trained to perform functions and reserved con- (electromyographic signal) is about 360 times of
duction pathways are activated, which are the that of MMT. Moreover, the recovery of motor
basis of promoting CNS function reorganiza- program signal is earlier than that of myody-
tion. The training method is the process of CNS namia. Therefore, zero myodynamia is not equal
potential development. Therefore, CNS poten- to zero signals. The author tested 343 muscles
tial development is the principal training target with zero myodynamia of 77 patients with para-
of this stage. plegia and found that there are 11 muscles with
4.2 Three Stages of Rehabilitation Training Method in Neurological Training 123
zero myodynamia and the coincidence rate is after thermal therapy and restraining force
only 0.3%, which demonstrate that the sensitivity orthotics.
of MMT is far below motor program the sensitiv- • Neural potential development includes upper
ity of receiving equipment of motor program sig- limbs, lower limbs, tibialis anterior muscle,
nal. Clinical observation found that if autonomous hamstring muscles and trunk potential devel-
motor program signal of the muscle can be opment training and physical therapy of neu-
received, the functions of the muscle can be rological training.
recovered to varying degrees through rehabilita- • Reestablishment training of motor program:
tion therapy of neurological training. After CNS damages, destruction of motor pro-
Autonomous contraction of muscle with zero gram induces abnormal motor pattern and
myodynamia cannot be observed with eyes. long-term movement with abnormal motor
During training, the patients try many times but pattern promotes excitability of abnormal
they fail to see the effects and progresses. And motor program. And then the vicious cycle is
then they will lose confidence. The therapists feel formed. Ultimately, abnormal motor program
absent, feel difficult to continue the training and is consolidated and is difficult to be rectified.
even give up therapy. Therefore, therapy in this stage is to decrease
How to make the patients to see the progress the excitability of abnormal motor center and
of therapy? Except the specific training, it is use- reestablish motor program training. However,
ful for motivating the desire and confidence of it is not all right to overemphasize the propor-
the patients for rehabilitation. Six-step Daoyin tion of motor program because excessive
technique with motor program signal reception motor restriction can affect training effects of
and real-time display can induce motor program neural potential development.
from CNS to muscle. Although the patients can-
not see muscle contraction, the signal can be In this stage, the exercise (multi-joint coordi-
received from the skin surface. After amplifica- nated exercise) of the patients are prohibited in
tion, the signal can be displayed on the screen in case that abnormal motor pattern is formed or
a curve form real-timely, which make the patients deepened because the function of paralyzed mus-
and the therapists see the effect and progress of cles is compensated by other muscles. For the
training. In addition, the goal for the patients is patients with abnormal motor pattern, the exer-
like the cross bar in jumping, which is an objec- cise is prohibited to decrease the excitability of
tive indicator to reach or surpass. The patients abnormal motor program, which can make the
must try their best to develop more potential in patients forget motor pattern under abnormal
order to promote the intensity of this signal. motor pattern in order to reestablish normal
Through the training of surpassing the peak of motor program. Therefore, that the exercise is
the last, neural potential is constantly developed prohibited is the fundamental therapeutic mea-
and the lost motor function is finally recovered, sure in this stage. However, for the patients with
which help the patients and their family to good motor function, they can do motor pattern
enhance confidence of rehabilitation. Through remodeling training under the protection of
this method, after training, the functions of 343 motor pattern remodeling training equipment.
muscles with zero myodynamia are recovered to
varying degrees. 4.2.1.2 Second Stage: Reestablishment
For the patients with abnormal motor pattern of Motor Program
in the recovery stage and late recovery stage, the The second stage is the process that new acti-
key points of therapy are as follows: vated cells perform functions coordinately and
orderly.
• Reduction of myospasm and relaxation of Through the previous potential development
adhesion include standing bed, varus-valgus training, autonomic nerve innervation of para-
standing plate training, passive joint motion lyzed muscles is recovered to varying degrees,
because the function of undead CNS cells is therapists can start the training of reestablishing
recovered through training to activate normal motor program of associated movement. Before
cells around injured area and reserved conduc- therapy, the pattern of associated movement should
tion pathway. Although there is new connection be designed such as using teacup to drink water of
pathway between these cells and the dominant upper limbs, stepping forward for walking of lower
muscles, it is necessary to establish work coordi- limbs and speech therapy for stammer.
nation. Only if coordinated operational capability In this stage, the training of remodeling motor
of CNS cells that dominate joint motion is estab- pattern under the detection of motor program sig-
lished, it is possible to recover autonomous and nal is mainly used such as walking training that is
coordinated motor function. This process is the divided into two-step method, three-step method
process of reestablishing motor program, which or four-step method in order to achieve the reha-
is the basis of establishing and recovering normal bilitation training principle of step by step and
motor pattern. from easy to difficulty.
Reestablishment of motor program includes
reestablishment of motor program of single joint 1. Operation process of two-step method of gait
and multi-joint coordinated exercise, which training only emphasize on the training of hip
means that cortex motor center IV area and VI joint and ankle joint involved in gait motion
area are recovered separately. In the early stage (Fig. 4.6).
of reestablishing motor program, the function of –– Hip flexion movement: The signal is
cortical motor area IV area should be recovered induced from CNS to hip flexor to lift the
firstly, which means reestablishing motor pro- legs and step forward.
gram of single joint. Meanwhile, reestablishment –– Dorsiflexion of foot: The signal of tibialis
of motor program of multi-joint associated move- anterior muscle is induced secondly to
ment should be considered. In the middle and assure the degree of dorsiflexion of foot,
later periods of reestablishing motor program, the make toe not rub the floor, make the heel
training of reestablishing motor program of asso- touch the ground first and prevent varus.
ciated movement should be emphasized, which 2. Operation process of three-step method of gait
means recovering the function of cortical motor training only emphasize on the training of hip
area VI area. joint, knee joint and ankle joint involved in
Rehabilitation techniques of neurological gait motion (Fig. 4.7).
training are adopted in the training. On the basis –– Hip flexion movement: The signal is
of real-time display of motor program signal induced from CNS to hip flexor to life the
induced by six-step Daoyin technique, the legs and step forward.
patients are instructed to increase the signal –– Flexion of knee: The signal of hamstring
intensity of agonistic muscle and decrease the muscles is induced secondly to help flex
signal intensity of antagonistic muscle gradually knee joint in order to assure stride with cer-
until the proportion of the motor program signals tain length and height.
between them are returned to normal. Through –– Eversion of dorsiflexion of foot: The sig-
repeated training, the proportion can be consoli- nals of tibialis anterior muscle, peroneus
dated. In the training of physical therapy of neu- longus and peroneus brevis are induced
rological training, the patients are instructed to finally to assure adequate dorsiflexion of
promote myodynamia of agonistic muscle and foot and strephexopodia degree.
relax antagonistic muscle, because the actual 3. Operation process of four-step method of gait
state of motor program signal and its proportion training only emphasize on the training of hip
cannot be observed in physical therapy of neuro- joint, knee joint and ankle joint and four kinds
logical training. of exercise involved in gait motion (Fig. 4.8).
When the joints involved in associated move- –– Plantar flexion: The signal is induced from
ment are possessed with active joint motion, the CNS to musculus gastrocnemius to induce
Fig. 4.6 Operation
process of two-step
method of gait training
Fig. 4.7 Operation
process of three-step
Fig. 4.8 Operation
process of four-step
plantar flexion of ankle joint so that heel is guish them and induce disorder. Therefore, the
full of the strength of back step to make the training procedure should be as easy as possible
body step forward. on the premise of satisfying training demands.
–– Hip flexion movement: The signal is The principle of from easy to difficult and step by
induced from CNS to hip flexor to lift the step should be abided by. When doing the multi-
legs and step forward. joint associated movement training, the therapists
–– Flexion of knee: The signal of hamstring should avoid very difficult training. The patients
muscles is induced to help flex knee joint are often pessimistic because they cannot meet
in order to assure stride with certain length the requirements, which can affect training effect.
and height. In this stage, the patients are required to
–– Eversion of dorsiflexion of foot: The sig- decrease the whole movement. The patients with
nals of tibialis anterior muscle, peroneus good motor function can use motor pattern
longus and peroneus brevis are induced remodeling trainer and abnormal gait rectifica-
finally to assure adequate dorsiflexion of tion weight loss walking device to do movement
foot and strephexopodia degree, make toe training. Combined with the training of reestab-
not rub the floor, make the heel touch the lishing motor program, they can be seen as the
ground first and prevent varus. early training of the third stage (remodeling stage
of motor pattern).
Associated motor pattern training can be
arranged with real life demand according to 4.2.1.3 The Third Stage: Remodeling
actual state of functional recovery in the patients Stage of Motor Pattern
such as using teacup to drink water (Fig. 4.9), Just as the items mentioned above, the motor pro-
dressing and walking. Generally, too many and grams of single joint and multi-joint associated
fine steps can make the patients difficult to distin- movement are merely established, which is not
Fig. 4.9 Operation
process of three-step
method of grasping
equal to actual motor function. The established limbs and trunk. Variable motor pattern remodel-
motor program can be turned into actual motor ing trainer is complicated and heavy, which is
ability in daily life through actual practical train- inconvenient to put on or put off. It is appropriate
ing, which is a process of motor pattern remodel- for the patients with serious illness to do training
ing. For example, in the walking motor pattern in rehabilitation hall of hospital. According to
training, when the patients are capable to stand individual demand, portable motor pattern
up with balance, flex hip and ankle joint of remodeling trainer is light and easy to put on or
injured side actively, they can do gait remodeling put off, which can be used for the self-exercise of
training, shifting of weight, stride gait training, the patients out of hospital. The device can assure
walking marked by gait and training with walk- the correctness of motor pattern in self-exercise
ing device marked by gait assisted by weight loss so that recurrence of abnormal motor pattern can
device. Along with the increase of the patients’ be prevented effectively.
walking ability, the weight of weight loss is The first and second stage of the therapy is
decreased gradually, and then the training is basic training. Its purpose is to recover autonomic
turned into walking without weight, training with nerve innervation of the muscle and reestablish
motor pattern remodeling trainer under protec- motor program. The patients are required to avoid
tion in lower limbs and independent ambulation associated movement in abnormal motor pattern.
under protection. The patients’ normal walking Its purpose is to decrease or eliminate abnormal
ability is increased gradually until they can walk motor pattern effectively. The excitability of
without help. abnormal motor program in cortex motor center is
In this stage, the patients are encouraged to do in favor of reestablishment of normal motor pro-
training of motor pattern remodeling step by step gram. In the third stage, training results of the first
with guidance and protection, which can prevent and second stage are turned into actual functional
abnormal joint motion of motor pattern remodel- movement in daily life and labor work through
ing trainer of upper limbs, lower limbs and trunk. motor pattern remodeling. Three stages supple-
It plays an important role in rectifying and ment one another. According to the actual condi-
remodeling motor pattern of upper limbs, lower tion of the patients, they can be used flexible.
4.2.2 B
asic Methods and Clinical the process of joint motion, the therapists
Indications in All Stages use manipulation to exert resistance in the
of Neurological Training orientation of joint motion and use Daoyin
technique to guide the patients to do anti-
4.2.2.1 The First Stage: Neural resistance training such as hip flexion, knee
Potential Development Stage extension, dorsiflexion of foot, strephexo-
1. Basic training method is the training method podia of lower limbs and shoulder abduc-
that is appropriate for neurological training to tion, elbow extension and flexion, wrist
promote CNS plasticity and functional extension and flexion, finger extension and
reorganization. flexion of upper limbs. In the interval of
• Potential development training: With the training, the therapists can do passive joint
help of human potential development train- motion for the patients in order to loose
ing device, the therapists can help the joint and soft tissue adhesion.
patients to regulate weight loss until the • Standing bed or standing board training:
patients can stand up with lower limbs, For the patients in the early stage of recov-
hold up with upper limbs and stick out with ery with poor cardiovascular stress
waist. The weight is about one-third to response ability or foot drop and foot
one-fifth of the patients’ weight. Six-step varus-valgus, the patients can do standing
Daoyin technique in traditional Chinese bed training or dorsiflexion of foot train-
medicine is used to guide the patients to do ing, foot varus-valgus training in order to
training of different parts on the basis of promote cardiovascular stress response
regulation of mind, breathing and move- ability of the patients, alleviate contracture
ment such as standing up, squatting and and adhesion of soft tissue and provide
control ability training of lower limbs and condition for active movement training.
upper limbs. • According to the specific condition of the
• Neurological training: Daoyin feedback patients, adjuvant therapy methods such as
technique in traditional Chinese medicine acupuncture, massage, thermal therapy and
is used. The motor program signal induced electrical stimulation are used to promote
by six-step Daoyin technique is displayed therapeutic effect.
real-timely. Agonistic muscle signal is pro- In this stage, the patients are allowed to
moted through biological feedback. do single joint motion exclusively and are
Meanwhile, it is time to attenuate the sig- prohibited to do associated movement of
nal intensity of antagonistic muscle. In this multi-joint motion.
stage, the proportion of motor program sig- 2 . Clinical indications
nals between agonistic muscle and antago- • The patients in the early stage of the dis-
nistic muscle cannot be emphasized. If we ease with dyskinesia who don’t walk out of
overemphasize the proportion of motor the bed.
program signals, it is easy for the patients • The myodynamia of paralyzed muscle is
to affect the intensity of agonistic muscle less than or equal to level 2. The intensity
signal because of worrying about excessive of motor program signal is less than or
antagonistic muscle signal, which makes it equal to 80 μv.
difficult to promote CNS plasticity, espe- • The patients with potential development
cially the training induced by autonomic training who can stand erectly for 30 min
signal of weak myodynamia or zero and the vital signs are stable.
myodynamia. • The patients with abnormal motor pattern of
• Physical therapy of neurological training: upper limbs, lower limbs, trunk or face such
Six-step Daoyin technique in traditional as circle gait, dragging gait and hemiplegic
Chinese medicine is used to guide the gait of lower limbs and the patients with
patients to do active joint motion. During uncoordinated swing of upper limbs and
posture malformation in trunk movement in continued. Potential development train-

recovery stage. The state of the illness is ings of upper limbs and trunk are contin-
slight and the motor function can be recov- ued too.
ered through three-stage method training. • Basic training of reestablishing normal
3 . Clinical contraindications motor pattern: The first is stride gait training
• The patients with severe diseases and and shifting of weight training. Weight loss,
unstable vital signs stride gait and shifting of weight device are
• The patients with poor cardiovascular used for training. Regulation of weight loss
stress response ability who cannot stand can make the patients stand up and the
erectly for 30 min weight loss is one-third to one-fifth of the
• The patients with severe hypertension and patients’ body weight. According to the
diabetes who cannot keep state stable after length of stride, the training device is divided
corresponding medicine therapy. into five kinds. The training is from the pri-
• It is used with caution in the patients with mary to normal stride. The second is remod-
fractures of rib, spinal cord, pelvis and eling training of abnormal gait rectification
lower limbs and uncompleted healed after and weight loss gait. Abnormal gait rectifi-
damages of joint and muscle. cation and weight loss gait training device
are used. The training is done in the training
4.2.2.2 The Second Stage: footpath marked with gait. Adjustment
Reestablishment of Motor strength of lower limbs adduction and foot
Program drop elastic orthotics band of this device can
1. Basic training method: It is appropriate for the make the patients to prevent lower limbs
training of coordinated work ability between adduction and foot drop when stepping for-
CNS cells, which includes the training of sin- ward. The third is flexibility training of seg-
gle joint motion and reestablishment of motor ment of motor program in lower limbs,
program of associated movement. However, upper limbs and trunk.
in this stage, we should consider the slow of In this stage, the patients are still required
CNS functional recover. The patients still do to do the training mainly with single joint
potential development training, but the train- motion. If the restriction is not available,
ing time is less than that of training of reestab- the training of associated movement of
lishing motor program. multi-joint motion can be started.
• Neurological training: The proportion of 2. Clinical indications
motor program signal of agonistic muscle • The patients with stable blood pressure and
and antagonistic muscle that control joint without dizziness and nausea who can sit
motion is emphasized. Meanwhile, the or stand with balance
training of enhancing agonistic muscle sig- • The myodynamia of paralyzed muscle is
nal is continued, such as the proportion of recovered to level 2 to level 3.
motor program signal of single joint such • The patients can partly complete active
as hip flexion, knee extension, dorsiflexion joint motion such as hip flexion, knee flex-
of foot and strephexopodia of lower limbs ion, dorsiflexion of foot, strephexopodia,
and shoulder abduction, elbow extension, shoulder abduction, elbow extension and
elbow flexion, wrist extension and wrist elbow flexion.
flexion of upper limbs. Reestablishing • The signal intensity of motor program
motor program of multi-joint associated (sEMG) is from 80 μv to 150 μv.
movement is continued too. 3 . Clinical contraindications
• Potential development training: The train- • The myodynamia is less than level 2 and
ings of standing up and squatting with sEMG is less than 80 μv. The patients can-
lower limbs and body control ability are not do active joint motion.
• It is used with caution in the patients with

fracture of rib, spinal cord, pelvis and lower
limbs and uncompleted healed after dam-
ages of joint and muscle.
4.2.2.3 The Third Stage: Training Stage

of Remodeling Motor Pattern
The purpose of the third stage is to turn the previ-
ous training results into daily life and work abil-
ity step by step through actual practical training
of restricting effectively unnecessary movement
in body exercise. However, reestablishment tech-
nique of motor program can be used to establish
and consolidate motor program of associated
movement.
1. Basic training method

• Neurological training: The training of rees-
tablishing motor program of multi-joint
associated movement is emphasized such
as reestablishing motor program of dorsi-
flexion of foot and strephexopodia in walk-
ing, two- step method, three-step method
and four-step method gait training.
• Motor pattern remodeling training: Motor
pattern remodeling trainer is used. The Fig. 4.10 Gait on the track of walking machine
patients with poor motor function such as
unstable gait with lower limbs, can do the
training with the help of abnormal gait rec- • Comprehensive walking trainings include
tification and weight support treadmill walking training with balance bar or walk-
training device. The weight depends on the ing aid marked with gait, ascending and
specific condition of the patients and is descending the stairs training and indepen-
about one-fifth to one eighth of the body dent walking training marked with gait.
weight. The device can be also used for
preventing the patients from falling down In this stage, the patients are required to try their
without weight loss function. During gait best to do actual movement training without assis-
training, the patients should be walk on the tive device. For example, the patients try not to use
footpath marked with gait. This footpath wheelchair, walking stick and walking aid to do
requires the patients to achieve clear objec- walking training in the remodeling of lower limbs.
tives of the stride and stride width. The actual practical training can be done such as
• Gait training of weight loss: Weight loss combing and dressing of upper limbs without help.
walking trainer is used and the weight is
about one-fifth to one eighth of the body 2. Clinical indications
weight. Track rotation speed of walking • The patients without complaints in depen-
machine is started from 0.22 m/s and the dent ambulation.
speed is increased with the increase of • The myodynamia of muscles of paralyzed
walking ability. The patients are instructed side include deltoid, triceps muscle of arm,
to do the training on the track of the walk- bicipital muscle of arm, extensor carpi and
ing machine marked with gait (Fig. 4.10). flexor muscle of wrist of upper limbs, hip
flexor, quadriceps femoris, tibialis anterior The training process of CNS potential devel-
muscle, peroneus longus and peroneus bre- opment is like an army that needs to have a rest
vis of lower limbs and lumbodorsal mus- after long-term combat in order to fill soldiers,
cles is more than or equal to level 3. ammunition and living supplement and then can
• The patients who can complete active joint throw them into new combat. After a period of
motion. time, the potential ability of CNS is partially
• The signal intensity of motor program of developed and the potential resources are con-
agonistic muscle is more than or equal sumed for a certain amount. Therefore, the
to160 μv. patients feel fatigue and need to take a break to
3 . Clinical contraindications supplement nutrition. After that, they continue
• The myodynamia is less than level 3 and training to get better therapeutic effect.
sEMG is less than 160 μv.
• The patients who cannot actively complete
multi-joint associated movement. 4.2.4 F
lexible Use of Three-Stage
• It is used with caution in the patients with Neurological Training Therapy
fracture of rib, spinal cord, pelvis and lower
limbs and uncompleted healed after dam- In clinic, we found that three-stage therapy is
ages of joint and muscle. appropriate for most patients. The therapy time
(one month per stage) is enough to achieve the
therapeutic effect but is not appropriate for the
4.2.3 T
he Training Time rehabilitation training of every patient. Therefore
and Therapy Course of Three- the therapists should use it flexibly in clinic.
Stage of Neurological Training
Therapy 4.2.4.1 In Each Stage of the Therapy,
We Take One Therapy Goal
• The schedule of daily therapeutic programs: as the Principal Thing and
There are 4–6 therapy programs every day and Take Other Methods
the therapy time is 30–50 min. The interval time as the Subsidiary Thing
is about 5–10 min for the patients to have a rest. Training time and content from three stages cannot
• The schedule of therapy time: According to completely satisfy the demands of CNS functional
the particularity of CNS system development, recovery, even draw a clear distinction. Neural
reestablishing functions in the injured brain potential development, reestablishment of motor
takes a long time, because human take 1 year program and remodeling of motor pattern all
to learn walking after birth. According to the require long-term training. Rehabilitation training
patients, the patients’ family, hospital beds, in hospital doesn’t allow us to do the training
therapeutic effect and costs, long hospital according to neurodevelopment mechanism. The
days is bad for various aspects. After clinical training time can only be short. However, in the
exploration for many years, it is proved pri- therapy of every stage, we take one kind of therapy
marily that 3 months of one therapy course goal as the principal thing and take other methods
that includes three stages (1 month per stage) as the subsidiary thing. They can make up with
is appropriate for most patients’ training. This each other through cross- over application. For
scheme can achieve the expected therapeutic example, in the therapy of the first stage, we take
effect and the hospital time is short. The hos- neural potential development training as the prin-
pital time can be prolonged in special condi- cipal thing and take reestablishment of motor pro-
tion or the second therapy course is continued. gram as the subsidiary thing. We cannot
After that, the patients can go home and do overemphasize the proportion of motor program,
self-exercise. After six to twelve months, the or it can affect the effect of potential development.
patients can go to hospital for rehabilitation Similarly, in the therapy of the third stage, we take
training as needed. remodeling of motor pattern as the principal thing.
The signal intensity of motor program and myody- 4.2.5 Clinical Verifications of Three-
namia of the patients cannot meet the requirements Stage Neurological Training
so that the training of neural potential develop- Therapy
ment and reestablishment of motor program is still
continued. The time spent on remodeling training 4.2.5.1 General Data
of motor pattern is more than the time spent on the From June 2006 to May 2008, there are 60
training of potential development and motor pro- patients with hemiplegia who are all the inpa-
gram reestablishment. tients in neurological rehabilitation training cen-
ter in Beijing Tongren Hospital affiliated to
4.2.4.2 In Every Stage, the Therapists Beijing’s Capital Medical University. There are
Can Adjust Indications Properly 52 males and 8 females. The age is form
According to the Specific 15–69 years old. The average age is 48.2 years
Condition of the Patients old. There are 29 patients with hemiplegia after
During therapy, the therapists should analyze the cerebral infarction, 18 patients with hemiplegia
specific condition of the patient comprehensively after cerebral hemorrhage, 13 patients with hemi-
and ascertain the corresponding method to obtain plegia after brain damage. There are 28 patients
better training effect. For example, the patients with left hemiplegia and 32 patients with right
with higher myodynamia (it is more than or equal hemiplegia. The patients are divided into two
to level 3) can do the training of the second stage. groups include prevention group and rectification
For the patients with severe disease and slow group and there are 30 patients in each group.
recovery of autonomous motor functions, the Prevention group includes the patients who can-
therapy of the first stage should be prolonged. not walk off the bed. There are 25 males and 5
females. The average age is 48.1 years old.
4.2.4.3 The Idea of Accepting or Therapy group includes the patients who can
Rejecting Should walk but with abnormal gait. The disease history
Be Established and the Severe is form 1 month to 5 years. There are 27 males
Patients Can Do the Training and 3 females. The average age is 48.3 years old.
of the Third Stage Directly The inclusion and exclusion criteria are as
For the severe patients with long disease course follows:
(more than half a year) and without autonomous
movement can do usability training in the motor • The inclusion criteria: According to the diag-
pattern of weight loss during the training of nostic criteria of national cerebrovascular dis-
potential development and motor program rees- ease conference in 1995, the hemiplegic
tablishment. These patients can also do motor patients are diagnosed with cerebral infarction
pattern remodeling training directly. If the or cerebral hemorrhage and by CT or MRI;
patients still do the training according to three- the patients without obvious dysgnosia
stage method, the functions may be not recovered (MMSE score is more than or equal to 20);
finally. For the patients with severe disease, “To There is no serious contracture of the knee
accept the lesser of two evils” idea should be joint or ankle joint and passive movement
established in designing therapeutic principle, range is normal.
which means that the patients try to make the • The exclusion criteria: The patients with
paralyzed limbs move and then let them move severe organ dysfunction such as heart and
normally. Walking under abnormal motor pattern lung, severe infectious disease, bone fracture,
is better than lying on the bed. The author estab- dyscrasia and so on cannot do rehabilitation
lished the rehabilitation principle “standing on training; The patients with severe cognitive
the early stage and walking for recovery”. disorder or long-term drug use such as seda-
Satisfying clinical effect can be obtained after the tives, antidepressants and diazepam cannot
training with specific principle. cooperate with therapy; the patients with fre-
quent epileptic attack; the patients with dis- induced by six-step Daoyin technique in
eases such as various myopathy, bone and traditional Chinese medicine that is from
joint diseases and peripheral neuropathy that cortex motor center to agonistic muscle
can affect movement; the patients stop therapy and antagonistic muscle. Through biofeed-
for any reason or cannot persist in the therapy back mechanism, agonistic muscle signal
for 90 times. enhancement training of hip flexion, knee
extension, dorsiflexion of foot and
4.2.5.2 Therapy Method Includes strephexopodia is done. In this stage, it is
Division of the Three Stages, not appropriate to emphasize the propor-
Indications and Training tion of motor program signal of agonistic
Methods muscle and antagonistic muscle. The train-
• The first stage is neural potential developing time is 10 min for one joint and the
ment. Adopted rehabilitation training methods total is 50 min.
are as follows: –– The above therapy is once a day and 30
–– Standing bed or board training: For the time totally.
patient with poor cardiovascular stress –– In this stage, the patients are required to sit on
response, foot drop or varus and valgus in the wheelchair and is prohibited to walk.
the early stage of recovery can use stand- –– Clinical indications of the first stage: the
ing bed, dorsiflexion of foot standing hemiplegic patients who cannot yet walk
board or varus and valgus standing board off the bed in the early stage of recovery;
to do the training in order to enhance car- the patients with circle gait or dragging
diovascular response ability and alleviate gait in the recovery stage; The myody-
contracture of Achilles tendon and adhe- namia of hip flexion, quadriceps femoris,
sion of musculus gastrocnemius (30 min tibialis anterior muscle, peroneus longus
per time). and peroneus brevis is less than or equal to
–– Neurological training therapy: According level 2; The signal intensity of hip flexion,
to therapeutic schedule, six-step Daoyin quadriceps femoris, tibialis anterior mus-
technique in traditional Chinese medicine cle, peroneus longus and peroneus brevis is
is used to do the training of hip flexion, hip less than or equal to 80 μv.
abduction, knee extension, dorsiflexion of • The second stage is the reestablishment of
foot and strephexopodia. The training time motor program. The adopted training methods
is 10 min for one joint and the total time is are as follows:
40 min. –– Potential development training of lower
–– Potential development training of lower limbs: The training of standing up, squat-
limbs: Potential development training ting and limbs control ability are continued
equipment of lower limbs is used and the and the training time is 30 min.
regulation of weight loss can make the –– Neurological training: The proportion
patients stand. The weight is about one- reestablishment training of motor program
third to one-fifth of the body weight. Six- signals of agonistic muscle and antagonis-
step Daoyin technique in traditional tic muscle of hip flexion, knee extension,
Chinese medicine is used to guide the dorsiflexion of foot and strephexopodia is
patients to stand up, squat and do limbs emphasized. The training is 10 min for one
control training. There are ten times per joint and the total time is 50 min.
group and the training time is 30 min. –– The training of stride, gait and shifting of
–– Neurological training: Daoyin feedback weight: The training device of weight loss,
technique in traditional Chinese medicine stride, gait and shifting of weight is used.
is used to display motor program signal The regulation of weight loss can make the
patients to stand up. The weight is about lower limbs adduction, the training is
one-fourth to one-sixth of the body weight. 30 min every time.
The length of stride is increased gradually. –– Weight loss gait training: the patients dress
The training time is 30 min per time. motor pattern remodeling trainer and do
–– The above therapy is once a day and 30 the training with weight loss gait training
times totally. device. The weight is one-fifth to one-
–– In this stage, the patients are required to sit eighth of the patients’ body weight.
on the wheelchair and is prohibited to Rotational speed of walking machine is
walk, but they can walk with help from started from 0.22 m/s. The speed is
wheelchair to bed or from wheelchair to increased with the enhancement of walk-
pedestal pan. ing ability. The patients are guided to do
–– Clinical indications of the second stage: the training according to the marked gait
–– The patients with stable blood pressure and on the walking machine track. The training
without dizziness or nausea who is recov- time is 30 min every time.
ered to sit or stand with balance. –– Comprehensive walking training includes
–– The myodynamia of hip flexor, quadriceps walking training of balance bar or walking
femoris, tibialis anterior muscle, peroneus aid marked with gait, ascending and
longus and peroneus brevis in paralyzed descending the stairs training and walkpath
side is from level 2 to level 3. marked with gait training. The training time
–– The patients who can actively complete the is 10 min for each item and the total time is
joint motions such as hip flexion, knee flex- 30 min. In the beginning stage, the patients
ion, dorsiflexion of foot and dress motor pattern remodeling trainer to
strephexopodia. do training, and then they can walk without
–– The signal intensity of hip flexor, quadri- motor pattern remodeling trainer.
ceps femoris, tibialis anterior muscle, per- –– The therapy time is one time a day and the
oneus longus and peroneus brevis is from total number is 30.
80 to 150 μv. –– In this stage, the patients are required to
• The third stage is the remodeling of motor pat- abandon the wheelchair. The patients are
tern. The adopted training methods are as helped or guided to do walking training.
follows: –– Clinical indications of the third stage:
–– Neurological training: when the patients –– The patients with no complaints who are
do the signal intensity enhancement train- recovered to sit or stand with balance.
ing of agonistic muscles in hip flexion, –– The myodynamia of hip flexor, quadriceps
knee extension, dorsiflexion of foot and femoris, tibialis anterior muscle, peroneus
strephexopodia, the proportion reestablish- longus and peroneus brevis in paralyzed
ment of motor program signal of agonistic side is more than or equal to level 3.
muscle and antagonistic muscle motor pro- –– The patients can actively complete joint
gram is emphasized. The training time is motions of hip flexion, knee flexion, dorsi-
10 min for one joint and the total time is flexion of foot and strephexopodia.
50 min. The training time is 2–3 a week. –– The signal intensity of hip flexor, quadri-
–– Remodeling training of Abnormal gait ceps femoris, tibialis anterior muscle, per-
weight loss rectification: the weight is oneus longus and peroneus brevis is more
about one-fifth to one eighth of the patients’ than or equal to 160 μv.
body weight. On the walkpath marked with
gait, the patients dress motor pattern 4.2.5.3 Observation Indicators
remodeling to do walking training. International functional assessment methods
According to foot drop and elastic band of are used for evaluation, which include Fugl-
Meyer motor function of lower limbs, Lovett and the gait is obviously rectified, but there
manual muscle test, the intensity and propor- are two patients with foot aid. After therapy,
tion of signal, stride, bearing time of injured there are significant difference in Fugl-Meyer
limbs, range of joint motion in hip flexion, hip motor function of lower limbs, Lovett manual
abduction, dorsiflexion of foot and strephexo- muscle test, the intensity and proportion of
podia. The assessment should be done and the signal, stride, bearing time of injured limbs,
data should be collected in the beginning of the range of joint motion in hip flexion, hip abduc-
therapy and at the end of the therapy. SPSS12.0 tion, dorsiflexion of foot and strephexopodia
statistical software is used for statistical between before therapy and after therapy
analysis. (P < 0.01) the results are referred to Tables 4.1
and 4.2.
4.2.5.4 Results
There are 30 patients in prevention group. 4.2.5.5 Conclusion
There are 26 patients without abnormal gait Three-stage therapy of neurological training is
and with normal walking pattern. There are the effective method of preventing and rectifying
four patients with unrecovered functions of hemiplegic patients with abnormal motor pattern
peroneus longus and peroneus brevis. The of lower limbs. The index of clinical indications
patients with slight strephenopodia, walk with is appropriate for every stage.
slight circle gait and can be rectified with foot This paper is published on Chinese chemist
aid. There are 30 patients in rectification group and druggist 2011, 6(5): 621–623.
Table 4.1 Prevention of abnormal gait before therapy and after therapy ( x ± s)
Assessment items Before therapy After therapy t Value
FMA score of lower limbs 9.27 ± 5.06 27.47 ± 5.12 −21.44*
Stride (cm) 4.87 ± 7.08 23.36 ± 7.75 −10.87*
Bearing time (s) 0.15 ± 0.36 3.29 ± 1.12 −15.52*
sEMG (μV)
Hip flexor 17.90 ± 13.06 57.27 ± 26.74 −11.81*
Quadriceps femoris 37.00 ± 27.23 101.67 ± 42.92 −14.28*
Tibialis anterior muscle 32.00 ± 25.23 97.26 ± 39.02 −9.23*
Peroneus longus and peroneus brevis 11.00 ± 12.04 50.30 ± 37.29 −7.51*
sEMG (μV)
Hip flexor/gluteus 18.12 ± 9.64 67.33 ± 23.46 −10.56*
Quadriceps femoris/hamstring muscles 26.07 ± 22.97 86.10 ± 38.37 −13.94*
Tibialis anterior muscle/musculus gastrocnemius 14.12 ± 5.23 58.28 ± 19.36 −9.86*
Peroneus/tibialis posterior 6.63 ± 8.71 41.70 ± 32.30 −7.17*
MMT (level)
Hip flexor 0.5 ± 0.50 3.5 ± 2.50 −5.67*
ROM (°)
Hip flexion 6° ± 2.5° 52° ± 13.6° −12.56*
Hip abduction 3° ± 2.5° 22° ± 10.14° −11.47*
Dorsiflexion of foot 9° ± 5.8° 24° ± 12.7° −9.32*
Strephexopodia 1.3° ± 0.4° 12° ± 6.4° −8.97*
*p < 0.001
Table 4.2 Rectification of abnormal gait before and after therapy ( x ± s)
Assessment items Before therapy After therapy t Value
FMA score of lower limbs 18.10 ± 6.16 29.71 ± 3.36 −15.19*
Stride (cm) 14.77 ± 7.21 30.23 ± 4.94 −14.76*
Bearing time (s) 1.28 ± 0.75 5.93 ± 1.78 −17.83*
sEMG (μV)
Hip flexor 22.03 ± 8.87 59.23 ± 20.53 −12.01*
Peroneus 12.52 ± 9.14 58.16 ± 29.43 −9.93*
sEMG (μV)
Hip flexion/gluteus 46.33 ± 18.57 112.47 ± 44.22 −10.25*
Quadriceps femoris/hamstring muscles 27.94 ± 17.26 98.10 ± 34.33 −11.71*
Tibialis anterior muscle/musculus gastrocnemius 65.32 ± 31.66 −9.46* 9.61 ± 5.98
Peroneus/tibialis posterior 7.61 ± 8.67 45.42 ± 26.86 −8.46*
MMT (level)
Hip flexor 1.5 ± 1.50 3.5 ± 1.50 −8.32*
ROM (°)
Hip flexion 12° ± 7.6° 78° ± 16.8° −11.45*
Hip abduction 16° ± 12.5° 42° ± 23.7° −7.65*
Dorsiflexion of foot 12° ± 10.2° 43° ± 15.8° −6.71*
Strephexopodia 3° ± 1.6° 19° ± 8.4° −9.89*
*p < 0.01
4.2.6 Clinical Application are guided by philosophy to develop gradually.

Experiences in Three-Stage According to the requirements of functional
Rehabilitation Method recovery, the methods are added gradually.
of Neurological Training: According to the methods, the equipment is
A Philosophical Method developed. After development, people can ana-
with Dialectics and Natural lyze the condition and realize that the methods
Law are guided by philosophy to develop gradually. In
the three-stage rehabilitation method of neuro-
4.2.6.1 Three-Stage Rehabilitation logical training, people found that the methods
Method of Neurological are guided by philosophy. Main representations
Training Is a Philosophical are as follows:
Method with Dialectics
and Natural Law • “Theory of use and disused”: in the three-
Philosophy is the hypostasis and wisdom that can stage methods, the therapists should seek the
guide people’s life and work. “Theory of use and method that active movements of limbs are
disused” in Darwinian evolution and “sparks of dominated to recover brain function as soon
fire, set the prairie ablaze” are the concepts that as possible, which is in accordance with
can make people reborn, which are the hypostasis “theory of use and disused” in Darwinian
that can guide human life. evolution. Moreover, the patients are guided
In the three-stage rehabilitation method of to do active movements of limbs are domi-
neurological training and long-term development nated by brain and the therapeutic effects are
of methods, people don’t realize that the methods better.
• “Transcendence goals and motive force mind, Yin-Yang dissociation, exhaustion of

source”: Goals are widely used in daily life vital essence” is meaningful for maintaining
such as “five-year plan”. “The whole day’s normal vital essence.
work depends on a good start in the morning
and the whole year’s work depends on a good After CNS damages, the original steady state
start in spring.”, which demonstrated that is destroyed and there are a series of dyskinesia.
where there is no goal, there is no motive. In Six-step Daoyin technique in traditional Chinese
the three-stage rehabilitation method of neu- medicine of guiding collaterals through meridians
rological training, it is established on the basis is used to clear and activate the channels and col-
of transcendence goal. Six-step Daoyin tech- laterals, regulate of Qi and blood, develop neural
nique in traditional Chinese medicine of guid- potential and recover equilibrium between Yin
ing collaterals through meridians is used to and Yang. Some researchers think that the role of
induce and encourage the patients to surpass rehabilitation methods of neurological training is
the increasing goal to develop potential, rees- related to homeostasis that is recovered by
tablish program and remodel motor pattern. increased negative entropy in vivo after the train-
Therefore, rehabilitation methods of neuro- ing of clearing and activating the channels and
logical training are not simple active move- collaterals and developing neural potential.
ment training, but the training guided by
Daoyin technique. Through creating safe state 4.2.6.2 The Three-Stage Method Is
of emergency, speech encourage and inspira- in Accordance with Law
tion, resistance of enhancing active movement of Nature of Functional Shift
to surpass goal, it is easy to develop and utilize of Subject, Knowledge Subject
neural potential. and Functional Subject
• “There’s no making without breaking” princi- Law of nature, also named natural rule, is the law
ple: If the original pattern or habits not that exists in the inner of objective things in natu-
removed, it is difficult to establish new pattern. ral world, which is the inherent essential connec-
If an old habit is not corrected, there is no way tion of natural phenomena that is independent of
to establish a good one. During the process of human willpower. If there is necessary condition,
rectifying abnormal motor pattern, on the basis the law can play a role repeatedly.
of prohibiting and restricting the walking of Human is the subject of application method.
the patients and eliminating old pattern, neural People learn methods through study, but this is
potential development and reestablishment of not equal to actual function. People can use
motor program are continued. And then the method to figure out problem better through
remodeling of motor pattern is started. With practical application. It is like the process that the
the help of effectively restricting abnormal Gongfu master learn wushu and apply it. Hundred
joint motion of body movement device, normal thousand soldiers do physical training, learn gun-
gait remodeling training can be done, which is nery and soldier’s formation, but they still need
transited into independent walking. On the practical training (military exercise) to turn
moment of “breakthrough”, new normal gait learned knowledge into actual skill ability.
training should be established form basis. And In this process, in accordance with functional
then the better clinical effects are achieved. shift of “subject, subject with methods and sub-
• “Yin and Yang in equilibrium and harmony is ject with practical application methods”, none is
most precious” principle: In traditional dispensable, which is internal law of nature that
Chinese medicine, unity and opposites of Yin can turn method into function.
and Yang are used to emphasize balance and Rehabilitation methods of neurological train-
coordination of functional movement in vari- ing are the process that the methods are turned
ous organs and tissues, which summarize the into functions in vivo. The subject is brain cell
rule of various vital movement. Explanation and it is the primary target in the training of the
of “Yin and Yang in equilibrium, regulation of first stage. Through potential development meth-
ods, new cells are activated and reserved conduc- apeutic scheme and implementation process
tion pathway is activated. These cells learn to (doctors, the therapists, site and time). In reha-
how to dominate body movement, which is the bilitation principle, for the patients who cannot
second stage. Motor program reestablishment get off the bed after the disease or whose func-
technique is used to combine new activated brain tions can be better recovered through rehabilita-
cells and undead brain cells closely. These cells tion techniques of neurological training, even
perform functions coordinately and orderly. After abnormal motor pattern is formed, the patients
that, through motor pattern remodeling training can use typical three-stage rehabilitation princi-
(actual practical training) of the third stage, pre- ple and do the training strictly in accordance with
vious training results are turned into actual abil- requirements of every stage. For the patients with
ity to dominate body movement. In accordance dysfunction of individual part and the patients’
with inherent law of three-element process “acti- function can be recovered quickly through assess-
vate cells, learn method and apply practically”, if ment, the patients can use atypical three-stage
the method is proper, indications is appropriate rehabilitation principle and enter into therapy of
and training time meets the requirement, there the third stage after solving the primary problem.
will be better clinical effect. For the patients with severe dysfunction, old and
In the other hand, although natural law is inde- frail or obvious cognitive function, rehabilitation
pendent of man’s willpower, human can use wis- principle of standing in the early stage and walk-
dom and method to induce, regulate and control ing recovery is used for therapy. For the patients
real object, energy and information in natural with child cerebral palsy, rehabilitation principle
world, make them change or make them become of standing in the early stage and walking devel-
stable for human body. This is the subjective ini- opment is used for therapy. On the moment doing
tiative on the basis of objective law. In the three- the training of lower limbs potential develop-
stage method of neurological training, for the ment, abnormal gait rectification body weight
severe patients with severe cognitive dysfunction support treadmill trainer is used to support walk-
and low conscious state, rehabilitation principle ing training in order to develop neural potential
of “standing in early stage and walking recovery” and recover autonomous movement dominated
should be established. Guided by this principle by brain.
through potential development, standing and In addition, for the elderly patients with severe
walking training, the severe patients can learn disease, according to choose the less of two evils,
methods and develop potential. The patients who the patients should abandon the therapy of the
use normal methods cannot do active movement part whose function is difficult to be recovered.
training to recover functions, can do the required Therefore, functions that are important for daily
training, which is in favor of functional life ability are recovered. Compared dysfunction
recovery. of upper limb with dysfunction of lower limb,
because the function of upper limb is difficult to
4.2.6.3 Dialectical Therapy be recovered, upper limb can be protected in the
and Formation of Individual functional position. The patients can do rehabili-
Rehabilitation Principle tation training of lower limb first. Moreover,
of the Three-Stage Method upper limb of one side whose function is normal
In order to improve clinical therapeutic effect of can complete daily life movement. However, if
rehabilitation methods of neurological training, only lower limb of one side is normal, daily life
on the basis of three-stage method, the specific self-help ability can be affected severely.
individual therapeutic principle and scheme are Compared functional recovery of lower limb in
formed. Through detailed functional assessment, one side with functional recovery of strephexo-
the therapists find out primary stagnation point podia, functional recovery of strephexopodia is
(the reason of circle gait is denervation of pero- relatively difficult. The patients can use foot aid
neus longus and peroneus brevis), ascertain final to rectify strephexopodia, which cannot affect
rehabilitation goal, rehabilitation principle, ther- walking function recovery of lower limb.
Standing and walking of lower limbs are vital for of the therapists effectively. Especially autono-
improving the self-help ability of the patients. mous rehabilitation therapy of neurological train-
ing equipment has an advantage.
4.2.6.4 The Equipment That
Cooperates with Method Is 4.2.6.5 Rehabilitation Process
an Effective Instrument of Recovering Motor Function
to Assure Therapeutic Effect After CNS Damages Is a System
The equipment is the effective instrument to Process
guarantee standard application of method, Recovery of motor function after brain damages,
broaden applied range of method, improve is different from therapy process of damages and
method effect and decrease labour intensity. At lesions in various body parts, because the therapy
present, rehabilitation methods widely used at of lesions in various body parts is the process of
home and abroad and invented in last century repairing or replacement of individual part. For
include Bobath, Rood, Brunnstrom, PNF example, if the battery or tyre of a vehicle is bro-
(Proprioceptive Neuromuscular Facilitation), ken, after the battery is replaced or the broken
MRP (Motor Relearning Program) and so on. tyre is repaired, the vehicle can run on the road
The required equipment only includes PT bed, intact. For example, if the liver is ruptured,
balance bar and Bobath ball, and the others are through surgical repair or partial hepaolithiasis,
manual performance. function can be recovered after heal and the
Most of clinical applied rehabilitation equip- patients can return to work. The cancer of kidney
ment aim at symptoms such as standing bed for can be removed through surgical extraction. After
foot drop, CPM device for muscle and joint adhe- wound healing, daily life ability can be recov-
sion, rehabilitation training robot of lower limbs ered. If the bone is broken, reduction fixation can
of the patients without walking ability and so on. be done through surgery. After taking a rest, the
Obviously, this equipment plays a role in some fracture is healed and the original function can be
respects, but cannot affect functional recovery of recovered through exercise. The patients can use
brain because it is not in accordance with pro- rehabilitation training in the early stage to pre-
moting brain plasticity. However, it is a reserved vent complications effectively, promote healing
training of recovering brain function after reha- and shorten course of disease.
bilitation training. However, recovering the lost motor function
In the rehabilitation therapy of neurological after brain damages is different. Not only the
training equipment, whether potential develop- injured brain should be repaired, but also func-
ment, reestablishment of motor program and tion of trunk and organs dominated by brain
motor pattern remodeling training equipment or should be recovered. Therefore, for functional
rehabilitation therapy of neurological training recovery of organs and body parts, recovering the
robot of guiding collaterals through meridians functions after brain damages is the relationship
and one-to-many automatic training system of between use and disuse on the basis of self-
guiding collaterals through meridians, all are functional recovery. Brain can dominate body
clinical applied design that aim at methods such parts and organs and body parts and organs are
as potential development equipment. With the dominated by brain. In the process of recovering
function of weight loss equipment and protec- brain function, the function of brain and the func-
tion, the patients with big body weight, severe tion of body parts dominated by brain both are
symptoms, cognitive dysfunction and low con- recovered. Therefore, the functional recovery of
scious state can do autonomic move movement brain is a system process. Moreover, for the brain
and auxiliary movement training or are forced to function, not only the function of individual cell
do active movement training, which can obvi- should be recovered, but also coordinated work
ously broaden applied range of methods, is in function of brain cells should be recovered. For
favor of standard application of methods and example, the functional recovery of hemiplegic
improvement of effects, alleviate labor intensity patients with cerebral infarction in one side, at
first, the function of injured brain cells should be excitability of muscles dominated by lower nerve
recovered or replaced by other brain tissues. And center. And then there are spasm and abnormal
then the coordination function between new cells gesture. Severe patients usually lose standing and
and old cells should be recovered. On the basis of walking ability and it is difficult to be treated in
that, the function of domination of limbs move- clinic. At present, there is no specific equipment
ment is recovered. In addition, the function of and method for these patients to do walking train-
limbs is required to be recovered such as muscle ing. The author developed weight support tread-
and joint adhesion, deformity (such as foot drop mill training device of abnormal gait rectification.
and varus). Finally, the limbs are dominated by The purpose is to develop a rehabilitation therapy
brain to complete the movement. Therefore, of neurological training device for the patients
rehabilitation process of brain functions that who cannot stand, walk and do normal weight
rehabilitation methods and medical engineering support treadmill training with the help of weight
technology are used to make the disabled recover loss, prevention of abnormal gait and safe protec-
to the person with independent daily life ability tion. Walking training in the early stage can
and work ability if surgery and drug have no improve motor function of lower limbs and pro-
effect on recovery. It is a cultivating project and mote recovery of normal walking ability through
medical subjects with high technology. promoting functional recovery of higher
In short, three-stage rehabilitation method of CNS. The therapists observe the effect and dis-
neurological training is philosophical scientific cuss clinical indications.
method that is in accordance with natural law. It
is the specific manifestation of chiastopic fusion 4.3.1.2 Basic Composition
and compound integration of various rehabilita- Weight support treadmill training device of
tion techniques of neurological training and tra- abnormal gait rectification is made of weight
ditional rehabilitation technique. The author device, abnormal gait rectification system and
thinks that it is ultimately improved and devel- footpath.
oped with increase of clinical application, further
research, updated method, continuous innovation • Weight loss system is composed of loading
and improvement of equipment type and quality, frame, weight winch, pulley, handrail and
which can promote the development of rehabili- weight loss hammock. The loading frame is
tation work. made of double joint of hot drawing welded
steel tubes. The diameter is 36 mm and the
wall thickness is 4 mm. Two tubes are curved
4.3 Three-Stage Associated to rectangle frame (150 cm × 180 cm) with
Equipment and Clinical two layers and the space between them is
Verification of Neurological 50 cm. double joint U-tubes in parallel are
Training welded in the middle of the frame. In the mid-
dle of the top of U-tubes, fixed pulley and its
4.3.1 A
bnormal Gait Rectification guard board are welded. In one side of the cor-
Weight Support Treadmill ner in the top of U-tubes and in the middle of
Training Device and Clinical middle point in the wall, fixed pulley and
Verification winch are welded. Steel wires (the diameter is
3 mm) are used to link hammock connecting
4.3.1.1 Objectives rod in the frame and weight loss winch in the
In higher CNS damages (such as child cerebral side wall. In the front and back of underside of
palsy, brain damages and so on), because inhibi- rectangle frame, four universal wheels are
tion of lower nerve center is lost, the excitability fixed separately. Handrail is fixed on the mid-
of lower nerve center is released to varying dle of the front and the height is adjustable.
degrees, which lead to abnormal increase in the Disassembly protection bar is connected to
4.3 Three-Stage Associated Equipment and Clinical Verification of Neurological Training 141
the back. Weight loss band is divided into dage, walking cannot be affected by lower
swimsuit type and waistcoat type. The stress limbs adduction and foot drop.
point of swimsuit is located in inguinal region, 2. Training includes auxiliary power, autonomic
chest and double oxters. Waistcoat type is power walking training and disassembled gait
connected to thigh of both side through ham- slow motion training of Daoyin technique.
mock and the stress point is located in chest • Auxiliary power walking training: The ther-
and hip. According to the specific condition of apists push the training instrument forward
the patients, the equipment is comfortable to and the patients step forward with the
wear, there is no press of local soft tissue and instrument.
the activities are not influenced. • Autonomic power walking training: The
• Abnormal gait rectification system: Elastic patients push the training instrument for-
traction belt of lower limbs abduction and dor- ward and step forward with the instrument.
siflexion of foot with different elastic force are • Disassembled gait slow motion training of
made from elastic bandages of different width Daoyin technique: Six-step Daoyin tech-
and thickness. The function of lower limbs nique in traditional Chinese medicine are
abduction band is to prevent excessive abduc- used to guide the patients do disassembled
tion of lower limbs in walking. One end is gait training on the basis of regulation of
linked to the superstratum steel tube of load- mind and breathing. The specific proce-
ing frame and the other end is fastened to the dures are as follows: The patients are guided
underneath of knee joint of the patients with to regulate breathing, concentrate, put the
nylon thread gluing. The function of dorsiflex- center of body weight on one side slowly
ion of foot elastic bandage is to prevent foot and try to flex hip joint to step forward. For
drop and strephenopodia in walking. One end example, in the associated movement with
is fixed to the top of loading frame and the lower limbs adduction, the patients try to
other end is fastened to the front of feet. abduce lower limbs at the same time and
Tightness of traction belt can be adjusted in pay attention to tibialis anterior muscle and
order not to affect walking with adduction of peroneus longus and peroneus brevis to do
lower limbs and foot drop. dorsiflexion of foot and strephexopodia in
• Footpath is made from transparent and soft case of foot drop and strephenopodia. After
plastic plate with 2 cm thickness. The width is that, the patients bend forward to step for-
30–50 mm and the length can be adjusted ward. According to the footprint on the
according to the rehabilitation hall. Footprint floor, the patients make the foot touch the
is drawn on the footpath according to different ground first and then the entire foot is on the
stride of children and adult. footprint. The center of the body shift to
this side and offside disassembled stepping
4.3.1.3 Training Methods training is done with the same method
1. Preparation before training: The patients can repeatedly.
dress the hammock in standing or sitting posi- • Body control ability training: In the weight
tion. Based on movement prescription, through loss and safe protection condition, the
regulating overhang traction system, the patients are guided to do hip flexion, dorsi-
patients drag hammock to lose weight. flexion of foot and hip abduction training in
According to the specific condition of the plgenius. The specific procedures are as fol-
patients, therapists stand on one side, the front lows: the patients put the center of body
or the back of the patients. The patients grasp weight on one side in standing or sitting
frontal handrail with two hands. According to position. The patients are guided to flex hip
the degree of lower limbs adduction and foot joint quickly on the basis of regulation of
drop, the therapists can adjust the tightness of mind and breathing. In the movement of
elastic bandage. With the help of elastic ban- lower limbs adduction, the patients are
guided to abduce hip joint at the same time, dizziness and drop of blood pressure when
dorsiflex ankle joint quickly, make the heel standing up.
touch the ground first and put the entire foot
in the footprint on footpath. The purpose of Cautions
this training is to improve speed and flexi- • For the patients with long-term bed and infir-
bility of body limbs movement. The patients mity, the adaptive training should be done
are required to relax as much as possible before this type of the training in order to
and not to exert too much in case of exces- increase the stress capability of the patients’
sive united reflection. The patients can angiocarpy. When the patients stand erectly
shorten the movement accomplishment for 30 min and blood pressure, pulse and elec-
time gradually. With the increase of myody- trocardiogram are stable, this type of the train-
namia of lower limbs hip flexor, abductor, ing should be done.
tibialis anterior muscle and peroneus lon- • The training should be implemented step by
gus and peroneus brevis, autonomic control step. The therapists regulate the training
ability, body control ability and walking through adjusting the weight and training
ability, the quantity of weight loss and the time. High training intensity should be
pull strength of traction belt are gradually avoided.
decreased. The patients can gradually walk
independently without weight loss, traction During training, the enthusiasm of the patients
and handrail. and the training atmosphere should be fully acti-
vated. The therapists should use encouraging
The training is 30 min per time and 30 times words and scolding and critical words should be
per therapy course. After one therapy course, the avoided.
therapists should assess the patients to decide
whether do the next therapy course or not. 4.3.1.5 Clinical Verification
4.3.1.4 Clinical Indications Cases Selection

and Contraindications From October 2004 to June 2006, potential
development training equipment was used to
Indications treat 52 patients with lower limbs motor dys-
It is appropriate for the patients with severe lower function who are all the inpatients and outpa-
limbs motor dysfunction who cannot do normal tients in neurological rehabilitation training
weight support treadmill training and is in stable center in Beijing Tongren Hospital affiliated to
condition with acute, chronic and obsolete hemi- Beijing’s Capital Medical University. There are
plegia, cerebral palsy, child cerebral palsy, 31 males and 21 females. The age is form 23 to
incomplete paraplegia after CNS damages and 76 years old. The average age is 44.33 years
the patients with lower limbs adduction or foot old. The shortest medical history lasts fifteen
drop induced by muscle spasm or paralysis who months and the longest lasts 62 months. The
feel difficult to do normal weight loss walking average is 38 months. There are 29 patients
training. with hemiplegia after cerebral infarction, 18
patients with hemiplegia after cerebral hemor-
Contraindications rhage, five patients with hemiplegia after child
Contraindications include the patients in acute cerebral palsy.
stage with unstable condition, the patients in
uncontrolled condition with severe hypertension Functional Assessment
and diabetes, the patients with severe heart dis- In the beginning of the training and the end of the
ease, pulmonary dysfunction and low cardiovas- therapy course, the therapists do functional
cular response capacity, the patients with ambulation category (FAC).
Zero Grade: The patients cannot walk or can reports about body weight support treadmill
walk with the help of two people. training, which is a safe and effective therapeutic
First Grade: The patients can walk with the measure.
help of one person to lose weight. Some research demonstrated that central pat-
Second Grade: The patients can walk with the tern generator (CPG) located in spinal cord or
help of one person to support continuously of brainstem can receive specific proprioception
intermittently. afferent information, integrate them and generate
Third Grade: The patients can walk under rhythmic electrical activity, and induce circula-
supervision of others. tion gait motion. However, this is the results from
Fourth Grade: The patients can walk on the cats’ spinal cord. Faster exercise treadmill speed
flat ground independently but hey need help is adopted and stretching exercise of hip is main-
when they walk upstairs and downstairs, up the tained by therapists. Meanwhile, foot position
slope and down the slope, on unstable ground. helps the patients with complete spinal cord
Fifth Grade: The patients can walk every- injury to reestablish passive physiological gait.
where independently. However, on the same conditions, primates can-
Myodynamia of hip flexor, range of motion in not do stepping movement, because the walking
hip joint flexion and Fugl-Meyer methods are of the primates is more dependent on efferent
used for lower limbs motor function assessment. stimulus of superior spinal cord. Reticulospinal
SPSS 12.0 statistical software is used for analy- movement pathway that is descendent along ven-
sis. The difference before therapy and after ther- tral spinal cord is closely related to stepping and
apy is analyzed with T-test. walking. Therefore, for primates, functional
recovery of cortex motor center and activation of
Results reserved conduction pathway are critical for
There are significant differences in four assess- recovering walking ability of the patients.
ment indicators before and after training Theoretical basis of functional recovery cor-
(p < 0.01). In all the 52 patients, there are six tex motor center is CNS plasticity, which is the
patients with zero myodynamia of hip flexor and reorganization ability of structure and function
the myodynamia is recovered to 2.68 grade after on the basis of “skillful use and dependence”
training. Autonomous hip joint motion of all the principle. Some research demonstrated that the
patients is recovered. The results are referred to training under “state of emergency” and repeated
Table 4.3. training with “goal and willpower” can better
The safety of the equipment: There is no promote functional reorganization of central
injury of all the patients during training. The nerves. During the process of weight supported
training devices run without fault, they are easy walking, the patients try their best to keep the
to be operated, flexible and convenient, manual pace of the treadmill machine in order to walk on
and reasonable designed, safe and reliable. the treadmill machine. Therefore, the autonomic
uniform rotation of treadmill machine track can
Discussion provide a kind of “state of emergency” for the
For the patients with hemiplegia after brain patients. Through weight support walking, the
infarction and spinal cord injury, there are a lot of repeated and specific training is also a kind of
Table 4.3 Functional assessment control table in paralyzed side before and after training ( x ± s)
Assessment items Before training After training P value
FAC 0.27 ± 0.87 3.67 ± 1.45 <0.01
MMT 1.45 ± 0.87 3.62 ± 1.33 <0.01
ROM 8° ± 3.23° 45° ± 8.37° <0.01
Lower limbs FM 12.82 ± 4.71 23.41 ± 11.37 <0.05
forced movement, which is good for central limbs abduction traction belt, the patients can
nerves plasticity and functional reorganization. adduce lower limbs in order not to affect the
During this process, information feedback of patients’ walking. Through regulation of dorsi-
load bearing receptor plays an important role in flexion of foot elastic traction belt, the patients
promoting the recovery of the patients’ motor can walk and keep the front of the foot out of the
function. ground. During training, the patients or therapists
The purpose of treadmill walking training is to push the training machine forward and the for-
make the patients without load bearing ability ward speed is the same as the walking speed of
and balance keeping ability to do walking train- the patients. Without the feeling of tension
ing erectly in order to use the early stage of induced by autonomic uniform rotation treadmill
recovering potential when the disease is stable. machine track, the patients can avoid ataxia
However, treadmill walking training can be done induced by tension and the training is closer to
by the patients with certain ability. For example, actual walking (Fig. 4.11, 4.12, 4.13, and 4.14).
the average myodynamia of lower limbs is equal In the beginning of the training, the patients
to or more than level 2. Treadmill walking train- try to decrease the walking speed and the thera-
ing can be done by the patients with the help of pists guide the patients to lift toe to overcome
one or two therapists. However, for myodynamia, foot drop by themselves. The patients try to
especially for obviously insufficient myody- abduce lower limbs to overcome adduction of
namia of primary muscles (such as hip flexor, lower limbs in walking. When the patients cannot
tibialis anterior muscle and quadriceps femoris), overcome it by themselves, elastic traction ban-
the patients with complete paralysis and zero dage can play a role in the walking of the patients.
myodynamia or the patients with severe foot During this process, every step of the patients is
drop, strephenopodia or lower limbs adduction completed by agonistic muscle and antagonistic
deformity (scissors gait), it is difficult for them to muscle dominated by cortex motor center to
do this training. In addition, in actual weight sup- complete unaccomplished body movement
port treadmill training, the author found that
there are some patients whose lower limbs myo-
dynamia is equal to or more than level 2, but they
are still worry about the danger of walking on the
treadmill machine. It is easy for them to generate
fear and they even refuse to do this training.
The purpose of developing weight support
treadmill training device of abnormal gait rectifi-
cation is to make the patients do treadmill train-
ing who cannot do body weight support treadmill
training or the weight support treadmill training
is not appropriate for the patients in order to
recover walking ability on the basis of recovering
the excitability of gait motor center. For the
patients with child cerebral palsy, load bearing in
standing position has a promoting effect on
development of joint and bone.
Under the protection of the equipment, accord-
ing to the specific condition of the patients,
through the regulation of weight support, the
patients can do the training with the principle
“from easy to difficulty and step by step”. Fig. 4.11 Weight support treadmill training of
Through regulation of the tightness of lower abnormal gait rectification
Fig. 4.12 Rectification
elastic bandage to
prevent foot drop and
lower limbs adduction
Fig. 4.13 The training

for severe child cerebral
palsy
before, which is good for neural potential hip abductor. Daoyin technique in traditional
development and functional reorganization. The Chinese medicine is used to activate the willpower
function of footpath is to establish subjective of the patients. The patients can complete walking
indicators of stride and stride width for the and overcome the shortages in the walking by
patients. Stride can rectify the small stride of themselves. The comprehensive results are
lower limbs in injured side and insufficiency of appropriate for “standing in the early stage and
load bearing time. Stride width can induce the walking development” of the children or“standing
patients to rectify adduction of lower limbs, in the early stage and walking recovery” of the
which is better for the training of hip flexor and adult, which is good for central nerves plasticity
home and abroad, the training effect is greatly

affected because there is no way to restrict the
unnecessary movement in exercise. The author
developed lower limbs motor pattern remodeling
trainer and its purpose is to turn the training
results of neural potential development and motor
program reestablishment into normal walking
ability and consolidate them in order to improve
lower limbs motor function, enhance the patients’
life quality and obtain good effect.
4.3.2.1 Purpose
It is necessary to develop a method to effectively
restrict unnecessary joint motion in lower limbs
movement, which assure the patients to walk
with normal gait. On the basis of neural potential
development and motor program reestablish-
ment, normal motor patter of lower limbs is
remodeled.
4.3.2.2 Basic Composition

Lower limbs motor pattern remodeling trainer is
composed of waistline, assistive device joint
prosthesis of hip, knee and ankle, aluminium
alloy lattice framing, foot orthosis and fixed band.
Joint prosthesis can confine range of activity and
original angle (such as 15° flexed position) of hip,
knee and ankle joint. The joint only allow the
movement on the sagittal orientation (frontal
axis). Joint prosthesis of hip, knee and ankle are
Fig. 4.14 Able to stand and walk after training
connected with aluminium alloy lattice framings.
The lattice framings between hip joint and knee
joint or knee joint and ankle joint are double
and functional reorganization and promote layers. There is a groove in the center and it can
walking ability recovery finally. slide up and down. The length is adjustable and
This paper was published on Chinese Journal adjustable bolt can be used to fix it for the patients
of Tissue Engineering Research 2009, with different altitude to dress. The bottom of
13(48):9455–9458. ankle joint prosthesis is connected to aluminium
alloy foot orthosis (high temperature thermoplastic
plate in domestic type). Bilateral hip joint is fixed
4.3.2 Clinical Verification of Lower on both side of waistline made of high temperature
Limbs Motor Pattern thermoplastic plate through rivet of lattice framing
Remodeling Trainer in order to support and restrict adduction and
abduction of lower limbs. Foot orthosis is used to
Abnormal motor pattern of lower limbs is the rectify abnormal joint position such as foot drop,
common motor dysfunction after CNS damages, strephenopodia and strephexopodia, which don’t
which is difficult to be treated in clinic. At affect the ankle joint motion on the sagittal
present, in widely used rehabilitation methods at direction (frontal axis).
Lower limbs motor pattern remodeling trainer • Motor program reestablishment training:
is divided into training type and maintenance Neurological training instrument is used for
type according to application. It is divided into motor program signal reestablishment training
double limbs type, single limb type, trunk double of agonistic muscle and antagonistic muscle
limbs type, trunk single limb type and local type in hip flexion, knee extension, dorsiflexion of
according to different part. Training type can be foot and strephexopodia of lower limbs.
adjusted according to limb length of the patients, During the process of enhancing the signal of
which is appropriate for different individuals. It agonistic muscle, the signal proportion train-
is used in rehabilitation hall of hospital. ing of agonistic muscle and antagonistic mus-
Maintenance type is made of lighter magnesium cle is emphasized. The training time is 10 min
alloy according to different individuals, which is for each joint and the total time is 50 min. The
light and appropriate for the patients to do self- frequency is one time a day. There are 90
training when they leave hospital. It also can pre- times in one therapy course.
vent relapse of abnormal motor pattern. • Motor pattern remodeling training:
According to the specific condition of the
patients, corresponding type is chosen to restrict Preparation before training: After the patients
abnormal joint motion effectively and make it dress lower limbs motor pattern remodeling
comfortable to dress. trainer, Wenru weight support treadmill training
device of abnormal gait rectification produced by
4.3.2.3 Clinical Verifications Beijing Xing Chen Wan You Science and
Technology Ltd. and gait marked footpath are
Cases Selection used for the patients to do the training. Based on
From October 2010 to June 2011, potential devel- movement prescription, weight support can be
opment training equipment was used to treat 30 regulated. According to the specific condition of
patients with lower limbs motor dysfunction who the patients, therapists stand on one side, the
are all the inpatients in neurological rehabilita- front or the back of the patients. The patients
tion training center in Beijing Nanyang Hospital grasp frontal handrail with two hands or walk
and Beijing Sun City Hospital. There are 21 freely.
males and 9 females. The age is from 38 to The training includes auxiliary power walking
65 years old. The average age is 48.3 ± 16.8 years training and autonomic power walking training.
old. The shortest medical history lasts 6 months Auxiliary power walking training: The therapists
and the longest lasts 78 months. The average is push the training instrument forward and the
33 months. There are 23 patients with hemiplegia patients step forward with the instrument.
after cerebral infarction, seven patients with Autonomic power walking training: The patients
hemiplegia after cerebral damages. There are 20 push the training instrument forward and step
patients with circle gait and ten patients with forward with the instrument. Disassembled gait
dragging gait. slow motion training of Daoyin technique: Six-
step Daoyin technique in traditional Chinese
Training Methods medicine are used to guide the patients to do dis-
• Lower limbs potential development training: assembled gait training on the basis of regulation
Wenru lower limbs potential development of mind and breathing. The specific procedures
training device is used and six-step Daoyin are as follows: The patients are guided to regulate
technique in traditional Chinese medicine is breathing, concentrate, put the center of body
used for lower limbs potential development weight on one side slowly and try to flex hip joint
training and lower limbs control ability to step forward. According to the footprint on the
training. The training time is 30 min every floor, the patients make the foot touch the ground
time and the frequency is one time a day. first and then the entire foot is on the footprint.
There are 90 times in one therapy course. The center of the body shift to this side and off-
side disassembled stepping training is done with activity of daily living should be assessed. SPSS
the same method repeatedly. 12.0 statistical software is used for analysis. The
Body control ability training: In the weight difference before therapy and after therapy is
loss and safe protection condition, the patients analyzed with T-test.
are guided to do hip flexion, dorsiflexion of foot
and hip abduction training in plgenius. The spe- Results
cific procedures are as follows: the patients put There are significant differences in six assessment
the center of body weight on one side in standing indicators before and after training (p < 0.01). In
or sitting position. The patients are guided to flex all the 30 patients, there are six patients with zero
hip joint quickly on the basis of regulation of myodynamia of hip flexor and the myodynamia is
mind and breathing. In the movement of lower recovered to 3.25 grade after training. Autonomous
limbs adduction, the patients are guided to abduce hip joint motion of all the patients is recovered.
hip joint at the same time, dorsiflex ankle joint The results are referred to Table 4.4. There is no
quickly, make the heel touch the ground first and patient with zero myodynamia of quadriceps fem-
put the entire foot in the footprint on footpath. oris (more than level 2) and the myodynamia is
The purpose of this training is to improve speed recovered to level 4 after training. There are eight
and flexibility of body limbs movement. The patients with zero myodynamia of tibialis anterior
patients are required to relax as much as possible muscle and the myodynamia is recovered to 3.42
and not to exert too much in case of excessive grade after training. There are 11 patients with
united reflection. The patients can shorten the zero myodynamia of peroneus longus and pero-
movement accomplishment time gradually. With neus brevis. The myodynamia of three patients is
the increase of myodynamia of lower limbs hip recovered to level 3 after training, the myody-
flexor, abductor, tibialis anterior muscle and per- namia of five patients is recovered to level 2 and
oneus longus and peroneus brevis, autonomic the myodynamia of four patients is not signifi-
control ability, body control ability and walking cantly changed. When walking, the patients need
ability, the quantity of weight loss is gradually to wear foot aid to rectify strephenopodia. Average
decreased. The patients can gradually walk inde- myodynamia is from 1.45 grade before training to
pendently without weight loss, traction and 3.62 grade after training. Motor program propor-
handrail. tion of knee extension is from 2.76 times before
The training time is 30 min every time and the training to 6.34 times after training. Although
frequency is one time a day. There are 90 times in there is difference between motor program pro-
one therapy course. portion of knee extension and normal proportion
Self-training at home: After abnormal motor (the proportion of agonistic muscle and antago-
pattern of lower limbs is rectified and normal nistic muscle is 10–1), there is significant differ-
motor pattern is formed, in order to shorten hos- ence before and after training.
pital stays, the patients dress domestic motor pat-
tern remodeling trainer to do self-training at The Safety of the Equipment
home, which require 6–12 months to maintain There is no injury of all the patients during train-
therapeutic effect. The normal motor pattern ing. The training devices run without fault, they
should be guaranteed to be consolidated. are easy to be operated, flexible and convenient,
manual and reasonable designed, safe and
Functional Assessment reliable.
In the beginning of the training and the end of the However, during the follow-up, it was found
therapy course, the therapists do functional that there were three cases of household-type
ambulation category (FAC). Range of motion of broken due to the insufficient stiffness of the
hip flexion, knee extension and dorsiflexion of magnesium alloys stent. The bending strength of
foot, Fugl-Meyer lower limbs motor function the magnesium alloys also need further improve-
assessment, signal intensity and proportion, and ment. At present, I adopt the aluminum alloys
Table 4.4 Functional assessment control table in paralyzed side before and after training ( c ± s)
Items Before training After training t Value P value
FAC 0.27 ± 0.87 3.67 ± 1.45 7.01 <0.01
Hip flexion MMT 1.45 ± 0.87 3.62 ± 1.33 4.32 <0.01
ROM(0)
Hip flexion 57.73° ± 34.55° 110.60° ± 17.91° 9.02 <0.01
Knee extension 110.68° ± 12.63° 160.86° ± 4.26° 10.11 <0.01
Dorsiflexion of foot 3.67° ± 6.49° 15.47° ± 7.10° 8.01 <0.01
FM 14.97 ± 25.01 29.60 ± 8.79 9.39 <0.01
sEMG (μV)
Hip flexor intensity 23.70 ± 21. 60.97 ± 26.90 10.29 <0.01
Quadriceps femoris intensity 45.57 ± 33.69 103.73 ± 42.80 11.73 <0.01
Quadriceps femoris/hamstring muscles 2.75 ± 2.01 6.34 ± 2.33 10.54 <0.01
Tibialis anterior muscle intensity 15.77 ± 21.48 39.77 ± 28.04 6.39 <0.01
Tibialis anterior muscle/musculus gastrocnemius 1.47 ± 1.64 4.50 ± 2.37 9.43 <0.01
The intensity of peroneus longus and peroneus brevis 19.93 ± 24.90 41.47 ± 28.59 7.23 <0.01
ADL 55.83 ± 25.53 79.33 ± 11.72 7.02 <0.01
stent for children to produce motor pattern plas- Training Cautions

totype training devices. It both adds the rigidity The training procedure should be step by step,
of the stent and achieves the portable characteris- and avoid by all means of blindly high-intensity
tic of household-type basically. Clinical applica- training. Each training time should not be too
tion has got primary success. long, generally 30 min. Patients who feel discom-
fort in training should stop training immediately
Clinical Indications and Contraindications and find out the reasons and then go back to train-
• Indications: It is not only suitable for the training. It can also be regulated through reducing
ing of the convalescence stage of obstacle of weight or shortening training time. It should be
limbs movement accompanied with abnormal paid attention to use six-step Daoyin technique in
motor pattern, but in stable condition such as traditional Chinese medicine correctly during
stroke and brain trauma, but also for the reha- training. The enthusiasm of the patients and train-
bilitation training of other lower limbs abnor- ing atmosphere should be fully activated, encour-
mal motor pattern patients whose rehabilitation aging words can be used and rebuke and critical
methods training was ineffective. words should be avoided.
• Contraindications: Patients with one of the
following indications should be forbidden or Discussion
careful to use motor pattern remodeling At present, methods used to rectify abnormal gait
training device for training: in domestic and abroad are few. The most com-
monly used methods include good limb position
Hypertensive and diabetic patients whose con- in early stage, restriction walking off bed, varus-
dition has not been controlled effectively. valgus rectification board standing, wearing
Patients after stroke whose condition is orthotic devices, Bobath technique, body weight
unstable. support treadmill training (BWSTT) and gait
Patients with lower limb fractures, articular training under the verbal instruction of the thera-
cartilage and ligament injuries whose concres- pists and so on. These methods have some certain
cence is not good. effects on the aspect of recovering the walking
Patients with pelvic fracture or injury of pel- ability of stroke patients and improving the gait
vic soft tissue. symmetry and so on, especially like body weight
support treadmill, which can be used to improve program in the cortex motor center in order to
the adaptation of cardiovascular and walking promote reestablishment of normal motor pro-
ability. Some research reported that although gram. In the last stage, body weight support
Mobile Gait Monitoring System (MGMS) and treadmill training device of abnormal motor pat-
lower limbs rehabilitation training robot have a tern is used. Unnecessary joint motion is
better effect on improving the lower limbs motor restricted in the lower limbs movement through
function and the gait, both of them lack the cor- an elastic band. Although there are some certain
rect effect on abnormal gait due to no restriction clinical effects, we found some shortage in clini-
of unnecessary movement during exercise. cal application:
Moreover, all of the training methods lack a valid In a long-term walking restriction, the patients
movement constraint after training, so that most cannot keep on it because it is difficult to accept.
of the patients still walking according to the pre- Elastic band is used to limit abnormal joint
vious motor pattern once they left the training motion, which is soft limitation. For the patients
room. This is especially not good for the decrease with severe abnormal joint motion, it is difficult
of the abnormal motor center excitability, which to meet the requirements.
make the abnormal motor pattern hard to be cor- The time of motor pattern remodeling training
rected and even easy to relapse. only lasts one month. It is too short to be consoli-
There are many deficiencies of training meth- dated and it is easy to relapse.
ods at home and abroad that is used to rectify The patients are required to do self-training
abnormal gait, which are as follows: for a long time aftercare. Although patients were
Most of gait trainings are mainly dependent told how to do the training when they left hospi-
on the verbal instructions of the therapists. There tal, abnormal motor pattern often relapse because
are no systematic rehabilitation methods to rec- of wrong training, which affects remote thera-
tify abnormal gait. All of them cannot limit peutic effect.
unnecessary joint motion, which is bad for the The mechanisms underlying remodeling
reestablishment of normal gait. motor pattern by lower limbs movement pattern
The gait training method at present is lack of remodeling training device. The motor program
definite indications and contraindications. and the motor pattern interact with each other.
There is no training device that is used for rec- The motor pattern is determined by the motor
tifying abnormal gait and recovering normal gait program and the long-term movement with the
again. abnormal movement pattern can modify the
The patients still walk with original pattern, motor program developed in the cortex motor
which make it impossible to decrease the excit- center. On the contrary, in the normal motor pat-
ability of the abnormal motor center effectively tern with limitation, due to the effective limita-
and is bad for the establishment and consolidation of abnormal joint motion induced by
tion of normal motor pattern. Above-mentioned abnormal muscle contraction, the myodynamia
deficiencies affect the training results of the of this muscle gradually decrease. At the same
motor pattern remodeling. time, it forced the muscle of this joint, which is
Zhao Wenru and his colleague developed a produced normal activities, can be utilized.
therapy named three-stage therapy of neurologi- Therefore, the myodynamia gradually increase.
cal training, which includes neural potential For a long time, there can be a balance of the
development, reestablishment of motor program myodynamia that participate in the normal
and motor pattern remodeling. The training time motion of this joint, which establish a normal
is two months for each stage. At the first two motor program to dominate joint motion in the
stages, the patients are prohibited to walk and are cortex motor center.
required to sit on wheelchairs. The purpose is to Lower limbs motor pattern remodeling device
eliminate the excitability of the abnormal motor can rigidly limit the abnormal joint motion in
lower limbs movement through the design of There are many types of lower limbs motor
assistive device steel bar and the one-way joint pattern remodeling devices according to the dif-
motion, which assure the normal of the motor ferences of the body location and necessity of the
pattern. The muscles required to complete correct training. It can be divided into training-type and
movement can be increasingly utilized, and the household-type according to its usage.
muscles formed abnormal joint motion is utilized The training-type device uses the double-
on the decrease. Normal motor pattern is consoli- layer assistive devices of aluminum alloy bar
dated and then is gradually transited to normal with strong capability of countering bending.
walking without assistance. There is a tank in its center and it is possible to
As long as the patients can walk with weight slide up and down to adjust length. It is fixed by
loss or assistance, in the early stage, the motor the adjustable bolts and can be used by the
pattern remodeling training can be done with patients in different heights. This type of device
potential development and motor program is strong and durable, but the weight is big,
remodeling training. It can not only change the which makes it relatively complicated when
developed potential and reestablished motor pro- putting on and off. It is suitable for the recovery
gram into motor function, but also satisfy the room of the hospital.
request of the patients who want to walk as soon The household-type of lower limbs motor pat-
as possible, improve the effect of rehabilitation tern remodeling device is a restrict device that is
training, shorten the time of training and inspire portable and used for maintaining the developed
the patients’ motivation for training. Moreover, normal motor pattern. It is developed to protect
the household-type guaranteed the correctness of the patients from the relapse of abnormal motor
self-training after the patients leaving hospital, pattern due to the abnormal movement of the
which is good for the consolidation of the normal joint in the process of self-training. The device
motor pattern. adopts magnesium alloy bar and usually use sin-
The differences between the motor pattern gle bar. The waist and foot baseboards are made
remodeling device and the walking assistance of thin layer of high-temperature thermoplasti-
device are as follows: There are significant differ- cized board. The characteristics of this type are as
ences in application and structure between the follows.
motor pattern remodeling device and the walking The unnecessary joint motion in the move-
assistance device. Walking assistance device is ment of lower limbs can be effectively restricted,
mainly used for paraplegic patients, the function while the joint motion to normal direction is not
of which is to bear load and prevent joint motion. affected.
The joint is in a lock and fixed pattern condition The abnormal location of the joint can be
when the patients are in passive standing and pas- effectively corrected, such as foot drop, strephe-
sive walking condition. While the motor pattern nopodia and strephexopodia, etc.
remodeling device is a proprietary training device The weight of magnesium alloy is light, only a
that can change the established motor program third of the weight of aluminum alloy.
into practical motor function. Every joint is acti- It can be assembled as requirement and disas-
vated when it is used. According to abnormal sembled flexibly. It also can be dressed in a trou-
angle (like genu recurvatum) of the joint, the ser. Therefore, it is convenient to wear and
joint motion is restricted appropriately, the joint possible to wear in a long term, usually
is only allowed to move in normal direction and 6–12 months.
movements to abnormal direction are restricted It is suitable for the patients whose normal
rigidly. The active training of motor pattern motor pattern was basically set up after the motor
remodeling guided by the therapist can change pattern remodeling training. The weight of this
the established motor program into exclusive kind of training device is light, but the bending
training device of active movement with actual strength is relatively poor so that it is suitable for
motor function. the patients with self-training after leaving hospi-
tal, whose normal motor pattern was basically set This paper is published on Chinese Medicine,
up after the motor pattern remodeling training. 2013, 8(7):921–923.
The differences between the training-type and
household-type of movement pattern remodeling
training devices are as follows: the training-type is 4.3.3 T
he Design Principle
used in the early-stage of the training and for the and Clinical Verification
patients who just started to take the motor pattern of Limb Multifunctional
remodeling training and whose abnormal motor Training Box
pattern is relatively serious. High bending strength
of double aluminum alloy bar is used. The whole The training of limbs dyskinesia is lifelong. The
structure is solid and the ability of supporting and functional training under the guidance of the
restricting joint motion is strong so that it is suitable therapist of the rehabilitation department in a
for recovery room of a hospital. It must be dressed hospital is relatively short. The more is self-
outside the clothes. The household-type is a portable training after leaving hospital. It requests not
restriction device developed for maintaining the only a strong desire to rehabilitate and a strong
developed normal motor pattern and is suitable for willpower of the patients, but also require the
the patients whose normal movement pattern is correct training methods and the training devices.
basically set up after motor pattern remodeling For this purpose, the author designed a training
training. It also protects the patients from relapse in belt used for the training of every muscle and can
the process of self-training after leaving hospital. be assembled into a box. It can be used to increase
This type of training device use slightly poor the muscle strength, maintain and increase the
bending strength of magnesium alloy bar whose limbs function by combined the elastic force of
weight is only a third of weight of the aluminum the elastic belt with the application of Daoyin
alloy bar. The whole weight is light, it can be dressed technique in traditional Chinese medicine. The
within the clothes and it is easy to wear. It also can training box is small and light and simple to use,
be dressed for a long time, usually 6–12 months. makes it possible to use at any time in any place
Besides, it can be divided into five types include to achieve good effects.
double-limbs type, single-limb type, double-limbs
of trunk, single-limb of trunk and local type 4.3.3.1 Materials and Methods
according to the body part. It can be divided into
children-type and adult-type according to the size. Materials and Production
In order to lose weight and make it convenient to Six and eleven centimeter black or brown elastic
wear, the children-type is to the greatest extent belt sold in market is chosen and the tensile
made by magnesium alloy and thin layer of high- elongation elasticity is 2.4 times. The hip abduc-
temperature thermoplasticized board. tion resistance band is made of double layer and
The principles and structures of all kinds of the others are all made of single layer. All of them
types are basically the same, that is the abnormal are cut into elastic band that is 15 cm in length,
angle and activities are restricted by the joint and the two ends are linked by a black canvas
motion limiter and the restricting effects of the whose width is the same as the elastic band. The
bars. nylon fastening tapes are fixed on the two ends of
In brief, lower limbs motor pattern remodel- the canvas belt, respectively.
ing training device can effectively restrict the The training device for special parts and its
unnecessary joint motion in the lower limbs production:
movement, it also can effectively remodel the
normal motor pattern of the lower limbs training • Hip adductor training seat: an 11 cm depth stiff
by this device on the basis of nervous potential paper sponge can be chosen and is cut into a
development and movement procedure rebuilding trapezoid block whose down base line is
training. 22 cm, the top base line is 10 cm and the height
is 18 cm. The two sides are cut into a concave increase the angle of the foot plantar flexion as
shape, a corduroy soft cloth is enclosed. far as possible. Maintaining 6 s at the highest
• Wrist-hand training board: a wood board point you can reach, then breathe in deep and
(30 cm × 15 cm × 1 cm) is chosen. The front breathe out slowly, relax the mind to the
of it is blunt and the shape is like a hand. Five greatest extent in order to relieve fatigue. The
set of rubber band that is linked with finger- next training can be started after take a break
stall is fixed on the front of edge after pol- and the same parts can be trained 6–8 times.
ished. A wrist flexion and extension training
elastic belt is fixed on the location of metacar- The training can be taken under the guidance
pophalangeal joints of the training board. A of video or audio tape, and also can be taken with
forearm fixing band is fixed on the location of the help of families or caregiver.
wrist joint of the training board. The patients should take the training 30 min
• Dorsiflexion of foot, strephexopodia training per time, two times per day, and should be kept
board: a wood board (30 cm × 25 cm × 2 cm) on.
is chosen. A 10 cm groove is in the center of
the front, clip the two sides of it and make 4.3.3.2 Indications, Contraindications
them blunt and like shoe sole. Elastic belt is and Cautions
fixed on the two sides, 8 cm from the front
edge, and the center groove after polished. Indications
The patients with limb dysfunction after CNS
Shoulder abduction, elbow flection or damages, such as the hemiplegic paralysis caused
extension, hip abduction, knee flection or by cerebral hemorrhage, cerebral infarction, cere-
extension, foot plantar flexion and special bral embolism and subarachnoid hemorrhage.
parts training board with operating instruc- Incomplete paraplegia caused by spine injury.
tion, video CD and guidance audio tape are The patients with decreased muscle strength
packed for reservation. and joint range of motion caused by osteoarticu-
lar muscle injury.
Methods of Application Children with cerebral palsy.
Choose the relevant training band according to Muscle paralysis caused by peripheral nerve
the training parts and take training according to injury.
following steps after wear as required and
fixation. Contraindications
There are no obvious contraindications, but the
• Regulation of breathing: sit up and chest out, patients with fracture and injuries of articular
adjust your breath to stable. ligament, muscle tendon and muscle should take
• Regulation of the mind: relax your body and the training after the agreement of the in-charge
mind. In a state of tranquility, pay attention to physician.
the contralateral brain of the limbs which is
going to be trained (pay attention to the left Cautions
brain when training the right limbs and vice Before the self-training, the therapists should set
versa). an example to the patients on the basis of expla-
• Regulation of movement: The target point nation of training mechanism and method of
should be ascertained at first. For example, in application to guarantee the correctness of the
the foot plantar flexion training, the target exercise. In addition, there are some cautions:
point of attention is anterior tibial muscle.
Excitation pattern is adopted in order to take • The training should be done in a warm and
effort to contract anterior tibial muscle on the quiet environment (indoor or outdoor) and the
basis of regulation of breathing and mind to patients are required to concentrate.
• There are intervals for a certain time in the with foot drop after lumbar spine surgery. There
training. Increasing frequency too soon is not were 19 males and 11 females in the control
appropriate. Amount of training is enough group. The age was 33–72 years old. The average
when the patients sweat slightly and breathe age was 47.8 years old. The shortest medical
smoothly. The patients can also do the training history lasted 12 months and the longest lasted
with the instruction of the video and audio 60 months. The average was 42 months. There
tape. were 18 patients with hemiplegia after cerebral
• It is important to set a target point. During infarction, five patients with hemiplegia after
training, the patients try to pay attention to cerebral damages and seven patients with foot
agonistic muscle of movable joint and feel the drop after lumbar spine surgery.
slight hotness of muscle contraction.
Meanwhile, the patient should relax antago- Functional Assessment
nistic muscle. Tibialis anterior muscle, Lovett MMT, range of
motion of ankle joint, Fugl-Meyer of dorsiflexion
The training should be durable, but not of foot were used to assess the functions.
intermittent. 0: The patients cannot do dorsiflexion actively.
1: The patients can do dorsiflexion partially.
4.3.3.3 Clinical Experiments 2: The patients can do dorsiflexion fully.
This criterion was used for functional assess-
Materials and Methods ment. T-test was used to analyze the data of func-
From June 2006 to February 2008, 52 patients tional assessment in hospital and out of hospital.
with foot drop were all the inpatients in neuro-
logical rehabilitation training center in Beijing Results
Tongren Hospital affiliated to Beijing’s Capital Statistical analysis of three assessment indicators
Medical University. After 3 months’ therapy, they of training group demonstrated that there is no
left hospital. We chose 60 patients randomly. significant difference of Fugl-Meyer between
There were 30 patients using multi-functional discharge and three months later (P > 0.05) and
training box in training group and there were 30 there are significant differences of the other indi-
patients using self-training in control group. cators between discharge and three months later
There were 21 males and 9 females in the train- (P < 0.05). There is no significant difference of
ing group. The age was 36–77 years old. The all indicators between discharge and three months
average age was 49.3 years old. The shortest later (P > 0.05) in control group (Table 4.5). The
medical history lasted 19 months and the longest results demonstrated that the patients in training
lasted 59 months. The average was 40 months. group not only maintain function level 3 months
There were 16 patients with hemiplegia after later, but also improve it slightly. The function
cerebral infarction, nine patients with hemiplegia level of the patients in control group is decreased
after cerebral damages, two patients with hemi- compared with that at the time of discharge.
plegia after child cerebral palsy and three patients
Table 4.5 Functional assessment comparison table of training group and control group at the time of discharge and
three months later x ± s
Assessment items Group Discharge Three months later p Value
Myodynamia Training group 3.34 ± 0.65 4.06 ± 1.21 <0.05
Control group 3.31 ± 0.47 3.36 ± 101 >0.05
Range of motion Training group 18.23° ± 2.36° 19.43° ± 2.68° <0.05
Control group 16.12° ± 2.36° 16.47° ± 4.36° >0.05
Fugl-Meyer Training group 1.71 ± 0.50 1.82 ± 0.47 >0.05
Control group 1.62 ± 0.50 1.70 ± 0.47 >0.05
Discussion CNS functions. The CNS contains great poten-

After CNS damages, rehabilitation of body limbs tials that originate from numerous cells and syn-
motor dysfunction takes a long time and most is apses and is the basis of recovery of limbs motor
the self-training post-discharge. Therefore, that functions through training after central damages.
how to use and exert the function of self-training Therefore, development of neural potentials is
play an important role in maintaining or promot- the key of recovery of motor functions after cen-
ing the effect of rehabilitation therapy, reducing tral damages.
family financial burden and improving daily life CNS potentials are the results of CNS plastic-
ability of the patients. However, family self- ity and functional reorganization. However, the
training is affected by many factors such as living plasticity of nervous system is based on the
space, training appliance, lack of instructions and “skillful use and dependence” principle, which
improper methods so that it is difficult to do the means only active limbs movements can induce
training well. Family self-training mainly is plasticity of motor cortex function and then
simple walking, which is difficult to meet improve the motor functions of limbs.
requirements and decreases functions. The foot The question is that which kind of methods
drop of hemiplegic patients is one of the main can quickly induce the potential of human body
obstacles that influence the patients’ lower limbs to compensate the lost functions. In normal life,
motor function, which can lead to abnormal people can overcome difficulties and hardships
motor pattern of lower limbs. The patients in using willpower. In dangerous condition, people
control group use voluntary walking as the main can get through the difficulties through bursting
training pattern post-discharge. If the entire into extraordinary ability. In specified conditions,
coordinated movement ability of lower limbs is tough training can lead a person to be a super-
not improved, there is foot drop to varying man, such as the training of special troops of lib-
degrees in walking, which can affect normal gait. eration army. These examples showed that human
Household equipment should be small, porta- potentials can be induced through dangerous
ble, easy to be operated, inexpensive and with conditions such as willpower, goal, stimulus,
good effect. Therefore, problems needed to be misfortune, disaster and accident. These factors
resolved that how to make the patients do correct can promote the development of human poten-
self-rehabilitation training anytime and anywhere tials. The human potentials mainly are CNS
and how to improve enjoyment and effect. potentials, because all the muscles are dominated
Necrocytosis of axoneuron and destruction of by CNS. However, patients with hemiplegia and
conduction pathway are the root that can lead to brain paralysis always have serious protopathy,
dyskinesia of limbs after CNS damages. The key such as hypertension, diabetes and heart disease.
point of treatment is the functional recovery of Therefore, under imminent danger, train may
axoneuron and conduction pathway. Because the worsen the condition. Obviously, under immi-
axoneuron is unable to regenerate itself, the lost nent danger, the potentials development training
functions after central damages should be com- cannot simply be employed in the rehabilitation
pensated by the normal cells around the injured of patients with central lesion.
area. The standby conduction pathway is acti- Regulation of movements based on regulation
vated to replace the functions (development and of mind and regulation of breathing is the basic
utilization of neural potentials) of injured cells, technique of Daoyin technique in traditional
which is called neural potential development. Chinese medicine. The speech in Daoyin tech-
Although the cells around injured area are the nique is able to enlighten and motivate human
same as the injured cells, in normal condition, willpower commendably, which construct a safe
they cannot be used for life long. Only in special “imminent danger” condition for functional reha-
conditions, these cells can be used and exerted bilitation. In modern opinion, the patients are
through special training. Therefore, there is instructed to concentrate to complete a designed
potential ability of the neural tissues for injured movement and during this the therapists use
Daoyin speech to create a condition of imminent Elastic recoil of elastic bandage of multi-
danger, such as “Stand up, or you will fall down”, functional training box is exerted on the move-
“Hold up your body or you will crash” and so on. ment orientation of agonistic muscle that induce
Daoyin technique in ancient traditional joint motion, which make the agonistic muscle to
Chinese medicine has a long history. According find the orientation easily. Therefore, it is easy
to Mister Lv’s Spring and Autumn Annals, in for the induction of spontaneous movement of
ancients time, people used dancing to prevent agonistic muscle under the action of Daoyin tech-
diseases and keep fit. Until 610 B.C., Chao nique in traditional Chinese medicine. Elastic
Yuanfang in Sui Dynasty compiled General recoil of elastic bandage is directly proportion to
Treatise on the Cause and Symptoms of Diseases stretched length (from zero to infinity), so that it
and systematically listed about 300 kinds of can be used for most patients. Elastic recoil of
Daoyin techniques. There are 20 kinds of them elastic bandage in training methods keep on the
that are used to treat hemiplegia. In 1973, in point of maximal force for six seconds, which is
Changsha City of Hunan Province painting on the quantitative index of time and is good for
silk Daoyin pictures from Mawangdui tomb 3 neural nerve potential development. And then
draw 44 Daoyin pictures with color, which through promoting central nerves plasticity, func-
reflect the diversity of Daoyin technique. From tional reorganization can be achieved and motor
the origination, Chinese medicine rehabilitation function is recovered finally. For example, train-
therapy has close connection with Chinese ing plate of dorsiflexion of foot is used to do dor-
traditional culture. Especially in the inheritance, siflexion of foot training. Through anti-resistance
the various factions summarized, replenished of elastic force on the orientation of dorsiflexion
and developed it. The theory is extensive and of foot, myodynamia of tibialis anterior muscle
profound, but inescapably mysterious, which is and autonomous movement degree can be
lack of definite concept. The principles are increased, which is good for promoting the entire
subjective abstract. Therefore, the application of motor function of lower limbs.
Chinese medicine rehabilitation therapy is under Multi-functional training box of body limbs
restrictions. In addition, there is no objective can be fully used by the patients in their spare
indicator in the therapy and it is difficulty to be time in or out of the hospital to help them recover.
proved in basic research for application. It is easy to be operated and portable. The patients
Therefore, it is hard to be promoted in clinical can do specific training with the instruction of
rehabilitation. Modernization of Daoyin video with light music and audio tape, which can
technique can promote renaissance of this provide a good training condition and atmo-
technique. Six-step improvement Daoyin sphere. Persevering correct training can maintain
technique in traditional Chinese medicine is an and improve rehabilitation training effect.
attempt in this way.
Rehabilitation training is like other physical
training. Definite quantitative index is very 4.3.4 Development and Clinical
important for improving training effect. For Verifications of Controlled-
example, a high jumper practices high jump Release Force Ankle-Foot
without cross-bar elevation. It is hard for him to Orthosis
increase the altitude of the jump. The cross-bar is
the indicator of new jump altitude on the basis of We usually see foot drop in clinic, which is an
training achievement in last jump. In order to important factor to form abnormal motor pattern
jump over the new altitude, the high jumper of lower limbs and affects the lower limbs func-
needs to adjust mood, run-up speed, take-off dis- tion of the patients greatly.
tance, ground force and throw-over gesture to Foot drop is usually induced by innervation of
develop jump potential adequately. Then the tibialis anterior muscle after coma, central nerve
jump altitude will be increased gradually. injury and peripheral nerve injury. If it is handled
improperly, for a long time, spasm of musculus for 2 cm and the inside of the foot encases lon-
gastrocnemius and Achilles’s tendon and fibrous gitudinal arch. And then it is polished. The ther-
adhesion of ankle joint affect the body limbs apists punch a hole in the shank and ankle, use
function and rehabilitation training of the hollow rivet to fix fixing band and paste lamella
patients. Surgical Correction can be given to artificial limb sponge slice onto the inner face of
severe patients. For the patients with conscious the modeled brace. During fitting, the techni-
dysfunction, the surgery is doubted and then cians select proper elastic traction band. One
abandoned. Severe foot drop make it difficult for end of the band is fixed on the toe part of the
rehabilitation training and cause severe compli- brace and the other is linked to upper end of
cations, even lead to life danger. The patients can shank through the front of tibia. The length of
lose hope for functional recovery. It is a problem elastic band is adjustable. The traction of elastic
in clinic need to be solved. According to the prin- band can increase the angle of dorsiflexion of
ciple “small and sustained traction”, developed foot gradually.
controlled-release orthotics can help to solve the
problem. Structure and Function
Controlled-release force ankle-foot orthosis
4.3.4.1 Materials and Manufacture includes two parts. The main part is mobile
Method ankle-foot orthosis of ankle joint according to
foot and shank shape of the patients. Its function
Materials is to fix shank and pelma and generate dorsiflex-
Macromolecule fibrous material and high tem- ion of ankle joint through exogenous process at
perature thermoplastic plate produced by Nanjing the same time. The other is controlled-release
Shuang Wei Biomedicine Science and force traction part, which means that elastic band
Technology Ltd. are used. The characteristics of is used to link toe to tibialis anterior. Small and
macromolecule fibrous material are that before sustained traction is produced by retractive force
solidification it is as soft as mud, can adapt to the of elastic band to stretch contracture tendon and
model and is easy to forming. After solidification muscle in order to relax adhesive joint.
it is air permeable, light, strong but pliable in tex-
ture, which doesn’t affect X-ray examination and 4.3.4.2 Clinical Verifications
is comfortable to dress.
Clinical Data
Manufacture of Controlled-Release From July 2004 to February 2007, we produced
Orthotics 22 controlled-release force ankle-foot orthosis.
For semi-finished product of macromolecule The users are all the inpatients with foot drop.
fibrous material modeling, ankle functional There are 18 males and four females. There are
position orthotics materials are used. We open 13 patients with low conscious state and nine
the packaging bag, take macromolecule fibrous patients with spinal cord injury. Passive move-
material plate out, put it into room temperature ment of ankle joint is restricted (3.54° ± 1.63°).
water for six seconds, flatten it, cover it on ankle The average fixed angle of plantar flexion (mini-
and shank of the patients, wrap it with pressure mum plantar flexion angle of passive movement
and fix it for 6 min. When macromolecule of ankle joint) is 44.91° ± 5.35°. the patients can-
fibrous material is modelled, the therapists take not do the training in standing position.
it down, cut the edge, make the altitude of the
edge of the shank is equal to that of vertical Results
plane projection of tibia crista. The therapists Controlled-release force ankle-foot orthosis is
cut a wedge-shape part in the rotation center of used to treat the patients for four weeks. The
ankle joint in both sides, use it as axis and make average range of passive movement of ankle
it mobile like hinge. The outside of foot is tipped joint is 28.09° ± 9.26°. There are 16 patients
Table 4.6 Data comparison of fixed angle of plantar flexion and range of passive movement of ankle joint before and
after rectification ( X ± S)
Items Case number Before rectification After rectification
Fixed angle of plantar flexion 22 44.91° ± 5.35° 17.59° ± 10.04°*
Range of passive movement of ankle joint 22 3.54° ± 1.63° 28.09 ± 9.26°*
*P < 0.05
whose range of passive movement of ankle joint The ankle joints with fibrous ankyloses or
is equal to or more than 32.5°. The average fixed bony ankyloses.
angle of plantar flexion is recovered to The patients with ulcer of foot and ankle,
17.59° ± 10.04°. There are four patients with 25° lower limbs phlebothrombosis and severe
plantar flexion and foot drop, but they can do varicosity
standing bed training. There is no improvement • Cautions: Partial bruising should be avoided
in two patients with severe tendon spasm and in the training. Because body feeling of the
ankle joint adhesion. patients is not good or is none, the condition
T-test of SPSS12.0 software package is used should be observed carefully. In the first 3
to analyze data of fixed angle of plantar flexion days, every 2 h the therapists undress the
and range of passive movement of ankle joint orthotics to check if there is red and swollen
before and after rectification. There is significant and bruising. If there is no bruising, the orthot-
difference in data comparison (P < 0.05), which ics can be dressed day and night.
can be referred to Table 4.6. The results demon-
strated that Controlled-release force ankle-foot Discussion
orthosis has an rectification effect on foot drop Foot drop is the common cause to induce abnor-
with spasm of musculus gastrocnemius and ten- mal motor pattern of lower limbs, which is usu-
don and fibrous adhesion of ankle joint. ally in the patients with coma, low conscious
Controlled-release force ankle-foot orthosis state, central nerve injury, peripheral nerve injury.
made of macromolecule fibrous material has Because of innervation of tibialis anterior muscle
good air permeability and better adaptation for and spasm of musculus gastrocnemius, plantar
body limbs, which is easy to dress. There is no flexion of ankle joint lead to foot drop. In clinic,
bruising in all patients. Small and sustained trac- if there is no rehabilitation consciousness and no
tion is produced by retractive force of elastic good limb position and passive joint motion,
band to stretch contracture tendon and muscle in spasm of musculus gastrocnemius and tendon
order to relax adhesive joint. and fibrous adhesion of ankle joint can be induced
after a long time. Therefore, unrectified foot drop
Clinical Indications, Contraindications is closely related to braking and apraxia of body
and Cautions limbs [1]. In the early stage of foot drop forma-
• Indications: It is appropriate for the patients tion, through passive joint motion, spasm of mus-
with foot drop induced by various reasons, culus gastrocnemius and tendon can be stretched
especially with spasm of musculus gastrocne- and adhesive ankle joint can be relaxed. And then
mius and tendon and fibrous adhesion of ankle orthotics is kept on the functional position. If the
joint. rectification opportunity in the early stage is lost,
• Contraindications: foot drop that can be alleviated can be turned into
The patients with foot drop induced by scar an implacable disease gradually, which bring
contracture after deep burn of shank, foot and about difficulty to rehabilitation therapy and
ankle. affect the patients’ standing, gait and walking
The patients with severe spasm of musculus ability training greatly [2, 3].
gastrocnemius and tendon and no movement For foot drop with severe spasm of musculus
in passive movement of ankle joint. gastrocnemius and tendon, fibrous and bony
References 159
ankyloses, it is correct to be treated with surgery. shoulder joint, elbow joint and wrist joint, which
For foot drop with passive joint motion, it is care- obtain good effect.
ful to be treated with surgery. For the foot drop in Controlled-release force ankle-foot orthosis
the patients with coma and low conscious state, it can also be made of high temperature thermo-
is inappropriate to be treated with surgery because plastic plate. The characteristic of high tempera-
there are no indications. However, because of ture thermoplastic plate can become soft under
extreme plantar flexion of ankle joint, the patients the temperature of 180 °C. After modeling, it is
cannot do standing training and are forced to lie surface smoothing, good toughness, high strength
in bed for a long time, which can easily induce and can be repeatedly heated to modify. However,
severe complications of respiratory, urinary, car- the process is complicated with high temperature
diovascular, digestive system, even death. At thermoplastic plate. At first, gypsum model is
present, there is no rectification therapy report prepared, which requires plate heater. Because of
about this kind of foot drop. Although there are the material without breathability, punch a hole
many kinds of ankle-foot orthosis at home and for breathability is necessary. It is heavy and is
abroad, there is no report about controlled-release uncomfortable to wear. Medium high tempera-
force ankle-foot orthosis [4, 5]. ture thermoplastic plate is selected and heated
The author found that during the process of (180 °C) in plate heater for 10 min. After the
pulling rubber band, the stretched length in slow plate is soft, it is pasted on the gypsum model and
traction is more than the stretched length in the space is drained to vacuum so that it is pasted
quick traction. This phenomenon enlightened to gypsum model completely. After solidifica-
the author. Large traction of foot drop can induce tion, take it down. The rest procedures are the
bruising and make it difficult to relax spasm of same as the manufacture method of using macro-
musculus gastrocnemius and tendon. Retractive molecule fibrous materials.
force of elastic band of controlled-release force
ankle-foot orthosis and hinge in ankle-foot joint
are used. Elastic band pull the pelma of orthosis References
and increase dorsiflexion angle of ankle joint
gradually. Through small and sustained traction, 1. Tong W, Yong Z, Tao L, et al. An analysis of the
effect of ankle foot orthosis on the function of
spasm of musculus gastrocnemius and tendon lower extremity of foot. Theory Pract Chin Rehabil.
and fibrous adhesive ankle joint can be stretched 2004;19(1):30–1.
progressively, range of activity of ankle joint is 2. Hongtu W, Dongfeng H, Peng L, et al. AFO early
increased, foot drop is rectified under micro intervention for cerebral apoplexy patients daily life
activities ability and the quality of survival. Chin J
damage condition without muscle spasm Phys Med Rehabil. 2007;29(1):41–4.
response, which create conditions for decreasing 3. Nan Y, Shui W, Ling L, et al. The production and
complications, promoting functional recovery application of dynamic ankle orthotics in adult
such as rehabilitation training in standing hemiplegia patients. J Chin Phys Med Rehabil.
2002;24(4):232–4.
position and rectification of abnormal motor 4. Lin S, Shumei Z, Jiading Z, et al. Improvement and
pattern. application of ankle foot orthotics. Chin Rehabil
In a similar way, this kind of orthotics can also Magazine. 2005;20(1):64–5.
be used for rectification of other joints such as 5. Dawei Z, Jiankun Y. Effect of fixed ankle foot
orthotics on lower limbs. Chin J Rehabil Med.
controlled-release force orthosis of knee joint, 2006;21(9):829–31.
Training Method and Equipment
of Virtual Neurological Training 5
5.1 The Mechanism actual therapists can really know the mecha-
and Significance of Virtual nism of these methods and remind of the con-
Training Methods cept of motor program usually. Daoyin
technique in traditional Chinese medicine is
5.1.1 T
he Generation of Ideas used to guide the patients to try to complete
of Virtual Neurological designed movement and exert the role of these
Training methods fully.
2. It is related to degree of encourage and correct
The training methods of rehabilitation technique instruction of the therapists. In the process of
of neurological training mainly include neural regulation of mind and breathing, the patients
potential development, motor program reestab- are required to enter into meditation “concen-
lishment and motor pattern remodeling, which tration without distracting thoughts”, which is
can promote CNS plasticity and functional reor- called immersion. The patients can totally
ganization. These methods can recover motor immerse in the surrounding and the method
function after CNS damages through clinical plays a role of clearing and activating the
verification. channels and collaterals. In the fourth step
However, the training effect of rehabilitation (stimulation) and fifth step (insistence) of six-
methods of neurological training not only is step Daoyin technique, the therapists are
related to the correctness of diagnosis and ther- required to increase tone and intensity and
apy scheme, but also is closely related to many create a safe state of emergency by speech. In
factors. these processes, the therapists should be full
of passion and encourage the patients to
1. It is related to degree of accuracy of the profi- achieve the anticipated goal constantly. To
ciency and implementation method of the some extent, the higher the therapists’ passion
therapists to this technique. The therapist is, the bigger the activated willpower of the
should know the mechanism of recovering patients to overcome difficulties is, the better
motor function after CNS damages well. The the training effect is. The passion is propor-
therapist must accept the important role and tion to effect.
mechanism of neural potential development, 3. It is related to degree of understanding of the
motor program reestablishment and motor patients to rehabilitation methods of neuro-
pattern remodeling, as well as the correct logical training. Daoyin technique is the tech-
application of these methods. Because only nique to guide the patients to play a role by
https://doi.org/10.1007/978-981-13-0812-3_5
162 5 Training Method and Equipment of Virtual Neurological Training
themselves. In order to achieve this goal, the requirements mentioned above. The common
patients must know the mechanism of this influence factors are as follows:
method thoroughly. The therapists are required
not only to understand and know the mecha- 1. The therapists cannot implement rehabilita-
nism of the method correctly, and also use tion training method correctly because of
comprehensible and popular words to explain fatigue. Labour intensity of rehabilitation
to the patients repeatedly. Therefore, there are training is big, especially rehabilitation train-
cognitive disorder and recession of compre- ing of neurological training, because the train-
hensive ability and memory ability to varying ing is all active movement. At the moment of
degrees in many patients. In every therapy, the exerting proper resistance, the patients are
therapists are required to explain the training guided to do a series of training for develop-
mechanism to the patients clearly and con- ment of neural potential through anti-
cisely in order to make the patients understand resistance joint motion. Especially the
the mechanism thoroughly and obtain better potential development training of upper limbs,
training effect. lower limbs and trunk, the training should be
4. It is related to the progress of training effect. done when the patients have no autonomic
Because of the influence of the degree of spe- movement. Although the patients can lose
cies evolution, recovering motor function weight through weight support equipment,
after CNS damages takes a long time, which auxiliary force of the therapists is 30–60 kg
is a long-term slow rehabilitation process. when they do compulsive and auxiliary active
Therefore, the premise of training effect is movement for the patients. One therapist
long-term rehabilitation training. The prem- treats 6–8 patients every day. They word
ise of long-term rehabilitation training is the 22–24 days for 1 month. In the weekend, they
confidence of the patients and their families should guide the patients to do the training.
on rehabilitation method. The confidence They are very tired and the fatigue can influ-
come from the expectation of functional ence the implementation of rehabilitation
recovery and the effect of actual rehabilita- method.
tion training, especially for the obsolete 2. Repeated explanation of the methods and the
cases that the functions cannot be improved encouraging words of the therapists cannot be
by rehabilitation training. The therapists persisted. Explanation of the methods and the
should make the patients and their families to encouraging words can be achieved through
see the effect of rehabilitation training as speeches, which requires a therapist who
soon as possible in order to increase the con- trains several patients to keep high passion
fidence of the patients and their families on and explain to the patients tirelessly. It is dif-
rehabilitation method training, which is the ficult to achieve this. Because of fatigue, the
most direct and credible measure to improve therapist cannot guide the patients with pas-
the effect of rehabilitation training. sion or explain the mechanism to the patients
Therefore, before rehabilitation training, clearly and the training effect is influenced.
through detailed functional assessments, the 3. Limited to the individual level of the thera-
therapist can find out the main obstacle that pists, it is hard to implement Daoyin tech-
restrict the function and do interest training, nique correctly. Daoyin technique, especially
which can make quick progress and is good six-step Daoyin technique of guiding the col-
for the confidence, understanding of rehabili- laterals through meridians, the implementa-
tation method and the confidence for contin- tion should be in accordance with main and
ued rehabilitation. collateral channels, which brings about some
difficulties to the training. There are two rea-
In the realistic clinical rehabilitation training, sons. The first is that the rehabilitation doctor
the author found that it is difficult to achieve the and the therapists graduated from western
5.1 The Mechanism and Significance of Virtual Training Methods 163
medicine who are not familiar with main and These require medical ground electrode
collateral channels. The second is that disci- deeply buried under ground and copper wire
plinary patients even don’t know main and mesh shield. Even so, the signal can still be
collateral channels, which brings about great affected by other signal source such as pass-
difficulties to six-step Daoyin technique of ing vehicle, strong phone signal and shake of
guiding the collaterals through meridians. The signal conductor, even the position of the host
patients think guiding the collaterals through machine in the training room, conductivity of
meridians is entirely imaginary and unrealis- skin electrode and scurf on skin surface. In
tic. Therefore, it is difficult to be implemented many cases, because of the instability of sig-
correctly, even the patients object to or refuse nal baseline, it is hard to continue the
to do the training. training.
4. It is difficult to improve the therapy day by
day and is easy to affect the therapy effect In order to solve the problems mentioned
through influencing the patients’ emotion. above, the therapists should study a method not
The improve of neural function is very slow, only to implement rehabilitation methods of neu-
which is in accordance with the “all or none” rological training correctly in order to reflect the
law. When the training reach a certain level, mechanism of rehabilitation methods of neuro-
corresponding function movement appear. If logical training thoroughly, but also to alleviate
the function movement is not recovered, there labor intensity of the therapists. The patients can
is no obvious manifestation in motor function, see the progress of the therapy and keep confi-
which is called plateau period. However, if the dence of rehabilitation. Not only the patients can
patients continue training in this period, the do rehabilitation training with a purpose, but also
accumulation of minor functions can lead to the patients can master the method and do the
visible function movement. If the therapy is training with encouragement form the therapists.
stopped, all their previous efforts are wasted. Not only it is good for the correct implementation
Neurological training equipment is an equip- of Daoyin technique, but also the patients can
ment that can receive motor program signal feel Qi in the main and collateral channels.
and display it real-timely. Its characteristic is Therefore, the idea of investigating training
to know real-time change of motor program system of virtual reality of neurological training
signal, provide scientific basis for the estab- is created. Through modern computer technol-
lishment of the therapy schedule and set a sur- ogy, virtuality, simulation, animation explana-
passing goal for the patients. However, on the tion, six-step Daoyin technique record guide and
other hand, in the plateau period, there is no actual development method of neural potential,
change of motor program signal for a longer the actual problems of rehabilitation training can
time and the patients usually think that the be solved in order to improve the effect of reha-
training effect is halted and they may easily bilitation therapy and increase the understanding
lose confidence to rehabilitation training of the patients to the mechanism of the method,
because the patients can see the actual data. which can also alleviate labor intensity of the
5. The sensitivity of bio-electricity signal detect- therapists.
ing system is strong and it is easy to be influ-
enced by the environment. Another question
of reality is that the signal should be amplified 5.1.2 Background of Related
through amplification system after signal fil- Techniques: Virtual Reality
tration and can be displayed in a smooth curve
because the signal form CNS to muscle is very 5.1.2.1 Introduction to Virtual Reality
weak. Therefore, the sensitivity of signal Virtual reality [1] (VR) is developed in 1960s. it
reception equipment is high, which is easily is a virtual environment that imitate real object
disturbed by the surrounding and condition. with computer and through multiple sensors, the
users are put into this virtual environment to real- traditional exercise therapy, the patients are in a
ize the natural interaction between users and vir- passive position. The repeated and boring manip-
tual environment. The characteristics of VR ulations in the training can induce boredom of the
technique are immersion, interaction and imagi- patients, which is bad for the continue and in-
nation. Immersion is the ability that VR system depth of the therapy and affect training effect
can see, hear, smell, touch, taste and so on, which greatly.
can make users break away from external envi- However, virtual reality technique can figure
ronment and immerse into virtual environment out the problems mentioned above in rehabilita-
created by computer. Interaction is that users tion therapy. Through virtual reality technique,
interact with various objects in virtual environ- functional assessments, specific therapy and
ment to make users immersive. Therefore, inter- mental regulation in rehabilitation therapy are
action is the key factor of man-machine harmony. closely combined together. Music, picture and
Imagination is that through imagination virtual voice prompt are used to increase training plea-
movement can generate real effect. For example, sure and improve therapeutic effect.
when VR technique is used to do surgery and the
skin or muscle tissues are cut off by virtual scal- 5.1.2.3 The Application of VR
pel, the manipulator can have the real feeling of Technique in Limbs Motor
tissue response. Function Rehabilitation
General virtual reality system is composed of VR technique provides a carefree environment
professional graphic processing computer, appli- associated with real life for the patients with
cation software system, input equipment and dis- stroke to promote the therapeutic interest of the
play equipment. Through the information channel patients in order to improve training effect. For
such as vision, audio, and touch, people can feel example, the training of hand function, in the vir-
the senior user interface of designer’ idea. The tual environment, the patients can move, grab,
assisted hardware includes sensors such as hel- grasp or put virtual object, take part in the envi-
met mounted display, data glove, three- ronment, interact with computer actively, and
dimensional eYes, data clothes. The feedback receive the feedback information of vision, audio,
channel can be established through mouse and touch and smell in their own operation real-
keyboard. At present, the most widely used is timely. The patients can regulate themselves
Helmet mounted Display. VR systems software is according to the feedback information to enhance
the key to realize VR technique. The application the flexibility of finger movement in order to pro-
of VR technique in rehabilitation medicine is mote the generation of separation movement. VR
introduced in this chapter. technique is applied for gait training and balance
function training. At present, researchers form
5.1.2.2 Current Situation Israeli developed a set of “computer-assisted
of Rehabilitation Therapy at rehabilitation environment system”. Through
Home and Abroad simulation of boating, playing balls, jogging and
At present, rehabilitation therapy at home and so on can help the patients to improve balance
abroad is mainly the therapists’ manipulation, or capacity and recover body motor function. Novel
manipulation assisted by some simple equip- training mode with abundant videos can make the
ment. Through passive movement, auxiliary training of the patients become easy like a game
movement, active movement and anti-resistance and motivate the enthusiasm of the patients fully.
movement, the motor function of muscle is
recovered. Because of boundedness of existing 5.1.2.4 The Application of VR
rehabilitation instruments, it is unable to com- Technique in Cognitive Training
bine functional assessment, exercise therapy and With the development of computer technology,
psychotherapy together organically. Especially, computer is combined with cognitive
the psychotherapy cannot run through rehabilita- rehabilitation from theoretical research to devel-
tion therapy from beginning to end. In the opment and application of products, especially
5.1 The Mechanism and Significance of Virtual Training Methods 165
the appearance of virtual reality. The higher com- group are obviously alleviated. The view to alti-
bination of computer technology and cognitive tude is more positive. This experiment demon-
science is promoted. Virtual reality technique is strated for the first time that virtual reality therapy
used to study rehabilitation medicine for many can change human behavior in real world. After
years in America. In the cognitive rehabilitation, America’s 911, the therapy of posttraumatic
they accumulate rich experience and develop stress disorder attracted a wide spread attention.
various special VR techniques for different kinds Difede and Hoffman used virtual reality tech-
of cognitive disorder (memory dysfunction, spa- nique to recreate the explode scene of World
tial cognitive disorder, disturbance of thought Trade Center Building. They let a patient who the
and so on). traditional exposure therapy has no effect on
The advantages of VR rehabilitation technique enter into virtual explode scene again with vivid
compared with traditional training method: sound, the people from building to the street, col-
lapsed building and towering smoke. Finally, the
1. Various kinds and safe training: It can provide patient is cured.
various virtual therapy scenes for the patients Through virtual reality technique, the training
to do rehabilitation training in a safe is done and psychotherapy is developed and pro-
environment. moted. Because the therapy of the patients is con-
2. Specific designed training items: According to trolled by the computer, the training to varying
the practical situation of the patients, VR sys- degrees can be done through different pathways.
tem can design specific therapy process with At the moment of treatment, all kinds of param-
the same scene and mission. eters such as physiological signal of the patients
3. Feedback function: Through sensing equip- are collected constantly. Through analysis and
ment of various mode, VR system can master regulation, VR system can make a decision
the state and effect of the patients for informa- according to the specific situation of individuals
tion feedback and data storage. The physician and provide different feedback information auto-
can master the illness of the patients. matically such as encourage, implication and
4. Training with a purpose: The training can be suggestion. Through these feedback information,
done with a purpose. The training is scientific the therapists can help the patients to adjust ther-
and interesting and the training time is short apy mode timely. According to different scenery
with more obvious training effect. There is pictures and music generated from these signals,
superiority for rehabilitation of group disabil- the patients do the training in a carefree environ-
ity induced by war, severe disabled accident ment to relax anxious mood and increase training
and natural disaster. interest and therapeutic effect.
5.1.2.5 The Application of VR 5.1.2.6 Virtual Training Machine

Technique in Psychological There are many VR training systems of this kind,
Rehabilitation which is widely used in rehabilitation medicine.
It is generally acknowledged the application of At present, the relatively mature is used for reha-
virtual reality in psychological rehabilitation is bilitation training of bone surgery and orthopedic
started from 1993. At present, this technique is surgery. Although the principle is based on tradi-
used for anxiety disorder, posttraumatic stress tional rehabilitation theory, it is totally different
disorder, eating disorder and relieving pain. from traditional training pattern. Virtual training
Virtual reality technique is used to treat anxiety machine is intelligent, scientific and interesting.
disorder at the earliest, especially for acrophobia, The patients can receive therapy and rehabilita-
aerodromophobia and agoraphobia. In 1995, tion in an environment close to nature. Virtual
Rothbaum treated 20 patients with acrophobia reality exercise bicycle developed in Tsinghua
for 7 weeks. Our results demonstrated that com- University for rehabilitation and posture balance
pared with control group, the anxiety, avoidance, control training system made in Korea belong to
depression and other symptoms of virtual reality this kind of virtual training machine.
5.1.2.7 Prospect the problem. Scenario simulation is added to dis-

VR technique is already used in rehabilitation play the actual joint movement in VR technique,
training and the development prospect is better. which is lack of the training effect guided by
However, the application of this technique in training method. It is different from psychother-
rehabilitation medicine is in the primary stage. apy and it can simulate the scene of America’s
There are some problems need to be solved. For 911 through virtual reality technique. People
example, the display equipment cannot receive with anxiety duo to America’s 911 can place
high-quality and verisimilar medical image themselves into the virtual explode scene again to
splendidly. In complicated environment, the real- alleviate anxiety through repeated emergence.
time performance and generating velocity need This is why there is a notion in rehabilitation
to be improved. Importantly, the rehabilitation medicine engineering that the patients can be
method is in accordance with the principle of recovered after development of rehabilitation
recovering motor function or not, especially the equipment. Actually, rehabilitation equipment
mechanism of recovering lost motor function can assure the correct implementation of reha-
after CNS damages. With the development of bilitation method to make full use of the method.
computer, multimedia technology, sensor tech- The rehabilitation is from rehabilitation theory,
nology and communication technology, this tech- but it is the method of research and development
nique may be modified, improved and developed, of equipment that is based on theory and its pur-
which may be widely used in rehabilitation pose is method implementation, which cannot
medicine. achieve good effect usually. Only the combining
rehabilitation medicine engineering and clinical
5.1.2.8 The Assessment of rehabilitation medicine, rehabilitation equipment
VR Technique is the correct research and development way and
Although there is certain therapeutic effect in is with actual therapy value, according to clinical
rehabilitation training with VR technique in some actual demand.
reports, this technique is the real reflection of
actual movement. For example, video equipment
is used to record some joint motion or limbs 5.1.3 Research Purpose
movement and these movements can be displayed and Meaning of Virtual
in the computer screen in synchrony so that the Neurological Training System
patients can see their own movement. The main
function of this method is to increase the feeling 1. Purpose: Modern virtual and simulation tech-
of freshness of the patients, because they seldom nique are used to develop a kind of mecha-
see their own movement from the screen. The nism and method that is in accordance with
patients feel curious and the fun of the training is neural potential development and motor pro-
increased. However, the function of this method gram reestablishment, which can provide vir-
is the same as that the patients see joint motion tual reality motor dysfunction and simulation
directly. If the joint can be moved, VR technique motor program feedback signal. The machine
can be used to see joint motion displayed in can explain mechanism and methods and
screen. If the joint cannot be moved, VR tech- guide the patients with Daoyin speech. It also
nique can be used to see that there is no joint can simulate main and collateral channels in
motion displayed in screen. However, the current human body, promote the understanding of
situation is that the patients need rehabilitation the patients to therapy method, alleviate labor
training, especially for the patients with motor intensity of the therapists, and reduce the
dysfunction after CNS damages who has no obvi- instrument interference and environment
ous joint motion or has abnormal motor pattern. restriction. The standardization of rehabilita-
For these patients, a series of methods are tion training of neurological training can
required to recover the joint motion of the improve training effect and make use of the
patients, while only VR technique cannot solve widely used rehabilitation methods of
5.2 Composition and Training Method of Virtual Neurological Training System 167
eurological training and the replacement

n mechanism of motor dysfunction after CNS
training system of the equipment. damages recovery of motor function.
2. Meaning: According to rehabilitation training (a) Anatomy and basic functions of CNS:
method of neurological training, virtual real- What is motor program signal and how to
ity training system of neurological training dominate and control general movement?
use virtual reality motor dysfunction, simula- (b) CNS cells are lack of regeneration ability,
tion of motor program feedback signal, auto- but through neural potential development
matic Daoyin technique speech guidance and is reserved cells and conduction pathways
mechanism explanation to give the patients are activated to replace injured cells and
actual anti-resistance training. The training conduction pathways. Through reestab-
system is synthesized from the anti-resistance lishment training of motor program, the
of the therapists. The development of this sys- lost motor function can be recovered.
tem is to overcome many defects in rehabilita- (c) Active movement, willpower and state of
tion training of neurological training such as emergency are the condition to develop
incorrect application of methods, inability of neural potential. Six-step Daoyin tech-
passional guidance and encourage of the ther- nique in traditional Chinese medicine can
apists, lost enthusiasm of the patients due to guide the patients through creating safe
misunderstanding of the mechanism of the state of emergency and active movement,
method and the interference of signal detec- which is a better method to develop neural
tion equipment. Meanwhile, because the com- potential.
puter software can produce many kinds of (d) The archers practice archery only toward
motor program signals with music, the train- bull’s eye, which can improve the degree
ing is enriched and the boring training is of accuracy. Through simulation of differ-
avoided. Especially, the computer software is ent intensity and proportional motor pro-
used to establish animation light spot auto- gram signal curve in various joint motion,
matic tracking display system of main and the training can be used to develop neural
collateral channels pathway to make patients potential and reestablish motor program.
do the training correctly according to main (e) Human body animation imitates main and
and collateral channels pathway and promote collateral channels pathway. Six step of
the process of standardization of neurological guiding collaterals through meridians is
training. It is the precedent of computerization used for speech guidance. Animation light
of rehabilitation training of neurological train- spot flicker guides Qi to acupoint, main
ing, which is meaningful for training effect, and collateral channels, which covers
popularization and application of this twelve main and collateral channels and
technique. all joint motion.
2. Simulation parts of motor program signal: it is
necessary to know definite movement defects
5.2 Composition and Training and imitate normal movement goal.
Method of Virtual (a) The therapists use video to know actual
Neurological Training motor dysfunction. According to the fact
System that people are not familiar with their own
voice and motor pattern, through camera,
5.2.1 T
he Composition of Virtual the joint motion of the patients with motor
Neurological Training System dysfunction is displayed on fluorescent
screen.
5.2.1.1 The Composition of Virtual (b) Simulation of normal joint motion and
Neurological Training System establishment of therapy task and goal:
1. Virtual animation and dubbing: animation
The patients are guided to do the same
dubbing technique is used to explain the movement in the same joint of the unjured
side to find movement difference in injure selected according to the patients’ affection.
side and establish training goal and spe- Slow, relaxed or passion music is used to acti-
cific mission. vate therapy atmosphere and encourage the
(c) Video simulation and virtual animation patients’ passion to take part in the training
are used to explain the task, goal and actively.
mechanism of this therapy. Through sim- 4. Software operation interface of virtual neuro-
ulation video of normal motor pattern in logical training system is as follows:
the same joint with explanation record, (a) Icon: Virtual reality training system of
the therapists explain training mission neurological training on the computer
and goal to the patients clearly. Through screen is opened and the icon is Wenru
simulation animation, the therapist brand (square, colour). Clicking this icon,
explain the mechanism of neural potential entering into the home page and then vir-
development, motor program reestablish- tual reality training system of neurologi-
ment training and recovery of joint motor cal training is displayed in the screen.
function. (b) Items selection: The therapists operate in
(d) Simulation of motor program signal and this page. Clicking home page and enter
setting of an surpassing goal: Animation into the page of items selection, which is
technology is applied to imitate motor the operation page of the therapists. In the
program of joint motion, which includes double-screen display computer, the page
single line and double line. From zero to is existing from beginning to end. The
640 μV, there 6–8 levels to be completed. therapists fill the therapy items and press
If there are eight levels, they are 0, 10, 20, “Enter”. The screen will show the selected
40, 100, 200, 400 and 640 μV. After the therapy contents. In single screen display
10 μV training is completed, pink line that computer, the therapists select the item
stand for 10 μV is displayed in the screen and press “Enter”. The screen will show
of 20 μV and the patients are required to the selected therapy contents. The detailed
use this as the virtual goal. The patients information in this page are as follows:
try to make virtual blue line surpass the
altitude of pink line. The rest can be done The patients: _____ Age: _____ Gender: _____
in the same manner and CNS potential is Admission number: _____
developed and utilized in this process Diagnosis: _____ Onset date of illness: _____ Year
_____ Month _____ Day _____
constantly.
Therapy date: _____ Year _____ Month _____ Day
3. Active movement and anti-resistance training _____
with actual guidance: according to animation Background music: Yes _____ No (click Yes and there
light spot automatic tracking display system are many kinds of musics, select one and press
of main and collateral channels pathway, dub- “Enter”)
bing of six-step Daoyin technique, joint Mechanism demonstration: Yes _____ No _____
Therapy items: (kinds in appendix)
motions such as elbow extension or flexion, Selection of therapy state: sound _____ silence
actual movement ability, the therapists select Signal prediction: Yes _____ No (Through pressure
corresponding intensity virtual motor pro- sensor, the patients can feel real flection of their own
gram signal. After starting animation video, movement)
according to dubbing tempo, when it reaches Therapy demonstration: Yes _____ No (click Yes and
then enter into therapy items filling page and fill the
the summit of analog signal curve, the thera- animation demonstration type; Click No and then
pists exert resistance in the orientation of joint enter into data selection)
motion to make the patients find the way of Therapy data selection (μV)
the signal easily. Through anti-resistance Agonistic muscle _____ Antagonistic muscle _____
training, neural potential development is fur- Processing of results: _____ Save _____ Pass _____
ther promoted. Background music can be Quit
Instructions: Mechanism demonstration— Every item above is selected, press “confirma-

click Yes, the screen will show the mechanism tion” and enter into therapy data selection
demonstration animation. If the therapists don’t column.
click Yes, the page will go to therapy items selec- In the data selection state, fill 0, 10, 20, 40, 80,
tion. Click Yes, the screen will show the mecha- 100, 120, 140, 160, 180, 200, 240, 280, 320, 360,
nism demonstration animation. If the therapists 400, 480, 560, 600 and so on. After completion
don’t click Yes, the page will pass. the numbers, click “Enter” and the virtual motor
Video accompanying sound selection: Click program curve image can be operated. The ther-
sound and there is accompanying sound apy is started.
instruction. Click silence ans there is no Storage and analysis: after one training, train-
accompanying sound instruction. ing items, training degrees and training progress
Therapy items selection: the therapists estab- of the patients can be stored. Because virtual
lish database of various parts such as face, upper training is not real, it is only used for reference of
limbs, trunk and lower limbs, various joint the patients’ training. It is not used for data analy-
motions such as elbow extension, wrist flexion sis of training effect.
and dorsiflexion of foot and mechanism demon-
stration and store them separately. Vista software 5. Hardware part: The softwares mentioned

management platform is used and according to above should be installed on the central pro-
therapeutic requirements, the therapists can cessing unit of the computer and training
select it in items selection page and activate it screen is used to display mechanism demon-
autonomically. stration, animation and training curve.
Therapy items column: click therapy items or Operation screen is used by the therapists to
fill it directly and then enter into items selection select items, which include single screen and
page: Face, trunk, shoulders, upper limbs and double screen. The single screen is portable,
lower limbs, swallowing, diaphragm, sphincter, which is applied for bedside training and self-
gait, coordinated movement. Click the facial training of the patients post-discharge. Double
appearance: the frontal muscle, the risorius, bite screen is suitable for the training in rehabilita-
quadratus, round eYes, round mouth suck up tion hall of the hospital. The outline of the
muscles. Click the trunk: neck stretched out, machine refers to Fig. 5.1.
hold out a bosom, stretching. Click the shoul-
der: shoulder shrug before outreach, shoulder, 5.2.1.2 Operation Process
shoulder after the reach, shoulder rotation. Click
Start the computer, click brand and enter into the
the upper limb: the extension, flexion, wrist,
page of virtual reality training system of
wrist flexion, feet wide, radial deviation, and
neurological training. Click the page and enter
refers to, be, thumb outreach, thumb on the
into operation page of the therapists. After filling
palm. Click the lower limbs: spin, hip, hip flex-
basic items, select mechanism demonstration and
ion outreach, hip adduction, knees, bend your
the computer will play mechanism demonstration
knees, foot, foot dorsiflexion bends, strephexo-
animation. If the therapists don’t click, the page
podia, strephenopodia, extensor, toe. Click
goes to therapy items. Select sound button and
swallow: enter into therapy data selection
animation video will be played with voice. Select
directly. Click diaphram: enter into therapy data
No button and silent video will be played. Click
selection directly. Click sphincter: enter into
therapy items and enter into pandect page of
therapy data selection directly. Click gait: enter
therapy items. Click therapy item and press
into therapy data selection and time selection
“Enter”. Select agonistic muscle in the therapy
directly. Click center of body weight shift: enter
data (μV), press “Enter”, 0 μV data video will be
into therapy data selection directly. Click coor-
played in the patients’ screen. Combined with
dinated movement: drinking, combing, leg
video, the therapists guide the patients to do
stretching and steps.
Fig. 5.1 Wenru brand

training system of
neurological training
virtual reality
actual training. After one therapy, if the patients and prepare for elbow extension. Take a deep
need to do the same items therapy, the therapists breath, are you ready? Prepare for it, get up
select other data in the therapy data and press higher and higher (strong mood and long time).
“Enter”. The patients can do the same item ther- get up higher. One, two, three, higher, four, five.
apy with different data. The patients can do it Great, relax, relax, guide Qi to run along main
repeatedly until selecting other therapy item. and collateral channels and disperse in pericar-
The therapy process of other items are similar. dium slowly, great! You did great! (Fig. 5.2).
During the therapy process, the therapists can The second time: You did great just now. This
save the data at any time, store therapy content, time we use transverse line to mark the effect of
click quit button and log out. All kinds of anima- last time. We try to make the signal intensity
tions and videos are stored in database. surpass the transverse line together. Okay, pre-
pare for it. Take a deep breath, concentrate and
your mind originate form the tail end of the third
5.2.2 T
raining Method of Virtual finger, guide Qi to run along main and collateral
Neurological Training System channels indicatrix and run again. Okay, concen-
trate on outside of the upper arm and prepare for
5.2.2.1 Voice Instruction of Daoyin elbow extension. Take a deep breath, are you
Technique ready? Prepare for it, get up higher and higher.
Voice instruction of six-step Daoyin technique of Great, hold on and on. Good, relax, relax, and
guiding collaterals through meridians and anima- then relax. Guide Qi to run along main and col-
tion light spot automatic tracking display is used. lateral channels and disperse in pericardium
The example is the training of elbow extension. slowly, great! You improve a lot.
The description is accompanied with voice The third time: We will do it again and let
instruction of six-step Daoyin technique of guid- the signal line surpass the transverse line
ing collaterals through meridians and animation (Fig. 5.3). Take a deep breath, concentrate and
light spot automatic tracking display. your mind originate form the tail end of index
Now we start to do the training of elbow finger, guide Qi to run along main and collat-
extension, which belong to the Tri-energizer eral channels indicatrix and run again. Okay,
Meridian of Hand-Shaoyang. Please concentrate concentrate on outside of the upper arm and
and take a deep breath. Concentrate again (low prepare for elbow extension. Prepare for it, get
voice) and your mind originate form the tail end up higher. One, two, three, higher, four, five.
of the third finge, guide Qi to run along main and Great, relax, relax, guide Qi to run along main
collateral channels indicatrix and run again. and collateral channels and disperse in pericar-
Okay, concentrate on outside of the upper arm dium slowly, great!
Fig. 5.2 Abnormal
motor program of elbow
extension on right side
(blue signal line stands
for signal intensity form
CNS to musculus triceps
brachii and yellow signal
line stands for signal
intensity form CNS to
musculus biceps brachii.
Imbalance of the
proportion induce
dysfunction of elbow
extension)
Fig. 5.3 The therapists

guide the patients to
promote the signal
intensity of blue signal
line. If the blue signal is
too strong, the signal
intensity of yellow signal
is decreased. Pink line is
the altitude of blue signal
line of last time and is the
target for the patients to
surpass
The fourth time: Take a deep breath and relax, The fifth time: We will do it again and let the
look out and let the signal line surpass the transverse signal line surpass the transverse line. Take a deep
line. Concentrate and your mind originate form the breath, concentrate and your mind originate form
tail end of the third finger, guide Qi to run along the tail end of the third finger, guide Qi to run along
main and collateral channels indicatrix and run main and collateral channels indicatrix and run
again. Okay, concentrate on outside of the upper again. Okay, concentrate on outside of the upper
arm. Prepare for it, get up higher. One, two, three, arm. Prepare for it, get up higher. One, two, three,
higher, four, five. Great, relax, relax, guide Qi to higher, four, five. Great, relax, relax, guide Qi to run
run along main and collateral channels and disperse along main and collateral channels and disperse in
in pericardium slowly, great! pericardium slowly, great! What a quick pregress!
The sixth time: We will do it for the last time 5.2.2.3 Cautions of Clinical Application
and let the signal line surpass the transverse line. In actual clinical application, several aspects that
Take a deep breath, concentrate and your mind are paid attention to are as follows:
originate form the tail end of the third finger, Immersion: Adopted virtual elevation and
guide Qi to run along main and collateral chan- simulation of motor program signal are designed
nels indicatrix and run again. Okay, concentrate by human and they are not real elevation and
on outside of the upper arm. Prepare for it, get up motor program signal. The patients are need to be
higher. One, two, three, higher, four, five. Great, guided in the virtual environment. Through the
relax, relax, guide Qi to run along main and col- surpassing training of virtual goal and simulation
lateral channels and disperse in pericardium of motor program signal, neural potential is
slowly, great! (Fig. 5.4). developed and motor program is reestablished.
The rest can be done in the same manner. The therapists are required to guide the patients
to immerse into therapy environment. The
5.2.2.2 Clinical Indications patients should be made to believe the virtual
and Contraindications goal and simulation of motor program signal are
of Virtual Neurological Training real. Ang then there will be good training effect.
Method Therefore, the therapists use the equiepement to
Except for equipment, there is no difference of explain the mechanism and make the patients to
training method between neurological training immerse into the training environment as much
virtual reality training method and rehabilitation and deep as possible through regulation of mind
methods of neurological training. Therefore, and breath. If the patients can regard virtual ele-
indications and contradictions of this therapy are vation as real elevation and simulation signal as
the same as clinical indications and contradic- their own signal, which demonstrated that the
tions of three-stage of neurological training therapy is in a deep state and there will be good
therapy. training effect.
Fig. 5.4 Through
training, blue signal line
is increased obviously
and yellow signal line is
decreased obviously.
Abnormal motor program
can be rectified and be
consolidated after
repeated training. The
function of elbow
extension can be
improved obviously
5.3 The Mechanism and Function of Virtual Neurological Training System 173
Actual anti-resistance process should be keep nal further. In this aspect, the author insist to use
pace with the processing speed of simulation of one neurological training instrument with 3–5
motor program signal. In the actual clinical train- virtual reality training system to do the training,
ing, the patients should try to make the time of which can overcome the defects of the training in
anti-resistance joint motion keep pace with the actual motor program signal detection, know the
time and time frame (from the beginning to the benefits of that the actual motor program is good
end of motor program signal) of simulation of for diagnosis and achieve better clinical training
motor program signal in the screenrogram. The effect.
patients should try to make the beginning of anti-
resistance joint motion keep pace with the begin-
ning of motor program signal increase and the 5.3 The Mechanism
time of anti-resistance joint motion keep pace and Function of Virtual
with the time of motor program signal process- Neurological Training
ing. The system voice tells the patients to relax. System
When the motor program is zero, joint motion of
anti-resistance must be stopped. Otherwise, there 5.3.1 T
he Mechanism of Virtual
will be joint but not motor program signal and Neurological Training System
there will be motor program signal but not joint
motion at the same time, which can make the 5.3.1.1 The Training System of Virtual
patients think that the training is virtual and the Reality of Neurological Training
effect is not real. Finally, the training effect will Is Actual Training Underlying
be influenced. the Mechanism of
It is necessary to be combine with actual “Goal and Motive”
motor program signal detection. In order to The mechanism of “goal and motive” is an effec-
increase the patients’ reality to simulation of tive mechanism to develop neural potential and
motor program signal. Virtual reality training recover lost motor function after CNS damages.
method is combined with training with actual On the basis of animation simulation of motor
motor program signal detection, which can program signal with surpassing goal, through
achieve good effect. Generally, in the first train- actual anti-resistance done by the patients’
ings of the patients in hospital, the training should manipulation, Virtual reality training system
be done in the actual motor program signal detec- guides the patients to try to surpass the elevation
tion to know practical situation of motor program constantly and promote neural potential in order
signal, which is good for the design of therapy to develop it further. During this process, these
method and is the reference index of therapy two factors play an important role.
effect. In addition, because actual motor program
signal keeps pace with joint motion dominated by 1. Virtual motor program signal elevation and
brain, the patients can feel the relationship of proportion: The elevation and proportion has
brain and movement and the existence of t motor no therapeutic effect, but they are essential.
program signal he patients. Consequently, the The elevation and motor program proportion
patients can establish the concept and impression are like the target of the archery, which is the
of joint motion dominated by motor program. definite orientation and surpassing goal for the
After that, the virtual reality training system is patients. Just as the jumper without transverse
applied for training and the patients are easy to bar are asked to jump and the archers are ask
enter into immersion state. Afterwards, every to shoot without target. No matter how to do
once in a while, such as 1 week, the training can the training, there is no improvement of the
be done in actual motor program signal detection performance (Fig. 5.5).
to observe therapy effect and to deepen the 2. Actual anti-resistance training: With the ele-
impression of the patients to motor program sig- vation but without body active movement
usually accompanied with cognitive disorder. It

is necessary to explain it to the patients repeat-
edly and the system can explain it at any time
without resting.
Automatic speech instruction of six-step
Daoyin technique in the system can keep the
enthusiasm of the patients through increasing the
volume of voice amplification system. In addition
system can provide the pathway of main and col-
Fig. 5.5 Transverse bar is essential for improving the lateral channels and animation light spot auto-
jump performance matic tracking display to guarantee the correct-
ness of regulation of mind in the pathway of main
and collateral channels and increase the function
dominated by brain, there is no effect. Only of clearing and activating the channels and col-
with definite surpassing goal, through genuine laterals, which is the basis for implementing
own efforts, the patients can complete method and promoting effect.
designed mission or surpass designed goal in
order to increase the ability. In the actual
training, the therapists exert resistance in the 5.3.2 T
he Function of Virtual
orientation of the patients’ joint motion and Neurological Training System
guide the patients to try to achieve or surpass
the goal with the instruction of Daoyin Virtual reality training system of neurological
technique speech together. It is a procee that trainin can satisfy the requirements of the theory
the patients try to achieve the goal by. and method of neurological training. Through
themselves and is the most important segment motor program signal and elevation of various
that can affect the results. animations generated by software, the system
can provide all kinds of feedback and surpassing
5.3.1.2 Speech Instruction, Mechanism goal for Daoyin technique and use automatic
Explanation and Function speech instruction and animation light spot
Display of Animation Light automatic tracking indication technique of main
Spot Automatic Tracking and collateral channels pathway to increase the
Guarantee the Correctness function of clearing and activating the channels
of Qi Guided in the Main and collaterals. The system overcomes the
and Collateral Channels shortcoming of high enthusiasm and labor
The system provides automatic speech explana- intensity, can relieve labor intensity of the
tion for mechanism with the accompany of ani- therapists electively and can provide safe “state
mation notice and use comprehensive public of emergency” created by speech that is good
language to explain the following aspects: How for potential development, which provide a
does the brain dominate body movement? What good condition for development of CNS
is motor program? Why there is motor dysfunc- potential, reestablishment of motor program and
tion after CNS damages? Why the function is improvement of motor function through Daoyin
improved through the therapy? These question technique.
can make the patients understand the pathogene- The comprehensive results of this system make
sis and therapy mechanism and increase the the patients know their own dysfunction and the
enthusiasm of the patients to take part in the mechanism of recovering function, which is good
training actively. The adequate understanding for increasing active cooperation and emphasize
from the patients is the spring of motivation. The on the consciousness of recovering CNS function.
patients with brain infarction and damages are Especially the patients can know their own motor
5.4 Clinical Experiment of Virtual Neurological Training System 175
dysfunction and the gap between dysfunction and and grass-roots clinics, which can prevent the
normal motor pattern. The system increases the defects of poor therapeutic effect induced by sim-
excitability of chasing goal and bridge the gap. ple equipment in grass-roots clinics and shortage
Through excitatory competitive inhibition of of doctors.
cerebral nuclei, the system can provide the goal of
attention diversion for the patients, which is good
for decreasing pathological inhibition of brain 5.4 Clinical Experiment
nuclei. Automatic speech explanation, indication of Virtual Neurological
and six-step Daoyin technique training speech Training System
instruction provide advantage of self-training and
quality guarantee of self-exercise for the patients. 5.4.1 Clinical Data
The theory of development of CNS potential,
reestablishment of motor program and remodel- 5.4.1.1 Sampling
ing of motor pattern is new. The method of six- From June 2007 to June 2009, there are 120
step Daoyin technique in traditional Chinese patients with hemiplegia who are all the inpa-
medicine of guiding collaterals through meridians tients in neurological rehabilitation training cen-
is new. The equipment is simplified and the com- ter in Beijing Tongren Hospital affiliated to
puter animation is at low cost. There are many Beijing’s Capital Medical University and neuro-
functions that are rational and scientific such as logical training ward of Hengxing rehabilitation
automatic speech, mechanism explanation and centre. There are 84 males and 36 females. The
many actual training unit. The therapeutic effect is age is from 45 to 85 years old. The average age is
high. The patients know what to do and how to do 52.1 years old. There are 58 patients with hemi-
and the system can let the patients keep high plegia after cerebral infarction, 36 patients with
enthusiasm, which is good for the improvement of hemiplegia after cerebral hemorrhage, 26 patients
training effect. The userage is comprehensive. It with hemiplegia after brain damage. There are 56
can be used in many training items such as motor patients with left hemiplegia and 64 patients with
center training, potential development training right hemiplegia. The patients are divided into
and physical exercise therapy of neurological two groups include virtual simulation group and
training. The moment the effect is improved, the neurological training group and there are 60
enjoyment is increased. patients in each group. Virtual reality group
Developed types at present include immobile includes 41 males and 19 females. The average
table type and portable type. There are many age is 51.8 years old. Neurological training group
functions such as divi-screen display, speech includes 43 males and 17 females. The average
indication, virtual simulation in immobile table age is 52.3 years old.
type. This type should be kept away from sound
and light. This type is mainly used for the severe 1. The inclusion criteria: According to the diag-
patients in the rehabilitation hall of the hospital. nostic criteria of national cerebrovascular dis-
There are many functions such as single screen ease conference in 1995, the hemiplegic
display, speech indication, virtual simulation in patients are diagnosed with cerebral infarction
portable type, which can be used in training hall or cerebral hemorrhage and by CT or MRI;
and at home. the patients without obvious dysgnosia
The core content of both types are motion sim- (MMSE score is more than or equal to 20);
ulation, virtual elevation, actual training, develop- There is no serious contracture of the knee
ment of CNS potential, reestablishment of motor joint or ankle joint and passive movement
program and remodeling of motor pattern. range is normal.
The training system not only can be used in 2. The exclusion criteria: The patients with

large hospital, but also can be used in community severe organ dysfunction such as heart and
lung, severe infectious disease, bone fracture, time for every joint is 10 min and the total
dyscrasia and so on cannot do rehabilitation time is 50 min.
training; the patients with severe cognitive 3. Potential development training of upper and
disorder or long-term drug use such as seda- lower limbs: Wenru brand potential develop-
tives, antidepressants and diazepam cannot ment training device of upper and lower limbs
cooperate with therapy; the patients with is produced by Beijing Xing Chen Wan You
frequent epileptic attack; the patients with dis- Science and Technology Ltd. Regulation of
eases such as various myopathy, bone and weight loss can make the patients’ upper
joint diseases and peripheral neuropathy that limbs to support the trunk and the lower limbs
can affect movement; the patients stop therapy support the standing. The weight is usually
for any reason or cannot persist in the therapy one-third to one-fifth of the patients’ body
for 90 times. weight. Six-step Daoyin technique in tradi-
tional Chinese medicine is used to guide the
5.4.1.2 Training Method patients to push up and down with upper
The training is done in the two groups according limbs, stand up and squat with lower limbs
to training method in three-stage of neurological and do body control ability training. Potential
training such as development of CNS potential, development training of upper and lower
reestablishment of motor program and remodel- limbs should be done separately. The training
ing of motor pattern. Virtual simulation group time is 30 min per time.
uses virtual reality training system of neurologi- 4. Motor pattern remodeling training: The first
cal training to do actual training through anima- is weight support treadmill training device
tion mechanism display and virtual signal and of abnormal gait rectification. Wenru weight
elevation. Neurological training group uses real- support treadmill training device of abnormal
time signal detection of neurological training gait rectification produced by Beijing Xing
instrument and the therapists explain to the Chen Wan You Science and Technology Ltd.
patients and guide the patients to do the training. and gait marked footpath are used for the
The other therapy methods are the same as the patients to do the training. Regulation of hip
content such as the training of shoulder abduc- flexion, lower limbs adduction and foot drop
tion, elbow extension, hip flexion, knee extension rectification elastic band can help the
and dorsiflexion of foot. patients to complete hip flexion, dorsiflexion
of foot and lower limbs adduction. The
1. Neurological training: Virtual simulation
training time is 30 min per time. The second
group use Daoyin feedback technique in tradi- is weight support stride and gait shifting of
tional Chinense medicine. Under the instruc- weight training. Wenru brand weight support
tion of virtual mechanism display and stride gait and shifting of weight training
automatic speech of simulation motor pro- device produced by Beijing Xing Chen Wan
gram signal and elevation, the therapists use You Science and Technology Ltd. The
anti-resistance training method, six-step weight is one-fifth to one-eighth of the
Daoyin technique in traditional Chinese medi- patients’ body weight. The therapists guide
cine and biofeedback to do the training. The the patients to do stride gait and shifting of
time for every joint is 10 min and the total weight training. The training time is 30 min
time is 50 min. per time. The third is weight support gait
2. Physical therapy of neurological training: The training. Wenru brand weight support gait
six-step method includes motor imagination training device is produced by Beijing Xing
and simulation, assembly of “energy”, confir- Chen Wan You Science and Technology Ltd.
mation of target point, trigger, insistence and The weight is one-fifth to one-eighth of the
relax. Six-step Daoyin technique in traditional patients’ body weight. Track rotation speed
Chinese medicine is used for the training. The of walking machine is started at 0.22 m/s.
5.4 Clinical Experiment of Virtual Neurological Training System 177
With the improvement of walking ability, 5.4.1.5 Results

the speed is increased gradually. The patients There is significant difference of Fugl-Meyer,
are guided to do the training according to the MMT, sEMG, ROM and ADL between prether-
gait mark on the track of walking machine. apy and post-treatment in virtual simulation
The training time is 30 min per time. The group and neurological training group
fourth is comprehensive walking training, (P < 0.001). At post-treatment, There is no
which includes balance bar or walking aid significant difference of Fugl-Meyer, MMT,

gait mark walking training, ascending and sEMG, ROM and ADL between virtual simula-
descending the stairs training and tion group and neurological training group
independent walking training on gait mark (P > 0.05). The results are referred to Tables 5.1,
way. The training time is 10 min per item 5.2, and 5.3.
and the total time is 30 min. The fifth is
upper limbs and hand function training, 5.4.1.6 Discussion
which includes tightening the nut, picking The key point of recovering motor dysfunction
up balls and fastening the button. The induced by CNS damages due to cardiac and
training time is 30 min per time. cerebrovascular disease is to recover CNS
functions, but CNS cells are lack of regeneration
The patients can do the training once every ability. The functional recovery requires the func-
day and the are 30 time in each stage. The total tion of normal cells around injured area and acti-
times are 90. The therapy items are adopted alter- vation of reserved conduction pathway. CNS
natively according to the specific condition of the plasticity and functional reorganization are pro-
patients. For example, in the training of the third moted to compensate the lost functions. The plas-
stage, for the patients with low myodynamia, the ticity and functional reorganization is in
potential development training can be added accordance with “skillful use and dependence”
properly. For the patients with uncoordinated principle. Only active movement can promote
movement, the reestablishment training can be CNS plasticity. A large number of reserved cen-
done on the basis of rectification of abnormal tral neural cells and conduction pathways are the
motor program. basis of CNS plasticity. The functions of reserved
central neural cells and conduction pathways are
5.4.1.3 Methods of Functional the basis of functional reorganization. Training
Assessment method is the process of CNS potential
At the beginning of the therapy and at the end of development.
the therapy, international general functional There is great potential in CNS and other tis-
assessment methods are used, which include sues of the body. These potentials can be acti-
Fugl-Meyer, Lovett manual muscle testing vated and used in specific condition. Their basis
(Lovett MMT), surface electromyogram signal or origin is come from the functional enhance-
(sEMG) strength and proportion, range of joint ment of tissues or organ cells. However, the
motion (ROM), and ability of daily life (ADL) number of involved cells is not decreased. On
assessment. The data is collected to establish the other hand, the reason may be the increase of
database. cell without functional enhancement of single
cells. There are both at the same time. However,
5.4.1.4 Statistical Analysis functional enhancement of single cell is limited.
The analysis results are showed as Mean ± SD The increase of involved cell number can
( X ± S). SPSS12.0 statistical software is used improve the entire function. Therefore, human
for statistic analysis. At pretherapy and post- potential is root in reserved body tissues and
treatment, within group therapy and between cells. For example, there are 140 billion brain
group therapy, T-test is used to compare the mean cells, but only 6% is in use. There are 300 mil-
of the two groups. lion alveoli in human lung and the area is 70 m2.
Table 5.1 Functional assessment scontrol table pretherapy and post-treatment of virtual simulation group ( X ± S)
Items Before therapy After therapy t P
MMT (grade) Deltoideus triangularis 2.20 ± 1.20 3.57 ± 0.95 14.86 P < 0.01
Musculus triceps brachii 1.97 ± 1.18 3.30 ± 1.18 16.42 P < 0.01
Hip flexor 2.43 ± 1.05 3.83 ± 0.76 14.20 P < 0.01
Quadriceps femoris 2.67 ± 1.05 4.18 ± 0.65 15.26 P < 0.01
Tibialis anterior muscle 1.28 ± 1.19 2.45 ± 1.35 10.93 P < 0.01
sEMG (µV) Deltoideus triangularis strength 34.17 ± 28.02 88.98 ± 42.88 13.87 P < 0.01
Musculus triceps brachii strength 32.63 ± 32.69 88.88 ± 66.54 9.60 P < 0.01
Musculus triceps brachii proportion 1.91 ± 1.58 5.29 ± 2.79 13.33 P < 0.01
Hip flexorstrength 21.03 ± 19.51 63.48 ± 42.34 11.28 P < 0.01
Quadriceps femoris strength 41.93 ± 30.24 106.88 ± 48.46 13.88 P < 0.01
Quadriceps femoris proportion 2.49 ± 1.61 6.01 ± 2.10 15.87 P < 0.01
Tibialis anterior muscle strength 15.05 ± 21.84 41.80 ± 35.26 9.33 P < 0.01
Tibialis anterior muscle proportion 1.39 ± 1.32 4.21 ± 2.26 13.22 P < 0.01
ROM (degree) Shoulder abduction 52.42° ± 47.61° 96.88° ± 48.03° 13.86 P < 0.01
Elbow extension 99.25° ± 32.79° 127.33° ± 31.86° 17.01 P < 0.01
Hip flexion 64.40° ± 32.18° 105.02° ± 22.86° 11.44 P < 0.01
Knee extension 114.58° ± 13.63° 132.92° ± 4.35° 11.20 P < 0.01
Dorflexison of foot 4.03° ± 8.19° 13.65° ± 11.03° 8.86 P < 0.01
FMA 34.10 ± 25.76 53.12 ± 22.31 13.43 P < 0.01
ADL 51.33 ± 25.28 77.33 ± 14.71 11.87 P < 0.01
Table 5.2 Functional assessment scontrol table pretherapy and post-treatment of neurological training group ( X ± S)
Items Pretherapy Post-treatment t P
MMT (grade) Deltoideus triangularis 1.92 ± 1.17 3.27 ± 0.84 14.75 P < 0.01
Musculus triceps brachii 1.80 ± 1.33 3.63 ± 0.52 9.66 P < 0.01
Hip flexor 1.92 ± 1.03 3.63 ± 0.52 13.88 P < 0.01
Quadriceps femoris 2.32 ± 1.00 3.97 ± 0.55 12.50 P < 0.01
Tibialis anterior muscle 1.23 ± 0.98 2.57 ± 1.13 9.39 P < 0.01
sEMG (μV) Deltoideus triangularis strength 18.63 ± 19.42 74.08 ± 40.56 16.1 P < 0.01
Musculus triceps brachii strength 30.38 ± 33.24 100.02 ± 64.37 11.93 P < 0.01
Musculus triceps brachiiproportion 2.47 ± 1.52 6.28 ± 2.89 13.09 P < 0.01
Hip flexor strength 27.27 ± 17.51 74.75 ± 29.48 16.47 P < 0.01
Quadriceps femoris strength 46.52 ± 34.80 112.08 ± 42.15 18.06 P < 0.01
Quadriceps femorisproportion 2.38 ± 1.83 5.66 ± 1.88 12.75 P < 0.01
Tibialis anterior muscle strength 11.13 ± 9.49 41.38 ± 25.58 10.61 P < 0.01
Tibialis anterior muscle proportion 2.41 ± 1.24 4.86 ± 2.04 12.08 P < 0.01
ROM (degree) Shoulder abduction 47.93° ± 35.85° 96.10° ± 43.19 19.83 P < 0.01
Elbow extension 101.75° ± 11.38° 130.75° ± 5.03 19.81 P < 0.01
Hip flexion 51.25° ± 27.32° 100.58° ± 19.18° 18.57 P < 0.01
Knee extension 112.67° ± 12.30° 134.08° ± 4.17° 13.17 P < 0.01
Dorflexison of foot 3.07° ± 4.39° 10.53° ± 6.04° 12.03 P < 0.01
FMA 31.02 ± 17.64 60.55 ± 19.54 16.08 P < 0.01
ADL 35.75 ± 20.66 75.08 ± 15.00 19.45 P < 0.01
Table 5.3 Functional assessments control table post-treatment of virtual simulation group and neurological training group ( X ± S)
Items Post-treatment of virtual simulation group Post-treatment of neurological training group t P
MMT (grade) Deltoideus triangularis 3.57 ± 0.95 3.27 ± 0.84 1.84 P > 0.05
Musculus triceps brachii 3.30 ± 1.18 3.02 ± 1.00 1.42 P > 0.05
Hip flexor 3.83 ± 0.76 3.63 ± 0.52 1.68 P > 0.05
Quadriceps femoris 4.18 ± 0.65 3.97 ± 0.55 1.97 P > 0.05
Tibialis anterior muscle 2.45 ± 1.35 2.57 ± 1.13 0.51 P > 0.05
sEMG (μV) Deltoideus triangularis strength 88.98 ± 42.88 74.08 ± 40.56 1.96 P > 0.05
Musculus triceps brachii strength 88.88 ± 66.54 100.02 ± 64.37 0.93 P > 0.05
Musculus triceps brachiiproportion 5.29 ± 2.79 6.28 ± 2.89 1.91 P > 0.05
Hip flexorstrength 63.48 ± 42.34 74.75 ± 29.48 1.69 P > 0.05
Quadriceps femoris strength 106.88 ± 48.46 112.08 ± 42.15 0.63 P > 0.05
Quadriceps femorisproportion 6.01 ± 2.10 5.66 ± 1.88 0.97 P > 0.05
5.4 Clinical Experiment of Virtual Neurological Training System
Tibialis anterior muscle strength 41.80 ± 35.26 41.38 ± 25.58 0.07 P > 0.05

Tibialis anterior muscle proportion 4.21 ± 2.26 4.86 ± 2.04 1.67 P > 0.05
ROM (degree) Shoulder abduction 96.88° ± 48.03° 96.10° ± 43.19° 0.09 P > 0.05
Elbow extension 127.33° ± 31.86° 130.75° ± 5.03° 0.82 P > 0.05
Hip flexion 105.02° ± 22.86° 100.58° ± 19.18° 1.15 P > 0.05
Knee extension 132.92° ± 4.35° 134.08° ± 4.17° 1.50 P > 0.05
Dorflexison of foot 13.65° ± 11.03° 10.53° ± 6.04° 1.92 P > 0.05
FMA 53.12 ± 22.31 60.55 ± 19.54 1.94 P > 0.05
ADL 77.33 ± 14.71 75.08 ± 15.00 0.83 P > 0.05
179
Generally, only 1.8 million cells and 40 m2 area • Real-time reception and display of motor pro-
are in use. It is always the case in other tissues gram signal
and organs such as reserved conduction pathway • The scheme of rectification of disordered
of nervous system, blood reserve and muscle tis- motor program and reestablishment of normal
sue reserve. When needed, these reserve can motor program and the setting of the goal
play functions. Previous training and special
education are the premise to develop human Neurological training rehabilitation method is
potential. For a bridle-wise person, in an emer- a therapy of active movement, which requires the
gency, strong will and great potential may be involvement of the patients actively. Therefore,
activated. On the contrary, for a person without the patients’ understanding of the mechanisms of
training and mental preparation, in an emer- therapy method that includes the mechanism of
gency, not only the potential cannot be activated, recovery and formation of motor dysfunction is
but also the function of nervous system is para- the important factor that can influence the ther-
lyzed. Not only the ability of resisting and apy process and effect. Meanwhile, training
defending danger cannot be improved, but also effect is affected by comprehension and memory
the function is decreased. And then the patients of the patients, comprehension and expression
are in a dangerous and passive situation. of the therapists to therapy method. Because the
Potential can be activated in special condition therapists cannot use the method correctly,
such as state of emergency and there is no poten- the therapy goal cannot be achieved. Because the
tial ability in normal condition. The potential patients misunderstand the mechanism, the ther-
ability in state of emergency can be transferred to apeutic effect is influenced.
ability in normal condition through rehabilitation In the process of six-step Daoyin technique in
training, which is the important mechanism of traditional Chinese medicine, the therapists use
motor function recovery after CNS damages. At speech to guide the patients to regulate mind and
present, rehabilitation methods such as Bobath, breath and then regulate movement on the basis
Rood, Brunnstrom and PNF developed in 1950s of regulation of mind and breath. Regulation of
abroad have a weak effect on functional recovery movement is completing active movement of
of CNS, because they take primary reflexes such some joint such as dorflexison of foot. In this pro-
as myotatic reflex and tonic neck reflex, passive cess, the correctness, passion and encourage
movement and efferent stimulus as the principal words of Daoyin methods and the encourage
thing. The effect of rehabilitation therapy is dis- degree of the patients are directly related to thera-
satisfactory [2]. peutic effect. Especially when the curve of ago-
Zhao Wenru improves ancient Daoyin tech- nistic muscle reaches the peak last time and the
nique in traditional Chinese medicine to six step therapists ask the patients to try to surpass it, the
method that can be used for clinic. On the basis therapists should raise the voice and encourage
of that, neurological training rehabilitation ther- the patients with passion. One therapist do this
apy technique is developed. Bio-electricity signal job in a short time and treats several patients
reception device is used to receive motor pro- every day. They can keep high enthusiasm. If the
gram signal real-timely and display it in a curve therapist do this job for a long time and treats
form. Motor program signal is used as feedback 8–10 patients every day, it is difficulty for him to
signal and Daoyin technique is used repeatedly to keep high enthusiasm.
do motor program training with a purpose. The The sensitivity of human bioelectrical signal
effect of this method is related to the factors as reception and display equipment is high and the
follows. equipment can receive interference signal of
electrocardio on the skin surface of lower limbs
• The patients’ understanding of therapy muscle. The signal of vehicle and cellphone in
mechanism the surroundings can affect the reception greatly.
• Correctness and passion of the therapists use The equipment works in room A, but cannot
six-step Daoyin technique work in romm B. The equipment works today,
Reference 181
cannot work tomorrow. Therefore, the equipment found that VR has some therapeutic effects on
should be installed in a good environment such as hemiplegia [3], but this is because VR is used to
deep medical ground electrode and copper net ease the patients’ mood with display of com-
shield. In spite of this, the therapy is usually dis- pleted functional movement. The patients can
turbed. In addition, the signal detection equip- observe their actual movement. When the patients
ment is expensive, which can increase the clinical cannot complete active movement with auto-
cost and family burden. It is difficulty to popular- nomic movement deficiency, virtual reality tech-
ize and apply, especially in grass roots, commu- nique cannot affect it too. VR technique is lack of
nity hospital and health-center. the actual rehabilitation training process such as
According to the requirements of neurological neural potential development, motor program
trainingrehabilitation therapy, the patients should reestablishment and motor pattern remodeling,
fully understand therapy methods. The therapists which can influence practical therapy value and
should use six-step Daoyin technique correctly meaning.
and encourage the patients with high passion. The Virtual reality training system of neurological
defects of motor program signal detection training is appropriate for the therapy of neural
equipment, the mechanism of “goal and motive” potential development and motor program
and the anti-resistance in the orientation of joint reestablishment and is the rehabilitation training
motion are basic requirements. The patients equipment with rational design. It is simple and
understand the basic procedures of therapy and the at low cost. The patients can better understand
mechanism of functional recovery through virtual the therapy mechanism and can be motivated to
animation. Through simulation of motor program take part in the therapy with it, which can alleviate
signal curve and elevation, the objective goal is labor intensity of the therapists and improve
provided for the patients to surpass. Through six- therapeutic effect at the same time.
step Daoyin technique indication record, high
passion and encourage can be maintained. In the
orientation of joint motion, the therapists can exert Reference
proper resistance to develop neural potential.
Rehabilitation is the process of achieving goal 1. Burdea G, Patounakis G, Popescu V, et al. Virtual
reality-based training for the diagnosis of prostate can-
through special training method. The main differ- cer. IEEE Trans Biomed Eng. 1999;46(10):1253–60.
ence between virtual reality training system and 2. Sik Lanyi C, Laky V, Tilinger A, et al. Developing
virtual reality technique invented in 1960s is that multimedia software and virtual reality worlds and
VR is the virtual environment created by com- their use in rehabilitation and psychology. Stud Health
Technol Inform. 2004;105:273–84.
puto. Through immersion, interaction and imagi- 3. You SH, Jang SH, Kim YH, et al. Virtual reality-
nation, the users can throw them into the virtual induced cortical reorganization and associated locomo-
environment and the users can interact with vir- tor recovery in chronic stroke: an experimenter-blind
tual environment naturally. Some researchers randomized study. Stroke. 2005;36(6):116–7.
Rehabilitation Methods
of Neurological Training in Special 6
Diseases
6.1 Rehabilitation Methods cannot cooperate with the therapists to do reha-

of Neurological Training bilitation training that take active movement as
of Recovering Motor the principal thing and can promote CNS plastic-
Function in the Patients ity. The doctors and the therapists feel confused
with Severe on these patients. They have nothing to do but
Unconsciousness adopt some sustained rehabilitation measures
with passive movement and afferent stimulus that
6.1.1 Theoretical Foundation is difficulty to achieve effect.
of Motor Function Recovery For the patients with severe disturbance of
Training in the Patients consciousness, do they do rehabilitation training
with Severe Unconsciousness of functional recovery? At first, we should ascer-
tain and re-recognize the diagnosis and prognosis
In this section, we introduce the knowledge of the of various disturbance of consciousness.
patients with severe disturbance of consciousness A lot of people think that the wake up possi-
that include vegetative state and minimum con- bility of Vegetative state is low, but some paper
scious state. Rehabilitation methods of neurolog- demonstrated [3–5] that the recovery rate of VS
ical training and mechanism of motor function induced by traumatic accident 1 year after the
recovery is introduced. We don’t discuss the accident is about 50% and the recovery rate of VS
pathogenesis of these diseases and associated without traumatic accident is 15%. In addition,
progress of therapy. However, for understanding there are some reports that family affection is
and clinical application, we should introduce used to wake up VS in life. All these demon-
diagnosis, cardinal syndromes, classification and strated that the patients with disturbance of con-
main therapy method of disturbance of consciousness are able to recover conscience, which
sciousness in this chapter. Associated functional include the patients in vegetative state and mini-
assessment of conscience is not introduced in this mum conscious state. In addition, we know little
book. Please refer to associated professional about human CNS and the mechanism of forma-
books about rehabilitation assessment. tion and recovery of disturbance of conscious-
The patients with severe disturbance of con- ness. Therefore, it is necessary to research and
sciousness, especially the patients in vegetative investigate further.
state VS: Vegetative State [1] and minimum We can be enlightened by noctambulism.
conscious state [2], totally lose cognitive ability Sleepwalk is a variant conscious state and the
and communicative competence. Therefore, they incidence rate is 1–6%. The number of Children
https://doi.org/10.1007/978-981-13-0812-3_6
184 6 Rehabilitation Methods of Neurological Training in Special Diseases
with sleep walk is more than that of adult with On November 10, 2011, there is a paper in The
sleepwalk. There is usually a family history. Lancet found that electroencephalogram (EEG)
When in sleepwalk, the patients can complete can test latent consciousness in the patient is with
some kind of job, movement or complicated VS. Compared with functional magnetic reso-
operation unconsciously and speak the language nance imaging (fMRI) that can test slight con-
that cannot be understand. When the sleepwalk is sciousness in the patients with VS, it is convenient
ended, the patients know nothing about the sleep- and at low cost, which is not affected by metal
walk experience. This seems that human motor implant.
function can be separated from conscious state of In this study, the researchers examined 16
self- sobriety. This may be the factual basis for patients with VS due to brain damages (trauma
the patients with low conscious state to do motor and anoxia) and 12 healthy control. When they
function training. wear the electroencephalogram monitor, the ther-
In addition, in the clinical rehabilitation work, apist asked the patient to imagine they can move
the author found that at present, myodynamia their own fingers or toes. The researchers found
assessment criteria at home and abroad is Lovett that just like healthy control, three patients with
MMT (manual muscle test). The therapists use brain damages can generate two different kinds
hands to feel the muscle contraction or the ability of motor pattern according to command. One of
of anti-resistance to judge the myodynamia. The the patients did it for more than 200 times that is
myodynamia is zero in this test, which doesn’t more than that of healthy control. The research-
mean the muscle is paralyzed, because the human ers deemed that a new classification system is
perception is limited. Three hundred and forty- required to reflect the actual condition of these
three muscles are tested by Lovett MMT with patients more precisely. Although they are diag-
zero myodynamia. Surface electromyogram sig- nosed with VS, some of them are actually not in
nal equipment is used to test them again and the VS. VS actually is a new definition of behavior
results show that there are only 11 muscles with energy syndrome.
zero myodymania, because the sensitivity of bio- From the discussion above, we can conclude
electrical signal reception device is 300 times the following points:
more than human perception. Moreover, preci-
sion of the equipment can be increased with the 1. The patients with VS can change or wake up
improvement of industrial level of electronic with the time or stimulated by some kind of
instrument. For example, if we use hour as mea- factor. Some researchers found that 1 year
surement criteria for human running speed, we after trauma, the recovery rate of conscious-
cannot tell the difference of running ability ness is about 50%, but the recovery rate of
between man and man. If we use second as mea- consciousness in the patients without trauma
surement criteria for human running speed, we is only 15%.
can tell the difference of running ability between 2. Human motor function can be separated from
man and man. If we use millisecond as measure- conscious state. This may be the factual basis
ment criteria for human running speed, we can for the patients in unconscious state to do
tell the minor difference of running ability motor function training.
between man and man. 3. Through the investigation of EEG and MRI,
Similarly, the diagnostic criteria of VS in according to clinical diagnosis criteria at pres-
“Nanjing Standard 2001” established in our ent, some of the patients with VS are proved to
country include lost cognitive function, uncon- have conscious reaction and they are not actual
scious activities and inability of executing in VS. The researchers think that the assess-
instruction. All these measurement criteria are ment method at present is not precise, which
dependent on the subjective perception and expe- require more precise assessment criteria.
rience. The measurement is broad and not pre-
cise. If we used more sensitive method to assess Some research found that even the patients
the VS, the diagnosis of VS can be decreased. have been injured for many years and had no
6.1 Rehabilitation Methods of Neurological Training of Recovering Motor Function in the Patients… 185
response ability. It is necessary to re-assess 1. Coma: coma is a severe pathological distur-

the condition. Especially there is some bance of consciousness. There is close binoc-
improvement noticed by the family or other ulus, no spontaneous opening eyes and no
people. sleep-wake circle, which are different from
In a word, whether from the fact that the the syndromes of VS. Severe patients can lose
patients with VS are possible to wake up with any cognitive function and motor function.
time, or from the fact that some patients can The vital signs cannot be maintained. Life
wake up because of incorrect diagnosis, it is the support system such as breathing machine and
truth that some patients with VS can wake up. medicine are used to keep them alive.
Form the rehabilitation medicine, we don’t 2. Locked-in syndrome: this syndrome is usually
think that rehabilitation training of the patients in the condition that both side of corticobulbar
with VS is not valuable and merely do sustained tract and corticospinal tract are damaged. The
training. We should improve the training patients to almost completely lose motor func-
method constantly in order to be adaptable to tion. There is only opening eyes, closing eyes
the recovery training of consciousness and or slight eyeball movement in the patients
motor function of the patients with VS and low with complete perception and cognitive func-
conscious state. tion. In clinic, the patients can response to the
command through opening and closing eyes.
3. Minimum conscious state (MCS): this belongs
6.1.2 T
he Introduction of Severe to severe disordered conscious state. The
Unconsciousness patients can have cognitive function to them-
selves or outside world, spontaneous opening
6.1.2.1 Classification of Severe eyes and sleep-wake circle.
Unconsciousness 4. The part of vegetative state includes the defi-
Severe unconsciousness includes brain death, nition, clinical manifestation and diagnosis
coma, VS, minimum conscious state and locked- criteria of vegetative state (Table 6.1).
in syndrome. All kinds of diagnostic characteris-
(a) The definition of vegetative state: the
tics referred to Table 6.1. brain is damaged due to some kind of rea-
The definition and connotation of conscious- son. The patients lost the cognitive func-
ness: Consciousness is the perception and com- tion to themselves and outside world, but
prehensive function of human body to themselves they can open eyes and have sleep-wake
or outside world, which include the level, the circle. The function of hypothalamus and
range, the content. The maintenance of normal brain stem is maintained.
sober conscious state is dependent on the ascend- (b) Clinical manifestations of vegetative

ing reticular activating system of brain stem, state: the clinical manifestations of the
relay integration of thalamus and cortex patients with VS are diverse, but the basic
function. characteristic is no perception function to
Table 6.1 Clinical diagnostic characteristics of disturbance of consciousness

Sleep-wake Brain stem
Classification Cognitive function circle function EEG
Coma Lost None Stable or change Severe abnormal
Locked-in syndrome Definitely exist Yes Complete Normal
Minimum conscious Limited but definitely Yes Basic complete Severe abnormal
state exist
Vegetative state Lost Yes Basic complete Severe abnormal
Brain death Lost No No Mostly electrocerebral
silence
outside world or themselves such as sense 1. Traditional Chinese medicine: In traditional

and perception, memory, thinking, emo- Chinese medicine, severe disturbance of con-
tion and willpower. The patients can open sciousness belongs to neurological disease of
eyes, but there is no spontaneous speech. heart and brain, which is induced by invasion
They cannot understand others’ words. of evil into heart and brain or blockage of
There is entire or partial sleep-wake cir- heart and brain by exhaustion of qi and blood.
cle. There is unconscious movement in The common therapy methods include acu-
the body and there is no response to pain. puncture and moxibustion, massage and
There is entire or partial brainstem Chinese medicine, which can dredge brain,
reflexes such as pupillary light reflex, cor- dredge main and collateral channels and clear-
neal reflection and eyelash reflex, cough ing away the heart-fire, especially the injec-
reflex, swallowing reflex and sucking tion made from prescription in ancient time
reflex. The vital signs are stable. through modern purification technology such
(c) Diagnosis criteria of vegetative state: The as restoring consciousness jing. They are
cognitive function is lost. There is no con- widely used in clinic and play an important
scious movement and the patients cannot role in treating the patients with disturbance
execute instruction. The patients can open of consciousness.
eyes autonomously or under stimulus. 2. Hyperbaric oxygen therapy: Hyperbaric oxy-
There is sleep-wake circle. There is eye- gen therapy is the essential method to treat the
ball tracking movement without purpose. patients with CNS damages and low con-
The patients cannot speak and understand scious state, which is recognized domestic
the words. They can keep autonomous res- and overseas [6, 7]. Some reports think that
piration and blood pressure. The function the quicker hyperbaric oxygen therapy starts,
of hypothalamus and brainstem is normal. the longer the therapy course takes, the better
(d) Diagnosis criteria of permanent vegetative the therapeutic effect is. The principal mecha-
state: traumatic VS lasts more than nism is to improve the oxygen supply of brain
12 months and non-traumatic VS lasts cells and the function of the cells in reversible
more than three months, which can be state can be recovered, which can promote
diagnosed with permanent vegetative neural function recovery. Some papers found
state. that the recommend oxygen pressure is 1.5
(e) Brain death: Whole brain functions ATA. The therapy time is 1–2 times every day
including brainstem are damaged and lost and 5 time for a week. The therapy course
irreversibly. There are no brainstem includes 30–40 days. The severe patients can
reflexes and autonomous respiration. Life receive 200 times.
support system must be used to keep them 3. Neural electric stimulation therapy includes
alive such as breathing machine. electrical stimulus of peripheral nerve, high
cervical spinal cord and deep brain.
6.1.2.2 Current Situation of Therapy (a) Peripheral neural electric stimulation: it
Methods of Severe belongs to low-frequency electrical stim-
Unconsciousness ulation. Bilateral nervus peronaeus or ner-
vus medianus are stimulated constantly,
At present, there is no definite and effective mea- which have an effect on activating
sures in the therapy of severe disturbance of con- electroencephalogram to promote wake-
sciousness. Except for etiotropic therapy, there up of brain, but it is not widely used in
are many comprehensive measures such as nurs- clinic at present.
ing, nutritional support, medicine, traditional (b) High cervical spinal cord electric stimula-
Chinese medicine, hyperbaric oxygen, electric tion: Because the electrode of cervical
stimulation and rehabilitation. spinal cord should be implanted through
surgery, the required condition is high and mature. The practicability and reliability
it is difficulty to be kept for a long time, it remain further study and discussion.
is unable to be used.
(e) Rehabilitation methods: At present, the
At present, the most widely used is purpose of rehabilitation therapy for this
high cervical spinal cord electric stimula- kind of patients is maintenance therapy
tion. In general anesthesia, the electrodes such as physical therapy, homework ther-
are placed in the middle part outside of apy, speech therapy and psychological
dura mater from the second spine to the therapy. The Rood method is the main
fourth spine. Electric intensity is from 2 to method. Flapping quickly, squeezing and
5 V/0.1–0.5 ms. The frequency is 100 pressing, ice compress and hot water to
times/s. It is amplified to 15–25%. The stimulate the skin and sensitive part of the
stimulation time is 6–12 a day. If the elec- patients such as hand, foot and face to
trodes are placed subdural, electric inten- stimulate and induce autonomic movement
sity can be decreased 50%. The mechanism of the patients. Neuromuscular propriocep-
is that electricity go up through cervical tion promotion method is used to do pas-
cord to brainstem and finally reach cere- sive movement. Through deep sensation of
bral cortex through ascending reticular joint, central nerves can be connected and
activating system and activation system of the training of maintaining and recovering
hypothalamus. Animals experiment found joint motion can be done. And then the
that electric stimulation can increase the training is transmitted to standing balance
acetyl choline in brain, improve brain and standing in cant board training. These
electrical activity, increase α wave and training can improve the respiration, circu-
decrease slow wave. For the patients with lation, digestion and urinary system of the
severe disturbance of consciousness patients in VS. It is also important to
induced by head damages, anoxic enceph- enhancing the bearing ability of bone joint.
alopathy and cerebrovascular disease,
there are some certain effect. Various kinds of electro-optics stimulation
(c) Deep brain electric stimulation includes such as ultrasound, frequency spectrum and infra-
electric stimulation of thalamus, brain- red ray can improve brain blood flow and promote
stem, midbrain and epencephalon. metabolism of neural cells. Electric stimulates
Deep brain electric stimulation can peripheral nerves and muscles and photothermic
increase the excitability of reticular for- effect improves body dysfunction. In speech ther-
mation of brain stem, activate ascending apy, there is entire or partial conduction pathway
reticular system and wake up cerebral cor- of audio, vision and touch in the patients without
tex. This operation can be done through conscious activities. Visual and auditory stimuli
stereotactic operation and the stimulation are presented to the patients. Meanwhile, the vocal
electrodes are placed into cuneiform organ is stimulated such as stimulating oral cavity
nucleus of reticular formation of midbrain with ice swab and perioral muscles training.
or non-specific nucleus of thalamus. The
reception device is in subcutaneous of col-
pus. The stimulation time is more than 6.1.3 C
ompulsive Active Movement
6 months. The electrode should be kept for Method of Neurological
3–24 months. Some papers found that the Training of Recovering Motor
therapeutic effect is definite. Some patients Function of the Patients
waked up from VS and the EEG showed with Severe Disturbance
that there was arousal reaction. The brain of Consciousness
blood flow was improved.
(d) Neural stem cells transplantation is the According to the fact that consciousness can be
hot spot in research at present, but it is not separated from movement, at present, it is not
precise to judge the level of unconsciousness and lower limbs, the author developed weight sup-
the factors such as safe state of emergency that is port and protect system of potential develop-
good for potential development. Except for main- ment training device in upper limbs and lower
tained rehabilitation training and deep brain elec- limbs to make the patients in low conscious
tric stimulation, the author studies the methods in state and the patients without standing ability
allusion to recovering motor function and con- to keep in standing position and not to fall
sciousness of the patients with severe uncon- down or bump in the training.
sciousness. Compulsive active movements Compulsive active movement in upper
induced by positioning have achieved some cer- limbs and lower limbs lower limbs, it is easy
tain effects in clinic. to do compulsive active movement training in
lower limbs and the effect is better. For the
6.1.3.1 The Mechanism of Compulsive patients with severe dysfunction of conscious
Active Movements state, it is difficulty to do compulsive active
Except for the patients with brain death and severe movement training in upper limbs. Compared
disturbance of consciousness, the patients can with compulsive active movement training in
have some certain consciousness and the ability of upper limbs, compulsive active movement
responding to external stimulus. If there are some training in lower limbs can enlarge or enhance
methods to amplify or enhance the consciousness the existing consciousness and reaction ability
and reaction ability, it is possible to promote con- better.
sciousness recovery and functional recovery 2. Training Methods: Example of Compulsive
including movement controlled by consciousness. Active Movement Training in Lower Limbs.
Under safe state of emergency, active movement In clinostatism, the patients wear weight
can activate and amplify the existing conscious- support chest thigh band, with help of the
ness and reaction. For example, human can be therapists, the patients are in standing position
motivated to a superman in dangerous condition. and connect the hook of chest band to weight
Compulsive active movement of neurological support hook of potential development train-
training is non-subjective consciousness move- ing device in lower limbs. The therapists regu-
ment using specific equipment and human assis- late the weight in order to make the patients
tance. Because of sudden change of assisted keep in standing position with slight assis-
dynamics, the patients can be motivated to do resistance. According to the specific condition of
tivity active response movement that is instructed the patients such as body weight, lower limbs
by deep consciousness and is good for eliminating myodynamia and cardio-pulmonary function,
danger. After repeated training of this kind of the number of people that should take part in
movement, the existing consciousness and reaction the training and the assistance can be ascer-
ability are amplified and enhanced, which can pro- tained. Generally, the training requires 2–3
mote waking up and motor function recovery. people and they stand two side and behind the
patients. People grasp the waist training band
6.1.3.2 Training Equipment separately, one person commands the other
and Training Methods people involved in the training and make the
Because the patients are in unconscious state, patients from standing position to kneeling-
they cannot stand up and cooperate with move- squatting position. The depth of squatting is
ment. Therefore, developing the equipment that progressive, from 15° flexion of hip and knee
can make the patients to stand and move is key to 150°. And then, the therapists guide with
point of the training and is a tool to implement speech or play Daoyin technique record to
the method. help the patients to stand up slowly and in a
constant speed. Ascending every 5°, the three
1. On the basis of training equipment of compul- people should withdraw the force and grasp
sive active movement in upper limbs and waist training band. When the patients fall
down suddenly, they yell out “stand up, or you (e) Application of sudden postural change:
will fall down”. Generally, the patient’s body sudden postural change is the key point in
will react to the voice. Meanwhile, the thera- the training. Because the therapists only
pists should help the patients back to the origi- use sudden postural change but not uni-
nal position and help the patients to continue form and slow postural with proper
the training. Daoyin speech to create real state of
One training includes three groups and one emergency, which can motivate deep con-
group includes ten squatting training. The sciousness of the patients and amplify and
break between groups is 2 min. The training recover consciousness.
time is 30 min and one therapy course includes (f) The training of compulsive active walking
30 times. After completion of one therapy in lower limbs: For the unconscious
course, the therapists do the assessment and patients without standing and walking
decide to do the training of next therapy or ability, the training can help them to stand
not. The total training usually takes 3 months. and walk to recover the consciousness
3 . Cautions and walking ability of the patients. It is
(a) Training of improving cardio-pulmonary the training that can help the application
function: before training, the training of of Daoyin technique.
standing bed should be done first to • The training mechanism of compulsive
enhance cardiovascular response ability active walking in lower limbs: human
and bearing ability. When the patients can walking center is located in sacral spi-
keep at 90° position for more than 30 min nal cord. In the patients with in
and the vital signs are stable, this training extremely low conscious state, because
can be done. of long-term bed, the excitability of
(b) Preparation of range of joint: there are walking center is very low, even totally
adhesion of muscle and joint, even tendon be lost. Therefore, recovering the
contracture in the patients without reha- excitability of walking center is the
bilitation therapy even joint motion for a prerequisite to recover the walking
long time. Therefore, before doing com- ability of the patients. Assisted walk-
pulsive movement training in lower limbs, ing training in standing state is actual
the training of range of joint should be walking with bearing load of lower
done. Traction, physiotherapy and manip- limbs and constant stimulation of deep
ulation are used to relax the adhesion of sensation. Lower limbs walking sup-
joint and muscle. Meanwhile, constant port devices that are fixed on support
passive movement equipment is used to frame are connected with bearing.
achieve a better effect. Artificial hip and knee joint are bear-
(c) Prevention of accidental injury: because ings, which can increase the flexibility
of long-term bed, this kind of patients of joint motion in walking and make it
have severe osteoporosis. Through stand- suitable for the walking training of the
ing bed training, the patients get better, patients in low conscious state. In
but there is still osteoporosis. During addition, artificial hip and knee joint
training, the therapists should keep eyes are equipped with rotation resistance
on the force in case of bone fracture and regulation device that can increase the
soft tissue injury. resistance and difficulty of lower limbs
(d) For very weak patients with long-term
in the process of stepping forward and
bed, the training should be done with make it suitable for the walking train-
electrocardiograph monitoring. Once ing of the patients in consciousness
there is abnormal situation, the training recovery with bad walking ability in
should be stopped in case of accident. order to develop potential, increase the
excitability of walking motor center joint resistance device of walking sup-

and actual walking ability. port device of lower limbs according
• Walking training device or equipment to “step by step” principle to do the
for severe patients: training device is training with proper walking
mechanical equipment without power- difficulty.
driven and feedback functions. Before the patients’ consciousness
Training equipment is modified from is not recovered, because there is no
training device. Training equipment walking ability, at the time of playing
can detect and display motor program walking instruction record, the thera-
signal of quadriceps femoris in walk- pists pull the hauling cable of hip flex-
ing or resistance signal in walking, ion fixed on knee joint to help the
which is a biological feedback func- patients coordinate step movement
tion and make the patients do the train- synchronized with record. When the
ing with a purpose (Fig. 6.1). stepping leg is on the process of rising,
During training, the patients stand the therapists suddenly loose the haul-
on the exoskeleton of lower limbs of ing cable of hip flexion and encourage
gait training device and fix the fixing the patients “raise up or you will fall
band. According to practical condition down” and “pass over or you will
of the patients, weight support system bump”. Meanwhile, the therapists try
is used to regulate weight to make the to lift the falling leg and motivate the
patients keep in standing position. The consciousness recovery of the patients.
therapists stand on the pedal or both • Training time and therapy course: The
sides (when there is no pedal training training time is 30 min every time and
device) of gait training device of lower there are 30 times in one therapy
limbs and the therapists regulate the course. After one therapy course, the
resistance of artificial hip and knee effect should be reevaluated and the
Fig. 6.1 Gait training

equipment of severe
patients
6.2 Rehabilitation Methods of Neurological Training of Muscle with Zero Myodynamia 191
therapists decide to do the training of jective consciously, the rehabilitation methods of

next therapy course or not. The train- this kind of muscle are only passive methods
ing takes three months or longer time. such as flapping, stretching, massage and electric
• Cautions: The cautions are the same as stimulation, which can increase the excitability
these in compulsive active movement of the paralyzed muscle. Because these methods
training of lower limbs. cannot promote SND plasticity and potential
development, the therapeutic effect is not good.
The therapy of severe disturbance of con- However, there is no better training method and
sciousness introduced in this chapter is one of the there is no target for the training. Because the
unsolved problems in clinic. Although there are patients cannot see muscle contraction, joint
many therapy methods, it is hard to ascertain motion and any training effect, they are easy to
which method is effective. The operating mecha- lose enthusiasm of the therapy, even give up.
nism of CNS and therapy and rehabilitation train-
ing of nervous diseases require further
investigation and study. 6.2.1 The Mechanism
EEG has reference value for the prognosis of of Rehabilitation Training
the patients with severe disturbance of conscious- of Neurological Training
ness. Normal EEG is composed of three wave- of Zero Myodynamia
forms and basic amplitude symmetry such as α, β,
δ and two hemispheres asymmetry. The wave- Through the change of training mode and subjec-
forms of coma are mainly flat wave and slow tive indicator of myodynami, the training under
wave. If there is β wave, the patients may wake “goal and motive” mechanism can induce active
up. If the patients have sensitive reaction, the movement training. Muscles dominated by CNS
prognosis is good. Flat wave is the wave stand for are induced to complete joint motion, which can
brain cells death. Slow wave is the wave stand for promote CNS plasticity and functional reorgani-
brain cells apoptosis, which indicate that there are zation. Finally, the voluntary contraction of the
a few brain cells still alive. Apoptosis wave may muscle can be recovered and lost motor function
recover to normal wave such as α and β waves. can be recovered to varying degrees.
The change of training mode: Guided by six-
step Daoyin technique, through change of body
6.2 Rehabilitation Methods posture such as standing up and squatting, the
of Neurological Training purpose of compelling and helping active move-
of Muscle with Zero ment training can be achieved. Meanwhile,
Myodynamia Daoyin speech with safe state of emergency can
encourage the patients to try to complete intended
After central and peripheral nerve injury, there is goal with the help of the therapists. During this
disability phenomenon of the dominated muscle, process, CNS potential can be developed and uti-
unconscious muscle contraction. In clinic, man- lized to promote plasticity and functional
ual muscle test is used to assess myodynamia in reorganization.
order to find the degree and the reason of low The change of subjective indicators of myody-
myodynamia, which is important for musculo- namia: according to the intensity of myodynamia,
skeletal and nervous system lesion, especially within limits, it is in direct proportion to drive
functional assessment of peripheral nerve lesion. signal from CNS to muscle and the signal
In this section, we mainly discuss the recovery recovery is quicker than myodynamia recovery.
training method of muscle with zero myody- This signal can be measured by V, mV and μV,
namia tested by manual muscle test. Because the which makes very weak signal become visible
patients with zero myodynamia cannot do auto- indicator. During the process that Daoyin tech-
matic muscle contraction and joint motion sub- nique is used to guide the patients to use brain to
control joint motion. Through bioelectrical signal target and destination of muscle drive signal from
reception device, motor program signal can be CNS. Neurological training equipment can detect
received real-timely from brain to muscle and be very weak signal and display it in a curve form.
displayed in the fluorescent screen in a curve The patients can see their own effort. The thera-
form, which is visible subjective indicator of pists use this signal intensity to make an elevation
muscle contraction. The patients can see their transverse line that is the surpassing goal of next
effort and enhance the confidence for rehabilita- training. With guidance, drive signals from CNS
tion training. In the premise that last signal inten- are promoted, which is good for promoting
sity surpasses the goal of this training, because recovery of voluntary muscle contraction.
the patients have definite surpassing goal, anti- Whether the patients with zero myodynamia
resistance method of six-step Daoyin technique in the early stage of the disease, or the patients
is used in this training to encourage the patients with zero myodynamia in the recovery period,
to make the signal intensity surpass goal inten- they are all the indications for training methods
sity. Through repeated training, CNS potential is mentioned above. In the early stage of injury,
developed and functional recovery is achieved. muscle with zero myodynamia partially due to
When the signal is strong enough, there are visi- temporal muscle contraction dysfunction induced
ble muscle contraction and joint motion. by transient dysfunction (shock) after nervous
Many people don’t understand anti-resistance damages. In acute period, the patients’ myody-
training in zero myodynamia. They think it is namia is possible to be recovered. Through train-
impossible to do anti-resistance training in zero ing methods mentioned above, the functions of
myodynamia. However, it is proved to be practical paralyzed muscle can be recovered quickly and
in reality, because zero myodynamia is not equal the complications can be prevented. After acute
to zero drive signal of muscle, even not equal to period, for the patients with zero myodynamia,
muscle without tension. The author detects 343 the muscle function is difficulty to be recovered
muscles with zero myodynamia and found that because of organic pathologic changes of injured
when the patients try to control muscle contrac- nerves. The training methods must be used to
tion, although there is no visible muscle contrac- recover the lost functions.
tion, almost all the muscle drive signals from CNS
synchronized with muscle contraction can be
received. There are only ten muscles without drive 6.2.2 T
raining Methods of Zero
signal. The results demonstrated that most of mus- Myodynamia
cles with zero myodynamia in clinical test still
connect with CNS and are controlled by CNS, 6.2.2.1 Rehabilitation Training Method
which also demonstrated that central nervous tis- of Neurological Training
sue still have some functions after damages. This method can real-timely display the effect of
Because muscles with zero myodynamia are Daoyin technique on the moment normal or six-
relaxed, the patients try to complete joint motion step Daoyin technique of guiding collaterals
through active contraction and cannot induce through meridians is used. Through establishing
muscle contraction due to weak intensity of drive different surpassing goal and biofeedback, under
signal. There is no sensation of proprioception the mechanism of “goal and motive”, the patients
stimulation induced by muscle contraction and it are trained with a purpose to develop neural
is easier to make the patients lose the target of potential and promote CNS plasticity. Finally,
muscle drive signal and is harder to induce mus- functional reorganization is achieved and the lost
cle contraction. At this time, in the fixed orienta- motor function is recovered. The specific meth-
tion of joint motion, the therapists exert resistance ods are as follows:
to increase muscle tension through stretching it
and stimulate proprioception receptor in the mus- 1. Neurological training equipment method: bio-
cle to some extent. Proprioception receptor is the electric reception device of neurological train-
ing equipment can receive electric signal nique and Daoyin technique display simula-
guided by Daoyin technique from CNS to tive muscle drive signal and elevation. When
muscle and display it in fluorescent screen in Daoyin technique is used to guide the patients
a curve form. Through establishing surpassing to do joint motion, the therapists exert resis-
goal, Daoyin technique is used constantly to tance in the orientation of joint motion and
guide the patients to do neural potential devel- ask the patients to do anti-resistance accord-
opment, motor program reestablishment and ing to virtual signal intensity in order to
motor pattern remodeling with a purpose. The develop neural potential constantly. The inter-
signal intensity is measured by μV. The ference factor of this method is few and vir-
patients can see their own minor progress and tual signal designed by human can be
enhance the confidence of rehabilitation train- increased. Artificial virtual signal is always
ing, which is good for the improvement of increased. The patients should not misunder-
training effect. stand their trainings are not progressive and
2. Myodynamia Daoyin equipment method:
feel sad because of low intensity of actual
myodynamia Daoyin equipment can receive detected signal. They should keep optimistic
tension force generated by muscle contraction rehabilitation state that is good for progress of
through tension force receptor. Its sensitivity training. The key point of this method is to
can be measured by mg or μg. Where there is make the patients fit in training environment
muscle contraction, there is detection. Tension as much as possible through “immersion”
force can be transformed to visible curve in technique. When the patients regard virtual
the fluorescent screen. The precision of this signal as their own achievement, the therapeu-
method is less than that of bioelectrical signal tic effect is better.
reception device, but it can display subjective
indicator of Daoyin technique and make the 6.2.2.2 Assisted Active Movement
patients do goal surpassing training with a Training Method Through Body
purpose. Position Change
3. Muscular tension Daoyin equipment method: Upper limbs, lower limbs and trunk potential
muscular tension Daoyin equipment receives development training device are used for the
the pressure of pressoreceptor on the skin sur- training that is different from the training in the
face of agonistic and antagonistci muscle patients with severe disturbance of consciousness
induced by muscle tension when the patients the patients. Most of the patients with zero myo-
are guided to do joint motion, turn it into dynamia are conscious people who can cooperate
curve form and display it on fluorescent. with training and organically combine the guid-
Therefore, the patients can do the training of ance of the therapists and the patients’ effort.
potential development and motor program Therefore, this training is not compulsive but
reestablishment with a purpose under the assisted active movement training. The patients
mechanism of “goal and motive”. The sensi- should bring their subjective initiative. Daoyin
tivity of this equipment can be measured by technique is used to guide the patients to try to
μg, so it can display muscle tension change in complete designed movement. When the patients
a curve form when muscle tension is changed cannot complete the movement, the therapists
slightly. The patients can see their own effort, help them to complete it.
enhance the confidence of training and In the example of active movement assisted
improve training effect. with lower limbs, after the patients wear weight
4. Virtual reality training method: Virtual reality support chest thigh band, regulating weight make
training system of neurological training is the patients keep in standing position. Normally,
used to do the training. This technique cannot one therapist helps the patient and in in particular
detect or display the muscle drive signal and cases two therapists help the patient at the same
pressure really. Whereas, both virtual tech- time. The therapist help the patients from stand-
ing position to squatting position (the depth of patients. Therefore, before active movement
squatting from hip and knee flexion 25–150°), training of upper and lower limbs, range of
and then the therapists use speech or play Daoyin joint training should be done first and manipu-
technique record to encourage the patients to try lation is used to relax adhesion of soft tissues
to get up slowly by themselves. If there is diffi- such as muscle. After the training, continuous
culty in the getting up process, the therapist passive movement (CPM) can also be used to
should yell out “stand up, or you will fall down”. help joint motion.
The patients try to get up by themselves. If the 4. Prevention of accidental injury: because of
patients cannot get up, the therapists can help long-term bed, the patients are lack of stand-
them to get up. When the patients are able to get ing and walking exercise. There will be rar-
up by themselves, the therapist can exert resis- efaction of bone to a certain extent even severe
tance on the injured shoulder in the orientation of rarefaction. The bone is fragile and easy to be
standing up and encourage the patients to get up broken. During the training, the intensity
in order to develop more potential. should be paid attention to in case of bone
The training time is 30 min and one therapy fracture and soft tissue injury. It is better to do
course includes 30 times. After completion of standing bed training in case of accident.
one therapy course, the therapists do the assess-
ment and decide to do the training of next therapy
or not. The total training usually takes 3 months. 6.2.3 Clinical Research
In clinic, the author found that if there are of Neurological Training
physiological reflexes such as patellar tendon Therapy of Zero Myodynamia
reflex and achilles tendon reflex in the body with
zero myodynamia and there is no pathological In order to verify the training effect of neurologi-
reflexes such as patellar clonus, ankle clonus and cal training rehabilitation of the muscle with zero
Babinski’s sign. Whether the disease time is long myodynamia, we do clinical experiment study of
or short, through the training mentioned above, 343 upper limbs muscles with zero myodynamia
most of the patients’ voluntary autokinetic move- of the patients with obsolete spinal cord injury
ment can be recovered. and observe the relationship among training
effect, myodynamia and electromyographic sig-
6.2.2.3 Cautions nal (motor program). We analyze the reason,
1. The training should be in accordance with the investigate the mechanism and provide theory
principle “step by step and from weak to and clinical experiment basis for rehabilitation
strong”. It is forbidden to increase training training of muscles with zero myodynamia.
intensity, especially for the feeble patients.
The training can be done with electrocardio- 6.2.3.1 Materials and Methods
graph monitoring. If there is any abnormity, 1. Materials: there are 77 patients with spinal
the training should be halted in case of cord injury. There are 62 males and 15
accident. females. The male female ratio is 4:1. The age
2. The therapist can increase resistance gradu- range is from 11 to 64 years old. The average
ally: The muscle with zero myodynamia is age is 31.7 years old. The injured spinal cord
accompanied with sensory deficiency. During are from C1 to C5. There are 40 patients with
the training of anti-resistance, the resistance C5 injury, which accounts for 51.9% of all the
should not be too strong in case of injury of patients. There are 19 patients with C4 injury,
muscle and tendon. which accounts for 24.7% of all the patients.
3. Preparation for range of joint: the patients
The injury reason is mainly vehicle accidents
don’t do rehabilitation therapy and joint (60 patients, 77.9%). There are eight patients
motion for a long time. There are muscle and with exercise injury, which accounts for
joint adhesions, even tendon spasm in most 10.4% of all the patients. The disease history
is 0.5–20 years after injury. The average dis- new baseline. In the next joint motion guided by
ease history is 4.2 years. All the patients are Daoyin technique, the patients should try to
the people whose functions cannot be recov- make new EMG signal surpass the baseline.
ered through various kinds of routine rehabili- The rest can be done in the same manner until
tation method therapy for many times. The EMG signal cannot surpass the baseline, which
patients in this group complete one therapy requires 6–8 movements. The therapy time is
course. The EMG biofeedback therapy time is 50 min per time and there are 15 times in one
50 min per time and there are 15 times in each therapy course.
therapy course.
2. Equipment: Neuroeducator II with 3 M Ag- 6.2.3.2 Observational Indicators
AgCl surface electrode produced by International general assessment methods are
Therapeutic Alliances in America is used in used in the therapy. Pretherapy and post-treatment,
this training. The function of Neuroeducator the therapists do functional assessments.
II is to analyze the EMG signal to provide
EMG signal for feedback. Through root mean 1. Measurement of myodynamia: according to
square of potential of EMG signal (less than modified Lovett manual muscle test (MMT),
140 dB) whose noise level is less than 0.2 μV pretherapy and post-treatment, the therapists
and bandwidth is from 10 to 1000 Hz, the sig- measure myodynamia of each muscle and
nals are analyzed to get feedback signal. If the classify them.
combination of EMG signal is more than 2. EMG data collection: the raw strongest EMG
0.1 s, it can be standarded into μVs. The data data of each muscle before therapy and the
of one-tenth second is displayed in the color strongest EMG data at the end of therapy are
screen in a continuous curve form. Scanning recorded separately, which are used for com-
limit of every screen is 20 s and can be stor- parison and statistical analysis.
aged in the soft disk for analysis.
3. Therapy methods: In a quiet and lucifuge ther- 6.2.3.3 Results
apy room, the patients sit in front of display. The There are 343 muscles with zero myodynamia in
therapists put two 3M surface electrodes on the 77 patients. There are 16 middle deltoid, 21 mus-
skin surface of two ends of muscle belly and culus biceps brachii, 28 musculus triceps brachii,
place ground electrode between the two elec- 31 extensor muscles of carpus, 61 musculusflexor
trodes. Surface electrodes are connected to cor- carpi, 97 extensor digitorum muscle and 89 flexor
responding leads of Neuroeducator II through of fingers. Pretherapy and post-treatment, elec-
wire. The therapists ask the patients to watch tromyographic signal and statistical analysis
the EMG signal change on the display. results of myodynamia of each muscle refer to
Meanwhile, the therapists use Daoyin technique Table 6.2.
to guide the patients to do shoulder abduction, Pretherapy and post-treatment, the data of
elbow flexion, elbow extension, wrist flexion, electromyographic signal and myodynamia of
wrist extension, finger flexion and finger exten- 343 muscles are used for statistical analysis. The
sion actively. The strongest EMG signal col- analysis of electromyographic signal demonstrated
lected from this movement is the raw data for that there is significant difference between pre-
recording and is used to make a marked line. therapy and post-treatment (P < 0.001).
The therapists ask the patients to try to make the There are only 11 muscles with myoelectric
EMG signal intensity surpass the baseline level potential in 343 muscles with zero myodynamia.
and let the patients not concentrate on joint After one therapy course of 11 muscles with zero
motion and muscle contraction but watch the myodynamia, the myodynamia increases to 0.15
EMG signal curve on the display. If the EMG grades. Compared with pretherapy, there is no
signal surpass baseline, the new summit is the statistical significant difference (P > 0.05). The
Table 6.2 Statistical analysis results of raw and post-treatment EMG signal data
Electromyographic signal (μV) Myodynamia
Name Number* Pretherapy Post-treatment Pretherapy Post-treatment
Middle deltoid 16 27.69 134.81* 0.00 0.67*
X
SD 28.72 69.65 0.00 0.54
Bicipital muscle 21 26.10 105.76* 0.00 0.74*
X
SD 41.08 124.79 0.00 0.58
Triceps muscle 28 21.39 165.21* 0.00 0.92*
X
SD 33.14 188.18 0.00 0.84
Wrist extensor 31 24.19 120.45* 0.00 0.46*
X
SD 21.84 124.80 0.00 0.64
Wrist flexor 61 34.59 95.69* 0.00 0.75*
X
SD 137.73 153.97 0.00 0.81
Extensor digitorum 97 16.89 78.96* 0.00 0.27*
X
SD 32.89 97.65 0.00 0.46
Flexor of fingers 89 24.75 70.04* 0.00 0.39*
X
SD 44.92 95.51 0.00 0.82
*P < 0.01
average of myoelectric potential increases to with zero myodynamia due to obsolete nerve
8.01 μV. Compared with pretherapy, there is sta- injury for more than 1 year. If innervation of the
tistical significant difference (P < 0.05). There muscle is impossible to be recovered, the patients
are 121 muscles with myoelectric potential that is lose the ability of functional recovery and
less than 10 μV in 343 muscles. After one therapy improving life quality. The disease history of this
course, the myodynamia increases to 0.32 grades. group is 0.5–20 years and the average is 4.2 years.
Compared with pretherapy, there is statistical sig- After therapy, there are statistical significant
nificant difference (P < 0.01). The average of increases in electromyographic signal and myo-
myoelectric potential increases to 45.34 μV. com- dynamia. The results may be related to the fol-
pared with pretherapy, there is statistical signifi- lowing factors:
cant difference (P < 0.001).
1. The sensitivity of manual muscle test is low.
6.2.3.4 Discussion Manual muscle test is the assessment method
According to the definition of manual muscle that is used for diagnosis, therapy program
test, muscles with zero myodynamia mean that development and therapeutic effect assess-
the therapists cannot feel muscle contraction on ment in clinic. This method can distinguish
the skin surface of the muscle when the patients the grade of myodynamia well and assess it
are guided to do muscle contraction, which dem- quantitatively. The comparability and
onstrates that the muscle is in denervated com- repeatability are high. The method is easy to
pletely paralyzed state. Except that zero be mastered and memorized without the help
myodynamia of the patients’ muscles due to spi- of special equipment, which is widely used in
nal shock in acute period may be recovered, for clinic. MMT is one of the most credible and
the patients in chronic period, it is impossible to subjective methods for the assessment of
recover independent contractile activity of the motor dysfunction due to pain of lower limbs
muscle. Most of the patients abandon therapy and and waist. It is usually applied in rehabilita-
functional exercise, especially for the patients tion domain. Bohannon thinks that MMT has
good coherence to range of joint in lower ress. The therapists feel deeply out of their
limbs myodynamia. head. The therapy cannot be carried out and
Some reports indicated that the sensitivity the patients give up the therapy. With the mon-
of MMT is less than that of sthenometer for itoring of electromyographic biofeedback
assessing myodynamia that is less than grade equipment, when doing autonomic contrac-
IV. If the grade of myodynamia is equal to or tion and joint motion of muscles with zero
more than IV, MMT is better than sthenome- myodynamia, the equipment can receive very
ter. Compared with isokinetic myodynamia weak electromyographic signal that can be
assessment method that is used for myody- amplified and processed by the computer to be
namia assessment after spinal cord injury, we displayed in the screen in a curve form. At this
found that the sensitivity of MMT to myody- time, the therapists must explain the origin
namia assessment is not enough. The sensitiv- and meaning of the curve to the patients and
ity of MMT is less than that of isokinetic guide the patients to watch the change of the
myodynamia assessment method. Through curve and to increase the altitude of the curve.
root mean square of potential of EMG signal The patients should not pay attention to mus-
(less than 140 dB) whose noise level is less cle contraction and joint motion and the auto-
than 0.2 μV and bandwidth is from 10 to nomic nerve signal is easy to be induced. The
1000 Hz, the signals are analyzed to get feed- patients and the therapists can see the therapy
back signal. It is very sensitive. There are 11 progress anytime to enhance the confidence of
muscles with zero myoelectric potential in all rehabilitation.
343 muscles with zero myodynamia and the Some researches found that the intensity of
coincidence rate 3/1000, which demonstrated electromyographic signal is not in direct pro-
that the sensitivity of MMT is far from that of portion to myodynamia. The received electro-
myoelectricity biological feedback signal myographic signal is actually mixed signal
reception device. If the equipment can receive that takes EEG as the principal signal, which
autonomic electromyographic signal, through means the curve stands for the functional level
therapy, the functions of the muscles can be of muscles dominated by brain.
recovered to varying degrees. 3. Daoyin feedback technique in traditional

2. Weak electrical signal display provides effec- Chinese medicine provides surpassing objec-
tive surpassing target. The disabled patients tive target. Objective indicator is essential for
are always pessimistic and are accompanied learning and functional training. In daily life,
by severe mental disorders. Especially the there is a truth that archery athlete aims at
patients’ functions cannot be improved arrow target to practice archery so that degree
through rehabilitation therapy or the doctors of accuracy in archery can be increased.
tell them that it is impossible to recover the Otherwise, the degree of accuracy in archery
functions, the patients may be pessimistic. cannot be increased without target. This is
Therefore, the way to make the patients see because archery is a motor program that is
their own progress is vital for motivating the constructed in cortex motor center. Through
rehabilitation desire and confidence further. repeated practice, the archery skill will be
The effective method to induce autonomic promoted continuously. When archery athlete
muscle contraction and joint motion is to aims at arrow target to practice archery, the
induce the appearance or enhancement of first arrow may be shoot in the above of the
autonomic nerve signal that dominate the bull’s-eye. The archery result is sent to the
muscle through active movement. The auto- brain and the brain will analyze numerous fac-
nomic contraction and joint motion of mus- tors (altitude of arrow target, distance, wind
cles with zero myodynamia cannot be direction, bow weight, arrow weight, arm
observed with eyes. The patients tried many strength and emotion) comprehensively. After
times but lose confidence because of no prog- calculation, the gesture of the second arrow
can be decided such as lowering the arrow- confidence and encourage the patients to try
head. The second arrow may be shoot in the their best to move the muscles through giving
below of the bull’s-eye. The archery result is out signal from brain. The therapists can use
sent to the brain and the brain will know the assisted active movement method to induce
arrowhead is too low. The gesture of the third autonomic signal. For example, bicipital mus-
arrow can be decided such as raising the cle of arm can induce autonomic signal and
arrowhead. The third arrow is shoot in the activation of conduction pathway through
bull’s-eye. After repeated training, the speed assisted pull-up and quadriceps femoris can
and accuracy of the movements are controlled induce autonomic signal and activation of
precisely by the brain so that the speed and conduction pathway through assisted standing
accuracy of the movements will be increased. up from half kneeling-squatting position. The
Daoyin feedback technique in traditional author found that if there is autonomic signal,
Chinese medicine provides biological feed- it will be increased and never lose. Sometimes,
back signal that is equal to target. The results the reflex signal form spinal cord can induce
feedback to the patients; brain through vision. autonomic signal.
Brain can regulate the intensity and precision
of the signals. It goes full circle and promote
the functional recovery of brain cells, reestab- 6.3 Beauty Method
lishment or enhancement of nervous signal of Neurological Training
transduction pathway and finally improve the
body functions. In daily life, there are some phenomena we can
4. There are residual nervous signal transduction observe. For example, the actors’ face is younger
pathways after spinal cord injury. Some than their actual age. The face of the females who
reports deemed that the occurrence rate of spi- live in foggy and humid south is fine, smooth and
nal cord injury is low, which may be related to roseate. People who are broad-minded and with
anatomical structure of spinal cord. Generally, good psychological quality live a long life and
after spinal cord injury, if there are one-third their face is younger than their actual age.
normal spinal cord, the functions remain nor- Why these factors include actors, moisture
mal. If original conduction pathway is and psychological quality can influence beauty?
destroyed, the latent conduction pathway can We should analyze it from the actors. Actors
be activated, but this process requires proper major in performances. Before appearing on the
training methods. For example, scientific stage, they should coat make-up preparations on
training can improve the performance of the face. Dose make-up preparations influence the
athletes. For muscles with zero myodynamia beauty? Make-up preparations are chemical
and without zero myoelectric potential, agent. Long time use not only cannot influence
through active movement training, the electro- beauty, but also do harm to the skin. Obviously,
myographic signal can be received and sur- the reason that the actors’ face is younger than
passing target can be established. During the their actual age is not make-up preparations.
process of surpassing the target, it is easy to In that way, are the actors with good psycho-
activate the latent conduction pathway. For logical quality and less sadness? It is known that
muscles with zero myodynamia and zero the actual life of the actors is not as right as rain.
myoelectric potential, during the active move- They undergo great pressures such as ups and
ment training, the electromyographic signal downs of career, love frustration and social dis-
cannot be received and surpassing target can putes that can induce mawkishness and sadness.
be established, which demonstrates that there Obviously, psychological quality and mentality
is severe damage of the diseased region and it not always influence the beauty, but the person
is difficulty to activate the latent conduction with peaceful mind without sadness can keep the
pathway. At this time, the therapists must have endocrine system at a virtuous circle state, which
6.3 Beauty Method of Neurological Training 199
is good for the normal functions of respiration, Therefore, usual active contraction of facial
circulation, urinary, reproduction, digestion and muscle can make facial skin keep elasticity and
endocrine system and can delay senescence. gloss, which is the key factor to delay
The residual factor is the emotion of happy, senescence.
anger, sorrow and delight expressed by facial Moisture and warm weather can promote
mimetic muscle in the performance. Therefore, blood circulation and metabolism. Moisture can
active contraction of facial mimetic muscle may prevent facial dry skin and is good for sweat pore
be the key factor of good appearance, fine skin opening and metabolite discharge so that people
and gloss. can keep face gloss. However, the effect is very
The beauty of active movement of mimetic little.
muscle may be related to the following factors: In short, active movement of facial muscle is
the important measure to delay senescence.
1. Active movements can increase blood circula- According to this mechanism, active movement
tion of face and promote metabolism. When beauty training methods of neurological training
the facial mimetic muscle is in active contrac- is introduced as follows:
tion, the partial blood circulation can be
increased and the metabolism is promoted. On
the moment of increasing myodynamia, the 6.3.1 A
ctive Movement of Facial
increase of muscle volume is promoted or the Muscle Training Method
decrease is delayed. The facial shape cannot of Neurological Training
collapse or shrink with age.
2. Active movements can burn subcutaneous fat In a warm and quiet room, on the moment six-
and prevent skin expansion. Muscle contrac- step Daoyin technique is used, neurological
tion requires a lot of energy and can burn more training equipment is used to receive signal
fat, which can prevent facial subcutaneous fat from CNS to facial muscle through single chan-
deposits in order to prevent facial skin expan- nel and display it in a curve form. The therapists
sion due to subcutaneous fat deposits. used this baseline as the elevation. In the next
Eliminating the subcutaneous fat decrease due training, through exerting resistance in the nega-
to age can finally lead to facial or cervical tive orientation of muscle contraction, the
cutis laxa and shrinking. patients are guided to try to make the signal
3. Active movements can keep facial skin elas- intensity surpass the elevation. The rest can be
ticity. Long-term repeated contraction of done in the same manner in active movement
facial muscle can promote blood circulation training of facial muscle. Through enhancement
and make the facial skin full of blood with of motor program signal, the moment increasing
vigorous metabolism. Repeated contraction the sensitivity of muscle contraction, myody-
and relaxation of skin can increase skin ten- namia and muscle volume are increased
sion of the muscle and keep skin elasticity in constantly.
order to delay facial senescence. The training of frontal muscle and orbicularis
4. Active movements of facial muscle can pro- oculi muscle, cheek muscles, musculus risorius,
mote discharge of metabolite. The contraction bite quadratus, orbicularisoris muscles, cervical
of facial muscle can promote partial blood cir- anterior muscle and musculus nuchae are done
culation and enhance metabolism. It can keep separately and orderly. Every muscle is trained
the temperature in a high level. High skin tem- for 5 min (6–8 times). The total time is 50 min
perature can open the trichopore and further and there are 30 times in one therapy course.
promote vessels dilation and blood circula- After one therapy course, the patients rest for
tion. Sweats can promote discharge of metab- 6 months and do the second therapy course.
olite so that acid metabolic waste cannot harm During the rest, according to self-exercise sched-
facial skin and the face is hard to age. ule, the patients do self-exercise every day.
6.3.2 Active Movement Training patients to do active contraction training of facial

Method of Facial Muscle muscle and exert resistance in the negative orien-
of Virtual Neurological tation of muscle contraction. During this process,
Training the therapists use Daoyin speech to create state of
emergency and encourage the patients to promote
Training system of virtual neurological training the intensity of muscle contraction. During train-
is used to do the training. Six-step Daoyin tech- ing interval, the therapists can do facial massage
nique record is used to do the training according of the training muscle for the patients to increase
to simulated signal curve and elevation. The blood circulation and skin elasticity.
patients try to do active contraction of facial mus- The active contraction and anti-resistance
cle and the therapists exert resistance in the nega- training of frontal muscle and orbicularis oculi
tive orientation of muscle contraction. The muscle, cheek muscles, musculus risorius, bite
patients are guided to try to do active contraction quadratus, orbicularisoris muscles, cervical ante-
of facial muscle with the increase of simulated rior muscle and musculus nuchae are done sepa-
signal curve. Before training, immersion tech- rately and orderly with the same method.
nique is used to guide the patients to immerse Every muscle is trained for 5 min (6–8 times).
into virtual environment as much as possible The total time is 50 min and there are 30 times in
until the patients think the simulated signal curve one therapy course. After one therapy course, the
is from their own body. Their own efforts show patients rest for 6 months and do the second ther-
similar changes with the simulated signal curve apy course.
and the training effect is better than that of signal
detection of neurological training equipment.
However, it is better to do actual signal detection 6.3.4 S
elf-Training Method of Facial
training before this training to make the patients Muscle of Neurological
relate muscle contraction to motor program sig- Training
nal. It is easy to make the patients immerse into
virtual and simulated environment. In the therapy or after therapy, the patients go
The training of frontal muscle and orbicularis home and do self-exercise method of facial mus-
oculi muscle, cheek muscles, musculus risorius, cle. The training can be done in front of the mir-
bite quadratus, orbicularisoris muscles, cervical ror. According to training method of signal
anterior muscle and musculus nuchae are done detection with neurological training equipment,
separately and orderly. Every muscle is trained the patients do active contraction exercise of
for 5 min (6–8 times). The total time is 50 min facial muscle and use finger to exert resistance in
and there are 30 times in one therapy course. the negative orientation of muscle contraction
After one therapy course, the patients rest for (The finger control point is on the outside and
6 months and do the second therapy course. upward of orbital cavity in frontal muscle con-
During the interval of training, facial manual traction) for 6 s. During exercise interval, the
massage can be used. patients can do facial massage by themselves.
The active contraction and anti-resistance
training of frontal muscle and orbicularis oculi
6.3.3 M
anual Active Movement muscle, cheek muscles, musculus risorius, bite
Training Method of Facial quadratus, orbicularisoris muscles, cervical ante-
Muscle of Neurological rior muscle and musculus nuchae are done sepa-
Training rately and orderly with the same method.
Every muscle is trained for 5 min (6–8 times).
Manual active movement training method of The total time is 50 min and there are 30 times in
facial muscle of neurological training is a method one therapy course. After one therapy course, the
that the therapists use six-step Daoyin technique patients rest for 6 months and do the second ther-
in traditional Chinese medicine to guide the apy course.
6.4 Active Movement Conceptions and Methods of Aged Care: New Concept of Modern Aged Healthcare 201
6.3.5 Facial Physiotherapy aggravated. Empty nest phenomenon will be the

main mode of aging population family in cities
Far infrared mask (or helmet) is used to do the even in rural area in twenty-first century.
therapy. Far infrared mask is equipped with infra- For the biggest developing country of the
red light heating and atomization system auto- world, we encounter a series of challenges
matically controlled by temperature and humidity. because of aging of the population. Therefore, we
Its purpose is to increase facial blood circulation, can accelerate the reform and development of
wet facial skin, promote facial metabolism and old-age care, which is the important measure to
discharge of metabolite, increase muscle nutri- solve the inconvenience and confusion induced
tion and keep the elasticity and gloss of facial by aging and empty nest phenomenon.
skin. At present, the most popular ways of old-age
Therapy time and therapy course: the therapy care are home-based care for the aged,
time is 30 min per time and there is one therapy a gerocomium- based care for the aged and
day. There are 30 times in a therapy course. The apartment-based care for the aged. Regardless of
therapy can be done in the interval of facial care. what kind of way of old-age care, old-age care
concept is to look after the old as best as we can,
do what we can for the old, alleviate the burden
6.4 Active Movement of the old and satisfy the need of the old in daily
Conceptions and Methods life. Even there are some excessive cares. For
of Aged Care: New Concept example, some nursing institutions for the aged
of Modern Aged Healthcare use good service as key propagandist point. The
service staffs do many things for the old such as
Since the beginning of the reform and opening in tooth brushing and face washing. The service
1978, our country has sustained economic devel- staffs do the things that the old can do by them-
opment, the society is in a long-term secular sta- selves. For a long time, the motor function of the
bility, human life get better and better and average body can be decreased. The old cannot complete
life of a nation increases greatly. On the other daily life activity with time. In addition, the func-
hand, the problem of aging in our country is big- tions of organ and tissue are decreased such as
ger and bigger. According to statistics, in 2005, bones, muscles, joints, digestion, respiration, cir-
the number of the aged who are more than culation, and urinary system. Therefore, exces-
60 years old is 145 million, which accounts for sive care and movement replacement actually
11% of the gross population. The increase rate is promote functional decline and aging of the old.
3.3% every year. According to the standard of the Of course, this is not to say that it is not neces-
United Nations, if the proportion of the aged who sary to take care of the old. Especially for the
are more than 60 years old is more than 10%, the completed disabled old man, they should be
society is aging society. taken good care of. However, for the old with
Moreover, the moment our country enters into functions who can improve functions through
aging society, the proportion of empty nest phe- training, we should discuss how to take care of
nomenon is increased rapidly. Empty nest phe- the old and what we should do that is the best for
nomenon means that there are only the old in the improvement of life quality and physical and
family because the children grow up and go out psychological health of the aged.
for a living. In addition, there is still imbalance The first we should figure out is that what the
phenomenon between urban and rural areas. With happiness is for the old. The happiness is that
the increase of people’s life standard, accelera- they are taken good care of by others or by
tion of rural urbanization, obvious improvement themselves.
of medical sanitary condition and development of In daily life, we can obtain happiness from
body-building, expectation of life will increase doing many things such as taking a walk, travel-
constantly and the degree of aging society will be ing, riding a tricycle, fishing, exercise and eating
by ourselves. In other words, we are able to do music regularly or irregularly, these are appropri-
these things and obtain happiness through com- ate for the aged with good condition to do self-
pleting them. One person strives for experience exercise or do training with instruction and
and wealth for a lifetime. In the old age, it is time protection. Moreover, most of the aged are impa-
to enjoy them and to do something that they want tient and neglect of using fitness equipment to do
to do but don’t have time to do in childhood. If training. The exercise room becomes the exhibi-
they cannot do these things due to their physical tion room of fitness equipment. For completed or
state, there is only regret and no happiness. partial disabled old man, they give up because it
In addition, age is one of the symbols of expe- is difficult for them to do training with fitness
rience, technique and knowledge. They went equipment.
through a lot, received a lot of lessons and had Therefore, developing method and equipment
much successful experience. Through life and in allusion to improvement of motor function of
work of a lifetime, they understand the life thor- the aged and delay aging process of the aged is
oughly. They can teach young people the experi- essential to enhance the life quality of the aged
ence and learning in order to contribute to the and play roles of the aged.
society. Therefore, we do not treat the old as the According to the characteristic that active
burden of the society. They are useful for the movement of neurological training can promote
development of the society, because they are the CNS plasticity and functional reorganization,
initiator of human civilization, teacher of social mechanism of “goal and motive”, safe state of
experience, knowledge and skills, valuable emergency and other neural potential develop-
wealth to promote the development of the soci- ment concept and method, in allusion to the body
ety. On the other hand, imparting knowledge and characteristic of the old, different cognitive state
experience require healthy body and vigor. and cooperative degree, we use different rehabili-
Therefore, to recover self-function of the aged tation training method and equipment.
and prevent the function reduction is not only the
important goal to improve life quality of the aged,
but also the requirements of promoting society 6.4.1 Active Movement
development. Only in this way, the aged can be
able to enjoy themselves and have stamina and It is appropriate for the aged with stable funda-
vigor to impart their experience and learning to mental state, clear consciousness and normal
the descendant and the society. cognitive ability who can partially complete
According to the mechanism of promoting autonomic joint motion. With the cooperation of
CNS plasticity and functional reorganization, the old, whether the old can complete the
recovering self-function and slowing down func- designed movement or not, the therapists exert
tion reduction require not only increasing proper resistance in the orientation of joint motion and
nutrition and abundant rest, but also functional do anti-resistance training guided by Daoyin
training of active movement. Only active move- technique. The training is done on the basis of the
ment can develop neural potential. On the basis original functions to increase the ability of active
of that, body motor function, active old-age care movement and delay exercise aging, which is
concept and pattern can also develop neural called intensified active movement training. The
potential. specific methods are as follows:
Existing nursing institution for the aged,
whether gerocomium or apartment for the elderly, 1. Neurological physical therapy (NPT): The

take physical exercise as one part of old-age care. therapists use normal or guiding collaterals
There is exercise room or hall that is equipped through meridians six-step Daoyin technique
with treadmill, balance bar and dumbbell, even in traditional Chinese medicine to guide the
advanced fitness equipment. They organize the patients to do designed active joint motion on
aged to travel, playing gate ball and dancing with the basis of regulation of breathing and mind.
When active joint motion is on the summit, elevation and keep at the summit for 6 s to
the therapists exert resistance in the orienta- develop potential. Afterwards, the new sum-
tion of joint motion and use counting method mit is regarded as the baseline for the eleva-
to encourage the patients to insist for 6 s. tion. The same method is used to guide the
During this process, Daoyin speech such as patients to try to make the curve surpass the
“life up, or you will bump!” and “higher, or elevation. The rest can be done in the same
you will fall down!” is used to create safe state manner to develop potential constantly and
of emergency to encourage the patients to try improve motor function.
to achieve the goal. 5. Muscle tension Daoyin equipment method:

2. Neurological occupational therapy (NOT) is Daoyin technique is used to guide the patients
appropriate for the fine movement training of to use brain to dominate muscle contraction.
upper limbs and hands. According to the During this process, muscle tension Daoyin
requirements in daily life, we designed differ- equipment is used to receive the signal of ten-
ent training items such as combing, tooth sion change of agonistic muscle and antago-
brushing, face washing and dressing. Daoyin nistic muscle and turn it into curve in order to
technique is used to encourage the patients to display it in the fluorescent screen. Initial
complete the designed movement and during curve intensity is used for the elevation and
this process Daoyin speech is used to encour- Daoyin technique is used to encourage the
age the old such as “hold on, or your comb patients to try to make intensity of myody-
will drop; try, you are great” and make the old namia surpass the elevation and keep at the
feel joyful after the movement. summit for 6 s to develop potential.
3. Neurological training: Normal or guiding col- Afterwards, the new summit is regarded as the
laterals through meridians six-step Daoyin baseline for the elevation. The same method is
technique is used and motor program signal used to guide the patients to try to make the
from real-time detection of neurological train- curve surpass the elevation. The rest can be
ing equipment is used as baseline that is done in the same manner to develop potential
marked as the elevation. Daoyin technique is constantly and improve motor function.
used again to encourage the patients to try to 6. Virtual reality training methods of neurologi-
make the signal intensity curve surpass the cal training: Virtual reality training methods
elevation and guide the old to insist for 6 s at of neurological training system is used to do
the summit, which is good for CNS potential the training. Guiding collaterals through
development. Afterwards, the new summit is meridians six-step Daoyin technique record is
regarded as the baseline for the elevation. The used to instruct the patients to do joint motion
same method is used to guide the patients to through regulation of mind and breathing. The
try to make the curve surpass the elevation. therapists exert resistance in the orientation of
The rest can be done in the same manner to joint motion and use record to encourage the
develop potential constantly and improve patients to try to increase the virtual signal
motor function. line. In the next training, there is virtual signal
4. Myodynamia Daoyin method: Daoyin tech- line elevation. At this time, the same method
nique is used to guide the patients to use brain is used to encourage the patients to make sig-
to dominate muscle contraction. During this nal line surpass simulated signal line eleva-
process, myodynamia Daoyin equipment is tion. The rest training is done as the same way.
used to receive the signal of muscle contrac- The advantage of this method is that the actual
tion and turn it into curve in order to display it signal cannot decrease and the patients can
in the fluorescent screen. Initial curve inten- keep the confidence of the therapy because the
sity is used for the elevation and Daoyin tech- simulated signal intensity is increased con-
nique is used to encourage the patients to try stantly. In addition, six-step Daoyin technique
to make intensity of myodynamia surpass the record can make the patients maintain high
enthusiasm all the time and can relieve the

labor intensity of the therapists, which is good
for promoting the training effect of rehabilita-
tion training.
6.4.2 A
ssisted Active Movement
Training
It is appropriate for the weak aged with stable

fundamental state, clear consciousness and nor-
mal cognitive ability who can have conscious-
ness of active movement but cannot complete
autonomic joint motion by themselves.
For this kind of old people, assisted active
movement training of body position change is
used, such as push up and down of upper limbs,
standing up and squatting of lower limbs. During
the process of assisted active movement training
of lower limbs, lower limbs potential develop-
ment training device is used. The patients wear
chest hip band and connect weight support sys-
tem hook. According to the specific condition of
the patients, the weight is regulated to prevent
falling down and bumping. The therapists stand
one side of the patients and grasp the waist train- Fig. 6.2 Gait training equipment of severe patients
ing belt. On the basis of regulation of mind and
breathing guided by Daoyin technique, the
patients are guided to squat slowly. In the squat- function of body limbs due to diseases. This kind
ting process, the therapists should suddenly of training usually requires two or more therapists.
reduce the support and use Daoyin speech to According to the specific condition of subject,
encourage the patients such as “stop, or you will the therapists choose proper training items. The
squat!” and “get up, or you will fall down!” to patients can do the training with bare hands or
prevent fall down (Fig. 6.2). Along with the use potential development training device of
increase of stamina of the patients, the therapist upper limbs, lower limbs and trunk.
can reduce support gradually until they can com-
plete the movement by themselves. 1. Bare-handed passive active movement train-
Meanwhile, the therapists should choose ing method is the training without training
movement training of daily life such as assisted equipment (Fig. 6.5). In the passive active
ascending and descending the stairs (Fig. 6.3) movement training of lower limbs, the thera-
and assisted walking training (Fig. 6.4). pists dress the patients training waistband.
Two trainers stand two sides of the patients.
One is the main trainer and the other is the
6.4.3 P
assive Active Movement assisted trainer. The trainer make the patients
Training stand up slowly. According to the principle
“step by step”, the patients squat to a certain
It is appropriate for the aged with stable vital extent. The therapists use Daoyin technique to
signs and clear consciousness who lost motor guide the patients to regulate mind and breath-
Fig. 6.3 Gait training equipment of severe patients
ing. They let the patients stand up slowly and

use Daoyin speech to motivate the patients to
get up by themselves. During the standing
process, the therapists suddenly reduce sup-
port. During the process of falling down, the
therapists use speech to motivate the patients
such as “stand up, or you will fall down”. The
therapists help the patients to get up.
2. Passive active movement training with equip-
ment: Corresponding training equipment is
used to do the training of upper limbs, lower
limbs, trunk, neck and ankle such as passive
active movement training of upper limbs
(Fig. 6.6). Upper limbs potential development
training device is used. The patients wear
shoulder chest training waistcoat, lie in a
prone position on training mat of potential
development training device of upper limbs.
The therapists connect straps of shoulder 6.4.4 C

ompulsive Active Movement
chest training waistcoat to weight support Training
hook of the training device and suspend
weight support sandbag on the other end. The It is appropriate for the aged with stable vital
weight can make the patients stretch upper signs and unclear consciousness and is also
limbs straightly with the help of the therapists. appropriate for the old with clear consciousness
During training, the patients use hands to sup- and cognition impairment who don’t cooperate
port their body on the training mat and are with active movement training.
guided to regulate mind and breathing. The Before the training, the therapists should
patients use upper limbs to push down their explain the goal and advantage of the training and
body and make the chest touch the training its possible risks to the old. With the permission
mat slowly. Meanwhile, the therapists strain of the family, the training can be done, because
weight support handle and let the patients flex the mentality and body function of the old may
elbow, which is called pushing down training. fluctuate during the training.
On the contrary, upper limbs of the patients Compulsive active movement training includes
are on a flexed position and the patients are standing up and squatting training (Fig. 6.7),
guided to stretch upper limbs straightly slowly which requires two or more therapists. The two
on the basis of regulation of mind and breath- therapists stand on two sides of the patients and
ing. Meanwhile, the therapists strain weight use potential development training device of
support handle and control the elbow exten- lower limbs to do the training. According to the
sion speed of the patients. During this process,
the therapists can use Daoyin speech such as
“push up, or you will bump head” to motivate
the patients to develop potential in order to
induce automatic movement.
Fig. 6.6 Gait training equipment of severe patients Fig. 6.7 Gait training equipment of severe patients
principle “step by step” and the specific condition nique record and specific training video. Training
of the subject, the therapists ascertain the training content and method are chosen for the training
intensity. In the standing training, the therapists such as elbow extension of six-step method of
help the subject to squat at first and the depth is guiding collaterals through meridians. The trainer
from 150° flexion of knee joint. According to the put the distal end of the elbow extension band on
condition, the depth can be increased gradually. the dorsal part of the forearm on the upper end of
Daoyin speech is used to encourage the subject to wrist and put the other end on the back of forearm.
stand up and the therapists suddenly reduce sup- After the training is activated, main and collateral
port in this process. At this time, the subjects fall channels of elbow extension appear. Daoyin tech-
down and the therapists use Daoyin speech to cre- nique record is used to guide Qi to go along with
ate state of emergency to encourage the patients to virtual main and collateral channels to triceps
stand up again with the help of the therapists. muscle of arm. Record can encourage the patients
Squatting training is from the standing position to initiate joint motion of elbow extension and
and the subjects is helped to squat slowly. During make them to try to reach the altitude of simulated
the squatting process, the therapists suddenly curve for 6 s. Afterwards, the patients relax, let Qi
reduce support and encourage the subjects to go along residual meridians (Fig. 6.8) and let it
maintain the body position in case of squatting. disperse in collaterals. The training of all joints
Through repeated compulsive active move- and trunk can be done in the same manner.
ment training, movement response and auto- The training frequency is one time a day and
nomic motor function recovery of the patients are the time is 0.5–1 h every time. The patients
induced. During this process, for the old with should stick to the training.
clear consciousness and cognitive disorder, the
therapists should be patient and guide the patients
to adapt to the training and form habit. It is diffi- 6.4.6 Cautions
cult to communicate with this kind of old people,
so it is better to let them form the habit just like 1. During training process, the therapists should
three meals in 1 day. For the old who are reluctant increase the difficulty gradually and abide by
to do the training, it is hard to do the training. the principle “step by step”. The amount of
This kind of old people without cognitive disor- training should be dependent on the ability of
der are reluctant to do the movement. The thera- the subject. The patients should do the train-
pists should pay attention to the pattern and make ing according to one’s abilities and don’t push
the old realize the function of the training and it too much in case of accident.
cooperate with the training through increasing 2. Pay attention to the selection of training pat-
the training pleasure. tern: The therapists can design training items
with different pattern, difficulty and goal
according to the specific condition of the
6.4.5 Self-Exercise Method aged. The therapists should increase the
of Neurological Training amusement and interest of the training.
3. The therapists should lay emphasis on basic
It is appropriate for the old patients who can do training and do not do it with hesitation.
self-exercise to recover consciousness and motor Before training, especially the standing up
function to a certain extent through rehabilitation and squatting training of lower limbs, the
training of neurological training. patients should do standing bed training at
Portable virtual reality training system of neu- first. The patients can stand erectly for 30 min
rological training and multiple functions band are or more with stable vital signs and without
used to do the training. Virtual reality training sys- discomfortableness.
tem of neurological training is equipped with 4. At the beginning of the training, the therapist
explanation of training mechanism, Daoyin tech- should pay attention to monitoring of
practical training. Therefore, the therapists

should teach the patients by themselves and
help the patients to complete the movements.
Through repeated training, the patients are
possible to recover the functions, which is the
problem that the therapists should pay attention
to in practical training.
Initiative way of old-age care not only can sat-

isfy the health requirements of the old, but also
increase the life quality of the aged to make them
enjoy better happy life in old age.
biological signs. At the beginning of the

training, the training should be done with
Reference
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state: definition, diagnostic criteria and clinical fea-
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5. In the training, the therapists should be patient 2005;4(2):203–5.
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Function Assessment
and Therapeutic Schedule 7
Rehabilitation
Rehabilitation evaluation is the important measure rological training rehabilitation training schedule.
[1] for rehabilitation therapy schedule and reha- Activities of Daily Living (ADL), functional inde-
bilitation therapy effect assessment, which can pendence measure (FIM), movement assessment
guarantee the effect of rehabilitation training and scale (MAS), and visceral function assessment are
is the crucial basis of verifying the effect of reha- not introduced in our book.
bilitation method. The application can affect the
rehabilitation training effect and the assessment
results of rehabilitation method directly. 7.1 he Main Methods
T
Rehabilitation evaluation is similar with clini- of Rehabilitation Functional
cal diagnosis. Through objective and precise Assessment
examination, the therapists judge the character-
istic, part, range, degree and residual functions 7.1.1 T
he Principle of Neurological
of dysfunction of the patients and estimate the Training Rehabilitation
development, outcome and prognosis of dysfunc- Evaluation
tions. It is good for the protocol of rehabilitation
goal and rehabilitation therapy schedule. It is In the clinical rehabilitation work for many years,
also a process that the therapeutic effect is judged the author thinks that international rehabilitation
and the patients can go on with the rehabilitation evaluation items are used for the assessment of
therapy or not. rehabilitation training effect. The assessment
There are many books about rehabilitation evalu- should be done before rehabilitation training,
ation method, which account for a lot in rehabili- in the midterm of rehabilitation training and at
tation books. However, most of them are used for the end of rehabilitation training to accumulate
evaluating the residual functions and abilities of data. Through statistical analysis of the data,
the patients and the effect of rehabilitation training the training effect of rehabilitation method is
method. Although it is important for and handi- judged. Sometimes, these assessment items have
capped degree of the patients the advantage and no effect on rehabilitation training schedule.
disadvantage of the rehabilitation methods, some Because rehabilitation is a training that should be
assessment method have no effect on rehabilitation adjusted anytime, for therapy schedule, the prin-
therapy schedule. In this chapter, we introduce func- ciple of assessment method of application func-
tional assessment method that can influence neu- tion are as follows:
https://doi.org/10.1007/978-981-13-0812-3_7
210 7 Function Assessment and Therapeutic Schedule of Neurological Training Rehabilitation
7.1.1.1 Selecting Simple Assessment 1. Assessment of partial motor function: Motor

Method to Reflect Dysfunction program signal check of single joint motion,
Part and Degree muscular strength assessment and range of joint
1. Somatic movement function assessment: The motion are used for assessment. These assess-
therapists should select simple operative part ment items can exactly reflect the contraction of
that can be easily located such as one muscle every muscle, the intensity of myodynamia,
or joint and degree such as the intensity of motor program signal intensity and ratio between
myodynamia to do functional assessment. agonistic muscle and antagonistic muscle and
Generally, muscular strength assessment, ability of autonomic joint motion, which can
range of joint and muscle spasm degree are provide reliable reference for analysis and judge-
used for assessment. ment of single joint motion ability.
2. Functional assessment of speech, cognition
2. Assessment of entire motor function: the ther-
and swallowing function: Selective alogia apists can select assessment of coordinated
assessment, dysarthria assessment, cognitive and balanced function and gait analysis, motor
function assessment, swallowing function program check of associated movement to
assessment and sensory function assessment know the functions of brain stem and motor
are used for assessment. area VI of cerebral cortex, which can reliable
reference for rehabilitation therapy schedule.
7.1.1.2 Selecting Assessment Method
That Can Reflect Partial or 7.1.1.3 Selecting Assessment Method
Entire Function Degree That Can Be Used to Judge
Motor dysfunction induced by CNS damages Main Dysfunction Point and Is
varies in the degree and type of motor dysfunc- Good for Training Schedule
tion due to different injured part and degree. The The ultimate goal of recovering lost motor func-
manifestation of brain stem damage is balance tion is to recover functional movement that is
motor dysfunction. The manifestation of right meaningful for daily life and work, which means
cerebral hemisphere damage is motor dysfunc- motor pattern and ability of associated movement.
tion of upper and lower limbs in left side to vary- Abnormal motor pattern will influence associated
ing degree. The manifestation of motor area IV of movement to varying degrees. Abnormal motor
cerebral cortex damage is functional limitation of pattern is composed of one or two obstacle points.
single joint motion. The manifestation of motor For example, the circle gait is due to varus and
area IV of cerebral cortex damage is functional hip flexor paralysis. Through detailed assessment,
limitation of associated movement with multiple the therapist can find the principal obstacle point,
joint motion. which is good for formulating specific rehabilita-
Partial function degree stands for the abil- tion training schedule. It is the basic premise of
ity of contraction of one muscle and the func- obtaining good rehabilitation training effect.
tion of motion of one joint, which is the basic
requirements of single joint motion. Single joint 1. Assessment of motor pattern includes func-
motion is unable to complete functional move- tional assessment of upper limbs and lower
ment needed for daily life. The entire function limbs, gait analysis and balanced function
is the ability to complete functional movement assessment, which can be used to analyze
required for daily life and work, which is com- functional ability of upper limbs, lower limbs
posed of associated movement with multiple and entire movement. According to the assess-
joints. In most cases, normal single joint motion ment results of motor pattern and myody-
is not equal to normal associated movement with namia, the therapists can find out principal
multiple joint motion. Therefore, it requires fur- obstacle point of abnormal motor pattern.
ther detailed assessment of partial and entire
2. Motor program examination of associated
motor function. movement: The signal form cortex motor center
7.1 The Main Methods of Rehabilitation Functional Assessment 211
Fig. 7.1 Establishment
training of walking
motor pattern of lower
limbs
dorsiflexion
Hip Flexsion
Knee extension
to muscle of associated movement are exam- 4. Swallowing function assessment includes

ined and the therapists can observe the intensity muscular strength assessment and electro-
of sequence of signals. The therapists can ana- myographic signal of swallowing muscle.
lyze the reason of abnormal motor program of
associated motor pattern to provide reference 7.1.2.2 The Stages of Rehabilitation
for reestablishing normal motor program Evaluation
(Fig. 7.1). According to the process of rehabilitation train-
ing, from the beginning to the end, the purpose of
rehabilitation evaluation is to observe the effect
7.1.2 T
he Main Content of the method and provide reference for therapy
and Assessment Stages schedule [2].
of Rehabilitation Evaluation
1. Assessment in preliminary stage is the assess-
7.1.2.1 The Main Content ment of the patients in hospital before reha-
of Assessment bilitation training. The purpose is to know the
1. Functional assessment of the trunk includes functional state, dysfunction degree, disability
range of joint motion assessment, muscular reason and prediction of rehabilitation prog-
strength assessment, functional assessment nosis, which is the important evidence of
of upper limbs and lower limbs, gait analy- rehabilitation goal and therapy schedule and is
sis, nerve electrophysiology assessment, the basic data of measuring effect of rehabili-
spasm assessment, sensory function assess- tation training method.
ment, coordinated and balanced function 2. Assessment in midterm is the assessment that
assessment. is done in stated midterm of rehabilitation time.
2. Mental and psychological function assessment Assessment in midterm should be done at least
includes apraxia and agnosia assessment. once a month. The purpose of it is to know the
3. Linguistic function assessment includes alo- effect of rehabilitation method, find out short-
gia and dysarthria assessment. comings and defects and analyze the reason.
The therapists should know the functional state the difference of muscular strength between
of the patients after a length of therapy, which man and man and is the most valuable and
can provide basis for the adjustment of reha- the most common myodynamia assessment
bilitation training schedule. method in clinic.
3. Assessment in the late period is the assess- The myodynamia in every grade of this
ment that is done in the end of the rehabilita- assessment method can be divided into two
tion. The purpose is to assess the functional grades, which are manifested with “+” and
state of the patients after a length of therapy “−”. If the myodynamia is stronger than some
and to assess the effect of rehabilitation train- grade, the “+” should be marked on the top
ing. According to the cooperative situation right corner of the number that stands for this
and actual functional state of the patients in grade. On the contrary, if the myodynamia is
the therapy, the therapists can formulate self- weaker than this grade, the “−” should be
exercise method and subsequent visit plan of marked on the top right corner of the number
the patients and suggest the patients to go that stands for this grade.
home, go back to work or receive further reha- Generally, it is used for assessment of clin-
bilitation therapy. ical therapy schedule six grades (include zero
grades) myodynamia assessment can satisfy
the requirements. For clinical effect research,
7.1.3 Assessment Method twelve grades assessment method is more sen-
sitive. The standard of myodynamia assess-
7.1.3.1 Myodynamia Assessment ment classification refers to Table 7.1.
Manual muscle test and its classifications 2. Muscular strength test with equipment: if the
myodynamia is more than three grades and it
1. The common method used for assessing
is necessary to do further precise quantitative
myodynamia is manual muscle test [3] that assessment, special equipment can be used to
was invented by K.W. Lovett in 1916. It was do muscular strength test. According to the
modified but the principle is not changed. In muscle contraction type, the test types are vari-
a certain position, standard test movements ous such as isometric muscle strength, isotonic
are used to observe the movement comple- muscle strength and isokinetic muscle strength
tion ability of the muscle. Although the test. In the general rehabilitation evaluation
classification method is rough and the books, there are detailed descriptions of appli-
assessment is related to subjective judgment cation methods and classifications. The read-
ability, the method is simple and the indica- ers can refer to these books if necessary. They
tion is clear, which cannot be influenced by are not introduced in this book.
Table 7.1 Lovett myodynamia classification standard

Grades Name Standard Percent of normal myodynamia
0 Zero Undetectable muscle contraction 0
1 Slight contraction Slight contraction
But cannot induce joint motion 10
2 Bad Can do entire range of joint motion
In weight support state 25
3 Can Can do antigravity entire range joint motion
But cannot doanti-resistance joint motion 50
4 Fine Can do antigravity and anti-resistance
Entire range joint motion 75
5 Normal Can do antigravity and anti-resistance
Entire range joint motion fully 100
3. Cautions of muscle strength test: In order to their own ability, which belongs to
guarantee the precision, better repeatability active joint motion.
and comparability of the results, we should (b) Passive movement: the subjects can move
pay attention to the following aspects in the joint with outside force, which belongs to
muscle strength test. passive joint motion.
(a) Correct test position: correct position can 3. Basic position: all the joints should be placed
make the muscle give full play to contrac- in 0° of anatomical position. In the forearm
tion ability, which can prevent effectively movement, palm surface is in 0° vertical plane
supplement of other muscles and com- state. The concepts of axis and surface are the
pensatory contraction. same as that in anatomy.
(b) Standardization of test method: The ori- 4. ROM measuring method: The therapists use
entation of exerting force should be cor- protractor to do the test. Normal protractor is
rect in order to make the muscle give full composed of two rulers and a semicircular
play to contraction. protractor or whole circle protractor. Finger
(c) Comparison test: in every examination, joint is measured with small semicircular pro-
the comparison test of myodynamia of the tractor. In usage, the central point of protrac-
same muscle in both sides. If the myody- tor aims at the center of joint motion axis
mania difference of the same muscle in precisely. The distal end of two rulers is paral-
both sides is more than 10%, there is clin- lel to the long axis of the body. Along with the
ical significance. movement of distal limbs of joint, distal ruler
(d) Proper assessment time: The subjects
moves. The therapists can read the number of
should be in proper excited state and degrees of range of joint motion in dial of pro-
cooperate with the test. Before examina- tractor. The specific operation and normal
tion, the subjects do warm-up exercise to motion range of every joint refer to Table 7.2.
warm up the muscle. It is forbidden to do 5. The manifestation of ROM: The manifesta-
this test after exercise, in fatigue state or tions of ROM are various. One of them is in 0°
when the subjects are full in case of affect- of anatomical position in flexion or extension.
ing the accuracy of the results. When the extension of joint is limited, mea-
(e) Contraindications: in the muscle strength sure angle may be negative. The other is 0° in
test, especially isometric muscle strength full extension in flexion movement and is
test, constant isometric muscle contrac- 180° in full extension in extension movement.
tion can increase the blood pressure of the The therapist can choose any one and record
patients significantly and possibly induce the absolute value of range of joint motion,
Valsalva effect. It should be used with but not the negative value.
caution in the patients with severe blood 6. Cautions of ROM examination: In range of
pressure and heart diseases. joint motion examination, except the normal-
ized operation, there are many announce-
7.1.3.2 Range of Joint Motion (ROM) ments: the subjects should fully expose joint.
Examination The therapists should prepare separate room
1. The purpose of ROM examination includes for the female and the third person should be
the factors of hindering joint motion, degrees present when the opposite sex is tested. The
of joint movement disorder, the basis of for- patients should relax fully and the position
mulating therapeutic schedule and the effect should be correct. The position of limb immo-
of assessing therapy method. bilization should be at the proximal end or dis-
2. The type of ROM examination includes active tal end of the joint but not on the joint. The axis
and passive range of joint motion examination. of goniometer is in accordance with the axis of
(a) Active movement: the subjects should the joint, which cannot hinder the parallel
complete range of joint motion with translation of the axis. Before joint motion and
214
Table 7.2 Range of joint motion examination

Protractor placement mark
Joint Movement Position Center Proximal end Distal end 0 Point Normal value
Shoulder Flexion and extension Anatomic position, stand Acromion Midaxilla Lateral epicondyle of Two rulers Flexion 180°
with the back on column (plumb line) brachialis overlap totally Extension50°
Abduction ditto Ditto Ditto Ditto Ditto 180°
Internal and external Lie on one’s back, Olecranon Plumb line Styloid process of Ditto 90°
rotation shoulder abduction, ulna
elbow flexion90°
Elbow Flexion and extension Anatomic position Lateral epicondyle Bone peak Styloid process of Two rulers are in Flexion 150°
of brachialis ulna alignment Extension0°
Wrist Flexion and extension Anatomic position Processus Vertical axis The second head of Two rulers are in Flexion 90°
styloideus radii of forearm metacarpal bone alignment
Ulnar and radial flexion Anatomic position Midpoint of wrist Ditto The third head of Ditto Radial flexion 25°
joint metacarpal bone Ulnar flexion 65°
hip Flexion Lie on one’s back, hip Trochanter major Horizontal Lateral femoral Two rulers are in 125°
hyperextension offside line epicondyle alignment
Extension Lie on one’s back, hip Ditto Ditto Ditto Ditto 15°
flexion offside
Adduction, abduction Lie on one’s back in Anterior superior Anterior The center of patella Two rulers are at 45°
case of thigh rotation spine superior spine right angles
offside
Internal and external Lie on one’s back, Extremitas inferior Plumb line Anterior border of Two rulers 45°
rotation lateral drop of two crus of patella tibia overlap totally
Knee Flexion and extension Lie on one’s back Lateral malleolus of Trochanter Lateral malleolus Two rulers are in Flexion 150°
thighbone major alignment Extension 0°
Ankle Flexion and extension Lie on one’s back Malleolus medialis Malleolus The first head of Two rulers are at Flexion 150°
medialis of metatarsal bone right angles Extension 0°
thighbone
Varus and eversion Lie prostrate The midpoint of Vertical axis The midpoint of heel Two rulers are in Varus 35°
two ankles at the at the back of alignment Eversion25°
back of ankle crus
7 Function Assessment and Therapeutic Schedule of Neurological Training Rehabilitation
after joint motion, goniometer is used for mea- During walking, the center of body weight
surement twice. Contrast measurement of the moves forward like a complicated revolved
same joint in both sides is proceeded to guar- curve. The projection in vertical plane or
antee the correctness of the results. horizontal plane is sinusoid. The center of
body weight moves forward in sequential
7.1.3.3 Gait Examination acceleration and deceleration. In order to
Gait is the motor patter of associated movement keep the smooth and steady of the movement
with multiple joints in lower limbs, which is of the center of gravity in axial view, the
widely used in clinic. movement and acceleration of four orienta-
tions should be decreased. The subjects can
1. Basic information of gait: From heel in one not only decrease energy consumption, but
side touches the ground to the other heel also cooperate with the movement of hip
touches the ground and then the heel touches joint, knee joint and ankle joint and the hori-
the ground again, this is called gait cycle or zontal displacement and four orientations
stride. From heel in one side touches the incline of pelvis.
ground to the other heel touches the ground, During walking, normal variations of
this is called step. movements mentioned above are the charac-
In gait cycle, every foot should be through teristics of the diversification of gait. The vari-
the stance phase and the swing phase. ations go beyond a certain range due to
(a) Stance phase: there are five courses such pathological factors, which form abnormal
as heel stride (HS), foot flat (FF), mid- gait. The inspectors are familiar with the con-
stance (MST, the center of gravity is in the figuration of normal gait and basic character-
upward of ankle joint), heel off (HO, the istics of common pathological gait. Through
body move forward until the heel off the observation, the inspectors can do gait assess-
ground) and toe-off (TO). ment and use multidimensional continuous
In a gait cycle, two legs both are in camera, digital protractor and multiple-lead
stance phase, which is called double sup- electromyogram to observe and acquire activ-
port (DS) and is the characteristic of ity routines of muscle, joint or center of body
walking. In a gait cycle, if there is no dou- weight in walking in order to compare with
ble support and there is soar of two feet, it normal activity routines. Finally, they can
is called running. judge the form and degree of abnormal gait.
(b) Swing phase: from the toe off the ground, Their efficiency of normal gait is very
through acceleration period, to vertical high, especially when they walk with the
impaction of lower limbs, this is called mid- speed of 4.5-5 km per hour. The energy con-
swing (MSW). After that, through decelera- sumption in unit distance is low. At this time,
tion period, the heel touches the ground. the myoelectric activity is the least. The
In a gait cycle, the time of stance phase is impetus of moving forward of body in walk-
more than that of swing phase. The time of ing is not totally provided by muscle contrac-
stance phase accounts for 60% of the entire tion, but mainly is provided by gravity and
cycle. The time of swing phase accounts for inertia. In abnormal gait, the energy con-
40% of the entire cycle. sumption is increased. When the patients with
Cadence stands for the walking times in paraplegia wear assistive device or the
every minute. The cadence of adult is 110-120 patients with amputation wear artificial limbs
steps per minute. The fast cadence can reach in walking, the energy consumption is more
140 steps per minute. Step width (SW) stands prominent and the walking speed is limited.
for moving distance of one step, which is For example, the patients with paraplegia
related to cadence and stature. The step width walk with crutch and the walking speed is
of the male is 70–75 cm. confined to 1.6–2.4 km/h.
2. The common pathological gait: The classifi- rior muscle lead to foot drop. In swing
cation is made according to pathology and phase, flexion degree of hip and knee is
pattern of abnormal gait. increased in case of toe mopping, which
(a) Short leg gait: when the length of one leg is hurdle gait. When the triceps surae is
is shorten 3.5 cm than that of the other weak, in the late stance phase, the injured
leg, in the loading period of the injured hip drops and the body moves forward
leg, ipsilateral pelvis and shoulder sub- slowly. Due to myasthenia of quadriceps
merges, which is called oblique shoulder femoris gait, injured limbs cannot main-
step. When swinging the injured leg, there tain stable knee extension actively in
is compensatory foot drop. stance phase. The patients can make the
(b) Joint rigidity gait: when there are spasm body incline forward to make line of grav-
and contracture of joint in lower limbs, ity pass through the front of knee in order
the range of joint motion is limited and to extend the knee passively. Microbending
the gait is changed. Especially when the of hip lead to tension increase of gluteus
joint contracture is in the malformation and hamstring muscle and backswing of
position, the gait is changed more obvi- distal femoral, which is good for passive
ously. For example, flexion and contrac- knee extension. In the early stance phase,
ture of hip joint can lead to compensatory constant hyperextension of knee usually
anterior pelvic tilt, lumbar vertebra hyper- leads to genu recurvatum as one kind of
extension and stride shortening. When the compensatory stabilization. Accompanied
angle of flexion and contracture of knee is with myasthenia of hip extensor, the
more than 30°, there is short leg gait. patients should bend the body and press
When knee is in extension contracture thigh with hands to make the knee extend
state, in swing phase, there are abduction straightly. Gluteus maximus gait: Due to
of lower limbs or lifting of ipsilateral pel- myasthenia of gluteus maximus (hip
vis in case of toe mopping. When ankle is extensor), the patients make the body tilt
in plantar flexion contracture state, heel backward to make gravity line go through
cannot touch the ground. The subjects the back of hip joint in order to maintain
compensate ankle through hyper flexion passive hip extension and control inertia
of hip and knee like hurdles, which is forward movement of the trunk, which
called hurdle step. In the stance phase of forms the posture of chest up and entasis.
injured limbs, there is usually overexer- Gluteus medius gait: Due to myasthenia
tion of knee and genu recurvatum. of gluteus medius gait (hip abduction
(c) Joint unsteady gait: The patients with muscle), the patients cannot maintain lat-
congenital dislocation of the hip wag eral stability of hip. Therefore, in stance
from side to side like a duck, which is phase, the patients have to make the body
called duck gait. incline to the injured side to make gravity
(d) Pain gait: Limbs lesion due to various rea- line go through the lateral of hip joint in
sons can induce pain when the injured order to maintain the stability with adduc-
limbs are bearing load. In order to relieve tor in case of drop of contralateral hip.
pain, the patients shorten the weight bear- Meanwhile, the patients can lift contralat-
ing time of injured limb in stance phase as eral lower limbs and swing it. When hip
much as possible. Therefore, the patients abductor in both sides are damaged, the
use contralateral leg to move forward with patients vacillate to the left and right like
small and saltatory stride, which is called a duck, which is called duck gait.
briefness gait. (f) Myospasm gait is due to muscle spasm.

(e) Muscle weakness gait: tibialis anterior Hemiplegic gait: there are foot drop, stre-
muscle gait: Myasthenia of tibialis ante- phenopodia, extorsion or intorsion of
lower limbs and inability of relaxation on the spot slowly or standing with one foot
and flexion of knee. In case of foot mop- and standing with closed eyes. As the circum-
ping in walking, the patients can make the stances may require, the patients are asked to
injured limbs convolute forward through walk with closed eyes and the therapists
arc line, which is called circle gait. At this observe the abnormal condition of gait.
time, the upper limbs are in a flexion and For the patients using crutch to walk, the
adduction state and the swing is stopped. therapists should examine the gait of the patients
Scissors gait is also called cross gait, with crutch or without crutch, because crutch
which is seen in the patients with child may cover the actual condition of abnormal gait.
cerebral palsy or incomplete high para- Gait examination and basic condition
plegia. The reason is adductor spasm. examination are used for analysis and the ther-
During walking, two hips adduct and two apists can judge it with examinations such as
legs cross over in the severe patients, physical examination of nervous system,
which lead to unstable gait and walking. myodynamia and muscle tension examination
(g) Other gait due to CNS damages: the
of various muscle groups, range of joint
patients with ataxia of epencephalon motion examination, the length test of lower
shamble like a drunken man, which is limbs and morphological examination of spi-
called drunkenness gait. In the patients nal cord and pelvis, which are important for
with Parkinson’s disease or other basal determining the reason, characteristic and rec-
ganglia diseases, there are small stride, tification method of abnormal gait.
quick walking speed and paroxysmal
acceleration. The patients cannot stop or 7.1.3.4 The Intensity and Proportion
turn around at will. The arm swing slightly of Motor Program Signal
or is stopped, which is called propulsion Motor program signal test is good method to
gait or festinating gait. Bizarre gait is that ascertain the origin of abnormal motor pattern.
there is no certain powerless muscle and Through this test, the therapists can find out spe-
there is no explanations for abnormal gait cific muscle group or single muscle of abnormal
except for hysterical gait whose charac- motor pattern and provide basis for formulating
teristics are inconsistent gait (sometimes rehabilitation therapy schedule.
fast and sometimes slow) that is different Motor program signal intensity is in direct
form inconsistent myodynamia. In mus- proportion to myodynamia with limits. The
cle tension examination there is gear-like stronger the signal is, the stronger the myody-
reaction. namia is. Signal intensity stands for the quantity
3. Gait examination: The therapists ask the
and quality of central nervous cells that dominate
patients to walk autonomously or with assis- muscle contraction. The proportion of muscle
tance and observe the body balance especially signal intensity between agonistic muscle and
the balance of lower limbs include stride, antagonistic is the specific manifestation of coor-
cadence and shifting of weight. The gait and dination of central nervous cells that dominate
upper limbs swing are coordinated or not. the joint motion.
Secondly, the therapists ask the patients to Motor program of single joint located in motor
walk quickly or slowly. If necessary, the area IV of cortex is tested to find out that there is
patients should relax or concentrate on walk- mainly the signal that dominate agonistic muscle
ing and the therapists observe the movements and antagonistic muscle and the other muscles
separately. The patients can do the movements that is involved in joint motion can be ignored
such as standing still, turning around, turning such as neutralized muscle and congener mus-
round, walking up and down stairs or slope, cle. Generally, the normal proportion of signal
bypassing obstacle, going through door open- between agonistic muscle and antagonistic mus-
ing, sitting down and standing up, marching cle is 10–1. When the signal of agonistic muscle
can drive joint motion, if the signal of antagonis- cular surgery and rehabilitation medicine. The
tic muscle is too strong, there are difficult joint group should include complete experts and skill-
motion, inflexible activity, slow-movement, ful techniques for functional assessment, sched-
inability of movement and even the wrist flexion ule formulation and specific therapy execution
when the patients are asked to do wrist extension and instruction, which are the guarantee of pre-
due to tension increase or spasm of the muscle. cise functional assessment, correct schedule for-
There are many types of motor program of mulation, proper therapy method and expected
multiple joints associated movement located in therapy effect.
motor area VI of cortex. According to the actual
condition of abnormal motor pattern of the 1. Manning: Combination therapy group is led
patients, if there is cycle gait in the walking of the by head of department or rehabilitation chief
patients, the therapists can test the signal inten- physician, which includes rehabilitation asso-
sity of hip flexor (hip flexion), hamstring muscles ciate chief physician, visiting staff, bedside
(knee flexion), tibialis anterior muscle (dorsi- physician, group leader of therapists and
flexion of foot) and peroneus longus and brevis orthotics therapists. According to the state of
(strephexopodia). The reason of cycle gait is the an illness of the patients, the group can invite
weak signal of hip flexor, tibialis anterior muscle experienced physicians of related
or peroneus longus and brevis. The measure goal departments.
of motor program of associated movement is not 2. Responsibility of combination therapy group:
the proportion of muscle signal intensity between the main responsibility of combination ther-
agonistic muscle and antagonistic, but the apy group the patients are functional assess-
sequence and the intensity of signal of agonistic ment, therapy schedule formulation, therapy
muscle of all joints involved in the movement. implement, supervision and inspection,
From this, the therapists can judge the program is instruction and adjustment of therapy sched-
normal or not and analyze the reason of abnormal ule. The group is also responsible for organiz-
motor pattern in program signal. ing symposium of case report and therapy
Rehabilitation therapy schedule of recover- schedule formulation.
ing motor function includes myodynamia mea 3. Organization and implementation of sympo-
surement, balance ability measurement, muscle sium: For the patients in hospital or in outpa-
spasm degree measurement, motor program sig- tient service, before symposium formulated in
nal test and cognitive function assessment, which rehabilitation therapy schedule, combination
have essential significance. therapy group should notice all the doctors
and therapists ahead of time. Bedside physi-
cian should know functional assessment of the
7.2 The Formulation patients and record actual condition of func-
of Rehabilitation Therapy tional examination. Other physicians can do
of Neurological Training essential examination in person. Symposium
Schedule should include case report and video playing
of the patients to increase third dimension and
7.2.1 The Composition precision of schedule formulation. Generally,
of Combination Therapy bedside physician should first put forward
Group preliminary therapy schedule and explain the
basis of therapy schedule.
Recovering lost motor function of the patients
is very complicated, which involves not only Symposium usually is presided by head of
rehabilitation medicine, but also neurology department or rehabilitation chief physician.
department, general medicine, neurosurgery, The doctors, therapists and other personnel can
department of orthopaedics, spine surgery, vas- declare themselves or modify the schedule for
7.2 The Formulation of Rehabilitation Therapy of Neurological Training Schedule 219
preliminary therapy in allusion to specific dys- Rehabilitation training method is used to

function of the patients and explain the reason to promote rehabilitation of the patients, which is
the patients. Head of department discusses with an engineering, especially for the patients with
the participants and get final determination. They complicated condition. It is a mammoth project.
can explain the mechanism of some common Rehabilitation chief physician can command var-
problems. In addition, on the basis of modifica- ious rehabilitation medical staffs such as doctors,
tion and supplement of original schedule, they exercise therapists, profession trainer, speech
can improve the level of rehabilitation therapy. therapists, cognitive therapists, psychological
therapists, physical therapist, potential develop-
ment trainers, motor program reestablishment
7.2.2 B
asic Principle of Formulating and motor pattern remodeling trainer and orthot-
Therapy Schedule ics maker. In different therapy stages, various
measures are used to recover and apply the func-
The illness of the patients that need rehabilita- tions of the patients rationally. For example, a
tion therapy is complicated, always with various general command all arm of the services to win
kinds of dysfunctions such as exercise, men- a tough war. In this process, the crucial factor is
tality, emotion, cognition, swallowing, sphinc- formulating rehabilitation therapy schedule. The
ter incontinence, joint deformity, spasm and correctness and implement of therapeutic sched-
contracture dysfunctions. There are protopa- ule are related to therapeutic effect. The basis
thies such as hypertension, diabetes mellitus, of schedule assessment are accurate functional
nervous lesion. Therefore, the rehabilitation of assessment and abundant medical knowledge and
the patients is extremely complicated, which experience of rehabilitation medical staff.
requires a lot of disciplinary knowledge and The specific principle and procedure of for-
skills. Therefore, the requirements of rehabili- mulating rehabilitation therapy of neurological
tation chief physician and head of department training schedule are as follows:
are more restrict than other subjects. Because
the rehabilitation therapy in our country is still 7.2.2.1 Careful Comprehensive
in preliminary stage, we know little about the Assessment, Video Playing,
importance of rehabilitation and don’t empha- Formulation of Preliminary
size talent cultivation of rehabilitation. The Schedule and Group Discussion
society looks down on the rehabilitation person- and Decision
nel, which lead to small number of rehabilitation First diagnosis responsibility should be used for
practitioner, especially top-level talents. Under the patients in hospital or in outpatients. First
this condition, current rehabilitation personnel diagnosis doctor is responsible for the patients,
should give play to rehabilitation function and especially the patients in outpatients. If the
regularize the flow and method of rehabilitation doctor is not responsible for the patients, there
to let the society see and feel the importance of will be careless omission. If the therapists cannot
rehabilitation. For this reason, simple therapy adjust therapeutic schedule timely, the therapeu-
mode is transformed to medical model of ther- tic effect will be affected.
apy and function, which is good for the disabled Supervisor physician should first do com-
in our country. prehensive functional assessments that include
In a broad sense, rehabilitation is that various not only the assessments about rehabilitation
kinds of measures such as medicine, surgery, func- such as myodynamia, spasm degree, range of
tional training, physics, mentality and biomedical joint motion, motor pattern, cognitive function,
engineering are used to recover the original func- sensory function and osteoarticular deformit,
tions of the patients as much as possible, which is but also the assessments of the entire condition
the problem that cannot be solved by single drug, such as vital signs, visceral functions, nutrition
surgery and any other subject technology. condition, psychological states, emotional state
and therapy compliance. Specific to the main For example, if the rehabilitation condition of the
dysfunction and therapy point of the patients, patients is good but family economic status is in a
the therapists record the functional assessment poor state, it is difficult for rehabilitation training
and dysfunction degree. According to the results to be completed. If the goal is set too high, it is
of functional assessment, responsibility doctors possible to draw a blank. The rules of application
discuss with related doctors and therapists and for reimbursement health insurance in all parts of
formulate preliminary therapeutic schedule. The the country are different. Reimbursement cannot
therapists can try to do rehabilitation training if be applied in some areas and reimbursement can
there are no contraindications. be applied completely in some areas and in special
Generally, head of department or rehabilita- crowd. In Beijing, affected by period of validity
tion chief physician organize symposium of all of western rehabilitation method, the deadline of
department and formulation of therapeutic sched- application for reimbursement health insurance
ule at least once a week. Responsibility doctors for motor dysfunction induced by CNS damages
should first report the case and propose thera- is in half a year after onset of the disease. The
peutic schedule. During the process of playing deadline of application for reimbursement health
the video of the patients, the therapists should insurance for dysfunction induced by peripheral
explain the purpose and mechanism of therapeu- nerve injury is in 3 months after onset of the dis-
tic schedule. After that, participants have a disease. If missing the deadline, the patients should
cussion specific to therapeutic schedule and put pay all the costs. For some patients with cranio-
forward their opinion and suggestion. Head of cerebral injury and cerebral infarction, they pay
department or rehabilitation chief physician sum- a lot of hospitalization costs in first-aid stage. In
marize it, put forward rectification opinion and rehabilitation stage, some families cannot afford
explain the reason and mechanism of rectifica- long-term rehabilitation therapy costs. Therefore,
tion schedule. All the doctors reach an agreement in formulating therapeutic schedule principle,
and ascertain therapeutic schedule of the patients. except the requirements of functional recovery,
the therapists should consider the actual condi-
7.2.2.2 According to Specific Condition tion of the patients. For example, in the patients
of the Patients, Final with hemiplegic circle gait, the main obstacles
Individualized Rehabilitation of abnormal gait are hip flexion and paralysis
Goal Should Be Established of peroneus longus and brevis. In order to rec-
According to the individual condition of differ- tify abnormal gait, the therapists should train two
ent patients, the therapists formulate the plan muscles to recover autonomous contraction abil-
to achieve training effect through rehabilitation ity at the same time. The therapist should adopt
training, which is final individual rehabilitation three-stage rehabilitation principle to do the train-
goal. This goal is the ultimate goal that can be ing that takes about 3 months. However, family
achieved through training. In order to obtain economic capability of the patients is limited and
better effect, incentive method of rehabilitation they cannot do 3 months’ therapy. At this time,
group is designed and is carried out in inside the therapists can abandon the training of tibialis
of rehabilitation group. This is not the statutory anterior muscle and peroneus longus and brevis.
mission and the therapists should explain it to the The therapists use foot tray to keep the foot in 90°
patients and their family or there is no need to tell dorsiflexion position. The therapists can only do
the patients and their family. the training of hip flexor and gait. After 1 month,
The formulation of final rehabilitation goal the patients can wear foot tray to walk.
and basic rehabilitation principle is achieved
through comprehensively analyzing the patients’ 1. The basis of formulating final rehabilitation
state of an illness, body condition, age, the part goal: The setting of final rehabilitation goal
and degree of dysfunction, therapeutic enthusi- originates from objective understanding and
asm and cooperation, family economic status. judgement of the state of illness of the patients,
the dysfunction degree of the patients, cogni- recovered. In the formulation of rehabili-
tive state and rehabilitation desire, applied tation training schedule, the therapists
rehabilitation method and effectiveness of should first select the part is easy to be
other measures. In order to increase the effec- recovered for rehabilitation training. For
tiveness of the method, except for formulating example, if the function of head is nor-
specific therapeutic schedule, there are several mal, the therapists select trunk for train-
principles that should be paid attention to in ing in order to recover the sitting by
order to achieve anticipated rehabilitation goal. themselves and balance ability in sitting
(a) The principle of recovering the function position as soon as possible. If the thera-
that is good for promoting self-care life pists select hand and wrist for functional
ability: Human functional rehabilitation training, because the fine movements of
includes movements, sense, cognition and hand and wrist require a huge number of
speech, which is a chronic process. It is central nervous cells, it is difficult to
closely related to evolution extent of spe- develop so many cells to replace the func-
cies. In this time consuming therapy, the tions of injured cells in a short time.
patients and their family can abandon Although the therapy time is long, the
therapy because they cannot observe functions are not improved obviously,
obvious rehabilitation therapeutic effect which affect the training of other parts.
soon or over a period of time. Generally, the complexity sequence of
Therefore, the therapists can select a functional recovery of human is head and
part that is good for improving the daily neck, trunk, lower limbs and upper limbs.
life ability of the patients and is easy to From functional recovery of single limb,
achieve therapeutic effect in order to let functional recovery of the proximal end is
the patients see the training progress as easier than that of the distal end. For
soon as possible, which can promote the example, the sequence of functional
confidence of the patients and their family recovery of upper limbs is shrug, shoulder
to rehabilitation training. abduction and adduction, elbow exten-
Compare with recovering functions of sion, elbow flexion, wrist extension, wrist
upper limbs, the reason to recover the flexion and finger. The functional recovery
function of lower limbs in priority is secu- of finger is difficult and takes a long time.
rity objective. For rehabilitation training The reason of recovering the functions
of the patients with hemiplegia, the first of head and neck is that head and neck is
choice is to recover the function of lower the rudder of human movements that can
limbs in hemiplegic side. Because the regulate orientation, feel the surrounding
function of upper limbs in one side of the and adjust body movement balance. If the
patients is normal, they can do the func- functions of head and neck are not recov-
tions required for daily life such as face ered, it is hard to recover motor functions
washing, tooth brushing, combing and of trunk and other parts.
clothing. Although the button is difficult (c) Functional training principle of choosing
to be fastened in dressing, we can change the less harmful one: the age and body
the dressing pattern to solve it. If the func- limbs function of the patients are also the
tion of lower limbs cannot be improved factor that should be considered in formu-
such as severe strephenopodia or foot lating training schedule. For rehabilitation
drop, they may have accidents due to training of children and adult, the main
ankle joint sprain or tumble in mobility purpose is to recover daily life ability and
limitation or walking. work ability and go back to home, society
(b) The training principle of recovering the and post of duty, which require long-term
function in the part that is easy to be and comprehensive rehabilitation training
schedule. This schedule can be completed parts whose functions can be recovered are
in different stages, even beyond the year. not recovered and the parts whose func-
For the old, the main training purpose is to tions cannot be recovered are not improved.
recover basic self-help ability. In order to Because of long-term training, the patients
achieve this purpose, rehabilitation train- are easy to lose confidence of further ther-
ing schedule should be prominent but not apy and feel suspicious or dissatisfied with
comprehensive. For an old patient with rehabilitation training method.
hemiplegia whose age is 80 years old, the 2 . The types of individualized final rehabilitation
upper limb function in one side is good goal: After understanding the state of illness
and the self-help ability required for basic of the patients comprehensively, according to
daily life is completed. With the permis- the significant degree of rehabilitation princi-
sion of the patient and his family, it is pos- ple, the therapists can anticipate the possible
sible to abandon the functional training of final results.
upper limb in hemiplegic side and focus (a) Motor function is close to the normal: the
on rehabilitation training of lower limbs symptom is slight and protopathies such
functions, which can increase the time of as hypertension and diabetes mellitus are
lower limbs training time and obtain better controlled in a stable state with drugs.
functional recovery. The old are able to Through three-stage rehabilitation train-
walk independently or walk with crutch. ing method of neurological training,
They can take a walk and talk with their motor function and pattern can be recov-
friends, which can increase their happi- ered to the normal.
ness index in old age. (b) The patients can walk independently with
For the patients with paralysis of lower simple assistance: These patients usually
limbs in one side and foot drop, strephe- have entire abnormal motor pattern due to
nopodia and circle gait, they can do the dysfunction of individual part, which
training of tibialis anterior muscle and decrease athletic ability. However, motor
peroneus longus and brevis to recover dysfunction cannot be recovered through
independent contraction ability of pero- rehabilitation training of neurological
neus longus and brevis, which is difficult training. At this time, the patients can use
and takes a long time. For the old patients assisted device to recover the function of
or the patients with severe central nervous obstacle part and then improve the entire
injury, they can abandon the therapy of function. The functions of the patients
foot drop and strephenopodia and use foot with circle gait due to strephenopodia can-
tray for therapy. The training point is the not be recovered completely after training,
functional recovery of hip and knee joint but they can use foot tray to keep the foot
and the remodeling of motor pattern, in a 90° dorsiflexion position. Through the
which is easy to recover the walking abil- training of motor pattern remodeling, it is
ity of the patients. They should do the possible to recover the independent walk-
training of tibialis anterior muscle and ing ability of the patients. After the second
peroneus longus and brevis at regular therapy course of rehabilitation training,
intervals. With time, CNS can activate the patients can walk without foot tray.
more cells to replace the injured cells in (c) The ability of walking with crutch: The
compensatory mechanism. In addition, patients with severe CNS damages can
the training can promote compensatory recover most of the functions through the
mechanism and functional recovery. training. Through assisted device, the
Omnibearing training can decrease the joint can be kept in a functional position.
training time of the parts whose functions The patients’ independent walking ability
can be recovered, which lead to that the can be recovered with the help of axilla
crutch or elbow crutch, four legs cane or and functional recovery to a maximum
single leg cane. extent. From this, the formulation of final
(d) Assisted walking device is used to recover rehabilitation goal is valuable in clinic.
standing and walking ability: it is suitable
for the patients with involuntary move- 7.2.2.3 Ascertaining Definite Principal
ments due to development of limbs and Training Schedule of Achieving
joints and incomplete spinal cord injury. Rehabilitation Goal
The motor function of this kind of the Through functional assessment and actual condi-
patients is in a certain extent, but they tion of the patients, the principle of rehabilitation
cannot stand up or walk because of mus- goal in this therapy course should be ascertained,
cle spasm, joint deformity and involun- which is important for the purpose of functional
tary movement. After rehabilitation recovery of the patients. For example, the devel-
training of neurological training, body opment of our country requires five-year plan.
motor function can be increased and the The whole day’s work depends on a good start in
body limbs can be stretched to the func- the morning and the whole year’s work depends
tional position. After wearing walking on a good start in spring, which are required in
assisted device or not using crutch, the the progress of enterprise and individual work.
standing and walking ability of the If we want to make a progress in the work, we
patients can be recovered. should have a plan. Without requirements and
(e) With the help of other methods, orthotics goals, we cannot obtain good marks.
or assisted device are used to recover For the patients, according to actual condition
standing and walking ability, which is of the patients and the function of various kinds
suitable for the severe patients with older of rehabilitation methods, anticipation goal should
child cerebral palsy, poliomyelitis, spinal be set up for the patients in order to recover the
damages and severe joint deformity. It is function maximally. After that, we should ascer-
hard to recover involuntary motor func- tain the general guideline of rehabilitation method
tion in this kind of patients, but after reha- of actual goal. For example, for an old patient
bilitation training, joint deformity can be (80 years old) with stroke and hemiplegia who is
rectified and the standing and walking with cognitive disorder and cannot stand up for 6
ability can be recovered with the help of months, hypertension and diabetes mellitus can
orthosis or walking assisted device. The be kept in a normal level with drugs. Through
patients can walk in the balance bar or examination of lower limbs in hemiplegic side, the
weight support equipment. myodynamia of hip flexor is grade III. The myo-
Because of the different state of the dynamia of hip abductor and adductor are grade
patients, the formulations of rehabilita- II. The myodynamia of quadriceps femoris is
tion goal are various, which requires com- grade II. The myodynamia of tibialis anterior mus-
prehensive analysis and judgement of cle and peroneus longus and brevis are zero. The
actual condition, however, the formula- understanding ability and memory of the patients
tion of rehabilitation goal is not essential are good with great rehabilitation desire. For an
for rehabilitation training. The author old weak patient with many diseases, except that
deemed that the anticipation of rehabilita- the myodynamia of tibialis anterior muscle and
tion goal can make the rehabilitation med- peroneus longus and brevis are zero, the myo-
ical staff form clear rehabilitation idea dynamia of other muscles are more than grade
and training process. Before rehabilita- II. The patient has greater rehabilitation desire and
tion training, the entire training plan is ability of understanding and memory. Through
formulated to do the entire training with a 3 months’ rehabilitation training, the functions
purpose in order to obtain orderly reha- can be recovered to a certain extent, but the weak
bilitation training rational rehabilitation patient with many diseases cannot walk for a long
method, timely adjusted training schedule time. Therefore, the training goal should not be too
high. The functions can be recovered to the extent Long-term walking in this abnormal pat-
that the patients can take care of themselves with tern, abnormal motor pattern can be con-
the help of walking aid or crutch. solidated in varying degrees. The patients
The functions should be recovered as much as and their family deemed that it is good to
possible. Meanwhile, recovering normal motor walk more, but they don’t realize that
pattern is ultimate rehabilitation goal. On the under abnormal motor pattern, abnormal
basis of this, according to different actual condi- motor can be consolidated and it is hard to
tions and requirements of the patients, principal be rectified with more and more walking.
schedule of rehabilitation therapy of neurological Therefore, for rehabilitation training of
training for achieving rehabilitation goal includes this kind of patients, the training schedule
several kinds as follows. The specific therapeutic of using stop as establishment and recov-
schedule is introduced in rehabilitation therapy ery step by step is proper. During the pro-
of neurological training of various diseases. cess of limitation of walking, on the basis
of rectifying disordered motor program,
1. Three-stage rehabilitation principle training
through repeated training, the therapists
schedule of neurological training: Three-stage should use normal motor program to do
rehabilitation training method is the compre- the training of motor pattern remodeling
hensive application pattern of rehabilitation in order to recover normal motor pattern.
technique of neurological training, which is All these principles should be achieved
suitable for the prevention and rectification of through three-stage rehabilitation method
abnormal motor pattern. of neurological training, which includes
(a) Prevention of abnormal motor pattern: It neural potential development, motor pro-
is suitable for the patients in the early gram reestablishment and motor pattern
stage of the disease whose motor function remodeling. With the help of forbidden
cannot be recovered and who cannot do walking, limitation of walking and walking
movements out of bed. Before the func- in motor pattern molding instrument, the
tions of the muscle are totally recovered, patients can walk without assisted device.
the patients cannot do movements out of For prevention kind of patients, walking
bed. When the movements cannot be should be restricted in the first stage in
completed because of paralyzed muscle, order to prevent abnormal motor pattern.
other muscles or body gestures are used to For rectification kind of patients, walking
compensate abnormal motor pattern. For should be restricted in the first stage in
this kind of patients, the training schedule order to make the patients forget abnormal
is establishing the normal and preventing motor pattern, which is good for the rees-
the abnormal. With the limitation of the tablishment of normal motor pattern.
patients’ walking out of bed, on the basis 2. Principal training schedule of motor coordina-
of potential development, the patients can tion: in fact, uncoordinated movement is one
do the training of motor program reestab- kind of abnormal motor patterns. Although
lishment, which is the basis of establish- there is no obvious abnormal motor pattern,
ing normal motor pattern. there is uncoordinated condition of body
(b) Rectification of abnormal motor pattern: motor function in practical work and daily life
For the patients in recovery phase, with such as fine movement of hand, uncoordinated
obsolete motor dysfunction or abnormal swing of upper and lower limbs in walking,
motor pattern, they can do movements out slight strephexopodia, strephenopodia or
of bed or even walk independently. inflexible movement of lower limbs in walk-
Because of the inappropriate walking time, ing. In addition, there is normal single joint
abnormal motor pattern can be induced by motion, but it is difficult to do entire body
the compensatory functions of the muscle. movement (associated movement of multiple
joints). Motor pattern of limbs is normal, but it ing, the patients want to make the injured foot
is hard to start the movement or the patients touch the ground and they have to move injured
are slow-moving. limb forward through hip abduction to make the
For this kind of patients, the principal outside of the foot touch the ground first. After
training is motor program reestablishment of that, lower limbs abduction can make the entire
associated movement and movement starting foot touch the ground and bear load. Under the
speed (signal transduction) training but not circumstances, the patients lift injured limbs and
potential development training, but the move it forward, which indicated that the myo-
patients usually need long-term motor pattern dynamia of the patients’ hip flexor is normal. The
remodeling training. main obstacle of abnormal motor pattern may be
3. Principal training schedule for different symp- paralysis of peroneus longus and brevis.
toms: For the patients with facial paralysis, Therefore, through precise functional assess-
speech disorder, swallow disorder and gatism, ment, the therapists can find out the main obstacle
according to the actual condition of the point (paralyzed muscle) and formulate principal
patients, the adopted methods and the doctors’ training schedule specific to the paralyzed muscle
experience, the main goal and therapeutic in order to employ the limited time on the train-
schedule can be ascertained. For the patients ing of the main obstacle part, which is good for
with facial paralysis, the method at home and shorting the therapeutic course and obtain better
abroad is normal therapeutic measure, which training effect. If the therapists don’t find out the
is short of functional training. Through func- main obstacle point, it is forbidden to do a physi-
tional training method, this kind of patients cal exercise therapy or professional training with-
can obtain better therapeutic effect with other out a purpose, which may get half the result with
measures such as adhesion release, pulmonary twice the effort and affect training effect greatly.
functional training and clean catheterization.
This kind of patients should use active func-
tional training as the principal method and use 7.2.3 The Implementation
other trainings as the subsidiary method. The and Adjustment
rehabilitation goal cannot be set up too high, of Therapeutic Schedule
especially for the training effect of gatism.
Through clinical practice, the therapeutic 7.2.3.1 Implementation of Therapy
effect of the current method for gatism is not Method
ideal, especially for the therapy of gatism due That whether therapeutic schedule can be imple-
to spinal roots injury in sacrococcygeal region. mented correctly or not is essential for the
anticipated effect of the training. In principle,
7.2.2.4 Principal Training Schedule therapeutic schedule is one kind of medical
of Assault Fortified Positions prescriptions. The medical staffs must carry it
Specific to Main Functional out, but rehabilitation training should be com-
Obstacle Point pleted by rehabilitation doctors, therapists and
In most cases, in recovery stage, the patients’ the patient. The training is completed with the
motor dysfunction usually is induced by one detailed explanation and instruction of the doc-
or several paralyzed muscles. The circle gait of tors, guideline of therapists’ enthusiasm and
lower limbs in the patients with hemiplegia may positive cooperation of the patients, which depen-
be induced by paralyzed hip flexor. The patients dent on the correctness of manner of execution
cannot complete hip flexion with their myody- of the therapists, the quality of implementation
namia, and hip abductor and the trunk compensate method and the time of practical training. On the
to the uninjured side, which induce circle gait. other hand, it depends on the understanding and
Peroneus longus and brevis paralysis in injured cooperation of the patients. Because the neuro-
side may lead to strephenopodia. During walk- logical training is entire active movement, the
patients are required to cooperate with the train- one side of the card and specific therapy items,
ing actively and take part in the training, which place, time and the therapist are written on the
is different from taking medicine in safe dosage other side. The card should be written with a
according to medical prescriptions. Therefore, pencil so that it is easy to adjust the therapeu-
corresponding measures and regulations should tic schedule and therapist who is responsible
be formulated to guarantee the effective imple- for the patient.
ment of the method. The patients are required to put this card on
bedside in ward and wear it in the chest in
1. Therapeutic schedule and specific item ther- the rehabilitation training hall to make the
apy card system: In order to know the basic patients, their family, caregivers, therapists
information of the patients, therapeutic prin- and doctors know the therapeutic condition of
ciple and specific therapy method, regulation the patients at any time, which is good for spe-
of therapy chest card can be used. General cific practical implement condition and adjust-
information, the main dysfunction point and ment of therapeutic schedule. Physical photo
rehabilitation therapy principle are written in of therapy card refers to Figs. 7.2 and 7.3.
Fig. 7.2 The information Neurological training rehabilitation prescription

side and rehabilitation Name: Sex: Age: Bed number: Diagnosis:
principle side of the project content time Therapist
therapy card of the
Date of hospitalization: NT
patients
Hospital number: LIPD
Rehabilitation objectives: UIPD
Principle: 1.Typical three stages; VS
2. Atypical Phase III; 3. Early standing SSGS
and walking development;
DGMP
4. Early standing and walking recovery
Main obstacles: GR
SUBT
PT
Particular considerations:
other
Physician:
Date:
NT : Neurological training ; LIPD : Lower limb potential development

ULPD : Upper limb potentia ldevelopment ; VS : Virtual simulation
SSGO : Six-Step guidance operation ; GR : Gait remodeling
DGMP : Development of gastrocnemius muscle potential
SUBT : stand-upbed training ; PT : Physical therapy
Fig. 7.3 The specific

therapeutic content side Rehabilitation Prescription
of the rehabilitation
therapy card of the NAME: F/M AGE: DATE: BED NO:
patients Diagnose:
History:
Major disabilities:
2. Group leader responsibility system: There are iar with all kinds of rehabilitation therapy
many rehabilitation therapy staffs in the neu- techniques. The responsibility of the doctors
rological training rehabilitation center of a big is equal to that of neurologists. There is severe
hospital. The therapists with professional gappy phenomenon between rehabilitation
technique and managerial experience can be doctors and rehabilitation training. The author
selected to hold the post of group leader and called it little neurologists, which is bad for
belong to the key group of the department. the development of rehabilitation technique
They can help to manage the department and and improvement of rehabilitation therapeutic
know the therapists and the difficulties in effect. Compared with rehabilitation thera-
work. The specific tasks of the group leader pists, rehabilitation doctors received compre-
are to assign therapeutic task, arrange therapy hensive and long-term rehabilitation medical
time, examine the implement of the schedule knowledge education and restrict training.
and instruct the technique. They organize The questions and solution abilities are better
morning conference of the therapists every than the therapists. If they don’t contact reha-
day and hold vocational study conference of bilitation training and work on practical reha-
the therapists at regular intervals. bilitation therapy, they cannot understand the
Neurological training is a brand new tech- mechanism and effect of various kinds of
nique. According to the therapy and method rehabilitation training. They are not familiar
of rehabilitation technique of neurological with the practical problem and unreasonable
training, they use special corollary equipment method of rehabilitation training. The new
of neurological training for the rehabilitation theory, method and equipment of rehabilita-
of the patients, which is one of the primary tion cannot be accomplished.
conditions. The therapists are required to keep In order to solve this problem and eradicate
high enthusiasm to encourage the patients to rehabilitation doctors to become neurologists,
gradually complete unaccomplished active rehabilitation doctors should take part in reha-
joint motion before. The labor intensity is bilitation training and the pair regulation of
high. At present, western rehabilitation rehabilitation doctors and therapists is neces-
method takes passive movement as the princi- sary. Both head of rehabilitation department
pal thing and is widely used at home and and rehabilitation resident doctor should take
abroad. When the therapists move the joint of part in practical rehabilitation training. Head
the patients passively, they can keep in a posi- of department and chief physician mainly
tion for a while and there is no speech encour- assess and treat new inpatients for the first
agement, which can save labor. Therefore, the time, explain the mechanism of neurological
therapists prefer to move the joint of the training rehabilitation, reassess the functions
patients passively, but it is not in accordance when leaving hospital and explain announce-
with the mechanism of the plasticity of central ments of self-exercise out of hospital.
nerves. Form the view of motor functional Rehabilitation chief physician and resident
recovery, there is no obvious training effect. doctor complete medical record and clinical
Therefore, it is necessary to do technique therapy of the patients and select one or two
instruction, inspection and supervision. difficult rehabilitation training or scientific
3. Physician-therapist pairing system: At pres- research training items to do practical train-
ent, in domestic rehabilitation medical estab- ing. Treatment team is composed of one reha-
lishment, the doctors receive the patients, bilitation physician and 3–5 rehabilitation
write medical record, give the patients various therapists. The doctors are responsible for
examinations and prescribe medicine. The holding a symposium every week and analyz-
doctors only formulate the therapy principle ing the effect of training schedule. If there is
generally, but they don’t take part in the prac- problem, they should propose solution and
tical rehabilitation training and are not famil- submit to superior physician. The combina-
tion of doctors and therapists is good for reha- dysfunction at present. The therapists can judge
bilitation method and new problems, which the adaption and sensitivity of therapeutic sched-
provides opportunity for improvement and ule in solving the dysfunctions of the patients. If
innovation of rehabilitation method. there is any problem, they should report to the
4. First-diagnosis and last-diagnosis system of doctors in charge, put forward individual opinion
head of rehabilitation department or chief phy- and apply for the adjustment of training schedule.
sician: Because head of department is in charge Doctors in charge should take part in the training
of the work of the entire department, espe- and know the actual condition of the training. The
cially clinic, outpatient service, budget, decla- therapists should examine the patients in detail
ration and implement of scientific research and adjust the therapeutic schedule in time accord-
task. The primary task of head of department is ing to the examination result. Head of department
chief executive officer of the department. or chief physician make the rounds of the wards
Therefore, First-diagnosis regulation can be every week, examine the severe patients with
established, which is helpful for head of difficult symptoms in detail and know the effect
department to know actual dysfunctions of the of original schedule, the therapy response of the
patients, instruction of therapeutic schedule patients and the condition of the disease, which is
and ultimate determination of therapeutic the basis of adjustment of therapeutic schedule.
schedule. First-diagnosis can be done with The doctors are not responsible to give the
motor program signal detector in neurological tasks of therapeutic schedule to the therapists and
training room, which is good for the correct- let the therapists to do therapy with their personal
ness of functional assessment and rehabilita- experience and will. The therapists cannot com-
tion therapy of neurological training. It plays plete therapeutic schedule. It is improper that the
an important role in the understanding of the therapeutic schedule is not changed from admis-
method and mechanism of rehabilitation ther- sion to hospital to out of the hospital, which is
apy of neurological training and in activating irresponsible for the therapy of the patients.
the therapy enthusiasm of the patients. The
head of the department and chief physician do
functional assessment of the patients before 7.2.4 T
he Role of the Patients
leaving hospital and know the actual effect of and Their Family
the method, which is good for the improve- in Rehabilitation
ment and development of the method.
Rehabilitation is a complicated project that takes
7.2.3.2 Timely Adjustment time and labor and is related to the economic
of Therapeutic Schedule capability of the patients’ family. Especially
For established therapeutic schedule specific to in most areas of our country, medical insur-
the patients’ dysfunctions, it is not invariable. ance reimbursement of rehabilitation is limited
The schedule should be adjusted in time through and the family should afford to all the costs.
assessment in order to obtain better training Financial burden can block the rehabilitation of
effect, especially three-stage rehabilitation train- the patients. In addition, the insistence of the
ing schedule of neurological training. The therapy patients is related to effectiveness of the rehabili-
time of every stage is not confined to 1 month. tation method. There are three factors can affect
After 1 month’s training, the condition of the rehabilitation effect and anticipated rehabilitation
patients should be assessed, reassessed, adjusted goal such as family affection, tenacity and reha-
and re-adjusted in order to decide whether to do bilitation method.
the training of the second stage or not. Generally,
before every therapy, the therapists should assess 7.2.4.1 Family Affection
the patients briefly and know the changes after last Because there is no regeneration ability of CNS,
training and the actual condition of the patients’ it is difficult and chronic to recover the dysfunc-
tions of movements, cognition and speech due to lies are rich, but they don’t support the rehabilita-
damages. There are three stages in the emotion of tion therapy of the patients. Furthermore, they ask
the patients. the doctors to say to the patients that there is no
therapy method for this disease. They are unwilling
1. Deny and incomprehension: the patients can- to devote to the patients. The reason why there is
not accept the fact that they are sick. They so big difference is related to the following factors:
think they are healthy before and they don’t Morality: happiness is due to love in the world
understand why they fall ill suddenly. They and selfish help and devotion are the spring of
will feel wronged and be down in spirits. They happiness. Life is the most important in all the
has lost all desire for food and drink and can- treasures.
not fall asleep at night. Financial condition: with the limitation of
2. Sadness and hopeless: with the understanding the family financial condition, the family cannot
of the disease, the patients find that they can afford to the therapy costs.
fall ill just as other people. They will accept The recognition and importance of rehabili-
the fact. They don’t know the severity of the tation: the patients think that rehabilitation is
disease, the recovery condition, the time of dispensable and only surgery and medicines are
recovery, self-care condition, working ability, effective. They don’t realize that rehabilitation
the pain of the disease, the financial burden training is essential and irreplaceable in func-
and the burden of the family. The patients feel tional recovery. For example, the patients remain
hopeless about the future. They usually feel in bed with motor skill disorder and abnormal
upset and sorrowful. They don’t cooperate motor pattern a housing estate or village. They
with the therapy even give up the therapy or take medicines do self-exercise for years and
have other ideas. the disease cannot be improved, but they cannot
3. Rise against the disease: With the time, the accept the rehabilitation training.
patients adapt to the disease and recognize that Therefore, rehabilitation medical staffs should
sadness has no effect on functional recovery. understand rehabilitation deeply and explain it to
The only way is to rise against the disease. the family of the patients ahead of schedule. The
Therefore, they get up the courage and confi- therapists should use effective method to make
dence to defeat the disease and start to cooper- the patients and their families see the effect of
ate with the therapy. In this stage, the disease is rehabilitation training to increase the confidence
in the chronic phase. The family cost a lot of of rehabilitation therapy, which provide precon-
money in the acute phase of the disease and dition for the entire rehabilitation of the patients.
they will encounter economic problems.
7.2.4.2 Toughness
In every stage, the patients can encounter dif- Scientific training guided by the doctors, attic
ferent difficulty. Solving these problems is related faith and remorseless toughness are the premise
to the care and devotion of the family members. of functional recovery. In rehabilitation training,
Especially when these patients lose self-help the power of determined will and toughness of
ability, the destiny of the patients depends on the patients can make the patients obtain ideal
their family. Therefore, the care and devotion of rehabilitation training effect, which is related to
family member and the degree of the care and the particularity of rehabilitation training.
devotion are related to rehabilitation training and
the degree of functional recovery of the patients. 1. It takes a long time to recover lost motor func-
There are significant differences in the care tion after CNS damages, because the regenera-
and devotion of the family member to the patients. tion ability of central nervous cells is poor.
Some families are not rich, but they can devote Development, mature and repair after damages
everything to the rehabilitation of the patients. take a long time. Human take 1 year to learn
Parents can do this for their children. Some fami- how to walk after birth, while lower animal
such as sheep can learn to run a few hours after 4. The patients should take part in rehabilitation
birth. Clinical practice indicate that functional training actively. The patients should not take
recovery of paralyzed lower limbs takes 3 part in normal therapy such as medicine and sur-
months, while functional recovery of upper gery actively. The therapeutic effect depends on
limbs takes more than 6 months. Functional the effect of medicine and surgery. The patients
recovery needs long-term training, which is accept the results passively. The purpose of reha-
not a circumstance to taking medicine to bring bilitation is to recover the lost motor function of
down a fever. Therefore, rehabilitation training the patients. Through training process of motor
may make the patients think that there is no relearning program, the anticipated goal can be
effect of the therapy. It is more difficult to achieved. All the measures and methods can
recover the functions of injured brain tissues play a role through the endeavor of the patients.
than to establish functions in neonatal brain. Therefore, the patients must take part in it to
2. It is hard to be rectified after abnormal motor achieve it. For example, in cycling and swim-
pattern is formed. Every movement of human ming, the learner can learn to cycle or swim only
body is controlled and dominated by motor through practical self-training. The learner can-
program in motor center of brain cortex. After not learn to cycle or swim without practice even
brain cells damages, motor program can be if the coaching technology is good.
destroyed in various degrees. Because of com-
pensatory role of human tissues, the lost func- Therefore, the cultivation and guidance of
tions of some parts can be replaced by that of rehabilitation self-confidence of the patients
tissues of other parts. If there is no timely should be emphasized. The preserved rehabilita-
training to consolidate these compensatory tion determination and strong willpower of the
functions, it will lead to disorder of associated patients are established, which are the basis and
movement and abnormal motor pattern. For important fundament of rehabilitation training.
example, the hemiplegic patients with foot
drop cannot do dorsiflexion of foot and cannot 7.2.4.3 Rehabilitation Method
lift the leg away from the ground. When hip The purpose of rehabilitation therapy is to
flexor is paralyzed, the patients cannot incline recover self-help ability, improve life quality
to the uninjured side to make the foot away and return to society. Therefore, family affec-
from the ground. They can only move the tion and toughness are the premise and basis, but
limbs forward through dragging, which induce they are not enough. A good therapeutic effect
drag gait. After a long time, disuse of hip of rehabilitation method can promote functional
abductor and tibialis anterior muscle can lead recovery of the patients and solve practical prob-
to weak myodynamia and the abnormal inten- lems. Therefore, we should investigate and use
sity of drag gait is more and more severe. rehabilitation training method to promote cen-
Finally, abnormal motor program is formed in tral neural plasticity and functional reorganiza-
brain cortex and it is difficult to be rectified. tion, which is essential for functional recovery.

3. Self-training is lifelong after rehabilitation Rehabilitation medical staffs should focus on
training. With limitation of regeneration ability functional recovery of the patients and recog-
of central nervous system, functional recovery nize the mechanism and effect of various kinds
after damages should be replaced by the nor- of rehabilitation method. The therapists should
mal cells in injured area and be compensated be practical and realistic, not worship things for-
by reserved conduction pathway. Compared eign and fawn on foreign countries and not fol-
with original cells, the functions of reserved low suit. The therapists should investigate and
cells and conduction pathway are poor. The lost explore new methods to increase the effect of
function cannot be recovered to the level before rehabilitation therapy.
damages. It requires repeated self-exercise to Functional recovery after CNS damages is
consolidate the recovered functions. peculiar, chronic, difficult. The patients should
References 231
stick to it for a long time and take part in it actively. to bring benefit to all the disabled and contribute
It requires the full recognition and definite con- to the society.
fidence of rehabilitation medical staffs, the
patients and their family who have fortitudinous
willpower and prepare for protracted war, which References
can provide basis for realizing anticipated goal
of rehabilitation. All rehabilitation medical staffs 1. Delisa JA, Gans BM. Rehabilitation medicine:
principles and practice. 3rd ed. Philadelphia, PA:
should pay attention the mechanism and effect of Lippincott-Raven Publishers; 1998.
rehabilitation method and investigate new reha- 2. Dengkun N, editor. Rehabilitation medicine. 2nd ed.
bilitation method that is in accordance with CNS Beijing: People’s Health Press; 2001. p. 10.
plasticity to increase the effect of rehabilitation 3. Yulong W. Rehabilitation evaluation. Beijing: People’s
Health Publishing House; 2000. p. 88.
training and life quality of the disabled in order
Integrated Method
of “Physiotherapy-Physical 8
Exercise and Self-Exercise”
The range of physiotherapy is extensive such sule. Due to trauma, inflammation and tractive
as sound therapy, phototherapy, hydrotherapy, sprain, tear and muscle fiber necrosis and exu-
electrotherapy, cold therapy and thermal therapy, dation are induced. The manifestations in acute
which is an inalienable part of rehabilitation stage are local swelling, pain and limitation of
medicine and plays an important role in modern joint motion. According to the degree of damages,
and traditional medicine. It is used to treat many the clinical manifestation and disposition are dif-
kinds of diseases in all disciplines. The methods ferent. The severe patients require decompression
and mechanisms of physiotherapy are introduced in closed operation, debridement or repair. In less
in physiatry that is chiefly compiled by Jiao serious cases, the patients require cold compress,
Zhi-Heng and Fan Wei-Ming. It is published by immobilization, elimination of swelling and other
Science and Technology Literature Press. We physiotherapies [1].
don’t discuss these in our book. Joint soft tissue injury can lead to pain.
Our book is mainly to the pathogenesis of Meanwhile, joint motion can aggravate the
common bony joint and muscle diseases. We dis- pain, which is one kind of protection mecha-
cuss the reason why the disease is difficult to be nism. Limitation of joint motion is to prevent the
cured and easy to relapse and propose specific aggravation of tissue injury and to promote tis-
integrated therapy method of “physiotherapy- sue healing. When the injure tissues are repaired
physical exercise therapy and self-exercise. or healed to a certain extent, there is no pain in
joint motion, but soft tissue injury and exudation,
inflammatory and joint limitation can lead to
8.1 he Reason Why Bony Joint
T adhesion of muscle fiber, ligament, joint capsule
and Muscular Painful and nervus vascularis and the adhesion between
Diseases Are Difficult cartilages in articular surface, which affects the
to Be Cured and Easy range of joint motion. According to the injured
to Relapse degree and the course of disease, if the patients
don’t receive timely and effective therapy, the
8.1.1 S
oft Tissue Adhesion After adhesion may get worse and the tendon may
Damages Is Not Lessened contract and shorten. After that, severe tissue
Effectively adhesion is induced such as articular fibrous
ankyloses. Finally, with the deposition of cal-
Bony joint, especially soft tissue around joint, cium salt, incurable bony ankyloses of bony joint
includes muscle, ligament, tendon and joint cap- is formed [2].
https://doi.org/10.1007/978-981-13-0812-3_8
234 8 Integrated Method of “Physiotherapy-Physical Exercise and Self-Exercise”
Some researches show that adhesion between 1. Age: The morbidity of osteoarthritis increases
soft tissues induced by shoulder joint with plas- with age. In the middle age of human life, the
ter immobilization of 1 day requires 7 days’ joint functions of muscle and peripheral nerves
motion to make the range of shoulder joint to decrease gradually, nervous reflex recede and
be recovered to the original motion range. If the the conduction time extend, which can lead to
shoulder joint are immobilized for 3 weeks, the the incongruity between nerve and muscle and
range of shoulder joint can be recovered to the joint injury. In addition, the blood supply of
original motion range through 300 days’ joint bone and cartilago articularis decreases with
motion. Therefore, joint immobilization is an age. Due to inanition, cartilago articularis
important factor of soft tissue adhesion. becomes thin. Cartilage matrix decreases and
Different levels of adhesion of joint and soft it is easy to induce fibrosis. Inorganic sub-
tissue around joint can influence the range of joint stance of bone increases and the elasticity and
motion to varying degree. During the process of tenacity, which make the cartilage easy to be
joint motion, adhesion tissue can be stretched and damaged [3].
nerve endings may be compressed or stimulated 2. Obesity: Occurrence rate of knee osteoarthritis
to induce different levels of pain. The pain can of the patients with obesity is high, because
further affect joint motion. Limitation of range mechanical pressure of body weight to joint is
of joint motion can further aggravate adhesion high. The research indicated that the occur-
between tissues, which forms a vicious circle. rence rate of knee osteoarthritis in the female
The therapy methods used for osteoarthri- with obesity is three times more than that in
tis usually are medicine and physical methods, the female with normal body weight.
which emphasize the relief of pains such as ther- 3. Overuse: Joint overuse and repeated injury can
mal therapy, electrotherapy, acupuncture in tradi- lead to osteoarthritis. Some occupational labor
tional Chinese medicine, cupping and massage. and strenuous exercise (weightlifting) can
It cannot lessen the tissue adhesion effectively. induce overloaded stress to joint and degenera-
Therefore, after physiotherapy, during the pro- tive alterations of chondrocyte. Degenerative
cess of joint motion, the patients’ soft tissues are cells can decrease the synthesis of matrix and
stretched so that it is easy to induce slight lac- aggravate the destruction of chondrocyte. The
eration and sensation of pain through stimulating vicious circle is formed and lead to osteoar-
neural ending. This is the reason why bony joint thritis finally.
and soft tissue inflammation cannot be cured and 4. Repeated injury: Slight but repeated joint

are easy to relapse. injury is the nosogenesis of osteoarthritis such
as exercise without warm-up of joint and mus-
cle and repeated and unexpected stepping
8.1.2 T
he Factors That Induce Soft empty, which can induce soft tissue injury of
Tissue Inflammation of Joint joint and around joint.
and Muscle Aren’t Rectified 5. Climatic factor: The persons who usually live
in humid and cold environment are easy to be
Osteoarthritis is one of the most common arthri- diagnosed with osteoarthritis. For example,
tis, which belongs to degenerative change, aging some young white-collar wear skirt and work
of joint. It often involves the mostly used and in air conditioning environment for years.
load bearing joints such as hand, knee and lum- They are the high risk group of osteoarthritis.
bar vertebra, which usually induces fibrosis, frac- This is because that in cold environment they
ture, ulcer or loss of cartilago articularis. It is the don’t keep themselves warm and local blood
main reason to cripple the elder. circulation is affected. Inclement weather is
There are many factors that can induce osteo- the factor that induces or aggravates osteoar-
arthritis such as age, obesity, inflammation, thritis. In cold environment, if the person can-
trauma and genetic factor. The factors are sum- not keep themselves warm, vasoconstriction
marized as follows: can decrease tissue blood supply. In this case,
8.1 The Reason Why Bony Joint and Muscular Painful Diseases Are Difficult to Be Cured and Easy… 235
work, exercise or walking can easily lead to soft tissue in joint motion. It can stimulate nerve
the injury of soft tissues of cartilago articularis or vessel and induce different symptoms such as
and around cartilago articularis. pain, numb and insufficient blood supply such as
6. Special type of work and unhealthy life styles: dizziness, nausea and vomiting.
A sedentary life and no exercise can induce Except for cartilago articularis, bony spur
arthritis. Cartilago articularis of miner, heavy usually occur in joint capsule and adhesion area
worker, professional athletes or dancer receive between ligament and bone. For example, in spi-
high-intensitive stress wear for a long time and nal centrum, the position of bony spur is at the top
are easy to be injured. For example, the joint and bottom edge of centrum. After the repeated
motion is decreased in the persons who bend injury of fibrous rings of intervertebral disc and
over one’s desk in work and there is adhesion ligament, during repeated repair of tissue, repair
of soft tissue easily. The joint capsule is easy to is overdone and calcification is formed.
contract or compressed for a long time, which Therefore, if the factors that include inflam-
induces blood microcirculation disturbance mation of soft tissue in cartilago articularis, mus-
and degenerative change of tendon, ligament cle and ligament cannot be rectified effectively,
and cartilago articularis. the disease is possible to relapse although the
symptoms are relieved or cured.
In unhealthy life style, high-heeled shoes
is related to the formation of arthritis, because
walking with high-heeled shoes, the bearing 8.1.3 Single Therapeutic Method
pressure of knee increases and are easy to lead Without Comprehensive
to damages of cartilago articularis, which is the Therapeutic Method
biomechanics factor of osteoarthritis. for Pathogenesis
No matter what induce the disease, the result and Complication
is injury of soft tissue of cartilago articularis and
around joint without expectation. After tissue In treatise and textbook of physiotherapy, there
injury, self-repair mechanism can be activated. are many descriptions about the therapy of the
At ordinary times, most tissue cells are in dor- disease such as physical agent intervention of
mant state when they are not injured. Once they relieving pain, massage of lessening adhesion,
are damaged, they can feel the environment massage and joint mobilization, self-exercise
change and there is plasma leakage in the injure method for preventing relapse. However, in prac-
vessels, which lead to the migration of fibroblast tical therapy, the patients receive different thera-
into injured tissue. When the fibroblast contact pies in different departments, but the therapy is
with the injured tissues, they form collagen to not comprehensive. For example, some patients
seal wound. Through regeneration type such as think that the effect of physiotherapy is better
mitosis, new tissues are formed. The regeneration and they go to physiotherapy department for
is limited. After minor injury, through regenera- physiotherapy therapy such as ultrashort wave,
tion, the original morphology and function can far infrared and so on. Some patients trust tra-
be recovered. After severe injury, the wound is ditional Chinese medicine and go to traditional
recovered in scar and the original morphology Chinese medicine department. The doctors in
and function are hard to be recovered such as traditional Chinese medicine department usually
elasticity of tissue. Repeated minor injuries, dur- use massage, acupuncture, cupping and so on. All
ing the process of the tissue repair, fiber texture these therapies such as physical agent to relieve
increases, blood supply decreases, tissue elastic- pain, simple acupuncture, moxa-moxibustion or
ity decreases and the tissue is in a sclerosis state. massage are not comprehensive. These therapies
With time, there is calcinosis and ossification, cannot relieve pain effectively, lessen soft tissue
which forms “bony spur”. According to the posi- adhesion and prevent relapse of adhesion at the
tion of bony spur, it can stimulate the peripheral same time.
Because adhesion of soft tissue is not lessened local extravasated blood and granulation tissue is
effectively and bad habit that induces osteoar- formed. Tissue is to repair them. This stage lasts
thritis is not rectified, adhesion of the tissue can 1–2 weeks. Principle of management in this stage
be stretched when the patients go home and try is improving local blood circulation and promot-
to move adhesive joint. Adhesive tissue can be ing metabolism and repair of tissue. Thermal
stretched to compress neural ending. When the therapy, massage, medicine and physiotherapy
stretched strength is large, it can induce slight are used alternatively. Meanwhile, functional
tear of soft tissue to a certain extent and dam- rehabilitation training with little amount of exer-
age neural ending directly. All these can induce cise can be done.
pain, which can make the patients don’t want to
move joints. Immobility can aggravate the degree
of adhesion and induce the pain of joint and limi- 8.2.3 Late Stage
tation of range of joint motion. In addition, the
patients work and live as usual and the patho- In this stage, local symptoms such as edema
genic factors of arthritis are not eliminated. New and pressing pain disappear. Injured tissue is
arthritis is formed. The new symptoms cannot be repaired. However, intensity, elasticity and func-
relieved and the original symptoms are aggra- tion of healed tissue are lower than that of normal
vated gradually. tissue. Tissue adhesion still exists. Principle of
management in this stage is lessening adhesion,
recovering range of joint motion and enhancing
8.2 Neurological Training myodynamia. Functional training is the main
Rehabilitation training with physiotherapy, massage and reha-
for Osteoarthritis bilitation training.
Our book aims at the therapy of late stage
In the principle of dealing with injuries of soft or obsolete osteoarthritis induced by soft tissue
tissue in cartilage of bony joint and around joint, injury. This kind of disease includes three aspects
therapies at different stages are as follows [4]: of symptoms:
1. Pain there are many reasons such as injury,

8.2.1 Early Stage osteoporosis, gout, periostitis, osteoarthritis,
rheumatism and rheumatoid arthritis, arthro-
Twenty-four to forty-eight hours after injury, tis- meningitis and meniscus injury, which can
sue ischaemia induced by microvascular injury affect joint motion and induce pain in joint
can lead to acute aseptic inflammation. A lot motion.
of tissue percolate lead to local tissue swelling. 2. Soft tissue adhesion and contracture and ossifi-
Principle of management in this stage is immo- cation of joint capsule and ligament: The
bilization, hemostasis, detumescence, analgesia patients are afraid to move joints because of
and alleviating inflammation. After injury, immo- pain. Cellulose in inflammatory exudates can
bilization, cold compress, pressure dressing and induce adhesion of soft tissue in articular sur-
injured limbs lifting should be done as soon as face and around joint. With time, adhesive tis-
possible, but it is forbidden to do massage and sue, joint capsule, ligament and tendon may
thermal therapy in the injured area. contract and ossify, which can further affect
range of joint motion and aggravate the pain in
joint motion.
8.2.2 Middle Stage 3. Limitation of joint motion: Both pain and

adhesion can affect the range of joint motion,
After 24–48 h after injury, bleeding stops and which can limit range of joint motion and
acute inflammation starts to fade away. There is immobilize the joint motion (fibrous ankyloses
8.2 Neurological Training Rehabilitation for Osteoarthritis 237
or bony ankyloses of joint). It can affect the ing body, local temperature of the body increases,
joint functions in varying degrees. which is called thermal effect of infrared [5–7].
The therapeutic effect of thermal effect is related
Three symptoms interact with one another and to biophysics mechanism of thermal effect.
interact as both cause and effect. Pain can restrain
joint motion. Limitation of joint motion can lead 1. Activation of bio macromolecule is good for
to adhesion of soft tissue. Severe adhesion further the functional activities of bio macromolecule
aggravates the degree of joint motion limitation. such as regulation of metabolism and immune,
Limited joint can induce pain when joint motion which can recover body function, prevent dis-
causes tear of adhesive tissue. Therefore, therapy ease and cure disease.
method for osteoarthritis should be give consider- 2. Promotion and improvement of local and

ation to the three symptoms. If the therapy method entire blood circulation: infrared acts on the
only figures one of the symptoms, the therapeutic skin and the energy is absorbed by the skin.
effect is affected inevitably. The effect cannot last The absorbed energy is transformed into heat
long and the disease is easy to relapse. and it can increase local skin temperature.
The purpose of integrated therapeutic method Therefore, it can stimulate thermoreceptor in
in physiotherapy-physical exercise therapy and skin. It can relax vascular smooth muscle,
self-exercise of neurological training is to give dilate blood vessel and accelerate blood circu-
consideration to three factors mentioned above in lation through thalamus reflex. In addition,
order to obtain stable therapeutic effect. thermal effect can induce the release of vaso-
active substance, lower angiotasis and dilate
superficial arteriole, superficial capillary and
8.2.4 Physiotherapy superficial vein, which can promote local
blood circulation.
The purpose of physiotherapy is to relieve pain, 3. Enhancement of metabolism: The thermal

increase blood circulation of injured part, alle- effect of infrared can enhance the vitality of
viate swelling and promote heal of injured tis- cells and adjust neurohumour mechanism. It
sue. There are many physiotherapy methods. can also strengthen tissue metabolism and
We only introduce the frequently-used methods make the substance exchange in a stable state.
in “physiotherapy-physical exercise therapy and 4. Increase of immune function: Infrared can

self-exercise” in our book. increase the function of phagocytosis of mac-
rophage and can promote the functions of
8.2.4.1 Far Infrared human cells and humoral immunity.
Far infrared is the ray of light outside of red light. 5. Antiphlogosis and detumescence: Infrared can
The wave length is 0.76–400 μm, which belongs improve blood circulation, enhance tissue
to electromagnetic wave. It is a kind of radioac- nutrition, activate tissue metabolism, boost
tive ray with intense thermal effect that we cannot cell regeneration ability, which is good for
see with our eyes. According to the wave length localization and control of inflammation and
of infrared, it is divided into near infrared, middle repair of nidus. In addition, thermal effect can
infrared and far infrared. enhance the stability of cell membrane, regu-
The thermal effect of infrared is the important late ionic concentration, promote excretion of
part in therapeutic effect. The thermal effect is toxic substance and metabolite, accelerate
generated by the arrangement of dipole and free absorption of exudate and promote control of
charge according to the orientation of electro- inflammation and fade of edema.
magnetism in electromagnetic field. During this 6. Analgesia: The thermal effect of infrared can
process, aggravated random motion of molecule decrease excitability of neural ending and
and atom can generate heat. If the heat of the increase threshold of pain. With improvement of
infrared exceed heat dissipation potential of liv- blood circulation and fade of edema, chemical
and mechanical stimulus of neural ending are change surface tension of liquid. Surface ten-
relieved, which can alleviate pain. sion of some substance increases and surface
tension of other substance decreases. Under
8.2.4.2 Ultrashort Wave the influence of high speed alternating high-
1. The characteristic of ultrashort wave: The
frequency electromagnet wave, when the elec-
wave length of ultrashort wave is 1–10 m and tric field intensity is maximal, cells stretch to
the frequency is 30–300 Hz. The wave length electric field direction and become normal
of domestic therapeutic machine of ultrashort when the electric field intensity is minimum.
wave is 6, 7.2, 7.34 and 7.7 m. The frequency Proper frequency electric field can make cells
is about 50 MHz. Because the wave length of stretch out and draw back fully. It can produce
ultrashort wave is short and the frequency is special stimulus to cells and tissues and induce
high, electricity of ultrashort wave is easy to specific biological function.
pass dielectric medium. Therefore, in the ther- Although low-intensity ultrashort wave
apy the electrode does not directly touch the doesn’t increase tissue temperature, its biolog-
skin. ical effect is still obvious. Under the same cir-
Ultrashort wave act on human body and cumstance, exogenous heat has no such effect.
induce physiological reaction includes thermal Short time ultrashort wave without heat is used
effect and non-thermal effect. This is because for therapy. The therapeutic effect for acute
the electricity of ultrashort wave is divided into inflammation is more obvious than long-term
continuous and impulse type. Current oscilla- warmth and can induce reaction of other tis-
tion of continuous electrical curve continu- sues and organs, which is called non-thermal
ously exists and there is a lot of thermal energy. effect. Non-thermal effect is more obvious
On the basis of continuous ultrashort wave under the influence of low field intensity
electricity, the electricity of impulse ultrashort (lower than 40 mW/cm2).
wave is added with low frequency pulse modu- 2. Physiological and therapeutic effects of ultra-
lation and amplification, which forms intermit- short wave
tent rectangle ultrashort wave electricity. There (a) Medium-small dosage of ultrashort wave
is no thermal inductance in therapy and its has a sedative effect. Nervous system is
effect on human body comes from oscillation very sensitive to ultrashort wave field,
effect of pulse train. because nervous tissue is similar to dielec-
In the thermal effect of ultrashort wave, tric medium, especially for brain cells,
thermal energy is hard to spill out of the blood autonomic nerves and visceral peripheral
because there are few blood vessels in fat layer. nerves. Medium-small dosage of ultrashort
Therefore, the temperature is higher than that wave acts on head, which can induce sup-
of muscles with abundant blood supply. Some pression phenomenon of central nervous
researches indicated that when the wave length system such as drowsiness except sense of
of ultrashort wave is 7.34 m, the ratio between warmth. It can lower tensity of sympathetic
temperature rise of fat and temperature rise of nerve, alleviate vasospasm, promote collat-
muscle is 8–1. There still are some defects eral circulation, improve histotrophic nutri-
such as overheating of fat. The space between tion and increase functions.
skin and polar plate is adjusted to increase (b) Analgesia: Ultrashort wave has an inhibi-
deep tissue temperature and lower the temper- tory effect on sensory nerve and its analge-
ature of subcutaneous fat. In practice, we sic effect is obvious. Moreover, small
should pay attention to the distance of the skin. dosage of ultrashort wave can accelerate
Non-thermal effect is observed in ultrahigh the regeneration of incomplete broken
frequency and low intensity ultrashort wave. nerve fiber.
Ultrahigh frequency electrical oscillatory wave (c) Improvement of microcirculation: In cer-
can induce substance resonance in cells and tain extent, increase of ultrashort wave
intensity can dilate blood capillary even Grade 1 (8–10 min/time) or grade 2 (10–
blood vessel of deep viscera, increase vas- 12 min/time) is used for the therapy of acute
cular permeability, accelerate blood flow inflammation. Grade 3 (15–20 min/time) is
and improve blood circulation of tissue used for the therapy of chronic inflammation
and organ. or chronic disease. Grade 4 is used for the ther-
(d) Sterilization: not only ultrashort wave can apy of killing tumor cell, not for normal
kill bacteria directly, but also little dosage inflammation.
ultrashort wave increase phagocytic abil- The frequency of 8–12 min/time is used for
ity of macrophage, which is good for children. Course of treatment depends on the
sterilization. state of disease. The frequency of 6–8 min/
(e) Promotion of wound healing: Clinical and time is used for acute inflammation. The fre-
experimental research indicated that ultra- quency of 12–24 min/time is used for chronic
short wave can accelerate the regeneration of inflammation.
connective tissue and growth of granulation 4. Key points of operation include the patients’
tissue and promote division growth of vascu- position, the place of electrode and the dis-
lar endothelial cell and phorocyte. Therefore, tance between electrode and skin.
ultrashort wave can accelerate wound heal- (a) Position: The patients place themselves in
ing and promote escharosis. Large dosage a comfortable position and don’t expose
ultrashort wave for a long time can dehy- therapeutic area. Thickness of the clothes
drate and age wound and connective tissue should be calculated.
around it, which make the wound become (b) Electrode: The therapists should select
hard and difficult to be cured. proper electrode and aim at therapeutic
(f) The influence on inflammation process: area. The thickness of underbed should be
Ultrashort wave has a good therapeutic determined according to the depth of lesion.
effect on inflammation, especially acute (c) The place of electrode capacitance elec-
suppurative inflammation. In the therapy trode method is mainly used in ultrashort
of acute inflammation, small dosage ultra- wave therapy. Its electric field distribution
short wave has obvious antiinflammation. is closely related to the place method of
Large dosage can aggravate the state of electrode, pole plate and skin distance to
disease. Small dosage ultrashort wave is make intensive power line get through the
suitable for the therapy of acute inflamma- target. Two-pole method and body cavity
tion of superficial tissue. In the therapy of method are usually used. Two-pole method
deep visceral infection, the dosage should is divided into contrapost and apposition.
be increased. This is related to the distribu- Contrapost is used for the therapy of the
tion and loss of ultrashort wave penetrat- deep or visceral lesion and apposition is
ing human electric field. used for superficial lesion or extensive and
3. Therapeutic dose of ultrashort wave: In actual superficial lesion. Body cavity method is a
work, the dosage should be determined accord- peculiar form of two-pole method. Tailor-
ing to the feeling of the patients, luminance of made body cavity electrode (such as rec-
neon lamp and meter reading (Table 8.1). tum and vagina) is placed in the
Table 8.1 Ultrashort wave dosage classifications and indications

Classification quantity of heat The patients’ feeling Luminance of neon lamp
1 None No sense of warmth Faint light of neon lamp
2 Slight Slightly tepor Full bright of neon lamp, dim light
3 Warm Comfortable tepor Brightness of neon lamp
4 Hot obvious hotness, but can tolerate Brightness of neon lamp
corresponding cavity. Another plate or hydrops articuli, bone fracture and

band electrode can be placed in abdomen, swelling after replacement of dislo-
lumbosacral spinal or around pelvis, but cated joints. The ultrashort wave ther-
this electrode cannot be used in the therapy should not be used for too many
apy of osteoarthritis. times. The frequency is less than 15
(d) The distance between electrode and skin times in case of inducing tissue dehy-
is called air distance. The size of sir dis- dration and aging of granulation tissue
tance is related to therapeutic area and and new epithelial tissue.
output power of the equipment. In the (b) Contraindications: The patients with bleed-
superficial lesion, the distance is small ing tendency, hypotension, heart failure,
and the distance is big when the lesion is active tuberculosis, cancer (except for killing
deep. If we used the therapy equipment tumor cells through high thermal energy),
with big power, the distance should be pacemaker or valvular replacement.
enlarged. On the contrary, the distance
should be shrinking. In practice, we 8.2.4.3 Medium Frequency
should consider the range of the lesion Electrotherapy
and the size of the electrode. When we 1. The definition of medium frequency electro-
used therapy equipment with small power therapy: Medium frequency electrotherapy is a
and electrode, the distance is 0.5–1 cm. method that pulse current with the application
When we used therapy equipment with frequency (1000–100,000 Hz) is used for treat-
big power and electrode for deep lesion, ing diseases. Interferential current therapy,
the distance is 3–4 cm. In order to prevent modulated medium frequency electrotherapy,
uneven effect, the air distance should be width sine intermediate frequency (voice fre-
small for uneven surface. quency) and medium frequency electrotherapy
(e) Contraposition should be used with cau- controlled by computer are usually used in
tion in children’s head. The dosage clinic.
shouldn’t be too large for the therapy of 2.
The characteristics of medium frequency
human head. In apposition, the distance current
between two electrodes should not be (a) No electrolytic action: Medium frequency
shorter than the diameter of electrode or current is sine alternating current. There is
shorter than the radius of electrode. no positive and negative electrode and no
5. Main indications and contraindications of
electrolytic action. Therefore, it is easy to
ultrashort wave be operated.
(a) Indications: (b) Reducing tissue impedance and increasing
• Various inflammation diseases includ- action depth: Medium frequency current
ing inflammation of soft tissue, joint, can overcome tissue impedance and has a
bone, the five sense organs, viscera in deep therapeutic effect.
pleuroperitoneal cavity, nervous sys-
(c) Excitable effect on body tissue: After
tem and genitals. It has a good thera- action potential of motor nerve, there is
peutic effect on acute and sub-acute absolute refractory period and the duration
inflammation. is about 1 ms. If every stimulus can induce
• Painful diseases including neuralgia, action potential, the frequency of medium
causalgia, myalgia, acroaesthesia and frequency current should be less than
the diseases of vasomotor nerve and 1000 Hz. Therefore, the current with the
some autonomic nervous dysfunction. frequency that is less than 1000 Hz is
• Traumatic wound and ulcer: Ultrashort called low frequency current. Medium fre-
wave can accelerate the fade of various quency current with the frequency that is
traumatic reactions such as pain, from 1 to 100 kHz cannot induce action
edema, hematoma, hemarthrosis, potential every time, but combined action
of many stimuli can induce one action of muscle. The current with frequency
potential, which is called combined effect that is 25–50 Hz can induce tetanic con-
of medium frequency electrical stimulus. traction of muscle. The current with
(d) The characteristics of the stimulated effect frequency that is 100 Hz can weaken or
of medium frequency current on neuro- diminish muscle contraction.
muscular stimulation: medium frequency • The effect on sensory nerve: There is
current can stimulate the skin sensory obvious vibratory sense in the fre-
nerve but cannot induce excitement of quency of 50 Hz and analgesic effect in
fiber of sensory pain. There is comfortable the frequency of 100 Hz.
vibration sense but no pain. Therefore, • The effect on blood vessel: The current
current with strong intensity can induce with frequency that is 1–20 Hz can
intensive contraction of deep muscle, but increase tension of blood vessel and
cannot induce burn pricking of electrode. the current with frequency that is
Medium frequency current with the fre- 50–100 Hz can dilate blood vessel.
quency that is 6000–8000 Hz can induce • The effect on autonomic nerve: The
divergence phenomenon between muscle current with frequency that is 4–10 Hz
contraction threshold and threshold of can excite sympathetic nerve and the
pain. In this frequency range, there is current with frequency that is 20–40 Hz
strong muscle contraction but no pain. can excite vagus. When the frequency
(e) Physiologic characteristic of medium fre- is 100–150 Hz, the current can inhibit
quency current with low frequency: sympathetic nerve.
Medium frequency current with constant 3. Physiological effect and therapeutic effect of
range can be adapted for human body to medium frequency current: Medium frequency
decrease stimulation effectiveness. At current can ease pain, promote blood circula-
present, medium frequency current modu- tion, diminish inflammation, lessen adhesion
lated by low frequency current (0–150 Hz) and prevent scar formation.
is used in clinic to make range of medium (a) Analgesic effect: Medium frequency elec-
frequency current change with the fre- trotherapy can induce threshold of pain
quency of low frequency current. The cur- in local skin. In clinic, it has good analge-
rent has the characteristics of low sic effects, especially low frequency mod-
frequency current and medium frequency ulated medium frequency current.
current. Moreover, human body is difficult Analgesic effect includes immediate anal-
to adapt to the change of wave form, wave gesia and follow-up analgesia.
amplitude, frequency and modulated Immediate analgesia is that pain can be
amplitude. This kind of current includes relieved quickly after therapy. The mecha-
interference current and modulated nism of immediate analgesia may be mask-
medium frequency current. Rectified pulse ing effect theory, cortex interference theory
medium frequency current can be used for and humoral mechanism. Medium fre-
medicine-inductiveness therapy. quency current can induce obvious vibra-
• Physiological effects of medium fre- tory sense. When an impulse goes into any
quency current with constant amplitude node of pain stimulus afferent pathway, the
and low frequency modulated medium conduction of pain stimulus can be blocked
frequency current are different because or covered so that the pain can be stopped or
of different frequency of current. The relieved. Cortex interference theory is that
main functions are as follows: when electrical stimulus impulse and pain
• The effect on motor nerve and muscle: impulse go into cortical sensory area at the
The current with frequency that is same time, they disturb each other in the
1–10 Hz can induce single contraction cortex. According to excited competitive
inhibition of cerebral nuclei, the sense of tion have obvious dilation of blood
pain can be relieved or covered. Humoral vessels effect such as lactic acid.
mechanism of immediate analgesia is that • The effect of autonomic nerve: medium
endogenous morphine-like peptides (OLS) frequency current can inhibit sympa-
is secreted from brain, pituitary body and thetic nerve to promote local blood
intestines. It has the effect of morphine and circulation.
is one kind of natural neurotransmitter with • Skeletal muscle exercise: Low fre-
analgesic effect. Endogenous morphine-like quency modulated medium frequency
peptides include encephalin (short duration current can induce skeletal muscle con-
of analgesia) and endorphin (long duration traction. It has little stimulation on skin
of analgesia, 3–4 h). Medium frequency sensory nerve ending and no electro-
current can activate neurons of endogenous lytic action. It can be used for a long
morphine-like peptides and they can release time. Depth of current penetration is
OLS with analgesic effect. The analgesic good for the therapy of deep lesion.
effect of OLS is 3–4 time of that of mor- (c) Softening scars and lessening adhesion:
phine and they have no side effects. medium frequency current with constant
Follow-up analgesia: under the influence amplitude (sound frequency current) can
of medium frequency current, local blood soften scar and lessen adhesion, which is
circulation is changed to relieve edema widely used in clinic. Its characteristics
between tissues and between nerve fibers, are as follows:
decrease tissue tension, alleviate muscle (d) Instant effect: there is quick therapeutic
spasm induced by ischemia, improve anaer- effect in the therapy of spasm induced by
obic condition, promote elimination of path- cerebral palsy. Muscle spasm is due to
ological chemical substances such as higher central nerve injury so that the ther-
potassium ion, plasmakinin and amines, apeutic effect doesn’t last long.
which have indirect analgesic effect. • The therapeutic effect is fast: the thera-
Promotion of blood circulation: peutic effect of cerebral palsy spasm is
Medium frequency current, especially low fast, but the therapeutic effect of mus-
frequency (50-100 Hz) modulated medium cle spasm due to higher central nerve
frequency current can obviously promote damages cannot last a long time
local blood and lymphatic fluid circula- • Painless: There is on injury and pain in
tion, increase skin temperature and dilate medium frequency electrotherapy and
arteriole and capillary. The mechanisms most of the patients can adapt to it quickly.
are as follows: • Fewer side effects: Medium frequency
(b) Axon reflex: Medium frequency current electrotherapy seldom induces discom-
can stimulate skin receptor. Impulse go fort or anaphylactic reaction.
into the afferent neuron and can conduct to • Enduring therapeutic effect: the thera-
arterial wall another branch of the same peutic effect of medium frequency cur-
axon retrograde, which induce dilation of rent can last long. This may be because
local blood vessel. that there are additive effects after
• The effect of vasoactive substance: repeated therapies. Taking medicine,
medium frequency current can stimu- after several hours, the medicine lose
late sensory nerve and make them efficacy and the symptoms reappear.
release a little substance P and acetyl- • In addition to this, we can select and
choline that can induce dilation of apply rehabilitation department exist-
blood vessels. ing physiotherapy equipment of reha-
• The effect of metabolite muscle move- bilitation department for therapy such
ment: Metabolites of muscle contrac- as laser, kerotherapy, decimetric wave,
centimetre wave and millimeter wave. The classification is over-general, which covers
According to the different responses a lot and is easy to be confused. With the devel-
and requirements, the medicine can be opment and progress of rehabilitation medicine,
added properly. the definition should be more precise and the
• Non steroid analgesic and anti- classification is easy to understand and master.
inflammation medicine can inhibit the For example, the definition of physical exercise
synthesis of inflammatory substances, therapy is that manipulation and training skills
withstand inflammation reaction, relieve are used to increase or recover the original func-
joint edema and pain, but they have no tions of the patients. The most prominent thing is
effect on the progress of osteoarthritis. that the patients take part in the training process
We can use ibuprofen, rebellin, voltaren actively. The definition of physiotherapy is that
(diclofenac sodium) and celecoxib. natural physical agents such as electricity, light,
• Sodium hyaluronate is the main ingre- sound, cold and heat are applied for prevention
dient of articular cavity synovia, which and therapy of the injuries. The important thing
can lubricate joint, decrease tissue attri- is that the patients passively receive the therapy
tion, enhance vicidity of synovial fluid and there is no training process. However, both
and lubrication, protect cartilago articu- physiotherapy and physical exercise therapy are
laris, promote the healing and regenera- all the inalienable important ingredients of reha-
tion of cartilago articularis, relieve pain bilitation medicine.
and increase range of joint motion. This We mainly introduce the rehabilitation
medicine can be used for intra-articular method of neurological training applied for
injection once a week for 5 weeks. injury of bony joint and soft tissue and degenera-
• Glucosamine is to promote the synthe- tive inflammation.
sis of protein polysaccharide with nor-
mal structure in chondrocyte. 8.2.5.1 Neurological Training
Caleineurin polysaccharide can protect Rehabilitation
cartilago articularis cells from damage Daoyin feedback technique in traditional Chinese
in order to improve range of joint medicine is used for the training to relieve pain
motion, relieve joint pain and delay the and recover the range and function of joint
progress of osteoarthritis. The medicine motion.
should be taken orally 250–500 mg per
time, three times a day with meal. 1. Method and equipment Neurological training
equipment and Daoyin equipment of muscu-
The medicine can be combined with acupunc- lar tension are applied for the training.
ture and stimulation of main and collateral chan- The essence of neurological training is to
nels in traditional Chinese medicine to obtain combine six-step Daoyin technique of guiding
better therapeutic effect. collaterals through meridians and biological
feedback technique. The record of six-step
Daoyin technique of guiding collaterals
8.2.5 Method and Mechanism through meridians or the oral dictation of the
of Physical Exercise Therapy therapists are used to guide the patients to move
agonistic muscle of joint dominated by brain.
Physical exercise therapy is physical therapy Meanwhile, electronic equipment is used to
(PT). Somatic movement, massage, traction and receive motor program signal form brain to
training equipment are used for therapy and train- agonistic muscle and antagonistic muscle or
ing to prevent and treat injuries and recover func- tension signal of muscle contraction and dila-
tions. The physical agents are applied include tion and display it in the fluorescent screen with
electricity, light, sound, magnet, cold and heat. a curve form. Through establishing surpassing
goal with different signal intensity, the patients (b) The training of strain of lumbar muscles:
are guided repeatedly to enhance signal inten- Two-lead paralleling electrode (the left
sity of agonistic muscle and decrease signal and the right) are used and they are pasted
intensity of antagonistic muscle with anti-resis- on skin surface of musculus sacrospinalis
tance training to develop brain potential. 2 cm outside of spinous process of lumbar
Through active joint motion, tissue adhesion vertebra. The training of waist anteflexion
can be lessened, myodynamia can be strength- and rear protraction can be done sepa-
ened and the range of joint motion can be rately. The training of muscle in L1, L3
increased. and L5 of lumbar vertebra can be done.
The theory of neurological training equip- (c) The therapy of hip arthritis: The training
ment is that it can receive the motor program of anteflexion, rear protraction, adduc-
signal form brain to agonistic muscle and tion, abduction and cyclovergence of hip
antagonistic muscle that are involved in joint joint are done separately. The electrodes
motion, which provide the therapists the train- of anteflexion and rear protraction of hip
ing of motor program establishment with a joint are pasted on skin surface of hip
purpose to guide the patients. flexor and extensor separately. The elec-
The theory of Daoyin equipment of muscu- trodes of hip adduction and abduction can
lar tension is the same as that of neurological be pasted on skin surface of hip adductor
training equipment. The difference is the ten- and abductor. Four-lead electrode can be
sion change during the contraction of agonis- used for the training of hip cyclovergence.
tic muscle and antagonistic muscle that are Four electrodes are pasted on skin surface
involved in joint motion, which is the pressure of hip flexor, hip abductor, hip extensor
of muscular tension on reception electrode. It and hip adductor. Through establishing
is another outward pattern of manifestation of different surpassing goal, Daoyin tech-
motor program. This pressure signal can be nique is used to guide the patients to sur-
showed in fluorescent screen with a curve pass the goal through active anti-resistance
form. Through establishing surpassing goal training.
with different intensity of muscular tension (d) The training of knee arthritis the elec-
signal, it can provide the therapists the train- trodes of knee extension and flexion are
ing of motor program establishment with a pasted on skin surface of quadriceps fem-
purpose to guide the patients. oris and hamstring muscles.
2. Training part and the placement of electrode: (e) The training of ankle arthritis: The train-
According to the affected parts, the training ing of foot dorsiflexion, plantar flexion,
part can be ascertained all over the body. strephenopodia and strephexopodia. The
(a) Neurological training of scapulohumeral electrodes of foot dorsiflexion and plantar
periarthritis can be divided into the training flexion are pasted on skin surface of mus-
of shrug, shoulder protraction, rear pro- cle belly of tibialis anterior muscle and
traction of shoulder, shoulder abduction musculus gastrocnemius separately. The
and shoulder cyclovergence. Single lead electrodes of strephenopodia and
electrode is used for shrug and electrode is strephexopodia are pasted on skin surface
pasted on skin surface above shoulder of muscle belly of peroneus longus and
joint. Three-lead electrode is used for brevis and tibialis posterior.
shoulder abduction and it is pasted on skin (f) The training of musculi colli: The training
surface of anterior, middle and posterior of neck extensor and flexor is the main
bundle of deltoid muscle. It should be used training. Two-lead paralleling electrode
for the training of shoulder abduction, pro- (the right and the left) are used in this
traction of shoulder, rear protraction of training. The back electrode is pasted on
shoulder and shoulder cyclovergence. skin surface of musculi colli and 2 cm
outside of spinous process of cervical ver- to painless joint motion without any inter-
tebra. The front electrode is pasted on vention of physical agent is attention diver-
skin surface of muscle belly of cleidomas- sion. Through stimulant competitive
toid. The trainings of cervical flexion, inhibition of cerebral nuclei, attention
extension and cyclovergence are done diversion can be achieved. There is com-
separately. petitive inhibition in the excitability of cen-
Daoyin equipment of muscular tension is tral cerebral nuclei. For example, when a
applied for the training. Through receiving the cerebral nucleus is excited, the excitability
pressure of muscle contraction on reception of another cerebral nucleus can be inhib-
electrode and using it as the feedback signal, ited. This is because that human central
the electrode is hard to be placed in some area nervous system can receive or perceive the
and the sensitivity of the electrode is not more information of the most excited cerebral
than that of neurological training equipment. nuclei and neglect information of other
We can choose the therapy equipment flexibly. cerebral nuclei with low excitability.
3. Training time and therapy course: The train- However, the excitability degree of one
ing is 30 min per time and 15 times per course. cerebral nucleus with strong excitability
The therapy can be done continuously. can be influenced by other nuclei. In fact,
4. Neurological training used to treat osteoar- in actual life, there is such phenomenon.
thritis and its mechanism: Neurological train- For example, in competitive sports of the
ing equipment is not physiotherapy equipment. 110-m hurdles, if the performance of Liu
During therapy process, there is no interven- Xiang is better than others, the entire world
tion of physical agent, but therapeutic effect focuses on him. When his performance is
of chronic bony joint disease is significant. Its lower than any of the others, the concerned
mechanism is related to the following factors: person is changed. The patients with mul-
(a) Autonomic joint motion training and con- tiple injuries perceive the most severe
solidation of therapeutic effect: Six-step injured part or organ of the body. When the
Daoyin technique of guiding collaterals severe part is treated, they can perceive the
through meridians is the Daoyin tech- injuries of other parts or organ. In clinic,
nique according to main and collateral the therapists may overlook the injured
channels. Is has a good clearing and acti- part and delay the therapy. Most of the
vating the channels and collaterals effect. patients feel less painful in daytime
The current of main and collateral chan- because of accompany of other people and
nels can alleviate pain. Especially, six- feel more painful at quiet night.
step Daoyin technique is used to guide the Neurological training method is that
patients surpass specific goal and do anti- the patients are guided to do active joint
resistance autonomic range of joint motion, meanwhile the equipment receive
motion training, which can improve range the drive signal form central nerve to
of joint motion. Moreover, the inspired muscles of joint motion and displays it on
autonomic joint motion training through the fluorescent screen in a curve from.
reestablishing motor program belongs to There are three key points in the training:
methodology training. Once there is ther- • Through immerse technique, the
apeutic effect, it can be consolidated and patients are immersed into therapeutic
is hard to relapse. Just like a person has environment.
learned to ride a bicycle, after 1 year or • Through Daoyin technique of regula-
more time, he still can ride a bike. tion of mind and breathing, the patients
(b) The important measure of painless joint focus on concentration training.
motion is attention diversion. The reason • During the process of regulation of
why neurological training method can lead movement, the patients are guided to
concentrate on surpassing the signal ing can strengthen myodynamia to smooth

intensity of agonistic muscle and for- joint motion and increase the range of
get the joint motion training. The three joint motion. The enhancement of myo-
key points can better diverse the dynamia requires more blood supply to
patients’ attention. When the patients promote local blood circulation. The
move their joints, the sense of pain is increase of the range of joint motion is
greatly relieved or there is no sense of good for the loose of adhesion. It can turn
pain. After the therapy, the patients joint motion into a virtuous cycle of func-
find that the range of their joint motion tional recovery.
is increased and the sense of pain is
relieved. Moreover, there is no pain in 8.2.5.2 Physical Exercise Therapy
the therapy and the confidence of ther- of Neurological Training
apy is doubled. Physical exercise therapy of neurological training
• With the range of joint motion, is a training mode of six-step Daoyin technique
adhesive joint capsule, ligament, of guiding collateral through meridians with bare
tendon and muscle can be lessened hands. The training is done without neurological
to promote increase of range of training equipment. Its basic procedures are the
joint motion and remission of the same with the process with neurological train-
pain. This is why biological feeding equipment. They are all active joint motion
back technique can cure scapulo- training. According to specific conditions of the
humeral periarthritis and pain of patients, anti-resistance training can be done
lower waist. It can lessen soft tissue properly with the help of passive joint motion and
adhesion without inducing pain. massage of muscle and soft tissue.
(c) Promotion of blood circulation and elimi- In physical exercise therapy of neurologi-
nation of metabolite: After diagnosed with cal training, the movements of muscle training
osteoarthritis, because of pain during joint include isometric exercise training and isotonic
motion, the patients cannot move or do exercise training. Isometric exercise training is
less exercise and the range of joint motion that muscular tension is changed with constant
is decreased, which can affect blood circu- length of muscle, which is also called silent con-
lation of soft tissue around joint to a cer- traction training. It is suitable for the patients
tain extent and block the elimination of with arthritis. Except for acute and severe arthri-
metabolite. Accumulation of local metab- tis, the patients in any stage or any time can use
olite, especially lactate metabolite, can this training method. Isotonic exercise training is
stimulate nerve ending of local soft tissue, that the muscle tension is changed slightly before
which further induce pain and discomfort. and after exercises, but the muscle length and
In addition, lymph backflow obstruc- joint position are changed. It is suitable for anti-
tion aggravates local heaviness. The train- resistance training.
ing of automatic joint motion can promote Training time and therapy course: Physical
the contraction and dilation of local blood exercise therapy of neurological training can be
vessels with the increase of the time of used for treating osteoarthritis. The training time
muscle contraction and relaxation in order is 45 min per time. There are 15 times in one
to increase local blood circulation. With therapy course (once a day).
the increase of local metabolism, elimina-
tion of accumulative metabolite and 8.2.5.3 Manipulation of Lessening
smooth lymph backflow are good for Joint Adhesion
elimination or alleviation of local pain, It is a therapeutic method that manipulation is
tingling, swelling and heaviness. used to lessen tissue adhesion and to increase
(d)
Enhancement of myodynamia: anti- range of joint motion. The doctors or the thera-
resistance training of neurological train- pists can exert force on the joints of the patients
to improve range of joint motion, promote joint be fixed and the distal of joint is made to
functions and relieve pain. Passive movements swing in order to lessen adhesion.
are mainly used to lessen joint, relieve and elimi- During joint swing, in order to prevent tis-
nate soft tissue adhesion in order to recover phys- sue tear or bone fracture, it is necessary to
iological movement and accessory movement of do the operation when the range of joint
joint. The operation speed is slower than that of motion is more than 60% of normal range
massage. of joint motion. For example, during the
swing training of anteflexion of shoulder,
1. The classification of joint motion includes
it should be applied when the anteflexion
physiological movement and accessory of shoulder is at 100%. Otherwise, manip-
movement. ulation of accessory movement should be
(a) Physiological movement of joint: The used. Swing training can be used when the
joint motion can be complete in physio- range of joint motion meets the
logical range, which is called physiologi- requirements.
cal movement of joint. It can be completed (b) Roll: When one bone is rolling on the sur-
passively or actively. face of the other, the touch point is chang-
(b) Accessory movement of joint: in the allow- ing because of the bones with different
able range of joint and tissue around joint, shapes. The movement is angulation
the movements can be completed passively, movement. The rolling orientation is to the
which is called accessory movement. orientation of angulation, usually with
There is accessory movement in every slide and rotation of joint.
joint. Accessory movement is one kind of (c) Slide: When one bone is sliding on the
indispensable motion form. This move- other, if it is simple slide, the surface shape
ment cannot be completed actively and it of the two bones should be identical, plane
requires the help of others or offside limbs or hook face (concave-convex degree of
such as joint separation and lateral move- the two bone surface should be equal).
ment of patella. During sliding, one touch point of bone
When the joint is restricted because of surface can touch the touch point of offside
pain and stiffness, physiological and acces- bone surface. The slide orientation depends
sory movement can be confined. When phys- on concave-convex surface of bony joint.
iological movement is recovered, there are The bulge means the slide orientation is
still pain or stiffness in joint motion. This opposite to the angulation orientation. The
may be because that the accessory move- hollow means the slide orientation is the
ment of joint is still not recovered same as the angulation orientation.
completely. There is more sliding in the smooth joint
Before improving physiological move- surface and there is more rolling in the
ment of joint, we should improve acces- unsmooth joint surface. In clinic, sliding can
sory movement of joint. The improvement relieve pain. Combined with traction, slid-
of accessory movement of joint can pro- ing can lessen joint capsule, relax joint, and
mote the improvement of physiological improve range of joint motion. Therefore, it
movement of joint. can be applied in many spheres.
2. Basic methods are named according to appli- (d) Rotation means the touch point can rotate
cation mode of force of the joint and the mode around the rotation axis of static bone sur-
of movable joint. face. During rotation, the same point does
(a) Swing: Swing is the lever-like movement circular movement. Rotation usually is
of bone, which is physiological movement. done with sliding and rolling. It is rarely
During swing, the proximal of joint should done independently.
(e) Separation and traction: Separation and reaches 60% of normal ROM. In clinic,
traction are both called traction. Separation The manipulation of Grade III–IV are usu-
is that the surfaces of two bone of the joint ally used, while gradeI is seldom used.
are separated in a right angle under exter- 4. The therapeutic effect of lessening adhesion
nal force, which is called separation or through manipulation, the indications of clini-
intra-articular traction. Traction is that the cal application and operational programs.
external force moves along the long axis (a) Therapeutic effect: physiological effect
of the bone to make the joint shift in a long includes mechanical and neurological
distance, which is called traction of long effect. Mechanical effect can promote the
axis. flow of synovial fluid, increase the nutri-
The difference between separation and tion of cartilago articularis and cartilagi-
traction: During separation the external nous operculum to relieve pain and prevent
force is vertical to joint surface and the joint degeneration. Neurological effect
external force is strong. The force can sepa- can inhibit spinal cord and brain stem to
rate two joints. During traction, the external release pain factor and increase pain
force is parallel to long axis of the bone and threshold. Maintain of tissue tenacity: the
the joint surfaces may not be separated. manipulation of grade III and IV can be
3. Classification of manipulation and application used directly for traction of soft tissue
selection: The classification of manipulation is around joint to increase extensibility and
according to range of joint motion. tenacity in order to improve range of joint
(a) Matland classification: motion. The increase of noumenon feed-
Grade I: In the beginning of joint motion, back: with the increase of range of joint
joint can be lessened rhythmically in a motion, the sensitivity of the joint to sen-
small range. Grade II: Within the allow- sory information increases such as the
able scope of joint motion, joint can be information of joint immobilization,
lessened rhythmically, but not touch the movement speed and change, movement
beginning and the end of joint motion. orientation, muscle tension and change.
Grade III: Within the allowable scope of Therefore, movement form and body posi-
joint motion, joint can be lessened rhyth- tion can be adjusted to complete coordi-
mically and the therapists can feel the ten- nated movement.
sion of soft tissue around joint. Grade IV: (b) Manipulation application: The movement
The point of action is at the proximal of orientation of manipulation can be vertical
the joint. The joint can be lessened rhyth- or parallel to therapeutic plane (the plane
mically in a small range. When touching of spin axis of the middle point of joint sur-
the proximal of the joint every time, the face). In the separation manipulation, the
therapists can feel the tension of soft tissue movement orientation is vertical to thera-
around joint. peutic plane. In the manipulation of sliding
(b) Application selection: The manipulation
and long axis traction, the movement ori-
of Grade I and Grade II can be used for the entation is parallel to therapeutic plane.
therapy of pain. The manipulation of The degree of manipulation: For the con-
Grade III can be used for the therapy of fined joint, movement range should reach
pain and joint stiffness. The manipulation the limit of joint motion. For the joint with
of Grade IV can be used for the therapy of pain, movement range should reach the
contracture and adhesion. The manipula- pain point. With the alleviation of symp-
tion of Grade I–IV can be used for acces- toms, the movement range can be beyond
sory movement. The manipulation of the pain point. The movement range of stiff
Grade I–IV can be used for physiological joint should be beyond the stiffness point.
movement when the range of joint motion During therapy, manipulation should be
balanced. The force should be even and • Lessening the adhesion of soft tissue and
rhythmed. The manipulation should be stretching contracture joint capsule, liga-
kept on the action point for 30–60 s. ment and muscle tissue
(c) Therapeutic reactions: After joint mobili- • Improving local blood circulation, promot-
zation techniques, it is normal that there is ing elimination of inflammation and edema
normal reaction. If the pain cannot be and benefiting tissue repair
relieved in 24 h after that, even aggravated, • Relieving muscle spasm, relaxing muscle
it demonstrates that therapeutic intensity is and alleviating pain
too strong or the therapeutic time is too • Restoration of incarcerated synovium of
long. The therapeutic schedule should be joint or dislocation of zygapophyseal joint
adjusted appropriately. or recovering normal physiological curva-
(d) Clinical indications include joint dysfunc- ture of spine
tions due to any non-neuronal mechanical • Increasing foramen intervertebrale and
factor, pain, muscle intense and spasm, relieving stimulation and oppression of
reversible limitation of range of joint motion, nerve root
progressive limitation of joint motion and • Increasing intervertebral space, relieving
functional joint immobilization. pressure in intervertebral disc, benefiting
(e) Clinical contraindications: The patients return of protrusion of intervertebral disc
with acute arthritis, unstable joint or severe and alleviating bending degree and oppres-
deformation, swelling, tumor or unhealed sion degree of vertebral artery
bone fracture. 2. Traction mode: The classification should be
(f) Operational procedure: The body position of done according to the duration and action point
the patients should be comfortable, relaxed of traction
and painless. The position of the therapists: (a) Continuous traction: Tractive force should
the therapists should be close to the thera- be kept during the process of traction.
peutic joint. The therapists use one hand to (b) Intermittent traction: Tractive force can

fix the end of the joint and use the other hand increase or decrease regularly during the
to lessen the other end. Assessment before process of traction.
therapy: the therapist should find out the For lessening adhesion of soft tissue, skin
existing problems such as pain, stiffness and traction is usually used with small and con-
their degree, design corresponding therapeu- tinuous traction. Intermittent traction has a
tic schedule and put into effect. massage effect, but the stimulation is strong.
It is suitable for old patients or the patients
8.2.5.4 Continuous Traction with obsolete lesion or severe condition.
Traction is one kind of method in rehabilita- Continuous traction is usually used at first.
tion therapeutic method. External force is used The therapists can switch to intermittent trac-
to exert traction on some part or some joint of tion if the therapeutic effect of continuous
the body in order to separate them to a certain traction is not good.
extent. It also can stretch soft tissue around joint 3. Common tractions for the therapy of bony

to achieve therapeutic goal. For osteoarthritis, joint diseases include tractions of lower limbs,
the traction can be divided into traction of spinal upper limbs, cervical vertebra, lumbar vertebra
cord and traction of four limbs joint. and spine.
( a) Skin traction of upper and lower limbs:
1. Therapeutic effect of traction: The main pur- With the help of traction bed, traction
pose of traction of bony joint is to lessen adhe- bracket (Browns or Thomas traction
sion and relieve pain. The main effects are bracket) or bedside traction bracket,
summarized as following: the traction can be done through skin
traction band such as traction band of The body position of traction of cervical
bare foot, lower limbs, wrist, hands and vertebra usually is sitting position, but in
upper limbs. supine position, the back of intervertebral
Traction weight is about 3–5 kg and the space in C4–C7 can be broadened and the
body should be elevated to prevent edema. angle is easy to adjust. In sitting position,
During the process of traction, the thera- the traction is easy to operate, but the posi-
pists should observe the peripheral circu- tion is unstable and the angle change is
lation of the body closely in case of blood small.
circulation disorder of the body and Contraindications: Cervical vertebra
bruised soft tissue. tuberculosis, tumor, severe osteoporosis,
(b) Traction of cervical vertebra: it is suitable the long-term use of hormone, vertebral
for vertebral artery type of cervical spon- artery sclerosis, cervical spine deformity,
dylosis, nerve-root type cervical spondy- myocardial infarction, cerebral arterio-
losis, joint sprain of cervical vertebra, sclerosis and chronic cervical trauma.
herniation of cervical disc, cervical spon- (c) Lumbar vertebra traction: it is suitable for
dylolisthesis, retrogression of cervical ver- lumbar vertebra osteoarthritis, oppression
tebra, cervical small joint dysfunction and of ischiadic nerve by protrusion of inter-
cervical muscle strain. vertebral disc, tension of dorsal muscle,
Occipital-jaw traction band is usually strain of lumbar muscles and fiber inflam-
used to do traction in sitting position or in mation, stiffness of facet joint in lumbar
clinostatism. Traction force can increase vertebra, soft tissue spasm and adhesion.
intervertebral space of cervical vertebra, The key points of lumbar vertebra traction:
but not induce injuries of muscle and joint. • The patients lie on their back and bend
Traction weight is about 2–3 kg in sitting hip and knee until the lumbar vertebra
position and 10 kg in clinostatism. anteflect to decrease stress of spine as
Generally, continuous traction time is much as possible.
15–20 min per time. Long time traction can • Traction force should be started from
induce static injuries of muscle and liga- 20 kg or one-fourth of the body weight
ment. The magnitude of intermittent trac- that can overcome the friction between
tion force is according to 10–20% of the the body and the bed. The weight can
body weight of the patients. Traction time be gradually increased to 30–40 kg. A
is 20–30 min per time. There are 15 times moment later, according to the endur-
in one therapy course (once a day). The ance of the patients, the weight can be
angle of cervical vertebra in traction: the increased to half of the body weight.
angle of anteflexion of cervical vertebra is • Traction mode: Intermittent traction is
10–30°. In vertebra artery type cervical mainly used. The break and traction
vertebra traction, the angle of anteflexion time can be adjusted in 30 s. The traction
of cervical vertebra is 5°. In nerve root usually is 7 s and the break is 15 s.
type, the angle of anteflexion is 20–30°. In • Traction time: Traction time lasts
spinal cord type, the traction should be pro- 20–30 min per time. There are 15–20
tracted backward slightly. It is needed to times in a therapy course (1–2 times a
pay attention to that no matter what kind of day).
the traction, the traction should be adjusted • Traction announcements: the therapists
timely according to the response of the should observe the feeling and response
patients to the traction. Traction mode: of the patients in traction and adjust the
Continuous traction is usually used. traction according to practical condi-
Intermittent traction is also used or the tions. For the elder, traction time should
combination of the two can be used. be short and traction force should be
weak. If there is discomfort or the CPM can be used for injured limbs immedi-
symptom is aggravated in traction, the ately after operation, even the patients are still in
therapists should stop traction immedi- narcosis or there are too many surgical dressing
ately, find out the reason and adjust it or in the first 3 days after operation to block passive
stop the therapy. motion in other ways. After operation, according
to the condition, the patients can do movements
Contraindications: blood circulatory disorder in at the range of 20–30°. The range of motion can
spinal cord, osteomalacia of vertebra, cauda equina be adjusted every day or every time according to
syndrome, spondylosis, spinal cord disease, lumbar the condition.
vertebra tuberculosis, tumor, severe osteoporosis, For the patients with knee joint surgery, in
long-term use of hormone, severe hypertension, supine position, operation part of CPM can be
heart diseases and hemorrhagic disorders. fixed on the middle of thigh and the upside of
shank. In the first day after surgery, knee joint can
8.2.5.5 Application of Continuous be moved at the range of 30°. The period is 2 min
Passive Motion (CPM) and the activity time is 1 h. After that, the motion
In the setting motion range, CPM can be done angle can be increased gradually and the activity
continuously in a setting time through mechani- period can be accelerated.
cal drive equipment to drive the joint, which
belongs to passive joint motion. CPM can prevent
joint adhesion, promote wound healing, acceler- 8.2.6 T
he Method and Effect
ate repair of cartilago articularis and injured soft of Self-Exercise
tissue around it, relieve pain, improve range of
joint motion and decrease postoperative compli- After a period of time of the interventional
cations of joint. therapy of physical agents, osteoarthritis can be
There is random control study about the influ- eliminated gradually and the pain is relieved.
ence of CPM on postoperative complications Through rehabilitation training of active and
after fracture of lower limb. The therapy and passive joint motion and lessening adhesion
nursing are given to control group routinely. The through manipulation, the adhesion of cartilago
observation group are given CPM through CPM articularis and soft tissue around joint is less-
machine. The therapists observe the differences ened gradually to relieve or eliminate pain. The
of joint pain, edema and range of motion after range of joint motion can be recovered to the
operation between the two groups. The results level before injury or the range of joint motion
showed that there is significant difference of can be obviously increased compared with
therapeutic effect between the two groups. The pre-treatment. However, if there is no proper
therapeutic effect of observation group is better method to prevent the adhesion of cartilago
than control group. CPM of lower limbs joint articularis and soft tissue around joint, it is pos-
can promote blood circulation of joint, improve sible to induce adhesion and the cartilago artic-
synovium nutrition, relieve joint edema, prevent ularis may occur repeatedly or relapse. After
joint stiffness and alleviate pain. therapy, micro damaged wound surface of the
lessened soft tissue is still not healed. If there is
1. Clinical indications of CPM: it is suitable for no effective joint motion timely (enough range
osteoarthritis, joint spasm, intra-articular frac- and times), the adhesion can occur again and the
ture, hemiplegia, paraplegia, limitation of joint symptoms relapse.
motion ability and range of joint motion due to However, the therapy time of the patients in
muscle dysfunction, and postoperation of joint. hospital is limited, even in the therapy course,
2. Application method: according to the endurance because the patients usually receive the therapy
of the patients, the period time is 1–2 min and the in outpatient service. Obviously, it is unrealistic
activity time is 1 h per time (1–3 times a day). to move the patients’ joints by the doctors and
the therapists. The best method is to teach the improve and increase CNS function. Therefore,
patients to do self-exercise of joint motion in the body can endure intensive work and the bal-
order to prevent adhesion of soft tissue of joint. ance, flexibility and stamina are increased.
In the past therapy, the patients’ self-exercise
of joint motion is taught by the doctors generally. 1. The training can make brain switch between
The doctors say to the patients that they should excitation and inhibition orderly. It can elimi-
do self-exercise of joint motion such as shoulder nate fatigue, clear mind, sharpen thought, pre-
upthrow and cyclovergence movement of shoul- vent anxiety due to hypertension of nervous
der. There are two problems. The first is that system. With improvement of nervous system
there is no diagram to explain the detailed to the function, control and regulation of organ sys-
patients. The second is that the doctors don’t mas- tems, especially motor system, can be pro-
ter the correct exercise indeed. In addition, these moted and improved and the functions of the
methods cannot reach full range joint motion so whole body can be increased.
that the effect of self-exercise is affected. 2. Increase of blood circulation and promotion of
If the self-exercise becomes self-training, the metabolism: some research indicated that
effect of exercise can be increased obviously. blood volume of brain cells in work are 10–20
Exercise normally is based on personal motor times of blood volume of muscle cells, which
skills. Through repeated movements, it can accounts for 20–25% of oxygen consumption
forge or smelt the body, willpower and morality. of the whole body. The training can increase
It is one kind of personal movement, but it can blood supply of brain cells, increase myocar-
increase efficiency. For example, through produc- dia function, promote blood circulation and
tive labor, social fighting and working practice, metabolism of the whole body, make it in an
personal consciousness and working ability can aerobic exercise state, which are good for
be increased. Through various kinds of physical functional improvement.
exercise, normal development of the body can be 3. Facilitating skeleton calcinosis and increasing
promoted to increase the functions many times. bone functions: according to Wolff law, bone
The training should be done with the help of grow is stimulated by mechanical stimulation
professional skilled personnel in a planned way to change structure. The bone advance with
step by step. Through study and practice, some use and move back with obsolescence.
kind of skill can be mastered. The trainers change Continuous movement of specific part can
qualities and abilities of the trainees consciously induce hyperplasia and hypertrophy of local
to make the trainees acquire one behavior pattern bone such as humerus of tennis player.
or one kind of skill. Continuous fixation of specific part can make
Therefore, the training is more scientific than the local bone absorb hyperplasia and hyper-
the application method of exercise and the effect trophy such as collum femoris after complete
is better too. In order to obtain better effect in arthroplasty, which is the direct evidence of
self-exercise of the patients with osteoarthritis bone morphology adaptation induced by stress.
the patients, on the basis of physical training of Through muscle movement, exercise can
neurological training, the author simplified the exert stress on bone and stimulate bone forma-
methods into a set of self-training method that tion. Bone cortex becomes thick obviously, the
can prevent soft tissue adhesion of joint. diameter of bone increases, bone marrow cavity
decreases, and bone mineral density increases,
8.2.6.1 Physiological Effect of Self- which can make the bone endure bigger load.
Training of Joint Motion For the elder, especially postmenopausal
Improvement of neural function and increase of women, osteoporosis and occurrence rate of
the entire functions: it is the same as the theory of fracture of the old can be prevented or
rehabilitation of neurological training. Through decreased. Someone compared bone mineral
normal movement pattern, self-training can density of lumbar vertebra of older athletes
with that of age-matched older people and cal training is that the patients do self-training
found that bone mineral density of lumbar ver- without help of other people according to six-
tebra of older athletes is apparently higher than step Daoyin technique of neurological training,
that of age-matched older people. which can be cooperated with the record of six-
It is noticeable that the patients in old age or step Daoyin technique and some simple training
with postmenopausal osteoporosis cannot instruments. After the patients master the meth-
increase bone mass through large amount of ods, the training can be done without the record
hard exercise because bone is not sensitive to and training instruments.
mechanical signal. There is risk that bone tra-
becula may be broke off. Therefore, exercise
1. Self-training method of neck: The most com-
only can prevent osteoporosis, but it is not mon discomfort in neck are ache of the back
therapeutic method for osteoporosis. of neck and numb of upper limbs, which is
4. Increasing muscle strength and improving lig- due to working at the desk for a long time or
ament flexibility: After therapy of osteoarthri- neck injury that can induce mircodamage of
tis, the purpose of self-training is to move muscle of the back of neck and soft tissue, cal-
joint, lessen adhesion and prevent the relapse. cification of ligamentum nuchae, osteoprolif-
During training, rapid metabolism increase eration of cervical vertebra, protrusion of
blood supply of the muscle, thicken muscle intervertebral disc, calcification of posterior
fiber and enlarge muscle body. The change of longitudinal ligament and spinal canal
muscle structure can enhance the activity of stenosis.
enzyme, promote function of nervous regulat- After surgery or physiotherapy, the pur-
ing system and improve muscle functions pose of self-training is to keep the fitness of
entirely. The manifestations include strong spinal canal and suppleness of paravertebral
strength of muscle, fast startup, good elasticitysoft tissue and soft tissue of neck to increase
and strong endurance. range of joint motion of cervical vertebra,
Joint motion with a purpose can stretch decrease the stimulation and oppression to
joint capsule, ligament, tendon and muscle nerve root and blood vessels, lessen and pre-
effectively to improve extensibility of soft tis-vent tissue adhesion, and relieve symptoms.
sue around joint, which can further increase (a) The training of anteflexion, rear protrac
range of joint motion, joint soundness and tion and lateral bending of the neck: this
suppleness of joint. All these are good for method is mainly used to train muscles
avoiding or decreasing various injuries and around the neck to increase local blood
articular surface injury. circulation and stability of cervical
5. Correct self-training after therapy of osteoar- vertebra, lessen and prevent adhesion of
thritis can lessen adhesion fully, prevent adhe- soft tissue and move cervical joint.
sion of joint and soft tissue around joint The patients sit down, keep the trunk
effectively. It can also move the joint as much up-right, concentrate their mind and
as possible, even in the full range. Therefore, make a shell-like thing from elastic band.
cartilago articularis, muscle, tendon, ligament, The patients grasp the front end and put
nerve and blood vessel, and joint capsule can the rear end behind the head. In the train-
all be stretched to lessen adhesion, prevent ing of rear protraction of the neck, two
adhesion, consolidate therapeutic effect and hands cross over and put them on occipi-
prevent relapse. tal nodule to replace elastic band. On the
contrary, in the training of anteflexion,
8.2.6.2 Self-Training Method of Joint the front end of elastic band is put on
Motion facies frontalis and the rear end of elastic
During the therapy or after the therapy, self- band is fixed on the back of a chair or the
training method of joint motion of neurologi- wall. In the training of right bending of
the neck, elastic band is put on the right Self-massage of the rear of the neck
of the head. In the training of left bend- can be used for health protection mea-
ing of the neck, elastic band is put on the sures of the neck. The massage time is
left of the head. 15–20 min and there are 15 time in one
After the elastic band is fixed, the therapy course (once a day) (Figs. 8.1,
patients take a deep breath and concen- 8.2, 8.3, and 8.4).
trate on the training part of the neck. For (c) Cervical cyclovergence: the patients sit
example, in the neck extension training, down or stand. In standing position, the
the patients should concentrate on the rear two feet separate and the space between
of the neck, feel the warmth of training the two feet is the same as the shoulder.
part, and overcome the resistance from The patients draw in the chest slight and
elastic band or upper limbs. When the erect the back with arms akimbo.
movement of the neck reaches the maxi- Cooperated with breathing, the patients
mum range, the patients speak silently “1, regulate breath, look straight ahead,
2, 3, 4, 5 and 6” for 6 s. After training, the
patients take a deep breath and exhale
slowly. The ratio of inspiration and expi-
ration is 1–2. The patients try to relax cer-
vical muscle and soft tissue. The training
sketch maps refer to 8-2-1–8-2-4. After
that, the patients do next training and the
training time is 6–8.
(b) Self-massage of the rear of the neck: in
order to cooperate cervical self-training,
the patients can use massage to further
lessen soft tissue adhesion, which can
help to relieve stiffness of ligamentum
nuchae.
The patients sit down or lie on their
back. The patients extend their heads to Fig. 8.1 Training of cervical anteflexion
relax the tissue of the rear of neck and rub
the two hands until they are warm. The
patients put one hand on the rear of the
neck and use rub, seize, clutch, malaxa-
tion and pinch to do a massage on the rear
of the neck. The patients can use rub
method to warm local tissue and then use
malaxation method to move it laterally.
For the patient with stiffness or calcifica-
tion of ligamentum nuchae, the manipula-
tion should be soft at the beginning and
intensity is increased gradually. The
patients use massage method to move the
rear tissue of the neck laterally and feel
the stiffness or calcification of ligament.
After a period of self-massage, the tissue
of the rear of the neck include stiff
ligamentum nuchae can be relieved to
varying degrees. Fig. 8.2 Training of cervical rear protraction
Fig. 8.3 Training of cervical left bending
Fig. 8.5 Training of cervical cyclovergence
times). At the end, the patients do mas-

sage of the neck. In exercise, the patients
cannot move the body (Fig. 8.5). The
training time is 15–20 min. There are 15
Fig. 8.4 Training of cervical right bending’ time in a therapy course (once a day).
(d) Cervical cyclovergence and neck down:
concentrate on the abdomen, rotate in the patients take a deep breath, concen-
clockwise direction of cervical flexion trate on the abdomen, lift two shoulders
(lower their heads), left bending, cervical slowly, put down neck, rotate two shoul-
extension and right bending. The patients ders downward and backward, lift the
take a deep breath and exhale slowly. The shoulder again, extend neck, exhale
patients concentrate on the abdomen and slowly and go back to neutral position
rotate in anti-
clockwise direction (6–8 (6–8 times). the patients take a deep
inspiration, the head should anteflect and

in expiration the head goes back. In inspi-
ration again, the head protract backward
and in expiration the head goes back. In
the exercise, the movement should be
done slowly and repeatedly. After that, the
patients can do horizontal rotation. In
inspiration, the head turn to the right and
in expiration the head goes back to the
center. In inspiration again, the head turn
to the left and in expiration the head goes
back to the center. The training time is
15–20 min. There are 15 time in a therapy
course (once a day).
2.
Self-training method of scapulohumeral
periarthritis
Scapulohumeral periarthritis is chronic
traumatic inflammatory inside and outside
shoulder joint. It can aggravate or the disease
Fig. 8.6 Training of cervical cyclovergence and neck phase prolongs if the therapy is not proper,
down
even permanent dysfunction. Self-training
after therapy has an effect on consolidation of
breath, concentrate on the abdomen, lift therapeutic effect and preventing relapse.
two shoulders slowly, put down neck, (a) Katie·Chilly method: It is a therapeutic
rotate two shoulders downward and back- training method of shoulder joint devel-
ward, lift the shoulder again, extend neck, oped for the therapists in England. It can
exhale slowly and go back to neutral posi- be divided into primary, middle and
tion (6–8 times, Fig. 8.6). The training advanced phase. The primary exercise is
time is 15–20 min. There are 15 time in a flexibility training of shoulder. The mid-
therapy course (once a day). dle exercise is suppleness training. The

(e) Bend forward and backward: when in advanced exercise is the training of
inspiration, the neck should anteflect as intensity and stability. The patients can
much as possible to make the lower jaw do one grade of exercise every time. If
be close to the edge of manubrium. In the patients don’t complete the primary
expiration, the head go back to neutral exercise, they cannot do the middle
position. In the next expiration, the neck exercise.
should protract backward as much as pos- From preventing soft tissue adhesion,
sible and in inspiration it goes back to auxiliary movement training of
beutral position with immobilization of scapulohumeral periarthritis after therapy
waist and back (6–8 times). The training is suitable for primary exercise.
time is 15–20 min. There are 15 time in a The movement of shoulder extension:
therapy course (once a day). the patients flex elbow, lift arm, extend
(f) Do exercise of the neck in supine posi- forearm, anteflext shoulder joint, extort
tion: the patients are in supine position, and intort shoulder joint.
remove the pillow, put the head on the Self-help movement of shoulder: this
center, face to the sky, put two hands exercise can make upper limbs like pen-
beside the body and relax themselves. In dulum. The shoulder swing naturally
induced by their own weight in order to

increase flexibility of shoulder gradually.
Scapula control: the patients lean against
the wall and the two feet keep away from
the wall. The patients flex knee and the hip
lean against the wall. Two upper arms
relax and drop beside the body. The
patients flex their elbows and two hands
cross over before abdomen. The patients
do abdominal curl and use scapula to push
the wall. The patients insist and relax for
many time. This method can increase
strength of muscle around scapula.
Shoulder extension: self-extension and
self-flexion of shoulder.
Shoulder joint rotation: the patients
flex elbow and the injured forearm is ver-
tical to the ground. The patients put unin-
jured hands on the shoulder on the injured
side. In order to feel the movement, the Fig. 8.7 Training of joint motion of shoulder and chest
forearm rotate inside and outside.
Shoulder rotation: in sitting position, ing time is 15–20 min. There are 15 time in
the patients sit upright. Two shoulders a therapy course (once a day).
turn backward to form an arc. The patients (c) Range enlargement training of shoulder
stretch the muscle around scapula. When joint motion: With the help of offside upper
reach the maximum radian, the patients limbs, the effect of this method can increase
insist on for 10 s and relax for many times. motion range of shoulder joint in the train-
(b) Joint motion training of shoulder and chest: ing side passively to lessen and prevent
in sitting position, the patients draw in the adhesion fully, enlarge the active motion
chest slight, erect the back, flex elbow range of joint, consolidate therapeutic
joints slightly, put upper limbs before effect in the early stage and prevent relapse.
abdomen. During exercise, accompanied Range enlargement training of standing
with breathing, the patients look straight on another’s shoulders movement: in sit-
ahead, breathe to the pubic region, concen- ting position or standing position, the
trate on medial margin of double scapula. patients keep their heads up and thrust the
The patients take a deep breath, lift two chest forward. When the patients do joint
shoulders and make it be close to earlobe. motion of right shoulder, they use right
The two shoulders intort forward slightly hand to support the back of right elbow
and stretch bilateral scapula for 6 s at the joint. When the patients do joint motion of
peak. The patients exhale slowly, lower left shoulder, they use left hand to support
shoulders and thrust the chest forward. The the back of right elbow joint. Upper limbs
patients take a deep breath, lift shoulders is at a 30–45° flexion position of elbow
and make it be close to earlobe. The shoul- joint. The patients take a deep breath and
ders extort backward slightly and squeeze lift upper limbs in the training side upward
the medial margin of bilateral scapula for and inward. The patients use the hands of
6 s at the peak. The patients exhale slowly, upper limbs in the training side to touch the
lower two shoulders and thrust the chest offside shoulder until the shoulder joint in
forward for 6–8 times (Fig. 8.7). The train- the training side reaches the maximum
motion range. The patients fully relax wrist. The upper limb in the training side
upper limbs in the training side, use offside is at 120° elbow flexion position. The
hand to support elbow joint, exert force patients take a deep breath and lift upper
inward and upward, stop when feeling the limbs in the training side upward and
great resistance and hold on for 4–6 s at inward beyond the head. The patients
this point. The patients do support-relax fully relax upper limbs in the training
and relax-support for three times and the side, use offside hand, exert force inward
intensity is increased gradually. After every and upward, stop when feeling the great
trial, the patients exhale slowly, relax the resistance and hold on for 4–6 s at this
whole body and prepare for the next time point. The patients do support-relax and
training. The same method is used for the relax-support for three times and the
training of offside shoulder joint (Fig. 8.8). intensity is increased gradually. After
The effect of this method is to fully stretch every trial, the patients exhale slowly,
soft tissue of the back of shoulder, lessen relax the whole body and prepare for the
joint capsule, ligament, tendon and muscu- next time training. The same method is
lar tissue of the back of shoulder to increase used for the training of offside shoulder
motion range of offside standing on anoth- joint (Fig. 8.9). The effect of this method
er’s shoulders. is to fully stretch soft tissue of the
Range enlargement training of upthrow inferoposterior part of shoulder, lessen
movement: in sitting position or standing joint capsule, ligament, tendon and
position, the patients keep their heads up
and thrust the chest forward. When the
patients do joint motion of right shoulder,
they use left hand to grasp right wrist.
When the patients do joint motion of left
shoulder, they use right hand to grasp left
Fig. 8.8 Range enlargement training of stand on anoth- Fig. 8.9 Range enlargement training of upthrow
er’s shoulders movement
muscular tissue of the inferoposterior part

of shoulder to increase motion range of
lifting beyond the head of shoulder joint.
Range enlargement training of abduc-
tion movement: In sitting position or stand-
ing position, the patients keep their heads
up and thrust the chest forward. When the
patients do joint motion of right shoulder
abduction, they use left palm to support the
lower part of right elbow joint. When the
patients do joint motion of left shoulder
abduction, they use right palm to support
the lower part of left elbow joint. The elbow
joint is at a straight position. The patients
take a deep breath and lift upper limbs in
the training side upward and outward. The
patients use offside hand to support elbow Fig. 8.10 Range enlargement training of abduction
joint. The patients fully relax upper limbs in movement
the training side, use offside hand to push
upper limbs in the training side upward and
outward, stop when feeling the great support elbow joint. The patients fully relax
resistance and hold on for 4–6 s at this upper limbs in the training side, use offside
point. The patients do support-relax and hand to push upper limbs in the training side
relax-support for three times and the upward and outward, stop when feeling the
intensity is increased gradually. After every great resistance and hold on for 4–6 s at this
trial, the patients exhale slowly, relax the point. The patients do support-relax and
whole body and prepare for the next time relax-support for three times and the
training. The same method is used for the intensity is increased gradually. After every
training of offside shoulder joint (Fig. 8.10). trial, the patients exhale slowly, relax the
The effect of this method is to fully stretch whole body and prepare for the next time
soft tissue of the lower part of shoulder, training. The same method is used for the
lessen joint capsule, ligament, tendon and training of offside shoulder joint (Fig. 8.11).
muscular tissue of the lower part of shoulder The effect of this method is to fully stretch
to increase motion range of shoulder joint soft tissue of the lower part of shoulder,
abduction. lessen joint capsule, ligament, tendon and
Range enlargement training of front pro- muscular tissue of the lower part of shoulder
traction movement: In sitting position or to increase motion range of shoulder joint
standing position, the patients keep their extension.
heads up and thrust the chest forward. When Range enlargement training of standing
the patients do joint motion of right shoulder on another’s back movement: In sitting
abduction, they use left palm to support the position or standing position, the patients
back of right elbow joint. When the patients keep their heads up and thrust the chest
do joint motion of left shoulder abduction, forward. When the patients do movement
they use right palm to support the back of of standing on another’s back of right
left elbow joint. The elbow joint is at a shoulder joint, they use left hand to grasp
straight position or 90° flexion position. The wrist of right upper limb. When the
patients take a deep breath and lift upper patients do movement of standing on
limbs in the training side upward and another’s back of left shoulder joint, they
outward. The patients use offside hand to use right hand to grasp wrist of left upper
Fig. 8.12 Range enlargement training of stand on anoth-

er’s back
for the next time training. The same

method is used for the training of offside
shoulder joint (Fig. 8.12). The effect of
this method is to fully stretch soft tissue of
the lower part of shoulder, lessen joint
capsule, ligament, tendon and muscular
tissue of the lower part of shoulder to
increase motion range of offside standing
on another’s back of shoulder joint.
These methods can be used in turn for
training. The training time is 15–20 min.
Fig. 8.11 Range enlargement training of shoulder front There are 15 time in a therapy course
extension
(once a day).
(d) Self-anti-resistance training: The record of
limb. The elbow joint is at a 45° flexion six-step Daoyin technique or self-
position of elbow joint. The patients take a regulation of mind and breath is used to do
deep breath and lift upper limbs in the resistive joint motion with the help of elas-
training side backward, upward and tic training band. Through anti-resistance
inward. The patients use hand form the training, it can increase local blood circula-
back to touch offside scapula until the tion, enhance myodynamia, further lessen
shoulder joint in the training side reaches and prevent adhesion in stronger muscle
the maximum motion range. The patients contraction and relaxation movement.
fully relax upper limbs in the training side, 3. Self-training method of psoas: Pain in lower
grasp offside hand and pull upward, stop waist is usually seen in lumbar muscle strain,
when feeling the great resistance and hold which accounts for the most part in chronic
on for 4–6 s at this point. The patients do osphyalgia disease. The purpose of self-
support-relax and relax-support for three training of psoas is to further lessen and pre-
times and the intensity is increased gradu- vent soft tissue adhesion of waist, increase
ally. After every trial, the patients exhale blood circulation of waist, promote
slowly, relax the whole body and prepare metabolism, increase waist flexibility, which
are good for relieving the oppression of tissue

in foramen intervertebrale, canalis spinalis
and intraspinal on spinal cord or nerve root
and relieve or prevent waist pain.
(a) Waist rotation exercise: In standing posi-
tion, the space between two feet is as wide
as the shoulder. Two hands cross over
before the waist. The patients regulate
breath, breathe to the pubic region and
concentrate on lower waist. The patients
protrude the abdomen slowly, rotate the
waist in clockwise direction to the middle
line of the trunk, bend waist to protrude
the waist, rotate in clockwise direction to
the middle line of right part of the trunk
and protrude abdomen. After that, the
patients exhale slowly and do the same
training with the same method in anti- Fig. 8.13 Rotation training of waist
clockwise direction. A training includes
two directions (Fig. 8.13). The training
time is 15–20 min. There are 15 time in a
therapy course (once a day).

(b) The training of expanding chest and
straightening waist: In standing position
or sitting position, the patients regulate
breath, breathe to the pubic region and
concentrate on lower waist. The patients
bend waist as much as possible, drop
upper limbs naturally, expand chest and
straighten waist slowly and hold on for 6 s
at the peak (Fig. 8.14). The effect of
expanding chest is to fully straighten waist
in order to increase the intensity of psoas
contraction. Deep bending waist is to fully
stretch the tissue of waist and back. The
training time is 15–20 min. There are 15
time in a therapy course (once a day).
(c) The training of twisting hip and rotating
waist: before this training, the patients Fig. 8.14 The training of expanding chest and straighten-
should do warm-up exercise. In standing ing waist
position, the space between two feet is as
wide as the shoulder. The patients regu- right hip joint flex inside and forward.
late breath, breathe to the pubic region The upper part of the trunk and upper
and concentrate on lower waist. The left limbs rotate and swing to the left and
leg step forward and stand still. The right backward (Fig. 8.15a, b). The training
hip flex inside and forward. The upper time is 15–20 min. There are 15 time in a
part of the trunk and upper limbs rotate therapy course (once a day).
and swing to the right and backward. The (d) The training of bridging and swift flying:
right leg step forward and stand still. The it is a combination of bridging and swift
a b
Fig. 8.15 (a) The training of twisting hip and rotate waist to the right. (b) The training of twisting hip and rotate waist
to the left
flying. In the training of bridging, the 8.2.6.3 Cautions in Self-Training

patients lie on their back. In the training After the therapy of osteoarthritis, self-training
of swift flying, the patients are in ventral or exercise can be instructed by rehabilitation
decubitus. The patients regulate breath, doctor in hospital to master correct basic meth-
breathe to the pubic region and concen- ods and key points of training. The training or
trate on lower waist. The patients use exercise can be done according to movement
shoulder and two feet as the support point, prescription. There are some announcements in
protrude abdomen to support the trunk the training:
and waist, hold on for 6 s at the peak,
relax and lie down on the bed. The patients 1. The training is mainly with active movement:
inhale deeply and exhale slowly, and do During the therapy in hospital or at home
the second training. The patients repeat after therapy, the patients should insist on
the training for 6–8 times. In ventral decu- active movement self-training or exercise for
bitus, the patients regulate breath, breathe a long time.
to the pubic region and concentrate on 2. Correct application of active movement train-
lower waist. The patients use abdomen as ing on the basis of regulation of mind and
the support point, keep the front part of breath: The training is guided by Daoyin tech-
the trunk and upper limbs, the lower part nique to exclude distracting thoughts and the
of the trunk and lower limbs away from patients can concentrate on training. The
the bed like swallow walks on the water, movements in the training should be easy and
upwarp upper limbs and lower limbs for stable. After completion of every movement,
6 s, relax and lie down on the bed with the patients should go back to starting posture
abdomen. The patients inhale deeply and to obtain good therapeutic effect and prevent
exhale slowly, and do the second training. accident injury.
The patients repeat the training for 6–8 3. The difficulty of training or exercise should be
times (Fig. 8.16). The training time is increased step by step. The progress and effect
15–20 min. There are 15 time in a therapy cannot be chased one-sided in the training. The
course (once a day). tempo should be from slow to quick. The
Fig. 8.16 Bridging
training
amount of training and the range of joint motion 8.2.6.4 Precautions of Joint and Muscle
should be from small to large in case of new Injuries
injury. Precaution is more important than treatment.
4. Keep training record: under the premise of
Once there are bony joint, muscle injury and
guaranteeing the amount and quality of train- inflammation, there will be sequelae to a certain
ing, the patients should do the training contin- extent such as tissue adhesion, hyperostosis, low
uously and record the time, the amount, effect muscle strength or low local resistance. Even if
and problems of every training. Timely sum- the patients can be cured, it takes a long time.
marization and improvement are good for Therefore, in daily life, work and labor, the
accumulation of experience. patients should protect bony joint and muscle in
5. Find the problems and rectify them timely: in order to avoid injury and osteoarthritis.
the training or exercise, if there is any pain,
dizziness or other discomfort, the patients 1. Emphasize early treatment and try to cure the
should stop the training, seek the reason and disease without future trouble: In the early
adjust themselves. If the discomfort cannot be phase of scapulohumeral periarthritis, lumbar
eliminated, the patients should go to hospital sprain and osteoarthritis, the patients should
for therapy. go to standard hospital for therapy and try to
6. The patients should keep touch with the doctor cure it. The patients should take a rest until it is
and obtain training instructions. The patients cured in case of chronic disease that creates
should keep touch with the doctor during reha- great trouble for successive therapy.
bilitation training in hospital and report their 2. Avoid cold-dampness and pay attention to

training conditions in order to obtain technique changes in temperature: In daily life, the
instructions. If necessary, the patients can go to patients should increase and decrease clothing
rehabilitation department for help in order to according to climate. The patients should clean
adjust training or exercise schedule timely and the body after sweating and change clothes.
obtain better effect. The patients should avoid cold bath or air-
7. The patients can control the training time by conditioning cooling.
themselves. There are 15 times in one therapy 3. Emphasize labor hygiene: in the labor, espe-
course (once a day). After 2 days’ rest, the cially heavy physical labour, the patients should
patients do the next training. It can be treated pay attention to waist and joint. The patients
as life cultivation and health preservation and should do exercise according to their abilities
the patients can keep on it. in case of overwork that can lead to damage of
organ and tissue. The patients should alternate hands to grasp the reel and the legs should be
work with rest in work or labor. curled slightly to buffer impact force to bony
4. The patients should wear labor protection
joint. When walking, the person should look
tools: if the condition is permissive, the around in case of object falling from high alti-
patients should wear labor protection tool such tudes and vehicle, etc.
as waist support, wide belt and glove.
5. Warm-up before exercise: in any labor or physi- In a word, pain, limitation of motion and
cal exercise, especially aggravating activities, adhesion in osteoarthritis should be considered at
the patients must do warm-up, preheat muscle, the same time in therapy. Interventional therapy
tissue and joint in case of injury. of physical agent can alleviate pain, joint lessen-
6. Control body weight: Obesity gives too much ing can increase motion range and self-training
pressure on waist and lower limbs joint and or exercise can prevent relapse. Close combina-
induce injury. Therefore, the patients should tive application of the three is the common effec-
do exercise and control diet in case of obesity. tive method to treat scapulohumeral periarthritis,
7. Rectify bad posture: Abnormal posture is the lumbago-leg pain and pain due to osteoarthritis
common reason to induce tissue injury. and muscle injuries.
Therefore, in daily life, the patients should
avoid keeping a posture for a long time such as
long-term stoop or long-term bending over a References
table. If the time of maintaining a posture
exceeds 20 min, there will be muscle tension. 1. Yupu L, Xiaoting X, Baofeng G, et al. Practical
bone science [M]. 1st ed. Beijing: People’s Military
If the time is prolonged, there will be injury Medical Press; 1995.
such as stiff neck. Stiff neck is because after 2. Hua Z. Orthopedic rehabilitation medicine. Shanghai:
excessive fatigue brain cannot perceive long- Shanghai Medical University Press; 1999.
term traction of sternocleidomastoid and it can 3. Shifang Z, Fan Z. Practical rehabilitation medicine.
2nd ed. Nanjing: Southeast University Press; 1998.
lead to injury of sternocleidomastoid at the 4. The Medical Department of Ministry of Health of the
end. People’s Republic of China. The Medical Department
8. Strengthen physical exercises: Physical train- of Ministry of Health of the People’s Republic of
ing can make muscle, ligament and joint cap- China. First volume. Beijing: Huaxia Press; 1998.
p. 1–2.
sule in healthy and well developed state. The 5. Aiguo Z, Yanchun W, Qun C, et al. In vivo near-
patients with good myodynamia and elastic infrared photodynamic therapy based on targeted
ligament are difficult to be injured. upconversion nanoparticles. J Biomed Nanotechnol.
9. Reinforce protection and avoid injuries: In
2015;11(11):2003–10.
6. Pantiushenko IV, Rudakovskaya PG, Starovoytova
daily life and labor, there are dangerous factors AV, et al. Development of bacteriochlorophy lla-based
everywhere so that it is necessary to enhance near-infrared photosensitizers conjugated to gold
protection consciousness. For example, when nanoparticles for photodynamic therapy of cancer.
taking a bus, do not stand still or sit still in case Biochemistry (Mosc). 2015;80(6):752–62.
7. Dongmei L, Shuang L, Xiuhua F, et al. Study and fab-
of the injuries of centrum and joint due to acci- rication of broad band-pass filters in infrared therapy
dent turbulent jolt. The person should use apparatus. Acta Photon Sin. 2015;44(3):331001–6.
The Application of Rehabilitation
Medical Engineering 9
in Neurological Training
On the basis of modern engineering technique, 9.1 The Research

according to the principle of compensation and and Development
adaption, rehabilitation medical engineering is a of Preventive Orthotics
subject that can design and produce assistive
devices to help the disabled to improve their 9.1.1 Semi-Finished Product
independent life ability. Macromolecule Orthotics
Orthotics is an important content in rehabilita- Material
tion medicine, which belongs to rehabilitation
medical engineering. The purpose of orthotics is Orthotics for medicine is external fixation sup-
to prevent and rectify the deformity of the trunk port equipment that can relieve dysfunctions of
and joint, protect lesion tissue, prevent limbs dis- bone and muscle of injured limbs through restrict-
use, improve or compensate the lost functions ing and assisting body movement or changing
[1], which is essential for clinical rehabilitation body force line [2].
medicine and is widely used in clinic. From the wearing comfort and functional reli-
There are many types of orthotics. According ability, the characteristics of ideal orthotics mate-
to material type, it is divided into plastic orthot- rial are as follows:
ics, metal orthotics, metal framework orthotics
and so on. According to therapeutic goal, it • It is easy to process, mold and manufacture. Air
includes orthotics for medicine, temporary permeability is good. It is sturdy and durable.
orthotics for medicine and orthotics for rehabili- • It is in light weight and it is non-poisonous,
tation. The manufacture of artificial limbs and tasteless and hurtles.
walking assistive devices are complicated, which • It is radiolucent and it cannot affect the X ray
require special equipment and technique and are examination quality when wearing orthotics.
hard to be developed in normal hospital. • It is easy to use and comfortable to wear.
Therefore, we don’t discuss it in this book.
In rehabilitation therapy of neurological train- At present, orthotics materials widely used at
ing, in order to obtain better effect, except tradi- home and abroad include high temperature ther-
tional orthotics, independent research and moplastic plastic plate, resin matrix composite
development orthotics material and orthotics are and low temperature thermoplastic material.
classified according to the prevention, rectifica-
tion and function of orthotics. We discuss them 1. High temperature thermoplastic plastic plate:
separately. The characteristics of it is that it can go soft
https://doi.org/10.1007/978-981-13-0812-3_9
266 9 The Application of Rehabilitation Medical Engineering in Neurological Training
under high temperature (180 °C). Not only the The material can increase the weight of the
processing requires special equipment, but orthotics, but is not with air permeability. It
also the working procedure is complicated. requires drilling a pore to increase air permeabil-
Generally, the working procedures include ity. The number of the pores is small, which can-
negative plaster model, positive plaster model, not reach the requirements of air ventilation. The
model patching, plate clipping, heating, number of the pores is big, which can affect the
moulding, cooling, patching, fitting, re- strength of the orthotics.
patching, pasting body limbs sponge, drilling Because the processing of orthotics is compli-
sweat pore, fastening fixing band, polishing cated at present, many hospitals cannot develop it
and truing. Technical requirements to orthot- due to the limitation. It only can be processed in
ics master are high. In the non-rehabilitation the orthotics manufacture factory in big city and
hospitals such as normal hospital, county hos- rehabilitation medical engineering department or
pitals, community and country health-center, orthotics production room of several hospital so
it is hard to carry out the work and influence that many patients cannot wear orthotics timely
the application range. because this is no opportunity. It can induce
2. Resin matrix composite: it is fiber reinforced deformity of joint and abnormal motor pattern,
material on the basis of organic polymer, and then affect the recovery of body limbs
which includes glass fibre, carbon fibre or ara- function.
mid fiber. They are widely used in aviation, Therefore, it is easy to be studied and devel-
automobile, marine industry and medical sci- oped. The tenacity is good and the intensity is
ence. Reinforced polymer composites include strong. Air permeability is good and is not radio
epoxy resin and unsaturated polyester resin. parent. Through slight modification, semi-
The common used resins include thermoset- finished product macromolecule glass fiber
ting resin, thermoplastic resin and various orthopedic material can be used for different lev-
kinds of modified or alloying matrix. els hospitals in basic level and city, which has
Thermoplastic resin can dissolve in the sol- important clinical significance. We introduce sev-
vent. It can soften and fuse into viscous liquid eral types of new orthotics materials and orthot-
when heated and also harden after cooling. ics invented by the author and applied in clinic.
Thermosetting resin can be heated and be
molded once. It can solidify in the processing 1. Making and processing: macromolecule glass
and become networking macromolecule fiber is adopted. According to the shape of dif-
chemical compound that is non-melt and ferent part and functional requirements, the
insoluble. Therefore, it cannot be regenerated. materials are prefabricated to material plates
3. Low temperature thermoplastic material: The with different size and thickness. After dip in
characteristics of it is that it can soften in the solidification liquid, the materials are sealed
hot water (60–80 °C). It can be molded in the and enveloped. We select PEISS 020 antiseize
body limbs. After solidification, the strength non-woven fabrics (the thickness is 0.12 mm)
of this material is limited so that the applica- and cut it into pieces that is bigger than macro-
tion is confined. Moreover, in the limbs with molecule glass fiber plates. We use normal
severe deformity (hand palmatum in the hemi- saline to soak it and seal the envelope. Dry non-
plegic patients), it is difficult to be molded woven fabrics with same size are enveloped.
directly. It is easy to attend to one thing and Six fixing bands, several rivets and lining cloth
lose another and it is difficult to produce the inside and outside are separately enveloped. All
ideal orthotics that meets the requirements. It the goods mentioned above are sealed package
is easy to influence the quality and dressing with external packing (Fig. 9.1).
effect and may waste the materials. Semi-finished product medical macromol-
ecule glass fiber material is as soft as mud in
In addition, the basic material of high and low the airtight state, which cannot turn bad in 2
temperature thermoplastic material are plastic. years. After sealing off, water in room tem-
9.1 The Research and Development of Preventive Orthotics 267
put it on the wet non-woven fabrics of the

body limbs, press them slightly until they fit
with each other perfectly, put dry non-woven
fabrics on it, use temporary binder to bind
them up around for 6 min. After that, the assis-
tant check the border of macromolecule glass
fiber material and get them down if they are
solidified and molded. At this time, because
macromolecule glass fiber material is still not
solidified, the assistant can use hands to mold
specific unideal part and wash it with water to
promote solidification process. After com-
Fig. 9.1 Constitutional diagram of semi-finished product
plete solidification, scissors or electric saw are
macromolecule fabric orthotics material
used to cut off marginal excessive materials.
Three hours later, grinding wheel or abrasive
perature is used to soak it for 6 s and it can be paper is used to polish the margin until it is
molded at will. Six minutes after that, it can be smooth. The assistants use fine grit sandpaper
solidified. After molding, the strength is high for sanding or use polisher for polishing.
and the tenacity is good. Three layers can be Spare rivets are used to fix the fixing band and
used for upper limbs and six layers can be then the orthosis can be tried on. If there is no
used as back dry frame material. After mold- modification, the patients can try it on directly
ing, it is showed as micro grid with good air or put neck bush and dress it when the two
permeability and without artificial punching. sides are connected. Neck push can be
It is absorbent and moisture resistance. It can removed periodically for washing or change.
be washed for many times without metamor- If the deformity of the patients is severe, nega-
phosis or molding. It is light, non-poisonous, tive plaster model can be done first and then
tasteless and easy to dress, which cannot can be made to positive plaster model. After
affect X-ray examination. molding modification, it can be made through
2. Method of application: According to the body the method of macromolecule glass fiber
part of orthotics and somatotype of the material molding.
patients, suitable sized semi-finished product 3. Types and models of semi-finished product
macromolecule glass fiber orthotics material macromolecule glass fiber orthotics materials:
bag is selected. The therapists prepare for it According to body limbs part and function,
such as half basin water in room temperature semi-finished product macromolecule glass
and temporary binder. In a warm room, the fiber orthotics materials are divided into
patients expose their body part for orthotics orthotics material of the trunk, functional
and open the external packing of semi-finished position orthotics material of wrist-hand,
product macromolecule glass fiber orthotics functional position orthotics material of
material bag. Dry non-woven fabrics soak into elbow-wrist-hand, functional position orthot-
warm water, are squeezed out excessive liquid ics material of knee joint, functional position
and put on the limbs skin surface. At this time, orthotics material of foot-ankle, overhang
the assistant should keep the limbs in func- support material of upper limbs and cervical
tional position, open external packing of mac- gear material. Every kind can be divided into
romolecule glass fiber material plates, fold three types such as adult type, children type
macromolecule glass fiber and dip them into and special type. Every type includes three
water for 6 s. The assistant should press them sizes such as big, middle and small size.
on the plate as soon as possible until there is 4. Clinical application: From April 2006 to April
no bubble between layers, stretch it to the flat, 2007, semi-finished product macromolecule
glass fiber orthotics are used to make orthotics • It is necessary to fix and protect injured
in 115 patients who are all at hospital or out limbs or joints in order to promote
patients in Beijing Tongren Hospital affiliated manufacture of orthotics for healing
to Capital Medical University. There are 69 such as various kinds of orthotics for
cases of functional position orthotics of wrist- the therapy of bone fracture.
hand, 33 cases of functional position orthotics • Prevention of limbs deformity such as
of foot-ankle, ten cases of orthotics of trunk manufacture of orthotics used for con-
and three cases of cervical orthotics. They are genital talipes equinovarus, gonyecty-
all one-stage molding and the rate of finished posis and genu valgum.
products is 100%. It is in light weight, non- • It is necessary to alleviate load-bearing
poisonous, tasteless and is with good air per- of long axis of limbs or the trunk such
meability. It is strong but pliable in texture and as load-bearing of ischium of orthotics
it cannot affect the X ray examination quality for aseptic necrosis of head of femur.
when wearing orthotics. Semi-finished prod- • It is necessary to control abnormal
uct material is used to make orthotics. The movements of joint to decrease muscle
manufacturing operation is simplified obvi- spasm during standing and walking
ously and the rate of finished products is such as ankle-foot orthotics used for
increased. Manufacturing time is shortened to the patients with cerebral palsy to alle-
4 h from 3 days, which alleviate labor inten- viate spasmodic talipes equinovarus
sity and simplify manufacturing process. during walking and improve walking
5. Functions and indications: Except individual function of ankle-foot.
joint, the effects and indications are the same • It is necessary to improve the patients’
as these of orthotics made from high tempera- daily life movements and working
ture thermoplastic plate materials. ability such as wrist-hand orthotics to
(a) Functions: Except for foot-ankle orthot- improve defects of holding functions
ics, effects of macromolecule glass fiber of hand.
orthotics are the same as that of orthotics 6 . Cautions
made from high and low temperature (a) When use water to steep it, the therapists
thermoplastic plates. should immerse macromolecule material
• Prevention and rectification of joint into water and stir it slightly until soaking
deformity and prevention of tendon, degree is even because materials with dif-
muscle spasm and the formation of ferent hardenability can affect the quality
abnormal motor pattern of orthotics.
• Fixing function (b) After the material is totally solidified, the
• Movement or walking assistance func- therapists cut it and polish it in case of low
tion to help the patients move body limbs strength due to interlaminar separation.
• Protection function (c) After orthotics molding, sandpaper is
• Load-bearing and supporting functions used to polish inside and outside of orthot-
(b) Indications: This material is suitable for ics in case that it abrades clothes.
preventing abnormal position of joint and
trunk with orthopedic functions. Semi-finished product macromolecule glass
• It is necessary to restrict abnormal fiber orthotics material is easy to use and can sim-
movements of joint and limbs in order plify the manufacturing process of orthotics. It can
to stabilize joint, alleviate pain or meet requirements of high quality without special
recover the function of load-bearing and can be used in orthotics factory of big city and
such as manufacture of knee-ankle- orthotics department of big hospital or small and
foot orthotics used for poliomyelitis. medium hospitals and basic health organizations.
Cooperated with former of orthopedic brace On the basis of developing semi-finished

made from macromolecule materials, it is easy product macromolecule glass fiber orthotics
and comfortable to make orthotics from mac- materials, in order to cooperate with clinical
romolecule glass fiber orthotics materials, application of this material, according to the
especially for severe deformity such as chicken mooncake mould and different shape of different
feet. However, macromolecule glass fiber body parts, the author developed a series of for-
material molding is used for foot-ankle orthot- mer of orthopedic brace. After actual clinical
ics for walking. The heel part of orthotics application, the effect is satisfying.
should be flapped repeatedly in order to make
the solidification liquid to fill in mesh of the 1. Material: Macromolecule glass fiber material
materials to increase the strength of this part or other material is used and the thickness is
after solidification in case that there is no effect six layers. The material in sealed package is as
due to inadequate strength. Semi-finished soft as mud. After unsealing, the therapists
product macromolecule glass fiber orthotics steep it into cold water for 6 s and solidify it
materials are used to make ankle-foot func- for 6 min. After solidification, it is with good
tional position orthotics and wrist-hand func- air permeability and radio transparent. The
tional position orthotics (Fig. 9.2). tenacity and strength are good. It can resist to
moisture. It can be used for a long time with-
out metamorphism and deformation.
9.1.2 Former of Orthopedic Brace 2. The structure and function of former: Except
for shape, side and size, the other structures of
At present, at home and abroad, the manufactur- it are the same. We use wrist-hand functional
ing processing of orthotics is complicated, which position brace former as an example to intro-
is associated with poor suitability and material duce basic structure and functions.
loss because it is impossible to be molded in the Wrist-hand functional position brace for-
body or molded directly. It affects the quality of mer is composed of main body, fixing band
orthotics and their wide clinical application. and sponge slice (Figs. 9.3 and 9.4).
Therefore, development of processing technic (a) Main body: Forearm end is an arc groove
and methods that can mold the materials directly that is adaptable to human forearm. It is
or in human body can simplify the manufacturing the forearm part of molded orthotics
processing of orthotics, decrease orthotics mate- brace. Wrist part is a groove that is adapt-
rial loss and increase suitability of orthotics, able to the shape of wrist and palm. It is
which can make orthotics be widely applied in the wrist part of molded orthotics. The fin-
city and primary hospital. ger end is a groove that separates index
finger, middle finger, ring finger and little
finger and bends laterally to palm. It is the
Fig. 9.2 Ankle-foot functional position orthotics and

wrist-hand functional position orthotics made from mac-
romolecule materials Fig. 9.3 Former of orthopedic brace
model, positive plaster model is duplicated.

After that, on the basis of positive plaster
model, former of orthopedic brace is made
according to following technological process
(Fig. 9.5). Orthotics should be made uniquely
for the patients with special body type.
4. The kinds and types of former of orthopedic
brace: According to the body parts, former of
orthopedic brace is classified, which includes
wrist-hand former of orthopedic brace in
functional position, elbow joint former of
Fig. 9.4 Fixing band of former of orthopedic brace
orthopedic brace in functional position, neck
former of orthopedic brace, the trunk former
part from index finger to little finger of of orthopedic brace, knee joint former of
molded orthotics. The thumb end is thumb orthopedic brace and foot-ankle former of
part of molded orthotics. The comprehen- orthopedic brace. Except for the trunk and
sive effect can make the wrist joint be in cervical vertebra, every kind is divided into
30° dorsiflexion position. The functional two types and every type is divided into two
position is that five fingers bend to palm models. There are six different sizes in each
and it is in a teacup state. model and 12 models in two sides. Together
(b) Fixing band: It is made from elastic band with six thin layer sponge slices, they are
with different width, which includes fix- stored in special tool box for orthotics manu-
ing band of forearm, fixing band of wrist- facture center or studio.
hand and fixing band of thumb. The son 5. Clinical application of former of orthopedic
button nylon thread gluing at two ends can brace: According to processing norm, former
be compressed and fixed on the mother of orthopedic brace is used to process and
thread of nylon thread gluing on the lat- mold orthotics.
eral wall of former. Its role is to compress (a) Model selection: According to body part
materials in the condition of unmanned that requires orthotics, side and size, for-
compression and fixation in order to mold mer with proper model is selected.
it inside the former according to limb (b) Processing and molding: The procedures
shape. are as follows: Macromolecule glass fiber
(c) Sponge slice is soft sponge slice with thin orthotics materials are soaked into cold
layer. Its role is to increase adaptation of water for 6 s, taken out, squeezed out
former. If the therapists don’t find former excessive water, pressed on the plate and
with proper type, they can use sponge flattened. The therapists roll the materials
slice of one layer or two layers to fill in out in the former and spread a layer of
order to make the orthotics adapt to the drenched non-woven fabrics on it. The
outline of limbs. therapists put limb part into the mould,
3. Manufacture method of former of orthopedic press it slightly until the body part perfectly
brace: In order to make molded orthopedic matches the former. The therapists stretch
brace meet the requirements of human func- the fixing band of the former tightly and fix
tional position of various joints. Manufacture it on the outside of the other end of the
of former of orthopedic brace should choose former around the body. Tensile force of
normal people in different age and different fixing band should be equal to avoid
posture as the model. Functional position of impression after the molding of former.
every bilateral joint is chosen for negative The impression can affect the beauty or
plaster model. According to negative plaster can induce pression phenomenon after
The body part of Clip negative plaster Repair positive Choose proper
negative plaster model and pour plater model and macromolecule fiber
model is put on plaster into it until polish it for use material bag and
functional position. the plaster is unseal it
solidified
Use temporary Paste Press it slightly until Soak it into cold

binder to bind it up macromolecule fiber there is no bubble water for 6 seconds
around with even material on molded and stretch it until and put it on the
force and make it positive plaster it is flat plate
attach to positive model
plaster model
6 min later, take it Cut off redundance Fix nylon thread It is equipped with
down until it is and polish it gluing in the lateral thin layer sponge
solidified of former slice, elastic fixing
band and special
tool box
Fig. 9.5 Flow chart of former of orthopedic brace
dressing it. The materials are fixed for in the inside of thumb. The feeling can be
6 min until macromolecule glass fiber relieved after stiff paper sponge is pasted
material is solidified. After that, the on the inside of thumb. In one case of foot-
therapists loose fixing band and take it ankle orthotics in functional position, after
from the former carefully. Water washing dressing it for several days, materials
can accelerate the solidification process of problems lead to layering and low strength
macromolecule glass fiber material. The in the lateral of ankle. In two cases of the
therapists clip excessive materials on the trunk orthotics, after dressing it, the
margin of orthotics brace, use fine patients feel pressed in iliac crest and can
sandpaper to polish it, add lining, fix the be relieved through clipping. If there is no
fixing band and then use it for the patients. material loss, the rate of finished products
The therapists can wash the former, is 100%. Plaster model is unnecessary in
dry it in the air and put it into tool box for the process that former is used to make
standby application. orthotics, which can simplify manufactur-
(c) Clinical application: from April 2006 to ing operation and decrease manufacturing
February 2007, there are 54 patients who cost. The manufacturing time is shortened
use orthotics made from former of ortho- to 4 h from 3 days, which decrease labor
pedic brac. They are all the inpatients of intensity of the staff obviously. Because
rehabilitation. There are 23 cases of wrist- the solidness, tenacity and air permeabil-
hand orthotics in functional position, 20 ity of materials are good, these character-
cases of orthotics in functional position istics increase the quality of orthotics and
orthotics, eight cases of the trunk orthotics dressing comfort obviously. The method
and three cases of cervical orthotics. They doesn’t need many equipment so that it
are all one-stage molding, but there are can be used in village, community health
three patients who use wrist-hand orthot- center, big hospital in city, and special
ics in functional position and feel pressed orthotics manufacture factory.
6. The advantages of former of orthopedic brace: joint capsule in paralyzed side. Limbs are short-
although macromolecule glass fiber material ened at the muscle spasm state, which can make
is as soft as mud in airtight condition, the the muscle be in an improper initial length state
materials can be molded at will and solidified and can induce adhesion of muscle, ligament and
in 6 min after unsealing. However, soft mate- joint capsule and tendon contracture. In severe
rials don’t mean that they are easy to be made cases, there is joint deformity, which can affect
to qualified orthotics brace. In the process of motor function of joint and limbs.
manufacturing wrist-hand orthotics in func- The research demonstrated that if shoulder
tional position for the hemiplegic patients joint of normal person is fixed for 1 day, it may
with severe deformity (chicken feet), severe take 7 days to loose adhesion induced by immo-
spasm of flexor carpi and all digital flexor ten- bility of muscle and soft tissue. If the joint is
don make it difficult for the molding of the fixed for 3 weeks, it may take 300 days to loose
materials on the limbs. If the wrist is fixed, the adhesion. If the fixing time is longer, it can lead
finger cannot meet the requirement and if the to joint congelation, joint rigidity, even irrevers-
thumb is in functional position, the other four ible disability such as fibrous ankyloses or bony
fingers cannot meet the requirements. Molded ankyloses due to loose difficulty. Once the defor-
orthotics with too strong press are easy to mity is formed, through therapy, neural function
sunk inside and are difficulty to be made to can be recovered, but motor function of limbs is
satisfying orthotics, which may lead to mate- hard to be recovered because of joint deformity.
rial loss. The idea of former of orthopedic Therefore, the patients’ daily life ability is
brace is enlightened from mooncake mould affected. In order to prevent this situation, it is
and auto wrench tool box. Through repeated necessary to put limbs in good position and do
trial-manufacture and modifications, a series joint movements in clinic.
of molded former of orthopedic brace are Good limb position is different from func-
developed according to different parts of tional position. Good limb position is temporary
limbs. Orthotics made from macromolecule body position from therapeutic angle. For exam-
materials reduce the difficulty of orthotics, ple, after reduction of humerus surgical neck
shorten manufacture time, increase comfort of fracture, shoulder joint is necessary to be fixed at
dressing brace. Which provides advantages 45° abduction position temporarily for the heal-
for the increase of quality of orthotics and ing of bone fracture. However, if there are joint
wide application. spasm, adhesion or rigidity, they can affect
greatly motor function of shoulder joint.
Functional position is the angle and position at
9.1.3 R
etainer of Joint in Functional which the limbs and joints can play roles. In this
Position angle and position, even if there is joint spasm or
rigidity, the functions of limbs can be developed.
In clinic, unmovable limbs due to coma, hemiple- For example, the functional position of ankle
gia after central nerve injury, paraplegia after spi- joint is at 90° position, which means that the
nal cord injury, injury of bone, joint and muscle planta pedis is parallel to the ground. If the ankle
and extremely weakness, not only lose autoki- joint is fixed in this position, the patients can
netic movement ability, but also lead to abnormal walk.
joint positions because the paralyzed muscle is Regardless of functional position or good limb
lack of tension such as foot drop, strephenopodia, position, the purpose of them is to maintain the
hypertension of knee joint, elbow and wrist joint limbs and joints at the position that is good for
flexion. Therefore, it can induce abnormal motor complications prevention and functional r ecovery
pattern of limbs. Limbs are at the poor joint func- in the future. The bad position that leads to com-
tion position for a little long time, which can lead plications and affects joint functions is easy to
to extension of muscle, tendon, ligament and increase muscle spasm. After joint adhesion in
this position, the joints cannot exert functions. is proper without flexion of thoracic ver-
Therefore, the purpose of limbs in functional tebra. Hip in the injured side is cushioned
position is to prevent joint adhesion not in func- with a pillow to put forward the pelvis in
tional position, prevent loss of suitable initial order to prevent over flexion and extor-
length required for joint motion because of passion of joint. Shoulder joint in injured
sive stretching of paralyzed muscle, ligament, side is cushioned with a small pillow to
tendon and joint capsule and avoid increasing put forward the scapula. Elbow joint of
muscle spasm (antispasmodic position). upper limbs is extended and is put on the
From the goals mentioned above, in clinic, the pillow. Wrist joint is dorsiflexed and fin-
place of functional position of limbs should ger is extended. Two sandbags are sepa-
inhibit spasm pattern and be in accordance with rately put on the lateral of thigh and the
the principle of functional position. Meanwhile, middle of shank to prevent abduction and
the therapists should realize that place of func- extorsion of hip joint. Popliteal space is
tional position is not equal to prevention of tissue cushioned with a small pillow to prevent
adhesion. Joint adhesion in functional position hyperextension of knee joint.
can affect joint functions in a certain extent. (b) Lying position on uninjured side is the
There should not be complications. Therefore, lateral position on the injured side. The
during the process of placing limbs in functional specific method is that upper limb in
position, the patients should do rehabilitation injured side stretch out forward, shoul-
therapy in early phase such as active and passive der joint flex 90°, pillow is used to sup-
joint motion, which can promote blood circula- port the joint and upper limb in uninjured
tion, prevent muscle spasm and adhesion of joint side can be put at will. Hip and knee
and soft tissue, provide basis for motor function joints flex and are put on the pillow. Hip
recovery of limbs. joint in uninjured side is extended and
knee joint is slightly flexed. There is a
9.1.3.1 Common Place Method of Good pillow on the back to make the trunk in a
Limb Position relaxed state.
At present, in clinic, the medical staff don’t (c) Lying position on injured side is the lying
emphasize on good limb position and functional position method above the injured side.
position of limbs. Some simple supplies such as The specific method is that shoulder gir-
soft cushion, pillow, quilt and position retaining dle in injured side stretch out forward,
appliance of individual joint can keep the joint in shoulder joint flexes, elbow joint extends,
good limb position. These supplies not only can- wrist joint dorsiflex and the finger is like
not prevent joint deformity, but also should be grasping a teacup. Lower limb in injured
rearranged to keep good limb position due to the side extends and knee joint slightly flexes.
body position change because the patients in bed Hip and knee joints flex and a pillow is
should frequently turn over (at least once in every below them to prevent oppressing the
2 h). It is tedious and the effect is not reliable. lower limb in injured side. There is a pil-
At present, in clinic, the place method of good low on the back to be lied with the trunk
limb position is summarized as follows: in order to relax the body.
2. The place of good limb position with the help
1. Place of good limb position with the help of of appliance is used for keeping the body in
underbed means pillow, cotton cushion, quilt good limb position to prevent complications
and sandbag are used to keep the joint and limbs and make the body to exert functions.
in a position where the limbs can exert function (a) Ankle-foot orthotics brace can strictly
and the complications can be prevented. immobilize ankle joint to prevent foot
(a) Supine position: The head is put on the drop and talipes varus and valgus. It is
pillow to the uninjured side and the face is easy to dress and cannot be affected by
to injured side. The altitude of the pillow turning over.
(b) T-Shaped board shoes: in the heel of the The structures of retaining appliances of all
foot, 20 cm plank is nailed into the shoes, joints in functional position are the same,
which is vertical to the long axis of the shoes which include the main body, fixing band and
and T-shaped. The patients in supine posi- sponge slice.
tion wear shoes to prevent foot drop and (a) The main body is arc groove and is adapt-
internal and external rotation of lower limbs. able to human joint. Its role is to keep the
(c) Mattress and tail board are used to prevent joint in functional position.
foot drop. The patients lie on their back in (b) Sponge slice: The role of soft sponge
the bed. There is a 15 cm space between slice with thin layer is to increase
mattress and tail board. The patients put adaptability of retaining appliance of
heel into this space and make pelma close joint in functional position. If there is
to baseboard to make foot in a 90° dorsi- no proper retaining appliance of joint in
flexion position. It can prevent pressure functional position and the existing
sores due to oppression of heel and pre- retaining appliance is too big, sponge
vent foot drop. slice with one layer or multiple layers
can be used for filling. It can better
9.1.3.2 Retainer of Limbs Joints adapt to the outline of the body and
in Functional Position play a fixed effect.
Macromolecule glass fiber orthotics materials (c) Fixing band is made from elastic band
with air permeability and radio transparent are with different width. Its role is to fix
developed to a series of retaining appliances of retaining appliance of joint in functional
limbs joints in functional position according to position on limbs.
different sides, shape, part and age, which are Retaining appliance is easy to dress, light,
suitable for the coma patients and the mainte- fragrant, non-toxic, air permeable, radio trans-
nance of joint functional position of paralytic parent. It is convenient for the patients to do
limbs. Once in hospital, the patients wear it from X-ray examination in bedside. Except for
the early phase to prevent muscle spasm and joint retaining appliance of shoulder abduction and
deformity [3] of paralytic limbs effectively. hip abduction in functional position, the others
are not affected by the body position change of
1. Machine shaping: Macromolecule glass fiber the patients. All the joints can be maintained in
material is used to make the orthotics accord- functional position to prevent joint deformity
ing to the requirements of normal functional effectively, which provides advantages for
position of all joints. Normal orthotics materi- functional recovery in the future.
als can also be selected. 2. The types of retainers of limbs joint in func-
According to normal person in different tional position
age and posture and the shape of limbs joints, (a) According to body parts, it is divided into
positive plaster model is prefabricated. retaining appliance of shoulder joint, elbow
Macromolecule glass fiber orthotics materials joint, wrist-hand joint, hip joint, knee joint
with 3–6 layers are used. Before solidifica- and ankle joint in functional position.
tion, it is as soft as mud. It is sealed. After (b) According to the size, it is divided into the
unsealing, the materials are soaked in water at adult type, the children type and special
room temperature for 6 s and be solidified for type.
6 min. After solidification, the materials are (c) According to the body side, it is divided
not only with good air permeability and radio into upper limb, the trunk and lower limb
transparent, but also with good tenacity and or right side and left side.
solidness, strong waterproof and anti-damp- The adult type retaining appliance of
ness ability. It can be used for a long time the joint in functional position refer to
without metamorphism and deformation. Fig. 9.6, 9.7, 9.8, 9.9, 9.10, and 9.11.
a b
Fig. 9.6 (a) Brace of shoulder joint abduction in functional position. (b) Dressed brace of shoulder joint abduction in
functional position
a b
Fig. 9.7 (a) Retaining appliance of elbow joint in functional position. (b) Dressed retaining appliance of elbow joint in
functional position
3. Indications and contraindications: Retaining The patients with severe edema of joint
appliance of limb joints in functional position and limbs should use it with caution.
is widely applied. 4. Cautions of clinical application: The therapists
(a) Indications: It is suitable for the patients should realize that maintenance of functional
with motor function loss of limbs due to position is not equal to prevention of tissue
coma or various causes such as quadriple- adhesion. Joint adhesion in functional position
gia, hemiplegia, cerebral palsy, child may affect joint functions, which is the com-
cerebral palsy and paraplegia due to low plication that should not occur. Therefore, dur-
conscious state, CNS injuries, and inju- ing the process of keeping joint in functional
ries of bone, joint and muscle. position, the patients should emphasize on
(b) Contraindications: it is not suitable for the rehabilitation training. The patients undress
patients with unhealed local skin injuries retaining appliance of joint in functional posi-
such as burn, scald and openness injury. tion and do active and passive training of joint.
a b
Fig. 9.8 (a) Retaining appliance of wrist-hand in functional position. (b) Dressed retaining appliance of wrist-hand in
functional position
a b
Fig. 9.9 (a) Retaining appliance of hip joint in functional position. (b) Dressed retaining appliance of hip joint in
functional position
Fig. 9.10 (a) Retaining

appliance of knee joint
a
in straight position. (b)
Clinical application of
retaining appliance of
knee joint in straight
position
Fig. 9.11 Retaining
appliance of foot-ankle
joint in functional
position
The training time is 10–15 min per time (1–2 patients with pressure sores is big and the cost is
times a day) to prevent adhesion of joint and extremely high. It not only can increase the hos-
soft tissue. Physiotherapy can be used to pro- pital day, the time back to family and work time,
mote blood circulation in order to increase but also increase occurrence rate of other compli-
therapeutic effect. cations evidently. In 1992, clinical guideline
5. Functional position of all joints (Table 9.1). established by American health care policy and
research institute regards pressure sores as one of
the seven medical problems needed to be solved
9.1.4 Convenient Turning–Over and confirmed that pressure sores can be
Device to Prevent Pressure prevented.
Sores
9.1.4.1 The Definition of Pressure Sores
Pressure sores have affected human society for Pressure sores is that in a certain area, especially
centuries. Although there are progresses in the constant pressure of osseous process induces tis-
wound formation and therapy, the number of the sue ischemia, cells death and tissue necrosis and
Table 9.1 Functional position of all joints

Joint Functional position Angle (°) Supporting detail
Shoulder joint Abduction 45–75
Anteflexion 30–45
Extorsion 15–20
Elbow joint Flexion 70–90 Neutral position of forearm
Wrist joint Dorsiflexion 30
Ulnar deviation 5–10
Thumb joint Palmar opposition
Finger joint 140
Metacarpophalangeal joints 140
Near interphalangeal joint 130
Far interphalangeal joint 150
Hip joint Abduction 10–15
Anteflexion 15–20
Rotation 0
Knee joint Flexion 5–20
Ankle joint Foot dorsiflexion 90
it is commonly seen in bedrid patients so that it is occurrence rate of the patients in acute phase and
called decubitus ulcers or bedsores. Decubitus is in rehabilitation hospital is 40%. In the follow-up
Latin, which means lying down and the ulcer is visit of every 5 years, the occurrence rate is 30%.
induced by long time in bed. Constant pressure of
any part for a long time can induce it so that the 9.1.4.3 The Causes of Pressure Sores
name of pressure sores is more precise, which There are many causes of pressure sores.
indicates that the pathogenesis of pressure sores Pressure, shear force and friction force are the
is constant pressure that induce tissue ischemia three primary factors. The most important is
and necrosis but not simple special body pressure. Secondary factors include state of
position. motion, sense-motor function, state of nutrition,
age, blood system change, diabetes mellitus, cir-
9.1.4.2 Epidemiology of Pressure Sores culatory disturbance and gatism [4].
In the emergency medical establishment, the
occurrence rate of pressure sores is 15–18.3%. 1. Pressure: There are three important factors

Some people do study of nursing in acute stage on related to pressure, which include intensity,
large sample about 148 hospitals and found that time of duration and the tolerance of tissue to
the occurrence rate of pressure sores is 9.2%. The pressure.
occurrence rate of pressure sores in the patients in
a long period of hospitalization is 3.5–29.5%. In Pressure has negative relation with time,
skilled nursing facility and sanatorium, the occur- which means high pressure in a short time and
rence rate of pressure sores is 2.4–23%. low pressure in a long time do the same harm to
Occurrence rate of pressure sores differs in the tissue. The research found that 70 mmHg
different population and organizations. In acute pressure for 2 h can lead to pathological change
nursing institute, the occurrence rate is 3–40%. of tissue. The tolerance ability of tissue to inter-
Allman found that at least 7.7% of inpatients are mittent pressure is stronger than the tolerance
diagnosed with pressure sores 3 weeks after ability of tissue to constant pressure. For exam-
admitted to hospital. In special crowd, such as the ple, if the pressure is removed every 3–5 min, the
patients with senile diseases and orthopedic tissue can tolerate higher pressure. Therefore,
department of orthopaedics, the occurrence rate pressure must be removed regularly to reduce
reaches 24–59%. Young and Burns found that the pressure on the skin surface.
In clinic, one turning over every 2 h and fre- Damaged extent is confined to epidermis and
quent posture change can relieve pressure, which corium layer. If there are pressure and shear-
is based on these researches. Compared with ing force, the harm induced by friction force is
skin, muscle is more sensitive to pressure. bigger. If there is friction force, minor skin
Pressure can be transmitted from body surface to pressure can induce pressure sores [6].
the bone under it. Because of counter-acting
force, the tissue on the bone bears more pressure. The degree of spinal cord injury is not obvi-
Therefore, the pressure distributes like a cone ously correlated with the severity of pressure
shape. Basis pyramidis is the body surface under sores. If medical history of the patients is more
pressure, which lead to slight skin injury and than 3 years, the concentration of proline, lysine
severe subcutaneous injury. and hydroxylysine of the skin under the paraple-
In 1930, through microinjection, Landis gia level is decreased. Because these substances
proved that the average pressure of the part from are related to skin tension and can resist pressure,
artery to capillary is 32 mmHg. In the terminal of possibility of pressure sores is high.
vein, the pressure is decreased to 12 mmHg. The
average capillary pressure is about 20 mmHg. 9.1.4.4 Common Body Parts
Therefore, in clinic, the therapists should seek of Pressure Sores
bearing surface that can decrease pressure to More than 95% of pressure sores occurs in osse-
below 32 mmHg in order to decrease the harm of ous processes of bottom half of the body. Sixty-
the tissue due to constant pressure for a long seven percentage occurs around hip and haunch.
time. Constant low pressure does more harm than Twenty-nine percentage occur in lower limbs.
high pressure for a short time. The most common parts are ischium, sacrum,
greater trochanter of femur and heel. It can also
2. Shear force: When the skin touches the bed occur in any part of the body where soft tissue is
and they are immobile, subcutaneous tissue is pressed, which includes the oppression from
moved because of some kind of cause, which splint, orthotics or orthopedic fixity. The most
can induce shearing phenomenon [5] between common part of pressure sores is sacrum in the
subcutaneous tissue and skin. For example, patients with spinal cord injury. The more time
the occurrence of pressure sores in pars sacra- the patients spend in the wheelchair, the higher
lis is related to this. When the bedside is ele- the occurrence rate of pressure sores in ischial
vated, the pressure of tissue in the back of tuberosity and heel is. In the children patients
sacrum is stronger than that in normal time. whose age is from 10 to 13, the common part of
Although skin of sacrococcyx is attached to pressure sores is occipitalia. With age, pars sacra-
bed sheet, the body slides to the bedside and lis is the common part.
subcutaneous tissue moves with it, which
induce shearing phenomenon. The artery from 9.1.4.5 Prevention of Pressure Sores
subcutaneous fascia and muscle to skin is The prevention of pressure sores is based on the
pressed and it leads to ischemia and then understanding of etiology. The key point of pre-
necrosis, which easily induce shearing ulcer vention is to eliminate the dangerous factors that
with wide base area. can lead to injury such as pressure, friction force
and shearing force. They can be summarized as
The common causes that induce shearing follows.
include spasm, bad sitting position, bad prone
position and sliding in transfer. 1. Body posture adjustment can relieve local tis-
sue oppression. According to the oppressed
3. Force of friction: The movement of skin on body part, when the pressure reaches
the bearing surface can generate friction force. 70 mmHg for 2 h, pathological changes of tis-
Excessive friction force can lead to skin tear. sue occur. The following measures can be
used to decrease the oppressed intensity and 2. Improving bearing surface to decrease inten-
duration time. sity of pressure of the oppressed tissue: The
(a) Timing turning over: for the patients with bearing surface can decrease the pressure on
dyskinesia, body elevation and turning osseous process through the closest touch and
over is the simplest, most common and the weight redistribution in a larger area. In
most effective method [5] to avoid con- the bearing surface applied at present, bearing
stant oppression. The patients who lie in surface in bed, removable mattress and tailor-
bed should be turned over once every 2 h, made bed have effects [7].
which is widely accepted in clinic, but the
therapists should examine the skin care- Low air consumption system can supply flow
fully. If there is any problem, it should be air around skin except air filling channel to make
solved in time. the skin keep dry, which is good for decreasing
(b) Frequent body position change: the main friction force and shear force in the movement.
position is divided into supine position, Tailor-made bed can relieve pressure, decrease
prone position, right lateral position and shear force and friction force, prevent dampness,
left lateral position. Lateral position which includes entrained-flow bed, low air con-
should avoid the direct pressure on greater sumption bed and tailor-made power bed.
trochanter. Seiler suggested that in lateral Entrained-flow bed contains airflow bubble. Bed
position it is suitable to incline the body at is covered with osmotic nylon textile and human
30° to decrease the pressure on the skin of float on the bed to decrease skin pressure, which
greater trochanter. is good for wound drainage.
(c) Preventing the pressure on osseous pro- At present, at home and abroad, the types,
cess and heel: Wedge or pillow can be advantages and disadvantages of the common
used to prevent the oppression of osseous bearing surface refer to Table 9.2.
process. The device that can lift the feet
away from the ground is used, which is an 9.1.4.6 The Composition and Function
effective way to prevent pressure on heel. Mechanism of Convenient
(d) Preventing shearing injury of skin friction Turning Over Device to Prevent
and subcutaneous tissue: when the thera- Pressure Sores
pists take the patients away from bed or Although at present the measures have an effect
wheelchair, they should try to decrease on preventing pressure sores, there are some
the friction force and shearing force obvious shortcomings.
between body and bed or wheelchair.
(e) Decreasing pressure on hip in wheelchair: 1. No obvious effect of soft bearing surface on
when the patients go out with wheelchair, decreasing the intensity of pressure: Bearing
the sitting posture must be right. surface in soft bed can be used to enlarge the
Footboard should be put in the altitude contact area between skin and bearing sur-
that can make the thigh bear load to face. It can induce the weight distribution to a
decrease the load bearing of ischium. certain extent and decrease the intensity of
Moreover, the posture should be changed pressure in osseous process. Because the pres-
every half an hour such as inclining back- sure from osseous process on upholder is big-
ward, inclining laterally or elevating the ger than that in other body parts, the bigger
body. the pressure on upholder is, the bigger the
(f) The therapists should examine the bounce from upholder is. Therefore, it cannot
oppressed body part frequently: the thera- decrease the pressure on osseous process
pists should examine the body part at least effectively. This is why in clinic it is necessary
two times a day including skins, espe- to turn over the body regularly on the condi-
cially the skin in osseous process. tion of using bearing surface in soft bed.
Table 9.2 The types, advantages and disadvantages of the common bearing surface
Support device Type Advantage Disadvantage
Static upholder Foam Cheap, light, multiple-purpose uses Absorb liquid with
(bed or cushion) odorous, short service life
Air Light, good decompression, easy to Easy to pierce, unstable
clean air inflation, expensive
Floating body (gel and Good decompression, easy to move Heavy, expensive, heat
water) and adjust collector
Recombination cushion Convenient for body placement and Heavy and expensive
(foam and gel) decompression
Dynamic Mattress Portable, clean and easy to control Force requirement,
upholder in bed humidity expensive, noisy
Upper upholder Low air consumption bed Good decompression, easy to control Expensive
humidity, move and decrease friction
force and shear force
Replaceable mattress in Inner decompression, low supporting High initial cost
hospital cost
Breeze bed Good decompression, antibacterial Expensive, hard to carry,
glass ball, absorb liquid and affecting sense and
dampness dehydration
2. It is effective to turn over the body but the doesn’t bear pressure, which is good for pre-
labor intensity is high. Turning over once vention of pressure sores.
every 2 h is the effective measure to prevent Hereunder, the raw material is hard bearing
pressure sores and is the clinical care routine surface. The author developed a turning over
of the patients with pressure sores. However, device that can prevent pressure sores effectively,
the labor intensity of turning over the patients, is easy for turning over and is convenient for the
especially the patients with coma or heavy patients to defect, which is called convenient
body weight is big, which can increase the turning over device to prevent pressure sores.
nursing difficulty and workload.
1. The composition of convenient turning over
The key point of preventing pressure sores device to prevent pressure sores: The device
is to eliminate pressure, friction force and is made from macromolecule glass fiber
shear force. If the bearing surface in bed is orthotics materials with six layers. According
changed to hardness from softness, the osseous to molded arc-shaped body from back and
process cannot bear pressure, but can eliminate waist-hip to anterior axillary line, osseous
friction force and shear force effectively. It can process protrudes outside and hangs inside,
maintain ventilation of skin and avoid damp- which includes sacroiliac part, spinous pro-
ness. It is convenient for the turning over of the cess of the seventh cervical vertebra and
patients and decrease nursing difficulty and bilateral greater trochanter. The back of arc-
intensity. During the process of preventing shaped body is pasted with four arc hollow
pressure sores, it helps the patients to turn over strips molded form macromolecule glass
their body. Hard bearing surface with air per- fiber material, which adapts to arc-shaped
meability molded according to the body out- body. Four arc hollow strips of arc-shaped
line can enlarge the contact area between skin body touch the bed. The inner face of arc-
and bearing surface and decrease the intensity shaped body is pasted with ventilated sponge
of pressure of skin without the counter-acting with thin layer. The two sides of arc-shaped
force generated from the pressure of the body body are fixed fixing band. When dressing, it
on upholder. Through machine shaping tech- can be pasted and fixed with nylon thread
nology, the osseous part is suspended so that it gluing in the end, which is convenient to put
on or off. The patients lie inside and only one ventilation and keeping the skin dry to
person slightly pushes this device to make increase the comfort of using it.
the patients turn over and change the In addition, convenient turning over device to
oppressed part of the body. Wedge-shape prevent pressure sores materials are fragrant,
cushion or thin cushion is cushioned outside adaptable, firm and ductile. The patients lie inside
of turning over device to fix the patients’ it. The entire is hard but the osseous process is
body position. There is herringbone nursing suspended to avoid pressure. Radio transparent
opening in the hip for the nursing of the characteristic is convenient for the patients to do
patients’ urine and stool. X-ray exam in bedside. There is herringbone
2. The function mechanism of convenient turn- nursing opening in the hip for the nursing of the
ing over device to prevent pressure sores: patients’ urine and stool.
The difficulty in turning over is that the Hard inner face can enlarge the contact area
patients cannot turn over timely so that pres- between the body and the device and lining
sure sores are formed. The difficulty in turn- sponge has a buffer action, which can enlarge the
ing over is common in the patients with stress area of the body and decrease the intensity
severe state of illness and heavy body weight. of pressure obviously. It makes the device com-
Sometimes, it requires 2–4 people to help the fortable and reduces the pressure on the body
patients to turn over. In clinic, soft substances tissue.
such as air cushion, sponge cushion and
water bed are usually used to decrease the 3. The manufacture and application method of
pressure on skin from body weight through convenient turning over device to prevent
buffer action in order to prevent pressure pressure sores According to the shape of
sores. These materials are airtight and can human back and waist-hip and the level of
make the bed surface damp. The elasticity of anterior axillary line, positive plaster model
the upholder materials is proportional to is duplicated from negative plaster model.
pressed degree of the skin. The bigger the After modification, proper macromolecule
pressure of local part is, the bigger the bounce glass fiber material with six layers is taken
is. Therefore, the stress of osseous process is out, unsealed and soaked into cold water for
big and the risk of pressure sores exists. 6 s. After that, it is flattened in the operating
Convenient turning over device to prevent floor and is pasted on positive plaster model.
pressure sores adopts suspension technique It requires 6 min to mold and solidify. Arc-
of hard bearing surface in osseous process. shaped body is molded according to the
The functions are as follows: shape of human back and waist-hip and the
• Osseous process cannot bear load. level of anterior axillary line, osseous
• The drawback that the more the soft bear- process protrudes outside and makes inside
ing surface is pressed, the bigger the bounce suspended, which includes sacroiliac part,
is avoided. The force is uniformly distrib- spinous process of the seventh cervical
uted in all the contact surface to decrease vertebra and bilateral greater trochanter.
the intensity of pressure effectively. Four arc hollow strip are formed of four
• Bearing surface is ventilated to prevent arch apophysis that are made from
local skin temperature increase, exhaust macromolecule glass fiber material with the
dampness and keep the skin dry. same thickness outside of convenient
• The arc and four arc hollow strip of conve- turning over device to prevent pressure
nient turning over device to prevent pres- sores on the basis of plastic tube (the
sure sores can help the patients inside it diameter is 5 cm). The periphery of it is
turn over easily through rolling this device. fixed on arc-shaped body with rivet. The
• This device’s lining is ventilated sponge back of arc-shaped body is pasted with four
with thin layer, which is good for skin arc hollow strips molded form
macromolecule glass fiber material, which

adapts to arc-shaped body. Four arc hollow
strips of arc-shaped body touch the bed
(Fig. 9.12). After solidification and
modification, the inner face of arc-shaped
body of turning over device is attached with
artificial limb sponge with thin layer
(Fig. 9.13). The two laterals are pasted with
fixing band with nylon thread gluing. The
device can be divided into big, middle and
small size. The device should be made
uniquely for special body type. Fig. 9.14 Clinical application of convenient turning
over device to prevent pressure sores
When dress up, the patients turn over to one

side slightly, place convenient turning over
device to prevent pressure sores, change to
flat-on position and fasten fixing band. The
therapists can make the patients turn over to the
left or the right as needed and adjust the angle of
turning over through the inserted depth of
wedge-shape cushion from the bottom of the
device (Fig. 9.14).
After dressing convenient turning over device
to prevent pressure sores, the nurses and family
of the patients with high paraplegia can change
the turning over degree of the patients as needed
Fig. 9.12 Inside view of convenient turning over device and use wedge-shape cushion to keep the changed
to prevent pressure sores
position.
4. Clinical indications and contraindications of

convenient turning over device to prevent
pressure sores
(a) Indications: it is suitable for the long-term
bed patients with coma, paraplegia,
myasthenia gravis, severe bone fracture or
dyscrasia.
(b) Contraindication: it is forbidden in the

patients with burn of neck-back and
waist-hip or unhealed wound.
9.2 The Development

of Orthopedic Orthotics
In clinic, because of short of consciousness and

Fig. 9.13 Convenient turning over device to prevent methods of early rehabilitation intervention or
pressure sores with lining the development and prognosis of the disease,
there always are abnormal joint position, rigidity tions of rehabilitation training are even lost such
even bony ankyloses. The therapy is difficult and as severe foot drop of fibrous rigidity.
it affects motor function recovery of the patients’ For foot drop with severe contracture of mus-
limbs and promotion of life quality. In order to culus gastrocnemius and Achilles’s tendon,
solve these problems, not only rehabilitation fibrous rigidity and bony ankyloses of ankle
consciousness should be enhanced, the joints are joint, it is understandable to be rectified by
kept in good limb position or functional position operation [13]. For the foot drop with passive
in early phase and rehabilitation training should joint range of motion, the operation therapy
be done, but also the abnormal should be rectified should be careful. The foot drop of the patients
through requisite measures for the rigidity joint with coma and low conscious state cannot
in abnormal position. It provides conditions for rectified by operation because there are no
rehabilitation training and functional recovery of indications. Extremely plantar flexion of ankle
limbs. joint lead to unable standing training and long-
term bed, which induces a series of complications
of respiratory, urinary, cardiovascular and
9.2.1 A
nkle Orthotics of Controlled- digestive system, even life danger and losing the
Release Force hope of functional recovery. It is the problem
that to be solved in clinic.
In clinic, foot drop is the most common joint At present, there is seldom report about the
deformity due to improper handling. Tibialis rectification therapy of this kind of foot drop.
anterior muscle paralysis due to coma, central Although there are many types [14, 15] of ankle
nerve injury and peripheral nerve injury induces orthotics at home and abroad, there is no report
foot drop because of plantar flexion of ankle about orthotics of controlled-release force.
joint. If there is no rehabilitation consciousness The stretched length of slow traction of rubber
and the patients don’t do good limb position band is longer than that of quick traction of rub-
placement and passive joint motion in the early ber band. Strong traction of foot drop easily
phase, contracture of Achilles’s tendon and induce pressure ulcer and make it difficult to
musculus gastrocnemius, fibrous adhesion of loose contracture of musculus gastrocnemius and
ankle joint can be induced for a longer time. Achilles’s tendon. Through the bounce of orthot-
For a long time, fibrous rigidity and bony ics elastic band of controlled-release force and
ankyloses of ankle joint are formed, which hinge design of ankle joint of foot tray, elastic
bring about great difficulty to the training of band tracts the pelma part of orthotics to increase
functional recovery. Therefore, difficult orthotic dorsiflexion angle of ankle joint. Through slight
foot drop is related to long-term immobilization and slow traction, contracture of musculus gas-
and disuse [8]. trocnemius and Achilles’s tendon, fibrous adhe-
In the early phase of foot drop formation, passion of ankle joint receives progressive loosing
sive joint motion can stretch contracture of mus- and stretching to increase the motion range of
culus gastrocnemius and Achilles’s tendon and ankle joint and rectify foot drop without inducing
loose adhesive ankle joint. Orthotics is kept in micro injury condition of muscle spasm. It cre-
functional position to make the adhesion occur in ates conditions for decreasing complications and
functional position even if there is adhesion [9], promoting functional recovery.
which can assure the basic functions of the joint. Ankle orthotics of controlled-release force in
However, if the opportunity of early rectification accordance with the principle of slight and con-
is lost, the relievable foot drop may become irre- stant traction is developed using elastic recoil of
versible [10], which brings about further diffi- elastic band to slowly loose adhesion and rectify
culty to rehabilitation therapy and has a strong joint deformity, which can provide conditions for
impact on functional recovery of the standing and rehabilitation training and joint function recovery.
walking [11, 12] of the patients. General condi-
9.2 The Development of Orthopedic Orthotics 285
9.2.1.1 Basic Structure and Functions ing band and paste artificial limb sponge slice
Ankle orthotics of controlled-release force is with thin adhesive sticker layer to the inner
composed of the main part and traction part of face for fitting. During the process of fitting,
controlled-release force. The main part is that the technicians select elastic traction band
moveable ankle orthotics of ankle joint is made with proper elasticity with one end fixed on
according to the shape of facies cruralis posterior the toe of orthotics and the other end fixed on
and foot of the patients. Its role is to fix shank and the upper end of shank of orthotics from ante-
pelma. Meanwhile, exogenous process is used to rior tibia. The technicians adjust the length of
generate dorsiflexion of ankle joint to loose con- elastic traction band and fix it. Through trac-
tracture of musculus gastrocnemius and Achilles’s tion of elastic band, the angle of foot dorsi-
tendon. Traction part of controlled-release force flexion is increased gradually.
is that elastic band is used to connect toe and the
front of tibia. Through the bounce of elastic band, 9.2.1.3 Clinical Application
slight and slow traction can stretch contracture of 1. Clinical test results: Macromolecule glass

tendon and muscle to loose the adhesive joints. fiber material is used to make ankle orthotics
of controlled-release force. Because of good
9.2.1.2 Materials and Manufacture air permeability and better body limb adapta-
Method tion, it is comfortable to dress and there is no
1. Materials: Macromolecule glass fiber material pressure ulcer in all the ceases. Elastic recoil
or high temperature thermoplastic plate is of elastic band of orthotics has a slight and
used. The characteristics of the materials are slow traction effect persistently.
as soft as mud before solidification, adaptable
and easy to be molded. After solidification, In 22 patients with foot drop who are rectified
they are with good air permeability, light, by orthotics of controlled-release force, there are
strong but pliable in texture, radio transparent 18 males and four females. There are 13 patients
and easy to dress. with low conscious state and nine patients with
2. The manufacture of ankle orthotics of
spinal cord injury. Passive motion range of ankle
controlled-release force: We use semi-finished joint is 3.54° ± 1.63°. The average of fixing
product macromolecule glass fiber material as angle of plantar flexion (the minimum angle of
an example. The therapists select ankle orthot- plantar flexion of passive motion of ankle joint)
ics materials in functional position, open is 44.91° ± 5.35°. the patients cannot do standing
packing bag, take out macromolecule glass training. The patients receive orthotics therapy
fiber material slice, soak it into water of room of controlled-release for four weeks and the pas-
temperature for 6 s, flatten it, use it to cover sive motion range of ankle joint is 28.09° ± 9.26°.
the ankle and facies cruralis posterior of the There are 16 patients whose passive motion
patients. The materials are pressed evenly and range of ankle joint is equal or more than 32.5°.
fixed for 6 min. Until macromolecule glass The average of plantar flexion recovers to
fiber materials are solidified, the therapists 17.59° ± 10.04°. there are four patients who are
take it down, cut the edge and make the verti- at 25° plantar flexion, but they can basically
cal plane projection of shank margin and tibia meet the requirements of standing bed training.
ridge are at the same altitude. The therapists There are two patients whose functions are not
cut two wedge-shape slices from the two sides improved because of ossifying ankle joint, con-
of rotation center of ankle joint and use it as tracture of severe Achilles’s tendon and ankle
an axis with the function of hinge. There is a joint adhesion.
bordure (2 cm height) in outside of foot. The Before and after rectification, the data of fix-
therapists use the inside to encase longitudinal ing angle of plantar flexion of ankle joint and
arch and polish it. The therapists punch a hole passive motion range are analyzed by SPSS12.0
in shank and ankle, use hollow rivet to fix fix- software with T-test. There is significant differ-
Table 9.3 Before and after rectification, the data comparison of fixing angle of plantar flexion of ankle joint and pas-
sive motion range (X ± S)
Angle of ankle joint Case number Before therapy (°) After therapy (°)
Fixing angle of plantar flexion 22 44.91 ± 5.35 17.59 ± 10.04*
Passive motion range of ankle joint 22 3.54 ± 1.63 28.09 ± 9.26*
*p < 0.05
ence before and after rectification (p < 0.05,

(d) Other cautions: orthotics of controlled-
Table 9.3). Ankle orthotics of controlled-release release force can be made from high
has a good effect on foot drop with contracture of temperature thermoplastic plate. The
musculus gastrocnemius and Achilles’s tendon characteristics are that it becomes soft
and fibrous adhesion of ankle joint, but has no when heated at 180 °C. After molded, it is
effect on severe fibrous adhesion or ossification smooth, with good tenacity and strength.
stiffness. It can be repeatedly heated and modified.
High temperature thermoplastic plate is
used for machine shaping and its process
cautions is complicated. Positive plaster model
(a) Indications: it is suitable for the patients should be made first and flat heater is
with foot drop due to various causes, espe- required. Moreover, this material is not
cially accompanied with contracture of with air permeability so that the techni-
Achilles’s tendon and musculus gastroc- cians should punch a hole. It is heavy and
nemius, fibrous adhesion of ankle joint. uncomfortable to dress. In the manufac-
(b) Contraindications: all the following cases ture, the technicians clip high temperature
are not suitable for application of Ankle thermoplastic plate with proper size, put it
orthotics of controlled-release force. into flat heater for 10 min at 180 °C, paste
• Foot drop induced by scar contracture positive plaster model and drain it after the
after burn of shank and ankle part board becomes soft. The plate is com-
• Joints with severe contracture of pletely pasted to positive plaster model.
Achilles’s tendon and musculus gas- After solidification, the technicians take it
trocnemius; immobile joints in passive down. The other procedures are the same
movements as the method that macromolecule glass
• Ankle joint with fibrous rigidity or fiber materials are used to make orthotics.
ossification stiffness
• The patients with ankle ulcer, throm- In addition, this kind of orthotics can also be
bus of lower extremity veins or severe used for orthotics of other joints. According to
varicosity the shape of orthotic joints, the orthotics is
(c) Cautions: in clinical application, local processed and molded to increase compatibility
pressure ulcer should be prevented strictly. and decrease complications.
Because this kind of patients have not
good enough feelings or any feeling of the
limbs. Therefore, it should be watched 9.2.2 A
ntispasmodic Dynamic Joint
carefully in application. In the first 3 days, Position Retainer
the patients should undress orthotics every
2 h to examine if there is red and swollen There is spastic hemiplegia in the hemiplegic
and pressure ulcer in ankle part or not. If patients with stroke. Spastic hemiplegia.
there is no pressure ulcer, the patients can Generally, spastic hemiplegia is transformed
wear it day and night. from flaccid hemiplegia, but in some subacute or
chronic patients, spastic hemiplegia can be • In lateral position in uninjured side, the head
formed without flaccid paralysis. is supported by pillow. The trunk fade away
The characteristics of spastic hemiplegia are slightly and is cushioned with pillow in case
the paralysis of upper limb extensor and lower of downward of injured shoulder. Injured
limb flexor, especially hands and feet. Moreover, shoulder girdle extends forward fully.
the upper limb is more severe than the lower Shoulder flexes 90–130° and injured elbow
limb. There are paralysis of flexor of upper limbs extends. The forearm supinates backward and
and extensor of lower limbs to varying degrees in the hand is in dorsiflexion position without
hemiplegic side, which can lead to obvious grasping something.
weakness or total loss of motor function.
Spasm of flexor of upper limbs makes elbow However, these placements of antispas-
joint in passive flexed position. The wrist and modic position can be used without hard con-
finger are in flexed state, which make upper straints for the patients with coma or no
limb like carrying basket in paralyzed side. voluntary movements through pillow, soft
Spasm of extensor of lower limbs induces cushion or nature placement. If they are used
hyperextension and extorsion of knee joint. for the sober patients who can move their
Meanwhile, there are foot drop and strepheno- limbs, it is hard to keep antispasmodic posi-
podia, which make the foot like talipes equinus. tion. Because spasm of flexor of upper limbs is
When the patients step forward and lift injured severe, without hardness restricted device,
limbs away from ground, the patients with foot only pillow and soft cushion are difficult to
drop must incline the body to the offside and put keep injured elbow in extension and forearm
forth their strength to lift hip so that the lower supination position. For the patients with
limbs can be lifted upward. The patients step spasm of flexor of upper limbs and extensor of
forward in an arc and step down in front of the lower limbs, non-hardness restricted position
body to complete stepping movements, which is placement is difficult to relieve the spasm.
called circle. Result from the joint effects is that However, in paralyzed side, the spasm of
abnormal motor pattern, circle gait, is formed, flexor of upper limbs lead to abnormal motor pat-
which is the most common abnormal motor pattern of carrying basket, which not only easily
tern of hemiplegia. induces adhesion of muscle fiber and other tis-
In order to prevent spasm position in hemi- sues, contracture of tendon because of long-term
plegic side. In clinic, the prevention method is spasm of flexor of upper limbs in injured side, but
to keep antispasmodic position. The posture in also induce uncoordinated swing of upper limbs
antispasmodic position of upper limb is as in walking and more energy consumption.
follows: Therefore, prevention and rectification of spasm
effectively are the key points to prevent compli-
• In supine position, the head is on the pillow cations, joint deformity and recover autonomic
and there is no hyperextension and hyperflex- nerve innervation of spasm muscle. It is a prob-
ion. Injured shoulder is cushioned in case of lem to be solved in clinic.
shoulder retraction and injured upper limb The development of retaining appliance of
extends and slightly abducts. The forearm antispasmodic dynamic joint position is to rectify
supinates backward and the thumb points to spasm of flexor of upper limbs and extensor of
outside. lower limbs effectively in paralyzed side to keep
• In lateral position in uninjured side, the head the joint in functional position, which don’t affect
is supported by pillow in case of turning autonomic flexion and extension of joints obvi-
backward. The trunk is vertical and injured ously. After clinical application, there are good
shoulder girdle extends forward fully. therapeutic effects.
Shoulder flexes 90–130° and elbow and wrist Retaining appliance of antispasmodic dynamic
extend. Upper limbs are on the front pillow. joint position includes retaining appliance of
dynamic elbow joint in straight position and According to the specific condition of spasm
retaining appliance of dynamic knee joint in of flexor of upper limbs, elastic bands with differ-
flexed position. ent width and strength are selected. Elastic band
is strained to make elbow joint in 120–150°
9.2.2.1 Basic Structure straight position and make the patients can flex
of Antispasmodic Retainer elbow actively if the elbow flexion ability is not
of Dynamic Elbow Joint lost. After strength adjustment, elastic band is
in Straight Position fixed through fixing ring of elastic band in upper
Retaining appliance of dynamic elbow joint in and lower end.
straight position is mainly composed of angle
adjustable artificial assistive elbow joint and 9.2.2.2 Basic Structure
branch, elastic traction belt and elbow support of Antispasmodic Retainer
(Fig. 9.15). Bilateral angle adjustable artificial of Dynamic Knee Joint in Flexed
assistive elbow joint and branch can restrict flex- Position
ion of elbow joint in necessity. Fixing plate of Retaining appliance of dynamic knee joint in
upper arm and fixing plate of forearm are con- flexed position is mainly composed of angle
nected to branches, which make the bilateral adjustable artificial assistive elbow joint and
branches connect to upper arm crossing elbow branch, elastic traction belt and knee support.
joint. Fixing plate is made from macromolecule Bilateral angle adjustable artificial assistive
glass fiber material according to the shape of elbow joint and branch can restrict hyperflexion
upper arm and forearm. Elbow support is fixed on of knee joint in necessity. Fixing plate of thigh
the back of elbow through fixing band of elbow and fixing plate of shank are connected to
support. The function of it is to prevent friction of branches, which make the bilateral branches be
the back of elbow joint by elastic traction belt. fixed crossing knee joint. Fixing plate is made
The upper and lower end of elastic traction belt from high temperature thermoplastic plate
are separately fixed on fixing ring of the upside of according to the shape of thigh and shank. The
fixing plate and elastic band in the back of fixing upper and lower ends of elastic traction belt are
plate in forearm. separately fixed on fixing plate of thigh and fix-
Fig. 9.15
Antispasmodic retainer
of dynamic elbow joint
in straight position. (1)
Angle adjustable
artificial assistive elbow
joint and branch. (2)
Elbow support. (3)
Elastic traction belt. (4)
Fixing board of forearm.
(5) Fixing board of
upper arm. (6) Fixing
band of elbow support.
(7) Posterior view. (8)
Fixing ring of upper arm
of elastic band. (9)
Fixing ring of forearm
of elastic band
Fig. 9.16 Dynamic
knee joint position
holding appliance in
straight position
ing ring of elastic band in the back of fixing plate uncomfortableness regularly. Once found, the
in shank. Because the strength of extensor of therapists should adjust or modify it
lower limbs is big so that fixing plate of thigh and immediately.
shank is double plate structure to increase 3. Manufacture according to standard process: in
strength. order to dress is comfortably and prevent
According to specific condition of spasm of complications, the manufacture of retaining
the patients’ extensor of lower limbs, elastic appliance should be specific. Negative plaster
bands with different width and force are selected. model should be made first and then positive
Meanwhile, elastic bands are stretched to keep plaster model is duplicated and modified.
knee joint in 20–30° flexion position until the After that, on the basis of positive plaster
patients can extend knee actively. The techni- model, it is processed and molded according
cians adjust the intensity and use fixing ring of to standard process.
elastic band in upper and lower end to fix elastic 4. To obtain better effects with the help of orthot-
band (Fig. 9.16). ics: If simple application of antispasmodic
dynamic joint position holding appliance can-
9.2.2.3 Clinical Application not rectify deformity of joint position com-
of Antispasmodic Dynamic pletely such as waist, hand, finger and foot,
Joint Position Retainer the patients should wear wrist-hand or foot-
Because abnormal joint position due to muscle ankle orthosis in functional position to obtain
spasm is very common, clinical application of anticipated effect with retaining appliance in
antispasmodic dynamic joint position holding joint position.
appliance is wide. During the process of clinical 5. To cooperate with other methods: For the
application, the therapists should pay attention to patients with severe limbs spasm in paralytic
complications. side, antispasmodic dynamic joint position
holding appliance use elastic band as traction
1. Indications: It is suitable for the patients with force and is hard to keep the joint in the
flexion spasm of upper limbs in hemiplegic necessary position. Therefore, metal or high
side and hyperextension of knee joint. The temperature thermoplastic plate are used to
patients can dress it when they don’t do reha- make restrictive orthotics to keep the joint in
bilitation training, even at night. The force of functional position. Through rehabilitation
elastic traction belt shouldn’t be too strong so training or drug therapy, after alleviation of
that the joint can be kept in 120–150° straight muscle spasm, antispasmodic dynamic joint
position and the patients can flex or extend it position holding appliance is used to keep
actively. the joint in functional position and to move
2. Pay attention to avoid soft tissue injury: The joint, which is good for functional recovery
therapists should inspect if there is bruise or of the joint.
9.3 The Development

of Functional Assistive
Device
Functional assistive device is the device that can

make the patients complete unaccomplished joint
motion before or difficult joint motion and limbs
movements in order to increase original functions
obviously.
9.3.1 E
lastic Band Orthosis of Lower
Limbs
Elastic band orthosis of lower limbs is designed

for the patients who are difficult to lift lower
limbs because of inadequate strength of hip flex-
ion and cannot complete walking movement.
Through retraction force of elastic band that is
fixed on the waist, the patients can easily lift
lower limbs and lower it down to the ground sta-
bly. It is a simple assistive device for completion
of walking.
9.3.1.1 Basic Structure of Elastic Band

Orthosis of Lower Limbs
Fig. 9.17 Schematic diagram of elastic band assistive
Elastic band orthosis of lower limbs is composed walking device of lower limbs
of three main parts such as waistline, elastic band
and knee joint fixing band. Waistline can be hard
wide belt or high temperature thermoplastic plate In the process that the patients use elastic band
molding waistline to increase area of thrust sur- to walk with the help of orthosis of lower limbs,
face and decrease local skin pressure. Knee joint hip flexor can be strengthened and the myody-
fixing band made of soft cotton tape (5 cm wide) namia is enhanced until the patients can flex hip
is groined. Patella is fixed on the back of knee joint autonomously and easily.
joint. According to actual ability of hip flexion of
the patients, the force can be calculated and elas- 9.3.1.2 Indications
tic band with proper elastic force can be selected. and Contraindications
The upper end is connected to midline of lower 1. Indications: it is suitable for the patients with
limbs of waist. The lower end is fixed on the incomplete paraplegia, hemiplegia and myas-
upper end of the front of knee joint fixing band. thenia, myodynamia of hip flexor (grade II–
In the trial walking, the retraction force of elastic III), autokinetic movement of lower limbs
band should be adjusted to make the patients lift with hip flexion difficulty.
lower limbs easily and touch the ground easily in 2. Contraindications: the patients with soft tissue
straight position when the lower limbs are falling injury of waist and pelvis or unhealed bone
down. Elastic band is fixed (Fig. 9.17). After fracture in pelvis, soft tissue injury of knee
walking training for a period, the patients can joint or unhealed bone fracture, deep venous
gradually adapt to walking with the help of elas- thrombosis of lower limbs and limb swelling,
tic band orthosis of lower limbs. severe varicosis of great saphenous vein
9.3 The Development of Functional Assistive Device 291
9.3.2 Assistive Walking Device tive walking. KAFO is used for supporting dou-
of Complete High Paraplegia ble legs and provide essential guarantee for
supporting standing balance. Operating principle
In tradition, high paraplegia is the transverse of clock pendulum is used to realize passive for-
injury in the high level of spinal cord. Generally, ward and backward movement of paralytic limbs
paraplegia due to transverse injury of spinal cord with the help of interactive hinge device that is
above the second thoracic vertebra is called high installed in bilateral thigh when the weight of the
paraplegia. Paraplegia due to transverse injury of patients is shifted. When the trunk of the patients
spinal cord below the third thoracic vertebra is inclines the center of gravity to the left, WO
called paraplegia of the lower part of the body drives the right lower limb to get off the ground
(low paraplegia). and the center of weight move forward. Under
There is usually quadriplegia in high paraple- the action of gravity, with the help of interactive
gia. The sensory, motor, sphincter vesicae and hinge device, suspended right lower limb can
sphincter and functions are totally lost in the spi- move forward with the center of weight. After
nal cord injury under transverse plane without that, under the action of inertia, the patients
reflex, which is called complete paraplegia. After swing leg forward and complete stepping with
cervical spinal cord is damaged, there is neuro- right leg. When in standing and walking, the
logical dysfunction in double upper limbs, which patients need the help of double crutches.
is called quadriplegia. The hardcore of RGO includes two highwires
Paraplegia is one of the most severe dysfunc- that connect to hip joint and a pair of hip joints.
tion in motor function. There are complete or par- In addition, it still has associated the upper part of
tial autonomous motor function loss and standing the trunk and the lower part of thigh. The upper
and walking ability loss to varying degrees in the and lower lattice framing of hip joint can be sepa-
patients whose standing and walking ability can rately combine the trunk with thigh. The trunk
be recovered through assistive walking device. part is composed of lateral lattice framing, the
From the power producer, the orthosis that belt that fix the trunk and pelvis hipline. There is
help the patients with paraplegia to walk can be no inside lattice framing in the lower part of
divided into unpowered orthosis and powered thigh. Ankle-foot orthosis (AFO) made from
orthosis. Unpowered orthosis is without external polypropylene plastics wraps knee joint and mal-
human power producer and with the own stamina leolus medialis to increase stability.
such as hip-knee-ankle-foot orthosis (HKAFO), Action principle: Through guide lock, hip
knee-ankle-foot orthosis (KAFO), walkabout joints of orthosis are connected. When hip joint in
orthosis (WO), reciprocating gait orthosis (RGO), one side is over extended, through the movement
advanced reciprocating gait orthosis (ARGO), of guide lock, hip joint in the other side can be
isocentric reciprocating gait orthosis (IRGO) and flexed opposite to hip extension in order to move
so on. HKAFO and KAFO are used to restrict two legs forward alternatively so that the patients
range of joint motion. Meanwhile, crutch is used with paraplegia can do functional walking.
to support the body weight and keep the balance ARGO is mainly suitable for the patients with
of the body when the center of gravity is shifted, paraplegia due to injury of T5–L2. It is possible to
which is widely used for rehabilitation training of realize practical walking. Structural features of
the patients with paraplegia. The patients can walking assistive device not only include
obtain standing ability but cannot step [16] for- mobility-assisted function in walking, but also
ward alternatively with two lower limbs. can directly stand up or sit down without using
WO, RGO, ARGO and IRGO are the best no- hands to manipulate hinge lock if knee joint in
power orthosis. In design, WO is divided into two the switch between sitting position and standing
parts. Interactive hinge device is the key part of position. Because of spring in knee joint, the
the equipment. Through using gravitational patients can get support in position interchange.
potential energy, it can provide power for alterna- It can save labor and easy to be manipulated and
dress. Compared with traditional orthosis, it can These kinds of orthotics are only suitable for
better improve the standing and walking function the patients with walking rehabilitation training.
of the patients and decrease the energy consump- They can make the patients move passively, but
tion of the users, but it is expensive. this is not the walking in real sense, even not
IRGO is a modified type of RGO. Its struc- active walking. They are expensive and the fam-
tural characteristic is to use connecting rod equip- ily cannot afford it. In addition, there is still func-
ment that connects to bilateral hip joint to replace tional electrical stimulation (FES) orthotics.
wire of RGO for better assistive movement func- Through electric stimulation, the patients with
tion. This kind of connecting rod equipment is paraplegia who lose motor function of lower
more durable than wire of RGO. Its action prin- limbs can walk with orthotics. In the paraplegia
ciple is to flex hip joint in one side and extend hip due to spinal cord injury of cervical cord or upper
joint on the other side through moving bilateral thoracic cord, because it is difficult to obtain sta-
hip joint alternatively. ble gait with unstable trunk, it is not suitable for
KAFO, HKAFO, WO, RGO, ARGO or IRGO FES orthotics. Only in the spinal cord injury
are applied for the patients with paraplegia (T4– below lower waist, when the muscles that control
L2). Its clinical indications and functions are dif- standing and walking can response to electric
ferent. KAFO is suitable for the patients with stimulation, it is suitable for FES orthotics.
complete spinal cord injury (below L1). WO is Although various walking assistive devices
applied for the patients with complete spinal cord cannot be used for the patients with paraplegia to
injury (below T10). Swing equipment inner thigh is walk in reality, the walking without true sense of
closely connected with KAFO of two legs and the the patients with paraplegia is significant, espe-
coronal plane of lower limbs is increased rela- cially in the prevention of complications [17].
tively. RGO, ARGO and IRGO can connect upper
and lower lattice framing of the trunk with thigh 9.3.2.1 Preventing or Decreasing
orthotics through hip joint. Compared with WO, Complications Effectively
no matter in coronal plane or vertical plane, they 1. Decreasing pressure sores: Because sensory
provide more ideal stability for the walking of the and motor function under paraplegia plane are
patients with paraplegia. For the patients with high totally lost, the position of the patients with
paraplegia and paraplegia (below T4), there are complete high paraplegia cannot be moved at
some reports that RGO is used for therapeutic will. The skin and subcutaneous tissue of
walking successfully. However, in most cases, it is apophysis are oppressed and are turned into
difficult to use existing walking assistive device to necrosis, which can form pressure sores.
realize functional walking. When walking, because Because the nerve that dominates skin is
it is impossible to do hip and knee flexion, the injured, it leads to decrease of local neurot-
patients cannot lift lower limbs and can only move rophy function. Once there is pressure scores,
forward in the slippery ground difficultly. it is difficult to be cured. The standing and
Therefore, at present, walking assistive device that walking with assistive device can obviously
is applied in the patients with high paraplegia can- decrease bedtime and prevent pressure scores.
not realize actual walking of the patients. 2. Promoting digestive system function: After

Power orthotics is the orthotics driven by spinal cord injury, there are dysneuria of the
human external power. At home and abroad suc- body, imbalance of autonomic nervous func-
cessfully developed motor direct-drive unidirec- tion and digestive tract disorder. There are
tion double joint walking device, electric drive abdominal distension and hypoactive or elimi-
bidirection paraplegia walking equipment, and nated bowel sounds in the patients with com-
direct current power producer actuator are plete paraplegia, which make diaphragm rise
embedded in hip and knee joint of ARGO, which and affect breath. In the standing and walking
can produce external power producer gait orthot- with assistive device, enterocoelia content is
ics of hip and knee joint. decreased and diaphragm declines, which
increase thorax volume and are good for 9.3.2.3 The Significance of Preventing
recovery of respiration function. Exercise can Complications
promote gastrointestinal peristalsis and evacu- Through standing and walking training of walk-
ation of intestinal content, which can elimi- ing assistive device, the complications of the
nate abdominal distension and promote patients with high paraplegia can be prevented.
recovery of digestion-absorption function. The body and organ can be maintained in a good
3. Preventing respiratory tract infections: there state and it is significant.
are intercostal muscle paralysis, small vital
capacity and respiratory secretions in the 1. Creating conditions for realizing independent
patients with high paraplegia, which lead to life and improving life quality: Standing and
pulmonary infection. Standing and walking walking training with walking assistive device
are good for increasing vital capacity, which can effectively prevent complications. The
can promote elimination of secreta and then patients’ body is in good state, which can cre-
prevent pulmonary infection. ate basic condition for shifting training.
4. Preventing joint adhesion, amyotrophy and
Through the training, development and utili-
osteoporosis: The standing and walking can zation of residual functions of the patients, in
give pressure on paralyzed or spasmodic the condition of with or without assistive
limbs and move the joints, which can prevent device, the patients recover transfer capability
effectively disuse amyotrophy, osteoporosis, from bed to wheelchair and from wheelchair
joint and soft tissue adhesion, even joint to potty chair and daily life ability by them-
deformity. selves to increase the patients’ life quality.
2. Waiting for better therapeutic method and cre-
9.3.2.2 Promoting Motor Function ating conditions for recovering lost functions:
Recovery and Improving At present, the development of science technol-
General Conditions ogy is fast and changed quickly, especially in
1. Promotion of possible motor function recov- the repair of neural functions, which includes
ery: There is little possibility that motor func- medicine, neural transplantation and neural
tion of spinal cord injury is recovered stem cells transplantation. Although some tech-
completely. However, incomplete spinal cord nologies such as neural stem cell transplanta-
can be further recovered through rehabilitation are not immature, there are new theories
tion training. The standing and walking train- and therapeutic methods for clinical applica-
ing with walking assistive device is one of the tion. Only with good bone and muscle system,
best methods to promote motor function fur- the patients can receive the therapy of new
ther or make maximum use of residual method and is possible to be recovered.
function. 3. Changing thinking and creating condition for
2. Increase of metabolism after spinal cord
returning to the society: With the development
injury, neurotrophy function is decrease and and progress of technology, the disabled can
cardiovascular stress response ability is earn their own living and contribute to the
decreased, which can affect the metabolism of society through different ways. A famous
entire blood circulation, tissue and organ British physicist Stephen Hawking who is
greatly such as postural hypotension, even severely disabled and no one can compare with
shock due to improper standing. The standing him, contribute a lot to the development of
and walking training with walking assistive physics. The people should take this as a warn-
device can enhance cardiovascular stress ing and change thinking. They should re-
response ability, promote blood circulation recognize that the disabled is not disabled.
and metabolism, which are good for compli- They should use Stephen Hawking as an exam-
cations prevention and functional recovery. ple and apply modern technique apparatus and
procedure to go back to the work and society Walking assistive device of rollerskate can
in different extent and depth. No matter how help the patients with high paraplegia to slide
severe the paraplegia is, with normal brain forward independently with the help of walk-
function and intelligence, the disabled can ing assistive device and assistive standing
contribute to themselves, the family, the soci- device such as double crutches and rectification
ety and human. weight support walking training device of
abnormal gait.
Therefore, research and development help the
patients to walk independently with the help of 1. Basic composition: The device is composed
walking assistive device. of foot orthosis, spring column, pulley and
fixing band. Foot orthosis is cut out from steel
9.3.2.4 Walking Assistive Device plate (2 mm) according to pelma shape, which
of Rollerskate is divided into half sole part, heel part and
As mentioned above, at present, walking assis- middle part. The above of foot orthosis is
tive device used by the patients with paraplegia, pasted with a layer of stereoplasm sponge and
no matter walking assistive device of hip knee the below of foot orthosis is pasted with
ankle (HKAFO), reciprocating walking assistive rubber non-slip mat. Four spring columns are
device (RGO), or central reciprocating walking composed of axle sleeve and axostyle. Four
assistive device (IRGO), with the help of other columns are made of steel and are separately
assistive device such as balance bar and double fixed on four corners of foot orthosis. The
crutches, through shifting of weight and swing upper end of axostyle is equipped with spring.
training, the trunk shakes to make lower limbs It is enveloped into sleeve with axostyle. The
move forward. Because of hip and knee flexion, lower end of axostyle is equipped with pulley.
lower limbs cannot be lifted so that it only can Fixing band is made of backpack strip and is
move in slippery ground difficultly, especially in connected through snap joint. Its tightness can
the patients with complete high paraplegia. It is be adjustable (Fig. 9.18).
difficult to move forward through shifting of 2. Design principle and method of application:
weight and swing forward. It cannot be com- After wearing the walking assistive device and
pleted alone and the patients can swing forward bilateral pulley, the patients can stand up with
slowly with the help of others. the help of assistive device such as double
Fig. 9.18 Sketch map

of walking assistive
rollerskate
Shoes ladder
anti-slip pad
Wheel can move

up and down
Nylon buckle
Spring Column installation
Pressure sprin
Pulley shoes
crutches, rectification weight support walking 3. Indications and Contraindications

device of abnormal gait. At this time, foot (a) Indications: It is suitable for the patients
orthosis of two feet is stressed. Because the with complete or incomplete high
spring is compressed when the force is no less paraplegia to stand and step forward and
than 20 kg, the foot orthosis touches the the patients with low paraplegia to walk
ground and the pulley in the rollerskate cannot in the early phase with assistive device.
move forward. When the patients try to step (b) Contraindications: the patients should pre-
forward, the body weight center moves to pare the safeguard procedures of falling
offside. When the patients prepare to move the damages, especially for the patients with
limbs forward (the weight is less than 20 kg), high paraplegia and upper limbs paralysis.
the spring can bounce the foot away from the Mobile weight support walking device can
ground. Through swing force of the trunk, the lose weight and protect the body,
pulley move forward and the body move especially for the patients with high
forward with it. When lower limb in one side paraplegia in standing and walking
slides forward, the body weight center moves training.
to this side. When the weight is no less than
20 kg, the spring is oppressed and retracts. The 9.3.2.5 Walking Assistive Device
foot orthosis touches the ground and the lower of Shoulder Power
limb in this side bears load. Foot orthosis in No matter walking assistive device is advanced
the other side is bounced by the spring and or so expensive, they swing forward through
slides forward. The body moves forward with waggling the trunk but not step forward in a
it. The training is repeated and the patients can real sense. Walking assistive device of shoulder
slide ahead (Fig. 9.19 and 9.20). power developed by the author is active
walking device of high paraplegia that is
formed by that using self-shrug power as power
producer and locking joint to make the lower
limbs bear load in standing position, the
trapezoid self-locking hip and knee joint can
allow joint motion and lift legs in stepping.
With the help of this device, the patients with
high paraplegia are able to lift lower limbs and
step forward by themselves. So far, there is no
report using shrug force as the power producer
to make the patients with paraplegia walk
independently.
1. Feasibility study that human shrug force can

lift lower limbs: The main muscles of shrug
are trapezius and musculus levator scapulae.
Trapezius is dominated by accessory nerve
that belongs to the 11th brain nerve. Even in
high level spinal injury, generally, it cannot
hurt this nerve. Therefore, the patients with
high paraplegia are able to shrug and can
obviously increase myodynamia of this
muscle through training.
Fig. 9.19 The patients with high paraplegia can move The actual test demonstrated that the nor-
forward with the help of two people mal people’s shrug force is twice of lower
Fig. 9.20 The patients

can slide forward with
walking assistance
pulley independently
Table 9.4 Experimental results of comparison of shrug training, shrug force can be increased
force and lower limbs weight
obviously, which is good for completing
Shrug force Lower limbs Force weight movement of stepping forward.
Gender (kg) weight (kg) ratio
The experimental result demonstrated that
Male 33.45 14.41 2.32
Female 23.97 14.82 1.62
shrug force of the normal people is twice of
Mean 28.71 14.62 1.97 lower limbs force. It can life lower limbs.
value Shrug force can be obviously increased
through training. The realistic example is
bearer in the mountain. The normal people
limbs weight when shrugging (Table 9.4) and can bear 25 kg water and walk, but bearer
is able to lift lower limbs. With the help of through training can bear 50 kg goods or even
mechanical saving labor equipment, through more heavier and climb the mountain.
shrug, the patients can life lower limbs easily Therefore, the person uses shrug force to lift
and complete stepping movement. Through lower limb. It is possible in theory.
2. Basic composition of walking assistive device valves of brake cable. Its role is to prevent
of shoulder power: The equipment is com- stretching tight of pull wire when
posed of waistcoat of shoulder power, power shrugging so that it is not appropriate to
conduction system and self-locking system of wear inside the clothes. Movable block is
assistive device joint. fixed in plastic drivepipe in the chest part
(a) Waistcoat of shoulder power is composed of pull wire. Its role is to save the force of
of shoulder pocket, support rod, dead lifting body limbs. The upper end of pull
plate and corsage. Shoulder pocket is wire is connected to bayonet of pull wire
made from cattlehide or canvas. The outer in oxter of shoulder. The wire penetrates
is enveloped in L shape extremitas acro- into plastic drivepipe and invert upward
mialis of support rod, which can reach the bypassing movable block. Out of plastic
middle of clavicle. The anterior part of drivepipe, it is connected with the bayonet
shoulder pocket is long and is with slid- on the side wall of corsage. There is ring
able power line connection equipment, loop in movable block and there is bayonet
which can be connected to back part in ring loop. Bayonet is connected to pull
through bayonet. The length in oxter can wire in the below. The below pull wire is
be adjustable to the patients with different fixed on lock cylinder of self-locking
shoulder breadth. The extremitas acromi- system of hip and knee joint of assistive
alis of support is L shape, which is con- device and lifting leg point of strength
nected with the external of shoulder above knee joint of walking assistive
pocket. Spinal terminal of support is device when out of plastic drivepipe.
sphere, which can be adjustable to hemi- (c) Self-locking system of assistive device
spheric glenoid fossa of dead plate. It can joint: An important part of a walking
make support rod like shoulder joint that assistive device of shoulder power
can move to all directions. The role of includes a upside-down trapezoid metal
support is to prevent that sternoclavicular lock sleeve and a metal lock cylinder
joint cannot move upward because acro- compatible with trapezoid metal lock
mion move upward when shrugging. It sleeve. The above mouth of trapezoid
will make an incline that is higher in out- metal lock sleeve is open, which can
side and lower in inside. Because shoul- contain metal lock cylinder. The below
der pocket slides inside, it can affect the mouth is sealed with a small pore. The
strength of shrug. Hemispheric glenoid upper end of lock cylinder is connected
fossa of dead plate can accommodate with pull wire of shoulder power. Spring
spherical head of support rod. When is fixed on the bottom of lock cylinder,
shrugging, it drives support rod and which can penetrate the small pore of
moves with it with sliding inside. Dead trapezoid metal lock sleeve and is fixed on
plate is fixed on thoracodorsal part the lattice framing of walking assistive
through double team way using corsage. device. Its effect is to use the retraction of
Corsage is made from double canvas. The spring to pull down lock cylinder to
inside is coated with thin layer sponge complete self-locking. This self-locking
and is fixed with nylon thread gluing. system are separately fixed on the hip
(b) Power conduction system is composed of joint and knee joint of walking assistive
pull wire, movable block and standing device. The above mouth of trapezoid
valve. Pull wire is brake cable of bicycle. metal lock sleeve is parallel to the axis of
Pull wire is coated with plastic drivepipe knee joint and artificial hip of walking
in case the slide of pull wire abrase clothes assistive device. Two centimeter above
and skin. In the two side of high lattice framing knee joint of walking
temperature plastic plate of waist and assistive device of leg, the bracket that
corsage in the chest, there are standing protrude 5 cm upright forward is installed.
The end of bracket is connected with the

terminal of pull wire of shoulder power.
Its effect is to increase the arm of force of
point of strength to make the patients be
easy to lift lower limbs and step forward
through shrug. Drop ring lock of hip and
knee joint in walking assistive device is
eliminated to make hip and knee joint in a
free movement state.
After dressing walking assistive device of

shoulder power, in standing position, because of
trapezoid lock cylinder of self-locking joint, the
weight of limbs falling to the ground and traction
of spring below lock cylinder can make lock
cylinder slide downward in lock sleeve until it
fills in the whole lock sleeve in an entirely dead
lock condition to support hip and knee joint in an
upright position so that the patients can stand
still. When walking, the patients shrug actively.
The upward force of shrug can lift lock cylinder
upward of self-locking system in hip and knee
joint through power conduction system. The
higher the lock cylinder is lifted, the bigger the
space between lock cylinder and lock sleeve is.
The motion range of hip and knee joint is
increased accordingly. The patients flex hip and
knee joint and lift lower limbs. Meanwhile, the
patients antevert the body to form stepping
forward position. When the patients stop shrug
and the lower limbs touch the ground, lock
cylinder is on the double inclined plane in
trapezoid lock sleeve. The body weight and
traction of spring below lock cylinder can pull it
down. The longer the lock cylinder descends, the
smaller the space between lock cylinder and lock
sleeve is. The motion range of hip and knee joint
is decreased accordingly. Finally, it is in a dead
lock condition. Hip and knee joint is locked
extending state. With the help of steel walking Fig. 9.21 Sketch map of standing position of walking
assistive device of shoulder power
assistive device lattice framing, the body weight
can be supported to stand still.
The results of comprehensive effect make 3. Clinical indications, contraindications and

the patients walk independently. The patients cautions of walking assistive device of
repeat the above process in offside limbs and shoulder power
alternate the two sides until the process of (a) The patients with high paraplegia should
stepping and walking is completed (Figs. 9.21, meet the following requirements to use
9.22 and 9.23). walking assistive device of shoulder power:
Cautions: Before using this device,

the patients should do the training step
by step such as standing bed training
and development of lower limbs
potential and notice the protection in
case of falling damage. If necessary,
the patients can use axillary crutches,
walking stick or personal mobile
weight support walking device to help
walking for assurance.
Fig. 9.22 Using shoulder power to lift lower limbs and

walking with the help of assistive device
• Shrug force is basic normal.

• The patients are able to shift their
weight.
• The patients with paraplegia can use it
without hip flexion.
( b) Contraindications:
• The patients with poor cardiovascular
stress response or postural hypotension
in standing position;
• The patients with unhealed bone frac-
ture or unstable internal fixation;
• The patients with unhealed rib fracture
or unhealed soft tissue injury of chest Fig. 9.23 Real products of walking assistive device of
or pelvis shoulder power
References 9. Tong W, Yong Z, Tao L, et al. Analysis of the effect

of ankle foot orthosis on the function of lower
extremity of foot droop. Chin Rehabil Theor Pract.
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ing activity and the influence of the quality of life.
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Chin J Phys Med Rehabil. 2007;29(1):41–4.
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3. Changshui W, Huaimin G, Jun X. Effects of lower
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13. Nan Y, Bingshui W, Ling L, et al. The production and
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Rehabilitation Therapy
of Neurological Training 10
of Hemiplegia
Hemiplegia is also known as paralysis of working ability. Only 24% of limbs movement
half of one’s body, which means motor func- functions are recovered to basic normal level.
tion loss to varying degrees in one side of Clinical observation found that if in 1 month
the body includes the trunk, upper limbs and after the disease the patients’ finger can com-
lower limbs. It is induced by lesion to varying plete coordinated flexion and extension move-
degrees of brain tissue in offside of the hemi- ments in full range of joint motion, most of the
plegic side. Ninety percent is cerebrovascular functions can be recovered to practical hands.
accident hemiplegia. It is the common sequelae If in the early phase after cure the patients in
of stroke, which includes cerebral thrombosis, supine position can keep lower limbs at hip
cerebral infarction, cerebral hemorrhage and flexion position (more than 45°) and knee flex-
subarachnoid hemorrhage accompanied with ion (90°). There is no plantar flexion of foot
central nervous system injury diseases such as and the injured leg doesn’t incline to one side.
cerebral trauma and brain tumor. The morbid- About 90% of the patients can recover walk-
ity in China is about 0.55%. There are more ing ability. In the early phase after cure, there
patients in the North than in the South. There is no autonomic movement of the injured leg. If
are more male patients than female patients and the physiological reflex exists such as patellar
there are elder patients than adolescent patients tendon reflex and Achilles tendon reflex with-
[1]. Hypertension, heart disease, diabetes mel- out obvious pathological reflex, through proper
litus, hyperlipemia and smoke are risk factors training, most patients can recover autonomic
of stroke. movements, even walking ability.
The prognosis of the patients with stroke is Epidemiological investigation data demon-
related to illness degree, concomitant disease, strated that in the patients who survive after
therapy time, age, physical condition before the stroke, about 70–80% are disabled to vary-
disease, the patients’ rehabilitation desire and ing degrees. The patients who cannot take
the effect of rehabilitation method. It is reported care of themselves account for 42.5%, which
that in the 6 months after disease, about one to bring about heavy burden on the family and
third of the patients recovered hand functions and the society. Therefore, correct rehabilitation
70–90% of the patients recovered walking abil- therapy in early phase [2], especially rehabili-
ity, but accompanied with abnormal motor pat- tation method with good therapeutic effects to
tern. About 50% of the patients recovered daily promote CNS plasticity and functional reor-
life self-help ability and 30% recovered partial ganization, is of great significance to motor
https://doi.org/10.1007/978-981-13-0812-3_10
302 10 Rehabilitation Therapy of Neurological Training of Hemiplegia
function recovery of the patients, increase of 10.1 Dysfunction Type

daily life self-care ability and return to the and Rehabilitation Stage
society maximally. of Hemiplegia
At present, at home and abroad general
applied facilitated rehabilitation technique is 10.1.1 Dysfunction Type
used to recover motor function of the patients of Hemiplegia
with stroke, which begins in several days after
the disease. In 1–3 months, it can be recovered at According to the injured part, range and degree
the greatest extent. Individual patient’s recovery of the patients, the types of dysfunction are dif-
can last more than 1 year, but seldom more than ferent include the symptoms of pyramidal system
2 years. In the patients characterized by apraxia, injury, extrapyramidal system injury and cranial
even if the disease time is long, the functions can nerve injury.
be further improved through training.
It is generally acknowledged that at present 10.1.1.1 Motor Dysfunction
facilitated rehabilitation technique is applied The manifestations of motor dysfunction are
in 6 months after the disease, which is the best muscle paralysis and increase of reflex tension.
opportunity of rehabilitation. Six months later,
because there are complications such as amyot- 1. Pyramidal system signs: paralysis and atony
rophy, joint adhesion and tendon contracture, it of limbs to varying degrees.
is difficult to obtain obvious functional recov- 2. Extrapyramidal system signs: various kinds of
ery although rehabilitation training has some involuntary movements, increase of reflex
help. Therefore, most scholars regarded the 6 muscle tension, coordinated movement ability
months after the disease as the time point of and balance function disorder.
final prognosis.
However, functional recovery in the early phase 10.1.1.2 Cranial Nerve Dysfunction
(during the 6 months after the disease) is not com- The manifestations are hemianopsia, facioplegia
pletely the effect of rehabilitation training. Partial and bulbar paralysis.
functional recovery is achieved through medicine
or surgery to eliminate hematoma, decrease intra- 1. Hemianopsia and quadrantanopia: it is

cranial pressure, dredge blood vessels, decrease induced by injuries of optic radiation and
serum fat, control hypertension and diabetes occipital cortex. When there is bilateral occip-
mellitus. The functions of undead brain cells in ital lobe lesion, there is cortical blindness,
injured area are recovered. Therefore, rehabilita- which means vision loss of two eyes induced
tion training to recover motor function after CNS by bilateral lateral geniculate body, posterior
damages is the training to recover residual func- limb of internal capsule, optic radiation or
tions and make full use of it. visual cortex of occipital lobe with light
Clinical practices proved that rehabilitation reaction.
technique of neurological training whose basic 2. Facial nerve dysfunction: The manifestations
theory and training method are neural potential are disappearance of frontal line, distortion of
development, motor program reestablishment commissure and shallow of nasolabial groove
and motor pattern remodeling is not restricted due to motor dysfunction of mimetic muscle.
by disease time of the patients with stroke. The manifestation of supranuclear facial
In the patients have been sick for more than paralysis is dyskinesia of mimetic below pal-
2 year, this method can help to obtain better pebral fissure, which can influence pronuncia-
functional recovery. Therefore, in clinic, we tion and diet.
cannot lose confidence of rehabilitation train- 3. Bulbar paralysis includes true bulbar paralysis
ing and functional recovery because of long and pseudobulbar paralysis. Pseudobulbar
disease time. paralysis is common. The manifestations of it
10.1 Dysfunction Type and Rehabilitation Stage of Hemiplegia 303
are disorders of swallowing function, articula- the patients are with dysfunction mentioned
tion and emotion. above, there are self-care ability losses to vary-
ing degrees. Long-term lying in bed can induce
10.1.1.3 Sensory Disturbance apraxia syndrome such as pressure sore, pulmo-
It includes deep sensation disorder (proprio- nary infection, tendon contracture, amyotrophy,
ception) and superficial sensation disorder. The osteoporosis, postural hypotension, heterotopic
manifestations of it are decrudescence or loss of ossification, decrease of cardio-pulmonary func-
deep and superficial sensation accompanied with tion and melancholy.
hyperesthesia or paresthesia, even severe pain. In this chapter, we mainly introduce reha-
bilitation method to recover motor function of
10.1.1.4 Speech Disorder the patients with hemiplegia through neurologi-
It includes dysarthria and aphasia. Dysarthria cal training and rehabilitation therapy of other
is induced by motor muscle paralysis or coor- sequelae after CNS injury.
dinated movement disorder of articulators. The
main manifestations are unclear pronunciation
and low volume. Aphasia is due to speech area 10.1.2 Rehabilitation Stage
injury of cerebral hemisphere (dominant hemi- of Hemiplegia
sphere). The manifestations are loss or disorder
of listening, speaking reading and writing ability. What is acute phase and recovery phase of stroke
and what is early rehabilitation and convales-
10.1.1.5 Agnosia and Parectropia cence rehabilitation? The definition is unclear,
Both are the common dysfunctions in stroke, plentiful and without single standard. For exam-
especially in acute phase. Diseased region is in ple, someone deemed that the acute phase is 3
cerebral cortex. Agnosia is the cognition and days after stroke. Some reports demonstrated
identification disorder of sensory stimulus with that two weeks after stroke is acute phase. It is
the integrated sensory input system. For exam- generally acknowledged the rehabilitation in 3
ple, without visual field deficiency, the patients months after brain injury is early rehabilitation
cannot see objects in left half visual field. With and convalescence rehabilitation is the rehabilita-
normal vision, the patients cannot distinguish the tion after 3 months after stroke.
name and use of what they see and only can tell Hemiplegia has its unique recovery mode.
the shape, but they can tell the name and use once According to the specific pathological process
they touch it. and motor function evaluation after hemiplegia,
Agnosia includes visual agnosia, tactile agno- some reports think that Brunnstrom, the physi-
sia, auditory agnosia, body neglecting, body cal therapist in Sweden, suggested in six-phase
dysmorphic disorder and anosognosia. Apraxia recovery process of hemiplegia (Table 10.1),
is that the patients without motor and sensory phase I is acute phase (during 14 days after
disorder cannot complete conscious movement, stroke) and phases II–IV are the middle and later
but can do some unconscious movements. For phases (after 14 days after stroke).
example, the patients cannot execute oral instruc- The patients who are diagnosed and receive
tions of movements and cannot imitate other’s therapy in rehabilitation department of special-
movements such as dressing. The common types ized rehabilitation hospital are transferred from
include motor apraxia, ideational apraxia, ide- related clinics such as neurology department,
ational motor apraxia, structural apraxia, dress- surgery department and department of ortho-
ing apraxia, walking apraxia and verbal apraxia. paedics department in the same hospital or other
hospital. Their vital signs are stable after therapy
10.1.1.6 Other Disorders in acute phase. The patients who are transferred
Other disorders include mental retardation, men- from related clinics in the author’s hospital have
tal disorder and sphincter disturbance. When access to clinical departments for early rehabili-
Table 10.1 Six-phase evaluation method of Brunnstrom

Phase Characteristic Upper limbs Hand Lower limbs
I No voluntary No movement No movement No movement
movement
II Can induce Only synergic movement Impalpable flexion Only seldom voluntary
united movement movement
movements
III Random Synergic movement at will Can be hooked grip, In sitting and standing
associated but can not catch position, there is synergic
movement food flexion of hip, knee and
ankle
IV Common motor There are movements separated The patients can In sitting position, knee
pattern is form synergic movements. In the hold thumb between can flex more than 90° and
disrupted and condition that shoulder is at 0° the fingers and loose foot can slide backward.
there is and elbow flexes 90°, there is it with half optional Ankle can dorciflex when
separation pronation and supination of extension in a small the foot root touches the
movement forearm. Shoulder can flex range ground
forward at 90° with straight
elbow. The arm can touch
lumbosacral portion
V Muscle tension is There are movements separated Globular and The injured leg can flex
recovered form synergic movements. The cylinder grabing and knee at first and then
gradually and shoulder can abduct 90° with grasping. The five extend hip when the
there is straight elbow. In the condition fingers can extend at uninjured leg is in standing
separation fine that elbow is at straight position the same time, but position. The ankle can
movement and shoulder flexes 30–90°, there cannot extent dorsiflex when the knee is
is pronation and supination of separately in extension position
forearm. In the condition that
elbow is at straight position and
forearm is at neutral position, the
upper limbs can be lifted overhead
VI Approximate Motor coordination approximate The patients can In standing position, hip
normal level normal level. There is no obvious complete all the can abduct to the range that
dysmetria when using finger to grabing and holding the pelvis is elevated. In
point nose, but the speed is but the speed and sitting position, the patients
slower than the uninjured side accuracy are worse can extort and intort lower
(less than 5 s) than the uninjured limbs with talipes varus
side and valgus when knee is in
straight position
tation training in bedside. Others all enter into Ultimate goal of rehabilitation of neurologi-
convalescence rehabilitation. cal training is recovering normal motor pattern.
Therefore, in department of rehabilitation According to the patients have already got out of
medicine, according to the classification of bed or not, the classification may be of practical
acute phase and convalescence phase, targeted clinical value and guiding significance. Because,
rehabilitation training has significance, but under general circumstance, the patients who
there is no actual meaning because there are no don’t get out of bed are patients in acute phase
patients in acute phase received by rehabilita- except some in severe conditions or coma. There
tion department. If the early phase and conva- is no abnormal motor pattern in these patients
lescence phase are classified according to the because of not getting out of bed. For the patients
time point (3 months) in traditional significance, who already get out of bed and do exercise, most
there is still no obvious actual meaning because of them are the patients with stable condition
3 months after stroke is not the early phase of after acute phase. However, there is abnormal
rehabilitation. motor pattern to varying degrees in these patients
10.2 Rehabilitation Therapy of Hemiplegia 305
because the functions of paralytic muscles are phase of lying in bed and earlier phase before
compensated by other muscles due to too early off-bed.
or incorrect off-bed activity except case-by-case.
Therefore, the time of off-bed activity is the 1. Rehabilitation therapy in the early phase of
limit used for rehabilitation phase. It not only can lying in bed takes bedside rehabilitation train-
reflex the length of disease time and the sever- ing as the principal thing, which is suitable for
ity of the disease after stroke, but also can reflex all the patients lying in bed.
there is abnormal motor pattern in the patients or Bedside rehabilitation training can be done
not, which has practical guiding significance to without affecting the rescue treatment of the
the design of rehabilitation therapy schedule and patients. In fact, rehabilitation training can be
adopted basic rehabilitation method. According to done as soon as possible, which not only don’t
the time of off-bed activity, rehabilitation of neu- affect rescue treatment in acute phase, but also
rological training can be divided into “rehabilita- can prevent complications and increase inter-
tion lying in bed” and “rehabilitation off bed”. nal and surgical therapeutic effect [3]. It is a
pity that at present most of clinical doctors
doesn’t recognize it so well, which lead to
10.2 Rehabilitation Therapy complications and antibiotics abuse. For
of Hemiplegia example, after urinary system infection due to
long-term indwelling catheter, large dose anti-
10.2.1 Rehabilitation Therapy in Bed biotic is usually used to control infection.
Long-term bed without joint motion and mus-
10.2.1.1 Definition cle massage, especially in the coma patients,
Rehabilitation lying in bed in rehabilitation of usually lead to foot drop and joint deformity
neurological training means rehabilitation train- and tissue adhesion in knee flexion position,
ing methods used for the patients who cannot yet which brings about big problem to sequential
get out of bed after stroke or cannot get out of treatment.
bed due to disturbance of consciousness or severe Rehabilitation therapy in the early phase of
condition. For discussion, the author called the lying in bed includes retaining joints in func-
former convalescence patients lying in bed and tional position, passive movements and active
the latter severe patients lying in bed. motor function training.
(a) Placement of limbs in good limb position
10.2.1.2 Rehabilitation Therapy and retaining joints in functional position:
Rehabilitation therapy lying in bed includes reha- Good limb position is temporary position
bilitation therapy in the initial department before from clinical therapy. However, if there is
entering into rehabilitation department or reha- joint contracture in this position, it still
bilitation therapy in rehabilitation department affects motor function of limbs. Functional
with maintenance treatment such as medicine position is the angle and place required for
therapy for hypertension and diabetes mellitus the limbs and joints to play functions. In
and without follow-up therapy after acute phase. this angle and place, even if there is joint
In this kind of patients, most are convalescence contracture or joint rigidity, it can still
patients lying in bed who are stable and want to keep the basic functions of the limbs. The
do rehabilitation training for further functional purpose of the two positions is to keep the
recovery. Small parts are severe patients lying in limbs and joints in the position that is
bed who are severe and cannot do exercise out of good for complication prevention and
bed, but the vital signs are stable and the internal functional recovery in the future. In the
and surgical therapies are completed. hospitals or departments with good condi-
Therefore, rehabilitation therapy lying in bed tion, it is best to use retaining appliance of
is divided into rehabilitation therapy in the early joint in functional position and keep the
joint in functional position. At least twice technique to guide the patients to do regula-
a day, the patients undress retaining appli- tion of mind and breath with speeches. In the
ance of joint in functional position and do process that the therapists help the patients to
active or passive joint motion and muscle do autonomous joint motion, the therapist not
massage (10–15 min per time). In the hos- only encourage the patients to increase the
pitals or departments without retaining range of joint motion, but also exert resistance
appliances, the therapists can use pillow intermittently to induce natural anti-resistance
or cushion to keep the joints in good limb response of the patients’ body and make the
position and do active, passive movements patients find the signal orientation, which is
of joint and muscle massage. good for the recovery of autokinetic
The placement of limbs in good limb posi- movement.
tion and retaining joints in functional position For the patients with low conscious state,
are one of the important content in the early the patients are guided to do regulation of
rehabilitation of the patients lying in bed. mind and breath with speeches. After that, in
(b) Position change: The purpose of position the process of passive joint motion, the thera-
change is to prevent pressure sores. In pists exert resistance in the right-about sud-
addition, because supine position denly to induce natural anti-resistance
strengthens extensor, lateral position in response of the patients and use speeches to
uninjured side strengthen flexor in injured encourage the patients to do anti-resistance
side and lateral position in injured side training in order to promote awakening. The
strengthen extensor in injured side. patients are diagnosed with low conscious
Constant position change can make mus- state in clinic, which doesn’t mean they have
cle tension of extensor-flexor in a bal- no deep subconsciousness. For this kind of
anced state. It can prevent spasm pattern patients, the therapists should emphasize on
to a certain extent (position change per massage of muscle and soft tissue.
60–120 min). According to the sequence from proximal
(c) Passive movements of limbs and joints: end to the distal end of the limb, passive joint
The purpose of passive limb movement motion training should be started from unin-
and joint motion is to prevent adhesion of jured side and then to the injured side in
joint and soft tissues such as muscle, ten- accordance with range of joint motion in unin-
don contracture and joint deformity, jured side. The movement should be soft and
which can increase limbs bold circulation, slow. The key points are abduction, extortion,
prevent deep venous thrombosis and protraction, rear protraction and cyclover-
increase sensory input. It is suitable for gence of shoulder joint, elbow extension,
the patients with low conscious state or wrist and finger extension, abduction and
complete or partial loss of limbs active extension of hip joint, flexion and extension of
movements. knee, foot dorsiflexion and strephexopodia.
When doing passive joint motion, whether There are six time in a trial and two trials a
the patients is conscious or not, six-step day for each joint. With the improvement of
Daoyin technique can be used to do active and the disease and consciousness recovery, the
passive joint motion. For conscious patients, patients are recovered to do active and passive
the patients are guided to do regulation of joint motion by themselves (once a day).
mind and breath and do single joint motion. (d) Mechanical device is used to do passive
Anti-resistance training can increase potential joint motion. In a certain motion range,
development. The patients with low myody- continuous passive motion can drive joint
namia who cannot complete joint motion to do passive joint motion is a certain time
autonomously can adopt auxiliary active joint through mechanical transmission continu-
motion for training. The therapists use Daoyin ously, which can prevent joint adhesion,
promote blood backflow, relieve limb and millimeter wave, medical massage,
edema, prevent ankyloses and relieve traction.
pain, improve range of joint motion and (g) Active movement training: Retaining

decrease bedside complications [4]. limbs in functional position, turning over
Application method: according to the toler- and passive joint motion can prevent pres-
ance condition of the patients, one cycle is sure scores and contracture of soft tissue
1–2 min and the movement time is 1 h (1–3 and joint, but they cannot prevent apraxia
times a day). According to the specific condi- syndrome such as apraxia amyotrophy
tion of limbs dysfunction, different kinds of and cannot promote CNS function recov-
CPM can be used for passive motion of upper ery directly. Therefore, active movement
limbs, lower limbs, wrist, hand and ankle training should be done as soon as
joint. possible.
(e) The application of vapour-pressure type In principle, if the patients are conscious,
blood circulation driver: for the long-term with stable vital signs and the disease condi-
bed patients, because they lose the ability tion is not aggravated progressively, this train-
of the muscle contraction to push the ing can be done. For the stroke patients with
blood back to the heart, blood flow is slow mild symptoms and without disturbance of
and visible component of the blood can consciousness, active movement training can
precipitate and attach to the vascular wall. be started with vital signs (breathing, blood
It develops gradually and the thrombus is pressure, pulse and ECG) monitoring in the
formed finally. Blood backflow is second day after stroke. The training should
obstructed and there is edema of distal be progressive and be started with low amount
limbs. Once the thrombus fall off, there of training. According to the disease condition
may be pulmonary vascular embolism and and tolerance degree of the patients, the
cerebrovascular embolism, even mortal amount of training can be increased or
danger. For long-term bed patients, if decreased gradually.
rehabilitation training is not done timely, The purpose of active joint motion training
the occurrence of deep venous thrombosis is to develop CNS potential, promote undead
of lower limbs is 40–70%. brain cells to recover function in CNS injury
There are many types of vapour-pressure zone, induce autonomous muscle contraction
type blood circulation driver. The best func- and joint motion. It is suitable for the con-
tion is to squeeze muscle belly. Gasbag pres- scious patients with incompletely lost autoki-
sure is 8–12 kPa (60–90 mmHg) in upper netic movement of limbs.
limbs and the time is 12–15 min. Gasbag pres- According to neural development, sequen-
sure is 10.7–14.7 kPa (80–110 mmHg) in tial training should be done for better recovery
lower limbs and the time is 15–20 min. There of motor function. The recovery sequence of
are two times a day and 7–10 days in a therapy motor function of the trunk is the trunk, shoul-
course. If there is no adverse reaction, it can der girdle and pelvic girdle in sitting position,
be used for a long time. knee standing position and walking. The
(f) Physiotherapy: The purpose of interven- recovery sequence of motor function of the
tional therapy of physical agent is to limbs is from proximal end to distal end.
relieve pain, increase blood circulation of Because functional recovery of ankle joint,
limbs, alleviate edema, relieve spasm and toe and thumb takes a long time and are
increase tension of paralytic muscle. The difficult.
main methods are far infrared ray, medium The main content of active movement
frequency electrotherapy, interference training is as follows:
electricity, laser, kerotherapy, ultrashort Turning over training in bed: it is the basic
wave, decimeter wave, centimetric wave functional training of the trunk. The patients
cross fingers, extend upper limbs, lift it for- and are sequentially in 30°, 45°, 60° and 80°
ward and extend to the lateral. During turning sitting position. If the previous position can be
over, crossed hands extend to the turning over maintained for 30 min and there is no obvious
side and the flexed legs swing to this side until postural hypotension, the patients can trans-
the patients are in lateral position. The patients mit to the next position. If the patients can be
go back to supine position and then turn over maintained in 80° sitting position for 30 min
to the other side. There are several time in a and the vital signs are stable, there is no pos-
day and the trainer should help the patients as tural hypotension when the patients are in sit-
needed. During turning over, the head should ting position.
turn to the turning over side firstly. Sitting position training includes sitting
Bridge-style movement: its purpose is to position balance and tolerance training. During
training hip extension. The patients are in the process of balanced training, endurance
supine position, flex two legs, use foot to step can be increased. This training should be better
on the bed, lift hip for a while and put it down if there is no support and assistance.
slowly (double bridge-style movement). If the In static balanced training, the patients are
patients can easily complete double bridge- required to sit on the bed or chair without sup-
style movement, the patients suspend leg in port and flex hip joint, knee joint and ankle
uninjured side, only flex injured leg, use foot joint in 90° flexion position. If the foot cannot
to step on the bed and lift hip (single bridge- step on the ground, the trainers can use pedal
style movement). In the early phase of train- or low stool to keep it in 90° dorsiflexion posi-
ing, is necessary for the trainer to help the tion. The space between the two feet is as
patients to fix injured leg and stimulate thigh width as the shoulder and the hands are on the
contraction to complete the movement. knees. The trainers adjust the trunk and head
Leg lock movement: the purpose is to train of the patients to the center and loose their
intorsion and adduction of injured hip to pre- hands when they don’t exert force. The
vent extorsion gait of injured leg in walking. patients are required to keep in this position as
The patients are in supine position, flex two long as possible. The trainers can use count
legs, use foot to step on bed and separate two method to encourage the patients. When the
knees in extorsion position. The patients patients’ bodies incline to one side, the train-
actively fold two knees. Meanwhile, the ers require the patients to adjust their body
trainer exert resistance on uninjured leg of the back to home position. If the patients cannot
patients to prevent intorsion and adduction in do this, the trainers should help them.
order to induce intorsion and adduction of If the patients meet the requirements of
injured leg through associated movement. If static balanced positions, balanced training in
the patients can easily complete the move- dynamic sitting position can be started. the
ment, the patients can extend leg in uninjured patients cross fingers and move forward,
side and only do intorsion and adduction backward, left, right, upright and downward
training of injured leg. with center of gravity. If the patients can keep
Sitting position training: sitting position is balance on the condition of sudden push or
the easiest position to be completed by the pull, it demonstrates that the patients are able
patients and is the necessary movement to pre- to keep balance in sitting position and they
vent postural hypotension, standing, walking can do endurance training in sitting position.
and daily life movement. Because postural During the process of sitting position train-
hypotension usually occur in the elder and ing, transition training between sitting posi-
long-term bed patients, when the patients are tion and lying position helps the patients to sit
in sitting position for the first time, they are up by themselves. This training includes sit-
inappropriate to sit up-right (90°). The train- ting up from uninjured side and sitting up
ers can use standing up platform or back rest from injured side.
Sitting up from uninjured side: The patients There are 30 min in one training (once a
are asked to turn over to the uninjured side, day) and there are 30 times in a therapy course.
flex upper limb in uninjured side below the (i) The training of virtual reality: Cooperated
trunk of uninjured side, hand two legs down with virtual reality training instrument of
the bed, rise head and the trunk to injured side, neurological training of guiding collaterals
use upper limbs in uninjured side to support through meridians, the method is the same
the trunk and sit up with the trunk in 90° neu- as rehabilitation training of neurological
tral position. training. It is best to do the training accom-
Sitting up from uninjured side: The trunk panied with neurological training instru-
rotates to semipronation. The upper part of the ment. Virtual reality can make the patients
body straighten to uninjured side and upper know the actual conditions of motor pro-
limbs in uninjured side support the trunk to sit gram and instruct the training. The defect
up. This movement is opposite with the move- that the actual motor program signal cannot
ment from sitting position to lying position. It be increased for a long time and can affect
is more difficulty to sit up from injured side therapeutic enthusiasm of the patients can
than to sit up from uninjured side. be compensated by virtual reality training.
(h) Bedside rehabilitation training of neuro- In the virtual reality training in bed,
logical training: In the rehabilitation train- there are 30 min in one training (once a
ing in bed, neurological training technique day) and there are 30 times in a therapy
is used to do bedside rehabilitation train- course. One of the key points of training
ing. Because the sensitivity of neurologi- lying in bed is to prohibit the patients to
cal training instrument is high, it can walk out of bed in case of abnormal motor
detect very weak motor program signal. It pattern.
not only can set surpassing goals for the 2. Rehabilitation therapy in the early phase of
patients’ training, but also can increase off-bed: it means preliminary training before
therapeutic interests to motivate rehabili- overall training that the patients with stable
tation confidence and desire of the disease condition are ready to do in rehabilita-
patients. tion hall, which includes the patients with con-
Single channel is usually used in the train- sciousness and disturbance of consciousness.
ing. The therapists use Daoyin technique to Through further medicine therapy and
guide the patients to give out signal to agonis- rehabilitation training lying in bed, the disease
tic muscle of movable joint. Neurological condition of most patients is stable and func-
training instrument can display this signal on tions are recovered to a certain extent.
fluorescent screen in curve form. After According to the disease condition, this part
explaining the significance and functions of of patients can be divided into three types.
this signal to the patients, the therapists use (a) The patients with consciousness and partial
this signal intensity as a standard and mark it recovery of motor function: This kind of
in a transverse line that is the surpassing goal the patients usually is diagnosed with slight
of the next training of the patients. The thera- brain injury. For this kind of patients with
pists use new signal intensity as a baseline and hypertension and diabetes mellitus, if the
guide the patients to surpass it. The rest can be therapy is in time and proper with symp-
done in the same manner. The patients can tomatic medicine, they can be maintained
recover functions in carefree training. in basic normal level. Although there is
According to specific condition of motor motor dysfunction of limbs in one side, the
dysfunction of the patients, the therapists can active movements can still be maintained
design training schedule. The main training is to a certain extent, physiological reflex
the training of agonistic muscle but not the exists in physical examination and patho-
proportion of motor program signal. logical signs are not obvious or slight.
(b) The patients with consciousness but obvi- and they content 400–600 ml blood than that
ously or completely motor dysfunction of in lying position, which can lead to blood vol-
limb in one side: This kind of the patients ume redistribution among different organs.
usually is diagnosed with severe brain It can decrease temporary returned blood
injury. For this kind of patients with hyper- volume and central venous pressure. Cardiac
tension and diabetes mellitus, even if they output is decreased 25% in standing position
are treated with symptomatic medicine, than in lying position. Finally, blood pressure
they cannot be maintained in basic normal is decreased and there are a lot of symptoms.
level. The patients are conscious but with Normally, the reason why people cannot
cognitive, speech, emotional and mental have postural hypotension is related to cardiac
disorders. The myodynamia of limb in muscle contraction and squeezing action of
hemiplegic side is very weak or zero. It is skeletal muscle to blood vessel in movement.
usually with severe muscle spasm, obvious The contraction effect of cardiac muscle: The
hyperfunction of physiological reflex and stronger the cardiac contraction is, the more
obvious pathological signs. completely the ventricle evacuate after cardiac
(c) The patients with unconsciousness: It is ejection. The more obviously the intraven-
usually seen in the patients in coma after tricular pressure decreases in diastolic phase,
severe brain damage. It can be developed the bigger the effect of promoting blood flow
to low conscious state (vegetative state). of atrium and vena cava are. Squeezing action
of skeletal muscle: in walking, alternative
According to training procedures and require- contraction of muscles in lower limbs squeeze
ments of neurological training, regardless of intramuscular veins and veins between mus-
the type of the patients, they all should do neu- cles to accelerate blood flow in vein. Valves
ral potential development training that includes of veins in lower limbs make the blood only
CNS potential of upper limbs, lower limbs and flow to the heart. Therefore, skeletal muscle
the trunk. Because the training intensity is strong, and vein valve make the blood flow back to
cardiovascular stress response ability must be heart. The effect of muscle pump is important
increased before this training to keep enough for decreasing lower limb peripheral venous
blood supply of tissues and organs in order to pre- pressure in standing position and blood reten-
vent postural hypotension effectively. Therefore, tion in veins in lower limbs. For example,
the increase of cardiovascular stress response when the person stand still, venous pressure
ability is the main content of rehabilitation trainin foot is 12 kPa (90 mmHg) and decreased
ing in the early phase of off-bed. below 3.3 kPa (25 mmHg). In running, muscle
pump of lower limbs can squeeze several litres
(a) Standing bed training: long-term in bed can of blood per minute. In this case, muscle pump
lead to a series of problems such as pressure of lower limbs accelerates blood circulation
scores, urinary and digestive system func- of the whole body to some extent and pumps
tions disorders, hypostatic pneumonia, osteo- the blood back to heart. However, if rhythmic
porosis, amyotrophy and muscle apraxia. relaxation and contraction of the muscle is not
The leading problem is the decrease of car- normal, constant tonic contraction can press
diovascular function. When the body posi- veins continuously and decrease returned
tion of the patients is changed, blood gravity blood volume.
can easily lead to insufficient blood supply of The tonicity of venous blood wall in long-
brain tissue and there will be orthostatic term bed patients is low, the expansibility is
hypotension, even shock. high, the myocardial contractility decreases
The research demonstrated that in standing and contraction power of abdomen and
position, most of capacity vessels are below lower limbs’ muscle weakens. After that,
the heart plane. If a person stands still, the the squeezing effect on veins is weakened.
veins in lower part of the body are expanded When the patients are from horizontal lying
position to standing position suddenly, blood bed. The safety belt is fixed, lifting button of
retention in lower limbs can decrease return standing bed is pressed or the standing bed
blood volume and induce blood pressure is elevated manually. The therapists should
drop, even faint. The normal people squat observe the patients’ reaction. When the
for a long time and stand up suddenly, which patients feel discomfort, the patients should
can lead to insufficient blood supply of brain stop the training and decline gradually until
such as dizziness and seeing the stars. there is no any discomfort.
The leading function of standing bed is The standing training should be done
keeping the patients in 0–90° passive stand- under electrocardiograph monitoring. For
ing position through mechanical device. It is example, if the patients are in a critical
the preliminary training of doing other reha- condition, especially for the severe patients
bilitation training. who just start to do this training, the train-
The mechanism of standing training: ing should be done under electrocardiograph
when the people stand up, blood gravity monitoring to keep safe.
make the blood accumulate in lower limbs The effect of active training can be
and return blood volume is decreased, which increased. For the patients with consciousness
stimulate baroceptor of internal carotid sinus and stable condition, the therapists instruct the
and arcus aortae, decrease inhibitory impulse patients to slightly flex knee joints intermit-
from these areas to vasomotor center and tently in standing in order to make themselves
induce excitability increase of adrenergic stand up, which can promote CNS plasticity.
sympathetic nerve reflexively. The content of According to the specific condition of
noradrenaline in blood are increased, which the patients, standing angle and time are
lead to arteriole contraction and heart rate increased gradually.
increase. In addition, baroreceptor of blood There are 1–2 trainings in a day (30 min
vascular system is stimulated after venous per time). If the patients cannot hold on, they
passive congestion and then induces vaso- can rest for 1–2 times (5 min per time).
constriction, tension increase and isometric When the patients can stand up erectly (900)
contraction of muscle in lower limbs, which for 30 min without discomfortableness and
make the blood flow back to heart and stop vital signs are normal, the goal of standing bed
the sudden decrease of cardiac output. These training is achieved. Stronger training items
mechanisms can increase cardiovascular such as potential development can be done.
stress ability and there is no obvious blood (b)
Vapour-pressure type blood circulation
pressure decrease in standing position. driver: Because vapour-pressure type blood
In standing position, the broken ends of circulation driver can replace muscle con-
fractured bone, normal bones and joint sur- traction to promote blood back to heart and
face are pressed, which are good for calcar- increase return blood volume and contractil-
eous deposit, regeneration of osteocytes and ity ventricular muscle.
bone reconstruction. The researches dem- In rehabilitation training of lying in bed,
onstrated that with the increase of pressure the patients are forbidden to do exercise out
stress, piezoelectric effect is increased. When of bed, which is the important measure to
stress level of fracture end is coordinated prevent abnormal motor pattern. The patients
with stimulation of histological differentia- who can receive standard rehabilitation train-
tion, it can promote fracture healing. ing in the early phase, the rate of functional
The method of standing bed training: recovery is high and disability rate is low.
Standing bed includes automatic and manual Moreover, except for the patients with severe
types, but their functions are the same. There are brain damage, motor pattern of most patients
several points that should be paid attention to: can be recovered to normal level, which is
Step-by-step principle: The patients are good for increasing the patients’ life quality,
transferred from supine position to standing returning to family, work and society.
10.2.2 Rehabilitation Therapy Out 1. Detailed functional assessment is used to find

of Bed the main dysfunction point.
There are two kinds of functional assess-
Rehabilitation therapy out of bed is for the ments: The first is the assessment of survival
patients who can do exercise out of bed. This part capability after dysfunction. This kind of
of patients includes the patients who don’t do assessment method accounts for the most of
exercise out of bed through rehabilitation train- functional assessments such as ability of daily
ing of lying in bed. These patients mostly come living (ADL), Brunnstrom functional assess-
from associated departments of the hospital and ment and so on. This kind of method usually
complete rehabilitation training of lying in bed uses comprehensive abilities as assessment
according to training schedule, but don’t do exer- indicators such as clothes, going to toilet and
cise out of bed. This part of patients also includes walking up and down stairs. These methods
the patients who already do exercise out of bed can reflex comprehensive abilities of the
without doing rehabilitation training of lying in patients that are good for identification of
bed. These patients mostly come from associated degree of disability and assessment of thera-
departments of other hospitals or society and peutic effect. Therefore, the therapists can
don’t receive standard rehabilitation training, but know the effectiveness of these methods.
they start to do exercise out of bed. However, because this kind of assessment
Because these patients’ conditions are sta- cannot explain the cause of motor dysfunction
ble and cardio-pulmonary function are normal, of specific muscle, it is difficult to design tar-
the can tolerant strong rehabilitation training. geted rehabilitation therapy schedule accord-
Because the former don’t do exercise out of bed, ing to this. The second is the assessment of
there is no abnormal motor pattern. The main dysfunction cause and degree. Whether the
goal of rehabilitation training is to recover nor- patients are severe or not and whether motor
mal motor pattern directly. The training time is dysfunction is severe or not, abnormal motor
short, the therapeutic effect is good and there is pattern was formed. It is necessary to do
no abnormal motor pattern. Because the latter detailed assessment. Under general circum-
already do exercise out of bed with abnormal stance, not all the muscles are paralyzed in
motor pattern to varying degrees, the main goal paralytic limbs. The cause of abnormal motor
of rehabilitation training for these patients is to pattern is usually one or several paralytic mus-
rectify abnormal motor pattern and then remodel cles. If there is no detailed functional assess-
normal motor pattern. The training difficulty is ment, it is hard to find out the main obstacles
big and takes a long time. It is hard to recover of abnormal motor pattern and therapeutic
normal motor pattern without orthotic assistance schedule is blind. Therefore, the purpose of
device. In the early phase, correct rehabilitation rehabilitation training is not specific. The nor-
method is adopted for training in case of abnormal training not only wastes time, but also
mal motor pattern and has an important effect affects training effect.
on recovering and reestablishing normal motor For the formulation of therapeutic sched-
pattern. ule, the functional assessment methods that
can ascertain the cause of motor dysfunction
10.2.2.1 Functional Assessment and abnormal motor pattern are more valuable
of Rehabilitation Training in clinic.
Out of Bed One of external manifestations of CNS
Detailed and correct functional assessment is injury is motor dysfunction. The method to
the basis of formulating anticipated rehabilita- recover CNS functions through promoting
tion goal, ascertaining entire rehabilitation prin- CNS plasticity is achieved through recover-
ciple and specific rehabilitation schedule, which ing autonomous muscle contraction, single
can directly influence the effect of rehabilitation joint motion and limbs movement. Therefore,
training. if the therapists can definitely evaluate m
uscle
functions, single joint motion and the entire motor pattern. This kind of patients
motor function of the trunk and limbs, it can includes ordinary type of motor dysfunc-
help to formulate rehabilitation therapy tion and severe type of motor dysfunc-
schedule and is the most valuable assessment tion. Ordinary type: after rehabilitation
item. It is not the functional assessment training of lying in bed, motor function of
method that us only suitable for therapeutic limbs is recovered to a certain extent,
effect evaluation. muscle spasm degree is no more than
For the condition of motor function, Lovett grade II and there is no obvious mental
MMT muscle test, range of motion (ROM), retardation and affective disorder. This
motor program signal intensity and proportion kind of patients account for a great por-
exam, balance function assessment, spastic tion and the prognosis is good. Severe
degree assessment of muscle and gait assess- type: the patients are diagnosed with
ment, cognitive and speech function assess- severe motor dysfunction. There is no
ment are usually used. In addition, the entire autokinetic movement of limbs accompa-
body function conditions should be evaluated nied with severe muscle spasm and cogni-
such as vital signs, visceral functions, nutri- tive disorder. Muscle spasm degree is
tion condition and emotion, therapeutic more than grade II. This kind of patients
alliance. account for a small portion and the prog-
For example, a patient with right cerebral nosis is not good.
hemorrhage and left hemiplegia walk with (b) Localized type: Motor dysfunction of this
circle gait and the main obstacles of the kind of hemiplegic patients is slight, usu-
patients are paralysis of tibialis anterior mus- ally localized in one joint motion or the
cle and peroneus longus and brevis muscle patients feel fatigue, sore or discomfort in
induced by injury of right brain tissue that limbs. The patients cannot complete indi-
dominates these muscles. A patient with left vidual movement such as squat com-
cerebral hemorrhage and right hemiplegia pletely or stand up after squatting. There
walk with circle gait and the main obstacles of is no obvious abnormal motor pattern in
the patients may be paralysis of hip flexor this kind of patients and the prognosis is
induced by injury of left brain tissue that dom- good after training.
inates these muscles. (c) The type of abnormal motor pattern: The
The main obstacle provides basic situation for disease history of this kind of patients is
formulating specific therapeutic schedule, which long. The patients are those who walk
is good for all the rehabilitation therapy items out of bed without standard rehabilita-
that can be used in one point such as tibialis ante- tion training or walk too early or incor-
rior muscle or hip flexor in order to increase rectly after rehabilitation training with
therapeutic effect and save therapy time. abnormal motor pattern in different
2. Establishing the types of motor function for degree and types. The common abnor-
formulating anticipated rehabilitation goal mal motor pattern includes hemiplegic
and overall rehabilitation principle. gait (circle gait and drag gait) and myas-
In order to formulate specific rehabilitation thenic gait (tibialis anterior muscle gait,
goal and principle, the motor function of the quadriceps femoris gait and gluteus
patients can be divided into three types. maximus gait).
(a) The type of the patients who don’t do
exercise: This type includes the patients The muscle spasm degree is uncertain and
who don’t do exercise out of bed and are there may be chicken hand and genu recurvatum
transmitted from rehabilitation training in in severe patients. This kind of patients is divided
early phase. Therefore, although this kind into ordinary type of motor dysfunction and
of patients is with motor dysfunction to severe type of motor dysfunction. The prognosis
varying degrees, there is still no abnormal of ordinary type is better. Severe type requires a
longer time and functional recovery is not good appears and pathological signs are
enough. positive. This kind of the patients is not
suitable to receive three-stage rehabilita-
10.2.2.2 Establishing Anticipated tion method training of neurological train-
Rehabilitation Goals ing, because they are difficult to recover
and Overall Rehabilitation the degree required for the third stage of
Principle rehabilitation training. This kind of
1. Ascertaining rehabilitation goal to fight for patients recovers partial functions through
better therapeutic effect: through detailed comprehensive training. During the pro-
functional assessment, the therapists find out cess of potential development, they start
the main functional obstacle of the patients to do abnormal gait rectification weight
and formulate individual anticipated rehabili- support walking training. The training is
tation goal according to the actual condition difficult and requires 2–3 therapists to
of the patients. This goal is a comprehensive help the patients to complete walking
possible result according to dysfunction part, training. Moreover, at the end they need
degree, cognitive condition and the effect of assistance device such as walking assis-
rehabilitation method of the patients and is the tance device, foot tray or crutch to stand
internal material for rehabilitation staff, but and walk. Therefore, anticipated rehabili-
not the goal that definitely will be achieved. tation goal of this kind of patients should
Therefore, the therapists don’t need to tell the be formulated according to the specific
patients and their family the goal as the defi- condition of the patients. Generally, after
nite therapeutic effect. rehabilitation, with the help of assistance
Therefore, according to the degree and device, the patients are able to stand inde-
type of motor dysfunction of individual pendently and walk.
patient, cognitive dysfunction degree and gen- (b) Localized type: Because the dysfunction
eral physical condition, anticipated rehabilita- of this kind of patients is slight and it only
tion goal is formulated through comprehensive affect single joint (slight strephenopodia)
analysis. or the fatigue of limbs is the major mani-
(a) The type of the patients who don’t do festation, they have good functional
exercise: This type includes the patients recovery through rehabilitation training of
who don’t have abnormal motor pattern neurological training. Therefore, for this
and may recover motor function through kind of patients, rehabilitation goal is to
standard three-stage rehabilitation train- recover motor function to normal level
ing of neurological training. Ordinary without cognitive dysfunction.
type: the patients have good functional (c) The type of abnormal motor pattern: The
recovery after the third stage of rehabilita- disease history of this kind of patients is
tion method training of neurological train- long. They have abnormal motor pattern
ing. In the premise that there is no obvious to varying degree although they are able
cognitive dysfunction, rehabilitation goal to stand and walk with assistance or inde-
may be to recover independent ambula- pendently. Ordinary type: The patients’
tion and self-care. If there is cognitive abnormal motor pattern is slight, which is
dysfunction, the effect can be influenced. induced by foot drop or circle gait due to
Severe type: Degree of brain injury of the strephenopodia, genu recurvatum due to
patients is severe accompanied with cog- increase of extensor tension. This kind of
nitive and emotional disorder. Motor abnormal motor pattern is restricted to
function of limb in hemiplegic side is one or two groups of muscle.
almost lost, there is no autonomous mus- Rehabilitation training is easy and antici-
cle contraction, physiological reflex dis- pated rehabilitation goal is to rectify
abnormal motor pattern and gait to normal training is standard training procedure of rees-
level with the help of foot tray to prevent tablishing motor pattern.
foot drop or talipes varus and valgus. The formulation of overall rehabilitation
Severe type: the abnormal motor pattern principle is based on this combined with
of this kind of patients is severe accompa- appropriate adjustment and flexible applica-
nied with various kinds of abnormal tion of individual dysfunction of the patients.
motor pattern. For example, abnormal (a) The type of the patients who don’t do
motor pattern such as circle or carrying exercise: Ordinary type: Typical three-
basket is usually accompanied with glu- stage rehabilitation method is adopted for
teus maximus gait, which is the stretching training. Severe type: rehabilitation prin-
the chest and expanding the belly posture ciple of standing in early phase and recov-
due to myasthenia of hip extensor or wig- ering walking is adopted. During the
gly duck gait due to paralysis and fatigue process of implementing the first and the
of gluteus medius. The disease condition second stage training, the patients can do
of this kind of patients is complicated and the third stage rehabilitation training. The
the therapy time is long. Anticipated reha- principle of children is r ehabilitation prin-
bilitation goal is to rectify abnormal motor ciple of standing in early phase and walk-
pattern effectively and improve walking ing development.
ability obviously through assistance (b) Localized type: Atypical three-stage reha-
device after training. bilitation principle is adopted. On the
2. Establishment of overall rehabilitation princi- basis of potential development and proper
ple to realize anticipated rehabilitation goal: adjustment of motor program, the motor
Overall rehabilitation principle is the major pattern remodeling training in the third
principle of rehabilitation for anticipated reha- stage is done.
bilitation goal but not specific rehabilitation
(c) The type of abnormal motor pattern:
training schedule and method according to Ordinary type: typical three-stage rehabili-
individual dysfunctions and general physical tation method principle is used to do the
condition. According to the common abnor- training sequentially. Severe type: reha-
mal motor pattern of hemiplegic patients, bilitation principle of standing in early
from the view of reestablishing normal motor phase and recovering walking is adopted.
pattern, the adopted overall rehabilitation During the process of implementing the
principles are different. first and the second stage training, the
With recovering functions as much as pos- patients can do the third stage rehabilita-
sible, recovering normal motor pattern is the tion training. The principle of children is
final rehabilitation goal. In the premise of this, rehabilitation principle of standing in early
according to practical functional condition and phase and walking development.
requirements, overall rehabilitation principle to
realize rehabilitation goal includes four aspects: 10.2.2.3 Formulating and
three-stage rehabilitation training method prin- Implementing Rehabilitation
ciple; movement coordinated training princi- Therapy Schedule According
ple; training principle for different disease; to Overall Rehabilitation
training principle to recover main functions. Principle
Individual overall rehabilitation principle According to overall rehabilitation principle
is formulated according to the final rehabilita- based on the individual condition of the patients,
tion goal that is to recover normal motor pat- corresponding rehabilitation training schedule
tern. Prevention and rectification of abnormal is formulated and put into practice. After thera-
motor pattern is the premise of reestablishing. peutic schedule, it is forbidden for the doctors to
Three-stage training method of neurological show no interest in the patients and for the thera-
pists to implement it by them. The results don’t third stage rehabilitation training. The
meet the therapeutic requirements of the sched- practice has proved this method is good
ule. Moreover, the doctors should participate for recovery of motor function and con-
in actual rehabilitation training and explain the sciousness of the patients. The principle
mechanism of rehabilitation therapy of neurolog- of standing in early phase and recovering
ical training to the patients. The doctors organize walking is the rehabilitation policy
the exercise therapists in every therapy group to according to choosing the less of two
do the training in allusion to the main obstacles evils. Through compulsory assistance
and pay attention to timely adjustment of thera- walking, the patients can recover walking
peutic schedule, which can obtain anticipated ability to a certain extent, but the motor
therapeutic effect. pattern is not always normal. Compulsory
assistance walking is better than standing
1. The type of the patients who don’t do exercise and walking inability in decreasing com-
includes the patients who cannot do exercise plications and increasing life quality
out of bed through rehabilitation training of effectively.
lying in bed. It includes ordinary type and According to rehabilitation training of
severe type. The therapeutic schedule is as standing in early phase and recovering walk-
follows: ing or standing in early phase and walking
(a) Ordinary type: the training should be development, the specific training method is
done restrict according to three-stage the same.
rehabilitation method, which is the (a) Potential development training: this train-
training of neural potential developing is particularly suitable for the severe
ment, motor program reestablishment patients with disturbance of conscious-
and motor pattern remodeling. What ness. Potential development training
calls for special attention is that the device of upper limbs, lower limbs, and
implement should be strict. It is forbid- the trunk and tibialis anterior muscle is
den to walk in the first stage and the used for the training. Weight support sys-
walking is restricted in the second. In tem of the device is adjusted to support the
the third stage, the training should be patients’ body weight. The weight loss
done in the motor pattern molding should not be too big in case pectoral gir-
instrument and transmitted to natural dle oppresses the thorax and then affect
movement without help. If three-stage breath. Because this kind of patients can-
rehabilitation training is implemented not cooperate with therapy actively, it
actually, the patients’ function can be requires two therapists or the family and
recovered to the normal level. nursing workers to do this training. There
(b) Severe type: the symptom of this kind of are 1–2 times a day (30 min per time) and
the patients is severe and there is usually there are 30 times in a therapy course.
no autokinetic movement of limbs. If the Cautions: before training, the patients must
training is done according to three-stage do standing bed training. When they can stand
method, the therapy time is long and the erectly for 30 min with normal vital signs
anticipated goal is difficult to be achieved. such as breath and blood pressure, the patients
The principle of standing in early phase can do this training. Sudden position change
and recovering walking or the principle of is used to induce autokinetic movement,
standing in early phase and walking which plays an important role in this training.
development for child cerebral palsyis Because this kind of patients cannot cooperate
adopted in the training. During the pro- with the training actively, self-potential can-
cess of implementing the first and the sec- not be developed if the training is done with
ond stage training, the patients can do the the help of others. During the process of assis-
tance, the therapists suddenly reduce assis- induce the drive signal from brain to quad-
tance force for a while and use Daoyin speech riceps femoris.
to encourage the patients to overcome the There are 1–2 times a day (30–50 min
drop of their position when the patients’ posi- per time) and there are 30 times in a ther-
tion is decreasing such as “stand up, or you apy course.
will fall down!”. Self-response of the patients (d) Physical exercise therapy of neurological
is activated to develop neural potential. training includes active joint motion
For the severe patients who cannot com- induction, passive joint motion and loos-
plete the training full time, the training time ening soft tissue adhesion. There are 1–2
can be shortened or they can have 1–2 breaks times a day (45 min per time) and there
during the training. are 30 times in a therapy course. The
(b) Motor pattern remodeling training: In
training can include many therapy
actual, passive or assistance walking courses.
training is done. Abnormal gait rectifica- In addition, CPM is used to do constant
tion weight support walking training passive joint motion to prevent adhesion
device is used in the training. After the of joint and soft tissue. Physiotherapy
weight is adjusted, the therapists sit on such as medium frequency, interference
plate in the front of training device, put current, far infrared and ultrashort wave
training shoe cover on the ankle of para- are used to increase blood circulation of
lytic lower limbs, tell the patients to step local tissue and promote metabolism.
forward using uninjured lower limbs and For the patients with muscle spasm in
move the training device forward. Daoyin paralytic limb, tendon contracture, joint
technique is used to guide the patients to and soft tissue adhesion, skin traction and
try to step forward using injured limbs. If manipulation loosen are used for therapy.
the patients cannot complete it autono-
mously, the therapists help the patients to
step forward using lower limbs. The rest
can be done in the same manner and the
patients can increase walking ability grad-
ually (Fig. 10.1).
The walking training can be done when
lower limbs can step forward. There is one
time a day (30 min per time) and there are 30
times in a therapy course. The training can
include many therapy courses.
(c) Motor program reestablishment training:
the purpose of this training is to use neu-
rological training instrument to receive
motor program signal induced by joint
motion and anti-resistance training of the
patients. This signal is marked in trans-
verse line and the patients can use this line
as the surpassing goal to do repeated train-
ing. They can see their own progress that
is good for enhancing rehabilitation confi-
dence and interest. Position change can be
used to induce motor program signal. For
example, standing up and squatting can Fig. 10.1 Walking training of severe hemiplegic patients
2. Localized type includes the patients with local are guided constantly to increase signal
dysfunctions. For this kind of patients, atypi- intensity of agonistic muscle and
cal three-stage rehabilitation method is train- decrease signal intensity of antagonistic
ing principle. After a short time training of muscle. During the process of develop-
potential development and motor program ing central neural potential and increas-
reestablishment in dysfunction parts such as ing myodynamia, motor program of
lower limbs with foot drop and tibialis ante- normal single joint motion can be rees-
rior muscle, motor pattern remodeling train- tablished. When the myodynamia is no
ing can be started. If there is no abnormal less than grade III, motor program rees-
motor pattern, the walking should not be tablishment training of associated move-
restricted. ment can be done such as walking and
(a) Physical exercise therapy of neurological grasping.
training: Bare-handed operation method The training mentioned above can be coop-
of six-step Daoyin technique in traditional erated with virtual reality training instrument
Chinese medicine is used. The therapists and it is better to be applied with neurological
adopt proper position according to the training instrument. Not only the therapists
muscle, usually supine position and sit- can know exactly the specific condition of
ting position. Excitatory anti-resistance of motor program and guide the patients to
agonistic muscle and relaxation of antag- instruct the training, but also it can overcome
onistic muscle are the main training. the defect that actual motor program signal
During training, manipulation massage is cannot be increased for a long time and easily
used to loosen the adhesion of muscle and affect the therapeutic enthusiasm of the
soft tissue. patients.
There are 1–2 times a day (45 min per There are 1–2 times a day (50 min per
time) and there are 30 times in a therapy time) and there are 30 times in a therapy
course. course.
(b) Potential development training: According (d)
Motor pattern remodeling training:
to the dysfunction part of the patients, Because the symptoms of this kind of
corresponding potential development patients are slight, when the myodynamia
training is selected. Because there is cer- of the patients’ dysfunction muscle is no
tain muscle contraction ability of the less than III and agonistic muscle motor
patients, during potential development program signal intensity is no less than
training, the therapist can exert resistance 160 μV, the training can be done.
to increase the effect of potential develop- Meanwhile, the training of potential
ment training that should be guided by development and motor program reestab-
Daoyin technique. lishment can also be done.
There are 1–2 times a day (30–45 min per There are 1–2 times a day (50 min per
time) and there are 30 times in a therapy time) and there are 30 times in a therapy
course. course. The patients can receive therapy
(c) Motor program reestablishment training: courses repeatedly.
Under the guidance of animation light- In addition, other methods or physio-
spot blink indicator system of main and therapy such as massage, myodynamia
collateral channels guiding collaterals enhancement training, ascending and
through meridians, neurological training descending the stairs training and middle
instrument is used to receive and display frequency electrotherapy can be added to
the motor program signal form brain to the training.
agonistic muscle and antagonistic muscle The therapy course is 1 month. After one
real-timely. Through establishing target therapy course, the therapists evaluate the
line with different altitude, the patients effect and do the second therapies course if
necessary, but new therapeutic schedule c ondition, foot tray is temporarily used to rec-
should be formulated. tify strephexopodia, which is good for the
3. The type of abnormal motor pattern includes rectification of abnormal motor pattern.
the patients who do exercise out of bed with Motor program of associated movement can
abnormal motor pattern. According to the be reestablished in the second therapy course.
severity of abnormal motor pattern, it is The comprehensive results can shorten ther-
divided into ordinary type and severe type. apy course and get twofold results with half
However, because this kind of patients can do the effort.
joint motion actively, the adopted therapeutic (b) Severe type: except abnormal motor pat-
schedule all are three-stage rehabilitation tern of limbs, the patients are accompa-
method. The differences between ordinary nied with abnormal motor pattern of
type and severe type are training time and pelvis, the trunk and upper limbs. Because
assistance instrument. numerous abnormal motor patterns are
(a) Ordinary type: typical three-stage reha- hard to be rectified at the same time, on
bilitation method is the principle for train- the basis of adopting three-stage rehabili-
ing. The training method is the same as tation training method, according to spe-
the ordinary type of the patients who don’t cific condition, the training time of every
do exercise out of bed. Because there is stage can be prolonged and the method of
abnormal motor pattern in the patients, treating partial abnormality and rectifying
especially the patients who have been sick partial abnormality through orthosis assis-
for a year or more with solidified abnor- tive device is used, which can decrease the
mal motor program, it is difficult to rectify therapy difficulty. For example, back
it. Due to the limitation of hospital stay bracket is made to rectify abnormal motor
and family economic capability of the pattern of the trunk and motor pattern
patients, the patients cannot stay in the remodeling training device of upper limbs
hospital for a long time. Therefore, ortho- is used to make upper limbs swing coordi-
sis assistive device is used to rectify nately. The key point is the rectification of
abnormal position of joint, which is good abnormal motor pattern of lower limbs
for abnormal motor pattern rectification and it is easy to obtain training effect.
and therapy time shortening. After that, the patients can figure the
The common abnormal motor pattern of uncoordinated motor problem of upper
ordinary type of the patients is hemiplegic limbs.
gait. Hemiplegic gait is usually due to parapy- Skin traction and joint mobilization are the
sis of tibialis anterior muscle, especially common methods to loosen adhesion of bone
paralysis of peroneus longus and brevis mus- joint and muscle. For the therapy of tendon
cles. The paralysis of these muscles leads to contracture, standing bed training, manipula-
foot drop and strephenopodia and then induce tion release and shake release of tremor equip-
circle gait in walking. There are some diffi- ment are used to loosen tendon contracture on
culties in rectification therapy of hemiplegic the basis of heating (far-infrared irradiation
gait. The first reason is that it is difficult to and kerotherapy).
recover autonomous innervation of this mus-
cle and it takes a long time. The second rea- For severe joint deformity with a certain
son is that even if the functions of muscle tenacity such as flexion deformity of knee joint,
innervation, strephexopodia and foot dorsi- after it is loosened to a certain extent, plaster
flexion in sitting position are recovered, but support fixation is used to keep the position and
there is still strephexopodia or foot drop for a new loosen therapy is used on the basis of this
long time in walking. This is because the in case joint retraction after therapy and during
motor program of associated movement can- evening sleep affects therapeutic effect. If the
not be rectified and solidified. Under this range of joint motion is further improved, plaster
support is re-made to fix limbs and joints until is different because of different injury part, but
joint motion is loosened to functional position or all spasms are induced by higher motor neuron
maximally. injury. Therefore, the effective method to allevi-
ate muscle spasm due to CNS injury is to recover
functions of higher motor neuron.
10.3 S
olutions to Some Common In clinic, spasm is usually induced by stroke,
Problems cerebral palsy, brain trauma, disseminated scle-
rosis and spinal cord injury. The common myo-
10.3.1 Rehabilitation Method spasm pattern of hemiplegic patients are as
of Neurological Training follows (Table 10.2).
of Zero Myodynamia Spasm is a pathophysiological status, which
can affect motor function of limbs and daily life
In clinic, zero myodynamia assessed from hand ability to varying degrees. Movement resistance
feeling is not equal to zero motor program sig- is increase to make the voluntary movement
nal, which is far on behalf of the total necrosis of difficult to complete. Fine movement is diffi-
central nervous cells that dominate the muscle. cult. Increased resistance leads to bradykinesia,
For limbs in the hemiplegic side with physiologi- movement control difficulties. Therefore, it is
cal reflex and unconspicuous pathological reflex, difficult to complete fine movement. The move-
through training, most patients can recover ment is uncoordinated. Energy consumption is
autonomous motor function to a certain extent. huge and there may be accidents such as tumble
There is myospasm and pathological signs in and bruise. Abnormal motor pattern can affect
paralytic limbs. Through a series of training such gait and daily life activities.
as potential development, it is possible to recover Clinical therapy of muscle spasm due to CNS
some functions and it takes a long time. injury is difficult, but there are many therapy
methods such as posture and position control,
physiotherapies such as cold therapy, hydro-
10.3.2 The Therapy of Myospasm therapy, thermotherapy and electric stimulat-
ing therapy, orthosis and medicine such as
10.3.2.1 Functional Recovery dantrolene and baclofen, neural dissolution
of Motor Neurons in High technique of peripheral nerve, chemical dener-
Level Is the Fundamental vation technology (injection of botulinum toxin
Measure for the Therapy type A on motor point), selective posterior rhi-
of CNS Myospasm Induced zotomy (SPR), tendon elongation and neurotomy
by CNS Damage and kinesitherapy. Kinesitherapy is to training
Myospasm is the syndrome of abnormal increase antagonistic muscle of spasm muscle in order to
of muscle tension induced by CNS damage and decrease spasm degree through interactive inhi-
is one kind of motor dysfunction due to excit- bition. For example, active and anti-resistance
atory increase of myotatic reflex. Spasm degree contraction of triceps muscle of arm can be done
is positively correlated to stretch speed of the after spasm of bicipital muscle of arm. EMG bio-
muscle. feedback training is to train antagonistic muscle
Myotatic reflex is reflex contraction due to of spasmodic muscle. In addition, Bobath, Rood
muscle traction induced by external force. Its and PNF technique are used to inhibit spasmodic
reflex arc is located in spinal cord and the path- pattern passively.
way is simple but controlled by higher center. However, because the methods mentioned
When spinal cord is out of control, myotatic above are lack of the function of recovering
reflex is reinforced. Any motor neuron from higher motor neuron. The therapeutic effect is not
brain cortex to spinal cord is damaged, which ideal and it is necessary to explore new therapy
can lead to muscle spasm. The nature of spasm method further.
10.3 Solutions to Some Common Problems 321
Table 10.2 Typical myospasm pattern in hemiplegic patients

Part Pattern Manifestations
Head Spasm in injured side Head flex to injured side and face to uninjured side
Trunk Spasm in injured side The trunk lateral flex and rotate back
Upper limbs Flexor pattern Shoulder joint adduct and intort, flexion of elbow and wrist, flexion of
elbow joint and forearm supination
Wrist-hand Flexor pattern Wrist joints flex and incline to ulnar side, fingers flex and adduct and
thumbs flex and adduct
Lower limbs Extensor pattern Pelvis in injured side rotate back, lift hip joint, flex, adduct and intort it,
flex and inverse knee joint
Ankle Extensor pattern Plantar flexion, strephenopodia, flex and adduct toe
Table 10.3 Improved Ashworth method for assessment of myospasm

Grade Signs
1 Muscle tension is increased slightly and there is resistance suddenly in 50% of the range of joint motion.
After that, there is minimum resistance after 50% of the range of joint motion
II Muscle tension is increased obviously. Most muscle tensions are increased obviously in the range of joint
motion, but the involved part can do passive motion easily
III Muscle tension is increased severely and it is hard to do passive motion
IV the involved part is in contracture state when in passive flexion and extension and cannot move
Table 10.4 Modified improved Ashworth method for myospasm assessment

Grade Signs
I There is suddenly slight reflexive myodynamia in the 50% range of joint motion. The reflexive
myodynamia disappears with the increase of range of joint motion
II There is strong reflexive myodynamia in most range of joint motion, but the involved joint can still do
passive motion
III There is strong reflexive myodynamia in most range of joint motion and the involved joint is difficult
to do passive motion
IV There is reflexive contracture in full range of joint motion. The involved joint is in contracture state
and cannot move when in passive flexion and extension
10.3.2.2 Assessment Method basis to keep various posture of the body and nor-
of Myospasm mal movement. Examination method is to touch
In clinic, the common assessment method of the hardness of the muscle. Under normal cir-
myospasm is improved Ashworth method. cumstance, there is no obvious resistance of joint
Muscle reflex contraction angle induced by in passive motion.
passive flexion and extension of joint is the In the improved Ashworth method for myo-
basis to evaluate the severity of myospasm. spasm assessment, muscle tension is used to
The smaller the joint motion angle of muscle show the muscle contractility of myospasm
reflex contraction is, the more severe the spasm induced by myotatic reflex, which is easily to
is. The detailed assessment standard refers to be confused with the concept of normal muscle
Table 10.3. tension. Therefore, muscle tension of myospasm
Myotatic reflex is reflex contraction due to should be expressed as reflexive myodynamia to
external traction of muscle, which is different differentiate them distinctly. According to this
from muscle tension. Muscle tension is the ten- principle, improved Ashworth method for myo-
sity of muscle in static relaxed state, which is the spasm assessment refers to Table 10.4.
10.3.2.3 Rehabilitation Therapy 2. Motor program reestablishment: Contraction

of Neurological Training degree of agonistic muscle and antagonistic
of Myospasm muscle is adjusted. Spasmodic muscles are
Myospasm induced by CNS injury is the result mainly trained. In upper limbs, the training
of higher central nervous injury. According to the muscle usually is flexor, which means the
mechanism that skillful use and dependence can training of elbow flexion, wrist flexion and
promote brain plasticity and functional reorga- finger flexion. In lower limbs, the training
nization, rehabilitation method of neurological muscle usually is extensor, which means the
training is used to train normal central nervous training of hip flexion, knee extension, foot
cells. Through active movement, normal central dorsiflexion and strephexopodia.
nervous cells around injured area are trained and According to the method of reestablishing
reserved conduction pathway is activated to rees- motor program of single joint, receiving elec-
tablish motor program and then treat myospasm. trode of motor program is placed. Six-step
There is some certain therapeutic effect after Daoyin technique in traditional Chinese med-
clinical application. icine of regulating collaterals is used to guide
the patients to do active joint motion and to
1. Neural potential development training is the try to do anti-resistance. Motor program sig-
training in allusion to spasmodic muscle to nal from brain to agonistic muscle and antag-
recover higher motor neuron function and onistic muscle is received and displayed in a
conduction pathway. curve form. The signal is marked as trans-
(a) Potential development training device is verse line. Daoyin technique is repeatedly
applied for the training: according to used to encourage the patients to surpass the
spasmodic part, regulating collaterals original goal and reestablish normal motor
through meridians or normal six-step program. The effect of the training includes
Daoyin technique is used to guide the two aspects.
patients to do neural potential develop- (a) Development of central nervous poten-
ment training of spasmodic muscles in tial: Daoyin technique and the training
upper limbs, lower limbs or the trunk. The of surpassing goal constantly under anti-
specific method is the same as that in resistance condition are used to gradu-
potential development training of spas- ally develop the number of central
modic muscle. nervous cells that dominate spasmodic
There is 1–2 times a day (30 min per muscle, increase the quality of devel-
time) and there are 30 times in a therapy oped central nervous cells to replace
course. The therapists reevaluate the injured central nervous cells in order to
results after one therapy course. The alleviate muscle spasm.
patients can do the training repeatedly. (b) Actual motor program training with direct
(b) Physical exercise therapy of neurological vision: it can effectively regulate disor-
training: Daoyin technique is used for dered motor program and reestablish it.
active movement, anti-resistance and Disordered motor program is one of the
relaxation training of spasmodic muscle. reasons of joint motion stagnation, and
During the process, manual massage is myospasm. Therefore, motor program
used to loosen adhesion of muscle and reestablishment training can alleviate
soft tissue. muscle spasm to a certain extent. There
There are 1–2 times a day (30 min per are 1–2 times a day (50 min per time) and
time) and there are 30 times in a therapy there are 30 times in a therapy course. The
course. The therapists reevaluate the therapists reevaluate the results after one
results after one therapy course. The therapy course. The patients can do the
patients can do the training repeatedly. training repeatedly.
3. Motor pattern remodeling training is the train-

a
ing to increase movement flexibility and prac-
tical application ability.
(a) Disintegrated movement training is the

training that disintegrate an entire limb
movement into several movements
according to the sequence of joint motion
to decrease the difficulty of limb move-
ment and recover the entire movement
ability of limbs gradually. Disintegrated
movement of drinking through holding a
teacup: the patients sit on a chair and put
upper limbs on the desk. In front of them,
there is a teacup. The therapists ask the
patients to relax and do disintegrated
movement training according to the b
sequence of shoulder joint protraction,
elbow extension, grasping teacup and
elbow flexion. The patients are asked not
to overexert and to make joint motion
orderly (Fig. 10.2a–c). Disintegrated
movement training of walking: The
patients relax mind and body, and stand
up. The space between two feet is as wide
as shoulder. The patients use upper limbs
in the offside of the trained leg to grasp
handrail in case of falling down and ner-
vousness. After that, the patients do the
following disintegrated movement:
Stepping forward: The training is done
according to the sequence of hip flexion, knee c
flexion, foot dorsiflexion and heel landing
(Fig. 10.3a–c). The patients firstly flex hip and
make lower limb step forward, flex knee
slightly, dorsiflex foot and then step down-
ward to make the heel touch the ground.
Bearing load: at the position of heel landing,
the training is done according to the sequence
of hip flexion, knee flexion, foot dorsiflexion
and foot flat landing (Fig. 10.4a, b). The
patients firstly flex hip and make lower limb
step forward, flex knee slightly, dorsiflex foot
and then step downward in the lateral midline
of the trunk to make the foot flat touch the
ground.
Driving leg: at the position of bearing load, Fig. 10.2 (a) Drinking water through holding a teacup 1
(upper limbs protraction). (b) Drinking water through hold-
the training is done according to the sequence ing a teacup 2 (grasping a teacup). (c) Drinking water
of hip flexion, knee flexion, foot dorsiflexion, through holding a teacup 3 (grasping the handle of teacup)
Fig. 10.3 (a) Stepping

forward 1 (lifting lower
a b c
limbs). (b) Stepping
forward 2 (foot dorsiflex-
ion). (c) Stepping forward
3 (heel landing)
Fig. 10.4 (a) Bearing

load 1 (lift lower limbs a b
upward). (b) Bearing
load 2 (foot flat landing)
toe landing and driving leg (Fig. 10.5a, b). the traction, the therapists should observe the
The patients firstly flex hip and make lower patients at any time in case of skin pressure
limb step forward, flex knee slightly, dorsiflex ulcer and affecting blood circulation.
foot and extend hip to make lower limb step (b) The application of temporary orthosis:

backward, go across the lateral midline of the through manipulation and traction, spas-
body, step backward in half step and make toe modic muscle and adhesive tissue are par-
touch the ground like driving leg. tially loosened. In order to prevent retraction
According to the principle mentioned of spasmodic muscle at evening sleep, plas-
above, the therapists can design different ter support, macromolecule fiber orthosis
types of disintegrated movement training and plastic orthosis are used to fix it tempo-
schedule according to the actual dysfunction rarily. With the persistence of the therapy, the
of the patients. There is 1–2 times a day improvement of spasm and the increase of
(30 min per time) and there are 30 times in a range of joint motion, new temporary fixator
therapy course. The therapists reevaluate the should be changed timely to keep therapeutic
results after one therapy course. The patients effect.
can do the training repeatedly. The application time of temporary ortho-
(b) The integrated motor pattern remodeling sis should depend on the recovery degree
training: lower limbs can be trained with of range of joint motion. When the range
the help of abnormal gait rectification of joint motion is recovered to the possible
weight support walking training device maximum, the next therapeutic measures
and upper limbs are trained with the help such as auxiliary autonomous joint motion,
of upper limbs motor pattern remodeling medicine, functional orthosis and surgery are
training device. They can be separately decided according to actual situation. When
used or used at the same time to recover tendon contracture or joint adhesion cannot
the coordination of upper and lower limbs be loosened effectively and myospasm can-
movement. Through using training, the not be relieved, which can affect motor func-
control of central nerve to lower central tion greatly, selective posterior rhizotomy
nerve is recovered and finally muscle can be applied.
spasm is relieved. There is 1–2 times a (c) Physiotherapy: Thermotherapies such as

day (45 min per time) and there are 30 infrared, kerotherapy and microwave can
times in a therapy course. The therapists inhibit myospasm. Cold therapy such as long
reevaluate the results after one therapy time cold compress and soaking in ice water
course. The patients can do the training can inhibit spasm. Because the elder is intol-
repeatedly. erant to the cold and cold has bad effect on
4. Other therapies include the therapy methods the angiocarpy and kidney, it is not suitable
such as traction to relieve myospasm, massage for the elder. Electrical stimulation includes
and physiotherapy. spasmodic muscle stimulation, antagonistic
(a) Skin traction: Small dose constant skin muscle stimulation and functional electrical
traction has a certain effect on relieving stimulation. Low frequency electric stimula-
adhesion and contracture of muscle, ten- tion is mainly used to induce intense muscle
don and other soft tissues. It can be done contraction and the muscle enters into refrac-
at night, which can figure out the problem tory period, which can relieve spasmodic
that the therapists’ manipulation loosen muscle. The refractory period sometimes
time is limited and traction in daytime lasts several hours. The effect of functional
affects other rehabilitation trainings. electrical stimulation is the best.
The dose of skin traction is 3–5 kg. The The therapies mentioned above can be
time of one therapy course is 2–3 week. In done once a day (2–3 kinds of therapies a
Fig. 10.5 (a) Driving

leg 1 (lift lower limbs a b
backward). (b) Driving
leg 2 (toe landing and
driving leg)
day) for three weeks according to the specific

References
condition of the patients.
(d) Massage and acupuncture: massage and
1. Zhaosu W, Chonghua Y, Dong Z. Epidemiological
manipulation can loosen adhesion of muscle study of stroke morbidity and mortality in Chinese
and soft tissue. Acupuncture can relieve mus- population. PLoS. 2003;24(3):236–9.
cle spasm to a certain extent. 2. Dinghua F, Maobin W, Dameng H, Hu DM, et al. A
study of early rehabilition of stroke. Chin J Rehabil
The therapies mentioned above can be used as Med. 2001;16(5):266–72.
support measures of active movement training to 3. Yongshan H, Yulian Z, Peijun Y, et al. The effects of
improve the effect of active movement training. If early rehabilitation on motor function in hemiplegics
they are used alone, the effect of relieving muscle after stroke. Chin J Rehabil Med. 2002;17(3):145–7.
4. Xiaohong W. The application of the continuous pas-
doesn’t last long. Only if higher CNS functions sive active activity trainer (CPM) in the lower extrem-
are recovered, muscle spasm due to CNS injuries ity of the lower extremity in clinical rehabilitation.
can be relieved at last. Chin Foreign Med Res. 2011;9(36):161–3.
of Neurological Training of Facial 11
Paralysis
11.1 M
ain Dysfunctions of Facial lead to ischemia and anoxia of local tissue.
Paralysis Someone think that it is related to virus infec-
tion [2]. However, until now, no one can isolate
11.1.1 Pathogenesis and Dysfunction virus. In recent years, some reports think that it
Characteristics of Facial may be a immunoreaction. Ramsay-Hunt
Paralysis Syndrome is induced by infection of herpes
zoster virus and inflammation of geniculate
Facial paralysis is vulgo of facial neuritis and ganglion and facial nerve.
facioplegia, which is also called Bell disease [1]. In short, the factors that can affect func-
It is non-purulent inflammation of facial nerve, tional nucleus of facial nerve and neural axon
which usually occur in winter and spring. The functions can lead to dysfunction of facial
pathological change is neural edema, degenera- muscles dominated by them such as infec-
tion of myelin sheath and axon to varying degrees. tious, compressive, traumatic, physical and
The patients are recovered to varying degrees in 2 neurogenic factors.
months after disease attack and some patients are Infectious factor accounts for 42.5% of the
recovered 1 year later. Some got persistent total number. It is the herpes zoster virus in
sequelae. dormant state, which usually hides in sensory
ganglion of facial nerve. The virus is activated
1. Causes: Facial neuritis can be induced by vari- when local immunity is low. It can also be
ous factors. induced by inflammatory diseases such as
Facial neuritis usually is induced by cranial meningitis, mumps, influenza, scarlet fever,
nerve diseases. This may be because facial malaria, multiple cranial neuropathy, local
nerve canal is a long bony pipeline. If petrosal infection and otogenic infection (otitis media,
bone develops abnormally, there usually is labyrinthitis, mastoiditis).
facial nerve canal stenosis, which is the internal Compressive factor can induce facial neu-
pathogenic factor of facial neuritis. The external ritis, which is usually observed in tumors such
pathological factor of facial neuritis remains as acoustic neuroma, parotid gland and pri-
unclear. The early pathological change is mary acquired cholesteatoma and accounts
edema of facial nerve, degeneration of myelin for 5.5% of the total number.
sheath and axon to varying degrees. The reason The common traumatic factors of facial
may be that cold air blast induces nutritional paralysis include temporal bone fracture,
microvascular spasm of facial nerve and then facial trauma, surgery and injection of
https://doi.org/10.1007/978-981-13-0812-3_11
328 11 Rehabilitation Therapy of Neurological Training of Facial Paralysis
eurotoxic drug in facial nerve distribution

n droop, stretching face to offside, lacrimation
area and account for 8.2% of the total patients. or salivation.
Neurogenic facial paralysis accounts for The dysfunctions are different in different
13.5% of the total patients, which is usually injured part of facial nerve. It can be summa-
induced by cerebrovascular disease, ence- rized as follows:
phalic and non-traumatic neurogenic disease. (a) Facial nerve branch below stylomastoid
If cold wind blows the face for a long time, foramen is injured, which can induce
undercooling in face can directly stimulate peripheral facial paralysis. The main
local nerve trophic vessels and induce spasm, manifestations are forehead wrinkle dis-
which can induce ischemia and edema of neu- appearance in injured side, unable to crin-
ral tissue and dysfunctions. It is the common kle forehead and frown, palpebral fissure
factor to induce facial paralysis. enlargement, unable to close or close
In addition, poisoning, metabolic distur- incompletely, Bell syndrome (eyeball
bance such as diabetes mellitus and vitamin rotate upward and outside when closing
deficiency, vascular function insufficiency eyes and white sclera is exposed), nasola-
and congenital facial nucleus hypoplasia is bial groove becoming shallow, corner of
one of the pathological factors. the mouth skews to uninjured side, corner
2. Types: Facioplegia is divided into peripheral of the mouth deviate to uninjured side
type and central type. The majority is periph- when exposing teeth, air leakage in agitat-
eral type. ing cheek or whistle, food retention in
(a) Central type is paralysis of muscle in teeth buccal space when eating.
lower part of the face on the offside of (b) Facial nerve branch above tympanic cord
lesion induced by injury of supranuclear is injured. Besides peripheral facial paral-
tissue includes cortex, cortex and brain- ysis, there is dysgeusia in two third front
stem fiber, medullary triangle and pons, of tongue in the ipsilateral.
which are usually observed in cerebrovas- (c) Facial nerve branch above stapedius is
cular disease, brain tumor and injured. Besides peripheral facial paralysis
encephalitis. and dysgeusia in two third front of tongue
(b) Peripheral type is paralysis of all facial in the ipsilateral, there is hyperakusis.
muscles in the ipsilateral of the lesion (d) Geniculate ganglion is injured. Besides
induced by injury of facial nerve nucleus peripheral facial paralysis, dysgeusia in
or facial nerve, which is usually observed two third front of tongue in the ipsilateral
in catching cold, ear or meninx infection, and hyperakusis, there is pain in mastoi-
peripheral facioplegia induced by neurofi- dea, hypaesthesia of auricle and external
broma. In addition, there is dysgeusia in auditory canal, herpes of external audi-
the front two third of tongue and unclear tory canal or tympanic membrane, which
speaking. is called Hunt syndrome [3].
3. Dysfunctions mainly are motor and sensory 4. Sequelae: Facial dysfunction still exists half a
dysfunctions of facial muscle. year after the disease.
According to the motor dysfunction part of The main signs include no raising eye-
facial muscle, there are different clinical man- brow movement or incomplete raising
ifestations such as palpebral fissure enlarge- eyebrow movement, incomplete opening

ment, unable to frown or close eyes, forehead eyes, corner of the mouth going upward
wrinkle disappearance, grinningly, agitating when raising eyebrow, stretching the corner
cheek and unable to whistle. There are also of the mouth when closing eyes, eyes becom-
clinical manifestations such as forehead wrin- ing small when agitating mouth (synkinetic
kle disappearance, palpebral fissure enlarge- movement of mouth and eye), shallow
ment, nasolabial groove becoming shallow, nasolabial groove, facial stiffness, food

11.2 The Mechanism and Method of Rehabilitation Therapy of Facial Neuritis 329
retention, tears, secondary prosopospasm uninjured side are 3. The score is 2, which
and denervated muscle atrophy. stands for weak movement. The score is
Sequelae are due to delay of the illness or 1, which stands for slight movement. The
improper therapy method. Some reports deem score is 0, which stands for autokinetic
that half a day after attach is the best therapeu- movement inability. In addition, there are
tic opportunity. Nerve in injured side is not 2 score for impression. The score of com-
recovered timely, which lead to incomplete pletely normal is 20. Scoring scale refers
conduction of neural impulse or conduction to Table 11.2.
generalization. In addition, some sequelae are (b) Portmann assessment standard.
due to irreversible injury of facial nerve. –– Completely recovery (more than 17).
–– Partially recovery (16–14).
–– Just good (13–10).
11.1.2 Functional Assessment –– Bad (less than 9).
Method of Facial Paralysis
The lower the score is, the more severe the
International functional assessment methods of disease is.
facial paralysis are House-Brackmann assess-
ment method and Portmann simple measuring
scale. 11.2 T
he Mechanism and Method
of Rehabilitation Therapy
1. House-Brackmann assessment method [4] is of Facial Neuritis
divided into six grades (Table 11.1).
Assessment standard of therapeutic effect 11.2.1 The Mechanism
of House-Brackmann: six grades assessment of Rehabilitation Therapy
standard of facial nerve of House-Brackmann of Facial Neuritis
facial nerve are as follows:
–– Grade I: Normal. Facial muscle includes orbicularis, masticatory
–– Grade II: There may be slight asymmetry muscle and mimetic muscle, which are the same
in the facial movement functions and slight as muscles of the trunk that are controlled by
synkinetic movement. motor center of brain cortex. They can generate
–– Grade III: There is obvious asymmetry and voluntary movement. Therefore, promotion of
secondary defect, but there is still move- CNS plasticity [5] and functional recovery, acti-
ment in frontal part. vation of reserved conduction pathway are suit-
–– Grade IV: There is obvious asymmetry, but able for recovering lost motor functions after
there is no movement in frontal part. injuries of functional nucleus of facial nerve or
–– Grade V: There is merely slight movement facial nerve fiber.
in the face. In clinical therapy, there is usually of volun-
–– Grade VI: the paralysis is complete and tary autonomous movement of facial muscle,
there is no movement. The higher the grade which is neglected because they are not obvious
of House-Brackmann is, the better the as joint motion. The therapeutic methods usually
functional recovery of facial nerve is. are passive methods such as medicine, physio-
2. Portmann score: The full mark of this score is 20. therapy, acupuncture, massage, sunken cord and

(a) Specific assessment method: Simple surgery in the late phase.
assessment method of Portmann includes Although the potential ability of neural fiber
six autokinetic movements such as frown, (nerve trunk) is not so good as functional nucleus
closing eyes, moving wing of nose, smil- of central nerves, they also have reserved con-
ing, whistle and blowing cheek. The duction pathway, because one nerve trunk
scores of movement in injured side and includes many neural fibers. In addition, there is
Table 11.1 House-Brackmann functional assessment form of facial paralysis

Percent Clinical symptoms
of normal
Dysfunction function
Grade degree (%) Normal condition Rest Movement Secondary defect
I None 100 The function of facial The function of The function of facial The function of
muscle is normal facial muscle ismuscle is normal facial muscle is
normal normal
II Slightly 99–75 Mild myasthenia after normal Forehead movement There is slight
close examination Symmetry is partially normal or facial synkinetic
muscle tension completely normal. movement. There is
Closing eyes is no conbundleure or
normal regardless of spasm of face in
the force paralytic side
III Slight and 75–50 There is significant normal There is slight or no There is obvious
medium but non-disfigured Symmetry forehead movement non-disfigured
difference between muscle tension and there is synkinetic
two sides and there is asymmetry when movement. There is
no functional closing eyes with conbundleure or
impairment. There is force spasm in Grade
usually non-severe III. There is
synkinetic movement, voluntary
conbundleure and (or) movement in Grade
spasm of face in II
paralytic side.
IV Medium 50–25 There is obvious Normal There is slight or no There are spasm
and severe inability and (or) Symmetry forehead movement. and synkinetic
disfigured asymmetry muscle tension The patients cannot movement in Grade
close eyes with force. IV regardless of
There is symmetry severe impairment
movement in corner of autonomous
of the mouth movement
V Severe 25–1 There is merely There may be There is no There is no
observed movement distortion of movement in synkinetic
commissure, forehead. The movement but
asymmetry in patients cannot close there are
two sides. eyes or can do slight conbundleure and
Nasolabial eyelid movement spasm of facial
groove in one with greatest force. muscle in paralytic
side become There is slight side
shallow or movement in the
disappear corner of mouth
VI Completely 0 There is no tension, Non Non Non
paralyzed movement, symmetry,
synkinetic movement,
conbundleure or
spasm of face in
paralytic side
overlap domination phenomenon in the nerve. forward into abdominal wall and distributes in
For example, fiber end of intercostal nerve in the the skin of abdominal muscle and abdominal
third thoracic vertebra is involved in the domina- wall. Therefore, if the lower intercostal nerves
tion of intercostal nerve in the fourth thoracic and subcostal nerves are stimulated, they can
vertebra. Forepart of five pairs of intercostal induce reflex tonus of muscles in abdominal wall
nerves and subcostal nerves from the bottom, go and skin pain. In abdominal surgery, if too many
Table 11.2 Portmann simple scoring scale

The same as There is slight There is no autonomous Impression
Items uninjured side Weaken movement movement score Normal
Scoring standard 3 2 2 0 2 20
Frown
Closing eyes
Moving wing of nose
Smile
Whistle
Plumping cheek
lower intercostal nerves are cut off, there will be During this process, preventing or decreasing
paralysis of muscles in abdominal wall of domi- facial synkinetic movement is good for the
nated area, cutaneous sensation bluntness or dis- rectification of synkinetic movement of mus-
appearance. Therefore, peripheral nerves also culus facialis. Therefore, recovery of coordi-
have reserved functions and potential ability to nated movement of musculus facialis is
be developed. In addition, peripheral nerves have suitable for three-stage rehabilitation method
strong regeneration ability. of “neural potential development, motor pro-
Promotion of CNS plasticity and functional gram reestablishment and motor pattern
recovery, activation of reserved conduction path- remodeling”, which is called three-stage reha-
way are suitable for recovering lost motor func- bilitation method of musculus facialis move-
tions after injuries of functional nucleus of facial ment in order to be distinguished from
nerve or facial nerve fiber. three-stage method of motor pattern training
of limbs.
1. Musculus facialis is the muscle of voluntary 3. The basis of developing facial nerve potential
movement. Musculus facialis can complete is reserved neural cells and nerve fiber bun-
active movement under the domination of dles. Electrical signal from CNS to the domi-
somatic nerve. Therefore, through the training nated muscle is the most effective stimulus of
of promoting the active movement of muscu- activating neural reserved conduction path-
lus facialis, the lost functions due to injuries way. As mentioned above, nerve trunk
of facial nucleus and other neural fibers can be includes many nerve bundles and nerve bun-
recovered, which is in accordance with the dles are composed of numerous neural fibers
mechanism of promoting CNS plasticity and (Fig. 11.1).
functional reorganization.
2. Synkinetic movement of musculus facialis is The injury of nerve trunk doesn’t mean all the
abnormal motor pattern. Motor function nerve bundles are injured. Through training,
nucleus of CNS can give out electrical signal incompletely injured nerve bundle can be recov-
to control voluntary conbundleion of muscle. ered. In addition, human tissues have a great res-
The electrical signal is given out sequentially ervoir so that nerve bundle in nerve trunk is
and orderly. The formation of synkinetic enough to recover functions. Under normal cir-
movement of musculus facialis is the same as cumstances, because the motor degree and inten-
synkinetic movement of limbs. The basis is sity are different, the number of activated nerve
disordered motor program in motor center. bundles is different. The rest are still in standby
Therefore, it should be reestablished through state. These reservations are the potential ability
motor program reestablishment technique. of nerve trunk. Therefore, when the nerve trunk
Through motor pattern remodeling technique, in not injured completely, it is possible to be
facial movement is coordinated and orderly. recovered and the reserved nerve bundle is
nerve fiber
endoneurium
nerve trunk
perineurium
artery
epineurium
vein
Fig. 11.1 Basic structure of nerve trunk
p ossible to be activated. Active movement is the nerve bundle, the intensity is not enough to
effective method to recover and activate func- induce muscle contraction needed for movement
tions of nerve bundle. Daoyin technique is and bioactive substance (some kind of inducible
applied to encourage the patients to try to do anti- factor) can be increased through feedback mech-
resistance in order to induce autonomous con- anism. The effect of this factor is to activate nerve
traction of facial paralytic muscles. Musculus bundle in dormant state to replace injured nerve
facialis contraction signals from brain cortex or bundle to play conduction functions and recover
facial nucleus are increased. The increase of this neural functions.
signal has the following effects: electrical signal
from central nerves can promote the conduction
functions of nerve trunk. Inherent muscle con- 11.2.2 The Method of Rehabilitation
traction driven electrical signal form neural Therapy of Facial Neuritis
nucleus is suitable for the current in nerve bun-
dle. The current intensity and frequency can be Because central facial neuritis in the early phase
accepted by nerve bundle and the orientation the requires management of neurology or
current is from inward to outward to promote neurosurgery, it is not discussed in this chapter.
recanalization of injured part of nerve bundle. After therapy, remaining motor and sensory dys-
External stimulus such as acupuncture and elec- function refer to rehabilitation therapy of recov-
trical stimulus can generate impulse that is from ery period and chronic period of facial neuritis.
outward to inward. It is not physiological signal At present, there are many methods to treat
so that it is not suitable for the conduction in facial paralysis such as hormone, neurotrophic
nerve bundle. It not only can recover neural func- medicine, physics, surgery, acupuncture, partial
tions, but also emphasizes on the recovery of sen- closure, sunken cord, passive massage of facial
sory function, which has no effect on the recovery muscle. Among these methods, simple medicine
of motor functions. In dangerous situation, ner- therapy is not good and most patients reject hor-
vous system may generate some kind of induc- mone therapy. Operative therapies include facial
ible factor to activate reserved nerve bundle in nerve decompression, facial nerve transplanta-
order to replace the injured nerve bundle. When tion and facial nerve anastomosis. Because the
the cells of neural nucleus generate electrical sig- surgical trauma is severe and there is certain
nal or give out electrical signal through residual risk, it cannot be widely applied in clinic. In
some reports, acupuncture and acusector have inflammation, eliminate edema and accel-
good therapeutic effects, but most scholars erate tissue repair.
deem that the doctors should choose proper Specific therapeutic method: The
therapeutic opportunity. For example, in acute power of normal far infrared ray lamp is
phase, acusector can lead to sequelae such as 250–300 W. The distance between injured
musculus facialis spasm [6]. In addition, there musculus facialis and stylomastoid fora-
are 26 facial muscles. They interlap with each men is 30–50 cm. There is slight heat or
other with different functions. Acupuncture, warm heat. The frequency of musculus
acusector, partial closure, sunken cord or surgi- facialis is 15–20 min per time and the fre-
cal therapy can easily damage facial muscle, quency of stylomastoid foramen is
even muscular hemorrhage, fibrosis and inflam- 10–15 min per time. There is 15 times in
mation response. Some research indicate that it one therapy course (one time a day). It can
is impossible to recover active motor functions be applied persistently.
of musculus facialis through simple facial mus- During therapy, the thermal insulation
cle massage. pad should be covered on the eyes in case
of ocular damage.
11.2.2.1 Rehabilitation Therapy (b) Ultrashort wave: Ultrashort wave can ease
in Acute Phase pain, improve microcirculation, diminish
The clinical stages of facial neuritis are different. inflammation, sterilize bacteria, promote
Generally, the acute phase is 2 weeks after facial wound healing, promote regeneration of
neuritis. The recovery period is from 2 weeks to incompletely injured neural fiber to elimi-
1 month. The sequelae is more than 1 month. nate inflammation of facial nerve canal
Someone think that half a year or more than 2 and mucosa edema and promote recovery
years is defined as the sequelae. The clinical of neural functions and lost motor
stages are to instruct therapy and ascertain the functions.
therapeutic opportunity of facial nerve. The char- Specific therapeutic method: Ultrashort
acteristics of acute phase are the progressive dis- wave of the five sense organs is used. The
ease. Timely and effective therapy can increase diameter of round capacitor electrode is
cure rate and decrease disability rate. 4–8 cm. Stylomastoid foramen in injured
side is concatenated with eye part. Air dis-
1
. Anti-inflammatory, detumescence and tance space is 0.5–1.0 cm. There is no
increasing local blood circulation: The thera- heat. The frequency is 6–10 min per time
peutic purpose in acute phase is to eliminate (one time a day) and there is 15 times in
inflammation and alleviate mucosa edema of one therapy course. Through 3–5 days’
facial nerve canal in order to eliminate the rest, the second therapy course can be
injury of facial nerve from facial nerve and done.
alleviate compression of facial nerve. (c) Medium frequency electrotherapy modu-
For the early compression of facial nerve, lated by low frequency (computerized
medicine, acupuncture, ultrashort wave, far modulated medium frequency): Medium
infrared rays and injection around stylomas- frequency electrotherapy can ease pain,
toid foramen are used for the therapy. promote blood circulation, diminish
(a) Far infrared rays: Far infrared rays is used inflammation, loosen adhesion and pre-
to improve local blood circulation, vent scar formation. Medium frequency
increase metabolism, increase immune electrotherapy modulated by low fre-
function, enhance stability of cell mem- quency has the characteristics of low fre-
brane, promote elimination of toxic sub- quency and medium frequency and can
stance and metabolite, accelerate stimulate skeletal muscle contraction. It
absorption of exudate, control has slight stimulation effect on cutaneous
sensory nerve ending and there is no elec- to pinch and rub outside. There is 1–2
trolytic action, which can be used for a times (10–15 min) a day and 10–20 times
long time. The current is deep, which is in one therapy course.
good for the therapy of deep lesion. (g) Physiotherapy is the associated applica-
Specific therapeutic method: The tion method of rehabilitation technique of
diameter of round electrode is 2 × 5 cm neurological training. Generally, far infra-
(eye electrode). Stylomastoid foramen red rays, ultrashort wave, medium fre-
area is concatenated with the front of ear. quency and facial massage are used. In the
Tolerance dose, bidirectional pulse and early phase of the disease, acupuncture
amplitude are increased and decreased therapy should be used and the author
gradually. The frequency is (modulated thinks that there is a certain therapeutic
wave) is 100–150 time in 1 min. There is effect. The times of therapy course should
one time (10–20 min) a day and ten time be observed, because too many acupunc-
in one therapy course. ture can induce muscle spasm, corners of
(d) He-Ne Laser irradiation: In elementary
the mouth deviating to injured side.
beam irradiation, the distance between The therapists should ask the patients
stylomastoid foramen and temple is to keep the face warm and do standard
20–30 cm. The power is l0 mW. If the therapy timely in case of sequelae because
power is 3–6 mW, contaction irradiation of incomplete therapy.
can be used. The diameter of beam is 2. Recovering autokinetic movement of muscu-
0.5 cm. There is one time (3–5 min) a day lus facialis and preventing tissue adhesion and
and 7–10 times in one therapy course. facial deformity: The best method of recover-
• Microwave therapy: round radiator is ing autonomic nerve innervation of musculus
selected and the center points to the facialis is to develop functional nucleus of
space between the front of ear and facial nerve and potential ability of nerve bun-
mastoid process. The distance is 10 cm. dle through active movement training. On the
The dose is no heat or slight heat. There basis of regulation of mind and breathing,
is one time (10–15 min) a day and ten neurological training is active movement
times in one therapy course. training with definite target and has good ther-

(e) Acupuncture therapy: Acupoints are apeutic effect, which is better than self-
Taiyang, Dicang, Yangbai, Yingxiang, exercise and normal autonomous movement
Xiaguan, Jiache, Hegu and Lieque. The exercise or training.
therapists select 3–4 acupoints every time Neurological training includes physical
with medium stimulation. The needle is exercise therapy of neurological training
kept for 10–20 min and is twiddled for (bare-handed operation method), neurological
3–5 times. There is one time a day and training (six-step Daoyin technique training
7–10 times in one therapy course. under the detection of motor program signal)
Electrical acupuncture can also be used. and training method of virtual reality.
(f) Massage therapy: Touching, pressing, According to the actual situations that facial
pinching, rubbing, holding and trembling muscle is small and is distributed complicat-
are used for paralytic muscle or selecting edly, it is difficult to place signal acquisition
acupoint along channel. In early phase, electrode, pin electrode is not suitable to be
the manipulation is slight in case of neural used repeatedly and it is not easy to extract
injury because of too great force. The motor program signal of training muscle, dur-
patients can do massage by themselves. ing training, it is to detect the movement part
They use hand in the offside of facial of motor signal, place receiving electrode and
paralysis, wash it clean, put thumb into set a surpassing goal associated with muscle
mouth, use index finger and middle finger movement.
The training of facial active movement (a) Physical exercise therapy of neurological
includes raising eyebrow, wrinkling one’s training of musculus facialis is bare-
forehead, frowning, opening eyes, closing handed manipulation method of six-step
eyes, pulling up the corner of mouth, exposing Daoyin technique in traditional Chinese
teeth, pouting one’s lips and sucking. Involved medicine. The training is done according
muscles include Occipitofrontalis muscle, to start-stop and line feed of musculus
orbicularis oculi muscle, zygomaticus major facialis.
or minor, Albinus’ muscle, orbicular muscle Operational approach: In supine position,
of mouth, nasalis, levator labii superioris, the patients lie in therapy bed. In order to
depressor labii inferioris and buccinators. decrease the friction of face, the therapists
The starting and ending points, effect and can wear rubber gloves and smear a little
innervation of facial muscle refer to Table 11.3 cream or liquefied petrolatum on the gloves
and Fig. 11.2. and face. On the basis of regulation of mind
Table 11.3 The starting and ending points, effect and innervation of facial muscle
Muscle
group Name Starting point ending points Main effect innervation
Facial Occipitofrontalis Frontal belly: galea Frontal skin Raise eyebrows and Temporal branch
muscle muscle aponeurotica wrinkle forehead (VII)
Occipital belly: neck Galea Pull back scalp Auricular branch
line of the occipital aponeurotica (VII)
bone
Orbicularis oculi Face: around palpebral fissure Blink, close eyes, Temporal branch,
muscle Pars orbitalis: around orbit expand lacrimal sac zygomaticus (VII)
Lacrimal part: from lacrimal sac to face to discharge tear
Nasalis Transverse part: canine teeth of upper jaw Narrow nostril, Buccal branch (VII)
bone and teeth of second incisor expand nostril
Alar part of groove process: facies
lateralis of nasal alar cartilage
Orbicular muscle Around schistostoma Close schistostoma Buccal branch and
of mouth marginal mandibular
branch (VII)
Levator labii The orientation of The skin of the Raise upper lip Rami zygomatici and
superioris upper lip corner of mouth buccal branch (VII)
Zygomaticus Raise the corner of Rami zygomatici
mouth (VII)
Albinus’ muscle Parotid masseter Pull outside the Buccal branch and
muscle fascia corner of mouth marginal mandibular
branch (VII)
Depressor anguli The orientation of Lower the corner of Marginal mandibular
oris lower lip mouth branch (VII)
Levator anguli Below infraorbital Raise the corner of Buccal branch (VII)
oris foramen mouth
Depressor labii The orientation of Lower the corner of
Inferioris lower lip mouth and lower lip
Buccinator Deep part of cheek Make lip and cheek
close to teeth to chew
and suck
Mentalis Second incisor of lower Skin of mental Raise skin of mental Marginal mandibular
jawbone and alveolar region region to put upper branch (VII)
process of central lip forward
incisor
occipitofrantalis
corrugator
supercilii
orbicularis oculi
levator labii
superioris
alaeque nasi
levator labii
superioris
zygomaticus
nasalis
major
orbicularis oris
risorius masseter
depressor labii
inferioris
mentalis
Fig. 11.2 The distribution of facial muscle
and breathing, the patients are guided to tance orientations of muscles are as
raise eyebrow, wrinkle forehead, open eyes, follows:
close eyes, pull outside the corner of mouth, The training of opening eyes and wrinkling
close schistostoma, expose teeth, pout and forehead: The involved muscle is occipital
suck. During the training, in the ending of frontalis. The press part of the finger is supe-
training muscle, the therapists use finger rior border of geisoma. The anti-resistance
belly to press the muscle and pull the muscle orientation is downward form eyelid
in the negative direction of muscle contrac- (Fig. 11.3). The effect is to recover the func-
tion to complete anti-resistance training. tions of wrinkling forehead and opening eyes.
The patients are guided to persist for 6 s. The training of closing eyes: The involved
After completing one movement, the thera- muscle is orbicularis oculi muscle. The press
pists use palm or finger belly to do massage part of the finger is lower and upper orbit. The
of training part in order to loosen tissue and therapists use thumb and finger to enlarge eye-
increase blood circulation. The anti-resis- lid from above and below to increase resis-
tance (Fig. 11.4). The effect is to recover the effect is to recover the functions of raising the
functions of closing eyes. corner of mouth upward and outside to rectify
The training of raising the corner of mouth: distortion of commissure to uninjured side.
The involved muscle is levator anguli oris, The training of exposing teeth: The
zygomaticus major and minor and involved muscle is levator labii superioris and
Albinus’muscle. The press part of the finger is depressor labii inferioris. The press part of the
outside and upward side of the corner of finger is upper and lower lip. The therapists
mouth. The therapists use finger to exert force use thumb and finger to exert force upward
inward and downward along the corner of and downward of schistostoma to increase
mouth to increase resistance (Fig. 11.5). The resistance (Fig. 11.6). The effect is to recover
Fig. 11.5 The training of raising the corner of mouth

Fig. 11.3 The training of opening eyes and wrinkling
forehead
Fig. 11.4 The training of closing eyes Fig. 11.6 The training of exposing teeth
the functions of moving the corner of mouth The training of twitching one’s nose: The
upward and downward. involved muscle is nasalis. The press part of
The training of holding one’s jaw: The the finger is two side of the front of nose
involved muscle is orbicular muscle of mouth. wing. The therapists use finger to increase
The press part of the finger is the above and resistance to the two sides of nose wing
below of upper and lower lip. The therapists (Fig. 11.10). The effect is to recover the con-
use thumb and finger to exert force upward trol ability of enlarging or narrow nostril.
and downward of schistostoma to increase In clinical application, according to the
resistance (Fig. 11.7). The effect is to recover results of functional assessment, the thera-
the functions of holding one’s jaw to prevent pists find out the main obstacles and use the
non-autonomous overflow of oral content trainings mentioned above. The patients can
such as salivation and rice grain falling. do the training of three parts every time alter-
The training of sucking: The involved mus- natively (15 min for each part). There is one
cle is buccinators. The press part of the finger time a day (45 min) and there are 66–90
is upper and lower lip. The therapists use times in one therapy course.
thumb and finger to exert force upward and (b) Neurological training: Six-step Daoyin tech-
downward of schistostoma to increase resis- nique training is under the detection of motor
tance (Fig. 11.8). The effect is to make lip and program signal.
cheek close to teeth to decrease oral cavity. According to the start-stop and line feed
The effect is to recover the functions of chew- of musculus facialis, the therapist use fas-
ing and sucking. tener electrode or 3M electrode that is cut
The training of pouting: The involved mus- small and paste electrode according to the
cle is mentalis. The press part of the finger is location demonstrated in Figs. 11.11, 11.12,
chin. The therapists use thumb and finger to 11.13, 11.14, 11.15, 11.16, 11.17, and 11.18.
exert force downward to increase resistance If it is not fastened stably, the therapists can
(Fig. 11.9). The effect is to close upper and use non-woven fabrics adhesive tape to fix it.
lower lip further and pout forward. Daoyin technique is used to encourage the
Fig. 11.7 The training of holding one’s jaw Fig. 11.8 The training of sucking
Fig. 11.11 The training of opening eyes and wrinkling

forehead (occipitofrontalis muscle)
Fig. 11.9 The training of pouting
Fig. 11.12 The training of closing eyes (orbicularis oculi

muscle)
Fig. 11.10 The training of twitching one’s nose
Fig. 11.13 The training of raising the corner of mouth

Fig. 11.15 The training of holding one’s jaw (orbicular
(zygomaticus)
muscle of mouth)
Fig. 11.14 The training of exposing teeth (levator anguli

oris)
Fig. 11.16 The training of sucking (buccinator)
Fig. 11.19 Double screen training method
Fig. 11.17 The training of pouting (mentalis)

display motor program signal real-timely.
Initial or last signal intensity baseline is
regarded as the target line. Daoyin technique
is used repeatedly to encourage the patients
to surpass new goal and increase signal
intensity of agonistic muscle. During the
process of developing facial nerve potential
and enhancing myodynamia, autonomous
motor function of the muscle can be
recovered gradually.
Double screen method can be used for
neurological training therapy of musculus
facialis. The motor program signals from
injured and uninjured muscle are detected
and the signal form uninjured muscle is used
as target to guide the patients to do surpass-
ing training of autonomous movement of
injured muscle (Fig. 11.19).
(c) Virtual reality training of neurological train-
ing is that virtual reality training equipment
of neurological training is used in this
Fig. 11.18 The training of twitching one’s nose (oculo- training.
nasal muscle) Because there are many small pieces of
musculus facialis, it is difficult to paste single
patients to complete designed contraction muscle electrode. Moreover, face is not suitable
training of musculus facialis and neurological to be pasted with electrode with binding agent
training equipment is used to receive and repeatedly in case of skin injury. In addition, it
is hard to do anti-resistance training of then are accumulated. Acid metabolite can

musculus facialis. The training progress takes a stimulate local neural ending and induce sore-
long time and the patients cannot see the ness, numbness, dysesthesia and stiffness.
increase of the signal for a long time, which Manual massage can increase local tissue
can affect the confidence of therapy. blood circulation, promote exclusion of
Virtual reality training can figure out these metabolite, loosen adhesive tissue and extend
problems well. Virtual increased signal can contracture muscle in order to alleviate facial
make the patients see the progress of the therapy. discomfort and distortion.
Although the signal is virtual, it can develop Because of the beauty of the face, facial
neural potential because the patients actually do massage and tissue loosening should be gentle
the anti-resistance and surpassing training with and with proper force. The therapists can smear
definite goal in the training process. cream on the face such as paroline and facial
The virtual reality training and neurological cleanser to alleviate abrasion of facial skin.
training can be combined, which is one kind of Facial massage and tissue loosening are
good rehabilitation training. It can not only the common manipulations. On-the-point
make the patients know the actual situation and pressing includes finger on-the-point pressing
change of motor program signal, which is good and palm on-the-point pressing. Finger
for the formulation of therapeutic schedule and on-the-point pressing is that the therapists use
training with a purpose, but also can compensate thumb or finger prominence of index finger
the defect that actual motor program signal and middle finger to press the face or acupoint
cannot endure for a long time and may affect of the patients. Palm on-the-point pressing is
the therapeutic enthusiasm easily. The that the therapists use palm or heel of hand to
combined way is that the neurological training press the face of the patients. Touch method is
is once a week and virtual reality training is 4–5 that the therapists put finger or palm on face
times a week. There are 50 min per time and and do massage in straight line or in a loop,
66–90 times in one therapy course. which includes finger touch method and palm
(d) Massage and loosening of musculus facialis touch method. Finger touch method is that the
can increase blood circulation of facial tissue therapists adduct four fingers and use finger
in paralytic side, loosen tissue adhesion and pulp of index finger, middle finger and ring
alleviate facial distortion. finger to touch the patients. The movement
Paralysis of musculus facialis can lead to should be gentle and rapid. The frequency is
myodynamia asymmetry in two sides of facial 120–160 times per min. Palm touch method is
muscle. Facial tissues are stretched by the that the therapists use the center of the palm to
muscles in uninjured side to uninjured side, touch the patients in a loop. The movement
which form facial distortion. At this time, the should be gentle and slow. The frequency is
muscle in paralytic side is lengthened and the about 180 times per min. The speed of finger
muscle in uninjured side is shortened. They touch method is faster than that of palm touch
all lose the proper initial length and affect dia- method. The force of palm touch method is
stolic and systolic function of facial muscle greater than that of finger touch method.
further in case of adhesion between muscle Kneading is that the therapists use thenar
fibers or muscle fiber and peripheral tissue. eminence and heel of the hand to press the
They can further affect muscle contraction lesion part and knead the patients in a circle
and rectification of facial demormity. round gently and mildly with force, which
Therefore, rehabilitation therapy of facial includes finger kneading, thenar kneading and
paralysis includes therapy of the injured side heel of hand kneading. Finger kneading is that
and therapy of the uninjured side. the therapists use thumb (single finger
In addition, because muscular movement is kneading), index finger and middle finger
decreased, the local blood circulation is poor. (double-finger kneading) or index finger,
Metabolite cannot be excluded timely and middle finger and ring finger (three-finger
kneading) to knead the patients to and fro. musculus facialis is that the patients do active
Thenar kneading is that the therapists use exercise of muscle contraction through facial
thenar eminenceto press on the face and knead movement. The patients sit before the mirror
it in a circle round. Heel of hand kneading is and use six-step Daoyin technique to raise
that the therapists use heel of hand to press on forehead (occipital frontalis), frown, close
the face and knead it in a circle round. The eyes, smile, blow cheek, open mouth (zygo-
frequency is 120 times per min. The force of maticus) and pout (mentalis) after regulation
heel of hand is great and is suitable for of mind and breathing. The patients exert
loosening of adhesive tissue and contracture resistance using fingers in the negative orien-
muscle of the face in uninjured side. tation of muscle contraction for 6 s. if the
The frequency of musculus facialis mas- patients use the uninjured side as the target for
sage is 20 min per time. There is once a day surpassing exercise, the effect is better.
and 30 times in one therapy course. The frequency of self-exercise is 10–15 min
(e) Traction of musculus facialis: For the mus- per time. There is 1–2 time a day and 15–30
cles that induce the corner of mouth deviate times in one therapy course. Normal people
to the uninjured side and contracture in unin- who do this exercise can delay aging.
jured side, such as zygomaticus major and Self-traction of musculus facialis is the
minor, although the cause of facial distortion important content of self-exercise. Facial mas-
is the paralysis of muscles in injured side, sage can loosen tissue, but cannot fully loosen
traction of muscles in uninjured side is one of zygomaticus in uninjured side with contracture
the reasons that induce facial deformity such that induce facial distortion. The patients
as facial distortion. It can affect the func- should do self-traction. The patients use left
tional recovery of paralytic muscles. hand to pull right cheek and use right hand to
The traction method is that the therapists pull left cheek. The specific method is the same
wash the hands clean or wear sterile latex as that in the traction of musculus facialis.
gloves and put index finger into oral cavity in
uninjured side. At first, the therapists use 11.2.2.2 Rehabilitation Therapy
index finger and thumb outside of oral cavity in Recovery Phase
to do massage of oral cavity from outside to Two weeks to 1 month after disease is the recov-
inside. After that, the therapists use thumb ery phase of facial neuritis. During this phase, the
and finger pulp of index finger to pinch the progression of disease stops, edema of facial
corner of mouth slightly and exert force nerve fade away and incomplete injured neural
slowly to tract it to the injured side for several functions are recovered.
seconds. The therapists pull it repeatedly for The key point of this phase is to develop neural
10–15 times and time of duration is 20 min. potential, further promote edema elimination,
There is 1–2 times a day and 15–30 times in enrich blood circulation and loosen adhesive tissue.
one therapy course. The effect of traction is Rehabilitation method of neurological training is
better after local heating of far infrared rays. used to develop neural potential better, recover
(f)
Self-exercise of musculus facialis includes autonomous movement function of musculus faci-
facial massage, active muscle contraction and alis. Physical method is used to improve blood cir-
self-traction of musculus facialis. Facial mas- culation of local tissue, alleviate facial numbness
sage is that the patients sit on the chair, twist and stiffness, loosen tissue adhesion manually.
two hands until they are warm, adduct five fin-
gers, touch, knead and run on the face until the 1. Physiotherapy mainly includes thermal ther-
face is warm. The movement should be gentle. apy and medium frequency electrotherapy.
The face doesn’t feel any discomfort. The (a) Facial irradiation of far infrared rays: the
patients use index finger, middle finger and method is the same as the therapy in acute
ring finger or thenar eminence to do massage phase. There is once a day and ten times
with big force. Active contraction exercise of in one therapy course.
(b) Medium frequency electrotherapy modu- (c) Massage of musculus facialis: the method
lated by low frequency (Computerized is the same as the massage of musculus
modulated medium frequency or low fre- facialis in acute phase (20 min per time).
quency): the method is the same as the There is once a day and thirty times in one
therapy in acute phase. The diameter of therapy course.
round electrode is 2–5 cm (eye electrode). (d) Traction of musculus facialis: the method
Stylomastoid foramen is juxtaposed with is the same as the traction of musculus
the front of the ear. Tolerance dose, bidi- facialis in acute phase (20 min per time).
rectional pulse and amplitude are The traction time is 10–15 and 1–2 times
increased and decreased gradually. The a day. There are 15–30 times in one ther-
frequency is (modulated wave) is 100– apy course. The effect of traction is better
150 times in 1 min. There is one time after local heating.
(10–20 min) a day and ten times in one
(e) Self-exercise of musculus facialis: the
therapy course. method is the same as that of self-exercise
(c) Microwave therapy: the therapists choose in acute phase. The frequency is 10–15 min
no-heat or slight heat and the frequency is per time and there is 1–2 times a day.
10–15 min per time. There is once a day
and fifteen times in one therapy course.
2. Active movement training of musculus facia- 11.3 Rehabilitation therapy
lis: Development of neural potential and rees- in sequelae phase.
tablishment of motor program are the key
therapeutic measures of recovering autono- One month after facial neuritis is called sequelae
mous movement of musculus facialis. phase. Because some cases are not recovered com-
(a) Physical exercise therapy of neurological pletely, there are linked movement of mouth and
training of musculus facialis: Bare-handed eyes, ptosis, closing one’s eyes incompletely,
manipulation of six-step Daoyin technique facial distortion, salivation, dysesthesia of face in
in traditional Chinese medicine is used. In injured side, numbness, stiffness and inarticulate-
clinical application, according to the start- ness, which affect the life quality and beauty of the
stop and line feed of musculus facialis and patients greatly. The occurrence rate is about 25%.
the results of functional assessment, the The key point of rehabilitation in this phase is
therapists find out the main obstacles and symptomatic therapy such as the training of
use the trainings mentioned above. The active movement of muscle, coordinated move-
patients can do the training of three parts ment of musculus facialis, balanced capacity of
every time alternatively (15 min for each myodynamia and speech and the therapy of facial
part). There is one time a day (45 min) and paresthesia.
one therapy course takes 3 months.
(b) Neurological training: Six-step Daoyin
1. The mechanism of synkinetic movement of
technique training under the detection of face: After facial paralysis, there are synki-
motor program signal is used alone or netic movement (synkinesia) and musculus
combined with virtual reality training facialis spasm, which are all the complica-
method of neurological training. if it is tions of facioplegia. Synkinetic movement is
used alone, there are 50 min per time and that when closing eyes the corner of mouth
one therapy course takes 3 months. The moves to injured side or when moving the cor-
combined way is that the neurological ner of mouth the patients close eyes, which is
training is once a week and virtual reality abnormal motor pattern of orbicularis oculi
training is 4–5 times a week. There are muscle and zygomaticus. The mechanism of
50 min per time and one therapy course synkinetic movement remains unclear until
takes 3 months. now and there are three hypotheses.
11.3 Rehabilitation therapy in sequelae phase. 345
(a) Abnormal regeneration of degenerated

regeneration. Human facial nucleus
nerve: Synkinetic movement is induced includes four kinds of cell groups such as
by malposition connection in the regener- dorsomedial group, ventral medial group,
ation process of small neural fiber. intermediate group and lateral group. The
Although is widely accepted, there is still cells in intermediate group project fibers to
controversy. Some researchers think that dominate frontal belly of occipitofrontalis,
if synkinetic movement is induced by orbicularis oculi muscle, corrugator and
abnormal regeneration of nerve, there is zygomaticus that are related to synkinetic
synkinetic movement in the recovery of movement. Small cells in intermediate
the nerve. However, in clinic, synkinetic group dominate stapedius. Dorsomedial
movement and musculus facialis contrac- group cells project to nervus auricularis
ture appear 4 months after the disease. posterior to dominate auricularis muscle
After injury, the nerve regenerates from 2 and occipital belly of frontal occipitalis.
weeks after the disease. Ventral medial group cells project fibers to
The author thinks that the reason is not dominate platysma myoides through
solid, because regeneration of neural fiber cervical branch. Lateral group cells project
from 2 weeks of the disease is not equal to fibers to dominate buccinators and muscles
completion of regeneration and connec- in cheek and lip through cheek branch.
tion of targeted muscles. On the contrary, Erethism of intermediate group cells that
if the regeneration speed of nerve is 1 mm dominate orbicularis oculi muscle and
a day, the regeneration of facial nerve zygomaticus may lead to synkinetic
takes 4 months until the process is com- movement of mouth and eye.
pleted. The process is in accordance with Further peripheral nerve examination
the time of synkinetic movement in clinic. found that motor fibers of facial nerve are
Therefore, dislocation signal conduction distributed in diffusivity around temporal
is one of the reasons that lead to synki- part, which can easily induce synkinetic
netic movement of musculus facialis. movement because of imprecise excita-
(b) Potential abnormal propagation in injured tion transmission.
part: In the injured part, the regenerated (d) Motor program disorder: the author think
nerve fibers form potential and this poten- that synkinetic movement of musculus
tial can spread misdirected to other parts facialis is similar with abnormal motor
to induce synkinetic movement. pattern of limbs, which may be induced
This hypothesis cannot explain why by abnormal motor program in facial
synkinetic movement doesn’t happen in nucleus or cortex motor center.
the injury of facial nerve, but after the Facial muscle is the same as muscles
recovery of facioplegia. Certainly, when in the whole body, which are all domi-
facial nerves are not injured, it may be nated by motor program signal in
related to musculus facialis paralysis and CNS. This dominance is sequential and
motor inability, but there is evidence of orderly. When facial nucleus or facial
abnormal potential and wrong conduction nerve is partially injured, the ability of
without regenerated neural fibers. giving out or conduct motor program sig-
(c) Excitability increase of nerve nucleus: The nal is affected, the associated muscles are
formation of synkinetic movement may be paralyzed. During the process of func-
induced by erethism of neural cells in tional recovery of paralyzed muscles,
intermediate group of facial nucleus, before paralytic muscles’ functions are
which is one kind of synkinetic effect. recovered, inappropriate facial movement
Anatomic study of facial nucleus put can lead to abnormal motor pattern
forward questions to abnormal neural because of synkinetic movement through
activating other muscles to replace the signal return to zero. The purpose of this
functions of the unrecovered muscles. training is to make the diastolic and sys-
Repeated compensation can lead to tolic movement of musculus facialis in
abnormal motor program in CNS so that accordance with all or none law of neural
synkinetic movement is more difficult to signal conduction. Both contraction and
be rectified. relaxation are fast to recover the flexibil-
In clinical practice, this viewpoint is ity of autonomous nerve innervation
primarily verified in rehabilitation train- (Fig. 11.20). Synkinetic movement recti-
ing. For the patients with synkinetic fication method: The most advanced
movement of musculus facialis, 3 months’ motor pattern is separation movement.
motor program reestablishment training Synkinetic movement demonstrated that
can alleviate synkinetic movement greatly, the injured nerves are not completely
but the effect should be verified in multi- recovered. Through reestablishment of
center and large sample size study. motor program of musculus facialis, it
2. Rehabilitation therapy of synkinetic move-
can be rectified. The muscles with synki-
ment includes the training to enhance flexibil- netic movement are regarded as agonistic
ity of musculus facialis and reestablish motor muscle and antagonistic muscle in one
program of musculus facialis. movement for training. When in the train-

(a) Rehabilitation training of neurological ing of closing eyes, orbicularis oculi
training: The training includes flexibility muscle is agonistic muscle and zygomati-
training of single muscle with definite cus is antagonistic muscle. Six-step
surpassing goal and motor program rees- Daoyin technique is used to guide the
tablishment and myodynamia coordina- patients to increase signal intensity of
tion training of musculus facialis with a orbicularis oculi muscle and decrease
purpose. Flexibility training method is signal intensity of zygomaticus in order
the flexibility training of aingle muscle to eliminate synkinetic movement
according to different muscles of forming (Fig. 11.21). In the training of zygomati-
abnormal face. For example, zygomaticus, zygomaticus is agonistic muscle.
cus should be mainly trained in distorted
mouth, occipital frontalis should be
trained in ptosis and orbicularis oculi
muscle should be trained in incomplete
closing one’s eyes. Signal detection elec-
trode should be placed in the same posi-
tion where neurological training electrode
of musculus facialis is placed. However,
the difference between flexibility training
of musculus facialis and reestablishment
training of motor program is that motor
program reestablishment training is to
enhance signal intensity of agonistic
muscle and decrease signal intensity of
antagonistic muscle in order to recover
the normal proportion, while flexibility
training is to shorten muscle contraction
time at first as soon as possible and then
to enhance contraction signal intensity in
order to relax the muscle and make the Fig. 11.20 Flexibility training of contraction
(15–20 min per time) and there are 15

times in one therapy course.
(c) Medium frequency electriotherapy to
alleviate discomfort of face: The diameter
of round electrode is 2 × 5 cm (eye elec-
trode). Stylomastoid foramen area is con-
catenated with the front of ear. Tolerance
dose, bidirectional pulse and amplitude
are increased and decreased gradually.
The frequency is (modulated wave) is
100–150 time in 1 min. The frequency is
once a day (10–20 min per time) and there
are 15 times in one therapy course.
After assessment, the patients can do
the next therapy course. Once there is
excitability increase or spasm of muscu-
lus facialis, the therapy should be stopped.
(d) Loosening tissue adhesion: The methods
are introduced in the second part of this
Fig. 11.21 Synkinetic movement rectification training chapter such as on-the-point pressing,
rubbing manipulation and kneading
Six-step Daoyin technique is used to manipulation to do facial massage and tis-
guide the patients to increase signal sue loosening. The frequency is 1–2 time
intensity of zygomaticus and decrease a day (20 min per time) and there are 30
signal intensity of orbicularis oculi times in one therapy course. The effect is
muscle in order to eliminate synkinetic better after local heating.
movement. Bilateral comparison method: (e) Traction of musculus facialis in uninjured
it is suitable for the patients with simple side: the patients with facial distortion to
facial distortion, closing eyes inability uninjured side should receive traction
and raising forehead inability. The first therapy of musculus facialis in uninjured
and the second channel of neurological side. The traction method is that the
training equipment are separately used to therapists wash the hands clean or wear
detect the motoe program signal of the sterile latex gloves and put index finger into
same muscles in uninjured side and oral cavity in uninjured side. At first, the
injured side and display them in double therapists use index finger and thumb
screens. The therapists use signal in outside of oral cavity to do massage of oral
uninjured side as the surpassing goal and cavity from outside to inside. After that, the
use six-step Daoyin technique repeatedly therapists use thumb and finger pulp of
to guide the patients to increase signal index finger to pinch the corner of mouth
intensity in uninjured side to rectify the slightly and exert force slowly to tract it to
facial demormity. the injured side for several seconds (10–15
(b) Increasing local blood circulation and
times). The frequency is 1–2 time a day
promoting metabolism: Far infrared rays (20 min per time) and there are 15–30 times
are used for therapy. Twenty centimeter in one therapy course. The effect is better
away from aural skin in injured side, irra- after local heating of far infrared rays.
diation cover of far infrared rays is placed (f) Self-exercise of musculus facialis: it is the
and the heat should be comfort and don’t same as that in acute phase. The frequency
burn the skin. The frequency is once a day is 1–2 time a day (10–15 min per time).
3. Therapy of musculus facialis spasm: Musculus nique is used for active contraction train-
facialis spasm in the late phase of facial neuri- ing of musculus facialis spasm. The
tis is common in the patients with central frequency is once a day (30 min) and one
facial paralysis. therapy course takes 3 months.
Central facial paralysis is induced by injury
(b) Neurological training: According to the
of some part in the upstream pathway of facial pathway of spasmodic facial muscle, signal
nucleus, which is common in capsule interna. reception electrode is placed. Six-step
Internal carotid arterial system occlusion such Daoyin technique is used for autonomous
as occlusion of trunk and branch of middle contraction and relaxation training of
cerebral artery, hemangioma, intracranial spasmodic muscle. Contraction training is
hemorrhage and intracranial tumours due to to guide the patients increase the driven
hypertensive vasculopathy can lead to central signal intensity from upper central nerves
facial paralysis. to spasmodic muscle to develop potential.
The mechanism of musculus facialis spasm Relaxation training guides the patients to
may be that upper central nerves are injured control the intensity of spasmodic signal to
and lose control of lower central nerves (facial let it weaken or disappear (Fig. 11.22),
nucleus). Cells of facial nucleus are disinhib- which is also a kind of way to develop
ited and cannot work coordinately. Therefore, potentials of central nerves. It is an effective
recovering functions of upper central nerves is measure for the therapy of spasmodic
the important measure to alleviate musculus muscle. The signal is increased in muscle
facialis spasm. Neural potential development contraction, which demonstrated that the
and motor program reestablishment are the number and quality of central neural cells
effective methods to recover functions of involved in spasmodic muscle are
upper central nerves. enhanced. The signal is decreased in
(a) Physical exercise therapy of neurological spasm, which demonstrated that the control
training of musculus facialis: Bare-handed ability of upper central nerves to facial
manipulation of six-step Daoyin tech- nucleus is increased.
Fig. 11.22 Relaxation 20
training of spasmodic
facial muscle
16
Average of the last training signal intensity

12
signal
intensity
8
(mV)
4
mV
0 S 5 10 15 20 25 30 35 40 S
Time (s)
The training time is 50 min. The con- patients can drip eyewash for lubrication,
traction training takes 25 min and the diminishing inflammation and nutrition in
relaxation training takes 25 min. One daytime. At night, the patients wear
therapy course takes 3 months. blinder or use saline gauze piece to cover
This training can be combined with the eyes. The patients should decrease
virtual reality training of neurological using eyes and wear sunglasses in case of
training. The frequency of neurological direct sunlight.
training is once a week and the frequency (c) Facial partial nursing: hot compress to
of virtual reality training are 4–5 times a dispel the wind: fresh ginger residue is
week (50 min per time). One therapy used on the face in paralytic side (half an
course takes 3 months. hour a day). Moist heat: hot towel is used
In addition, it can cooperate with ther- to cover the face (2–3 times a day). In
mal therapy, massage, traction and self- addition, the patients should not wash
exercise of musculus facialis. Spasmodic face using cold water, take shelter from
muscle and antagonistic muscle are stim- the wind, add clothes timely, do exercise
ulated in sequence. At first, spasmodic and prevent from cold.
muscle contracts intensely and then (d) Persisted therapy and self-exercise: the

antagonistic muscle contracts. Through rehabilitation of neural function injure
reciprocal inhibition, spasmodic muscles takes a long time, 3 months or even lon-
are relieved (therapy equipment of muscle ger. The patients and their family should
spasm). Because it is not in accordance know this and persist the therapy. In addi-
with the mechanism of central nerve tion, whether the disease history is long or
potential development, the effect is short, proper rehabilitation training can
uncertain. recover the functions further and the
4. The prevention of facial neuritis includes
patients should not give up therapy
invigorating health effectively, keep face and because of long disease history.
post aurem warm in cold weather, avoid sitting
or sleeping in the wind blow to prevent attack Persisted self-exercise and health care of
or relapse. facial muscle has consolidated therapeutic effect,
(a) Psychological counseling: The onset of which can prevent relapse and facial neuritis.
facial neuritis is sudden. When getting up
in the morning, the patients are in facial
distortion and they feel nervous, anxious 11.3.1 Clinical Therapeutic Effect
and terrified. They are anxious about Observation of Peripheral
facial sequelae after therapy and are Facial Paralysis Treated by
ashamed of meeting other people. Rehabilitation of Neurological
Therefore, during the therapy, the Training
therapists should make explanations,
comfort and ease the patients to relieve Facial neuritis is called Bell’s Palsy, which
the nervous patients. The patients with belongs to peripheral facial paralysis and is usu-
stable mood can cooperate the training ally induced by aseptic inflammation of facial
and therapeutic effect is increased. nerve. The manifestations are special signs of
(b) Protecting eyes: because eyelid is not
facial mimetic muscle paralysis such as facial
closed completely or cannot be closed, distortion, disappeared forehead wrinkle and
cornea is exposed and there is no blinking incomplete closing eyes. It is usually accompa-
movement or corneal reflex. Intraocular nied with facial numbness, pain, dysgeusia and
infection is common. Therefore, protec- hyperakusis. If peripheral facial paralysis is not
tion of the eyes is very important. The treated timely or properly, there are sequelae
such as flaccidness of upper eyelid, no raising 2. Therapeutic method includes therapy of neu-
eyebrow movement, shallow nasolabial groove, rological training and physiotherapy.
facial distortion, facial stiffness, dyspepsia and (a) Facial neurological training: in a warm,
water leakage when brushing the teeth. In severe quiet, soundproof and lucifugl room, the
patients, there are musculus facialis spasm, con- patients sit in front of the display.
tracture and facial synkinetic movement. It can Biofeedback equipment is used and 3 M
not only induce facial dysfunction to varying Ag-AgCl surface electrode and reception
degrees, but also give mental stress to the patients electrode are separately placed in the two
because of affecting facial beauty, even affecting ends of the training muscle (the starting
social contact and daily life. point and dead point). Reference elec-
At present, physiotherapies include hormone trode is pasted between the surface elec-
and nerve neurotrophic medicine, acupuncture, trode and reception electrode or besides
massage, sunken lead and electrical stimulus, but them. Under proper anti-resistance condi-
there are dysfunctions to varying degrees. The tions, six-step Daoyin technique in tradi-
author use rehabilitation technique of neurologi- tional Chinese medicine is used to
cal training to treat the patients and obtain good encourage the patients to do active con-
therapeutic effect. traction training of the muscle. Electrical
signal from motor center to muscle is dis-
11.3.1.1 Materials and Methods played on the fluorescent screen in a curve
1. Clinical materials: From August 2007 to
form and this curve is regarded as the
August 2009, in rehabilitation center of neu- baseline (transverse line). The therapists
rological training of Capital Medical guided the patients to try to make the next
University affiliated Beijing Tongren Hospital, signal intensity surpass the baseline.
there are 30 inpatients and outpatients with During therapy, when the signal intensity
peripheral facial paralysis. There are 18 males almost reaches the peak, the therapists
and 12 females. The age is 22–65 years old. exert resistance on the negative orienta-
The average age is 38.6 ± 12.5 years old. The tion of muscle contraction and use
shortest disease history is 3 months and the speeches to encourage the patients to
longest is 12 months. The average is surpass the baseline as much as possible
5.0 ± 9.5 months. such as “hold on, higher, higher, or you
Inclusion criteria: will bump!”. After that, the therapists
It is in accordance with diagnosis criteria of use new summit as the baseline and
facioplegia. guide the patients to make new signal
The lesion is unilateral in all patients. intensity surpass new baseline. The rest
The disease history is 3–12 months. can be done in the same manner
All the patients receive standard therapy such (Fig. 11.23, 11.24, and 11.25). The same
as hormone and nerve neurotrophic medicine, method can be used for the training of
acupuncture and physiotherapy. frontalis, orbicularis oculi muscle,
The signs and symptoms of facial paralysis Albinus’muscle and orbicular muscle of
are still obvious such as numbness, facial dis- mouth. The training time is 10 min for
tortion, air leakage when blowing mouth and each muscle. The frequency is once a day
shallow nasolabial groove in paralytic side. (50 min) and there are 30 times.
Exclusion criteria: (b) Physical exercise therapy of facial neuro-
Facial paralysis due to complete injury of logical training: Six-step Daoyin technique
facial nerve induced by trauma. in traditional Chinese medicine is used to
Facial paralysis due to compression of tumor do active movement training of facial mus-
on facial nerve. cle under anti-resistance training such as
Facial paralysis induced by central diseases. raising eyebrow, closing eyes, exposing
teeth, pouting, blowing mouth, smile and apists stand beside the head of the patients.
movement of upper and lower lips. Its pur- The therapists wear gloves, smear adequate
pose is to recover the innervation ability of paroline or olive oil on the face in the para-
facial nerve to dominate facial muscle, lytic side, make the face in uninjured side
promote active movement of paralytic do the movement that the face in injured
muscle and reestablish motor program of side will do, guide the patients to establish
musculus facialis. During therapy, the movement idea and target of facial muscle
environment should be kept quiet. The in injured side. The therapists ask the
patients are in supine position and the ther- patients to take a deep breath, relax, con-
centrate on the brain and suddenly concen-
trate on the corresponding muscle of the
face in injured side. The patients are guided
to complete contraction movement of
facial muscle. Meanwhile, the therapists
exert opposite force and use speech to
encourage the patients such as “1, 2, 3, go
for it, 4, 5, hold on, fight!” the patients take
deep breath and relax. Every facial move-
ment should be trained for six times. In
therapy interval, the therapists should do
massage of facial muscle to relax muscle
and alleviate spasm. If there is musculus
facialis contracture in uninjured side, facial
massage and manipulation traction in
Fig. 11.23 Rehabilitation training of neurological train- uninjured side are done to loosen
ing in the patients with obsolete facial paralysis adhesion.
Fig. 11.24 Motor
program signal at the
beginning of the training
Fig. 11.25 After training,

program signal is
increased obviously and
the functions are
improved
There is one time a day (30 min per far infrared rays is placed and the heat
time) and there are 30 times in a therapy should be comfort and don’t burn the
course. skin. Its function is to improve local blood
(c) Medium frequency electrotherapy: circulation, eliminate inflammation and
Medium-frequency pulse therapeutic edema.
device with sinusoidal modulation is There is one time a day (20 min per time)
used. Two round electrodes are separately and there are 30 times in a therapy course.
placed in frontalis and Albinus’muscle. (f) Self-facial muscle exercise: According to
The pulse frequency is 1–10 kHz. Medium the training map of facial mimetic mus-
frequency electrical stimulation can cle, the patients do self-exercise of frown,
enhance excitability of muscle contrac- closing eyes, smile, blow cheek and pout-
tion to promote recovery of motor ing. Compared with the uninjured side,
function, improve blood circulation, alle- the exercise effect is better.
viate pain and numbness. There is two times a day (10 min per
There is one time a day (20 min per time) and there are 60 times in a therapy
time) and there are 30 times in a therapy course.
course. 3. Functional assessment: international general
(d) Ultrashort wave: Two electrodes are sepa- assessment method is used by special rehabili-
rately placed in the front of ear and mas- tation physician to do functional assessment at
toid process. The micro-thermal the beginning of the therapy and after the ther-
(60–100 mA) is used to eliminate edema apy. House-Brackmann and Portmann simple
of facial nerve canal to relieve the com- assessment methods are used for the intensity
pression of edema to facial nerve, recover assessment of surface electromyogram signals
functions of facial nerve and alleviate of frontalis, orbicularis oculi muscle,
pain in mastoid process. Albinus’muscle and orbicular muscle of
There is one time a day (20 min per mouth. The data are recorded in database.
time) and there are 30 times in a therapy (a) Therapeutic effect assessment standard of
course. House-Brackmann: House-Brackmann
(e) Far infrared rays:20 cm away from aural facial nerve classification standard is
skin in injured side, irradiation cover of divided into six grades.
• Grade I: Normal. •
Portmann assessment standard.
• Grade II: There may be slight asymme- •
Completely recovery (more than 17).
try in the facial movement functions •
Partially recovery (16–14).
and slight synkinetic movement. •
Just good (13–10).
• Grade III: There is obvious asymmetry •
Bad (less than 9).
and secondary defect, but there is still •
The lower the score is, the more severe
movement in frontal part. the disease is.
• Grade IV: There is obvious asymmetry, • The higher Portmann score is, the stron-
but there is no movement in frontal ger EMG signal is and the better the func-
part. tional recovery of facial nerve is.
• Grade V: There is merely slight move- 4.
Statistical analysis: statistical software
ment in the face. SPSS12.0 is used for statistical analysis. The
• Grade VI: the paralysis is complete and data results are expressed as Mean ± SD
there is no movement. The higher the ( X ± S). T-test is used for the data compari-
grade of House-Brackmann is, the bet- son before and after therapy. P < 0.05 is
ter the functional recovery of facial regarded as significant difference.
nerve is.
(b) Simple assessment method of Portmann 11.3.1.2 Results
includes six autokinetic movements such Assessment data analysis result of 30 before and
as frown, closing eyes, moving wing of after therapy patients refers to Table 11.4. There
nose, smiling, whistle and blowing cheek. is significant difference of the data before and
The scores of movement in injured side after therapy (p < 0.01), especially the therapy
and uninjured side are 3. The score is 2, data of Albinus’ muscle and orbicularis oculi
which stands for weak movement. The muscle.
score is 1, which stands for slight The comparison between Portmann scores
movement. The score is 0, which stands and therapeutic effect refers to Table 11.5. There
for autokinetic movement inability. In are 15 patients who are recovered completely in
addition, there are 2 score for impression. 30 patients. The Portmann scores is 17–20. There
The score of completely normal is 20. are two patients who are recovered poorly. The
Portmann scores is less than 9 (Table 11.6).
Table 11.4 Statistical analysis data of facial muscle signal and Portmann scores before and after therapy ( X ± S)
Assessment items Before therapy After therapy t p
Frontalis 13.93 ± 9.07 79.83 ± 42.80 9.17 <0.01
Albinus’muscle 22.76 ± 13.83 104.93 ± 41.35 13.76 <0.01
Orbicularis oris muscle 19.00 ± 20.71 81.40 ± 55.02 7.56 <0.01
Orbicularis oculi muscle 22.03 ± 12.44 109.17 ± 42.01 14.60 <0.01
Portmann scores 7.27 ± 2.20 16.20 ± 2.94 19.98 <0.01
Table 11.5 Recovery rate of therapeutic effect of Portmann scores before and after therapy
Therapeutic effect Case number Percentage
Completely recovery (more than 17) 15 50
Partially recovery (16–14) 10 33.33
Just good (13–10) 3 10
Bad (less than 9) 2 6.67
Table 11.6 The rate of therapeutic effect of House-Brackmann classification before and after therapy
Therapeutic effect Before therapy After therapy
Grade Case number Percentage Case number Percentage
I 0 0 10 33.33
II 1 3.33 15 50
III 15 50 3 10
IV 10 33.33 2 6.67
V 2 6.67 0 0
VI 2 6.67 0 0
11.3.1.3 Discussion dleure of facial muscle in uninjured side are

There are many methods to treat peripheral facial relieved effectively to recover autokinetic
paralysis such as medicine, acupuncture, physio- movement of facial muscle through neurologi-
therapy, sunken cord and massage [7]. These cal training method. Therefore, the compre-
methods have some therapeutic effects on the hensive rehabilitation method of treating facial
disease in the early phase, mainly through elimi- paralysis not only can recover autokinetic
nating inflammation, alleviating edema, nurtur- movement of facial muscle, but also relieve
ing nerve and activating non-functional cells and facial numbness, expression stiffness and
neural fibers in shock state, but these methods unusual facies, which obtain good effect.
usually have sequelae. They have no effect on In short, this therapy not only includes the
the patients in recovery period or in obsolete training of central facial nucleus to develop
cases. Because these methods all are passive potential, enhance the control ability of brain to
measures, they are not in accordance with the facial nerve and myodynamia of mimetic muscle,
mechanism of “skillful use and dependence” to but also includes the training of peripheral facial
promote neural plasticity. nerve to promote its regeneration, activate
Rehabilitation techniques of neurological reserved neural conduction pathway, recover
training mainly are active movements, which autokinetic movement of paralytic facial muscle.
are in accordance with the mechanism of pro- With physical therapy, improvement of compres-
moting central neural plasticity and functional sion of facial nerve increases therapeutic effect,
reorganization. Through neural potential devel- which is the new effective method to treat periph-
opment, motor program reestablishment and eral facioplegia. Long-term follow-up result of
facial muscle motor pattern remodeling guided this method should be surveyed further.
by Daoyin technique, the key point of therapy Coordination application of the method and for-
is put on recovery of neural functions to recover mulation of therapy course require further explo-
undead cells and conduction pathways and ration to rectify and improve this method in order
develop normal cells around injured area and to increase therapeutic effect.
conduction pathway so that they can play func-
tions to replace the injured cells. On the basis
of this, through motor program reestablish- References
ment technique, new activated neural cells can
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movement of facial muscle is relieved. function (Vestibular Neuritis). Laryngoscope.
Meanwhile, cooperated with manual massage, 2011;121(11):2494–5.
2. Jha AK, Nijhawan S, Nepalia S, Suchismita
facial muscle stretch and physiotherapy, adhe- A. Association of Bell’s Palsy with hepatitis E virus infec-
sion and spasm of facial muscle and conbun- tion: a rare entity. J Clin Exp Hepatol. 2012;2(1):88–90.
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Laryngoscope. 1997;107(9):1165–75. 6. Fabrin S, Soares N, Regalo SCH, Verri ED. The
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5. Daniel A, Drubach MD, Michael Makley MD, ress in the treatment of facial paralysis. J Tradit Chin
Maryellen L, Dodd MD. Manipulation of central ner- Med. 2010;25(05):1032–4.
vous system plasticity: a new dimension in the care
of Cerebral Palsy in Children
12.1 The Characteristics 1. It can be divided into five types [3] according to
of Cerebral Palsy the characteristic of movement dysfunction.
(a) Spasmodic type is the most common type.
Cerebral palsy (CP) is short called brain paralysis The lesion is located in pyramidal tract
[1]. From birth to 1 month after the birth, non- system and the main manifestations are
progressive brain injury syndrome is induced by limbs movement restriction, increase of
some factors. The main manifestations are cen- muscle tension, increase of passive move-
tral movement dysfunction, muscle spasm, ment resistance, clasp knife spasticity and
abnormal posture and bone and joint deformity tendon hyperreflexia.
accompanied with disorders of intelligence, (b) Athetosic type is common. The lesion is
speech, epilepsia, visual and auditory sense, located in basal ganglia and the main mani-
behavior and perception. festations are uncertain muscle spasm,
inconformity between movement will and
movement results, involuntary movement,
12.1.1 Characteristics and Types negative pathological reflex and dysarthria.
of Cerebral Palsy in Children (c) Ataxia type is rare. The lesion is located
in epencephalon and the main manifesta-
The common causes of brain paralysis are malde- tions are poor balance function, poor
velopment, premature delivery, apnea, low body coordination of voluntary movement,
weight, craniocerebral injury and genetics [2]. volitional tremor and nystagmus.
The morbidity is 0.15–0.5% and is one of the (d) Mixed type is common in clinic. It

main diseases that lead to disabilities in children, includes the characteristics of two or
which affect the growth and development and more types mentioned above, which is
self-care ability of children. induced by injuries of pyramidal system
Clinical manifestations of movement dysfunc- and extrapyramidal system or epencepha-
tion of cerebral palsy are various because of com- lon at the same time.
plicated pathological factors, injured parts and (e) Other types are rare. The manifestation of
different degrees. The classification is according relaxant type is low muscular tension. The
to the characteristic and degree of movement manifestation of rigidity type is increase
dysfunction and disease severity. of motor resistance (lead-pipe rigidity).
https://doi.org/10.1007/978-981-13-0812-3_12
358 12 Rehabilitation Therapy of Neurological Training of Cerebral Palsy in Children
The manifestation of tremor type is static (e) Motor development: big motor develop-
tremor of muscle. ment fall behind such as unable to turn-
2. According to the dysfunction degree of limb over, crawl, clench fist and grasp.
movement, it includes many types: (f) Myospasm: Convulsive seizure is usual.
(a) Paralysis of single limb: single limb is
paralyzed, which is rare. The doctors know clinical manifestations of cere-
(b) Hemiplegia: the limbs and trunk in one side bral palsy in early phase and find out the dysfunc-
are paralyzed, especially the upper limb. tion of cerebral palsy in early phase as soon as
(c) Triplegia: the limbs and trunk in one side possible, which is the premise of realizing the basic
and one limb in offside are paralyzed. rehabilitation principle of “early detection, early
(d) Quadriplegia: all the limbs and trunk are diagnosis and early therapy” of cerebral palsy.
paralyzed. The severity of upper limbs is
the same as that of lower limbs.
(e) Paraplegia: both lower limbs are severely 12.1.2 Complications and Secondary
paralyzed, but the trunk and upper limbs Diseases
are normal.
(f) Diplegia: all the limbs are paralyzed. The Except the main dysfunctions mentioned above,
trunk and upper limbs are slight, but both there are still complications and secondary diseases.
lower limbs are severe.
(g) Double hemipilegia: all the limbs are par- 1. Complications: the common complications

alyzed. Both upper limbs are severe and include dysgnosia (75% of all cerebral palsy),
sometimes the severity of left and right aphasis (30–70%), epilepsia (14–75%), hear-
side may be different. ing impairment (5–8%) and visual impair-
3. According to illness degree, it can be divided ment (50–60%). In addition, there are
into three types. dysfunctions of sensation and behavior.
(a) Mild: the patients can look after them- 2. Secondary diseases: it is induced by dysfunc-
selves in their daily life. tions such as joint adhesion, deformity, tendon
(b) Moderate: the patients can partially look contracture, dislocation or subluxation of
after themselves in their daily life. shoulder, hip and capitulum radii, osteoporo-
(c) Severe: the patients cannot look after sis, amyotrophy and scoliose.
themselves in their daily life completely.
4. Cerebral palsy dysfunction in early phase [4]:
The early phase is from birth to the ninth 12.2 Assessment Method
month after birth and the main manifestations of Cerebral Palsy in Children
are as follows:
(a) General manifestations: the children There are many assessment methods of cerebral
patients have a short fuse, cry and scream palsy, which are mostly used for effect assessment.
persistently or are excessively quiet, have There are few methods used for formulation of ther-
a weak sound of weeping, are difficult to apeutic schedule. Assessment method of children
be lactated or swallow, is easy to vomit rehabilitation of neurological training includes
and there is harmful weight gain. myodynamia assessment, balance function assess-
(b) Muscular tension and autokinetic movement and myospasm assessment. This chapter only
ment: there are low muscular tension and includes the assessment of motor function. Other
decreased autokinetic movement. functional assessment method of children cerebral
(c) Body posture and movement: the body palsy can refer to associated rehabilitation books or
becomes hand, the posture is abnormal rehabilitation functional assessment monographs.
and the movement is uncoordinated.
(d) Cognitive state: the patients are slow in 1. Comprehensive functional assessment of chil-
reacting, cannot recognize person and cry. dren cerebral palsy 4 (Tables 12.1 and 12.2).
12.2 Assessment Method of Cerebral Palsy in Children 359
Table 12.1 Comprehensive functional assessment table

Scores Scores
Items Month day Month day Items Month day Month day
I. Cognitive function 6. Stand
1. Recognition of common shape 7.Walk
2. Distinguishment of common 8. Walk up and down stairs
concept
3. Basic concept of space 9. Stretch out one’s hand to
fetch something
4. Know four kinds of colors 10. Use thumb and index
finger to fetch
something
5. Know something in the Summation
painting
6. Be able to draw circle, vertical, IV. Self-care movement
transverse and oblique line
7. Can concentrate on something 1. Open bibcock
instantly
8. Memory of the past 2. Wash face and hands
9. Seek help and express ideas 3. Wash teeth
10. Count, do addition and 4. Hold bowl
subtraction
Summation 5. Use hands or spoon to eat
II. Speech functions 6. Put on or put off jacket
1. Understand cold, heat and 7. Put on or put off trousers
hunger
2. Want to communicate with 8. Put on or put off footgear
others
3. Be able to understand others’ 9. Untie and tie button
expressions and behaviors
4. Be able to express own needs 10. Can deal with is before
or after using the toilet
5. Be able to say sentence with Summation
2–3 words
6. Can simulate oral movement V. Social adjustment
7. Can pronunciate b, p, a, o and 1. Know family member
ao
8. Follow easy orders 2. Respect others and say
hello to others
9. Can repeat easy words 3. Take part in group game
10. Can speak easy words 4. Self-called and all
according to pictures relationship
Summation 5. Can separate with mother
III. Motor ability 6. Look out and know not to
touch fire and electricity
1. Head control 7. Know the environments
2. Turn over 8. Are they familiar with
family or not?
3. Sit 9. Know health and disease
4. Crawl 10. Can answer the social
questions simply
5. Kneel
Total points: 1. _____ (2) _____ (3) _____
General comments if functional status:
Table 12.2 Evaluation standard of comprehensive func- Table 12.4 Assessment of myospasm degree of cerebral
tion assessment (hundred-mark system) palsy
Performance Scores of each item Total scores Grade Standard
All completed 2.0 100 0 Reflex muscular contractility is not increased
Most completed 1.5 75 and there is no resistance in the full range of
Half completed 1.0 50 passive limbs movement
Partially 0.5 25 1 Reflex muscular contractility is increased
completed slightly and there is slight resistance when the
Cannot complete 0.0 0 limbs are moved passively to the terminals
with slight resistance
1+ Reflex muscular contractility is increased
slightly. In passive limbs movement, in the
Table 12.3 Lovett myodynamia grading standard first half, there is sensation of slight locking
and in the last half, there is slight resistance
Percent of
2 Reflex muscular contractility is increased
normal
mildly. In passive limbs movement, there is
Grade Name Standard myodynamia
resistance in the most range of limbs
0 Zero No detectable 0 movement, but the limbs still can be moved
muscle contraction 3 Reflex muscular contractility is increased
1 Slightly Slight contraction, 10 moderately. In passive limbs movement, there
but cannot induce is resistance in full range of limbs movement
joint motion and limbs are hard to be moved
2 Bad Can do full range of 25 4 Reflex muscular contractility is increased
joint motion in highly. The limbs are stiff, the resistance is
weight support state big and passive movements are difficult
3 Just so So can do full range 50
of joint motion and
do anti-weight
movement, but and activities of children patients are used
cannot do anti- for the judgement of severity of lower
resistance limbs spasm.
movement
Severe: the angle of adductor is 0–30°.
4 Good Can do anti-weight 75
movement and The patients cannot do exercise by them-
anti-certain- selves or are difficult to do exercise.
resistance full range Mild: the angle of adductor is 30–60°.
of joint motion
The patients can do exercise with one
5 Normal Can do anti-weight 100
movement and pattern.
anti-sufficient- Slight: the angle of adductor is 60–90°.
resistance full range The manifestations are poor motor coor-
of joint motion dination and tractability.
4. Nervous reflex exam: Nervous reflex is the
2. Myodynamia assessment. important index of CNS development and
Lovett manual muscle test Table 12.3. children movement development, which is
3. Rehabilitation assessment of cerebral palsy
significant for diagnosis of motor
spasm. dysfunction.
(a) Improved Ashworth myospasm assess-
During the process of assessment, the ther-
ment method: in passive joint motion, apists should induce primitive reflex, correc-
according to range of joint motion with tion response, balance response and protective
reflex muscular contraction force, myo- extension response in every posture and
spasm can be classified into four grades observe the condition of response. If there is
(Table 12.4). any abnormity, the therapists should find out
Judgement of posture tension degree of the main reason that hinder the formation of
lower limbs: The angle width of adductor response and observe the response of children
12.2 Assessment Method of Cerebral Palsy in Children 361
patients with cerebral palsy to rehabilitation Table 12.5 Motor development index of normal baby
therapy of neurological training, which pro- Month Main motor development index
vides basis for formulation of therapeutic 1 The baby can raise head in the prone position.
schedule. Specific assessment method should Chin can be way from bed for 3 s. They can
grasp pen with two hands. They can open
refer to rehabilitation medicine books about month and simulate speaking
assessment of examination of the nervous sys- 2 The baby can raise head for a while and turn it
tem of children. around in the prone position. They can extend
5. Development assessment of big motor func- fingers and play them in front of chest. They
can suck thumb
tion: Motor development of children patients
3 The baby can raise half the chest in the prone
with cerebral palsy is significantly lower than position and can use elbow to support the
that of children in the same age. Motor func- upper body. The head can be straight and
tions and activities of daily life are required to upright. The hands can grasp each other and
be assessed. can be used to grasp clothes
4 The baby can raise upper body until it is
The degree of motor development retarda-
vertical to the bed. They can use leg to kick
tion can be judged according to proverb such clothes, quilt or lifting toy
as raising head at second month, turning over 5 The baby can turn over, sit against cushion.
at fourth month, sitting in sixth month, rolling When sitting, they can unbend waist. They can
at seventh month, creeping at eighth month stand up when they are helped. They can put
something into their mouth
and walking at ninth month. Motor develop-
6 The baby can use hand to hook the foot. They
ment index of normal baby refer to Table 12.5. can extend the body in flat. They can hold one
6. Balance ability assessment [5]: It can be
toy in each hand separately. They can take
assessed by balance response. biscuit to eat
(a) Tilting reaction: The babies lie in their 7 The baby can sit. They can creep with help.
They can use hand to take toy. They can use
back or are in the prone position on the voice and behavior to notice that they want to
plate and they keep their head uptight when defecate
they are swayed left and right. There is 8 The baby can stand up with handrail. They can
equilibrium reaction to outside of the upper give the toy to specified people. They can use
fingers to grasp something to eat
limbs and lower limbs in the upward side
9 They baby can stand up with something. They
and protective extension of the upper limbs can step crosswise with two feet. They can use
and lower limbs in the downward side. thumb and index finger to pinch tiny thing.
Tilting reaction appears in the sixth They can cooperate to wear clothes
month after birth and lasts for lifelong, 10 The baby can stand for a while by themselves.
which is the basic element of standing The can creep quickly. They can walk hand in
hand and get close to other children
balance and walking balance. 11 The baby can walk when lead by one hand.
(b) Sitting balance reaction includes balance They can point body part and can extend one
reaction in the front, sideward and back- finger to stand for 1-year-old
ward of sitting position. When the chil- 12 The baby can stand still and walk a few steps
dren patients are in sitting position and independently. They can complete simple
requirements and are willing to play games
are pushed forward, sideward and back- with other children
ward, they extend upper limbs forward,
sideward and backward to keep balance.
Sitting balance reaction appears in the
sixth–tenth month after birth and lasts for ward and backward, they can step forward
lifelong. and backward actively. When they incline

(c) Standing balance reaction: when the left and right, the lower limbs in one side
babies are in standing position and incline stretches out to the other side to support
to all around by external force. Under nor- the body weight, counteract external force
mal circumstance, when they incline for- and keep the body upright.
7. The assessment of deformity: the common

12.3.1 Rehabilitation Therapy
deformity includes hip flexion, adduction, Principle of the Baby
intorsion, flexion of knee joint or genu recur- and Infant with Cerebral Palsy
vatum, talipes equinus, foot drop, dislocation
or subluxation of hip joint, dislocation or sub- The baby is the new born from birth to one full
luxation of patella. year of life, while the infant is the children from
1 year old to 3 years old, which is the important
development stage of children. In this stage, ner-
12.3 The Formulation vous system and system of bone, joint and mus-
of Therapeutic Schedule cle of children patients are not developed
completely. In addition, the baby cannot or just
Rehabilitation therapy of cerebral palsy is compli- learn to walk and they cannot cooperate anti-
cated and is a systemic large-scale project. It not resistance training of developing neural potential
only recovers autonomous contraction function of like older children patients and adult with cere-
single muscle, but also establishes motor program bral palsy. However, cerebral palsy is due to
of associated movement of single joint motion injury of brain tissue induced by some factors.
and multiple joints. On the basis of this, normal The basis of recovering injured brain tissue is
motor pattern is established, which is three-stage CNS plasticity. When some methods are used to
rehabilitation method. In addition, the therapy of recover undead brain cells in injured area, normal
intelligence speech, swallow and gatism and the cells around injured area play functions to replace
rectification of bone and joint deformity are the the injured cells. However, the process that cells
important condition of motor function recovery. around injured area play functions to replace
In most cases, medicine and surgery cannot solve injured cells is different from the natural develop-
these problems. Only rehabilitation training can ment of brain. On the basis of normal movement,
achieve the anticipated goal. Therefore, the reha- the training should be intensified to promote CNS
bilitation of cerebral palsy is challenging and it is plasticity and functional reorganization.
a difficult and complicated disease so that reha- Therefore, rehabilitation therapy method of
bilitation is a great human building project. cerebral palsy should meet the requirements of
However, on the other hand, because of the active movement and intensified active move-
advantages of age and development, CNS plastic- ment. In addition, because the patients with cere-
ity [6] is good, only if we don’t fear difficulty, bral palsy are always accompanied with
treat it seriously, exam it carefully, analyze it in complications and secondary disease, the therapy
detail, use proper therapeutic method, implement of complications and secondary disease is neces-
therapy on the condition that the case is easy to sary on the moment of developing neural poten-
obtain therapeutic effect. For decades, the author tial. Therefore, children patients can be recovered
summarized a lot through clinical practice. comprehensively. This is the basic principle of
Through detailed functional assessment, we rehabilitation therapy of baby and infant.
can find the main obstacles and do therapy
according to order of priority, which is the key to 1. Induction training of active movement:

recover main functions and increase daily life Active movement is the effective method to
ability of children patients. recover and reestablish brain functions, but
Because cerebral palsy is complicated and the the baby and infant cannot cooperate with
age of the patients is different with different clini- the training actively so that active movement
cal manifestations, we should formulate individ- rehabilitation training is difficulty.
ual therapeutic schedule, which includes baby Rehabilitation method of neurological train-
and infant types. On the basis of three-stage reha- ing can induce active movement of children
bilitation training principle, individual therapeu- patients with the help of posture change
tic schedule is formulated. combined with game.
12.3 The Formulation of Therapeutic Schedule 363
2. Rectification of limbs deformity: the patients Specific method is as follows:

with cerebral palsy are always with develop- Support training of head forward: the
ment impairments such as congenital disloca- therapists use upper limbs in one side to
tion of hip joint, patella instability, pointed pick the baby up and make the baby
foot and talipes equinovarus. Therefore, dur- standing upright with slightly incline
ing the process of rehabilitation training, the backward. The therapists use the other
therapists should observe the rectification ther- hand to hold the head (Fig. 12.1), and
apy and prevention of bone and joint defor- hang or hand out a colorful toy in the
mity, which can recover motor function of front. The therapists loosen their hands
limbs on the basis of brain functions recovery. and the baby heads backward. The ther-
apists tell the baby “keep your head
upright and touch the toy!” Meanwhile,
12.3.2 Rehabilitation Therapy the therapists waggle the toy and make
Schedule and Specific Method it easy to see. If the baby cannot lift the
of the Baby and Infant limbs by himself, the therapists should
with Cerebral Palsy help him to lift it up. Through several
days’ training, the support ability of the
Because the baby cannot cooperate with rehabili- baby’s head is strengthened and the
tation training completely and the infant can support time can be lengthened to
cooperate with training to varying degrees, thera- increase the angle of inclining back-
peutic schedules for the baby and infant are ward. According to the specific condi-
different. tion of the baby, the therapists start to
increase the resistance of inclining
1. Rehabilitation therapy schedule of babies
backward. The location of resistance is
with cerebral palsy. frons (Fig. 12.2).
Induction training of active movement is Support training of head backward: the
used according to normal motor development. therapists use upper limbs in one side to
According to normal development law
such as raising head at second month, turning
over at fourth month, sitting in sixth month,
rolling at seventh month, creeping at eighth
month and walking at ninth month, the train-
ing method takes the body posture change as
the principle thing and incudes active move-
ment. Normal motor development law is that
the baby in certain months can have the cor-
responding motor function. Therefore, motor
induction training should be 1–2 weeks ahead
of the normal development standard. For
example, 3 weeks after birth, the baby starts
the training of raising head. Three months
after birth, the baby starts the induction train-
ing of turning over.
(a) Induction training of raising head: 3

weeks after birth, the baby can start the
training. Its purpose is to increase auton-
omous innervation of brain to musculi
colli to make it control the head. Fig. 12.1 Support training of head forward 1
Fig. 12.2 Support training of head forward 2
Fig. 12.4 Support training of head backward 2
to the specific condition of the baby, the

therapists start to increase the resistance
of inclining forward. The location of
resistance is occipital region (Fig. 12.4).
The frequency is 1–2 times a day
(30 min per time) and there are 30 times
in one therapy course. The therapy
course can be added according to the
functional recovery.
(b) Induction training of turning over:

Fig. 12.3 Support training of head backward 1 2.5–3 months after birth, the baby starts
the ability training of turning over. Its
pick the baby up and make the baby purpose is to induce turning over ability
standing upright with slightly incline of children patients.
forward. The therapists use the other hand The specific method is as follows:
to hold the head (Fig. 12.3), and hang or Motor induction training of turning
hand out a small bell in the front. The over to the right: in the training bed
therapists loosen their hands and the baby (3–5 m × 1 m) with adjustable inclining
heads forward. The therapists tell the angle, the training bed is adjusted to
baby “keep your head upright and touch 10–30°. The bed surface at the beginning
the bell”. Meanwhile, the therapists terminal of the training is high and the
waggle the bell to make noise. If the baby bed surface at the ending terminal of the
cannot protract backward, the therapists training is low. The bed is like a slope to
help children patients to restore the decrease the difficulty of turning over,
normal position of the head. Through which is called downslope turning over
several days’ training, the support ability training. Children patients recline on it
of the baby’s head is strengthened and the and a colorful toy is hanged in the front
support time can be lengthened to increase of the right of the body. The therapists
the angle of inclining forward. According sway left lower limb of children patients
Fig. 12.6 Training of turning over to the right 2

Fig. 12.5 Training of turning over to the right 1
From the downslope turning over train-

to the right, make it cross over right ing, the therapists sway right lower limb
lower limbs and put it on training bed. of children patients to the left, make it
After that, the therapists use speech to cross over left lower limbs and put it on
tell children patients to get the toy training bed. After that, the therapists use
through turning over to the right and speech to tell children patients to get the
help children patients to sway their upper toy through turning over to the left and
part of the body and left upper limb to help children patients to sway their upper
the right (Fig. 12.5). After completing part of the body and right upper limb to
turning over movement, the children the left (Fig. 12.7). After completing
patients are in ventral decubitus. The turning over movement, the children
therapists sway right lower limb of chil- patients are in ventral decubitus. The
dren patients to right backward and make therapists sway right lower limb of chil-
it cross over left limb until foot touch the dren patients to right backward and make
bed surface. After that, the therapists use it cross over left limb until foot touch the
speech to tell children patients to get the bed surface. After that, the therapists use
toy through turning over to the right and speech to tell children patients to get the
help children patients to sway their upper toy through turning over to the left and
part of the body and left upper limb to help children patients to sway their upper
the right (Fig. 12.6). After completing part of the body and right upper limb to
turning over movement, the children the left (Fig. 12.8). After completing
patients are in supine position. The baby turning over movement, the children
does the next training of turning over to patients are in supine position. The baby
the right until he gets the other end of the does the next training of turning over to
training bed. With the increase of turning the left until he gets the other end of the
over ability of children patients, the training bed. With the increase of turning
inclining angle of training bed is over ability of children patients, the
decreased gradually and is transmitted to inclining angle of training bed is
upslope turning over training. decreased gradually and is transmitted to
Motor induction training of turning upslope turning over training.
over to the left: Children patients lie on The frequency is 1–2 times a day
the back in bed and a colorful toy is (30 min per time) and there are 30 times
hanged in the front of the left of the body. in one therapy course. The therapy
Fig. 12.9 Sitting up training in right side
Fig. 12.7 Training of turning over to the left 1
Fig. 12.10 Sitting up training in the center
Fig. 12.8 Training of turning over to the left 2

palm to support the body on bed sur-
face and use upper limbs to make the
course can be added according to the trunk upright in sitting position. With
functional recovery. the increase of the ability, the thera-
(c)
Induction training of sitting up: pists reduce the support force and
4–5 months after birth, the baby starts exert resistance from left back to for-
the training of sitting up and balance ward in the process of sitting up to
ability in sitting position. Its purpose is further increase strength of low back
to induce sitting up and balance ability in muscle (Fig. 12.9).
sitting position of children patients by • Induction training of sitting up in the
themselves. center: when children patients are in
The specific method is as follows: supine position, the therapists guide
• Induction training of sitting up to the and help children patients to lift up
right: when children patients are in the upper part of the body, use two
supine position, the therapists guide hands to support the body on bed
and help children patients to turn surface and use upper limbs to make
upper part of the body to the right. the trunk upright in sitting position.
The therapists let children patients With the increase of the ability, the
use elbow of right upper limb and left therapists reduce the support force
and exert resistance from forward to The frequency is once a day (30 min per
backward in the process of sitting up time) and there are 30 times in one therapy
to further increase strength of abdom- course. The therapy course can be added
inal muscle (Fig. 12.10). according to the functional recovery.
Induction training of sitting up to the (d) Induction training of rolling movement:
left: when children patients are in supine 5–6 months after birth, the baby starts
position, the therapists guide and help the training of rolling ability. Its purpose
children patients to turn upper part of the is to induce continuous rolling ability of
body to the left. The therapists let children children patients.
patients use elbow of left upper limb and The specific method is as follows:
right palm to support the body on bed sur- • Induction training of rolling move-
face and use upper limbs to make the ment to the right: in the training bed
trunk upright in sitting position. With the (3–5 m × 1 m) with adjustable inclin-
increase of the ability, the therapists ing angle, the training bed is adjusted
reduce the support force and exert resis- to 45° downslope positions. Children
tance from right back to forward in the patients recline on it and a colorful
process of sitting up to further increase toy is hanged in the front of the right
strength of low back muscle (Fig. 12.11). of the body. The therapists sway left
Induction training of balance move- lower limb of children patients to the
ment in sitting position: The therapists right, make it cross over right lower
help children patients to sit upright and limbs and put it on training bed. After
tell them “sit still and do not fall down”. that, the therapists use speech to tell
The therapists loosen their hands but still children patients to get the toy
in protection and use counting method to through turning over to the right and
encourage children patients to keep in sit- help children patients to sway their
ting position for longer time. If children upper part of the body and left upper
patients are going to fall down, the thera- limb to the right. After completing
pists help children patients to sit upright
again. With the increase of the ability, the
therapists reduce the support force and
exert resistance from every direction to
push children patients slightly in order to
increase balance ability in sitting position
(Fig. 12.12).
Fig. 12.12 Induction training of balance movement in

Fig. 12.11 Induction training of sitting up in the left side sitting position
a training bed is decreased gradually

until they start the rolling training of
inclining upward to increase training
difficulty and promote the rolling
ability of children patients.
• Induction training of rolling movement to
the left: in the training bed (3–5 m × 1 m)
with adjustable inclining angle, the train-
ing bed is adjusted to 45° downslope posi-
tions. Children patients recline on it and a
colorful toy is hanged in the front of the
left of the body. The therapists sway right
b lower limb of children patients to the left,
make it cross over left lower limbs and put
it on training bed. After that, the therapists
use speech to tell children patients to get
the toy through turning over to the left and
help children patients to sway their upper
part of the body and right upper limb to
the left. After completing turning over
movement, the children patients are in
ventral decubitus. After that, the thera-
pists guided children patients to toll the
body to the left to complete continuous
rolling movement (Fig. 12.14) until they
c get to the other end of the training bed.
With the increase of rolling ability of chil-
dren patients, inclining angle of training
bed is decreased gradually until they start
the rolling training of inclining upward to
increase training difficulty and promote
the rolling ability of children patients.
The frequency is once a day (30 min per
time) and there are 30 times in one therapy
course. The therapy course can be added
Fig. 12.13 (a) Induction training of rolling movement to according to the functional recovery.
the right. (b) Induction training of rolling movement to (e) Induction training of crawling movement:

the right. (c) Induction training of rolling movement to the 6.5–7 months after birth, the baby starts the
right training of crawling ability. Its purpose is to
induce autonomous crawling ability of
turning over movement, the children children patients.
patients are in ventral decubitus. The specific method is as follows:
After that, the therapists guided chil- • Induction training of crawling movement
dren patients to toll the body to the in downslope: in the training bed of crawl-
right to complete continuous rolling ing movement, the baby is in prone posi-
movement (Fig. 12.13) until they get tion. The therapists wear thoracoabdominal
to the other end of the training bed. weight support band for the baby. The
With the increase of rolling ability of purpose is to make the trunk of the baby
children patients, inclining angle of 5 cm away from bed surface. The thera-
a a
b b
Fig. 12.14 (a) Induction training of rolling movement to

the left. (b) Induction training of rolling movement to the
left Fig. 12.15 (a) Induction training of crawling movement
in downslope. (b) Induction training of crawling move-
ment in downslope
pists adjust the angle of training bed to
30° Trendelenburg. The therapists help method are the same as induction training
the baby and guide them repeatedly to of crawling movement in downslope.
complete crawling forward movement With the protection of weight support sys-
according to the sequence that right upper tem, the training should be started from
limb moves forward to make forearm and small angle such as 10° and 15°. With the
palm touch the bed, left lower limb moves increase of ability, the difficulty is
forward to make knee joint and thigh increased gradually (Fig. 12.16a, b).
touch the bed, the body moves forward, • Induction training of retroaction crawling
left upper limb moves forward to make movement: in the training bed of crawling
forearm and palm touch the bed, right movement, the baby is in prone position.
lower limb moves forward to make knee The therapists wear thoracoabdominal
joint and thigh touch bed and the body weight support band for the baby. The
moves forward (Fig. 12.15a, b). With the purpose is to make the trunk of the baby
increase of crawling ability of children 5 cm away from bed surface. The
patients, inclining angle of bed surface is therapists adjust the angle of training bed
decreased gradually to the plane and the to 30° Trendelenburg. The therapists help
weight is gradually decreased. the baby and guide them repeatedly to
• Induction training of crawling movement complete crawling backward movement
in upslope: preparation and training according to the sequence that right lower
a a
b b
Fig. 12.16 (a) Induction training of crawling movement Fig. 12.17 (a) Induction training of retroaction crawling
in downslope. (b) Induction training of crawling move- movement. (b) Induction training of retroaction crawling
ment in downslope movement
limb moves forward to make knee joint The frequency is once a day (30 min
and thigh touch the bed, left upper limb per time) and there are 30 times in one
moves forward to make forearm and palm therapy course. The therapy course can be
touch the bed, the body moves backward, added according to the functional
left lower limb moves backward to make recovery.
knee joint and thigh touch the bed, right (f)
Induction training of walking movement:
upper limb moves forward to make 9–11 months after birth, the baby starts the
forearm and palm touch bed and the body training of walking ability. Its purpose is to
moves backward (Fig. 12.17a, b). With induce walking ability of children patients
the increase of crawling ability of such as standing, stepping and gait training.
children patients, inclining angle of bed The specific method is as follows:
surface is decreased gradually to the • The standing bed training: its purpose is to
plane and the weight is gradually increase bearing ability of bony joint and
decreased. spinal cord of children patients. Standing
bed of children is applied from 45°. The training belt and the therapists adjust the
frequency is two times a day (10 min per tension of elastic rope in the four corners
time). If children patients are not suitable of training equipment. When children
for this training, the standing training can patients swing to one orientation, the
be done directly. opposite elastic rope can keep the patients
• Standing training: weight support balance away from the arm of training equipment
training equipment is used for training. (Fig. 12.19). If lower limbs of children
The therapists help children patients to patients cannot support the body weight,
stand in the middle of training equipment weight support system can be used to
and wear weight support protection band. decrease the bearing of lower limbs of
The weigh is from half of the body weight children patients. The frequency is two
of children patients. Many colorful toys times a day (15 min per time).
are hanged around the training equip- • Shifting of weight training of stride and
ment. The therapists distract children gait: this is the basic training before walk-
patients through game to make children ing training. It is the training of shifting of
patients in standing position (Fig. 12.18). weight, weight bearing and stepping.
The frequency is two times a day (10 min Children Shifting of weight training equip-
per time). ment of stride and gait is used for the train-
• Standing balance training: in the weight ing. Abnormal gait rectification weight
support standing balance training equip- support walking training equipment is also
ment, children patients fasten balance used to do segment training of gait. In the

of standing training

of standing balance
training
weight support and secure protection, the

therapists guide children patients to move
the weight center to one side and life up
lower limb in the other side to step for-
ward. The heel firstly touches the ground,
the foot lands on the footprint of footpath,
the body moves forward, knee joint extend
straightly to bear weight and weight center
moves to this side. The patients lift up
lower limb in the other side to step forward
and do segment training repeatedly. With
the increase of walking ability of children
patients, the weight is decreased gradually
to increase the walking speed (Fig. 12.20).
The frequency is two times a day (15 min
per time).
• Abnormal gait rectification weight sup-
port walking training: through induction
training of walking ability mentioned
above, children patients with certain
walking ability can start this training. It is
suitable for compulsive active walking
training of children patients who cannot Fig. 12.20 Shifting of weight training of stride and gait
stand independently after therapy. The The frequency is once a day (15 min
training is done in the abnormal gait recti- per time) and there are 30 times in one
fication weight support walking training therapy course.
equipment. The therapists wear weight (g) Potential development training: Although

support pectoral girdle for children induction training of movement has some
patients and adjust the weight loss on the effect on potential development, it is not
standard that children patients can walk. enough. For the elder baby who can stand or
If children patients are accompanied with cooperate with training, potential develop-
adduction of lower limbs (scissors gait), ment training of lower limbs, trunk and upper
circle gait (foot drop) and so on, rectifica- limbs can be done. The frequency is once a
tion elastic band of adduction of lower day (15 min per time) and there are 30 times
limbs or foot drop is used. The tightness in one therapy course.
of elastic band can basically overcome (h) Motor program reestablishment training: For
adduction of lower limbs or foot drop. In children patients with basic understanding
the footprint training footpath, children ability and cooperation ability, the therapists
patients are guided to land every foot on find out main obstacles through detailed
the footprint of footpath precisely functional assessment and do therapy in
(Fig. 12.21). With the increase of walking sequentially and orderly. Motor program of
ability, the weight and strength of elastic single joint is established at first and then
band of adduction of lower limbs or foot motor program of associated movement with
drop are decreased gradually until the multiple joints is established. The therapy
elastic band is removed completely. should be interesting and joyful. The chil-
dren can receive therapy with game. The fre-
quency is once a day (20 min per time).
(i) Motor pattern remodeling training: On the
basis of potential development and motor pro-
gram reestablishment, motor pattern remodel-
ing training equipment is used and weight
support equipment of abnormal gait rectifica-
tion is applied. In the training footpath, gait
modeling training is done and transmitted to
walking without weight support gradually.
The frequency is once a day (15 min per time).
(j) Rectification of limb deformity: because the
baby’s tissue is soft, if the therapists can find
deformities of trunk, limbs or joints in the
phase, the therapeutic effect is good after
early rectification.
• Scoliosis deformity: Macromolecule
fibrous materials are used to make back
dry rack. The dome and the bottom of the
curve are under pressure to rectify scolio-
sis. The materials are ventilated, absor-
bent, radioparent. The side effect is small.
Back dry rack can be adjusted or changed
with the increase of the height of the baby.
Fig. 12.21 Abnormal gait rectification weight support • Muscle spasm or contracture joint defor-
walking training mity: it is common in elbow joint, wrist
joint and knee joint, which is mostly hands again and flat them outside. The
induced by muscle spasm or tendon con- patients restore the movement and repeat
tracture and includes deformity in flexion them for four times.
or extension position. Traction and local Elbow flexion movement: the patients flex
thermal therapy should be done first to bilateral elbow joints upward until the fore-
loosen adhesion of tissue and joint. arm is attached to upper arm, extend elbow
Rectification splint is used to fix them in joints straightly until they are parallel to the
functional position, which can be adjusted bed. The patients flex bilateral elbow joints
or changed at any time. upward until the forearm is attached to upper
Rectification of ankle deformity arm. The patients restore the movement and
includes talipes equinovarus and foot repeat them for four times.
drop, which is induced by development Shoulder joint movement: the therapists
deformity and paralysis of tibialis anterior hold the hands of the baby and rotate left
muscle or peroneus longus and brevis. On shoulder joint in circle from inward to out-
the basis of joint loosening by manipula- ward. The therapists hold the right hand of
tion, foot tray is used to fix them in func- the baby and rotate right shoulder joint in
tional position. The materials of foot tray circle from inward to outward. The patients
can be selected according to degree of restore the movement and repeat them for
deformity such as high temperature ther- four times.
moplastic plate and slim thermoplastic Upper limbs movement: the patients
materials. With the month of height, it divide right and left hand, open and flat them
should be adjusted or changed timely. The and make them vertical to the body. The
patients with severe deformity should patients raise two hands to the front, make
consider surgical therapy. the centers of two palms face to face. The
(k) Passive exercise of children patients is
distance is as wide as the shoulder. Two
suitable for children patients who cannot hands cross before the chest. The patients lift
cooperate with active movement training. two hands over the head and the center of the
Proper passive movement can prevent palm goes upward. The patients restore the
adhesion of joint and muscle and promote movement and repeat them for four times.
development of children patients, but it has Lower limbs movement: When the baby
no effect on recovery of brain function. is in supine position, the therapists use left
Passive exercise of children patients hand to hold left ankle of the baby and use
includes eight movements (four move- right hand to hold half sole of left foot.
ments of upper limbs and four movements Ankle joint movement: the therapists move
of lower limbs). the toe of the baby upward to flex ankle joint
Upper limbs movement: Children patients and move the toe of the baby downward to
are in supine position. The therapists use two extend ankle joint. The baby does the same
hands to hold the wrist of children patients, movements using right foot and repeats it
put thumb into the palm of children patients, for four times. Lower limbs extension and
let children patients make a fist and put two flexion movements: The therapists use two
hands beside children patients. Passive exer- hands to hold two thighs of the baby and
cises are as follows: extend knee joint alternatively like pedaling
Chest expanding exercises: the patients a bike. The baby flexes left leg to touch the
divide right and left hand, open and flat them, abdomen and then extend straightly down-
make them vertical to the body and the center ward. The baby flexes right leg to touch the
of the palm goes up. Two hands cross before abdomen and then extend straightly for four
the chest. The patients divide right and left times. Leg raising movement: the baby
extends straightly two lower limbs and flats side, on the basis of restriction of paralytic
them. The therapists pronate two palms and limbs in short time, according to the func-
hold two knee joints of the baby. The baby tional recovery condition, it can be trans-
extends two lower limbs straightly and lift mitted to actual using training such as
up them in 90°. The baby restores the move- motor pattern remodeling training.
ment and repeats them for four times. • Neural potential development training:
Turning over movement: when the baby is in according to paralytic part, corresponding
supine position, the therapists use one hand potential development training is done
to support the chest and abdomen of the such potential development training of
baby and use the other hand to support the lower limbs. If the patients can cooperate
back of the baby. The therapists help the with the training well, potential develop-
baby turn over from supine position to lat- ment method of guiding collaterals through
eral position, from lateral position to prone meridians or normal potential development
position and then from prone position to method is used. The frequency is 1–2 time
supine position. The baby repeats it for four (25 min per time) a day and there are 30
times. times in one therapy course.
This exercise is suitable for the baby in • Motor program reestablishment training:
the second month to sixth month after birth. neurological training equipment is used to
The frequency is 1–2 times a day. When the do the training of motor program
baby is awake or after shower, the baby can reestablishment of single joint and associ-
do the exercise in good mood. The exercise ated movement with purpose. The fre-
should be orderly. During training, the baby quency is 1–2 time (25 min per time) a day
wears soft and loose clothes. The operation and there are 30 times in one therapy
should be soft and orderly with the music course.
that the baby likes. 2. Motor pattern remodeling training: during the
reestablishment of motor program, motor pat-
12.3.2.1 Cerebral Palsy tern remodeling training can be started. The
The schedule and specific method of rehabilita- patients wear motor pattern remodeling train-
tion therapy of neurological training of children ing device and use abnormal gait rectification
patients with cerebral palsy who are older than 3 weight support walking training device to do
years old. These children are able to understand, the training in training footpath. Gradually,
describe the symptoms and cooperate with train- the patients do independent walking training
ing. According to the condition of cognitive dis- without help. The frequency is 1–2 time
order and motor ability of the children, (25 min per time) a day and there are 30 times
Rehabilitation therapy principles of neurological in one therapy course.
training are different. Three-stage rehabilitation principle of typ-
ical neurological training is suitable for the
1.
There are three rehabilitation therapy patients with a certain function with the help
principles: of rehabilitation method of neurological train-
Three-stage rehabilitation therapy princi- ing and assistive device, which can improve
ple of atypical neurological training is suitable abnormal motor pattern on the basis of recov-
for children patients with single limb paraly- ering body motor function. Moreover, the
sis and slight double lower limbs paralysis. trained children patients can cooperate with
• The main purpose of three-stage rehabilita- training.
tion method is to reestablish motor pattern • The first phase is neural potential develop-
of normal walking. Therefore, for children ment phase. Children patients are required
patients with slight limb paralysis in one to sit in wheelchair and are forbidden to
walk. According to the results of functional Therefore, the condition of motor pattern is not
assessment, corresponding potential devel- the key point. On the premise of reducing the
opment training equipment is applied. Six- assistance as much as possible, children patients
step Daoyin technique or six-step Daoyin are able to stand up and walk. Whether motor
technique of guiding collaterals through pattern is normal or abnormal, it can increase life
meridians is used to guide the patients to do quality of children patients and reduce life bur-
the potential development training of upper den of children patients.
limbs, trunk, lower limbs, tibialis anterior
muscle, musculus gastrocnemius and ham- 4. Preparations before walking training:
string muscles. The frequency is 1–2 time • Rectification of limb deformity: standing is
(25 min per time) a day and there are 30 one of the basic elements and is the basic
times in one therapy course. condition of extending double lower limbs
• The second phase is motor program rees- and trunk to bear load. However, this kind
tablishment phase. Children patients are of children patients belongs to mix type of
required to sit in wheelchair and are cerebral palsy. Because muscle spasm can
restricted to walk. According to the main lead to joint flexion deformity, especially
obstacles after functional assessment, neu- flexion deformity of double hips and knee
rological training equipment and virtual joints, the basic condition of standing train-
reality training system are used to do motor ing is restoring double lower limbs to basic
program reestablishment training of single extension position through therapy.
joint and associated movement with pur- Traction: the patients can receive small

pose and in order. The frequency is 1–2 dose continuous skin traction of lower
time (25 min per time) a day and there are limbs such as traction in extension posi-
30 times in one therapy course. tion, abduction position and extorsion
• The third phase is motor pattern remodel- position. The weight is started from 1 kg
ing phase. Children patients can walk with and is increased gradually, but it doesn’t
motor pattern remodeling training device exceed 3 kg. The traction is usually done at
and do a series of gait training. After that, night. Thermal therapy: far infrared or ker-
they can do independent walking without otherapy is used to soften tissue adhesion
help. The frequency is 1–2 time (25 min or contracture to obtain better effect of
per time) a day and there are 30 times in loosening tissues by traction and manipu-
one therapy course. lation. The frequency is 1–2 times a day
3. Rehabilitation principle of early standing and (15 min per time) and one therapy course
walking development is suitable for children takes 3 months. The therapy course can be
patients with cerebral palsy who have severe lengthened or the times can be increased.
motor dysfunction of limbs, lie in bed or sit in Manipulation: manipulation can be used to
wheelchair for a long time, have cognitive dis- loosen adhesive joint and tissue to alleviate
order or joint deformity, cannot cooperate tendon contracture. The frequency is 1–2
with the training and are difficult to stand up times a day (15 min per time) and one ther-
or walk even after rehabilitation method train- apy course takes 3 months. The therapy
ing of neurological training or application of course can be lengthened or the times can
assistive device. be increased. Loosening method of trem-
bling tissue: during the process of local
For this kind of children patients, according to thermal therapy and manipulation traction,
the procedure of three-stage rehabilitation hand massager is used to rub the muscle
method, the patients cannot meet the require- fiber to loosen adhesive tissue through
ments of the third training phase, not to mention tremble effect. The frequency is 1–2 times
functional recovery of children patients. a day (15 min per time) and one therapy
course takes 3 months. The therapy course forward. Meanwhile, children patients are
can be lengthened or the times can be guided to step forward. When children
increased. Orthopedic device fixation: in patients are not able to step forward, the
order to prevent second adhesion at night, therapists can help the patients to step for-
adhesive joint is recovered to 15–30° ward through assistive band. The rest can
through loosening and 6–8 layers of plaster be done in the same manner. With the
support can be applied to fix adhesive joint increase of the ability of children patients,
in case of joint retraction and relapse of the weight, elastic force of rectification
deformity. When the joint angle is hard to band and the help of the therapists can be
be recovered further, macromolecule fiber decreased. The frequency is 1–2 times a
or thermoplastic orthopedic device is used day (25 min per time) and one therapy
to fix the joint. For the joint with fibrous course takes 1 month. The therapy course
and bony ankyloses, if the flexion angle can be lengthened or the times can be
affects the standing greatly, the therapists increased.
should ask for consultation of doctors and • Potential development training: according
use surgery to rectify the deformity. to the results of functional assessment, cor-
• Standing bed training: when the hip, knee responding potential development training
and ankle joints are suitable for standing device can be used. Six-step Daoyin tech-
bed training, this training can be started. Its nique or six-step Daoyin technique of
purpose is to increase bearing capacity of guiding collaterals through meridians is
lower bony joint and cardiovascular stress used to guide the patients to do the poten-
capability. The training can be started from tial development training of upper limbs,
45° to 90° in erect position. For long-term trunk, lower limbs, tibialis anterior muscle,
bed children patients, in the beginning musculus gastrocnemius and hamstring
phase, the training can be done under the muscles, but the walking of children
monitor of Vital Signs Monitor. If there is patients is not restricted. The frequency is
any discomfort such as racing heart, palpi- 1–2 times a day (25 min per time) and one
tation or fall of blood pressure in children therapy course takes 1 month. The therapy
patients, the angle of standing should be course can be lengthened or the times can
adjusted or the training should be sus- be increased.
pended. The frequency is 1–2 times a day • Motor program reestablishment training:
(15 min per time) and one therapy course According to the main obstacles after func-
takes 1 month. The therapy course can be tional assessment, neurological training
lengthened or the times can be increased. equipment and virtual reality training sys-
• Walking training: abnormal gait rectifica- tem are used to do motor program reestab-
tion weight support walking training device lishment training of single joint and
and wearable children motor pattern associated movement with purpose and in
remodeling device are used for the train- order. The frequency is 1–2 times a day
ing. According to the degree and types of (25 min per time) and one therapy course
children patients’ dysfunction, the tight- takes 1 month. The therapy course can be
ness of lower limbs abduction and rectifi- lengthened or the times can be increased.
cation elastic band of foot dorsiflexion are 5. The principle of proper application of assis-
adjusted in case that foot touches the tive devices: assistive devices can compensate
ground and lower limbs adduces. Children functions, prevent and rectify deformity.
patients can keep in standing position and However, every assistive device has aide
the weight can be adjusted. The training is effect. For example, after the patients wear
implemented by 1–2 therapists. Weight waistline band, the stability of lumbar verte-
support walking training device is moved bra is increased, which can alleviate pain of
waist in the patients with fibrositis of psoas. If restrict normal joint motion. Therefore, the
the patients wear it for a longtime, because the patients can wear it for a long time.
waist muscles are used less, the myophagism According to external normal motor pattern,
and myodynamia decrease can be induced. abnormal motor program in motor center of
For example, ankle-foot orthosis can rectify cortex can be modified and can be transmit-
foot drop and strephenopodia to increase ted to normal motor program. Motor pattern
walking stability. If the patients wear it for a remodeling training device is good for the
long time, it can induce myodynamia decrease formation and solidification of normal
of tibialis anterior muscle and musculus gas- motor pattern.
trocnemius, in addition, the purpose of babaka 6. Assistive training induced by other autono-
sold in the market is to rectify posture hunch- mous movements:
back. The cause of posture hunchback is that • Fine motor training mainly trains the fine
low head position when people are watching motor ability of upper limbs and hand such
book or working and the low myodynamia of as nutting, game of string beads and build-
back muscles. The fundamental measures of ing blocks.
rectification are rectifying wrong posture and • Divertive game training such as sensory
strengthen active movement exercise of back integration training, combined ladder-
muscles. If people only wear babaka, but climbing training and climbing sand dune
don’t do functional exercise of back, not only training can increase the interests of
bad posture cannot be rectified, but also the children patients, induce autonomous

autonomous movement of back muscles can movement and increase motor ability.
be restricted further. If people wear it for a • Hydrotherapy has thermal, mechanical and
long time, the myodynamia of back muscles chemical stimulation effect. Through the
can be decreased, which may aggravate the mechanism of neurohumoral regulation,
degree of humpback. Therefore, assistive the functions of organs can be improved.
devices are the measures by necessity but not With the help of hydrostatic pressure,
the first choice. It cannot be overused for water flow impact pressure and buoyancy,
profit. the therapists can induce water exercise of
Through rehabilitation training, the active children patients and make them complete
contraction of muscle that induces joint defor- autonomous movements that cannot be
mity cannot be recovered. The patients should completed in normal condition.
wear orthotics to replace partial functions of
paralytic muscles. Otherwise, it not only
aggravates joint deformity, but also leads to 12.3.3 Amount of Training
abnormal motor pattern and affect movement of Children with Cerebral
quality. If autonomous contraction function of Palsy
paralytic tibialis anterior muscle cannot be
recovered in a short time, the patients can Because the baby and the infant cannot express
wear foot tray to rectify foot drop. Otherwise, their ability and feeling of amount of training and
foot drop can lead to abnormal motor pattern recovering dysfunction induced by CNS injury
such as circle gait. Moreover, long-term foot movement is recovering CNS function but not
drop can stretch tibialis anterior muscle fur- physical training to enhance myodynamia, the
ther and make it lose the proper initial length, patients are required to keep vigorous physical
which cause difficulties to functional power to do neural potential development train-
recovery. ing well. Therefore, proper amount of training is
Motor pattern remodeling training device very important. The therapists can assess the feel-
developed by the author only restricts the ing and degree of fatigue to adjust the training
unnecessary joint motion and doesn’t timely (Table 12.6).
Table 12.6 Proper amount of training assessment table amount of children patients, the training
in children with cerebral palsy
should be done three meals every day
Items 0 1 2
persistently.
Self- A little Tired exhausted
perception tired
(b)
Dressing and undressing training:
Muscular Recovered Recovered Cannot be According to individual condition of chil-
soreness, low after rest in the recovered dren patients with cerebral palsy, different
myodynamia second day in the training mode can be selected. The train-
and muscle second ing can be started from dressing and
hardness day
increase undressing simple clothes. The therapists
The heart rate The heart The heart The heart should let children patients know the
is increased rate is rate cannot rate sequence of dressing and undressing
ten times per normal be cannot be clothes. The children patients should
minute after rest recovered recovered
for 5 min after rest in the
undress the clothes in uninjured side and
for 5 min second then in injured side. The children patients
day should dress the clothes in injured side
Myocardial Normal Increase Double and then in uninjured side. The therapists
enzyme help children patients to dress and undress
clothes at first. With the increase of ability
Criteria: the total score is less than 2, which of children patients, the help force can be
means insufficient. The total score is 3–4, which decreased until the patients can dress
means proper. The total score is more than 5, themselves independently.
which means overdose. (c) Defecation training: Defecation training
should be started from 2 years old and is a
comprehensive training includes dressing
12.3.4 Training and Therapy in Other and undressing trousers, standing, sitting
Aspects balance and squatting. Disposal after def-
ecation is a process of hand functions
1. Daily life ability training: The purpose is to training of children patients. The thera-
transform the training results into daily life pists use children bed pan with handle in
self-care ability through life autonomous the front or in two sides to provide stable
movement on the basis of trainings mentioned sitting posture for children patients. The
above. patients should concentrate on defecation
(a) Feeding training: When the children with process. They don’t listen to the story or
cerebral palsy are eating, the training can read books and only concentrate on defe-
be done according to recurring problems. cation. The children patients defecate
Feeding position placement can help the regularly and learn to control defecation.
patients to relax and alleviate spasm. In every defecation, the children patients
Control of children patients’ jaw can should train themselves.
increase masticatory ability of children (d) Other life movements training such as

patients. The patients should choose plas- cleaning (tooth brushing and washing
tic tableware with shallow surface and use hands), face-lifting, social contact and
skid resistance dish and bowl with handle. using appliances. According to the gen-
The therapists should be patient during der, age and disease severity of children
training and split feeding movement into patients, the therapists formulate actual
several coherent petty actions. With the individual plan and implement it.
increase of feeding ability, the therapists Daily life ability training mentioned
can combine several coherent petty above can increase daily life ability and
actions. On the basis of keep the feeding social life ability of children patients,
promote mental and physical develop- articulation training to children patients

ment of children patients and make them from simple sound such as bilabial sound
do the movements independently in all to difficult sounds such as velar, dental
aspects. For severe children patients, not and linguo-dental.
only the functions should be improved, In order to increase the effect and
but also the life self-care ability should interest of speech training, pictures and
be increased through compensation slides can be used. Speech biological
according to the degree of dysfunction. feedback therapy can also be used.
2. Speech training: Its purpose is to provide
Through speech biofeedback equipment,
speech stimulation and to motivate the interest abnormal tone and sound are displayed in
of children patients to use speech. It can help fluorescent screen in a wave form or curve
children patients to establish and increase form. The therapists can do pectorophony
applying ability of interpersonal skills to meet or sound attenuation training with a
the requirements of daily life and learning. purpose.
(a) The training of ability to accept language: 3. Cognitive training: Cognitive training can be
attention training: under instructions, divided into three phases such as primary
children patients stop what they are phase, middle phase and advanced phase.
doing, listen to their own name and fol- (a) The training content in primary phase:
low the order of the therapists to do one enlightenment training includes
thing. Comprehension ability training of acquaintance of color, graph, digit, time,
symbols includes comprehension ability space and quantity of object. Basic cogni-
of real object and toy. Comprehension tive ability training includes the training
ability training of speech includes envi- of attention, outsight and memory.
ronment comprehension, one character (b) The training content in middle phase is
word or two characters word comprehen- information coding ability training, which
sion. The training associated with inter- includes the training of sequence inferen-
personal skills includes the training of tial capability, analogic reasoning capabil-
vision, auditory sense and other ity, transmissibility inferential capability
perceptions. and group ability.
(b) The training of expression ability: the
(c) The training content in advanced phase is
training before spoken language includes organizational strategy training, which
the training of movements or gesture, includes the training of information inte-
environmental pronunciation and imita- gration ability using linear structure, net
tion ability. The training of expression structure, coordinate structure and com-
ability includes the training of single prehensive structure.
words, two words and simple sentence. The hypothesis of human brain mem-
The training of non-verbal expression ory gate: whether the memory in human
ability includes the common gesture or brain is ring current or memory protein,
movements training and communication they are all the process that something is
graph. known, understand and memory is
(c) The training of dysarthria: Basic training formed, storage and retrieved. There is a
includes improvement of control of lower memory channel or gate. If there is a
jaw and upper lip, improvement of control problem in any gate, the memory is
of tongue, control of involuntary move- incomplete. The process of cognitive
ments, promote coordinated movements training is to use methodology to reestab-
and improvement of oral perception. The lish memory and open the memory gate.
training of articulation: according to the Through training, cognitive competence
examination results, the therapists give can be increased.
4. Physiotherapy. behaviors and restrict the motor and

Physiotherapy includes medium-frequency speech ability development of children
electrical stimulation, ultrashort wave, far patients. The clinical manifestations are
infrared and kerotherapy [7]. immoderate reliance and coward,
Medium-frequency electrical stimulation is extremely unstable emotion, low self-
given to paralytic nerve and muscles to increase control, impulsion, sensitivity, intense
the excitability. Transcranial electromagnetic self-respect, distracted attention, bad
stimulation can promote the wake of undead memory, loneliness, self-abasement, poor
brain cells. Far infrared and kerotherapy can adaptation to environment, unstable char-
promote local blood circulation, soften adhe- acteristic, autolesion or injury by another.
sive tissue or tendon contracture, which is good Psychotherapy, group therapy, behav-
for strengthening the effect of manipulation ior therapy, family therapy and other cul-
loosening. Continuous Passive Motion (CPM) ture, sports or musicotherapy are used in
training device is used for continuous passive therapy. The therapy should be patient and
motion of the joint in the maximum range of step by step. It can integrate learning and
motion after manipulation loosening to increase doing, has a positive education effect. It
range of joint motion, prevent relapse of adhe- can encourage the patients and create
sion and not to affect the implement of rehabili- normal mental environment. During the
tation therapy. CPM training can be done at process of motor and intelligence, psy-
night when children patients fall asleep. chological rehabilitation is done.
5. The application of orthotics and walking aid. (b) Education rehabilitation: Education is the
Orthotics is the appliance to prevent and rectify basis of human life. The earlier Children
the deformity of body and trunk. Walking aid is patients receive the education, the better the
assistive appliance to help the patients to walk. effect is, especially for the disabled infant.
The therapists should select the appliance The education objects include children
according to the actual requirements of chil- patients and their parents. The content
dren patients. The purpose of orthotics is to includes instruction of spirits and thoughts
decrease load bearing of injured limbs, keep in and instructions of training methods.
good limb position, maintain local stability, Rehabilitation staff should receive education
prevent and rectify contracture of limbs, help and the level should be increased to achieve
the patients to complete necessary movements the effect of education rehabilitation.
and control involuntary movement. Walking The disabled children are restricted in motor
aid includes wheelchair, crutch and walker. and intelligence. The environment of general
They can enlarge the support surface of chil- schools is not suitable for their teaching.
dren patients, decrease swing of the center of According to their special ability and required
weight, increase body stability and help the equipment, special curriculum is formulated
patients to stand and walk. and special education is done using different
6. Psychotherapy and education rehabilitation. teaching methods. Pavlov’s classical condition-
Child psychology [8] is a branch of psychol- ing theory indicated that learning any func-
ogy. It is a science to investigate children’s tional skill requires continuous practice entirely
law of psychological development and mental or partially. The therapists should combine
profile in every age stage of children. therapy and education, combine therapy with
(a) Psychotherapy: because children patients prevention, combine persistence (lengthways)
with cerebral palsy have motor dysfunc- and continuity (crosswise). The therapists
tion, restricted movements, small motion should integrate learning and training contents
range, mental retardation and abnormal into the whole day’s life of children patients,
psychological development. Abnormal which is good for the rehabilitation of mind and
mentality usually leads to abnormal body of children patients.
7. Surgical therapy: The main purpose is to rec- 12.4 Case Report:

tify line of bearing load, rectify deformity, The Rehabilitation Process
balance myodynamia, decrease muscle spasm of an Elder Child
and contracture. with Cerebral Palsy
It is suitable for congenital bone and joint
deformity, fibrous joint ankyloses, bony joint The child with cerebral palsy named YanYan
ankyloses and unrecovered paralytic muscles. (alias) who is 14 years old and never stand up,
Surgical therapy includes tenotomy, tendon finally is able to stand up after half year’s reha-
lengthening, tendon loosening, tendon trans- bilitation training. All the rehabilitation staff,
fer, osteotomy, joint fusion. wardmate and family members are excited and
Neurosurgery: Partial neurotomy and yell out “YanYan can stand up!” her mother has
selectivity or high selective posterior rhizot- confidence in the rehabilitation and recognizes
omy to alleviate spasm [9]. the importance of rehabilitation. Her mother said
It should be noticed that the cause of motor “we only know taking medicine before or did sur-
dysfunction of patients with cerebral palsy is gery. We think rehabilitation is moving arms and
brain dysfunction. Therefore, recovering brain legs and it is dispensable. We then realize the
function is the important measures of solving importance of rehabilitation and we use western
the problems. Before recovering brain func- rehabilitation technique, but there is no effect
tions, muscle tendon surgery may only after 1 year’s western rehabilitation training of
improve the functions for a short time. It will rehabilitation method. I realize that Daoyin tech-
relapse after a certain time. For example, nique in traditional Chinese medicine is good.
denervation of tibialis anterior muscle leads to Rehabilitation technique of neurological training
paralysis of the muscle and myodynamia developed from Daoyin technique in traditional
imbalance between tibialis anterior muscle Chinese medicine will contribute to human reha-
and musculus gastrocnemius, which induce bilitation enterprise”.
over plantar flexion of the foot. The most YanYan was born after 36 weeks’ pregnancy
effective method to treat foot drop is to recover (cesarean) and there is no abnormity during birth.
the domination of brain to tibialis anterior After birth, growth and development of she is
muscle. If brain functions are not recovered, slower than the infant in the same age and there
tendon lengthening can alleviate foot drop are involuntary movements of hand and foot,
temporarily after surgery. However, the paral- which is diagnosed with mixed type cerebral
ysis of tibialis anterior muscle is not recovered palsy in one hospital in Beijing. When she is 1
and the imbalance between tibialis anterior year old, she is able to raise head, turn over and
muscle and musculus gastrocnemius still sit up. She can speak but the speed is slow with
exists. After a certain time, foot weight in expression retardation. There are many involun-
walking and traction of musculus gastrocne- tary movements of upper limbs (chorea). She
mius can induce foot drop again. cannot use fingers to grasp and hold something.
Therefore, for patients’ interest, rehabilita There are severe spasm and adduction of lower
tion training should be done first. The func limbs. Maldevelopment of left acetabulum and
tions can be recovered with proper methods. caput femoris lead to congenital complete dislo-
The patients who cannot be recovered com cation of left hip joint. All these with instability
pletely use orthotics to rectify the dysfunction of double ankle joints make YanYan cannot stand
and then do rehabilitation training. If these up, even with the help of her family.
methods mentioned above cannot recover Her mother sees the doctors in many big
functions, surgical therapy can be considered. hospitals after YanYan’s birth. Once there is any
It should be cautious to suggest the patients therapy method, they will try it and never let off
with cerebral palsy to receive surgical any chance. In 2007, she received standard
therapy. rehabilitation training for almost 1 year in a
12.4 Case Report: The Rehabilitation Process of an Elder Child with Cerebral Palsy 383
well-known rehabilitation hospital and she can mechanism, the patients are guided to enhance
sit independently, but cannot sit upright. She signal intensity of agonistic muscle, decrease sig-
cannot raise her head. Her fingers are twisted so nal intensity of antagonistic muscle, establish
she cannot eat food and comb by herself. When normal motor program and increase control abil-
she tries to extend upper limbs, she will yell out ity of limbs movements.
and the speech is unclear. Increased muscle ten- After 2 months’ motor program reestablish-
sion of lower limbs, adduction deformity, flat ment training, she can raise her head and sit
feet, unstable ankle joint, complete dislocation upright. The involuntary movements are
of left hip joint make her cannot stand up, not to decreased and she can eat food by herself. All the
mention walking. family is excited. Over the years, this is the first
She never goes to the kindergarten and read time to see the great effect of rehabilitation ther-
books when she is 14 years old. Her mother feels apy. They have confidence in the rehabilitation
painful in heart. Her mother never stops seeking with surprise and amaze.
doctors for YanYan. Her mother is a great mum. Dislocated left hip joint and unstable double
In the early of 2008, her mother realized reha- ankle joint are the important factors to influence
bilitation therapy of neurological training in standing, lower limbs training and functional
internet. Potential development and motor pro- recovery. The patient must bear load with left
gram reestablishment theory and method are limb so that she can stand up. How to make the
used for the patients, which have good effects on dislocated left hip joint and unstable double ankle
the patients with cerebral palsy and are not joints bear load? In fact, the best method is hip
restricted by therapy course. She took the child to joint moulding or artificial joint replacement of
Beijing as soon as possible. After detailed exami- full hip and double ankle arthrodesis. She is
nation and assessment, although the state of dis- young and the limbs function is poor. Therefore,
ease is complicated and the disease history is hip replacement and double ankle arthrodesis
long, it is possible to recover the functions of may not be used for a long time. Because the
independent standing and assistive walking child grows and the life of artificial joint is lim-
through rehabilitation method of neurological ited, it is not suitable for the child to do hip
training. They rebuilt the hope of rehabilitation. replacement and double ankle arthrodesis.
According to her dysfunctions, the therapists After repeated discussion, hip surgery is not
formulate specific therapeutic schedule and suitable for her. The therapists decide to use
decide to give three-stage rehabilitation training orthotics to abduce hip joint to make undevel-
of neural potential development, motor program oped caput femoris bear load in acetabulum and
reestablishment and motor pattern remodeling to use ankle joint molding brace to make double
her. The therapeutic goal is to recover the func- ankle joint bear load. During the process of estab-
tions of independent standing and assistive lishing motor program, she can do standing and
walking. walking training. However, this is hypothesis.
Complete dislocation of left hip joint make Moreover, bearing load of immature developed
her cannot stand up, which makes it difficult for caput femoris may lead to femoral head necrosis.
potential development training of lower limbs. Undeveloped acetabulum may moves upward
Six-step Daoyin technique in traditional Chinese and damages peripheral tissues when caput fem-
medicine is used for her to do potential develop- oris is bearing load. It is risky to use this kind of
ment training of upper limbs, lower limbs and hip joint to stand up with the help of assistive
trunk bedside, motor program reestablishment device. It is no sense to give up training that can
training. According to biofeedback mechanism recover standing and walking functions in order to
that archery accuracy can be improved through keep an undeveloped caput femoris. It is meaningful
target exercise, under the instruction of motor to recover standing and walking functions regardless
program signal, the patients are guided to do the of undeveloped caput femoris, because hip joint can
training with a purpose. Through goal-motive be reestablished through hip replacement and hip
replacement is meaningful after recovering help. It is very important for her. Standing can
standing and walking functions. make bone bear load, which is good for bone
In order to cooperate with orthotics, basic development. Walking can promote the increase
training is given to her before the standing and of domination ability of brain to limbs and the
walking training. Training intensity of lumbodor- establishment of walking center functions in spi-
sal muscles, hip flexor, hip abductor and quadri- nal cord. Standing and walking can strengthen
ceps femoris is increased because they are muscle and myodynamia. Standing and walking
necessary for standing and walking. is the necessary training procedure to make her
When she wears orthotics to practice standing, take care of herself.
everybody look forward to the amazing standing Meanwhile, in order to increase her walking
and watch the detailed of wearing orthotics with ability, therapists add the center of body weight
attention and caution. When she wears hip joint training of stride and gait, balance training, hip
abduction orthotics and double ankle joint mold- abduction, coordinated motor program
ing brace and walk with the help of the therapists reestablishment training of hip flexion and knee
and without pain, everybody is excited and cheer extension and myodynamia enhancement
for the success. It is lucky that the caput femoris training.
is not moved upward. There is no accident in the In a long period, she gets into a stable training
standing for a while, which not means there is no program phase. In every day, the therapists use
injury after long-term standing. She receives innovated six-step Daoyin technique in tradi-
X-ray examination in the first month and third tional Chinese medicine to do potential develop-
month after standing training and there is no ment training of upper limbs, lower limbs and
injury. trunk with the help of potential development
After that, on the basis of motor program rees- equipment, to do gait training with the help of
tablishment and potential development training weight support stride and gait weight center shift-
of upper limbs, the therapists add potential devel- ing training device, to do motor program reestab-
opment training of lower limbs. When she is able lishment training with the help of virtual reality
to stand independently, according to the neuro- of neurological training system, to do walking
logical training of early standing and walking training with the help of abnormal gait rectifica-
development and rehabilitation principle of treat- tion weight support walking trainer and motor
ing cerebral palsy, she starts walking training. pattern remodeling training device. The doctors
With the help of abnormal gait rectification and the therapists in rehabilitation center observe
weight support walking training device and the the change of her carefully and adjust therapeutic
instruction of the therapists, she steps forward for schedule timely.
the first time. Although the gait is not beautiful In this way, 1 month later, 2 months later,
and is very slow, she feels excited, because this is there is no obvious progress. She feels frustrated
the first step in her life. and her mother feels confused. The therapists
Because severe adductor spasm of double feel that she and her family lose confidence of
lower limbs, although elastic band of walking rehabilitation. For this, the therapists explain the
device can prevent partially over adduction of detail to her and her family and tell them func-
lower limbs, there is still scissors gait in walking. tional recovery of central nervous system is a
Abduction supporter of lower limbs is used to chronic process, which likes a man can walk 1
make her do walking training successfully, which year after birth and is the necessary development
can effectively prevent scissors gait induced by process of central nervous system. Because she
adduction of double lower limbs. It is difficult to cannot stand and walk after birth, she loses the
walk with several orthotics such as hip joint best development period of central nervous sys-
abduction orthotics, abduction supporter of lower tem. At present, motor program of standing and
limbs and rectification brace of double ankle walking should be established in her brain, which
joints, but she finally can step forward with these takes longer time than that in the phase of the
References 385
baby. If the patients can persist on it, there will be the course of disease is long or not, the state of
good results. disease is complicated or not, it is possible to
She and her family know the mechanism and increase the functions. It is incorrect to give up
receive the training happily. In the tenth month the therapy and predicate that there is no
after training, the walking speed of her is improvement.
increased and self-care ability is improved. She In the clinical practice year after year, the ther-
can wash her face, brush her tooth, eat and write. apists can fully realize the importance of three
Slowly, she can bear load without double ankle elements of rehabilitation. They should tell the
joint molding. There is no abduction of lower patients, patients’ family and other medical staff
limbs without abduction supporter of lower timely and extensively and make the whole soci-
limbs. She can walk with the help of walking aid ety realize the importance and particularity of
and without abnormal gait rectification weight rehabilitation. It is good for the increase of reha-
support walking device. bilitation consciousness and progress of rehabili-
After a period of time of rehabilitation train- tation medicine.
ing and schedule adjustment, she can walk with
the help of walking aid and without others’ help.
She and her family have a higher goal. They References
believe family affection can conquer disease and
YanYan can achieve it. They believe they find the 1. Torres VM, Saddi VA. Systematic review: hereditary
thrombophilia associated to pediatric strokes and
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Family affection, tenacity and methods are 2. Bearden DR, Monokwane B, Khurana E, Baier J,
three necessary factors in rehabilitation therapy, Baranov E, Westmoreland K, Mazhani L. Steenhoff
which are similar and essential. The patients who AP pediatric cerebral palsy in botswana: etiol-
ogy, outcomes, and comorbidities. Pediatr Neurol.
require rehabilitation are unable to move, need to 2016;59(6):23–7.
be taken care of, are lack of finance resource and 3. Södermark L, Sigurdsson V, Näs W, Wall P, Trollfors
have no ability of choose and decision making. B. Neuroborreliosis in Swedish children: a population-
Therefore, they are the group who require family based study on incidence and clinical characteristics.
Pediatr Infect Dis J. 2017;36(11):1052–6.
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process, even lifelong. The patients and their developments in functional assessment tools for
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All of these are the basis of good effects of effec- 2008;19(6):667–70.
5. Hamer Elisa G, Bos Arend F, Mijna H-A. Assessment
tive rehabilitation method. of specific characteristics of abnormal general move-
Good method is the accumulation of experiments: does it enhance the prediction of cerebral
ence. The process of her therapeutic process not palsy? Dev Med Child Neurol. 2011;53(8):751–6.
only testifies the rationality and effectiveness of 6. Martinuzzi A, De Polo G, Bortolot S, Brogå
PMC. Pediatric neurorehabilitation and the
neural potential development, motor program ICF. NeuroRehabilitation. 2015;36(1):31–6.
reestablishment and motor pattern remodeling 7. Bailes Amy F, Paul S. Factors associated with physi-
training, but also shows the great potential and cal therapy services received for individuals with
plasticity of human body. In the training of stand- cerebral palsy in an outpatient pediatric medical set-
ting. Phys Ther. 2012;92(11):1411–8.
ing and walking, through bearing load of limbs 8. Lorenzee EJ, Cancro R. Role of nondirective play
and innervation of brain to muscle, the joint therapy as a technic of psychotherapy in cerebral
motion is done. Unstable ankle joint is stable, palsy. Arch Phys Med Rehabil. 1955;36(8):523–36.
muscle strength is increased and the movement is 9. Becmeur F, Schneider A, Flaum V, Klipfel C,
Pierrel C, Lacreuse I. Which surgery for drool-
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of Paraplegia
13.1 T
he Main Dysfunctions dysfunctions of spinal cord after injured level such
of Spinal Cord Injury as motor, sensation, sphincter and autonomic ner-
vous function. According to pathological factors
Spinal cord injury (SCI) [1] is injury of structure and neural dysfunctions, spinal cord injury is clas-
and function of spinal cord induced by various sified, which is important for the diagnosis, reha-
nosogenesis, which lead to dysfunctions of spinal bilitation therapy and prognosis of the patients.
cord under the injured level such as motor, sensa-
tion and reflex. It is severe disabled injury. It can 13.1.1.1 C lassification of Spinal Cord
induce paraplegia or quadriplegia to varying Injury
degrees and affect the self-care ability and social Many factors and diseases can lead to SCI. It can
ability of the patients greatly. It is difficult in the be divided into traumatic injury and non-
therapy, especially complete spinal cord injury. traumatic injury.
Except for implantable functional electrical stim-
ulation and compensation of assistive device, 1. Traumatic spinal cord injury: Traumatic injury
there are no other effective methods for the dis- is injury of structure and function of spinal
ease such as surgery, medicine and neural stem cord induced by destruction of spinal cord sta-
cells transplantation [2]. bility due to mechanical action.
Up to this day, many patients, their family and –– Direct external force: Blade puncture or
clinical physicians still think that rehabilitation penetrating injury of spinal cord by bullet,
therapy can be considered only if other methods shrapnel can lead to open spinal cord injury.
are hopeless. Dependence of surgery or aimless Stone or weight can hit the small of the back
use of medicine and therapy method without clin- directly, which is the common cause of spi-
ical verification can affect effects of rehabilita- nal cord fracture and spinal cord injury.
tion training because of delaying opportunity of –– Indirect external force: In traffic accidents
rehabilitation therapy. and fall accident from high place, external
force acts on spine and spinal cord, but
external force can lead to different spinal
13.1.1 Classification and Diagnosis fractures and dislocations, which can
of Spinal Cord Injury induce spinal cord injury.
Spinal cord injury is transverse injury of spinal External force is the main cause of injury of
cord due to various pathogenic factors. It leads to spine and spinal cord. Some spinal cord injuries
https://doi.org/10.1007/978-981-13-0812-3_13
388 13 Rehabilitation Therapy of Neurological Training of Paraplegia
are not always accompanied with fractures and below injured level are totally lost in spinal cord
dislocations of spine, even there is no abnormal injury, especially the complete loss of motor and
phenomenon in imaging changes, which are sensation functions of the lowest sacral segment
common in spinal cord injury of children and below injured level. Sensation function of sacral
adult patients with degenerative spondylodynia segment is deep sensation of anal and sensation
and spinal canal stenosis. It can be misdiagnosed of the junction of skin and mucosa in anal. Motor
so that we should pay attention to it. MRI and function of sacral segment is the degree of auton-
electrophysiological examination have some omous contraction of musculus sphincter ani
effect on the diagnosis of spinal cord injury with- externus in digital rectal examination.
out fractures and dislocations. Incomplete spinal cord injury means that there
is residual sensation and motor functions below
2. Non-traumatic spinal cord injury: There are injured level. There is motor or sensation func-
many causes of non-traumatic spinal cord tion in the lowest sacral segment (S3–5).
injury. They can be divided into two classes. Spinal shock: After external force action
(shock), the neural function of spinal cord are
Developmental pathogenesis includes congeni- totally lost below injured level in a short time, but
tal scoliosis, spina bifida and spondylolisthesis. this is not definitely complete injury. It lasts sev-
Spina bifida can lead to tethered cord syndrome. eral hours or weeks, even several months. In the
Acquired pathogenesis: Spinal cord injury due period of spinal cord shock, the injured degree
to non-spinal cause mainly includes: cannot be assessed correctly.
Rehabilitation centre of first affiliated hospital Quadriplegia: after cervical spinal cord injury,
of Henan College of Traditional Chinese there is motor function lesion or loss of limbs and
Medicine: arteritis, thrombophlebitis of spinal sensation lesion or loss below cervical injured
cord, arteritis and phlebophlogosis. level, which can lead to dysfunctions of trunk and
Infection: Guillain-Barr syndrome, transverse pelvic organs.
myelitis, anterior poliomyelitis and spinal tuber- Paraplegia means motor and sensation functions
culosis. Spinal tuberculosis was one of the impor- lesion or loss of chest, waist or sacrum of spinal
tant causes of spinal cord injury. cord. Paraplegia doesn’t affect functions of upper
Degeneration: spinal amyotrophy, amyo- limbs, but affect trunk, legs and pelvic organs, which
trophic lateral sclerosis and syringomyelia. includes injury of horsetail and conus medullaris.
Occupancy: various tumors, primary tumors Nerve root escape: after complete cervical
such as meningioma (spinal meningioma), neu- cord or lumbar cord injury, spinal roots are recov-
roglioma, neurofibroma and multiple myeloma, ered gradually above injured level and the neural
secondary tumors. Spine is the predilection site injury level is decreased.
of metastatic tumor. There is spinal metastasis in Qualitative diagnosis is very important for the
pathological examination in 90% of cancer degree of spinal cord injury and formulation of
patients. In the patients with spinal metastasis, therapeutic schedule. Digital rectal examination,
patients with spinal cord injury account for 20%. bulbocavernosus reflex and anal reflex are the
Iatrogenic: accident injury of spinal surgery. We essential items of qualitative diagnosis of the
should master surgical indications and be familiar patients with spinal cord injury.
with surgical technic to prevent iatrogenic injury. Digital rectal examination is the main indicator
of complete injury. The procedure is that finger is
13.1.1.2 D iagnosis of Spinal Cord used to be inserted into anal to exam the sensation
Injury and motor of anal. If there are still sensation and
1. Qualitative diagnosis includes complete spinal motor of anal, it is incomplete spinal cord injury.
cord injury and incomplete spinal cord injury. This exam can judge the completeness of injury.
Reflex examination includes bulbospongiosus-
Complete spinal cord injury: the functions of anal reflex and anal reflex. Bulbospongiosus
motor, sensation, physical reflex and sphincter reflex is the main indicator of spinal cord shock
13.1 The Main Dysfunctions of Spinal Cord Injury 389
period. The procedure is that stimulation of glans The relationship between level of spinal cord
penis or clitoris to see if there is reflex contrac- injury and key muscle refer to Table 13.3. The
tion of musculus sphincter ani externus. The level and severity of spinal cord injury are the
reflex is negative in 15% of normal people. main basis of determining the rehabilitation goal
Therefore, except for bulbospongiosus reflex, of the patients, which is important to rehabilita-
muscle spasm below injure level is the indicator tion therapeutic method selection, nursing sched-
of disappearance of spinal shock period. Anal ule formulation, therapeutic effects evaluation
reflex: the procedure is that stimulation of anal to and prognosis judgements.
see if there is contraction of musculus sphincter
ani externus.
If there is bulbospongiosus reflex, anal reflex 13.1.2 The Common Clinical
and muscle spasm below injured level, it means Syndrome After Spinal Cord
the end of spinal shock period. Injury
International Standards for Neurological
Classification of Spinal Cord Injury (Table 13.1). Typical transverse spinal cord injury is divided
into paraplegia and quadriplegia according to
2. Localization diagnosis: According to sensory injure level. Some incomplete injuries have spe-
level and motor level, the injured level can be cial manifestations, which is called clinical syn-
confirmed. drome. Specific clinical manifestations and signs
of these syndromes are good for understanding
Segmental structure characteristics of spinal the parts of spinal cord injury, diagnosis and for-
neurotomy determines the segmental manifesta- mulation of therapeutic schedule.
tions of spinal cord injury. After spinal cord Central cord syndrome is commonly observed
injury, the motor, sensation, reflex, sphincter and in the injury of spinal vessels. The injury may be
autonomous neural functions of spine are dam- started from the central of spinal cord to the
aged to varying degrees below injured level. The peripheral. Because the motor nerve of upper
relationship between injured level and sensory limbs is close to the central of spinal cord and the
key point refer to Table 13.2. motor nerve of lower limbs is close to the periph-
eral of spinal cord. The severity of nerves of
3. Functional diagnosis: After spinal cord injury, upper limbs is more than that of lower limbs. The
the sensation, motor and daily life ability are disorder of upper limbs is more severe than lower
assessed. limbs. It is possible to walk for the patients, but
the upper limbs may be partially or completely
Inspection items and scoring methods of sen- paralyzed.
sation and motor are used to assess sensory and Hemisection syndrome is common in blade
motor functions to ascertain the sensory level, injury or gun shot. It injures hemi-spinal cord.
motor level and level of spinal cord injury and Because thermal sensory nerve and pain nerve
assess daily life ability of the patients. cross over in spinal cord, proprioception and
Table 13.1 Grading table of international spinal function lesion (ASIA Impairment Scale)
Extent of Myodynamia of key
Grade injury Sensory function Motor function muscle
A Complete None (sacral segment) None None
B Incomplete Have (sacral segment) None None
C Incomplete There is sensation below There is motor function below Less than Grade 3
neurological level neurological level
D Incomplete There is sensation below There is motor function below No less than Grade 3
neurological level neurological level
E Normal Sensation is normal Motor is normal Muscle tension is
increased
Table 13.2 The relationship between injured level and sensory key point
Level Parts Level Parts
C2 Occipital tuberosity T8 The eighth intercostal (between T7 and T9)
C3 Supraclavicular fossa T9 The ninth intercostal (between T8 and T10)
C4 The top of acromioclavicular joint T10 The tenth intercostal (navel level)
C5 Facies lateralis of antecubital fossa T11 The 11th intercostal (between T10 and T12)
C6 Thumb T12 The middle part of inguinal ligament
C7 Middle finger L1 Upper one-third of T12 and L2
C8 Little finger L2 Anterior middle part of thigh
T1 Facies incisalis ulnaris of antecubital fossa L3 Medial femoral epicondyle
T2 Armpit L4 Malleolus medialis
T3 The third intercostal L5 The third metatarsophalangeal joint of acrotarsium
T4 The fourth intercostal (milk line) S1 Lateral part of heel
T5 The fifth intercostal (between T4 and T6) S2 Midpoint of popliteal space
T6 The sixth intercostal (xiphoid level) S3 Ischial tuberosity
T7 The seventh intercostal
Table 13.3 The relationship between level and key motor muscles
Level Key muscles Level Key muscles
C5 Elbow flexor (musculus biceps brachii L2 Hip flexor (iliopsoas)
and pronator teres)
C6 Extensor carpi (extensor carpi radialis L3 Knee extensor (quadriceps femoris)
longus and brevis)
C7 Elbow extensor (musculus triceps L4 Ankle back extensor (tibialis anterior muscle)
brachii)
C8 Digital flexor of middle finger (flexor L5 Digital extensor (extensor digitorum longus)
digitorum profundus)
T1 Abductor of little finger S1 Ankle plantar flexor (musculus gastrocnemius
and musculi soleus)
motor functions of ipsilateral limbs are lost in ment of spinal cord, which induces areflexia of
injured side and thermal sensation and pain sen- bladder, intestinal tract and lower limbs. The
sation of offside limbs are lost. reflex is kept in sacral segment.
Anterior cord syndrome: if the injury is Cauda equine syndrome means the injury of
located only in anterior spinal cord, because ante- nerve root in lumbosacral part of intraspine,
rior horn motor cell is from higher motor infor- which can induce areflexia of bladder, intestinal
mation conduction bundle and thermal sensation tract and lower limbs. Cauda equina belongs to
and pain sensation are from anterior spinal cord, peripheral nerve and is able to regenerate. The
which can lead to loss of motor, thermal sensa- neural functions can be recovered and it takes a
tion and pain sensation below injured level, but long time.
the proprioception exists. Spinal cord contusion means the temporary
Posterior cord syndrome: The injury is located and reversible physiological function loss of spi-
only in posterior spinal cord. Because slender nal cord and cauda equine. It is only observed in
fasciculus and fasciculus cuneatus of propriocep- simple compression fracture of centrum or short
tion are located in posterior spinal cord, the pro- pressure wave of spinal cord. There is no mechan-
prioception below injured level is lost, but motor, ical compression in spinal cord and no organic
thermal sensation and pain sensation still exist. injury. There are no positive results in radioactive
Conus medullaris syndrome: The injury is rays. There is hyperreflexia in the patients with-
mainly located in conus medullaris in sacral seg- out muscle spasm.
13.1 The Main Dysfunctions of Spinal Cord Injury 391
13.1.3 The Main Dysfunctions Functional assessment of trunk includes

Induced by Spinal Cord Injury assessments of range of joint motion, muscular
strength, functional assessment of upper limbs
Paralysis (motor dysfunction): Spinal cord injury and lower limbs, gait analysis, neural electro-
in chest and lumbar segments lead to paralysis of physiology, spasm, sensory functional assess-
lower limbs. Cervical spinal cord injury leads to ment, coordinated and balanced functional
quadriplegia. assessment.
Sensory disturbance: There are paresthesia, Functional assessment of mentality includes
hyperesthesia, hypaesthesia, even sensory depri- assessments of psychological states, character
vation of paralytic limbs that are correspondence and pain level.
with injured level. Functional assessment of social ability
Gatism: After spinal cord injury, there is usu- includes assessments of life ability and indepen-
ally gatism or dysuresia and there is constipation dence ability.
or incontinence. Indwelling catheter term and Assessment of spinal stability: Because one of
residual urine volume can induce urinary system the conditions of the patients’ rehabilitation
infection and stone, even renal dysfunction. training is the stability of spinal cord, or else it
Pain: After spinal cord injury, there is usually may aggravate or induce iatrogenic spinal cord
pain below injured level and it is hard to cure. injury. Therefore, the assessment of spinal stabil-
Muscle spasm: There is usually muscle spasm ity is the essential assessment item before reha-
after spinal cord injury above lumbar segments, bilitation training.
which can not only affect limbs movements and If the spinal cord is in the physiological laden
nursing, but also induce pain. range, even if there is abnormal deformation,
Pressure sores: The most common spinal cord shifting and movement of spinal functional unit,
injury complications are infection and motor the functions of spinal cord and nervous system
disorder. cannot be injured. Unstable spinal cord is usually
Psychological disorder: After paraplegia, observed after the injury of functional unit or
there are many problems. Most patients are with assistive structure of spinal cord. In the physio-
psychological disorders to varying degrees, logical laden condition, the functional units of
which can aggravate the state of the disease, even spinal cord lose the ability of maintaining normal
suicide. structure. Abnormal movements, shifting, defor-
Others: Autonomic regulation disorder, het- mity aggravation and functional impairments of
erotopic ossification and dyspnea because of spinal nerve are easy to occur. Diagnostic criteria
respiratory muscle dysfunction. of unstable spine from higher cervical spine to
low lumbar spine refer to Table 13.4, 13.5, 13.6,
and 13.7.
13.1.4 Functional Assessment Under this circumstance, the patients with spi-
of Spinal Cord Injury nal cord injury receive rehabilitation are the
patients who receive incision vertebrae reduc-
Rehabilitation assessment is the basis of formulation, spinal canal decompression and internal
tion of rehabilitation therapy schedule. There are fixation. With the improvement of internal fixa-
many methods that can be selected in the books tion devices and quality increase, internal fixa-
of rehabilitation medicine and monograph of tion can meet the requirements of spinal cord
rehabilitation functional assessment. The follow- stability. If it is not enough, the patients can wear
ing assessment methods are usually used in reha- orthopaedic assistive devices of back rack.
bilitation training of neurological training. Functional assessments of spinal cord injury
Functional assessment of spinal cord includes include injury degree, injured level, stability of
the level and severity of spinal cord injury. spinal cord after surgery, range of joint motion,
Table 13.4 diagnostic criteria of unstable upper cervical Table 13.7 Diagnostic criteria of unstable lumbar seg-
spine (C0–C2) ments (L1–L5)
Injured sites Degree Injured sites and degree Score
Atlanto-occipital rotation More than Anterior column destruction and function loss 2
8° Posterior column destruction and function loss 2
Atlanto-occipital shifting More than The angle of sagittal surface rotation is more 2
1 mm than 9%
Two sides shifting of atlanto-occipital More than Shifting distance of sagittal surface in flexion 2
lateral mass 7 mm and extension position is more than 8–9%
Pre-gap sagittal odontoid More than Cauda equine injury 3
4 mm
Assessment criterion: the full score is 11. No less than 5 is
Unilateral rotation of atlanto-occipital More than defined as instability
vertebra 45°
The space between posterior margin of No more
epistropheus atlanto-occipital arcus than 13 mm
posterior 13.2 S
pinal Cord Injury
Table 13.5 Diagnostic criteria of unstable cervical verte- of Neurological Training
bra (C3–C7)
Injured sites and degree Score 13.2.1 Early Rehabilitation Therapy
Anterior column destruction and function loss 2 of Spinal Cord Injury
Posterior column destruction and function loss 2
The angle of sagittal surface rotation is more 2 According to spinal function change and reha-
than 11° bilitation therapy method, spinal cord injury is
Shifting distance of sagittal surface is more than 2
3.5 mm
divided into early phase of spinal cord injury and
Spinal cord injury 2 recovery phase of spinal cord injury.
Cervical traction test is positive 2 The early phase of spinal cord injury
Root injury 1 includes the patients with unstable disease state
Spinal canal stenosis 1 within the 3 weeks after injury who receive
Assessment criterion: the full score is 14. No less than 5 is incision vertebrae reduction, spinal canal
defined as instability decompression and internal fixation. Their
wounds are just healed and the body reaches
Table 13.6 Diagnostic criteria of unstable thoracolum- dynamic balance under new condition, which
bar spine (T12–L1) are not suitable for large dose motor function
Injured sites and degree Score training such as off bed movements, standing
Anterior column destruction and function loss 2 and walking.
Posterior column destruction and function loss 2
Shifting distance of sagittal surface is more than 2 13.2.1.1 Rehabilitation Therapy
2.5 mm
Principle
The angle of sagittal surface rotation is more 2
than 5° Rehabilitation principle of this phase is to pre-
Spinal cord injury 2 vent complications and prepare for the prelimi-
Costovertebral joint rupture 1 nary training of off bed rehabilitation training.
Assessment criterion: the full score is 11. No less than 5 is
defined as instability 13.2.1.2 Therapeutic Schedule
and Method
myodynamis, spasm and balanced functional After spinal cord injury, there are many compli-
assessment, which are good for judgement of the cations. If they are not handled well, it is possible
patients’ prognosis, formulation of rehabilitation to induce secondary disease, which may affect
therapy schedule, the design and application of functional recovery of the patients in the future
assistive devices for walking. greatly, even life danger.
13.2 Spinal Cord Injury Rehabilitation Therapy of Neurological Training 393
1. Tertiary prevention to decrease disabled

may induce urinary tract infection easily. If the
degree and secondary disease as much as kidney is infected, there is nephropyelitis.
possible. The increase of residual urine can increase
intravesical pressure, which increases the resis-
Primary prevention is impairment prevention. tance of urine in ureter flowing into bladder, even
After spinal cord injury, during the process of regurgitation. High tension may lead to upper uri-
saving the patients, emergency treatment, immo- nary tract dropsy and injure renal function, which
bilization fixation, drug therapy and correct sur- finally induce renal failure. The main purpose of
gery are adopted in the early phase to prevent therapy is to recover balance function of bladder
secondary lesion and injury of spinal cord and the and urethra and prevent infection in order to pro-
aggravation of spinal dysfunctions, which creates tect renal function maximally. In clinic, preferred
condition for the functional recovery of spinal non-operation therapy method is intermittent
cord. Clinical physicians should memorize that catheterization and others include retention cath-
prevention of spinal cord injury is more impor- eterization, bladder irrigation, bladder urination
tant than therapy of spinal cord injury. training, outer urine collection device and drug
Aggravation of spinal cord injury must be avoided therapy.
in emergency. It must be pointed that correct sur- Although retention catheterization can evacu-
gical therapy is one part of therapy of spinal cord ate urine totally, avoid hyperinflation of bladder,
injury, while improper surgery may aggravate improve blood circulation of bladder wall and
spinal cord injury. promote functional recovery of bladder, indwell-
Secondary prevention is disability prevention ing catheter destroy germ free condition of blad-
to prevent various kinds of complications, to der and urethra and germ can go into bladder
carry out early rehabilitation training, to make through peripheral clearance of catheter and
full use of all residual functions to develop new inner cavity, which can induce bacteriuria. If this
functions, to reach self-care maximally, to pre- is not handled properly, it will lead to urinary sys-
vent or decrease disability. tem infection. If the catheter is kept for 1 day, the
Tertiary prevention is handicap prevention. incidence rate of bacteriuria is 50%. If the cathe-
Spinal cord injury leads to spinal dysfunctions ter is kept for 4 days, the incidence rate of bacte-
and rehabilitation measures (medicine, engineer riuria is 98–100%. Therefore, it is used in the
and education) are used comprehensively to patients who are severe and feeble and cannot
make full use of all residual functions and modify evacuate bladder, are with uroschesis or uroclep-
external conditions (barrier free accessibilities of sia (female patients), are difficult to use intermit-
house) to make the patients return to society in a tent catheterization or have upper urinary tract
short time. impairment and vesicoureteral regurgitation.
Therefore, if possible, the long-term indwelling
2. Reflex bladder is established to prevent uri- catheter should be avoided to prevent secondary
nary system infection, promote functional disease such as urinary system infection and
recovery of defection and prevent stone.
constipation. The preferred clean urethral catheterization
technique is also called intermittent catheteriza-
Prevention of urinary system infection and tion, which is the way of urethral catheterization
obstruction: urinary system infection and obstruc- without indwelling catheter by non-medical
tion finally lead to renal failure, which is the main staffs such as patients, their family or caregivers
cause of death of the patients with neurogenic to decrease the incidence of urinary system infec-
bladder and urethral dysfunction. Residual urine tion obviously.
due to unable evacuation of bladder provide If non-surgical therapy cannot figure out the
medium for growth and reproduction of bacteria problem, the patients can consider operation
and injure defense mechanism of bladder, which method therapy. Cystauchenotomy through ure-
thra is suitable for the patients who with obstruc- used in clinic. The recent effect is satisfying and
tion of export part of bladder, bladder contraction long-term effect remains to be observed.
inability, but without external urethral sphincter Rectum training: After spinal cord injury, the
dysfunction. Before surgery, phentolamine test problems of rectum include constipation. Enema,
can be sued to predict operation result. anus lubricating agent and laxative can be used.
Transurethral sphincterotomy is suitable for the Diarrhea is rare and most are accompanied with
patients with spinal cord injury above sacral cord intestinal infection. Antibacterial agents and
who have dysuresia due to hyper contraction of intestinal astringents can be used for therapy.
striated muscle of perineum and external ure- Functional training method of rectum active
thral sphincter. Dysuresia can lead to increase of movement refers to the common complications
residual urine and this surgery can reduce ure- disposition of spinal cord injury in the third sec-
thral resistance effectively. External urethral tion of this chapter.
sphincter incision is irreversible and there is uro-
clepsia to varying degrees after surgery. The sur- 3. Keeping joints in functional position to pre-
gery can be implemented 1 year after injury vent amyotrophy, muscle tendon contracture
when the nervous system disease is stable and and joint adhesion.
the functional recovery is finished. Suprapubic • Application of retaining appliance of limbs
cystostomy is suitable for the patients who are functions position: Keeping joints in func-
with repeated severe urinary system infection, tional position or in good limbs position is
neurogenic bladder urethral dysfunction and the basis of motor functional recovery of
urethral injury and it is temporary therapeutic limbs. After injury, without affecting first
measures. After surgery, fistula is adopted in aid, it should be used as soon as possible.
scheduled time opening. When the bladder • Passive joint motion: After vital signs are
reaches certain filling volume, the patients evac- stable, passive motion of all joints can be
uate it to avoid bladder contracture. When the started. The times of movements in axial
disease is better, fistula should be removed as direction is 6–8 (1–2 times per day) to pre-
soon as possible to recover urination. Bladder vent muscle tendon contracture and tissue
augmentation is suitable for the patients who adhesion of joint and muscle.
with increase of detrusor pressure and decrease
of bladder volume due to bladder contracture. The movement should be slow and reach the
Terminal ileum is used to enlarge the volume of maximal physiological range to avoid straining a
bladder in order to decrease intravesical pres- muscle or ligament. It should be operated accord-
sure, alleviate and prevent hydronephrosis and ing to regulations. For example, wrist and finger
hydroureter. Urinary diversion is only used for joints cannot be flexed at the same time in case of
the patients with severe hydronephrosis and straining wrist and tendon of extensor digitorum
hydroureter and renal insufficiency. The most muscle.
common used is napes fistulation of ileal loop Continuous passive motion device of joints
replacing bladder. There are many secondary can be used such as CPM devices of ankle, knee,
disease and it should be used with caution. hip, finger, elbow and shoulder joint. The joints
In some reports artificial urethral sphincter is motion in maximal physiological range can be
used to reestablish the function of bladder urina- done in turns to eliminate joint adhesion without
tion. After surgery, the incidence rate of compli- pain, improve the angle of joint motion, treat or
cations is high, which restricts the application of prevent joint stiffness, amyotrophy, degenerative
it. Implantation bladder stimulation device is and traumatic arthritis. It can be used after trac-
used to stimulate detrusor of bladder directly to tion of joint contracture and therapy of joint loos-
induce urination, but the effect is not satisfying. ening to keep the therapeutic effect.
Electrode is implanted into conus medullaris or Massage of trunk and limbs can increase
sacral nerve root directly, which is started to be blood circulation of muscle, promote metabo-
lism, prevent tissue adhesion and alleviate pain. setting surpassing goal. The training time is
Eight treating observances of massage is used for 45 min (one time a day).
the massage of lower back and four limbs. The Early sitting up and standing training: for the
movement should be gentle and soft to avoid patients with stable spinal cord, the sitting train-
aggravating muscle spasm. The frequency is 1–2 ing can be used in the early phase (after injury or
times a day. 1 week after surgery). If the internal fixation is
Active joint motion or induction training of not stable, back rack can be used for protection.
active motion: For the patients with incomplete Sitting up training is started in 30° elevation from
spinal cord injury, functional assessments are the head of the bed. If there is no adverse effect,
used to find out the main obstacles for physical the head of the bed can be increased 15° in every
training and occupational therapy of neurological 3 days until the patient can sit upright and the
training (six-step Daoyin technique). The patients duration is no less than 30 min. if there is any
are guided to do active joint motion and the thera- adverse effect in the training, the head of the bed
pists exert resistance in the orientation of move- should be decreased until the symptoms disap-
ment to develop spinal potential and increase pear. Under the guardianship of vital signs moni-
myodynamia in order to prevent amyotrophy and tor such as electro cardio, the therapists can find
phlebothrombosis. Every time, the therapists the problem timely and keep the safety of the
choose three joints to do active flexion and exten- training. Standing bed training: after injury or 3
sion motion training in turns. The training time is weeks after surgery, according to the specific
45 min (1–2 times a day). For the patients with condition of the patients, the training is done. If
complete spinal cord injury, six-step Daoyin the patients can keep in sitting position (90°) for
technique is used to do induction training. The no less than 30 min and there is no adverse effect,
patients should receive the therapy with patience. the standing training can be started. Standing bed
On the basis of regulation of mind and breathing, is used. The training can be started from 30°
regulation of movement can induce the motor inclination and the angle can be increased gradu-
center in brain cortex to give out motor program ally until the patients can stand upright for no less
signal to stimulate conduction bundle located in than 30 min and there is no adverse effect. In the
the part of spinal cord injury in order to recover training, the therapists should observe the change
the functions of incomplete injured conduction of the patients in case of postural hypotension. If
bundle and activate reserved conduction bundle there is any abnormity, the angle of standing bed
around injure zone. In most cases, complete spi- should be decreased immediately and symptom-
nal cord injury in early diagnosis may be not the atic treatment should be given to the patients
real complete injury and zero myodynamia from timely. Vital signs monitor with alarm is used to
assessment may be not the real zero motor pro- monitor the patients continuously. If there is any
gram signals. The functions are possible to be abnormity of vital signs, the therapists can find
recovered. Medical staffs, the patients and their out the problem and keep the safety of the
patients should have confidence and don’t give training.
up. The training of neurological training: In the If the patients cannot stand upright for no less
early phase, rehabilitation training of neurologi- than 30 min, it means that the patient’ injured
cal training can be done in the bedside. According level is higher and the cardiovascular stress
to the actual situation of the patients, clinostatism, response is poor. The following methods can be
semireclining position or sitting position can be applied for therapy. Elastic bandage of lower
used. Neurological training device is used to limbs can be used with bellyband to increase
monitor the motor program signal of agonistic returned blood volume. Pulse-activating injection
muscle (single channel). Six-step method or six- is the Chinese materia medica preparation puri-
step Daoyin technique of guiding collaterals fied from red ginseng, Radix Ophiopogonis and
through meridians is used to develop neural Schisandra chinensis, which can regulate the
potential and recover lost motor function through flow of vital energy and remove obstruction toit,
tonify qi and strengthen heart, promote the secre- motor function below paraplegic level, which
tion of saliva or body fluid and restore the pulse, easily induce pressure sores and deep venous
rescue from collapse by restoring Yang, thrombosis. When it does happen, it is diffi-
strengthen the body resistance to eliminate patho- cult to be handled so that we should prevent
genic factors, promote blood circulation to them effectively.
remove blood stasis and anticoagulated. 6.
Transfer training includes independent
Intramuscular injection: the injection dose is transfer training and transfer training with
2–4 ml every time (1–2 times per day). help. After injury, if the disease state is sta-
Intravenous drip: the dose is 20–60 ml every ble, the patients can start transfer training
time. It should be diluted with 250–500 ml 5% from bed to wheelchair and from wheelchair
dextrose injection (once a day). to toilet. Transfer training can be completed
independently or with the help of others
4. Breathing and sputum excretion training to such as one person or two persons.
keep the airway open and prevent pulmonary Independent transfer is the transfer move-
infection. ment that the patients can complete by them-
selves. It is one kind of life stand-alone
Dyspnea due to spinal cord injury is rarely capability training, which includes transfer
observed in high level injury, especially the from clinostatism to sitting position, cross-
patients with cervical spinal injury. Because wise and vertical transfer on bed or cushion,
paralysis of respiratory muscle and abdominal transfer from bed to wheelchair, transfer
muscle, atelectasis can induce dyspnea and from wheelchair to bed, transfer from wheel-
expectoration inability, which may easily induce chair to stool, transfer from stool to wheel-
pulmonary infection. The prevention methods are chair, transfer from wheelchair to the
as follows: The therapists help the patients to turn ground, transfer from the ground to wheel-
over and slap back to excrete sputum. If possible, chair, transfer from wheelchair to pedestal
the patients should be in semireclining position pan and transfer from wheelchair to vehicle.
to increase thorax volume through moving down In the transfer training, some assistive
visceral organs. If there is sticky sputum, aerosol devices can be used such as sliding plate.
inhalation is used to dilute sputum. Vibration
sputum elimination apparatus is used to excrete Assistive transfer training: the therapists face
sputum and the airway should be open. Active to the patients, use double knees to support the
movement training of respiratory muscle: deep knee of the patients, use two hands to support the
and slow abdominal breathing is the effective hip of the patients and lift up the patients. The
breathing form to increase tidal volume. Third- patients use one hand to support the shoulder of
fourth gas is inhaled because of increase of tho- the therapists and the other hand falls naturally.
rax volume induced by moving down of The patients are transferred to bed slowly.
diaphragm. For the patients with spinal cord Transfer forward training: Wheelchair faces to
injury and without diaphragmatic paralysis, pul- bedside and it is braked. The patients are trans-
monary functional training device can be used to ferred to bed slowly. The patients use two hands
drill diaphragm to increase its contraction ability, to hold the handrail of wheelchair to support the
which can form deep and slow abdominal breath- body in order to move to the bed from the front of
ing in order to prevent pulmonary infection. wheelchair.
Transfer lateral training: the angle between
5. Timely turning over and active and passive wheelchair and bed is 45° and the wheelchair is
movements of lower limbs to prevent pressure braked. The patients put two legs on the bed, use
sores and deep venous thrombosis effectively one hand to support the bed and use the other
because of paraplegia, especially complete hand to hold the handrail of wheelchair in order
paraplegia, the patients lose sensation and to move the hip out of bed.
In short, in the early rehabilitation phase of the the proximal in order to eliminate edema,
patients with spinal cord injury, vasomotion improve blood circulation of limbs, promote
training such as training from supine position to metabolism and prevent thrombogenesis.
sitting position, form sitting in bedside to sitting Therapeutic method is that the patients wear
in wheelchair, tilt bed transition, balance function and regulate inflated bag of upper and lower
training such as balance function training in sit- limbs. The pressure is 20–220 mmHg, which
ting position, on cushion and in wheelchair, can be adjusted according to the heart rate and
transfer training, wheelchair operation training, pulse of the patients. Inflation and evacuation
passive joint motion, muscle stretching, myody- time is 5–10 s and the therapy time is 30 min
namia training of residual muscles in the trunk (1–2 times a day). Medium-frequency electri-
and double upper limbs, breathing training are cal current, ultrashort wave, far infrared and
mainly used. In the late phase of rehabilitation, interference current can eliminate inflamma-
except for myodynamia training, balance function, alleviate pain, promote blood circulation
tion training and transfer training, standing train- and recover neural functions. They can be
ing with the help of assistive device or the selected according to the specific condition of
therapists, walking training with the help of body the patients.
weight center shifting walking orthotics, knee- 8 . Psychotherapy: Psychotherapy is the only
ankle- foot KAFO or ankle-foot orthotics are good medicine to encourage the patients to go
mainly used. Once the endurance is strengthened, out of the difficulty and fight with the disease.
overcoming obstacles, climbing stairs, standing The patients with spinal cord injury become
up after falling are mainly used. the person who lose functions from the person
who are healthy. Because of function loss, the
7. Physiotherapy can improve blood circulation patients know nothing about their future. After
of paralytic part and increase excitability of injury, most patients have severe psychologi-
paralytic muscle. There are many physiother- cal disorder includes severe repression or
apy methods. Nerve And Muscle Electrical depression, dysphoria, even mental symp-
Stimulation (NMES) can be used to treat dis- toms. Therefore, psychotherapists must
use muscle atrophy to increase excitability of explain the psychotherapy to the patients with
paralytic muscle, improve blood circulation, patience. They help the patients to analyze
increase or maintain range of joint motion, and know the three stages of the disease.
promote muscle relearning and facilitate it. Period of deny: the patients are thick suddenly
During therapy, electrode is placed on the and are lack of psychological preparation for
muscle belly and symmetry bi-directional this great fall. They don’t think they are ill and
square wave (1–100 Hz) is used. Break-make they feel contradicted, anxious, hesitated and
ratio is from 1–1 to 1–15. Motor threshold is unwilling to cooperate with therapy. In allu-
chosen in electricity and the time is 10–20 min sion to this condition, on the basis of fact,
(1–4 times a day). Transcutaneous Electrical psychotherapists explain to the patients that
Nerve Stimulation (TENS) is used to treat the law of birth, death, illness and old age is
various acute and chronic pains to improve irresistible. The patients gradually recognize
blood circulation. During therapy, the elec- that they are the same as other people and they
trode is placed in the pain point and asymme- can be thick. If these laws can be preached in
try bi-directional square wave (1–150 Hz) is the normal population, it is good for increas-
used. Pulse width is 0.04–0.3 ms. The elec- ing the consciousness of disease prevention
tricity is from sensation threshold to maximal and decreasing the morbidity. Period of sad:
bearing range. The time is 10–20 min (1–2 after a period of time, the patients recognize
times a day). Vapor-pressure type limbs blood that they are the same as other people and they
circulation drive device is used to accelerate can be thick. They will wonder their illnesses
return blood flow velocity from the distal to are healed or not, there is sequela or not, they
can return to society and work or not and the can be further recovered and the patients should
family is worried or not. They may be caught not give up.
in sorrow and then in sadness. They may have
no appetite for food and drinks, insomnia, 13.2.2.1 Rehabilitation Therapy
anxiety, and look extremely worried, which of Neurological Training
affect greatly physical and psychological Principle of the Patients
health of the patients. Psychotherapists should with Spinal Cord Injury
do psychotherapy on time and help the patients in Convalescence
to analyze the disease. They should ask the Rehabilitation principle of this phase is to recover
patients with the similar disease or with good normal motor pattern, cooperate with assistive
therapeutic effect to introduce the experience device, recover standing and walking functions,
and let the patients recognize that the disease establish neural reflex bladder, control complica-
cannot be defeated by pain and the patients tions such as urinary system infection and stone
should get up steam, face to the reality with effectively. Through vocational ability training,
courage, adjust psychology, cooperate with the patients have the ability of returning to the
therapy and do hard-training. And then they society and self-care.
can obtain good results. Period of positive in The types of spinal cord injury include injury
treatment: through the two stages, most of central nerve (above sacrococcyx (sacral end))
patients finally recognize that only facing to and injury of peripheral nerve (below sacrococ-
the reality can figure out all the difficulties cyx). It also involves the abnormal motor pattern
and cooperating with the therapists is the only of peripheral nerve. Because traditional rehabili-
way to functional recovery. The patients have tation medicine thinks that central paralysis is
faith and take part in rehabilitation training. qualitative change and peripheral paralysis is
quantitative change [3]. After peripheral paraly-
The mission of psychotherapy is to help the sis, there is no abnormal motor pattern and only
patients to realize the fact, get rid of the first two the change of extent such as myodynamia.
stages, transit to the third stage to alleviate extent Central paralysis is changed with the extent of
of injury to mind and body of the patients and voluntary movements. Abnormal motor pattern is
fight for best therapeutic effect. the main manifestation of qualitative change of
central paralysis. The disability induced by
peripheral nerve injury is amyotrophy, myody-
13.2.2 Rehabilitation Therapy namia decrease, muscle tension and tendon reflex
of Neurological Training decrease, while there is no abnormal motor
of the Patients with Spinal pattern. The chief measure of recovering func-
Cord Injury in Convalescence tions is the training of strengthening
myodynamia.
The convalescence of spinal cord injury means This is because people don’t recognize that
the period after acute phase. The undead cells or human motor pattern is dominated and controlled
cells in shock in injured zone are already recov- by motor program in motor center of brain cortex
ered through therapy. The compensation mecha- and the formation of abnormal motor pattern is
nism is activated to promote reserved conduction due to the appearance, completion and attenua-
pathway and spinal nerve cells around injured tion of associated response and associated
zone to replace the injured cells. This compensa- movement.
tion can be accumulated with time, which is good However, it is not the case. Nervus peroneus
for the improvement and recovery of spinal func- communis injury and paralysis of tibialis anterior
tions. Therefore, spinal cord injury is in convales- muscle and peroneus longus and brevis can lead
cence after acute phase. Although the recovery to foot drop and strephenopodia, there is usually
time is prolonged after injury, injured spinal cord abnormal walking motor pattern such as circle
gait ot drag gait. According to the theory of neu- Rehabilitation principle of early standing
rological training motor program, motor program and walking recovery is suitable for the
decides motor pattern and motor pattern is the patients with severe functional injuries in
manifestation of motor program. Abnormal multiple parts or cognitive dysfunction who
motor program leads to abnormal motor pattern are difficulty to recover functions because
and exterior abnormal motor pattern can modify they are reluctant to cooperate with the train-
the normal motor program in motor center of cor- ing. Three-stage rehabilitation schedule can-
tex. The abnormal motor program can be solidi- not meet the requirements of the third stage
fied with the application time. The exterior training. At this time, recovering walking abil-
abnormal motor pattern is hard to be rectified. ity of the patients with partial help is the ideal
Therefore, there is abnormal motor pattern in result. If the therapists still use three stages
peripheral nerve injury. The main purpose of therapy method, walking ability of the patients
rehabilitation is to recover lost neural function with partial help may not be recovered.
but not only strengthen myodynamia. Adoptive specific rehabilitation methods
The final purpose of rehabilitation is to recover are as follows:
the normal motor pattern that is good for body func- • Neural potential development is suitable
tions. Therefore, recovering motor function of spinal for central and peripheral nerve injuries.
cord injury is the basis of recovering normal motor Normal method or six-step Daoyin tech-
pattern. For the patients with complete or incom- nique in traditional Chinese medicine of
plete function loss, the purpose of rehabilitation is to guiding collaterals through meridians is
develop neural potential and residual functions max- used. According to the part of potential
imally through training to make the patients use development, the corresponding training
assistive device independently and recover standing, equipment is selected such as potential
walking and daily self-care abilities. development training device or apparatus
of upper limbs, lower limbs, trunk, tibialis
13.2.2.2 Therapeutic Schedule anterior muscle, musculus gastrocnemius
and Method and hamstring muscles. They can be done
1. The goal of rehabilitation training of neuro- gradually according to the difficulties. The
logical training of incomplete spinal cord training time is 30 (1–2 times a day) and
injury to recover normal motor pattern, there are 30 times in one therapy course.
develop potential functions maximally and The patients can receive multiple therapy
apply replacement function of assistive device courses.
in order to recover the standing, walking and • Physical therapy and occupational therapy
self-care ability of the patients. of neurological training (six-step Daoyin
According to detailed functional assess- technique bare-handed operation method):
ments and different degrees of paralysis, the Normal method or six-step Daoyin tech-
training principles are as follows: nique in traditional Chinese medicine of
Three-stage rehabilitation principle is suit- guiding collaterals through meridians is
able for the patients with more residual func- used for active movement training of every
tions or slight dysfunction who can recover joint. The therapists exert resistance in the
motor pattern through training. orientation of movement to develop spinal
Three-stage rehabilitation principle with potential functions fully. It is suitable for
the functional compensation of assistive the functional training of upper limbs,
device is suitable for the patients with local lower limbs, trunk, neck and hand. The
dysfunctions such as strephenopodia and foot training time is 45 (1–2 times a day) and
drop who can recover motor function through there are 30 times in one therapy course.
training and assistive device in spite the dys- The patients can receive multiple therapy
function is severe. courses.
• Neurological training: neurological train- is. The sequence is from lower to higher
ing apparatus is used to monitor the motor and the difficulty is increased gradually.
program signal of agonistic muscle and During training, the patients are guided to
antagonistic muscle continuously and the pay attention to correct shifting of body
signal is displayed in real-time. Through center and observe the balance in body
setting surpassing goal, six-step method or shifting, which provides basis for walking
six-step Daoyin technique of guiding col- training.
laterals through meridians is used to Rectification weight support walking
increase the signal intensity of agonistic training of abnormal gait: Rectification
muscle and decrease signal intensity of weight support walking training device of
antagonistic muscle. Motor program of abnormal gait is used. The patients wear
single joint is established at first and on the motor pattern remodeling instrument for
basis of that, motor program of associated training. The weight depends on the spe-
movement is established gradually. The cific condition of the patients. The weight
training time is 50 (once a day) and there usually is one fifth to one eighth of body
are 30 times in one therapy course. The weight. The patients do the walking train-
patients can receive multiple therapy ing in the footpath marked by gait. The spe-
courses. There is no side effect. cific goal of stride and stride width is set in
Virtual reality training of neurological the walking training on the footpath.
training: normal method or virtual reality Walking balance training: Walking bal-
training system of guiding collaterals ance training device is used. The patients
through meridians is used for the training. wear motor pattern remodeling instrument
The specific method is the same as the and lose weight. The patients do the train-
method of neurological training. The training in the footpath marked by gait. In the
ing time is 50 (once a day) and there are 30 first several trainings, except for weight
times in one therapy course. The patients support by suspension, there is no other
can receive multiple therapy courses. helps, just like independent walking.
Motor pattern remodeling training: On During walking, swing of the body can
the basis of potential development and make the patients feel nervous. The thera-
motor program reestablishment, when the pists should stand beside the patients, pro-
patients are able to stand up, flex hip and tect and guide the patients to alleviate
bear load with one leg independently or psychological burden of the patients.
with the help of assistive device, the train- Weight support walking training:
ing of motor program remodeling can be Weight support walking training device is
started. used for the training. According to the spe-
The training of motor pattern remodel- cific condition of the patients’ motor pat-
ing after spinal cord injury is as follows: tern, the patients wear (abnormal motor
Balance training: under the weight sup- pattern) or don’t wear (normal motor pat-
port protection of balance training device, tern) motor pattern remodeling instrument.
balance plate is used for balance training. The weight usually is one fifth to one
The inclination angle is from small to big eighth of body weight. Rotational speed of
gradually. track is from 0.22 m/s. With the increase of
Shifting of weight training of stride and walking ability, the speed is increased
gait: Training device of stride and gait is gradually. The patients are guided to do the
used. Stride is divided into five grades training according to the marked gait in the
according to the stride length. The lower track of walking machine.
the grade is, the shorter the stride is. The Footpath training marked by gait
longer the stride is, the bigger the difficulty includes balance bar footpath training
marked by gait or walking aid footpath pain to varying degrees. Complete

training marked by gait, the training of independent motor function is difficult to
ascending and descending the stairs and the be recovered and the functional defects
training of Footpath training marked by should be compensated by orthotics and
gait (Fig. 13.1). During the training, the support device. Therefore, the standing and
patients wear or don’t wear motor pattern walking abilities of the patients can be
remodeling instrument and gradually tran- recovered. There are many kinds of
sited to independent walking without help orthotics and support assistive device
and motor pattern remodeling instrument. including ankle-foot orthotics, knee-ankle
The patients can receive 4–6 therapy orthotics, wheelchair, walking aid,
items every day. The therapy time is interactive walking orthotics and intelligent
30–50 min and there are 30 times in one standing and walking system.
therapy course. The patients can receive It would be specially mentioned that
multiple therapy courses. application of any assistive device is the
The application of assistive device: the unavoidable replacement measure and it
functional recovery of the patients with should not be abused, especially for profit.
incomplete paraplegia is usually slow and Any replacement measure may lead to the
incomplete. Some patients have autono- disuse of the replaced part including mus-
mous movements, but there are spasm or cle and bone, which affects the functional
recovery of injured parts to varying degrees
in the future.
For the patients with incomplete spinal
cord injury, in order to make the patients
stand up and walk in the early phase, the
patients can wear walking assistive device.
With the progress of training, the patients
can remove some part of the assistive
device gradually and stand up and walk
independently on the basis of functional
recovery.
The therapy of muscle spasm: for
incomplete spinal cord injury, spinal cord
below injured level loses the control of
higher neural center. Its excitability can
lead to muscle spasm. At present, the com-
mon therapy method of muscle spasm at
home and abroad are as follows.
Rehabilitation methods include prevention
of harmful stimulation, motortherapy train-
ing such as extension, rectal probe electri-
cal stimulation, other physical therapy such
as stimulating antagonistic muscle and
acupuncture and moxibustion therapy.
Drug therapies includebaclofen, dantrolene
and diazepam. Nerve block methods
include motor spot block of phenol and
Fig. 13.1 The training of footpath training marked by Clostridium botulinum (creotoxin), para-
gait vertebral or nerve block of phenol and sub-
arachnoid space block of phenol. Nerve therapeutic effect of muscle spasm after
damage methods include high selective spinal cord injury need further clinical
posterior rhizotomy, selective posterior rhi- verification.
zotomy, rhizotomy, neurotomy, myotomy, Physiotherapy is the same as rehabilita-
myotenotomy, spinal tractotomy and tion therapy in the early phase after spinal
myelotomy. The methods are not specific cord injury.
for etiological treatment (recover higher Wheelchair use training: 2–3 months
central neural functions) and there are after injury, if the spinal cord of the patients
some shortcomings. is stable and the patients can sit indepen-
Rehabilitation method of neurological dently for more than 15 min, the patients
training: Neural potential development can start wheelchair use training if the
training and motor program reestablish- patients cannot recover standing and walk-
ment training of spasmodic muscle are ing ability in a short time. Upper body
used for the therapy and there are some strength and endurance are the premise of
preliminary clinical effects such as disap- wheelchair manipulation. Wheelchair use
pearance of pathological reflex of the training includes forward drive. Backward
patients (ankle clonus) and obvious drive, left and right turning, moving with
improvement of autonomous motor func- tilting front wheel, rotation training, climb-
tion. For example, a 9 years old Taipei ing slope and crossing barrier, up and down
child had paralysis of left limbs due to stairs, crossing curb kerb, going through
right cerebral infarction 2 years ago in narrow door, falling safely and sit up
America. After rehabilitation training in upright.
America and Taipei University affiliated In every 20 min sitting, the patients
children’s hospital, there are still poor fine should use upper limbs to support trunk or
movement of left hand and left foot drop, tilt the trunk to make hip away from seat in
circle gait in walking, strong positive of order to reduce pressure for 20–30 s, which
left ankle clonus, grade three of musculus can excrete local metabolism and guaran-
gastrocnemius spasm, grade two of myo- tee blood supply in case that compression
dynamia of tibialis anterior muscle and no of tuber ischiadicum for a long time can
autonomous foot dorsiflexion. In Jan 22, lead to pressure sores.
2013, the patient entered into national Activities of daily living training: For
research center for rehabilitation technical the patients with paraplegia, especially
aid affiliated hospital and receive the self-care activities such as eating, comb-
training of three- stage rehabilitation ing and dressing in upper limbs. In addi-
method of neurological training. During tion, daily life ability training should be
the process of neural potential develop- done after motor program reestablishment
ment of upper and lower limbs, the patient of hand through neurological training. it
received neural potential development can be combined with traditional hand
training of musculus gastrocnemius and function training such as grasping ability
motor program reestablishment training of fingers, flexibility training, artware fab-
of foot dorsiflexion. After 4 weeks’ train- rication using plasticine, drawing, clip-
ing, left foot dorsiflexion function is ping clip, turning the screw, nut and tying
recovered with slight strephenopodia and knots.
ankle clonus disappears. Fine movements 2. Complete spinal cord injury: Prevention of
of every finger in left hand such as sepa- complications effectively and recovery of
rating fingers, closing fingers, grasping functions with the help of assistive device are
and thumb opposing functions are recov- the rehabilitation training principle of com-
ered obviously. The long-term effect and plete spinal cord injury.
At present, for the patients with complete spi- it can improve body condition, prevent urinary
nal injury, the functional recovery is impossible. system infection, pressure sores and organ func-
Complete spinal cord injury in clinic is not tion disease and make the patients’ body keep in
always pathological complete spinal cord injury. a basic good condition to prolong life, return to
Of the patients with spinal cord injury treated by the society and create condition for waiting for
the author, some are told by the surgical doctors the effective therapeutic method.
that complete spinal cord injury is impossible to Specific therapeutic methods: the training of
be recovered and they may spend all their life in increasing cardiovascular stress response ability
wheelchair. After verification, it is not complete includes standing bed training and blood circu-
spinal cord injury and the functions are recovered lation drive training. on the moment increasing
partially through rehabilitation training, even bearing load ability of bone and preventing
independent walking ability. Therefore, for com- osteoporosis, it can promote blood circulation
plete spinal cord injury in clinic, rehabilitation of limbs and systolic and diastolic function of
physicians should be cautious with it. heart and vessels. Compulsive active movement
Prevention of complications: Effective pre- training: Potential development training device
vention of complications such as urinary system is applied. On the premise of weight support and
infection, pressure sores, musculoskeletal disuse, protection, six-step Daoyin technique is used to
joint adhesion and muscle tendon contracture is do autonomous movement induction training
the premise to guarantee the life of the patients through changing body position. During ther-
with paraplegia and functional recovery. It is the apy, the patients should be patient. On the basis
basis of recover functions using better therapeu- of regulation of mind and breathing, regulation
tic methods in the future. of movement can induce motor program signal
Rehabilitation training of neurological train- of motor center of brain cortex to stimulate the
ing: although the patients are diagnosed with conduction bundle in spinal cord injury part in
complete spinal cord injury, they should receive order to recover the functions of incomplete
rehabilitation training. Its meaningfulness is as injured conduction bundle and activate reserved
follows: There may be functional recovery. After conduction bundle around injure area. Abnormal
spinal cord injury, through therapy or with time, gait rectification weight support walking train-
the functions of undead cells and conduction ing: with weight support and protection of
pathways may be recovered. At this time, proper abnormal gait rectification weight support walk-
rehabilitation training can facilitate functional ing training device, the patients wear motor pat-
recovery. In addition, there are normal cells and tern remodeling training aid or shoulder power
conduction pathways around injure area. Neural walking assistive device and do walking train-
potential development training is activated for ing with the instruction and help of the
functional recovery. The required conditions of therapists.
using assistive device: rehabilitation training of For the patients with higher paraplegia who
neurological training, especially potential devel- are difficult to walk, they can wear walking aid
opment training, can effectively prevent disuse pulley to do walking training. The shoe sole is
atrophy of muscle to keep a certain muscle ten- equipped with four spring pulley. When the
sion and prevent joint and soft tissue adhesion to patients start to move the body center to offside,
keep a certain range of joint motion. These all the because the spring is compressed by the body
conditions required for the application of assis- weight, the shoe sole touches the ground and can-
tive device, walking aid or walking orthotics. not move. The spring upspring without the com-
Prevention of complications: motor function pression of body weight in the stepping side, and
training of body can effectively promote blood the pulley touches the ground to make lower limb
circulation of limbs and trunk, promote metabo- in stepping side slip forward. The movements are
lism of tissue, enhance body resistance, decrease repeated alternatively, which forms stepping
long-term compression of local tissue. Therefore, movement.
For the patients with complete paraplegia, the dorsiflexion position. In standing, the lower limbs
training should be progressive and from easy to tilt forward to keep hip stable and balanced using
difficult. The training time is 30 min. There are hyperextension position of hip. Every segment of
two breaks in the training. The frequency is once orthotics should be fixed on the limbs to disperse
a day and one therapy course takes three months. stress and prevent crush.
The application of walking orthotics: one of When wearing walking aid to walk, the users
the main functions of orthotics associated with should use armpit crutch or elbow crutch. At first,
walking is to compensate lost muscle functions the patients move the center of the body to one
of lower limbs in order to increase standing and side and then tilt pelvis backward. Lower limb in
walking ability and improve gait. this side is stretched by tightwire to step forward.
Paraplegia orthotics for standing and walking The other leg can step forward with the same
assistive device includes hip-knee-ankle-foot method. The movements mentioned above can be
orthosis (HKAFO) and alternate paraplegia repeated continuously to realize functional walk-
orthotics (RGO). Its design principle is that ing of the patients with paraplegia.
through specific mechanical structure, the shift- The development of shoulder power walking
ing of body weight center and the body are trans- assistive device: Walking orthotics mentioned
lated into impetus that can drives lower limbs above use passive walking. The author found that
forward, which realizes the stepping forward spinal cord injury includes cervical spinal cord
movement of lower limbs. Hip joint of orthotics, injury but accessory nerve (the 11th cranial
side lattice framing of the trunk and pelvis hipline nerve) that dominates trapezius is not injured in
guarantee the stability of the trunk to broaden the most cases. Accessory nerve is motor nerve,
application of walking orthotics. which is composed of cranial nerve root and spi-
RGO is suitable for the patients with complete nal nerve root. Cranial nerve root protrudes from
paraplegia below T6. The patients with paraplegia medulla oblongata below vagus nerve root to
below waist surface have normal functions of dominate skeletal muscle of throat. Spinal root
upper trunk. Therefore, the standing and walking arises from cell population of grey matter paras-
ability can be recovered. The patients with lum- tyle in superior cervical spinal cord to dominate
bar cord level injury have unstable ankle joint, trapezius and sternocleidomastoid. These fibers
but have normal functions of lumbar and abdomi- go up from spinal cord and combine with cranial
nal muscle. The patients who can control pelvis nerve into truncus nervi accessorii through fora-
can use KAFO. For the patients with injury of men magnum.
lower thoracic cord level, when lumbar and Trapezius is located in the superficial layer of
abdominal muscles are injured, the patients can cervical part and the front of back (Fig. 13.2). It
use HKAFO with pelvic support. The ankle joints arises from superior nuchal line, external occipi-
of KAFO and HKAFO should be fixed on the tal protuberance, ligamentum nuchae and all spi-
Fig. 13.2 An anatomy

charting of the trapezius Musculus
Trapezius
muscle, it is guided by leavator scapulae
cranial nerve (N XI), it’s
function can be reserved in Deltoid
Teres minor
high level spinal cord injures
Teres major
Latissimus
dorsi
nous processes of thoracic vertebra. Muscle ally are demoralized, depressed and are reluctant
fibers centralize to outside and end in outside one to contribute to the society and home even they
third of clavicle, acromion and mesoscapula. Its can face the disease. In allusion to this condition,
role is to shrug, elevating two shoulders to two rehabilitation therapists should explain to the
ears. Contraction of this muscle can make scap- patients and help them to broaden their mind. The
ula close to spinal column. Upper muscle bundle therapists should use fact to analyze the condition
lifts scapula up and lower muscle bundle for the patients to make them know what is devo-
decreases scapula, which completes the shrug tion. The author thinks that the disabled includes
movement. limbs disabled and spiritual or moral disabled.
According to this function, the author designed With the development of science and technology,
shoulder power walking assistive device, which limbs disabled can be replaced by many types
can use shrug as the power to complete hip and such as assistive device, artificial limb and walk-
knee joint flexion in order to lift lower limbs. ing aid. The patients with limbs disabled have the
Through joint self-lock system, in the falling of functions of intelligence and speech. The patients
lower limbs, hip and knee joints are locked in can do manageable work with the help of modern
extension state. Through firm lattice framing of facility. For example, through special technique
assistive device, the body weight can be sup- training, the patients can complete associated
ported and the standing position is kept. The
movements can be done alternatively in two
sides, which can complete stepping forward and
independent walking.
The comprehensive effects make the patients
walk independently. Through the force of shrug-
ging, lower limb can be lifted and the patients can
step forward, which is very close to the process
and posture of normal walking. The patients can
walk in asperous ground. In traditional walking,
assistive device is use to move the center of the
body and the other lower limb is passively wag-
gled forward to complete functional walking.
For the patients with higher paraplegia whose
upper limbs functions are not good, the author
designed foldable individual weight support
walking device (Fig. 13.3) to cooperate with the
application of shoulder power walking assistive
device in order to realize standing and walking of
the patients.
The training before returning to home and
society: through rehabilitation training in hospi-
tal, except for some patients, most patients should
return to home, society, even work. Therefore,
the special training should be done before to
make the patients adapt to new environment or
work. It includes several aspects of training:
changing concept and conquering oneself: many
patients think that they are with paraplegia and
lose motor function, becoming the disabled. They Fig. 13.3 Foldable individual weight support walking
cannot contribute to society and home. They usu- device
work through computer such as website estab is convenient for the disabled. Rehabilitation
lishment, internet marketing, drawing and finance medical staffs and the patients’ family should
and accounting. Stephen Hawking, a physicist in cooperate with each other to provide support and
England, was diagnosed with Lou Gehrig’s help to the patients. The patients can rebuild their
disease (Amyotrophic lateral sclerosis) who are own life target and find proper life position under
totally paralyzed and can only live for 2 years. He new condition.
cannot speak and only can communicate with
others using dialog phone and voice operation
demonstrator. He can read books with a machine 13.3 The Prevention
to flip pages. However, his research achievement and Treatment of Common
“black hole evaporation and quantum universe” Complications of Paraplegia
shocks natural science and has a far-reaching
influence on philosophy and religion. He becomes 13.3.1 Dysfunction of Urine
the recognized giant in Gravity physical science. and Stool and Rehabilitation
In western world, if you don’t read A Brief Therapy
History of Time, you will be despised. The reason
why he has a feather in one’s cap is that he has Dysfunction of urine and stool is the common
strong sense of mission and tough will. His story complications of the patients with paraplegia.
is the maximum of human willpower and the Urination dysfunction belongs to neurogenic
miracle of scientific spirit. He is an integral bladder, which includes dysfunctions of sphinc-
person in spirit. The criminals are with four ter vesicae and urethral sphincter, the early mani-
healthy limbs, but they do great harm to people’s festation is uroschesis. The final manifestation is
life and society. The criminals are the real uroclepsia urinary retention with overflow
disabled in spirits and morality. In all, the incontinence.
therapists guide the patients to exert subjective Neurogenic bowel is the rectum dysfunction
initiative to get a job and contribute to the society. induced by injury of CNS or peripheral nerve that
Persisting on self-exercise and preventing control rectum. The main manifestation is consti-
functional decay: the rehabilitation of spinal cord pation. The fecal incontinence is rare.
injury is lifelong. Comparatively, rehabilitation The detailed rehabilitation therapy refers to
therapy time in hospital is short and the therapists the second section of this chapter.
are responsible for figuring out the difficult and
complicated diseases. Active self-exercise of the
patients can induce slow functional recovery and 13.3.2 Treatment of Pressure Sores
prevent function decrease or loss. Persistence of
self-exercise can induce stable functional 13.3.2.1 T he Formation of Pressure
recovery. If possible, the patients can do further Sores
consultation to the rehabilitation department of Pressure sores is the necrosis and ulcer of skin
the hospital and receive standard rehabilitation and subcutaneous tissue induced by long-term
training for a while. Tiny functional recoveries local pressure and compression of human body.
are accumulated to form meaningful functions. Pressure sores is usually observed in the
Modifying environment and adapting to the life patients who are in wheelchair or bed for a long
of the disabled: according to functional recovery time, especially old people. The main external
of the patients, family environment should be cause of pressure sores is mechanical factor.
modified and the public environment should be When the direct pressure exceeds normal capil-
presided by the government. In recent years, with lary pressure (4.27 kPa) for a long time, the pres-
the rapid development of technique and economy sure sores is formed. In addition, shear force and
in our country, many communities are modified friction force [4, 5] are the important factors that
and there are many barrier-free facilities, which induce pressure sores. On the other hand, other
13.3 The Prevention and Treatment of Common Complications of Paraplegia 407
external factors include medical factors such as with air-permeability and the two side in
various braking, improper nursing, therapy and outside are fixed with fixing band. The
medicine and internal factors include malnutri- therapists use terminal nylon thread gluing to
tion, hypotension and poor tissue metabolism. fix it, which is convenient for dressing. The
They are the factors that include pressure sores. patients lie inside and one therapist push the
device to make the patient turn over and
13.3.2.2 Treatment of Pressure Sores change the pressure part of the body. The
The treatment of pressure sores is prevention and therapists use cuniform pad or thin pillow to
there are many therapeutic methods. fix the body of the patients. There is
herringbone nursing opening of urine and
• The prevention of pressure sores: The patients stool in hip for turning over, which can prevent
should select proper air bed and cushion. The pressure sores effectively.
patients should keep the skin and bed dry and • The therapy of pressure sores includes physio-
clean. For the patients who cannot move their therapy, changing a medical prescription and
body, the posture should be changed in every surgical therapy. Physiotherapy can alleviate
two hours to avoid dragging the patients in inflammation response and improve neural
turning over and prevent shear force injury of functions. Ultraviolet light therapy is suitable
the tissue. In wheelchair, the patients need to for the patients with skin injury but not muscle
extend double upper limbs in every 20 min injury. Grade II–III erythema dose is used for
and support the trunk to make the hip away the patients. The frequency is once every other
from cushion to prevent the long-term pres- day and there are 4–6 times in one therapy
sure in ischial tuberosity. The support time course. If the patients with muscle and bone
should be prolonged 20–30 s every time. The injuries, grade III–IV erythema dose is used
patients should improve the nutrition status of for the patients. The frequency is one time in
the body and intake protein, vitamin and every 1 or 2 days. Center overlap radiation
microelement. The therapists should improve method is used. If the granulation is fresh in
the appetite of the patients and give fat emul- the wound, in order to promote wound healing,
sion, albumin, amino acid or whole blood into the dose should be small, usually less than
vein. Excessive body weight is one of the grade I erythema dose. Before therapy, the
cause to induce pressure sores. Obese patients wound should be cleaned and should not be
should lose fat and control the body weight. smeared with any medicine to facilitate the
Convenient turning over device to prevent absorption of ultraviolet. Infrared therapy is
pressure sores: the author use macromolecule suitable for the ulcer wound in every stage that
glass fiber material with good air-permeability the infection is controlled, granulation tissue
to make tough support surface with arc bottom is fresh and there is no purulent secretion. The
according to the shape of the trunk. It can usage is that the frequency is 1–2 time a day
reduce the pressure of the support from the (20–25 min per time) and there are 15–20
body and the anti-acting force. It can enlarge times in one therapy course. Ultrashort wave
the contact surface between skin and support therapy: if the skin injury cannot influence
surface to lower the pressure in skin. Through muscle, non-heating or micro-heating
processing forming technique, the apophysis ultrashort wave is used. The frequency is 1–2
is suspended to avoid pressure, which is good time a day (10–15 min per time) and there are
for the prevention of pressure sores. The back 10–15 times in one therapy course. If the skin
of arc body is attached with four arc hollow injury influences muscle, micro-heating
strips made of macromolecule glass fiber ultrashort wave is used. The frequency is 1–2
material. The arc body is attached to the bed time a day (10–15 min per time) and there are
with four arc hollow strips. The inner face of 10–15 times in one therapy course. Millimeter
arc body is attached with thin layer sponge wave therapy: the secretions of wound should
be eliminated first and the radiator is placed The injury above thoracic cord level can lead
above the wound. The therapy time is to cardiovascular function disorder. The main
20–30 min (once a day) and there are 10–20 manifestation is out of control of sympathetic
times in one therapy course. Wound treatment: modulation and the change of parasympathetic
for the ulceration, saline is used to wash the nerve. Spinal cord injury above T6 level leads to
wound and then it is covered with wet saline out of control of sympathetic nerve and then the
dressing. The dressing should be changed stress capability and vasomotoricity are abnor-
timely to promote the expel of secretions. mal. Thoracic cord injury below T6 leads to out
Pressure sores paste can be used to change the of control of sympathetic nerve partially. Spinal
medicine. Ulcer wound: necrosis tissue of the cord injury in the level of lumbosacral spine not
wound should be eliminated. Anti-infection: only influence the functions of sympathetic ner-
according to the whole symptoms and the vous system, but also damage the control ability
results of bacterial culture, sensitive antibiotics of lower limbs’ vessels.
are used. For the patients with pressure sores The common abnormal manifestations of the
who has no constitutional symptoms and don’t patients with higher paraplegia or quadriplegia
need antibiotics. The nursing of pressure are hypotension, bradycardia and decrease of car-
sores: the clean of the wound and peripheral diac output. Generally, decrease of cardic sympa-
skin should be kept, especially pressure sores thetic nerve tension is related to contractile
of hip and pars sacralis. The nursing of urine mechanism disorder of vessels that make the
and stool should be paid attention to in order blood stagnate in abdomen and lower limbs.
to prevent the contamination of excrement. After spinal shock, segmental sympathetic
Once contaminated, the wound should be nerve function is recovered gradually and cardio-
cleaned immediately and the dressing should vascular function is improved, which form a new
be changed. Surgical disposition: for the stable dynamic equilibrium state. Aged cardiac
patients whose wound cannot be healed after hypofunction can be aggravated after spinal cord
long-term expectant treatment, the granulation injury, which can induce coronary heart disease,
of a wound is aged, the maiginal scar tissue is hypertension and heart failure.
formed, the pressure sores reaches muscle, the
bony joint is infected or deep sinus tract is • The common disposition of cardiovascular
formed, operation method therapy is used. complication of spinal cord injury.
The common surgical methods include skin
transplantation, skin flap transplantation, Just like the cases mentioned above, after spi-
muscular flap transplantation, neuromuscular nal cord injury, the types of cardiovascular com-
flap transplantation and free skin plications are related to the injured level. The
transplantation. The pressure part should be common complications are as follows:
avoided after surgery. Good pad is required to
prevent new pressure sores. The diet and 1. Arrhythmia usually includes bradycardia,

nursing of urine and stool should be enchanced. supraventricular arrhythmia and primary car-
diac arrest.
• Prevention measures: maintenance of
13.3.3 The Common Cardiovascular proper breathing is to keep oxygen content
Problem and Rehabilitation of blood and avoid hyoxemia. Alleviating
After Spinal Cord Injury heart load includes psychotherapy, reliev-
ing pain and reducing stimulation. Rating
• The relationship between the level of spinal of perceived exertion during defecation
cord injury and cardiovascular function should be noticed to save energy and
disorder. reduce cardiac muscle load. Maintenance
of internal environment is to keep suffi- medicine such as dopamine can be used to

cient blood volume, water and electrolyte keep the cardiac contractility and vascular
balance. Intake and output volume of liq- tension.
uid is measured timely to keep the organ 4. Abnormal autonomic nervous reflex is usually
perfusion and cardiac function. Avoiding observed in the patients with spinal cord
stimulating vagus nerve: the movement injury above T6.
should be gentle in sputum suction or tra- • The mechanism: Abnormal autonomic ner-
chea cannula. Before sputum suction, the vous reflex can be observed shortly after
patients can take in oxygen to prevent bra- spinal shock. The main pathophysiological
dycardia induced by stimulation of vagus mechanism is out of control of sympathetic
nerve. Reserved medicine: the reserved nerve excitability below injured level. The
medicine includes atropine for bradycardia induction factors include filling of bladder,
and drugs for arrhythmia. rectal stimulation, constipation, infection,
• Rehabilitation training: In physical exer- spasm, stone and apparatus manipulation.
cise therapy of neurological training, six- • Clinical symptoms include hypertension
step Daoyin technique is used for (300/160 mmHg), headache, sweating,
rehabilitation training of autonomous flushing, nausea, dermohemia and
movements of non-paralytic limbs in the bradycardia.
early phase. For the paralytic limbs, induc- • Therapy: Through examination, the induc-
tion training of autonomous movements is tion factors should be removed timely and
done. Passive movements of limbs and the patients should be moved to the bed in
blood circulation drive can increase blood sitting position. Drug therapy: For the
speed of paralytic limbs and cardio- slight patients, they can take calcium
pulmonary function and alleviate hypoten- antagonists orally such as amlodipine
sion and bradycardia. (amlodipine besylate tablet), verapamil
2. Edema is usually observed in lower limbs. and diltiazem. For the severe patients,
Lower limbs should be elevated in clinostatism blocking agent of sympathetic nerve or
and sitting position. For the patients with spi- nitroglycerin can be injected intravenously
nal cord injury below cervical level, the bed to dilate blood vessel. Rebound phenome-
foot can be elevated 10–15°. Stretch socks or non of blood pressure should be noticed. If
elastic bandage is used. Massage of injured the patients want to stop taking the medi-
limbs can promote blood circulation of mus- cine, the dose should be decreased gradu-
cle and lymphatic return. In the early phase ally to prevent rebound phenomenon.
after injury, active and passive movements of When the blood pressure is no less than
limbs are good for blood circulation of lower 200/130 mmHg and the therapeutic effect
limbs and edema prevention. is not good, epidural anesthesia can be
3. Postural hypotension is usually observed in used to block sympathetic ganglion to con-
early phase of movements’ recovery after trol blood pressure.
injury. Through elevating the head of a bed
gradually, prolonging sitting time and pres-
sure dressing with abdominal elastic belly- 13.3.4 Deep Vein Thrombosis
band, all these can decrease blood stagnation of Lower Limbs
in abdominal cavity. Standing bed is used for
stand upright of the patients gradually. In Deep vein thrombosis (DVT) is one of the com-
order to prevent anxiety of the patients, in plications of circulatory system in the patients of
wheelchair, the patients can antevert waist to long-term in bed. Blood clot in venous system of
alleviate postural hypotension. If necessary, lower limbs leads to blood vessel stagnation. The
main cause is the functional decrease of muscular stimulation: the wave width is 15 ms and the
contractility of lower limbs after long-term in bed frequency is 20 Hz. The electricity with mod-
and blood dilation and blood accumulation in ulated frequency (10–30 Hz per min) is used
venous system due to loss of sympathetic inner- to stimulate musculus gastrocnemius directly
vation. In addition, hypercoagulability of the to induce intense muscle contraction. The
blood is related to the trauma. effect is better than elastic sockings or elevat-
ing limbs. Functional electrical stimulation
13.3.4.1 O ccurrence Rate and Clinical (FES): the frequency is 30 Hz and the wave
Manifestation of Deep Vein width is 0.25 ms, the electrodes are placed in
Thrombosis inward and outward heads of musculus gas-
In the patients with spinal cord injury, occur- trocnemius to induce intense muscle contrac-
rence rate of deep vein thrombosis is 40–100%. tion. Blood circulation drive: trouser legs-like
Occurrence rate of the patients with complete gasbag is used for air inflation and deflation
quadriplegia is higher than that of the patients in continuous cycle, which can give pulse
with deep vein thrombosis. The patients with mechanical pressure to all the lower limbs to
swell of thigh and shank, rise in body tempera- accelerate backflow of venous blood of lower
ture and in local body temperature account for limbs. This method cannot be used in the
15%. If the patients with deep vein thrombosis early phase of thrombogenesis in case of fall-
cannot be observed timely and treated, dropped ing off. This therapy can be used when
embolism can induce pulmonary embolism and thrombus is activated and becomes fiber.
sudden death. Therefore, early diagnosis and
therapy are very important. Color Doppler The therapy frequency is once a day (10–
ultrasound examination contribute to early 15 min) and there are 15–20 times in one therapy
diagnosis. course.
13.3.4.2 The Therapy of Deep Vein • Anticoagulant therapy: Heparin is the most
Thrombosis Includes definite and effective drug. After the diagnosis
Rehabilitation, Medicine of deep vein thrombosis, heparin is given to
and Surgical Therapy the patients routinely overseas. It is rarely
• Rehabilitation therapy: Elevation of injured used in our country. Dextranum 40 and uroki-
limbs: the patients lie in bed and the injured nase are usually used in our country, which are
limbs are elevated 20–30 cm higher than more convenient than heparin. The dose of
heart. The angle between elevated injured dextranum 40 is 500 ml intravenously (drip,
limbs and bed surface is 30°, which is good qd). The dose of urokinase is 1000 U/kg
for blood backflow in lower limbs veins. Ten intravenously (drip) every day for 2 weeks.
days after therapy, the patients can do exer- The patients can do exercise after reduction of
cise off bed and control the movement swelling. Oral medicine includes warfarin
amount until the patients feel not tired or a sodium tablets that are suitable for the patients
little tired. If there is no effective anticoagu- who need long-term anticoagulant. This drug
lant therapy, it is forbidden to do passive is used for the therapy of thromboembolic dis-
joint movements. Supporting treatment is the ease to prevent the formation and develop-
common method of symptomatic treatment. ment of thrombus. It can treat the venous
Elastic bandage is used to bind up injured thrombus formation after surgery or trauma
limbs or the patients wear stretch socks to and is the adjuvant drug of myocardial infarc-
eliminate edema. Physiotherapy: faradiza- tion. For the patients who had thromboem-
tion is used to stimulate musculus gastrocne- bolic disease and are possible to have thrombus
mius. Modulated low frequency electric after surgery, it can be used for prevention.
The oral usual dose is 3–4 mg in the first to the 13.3.5.1 P revention Measures Include
third day to prevent impact therapy. The dose of Careful Observation, Early
older people, weak patients or the patients with Detection of Induction
diabetes should be cut half. Three days later, Factor and Paying Attention
2.5–5 mg can be given to the patients every day to the Body Temperature
for maintenance. According to blood clotting Changes
time, the dose is adjusted until the INR is 2–3. • Keeping warm: According to temperature
This medicine is slow to take effect. There is change, the patients can dress or undress
transient hypercoagulability because anticoagu- clothes. When the temperature is 21 °C, if
lant protein in plasma is inhibited in the first 3 there is no proper clothes to keep warm, the
days. If anticoagulation is required immediately, body temperature of the patients with quadri-
the patients can take heparin meanwhile they plegia is possible to drop to about 35 °C. On
start to take warfarin sodium tablets. The patients the outside, the patients with paraplegia
can stop heparin when the warfarin takes effect. should keep warm in case of inducing thermo-
regulation disorder and influencing normal
• Surgical therapy: The clinical application is functions of tissues and organs.
rare, only in the patients with big or severe • Keeping skin dry: The paralytic limbs are with
thrombus. Through surgery, the doctors can heat dissipation disorder, which may induce
take out thrombus in deep vein of lower limbs. sweating above paralytic level. There is no
If there is stenosis or blocking in deep veins of sweating below the paralytic level. The sweat
lower limb, these problems can be treated should be wiped to keep the skin dry in case of
together in surgery. catching cold.
• Eliminating induction factors: Overfilling
Thermal therapy is avoided during the treat- bladder and rectum can stimulate sympathetic
ment in case of infarction due to thrombus. nerve system and induce damage autonomic
hyperreflexia. The clinical manifestation
includes excessive sweating that can induce
13.3.5 Rehabilitation hypothermia. The doctors should observe it
of Thermoregulation Disorder timely and the patients should evacuate
bladder and rectum.
Heat-regulating center is located in hypothala-
mus. Through autonomous nerve conduction, 13.3.5.2 T herapy Includes Cooling
after spinal cord injury, heat-regulating center and Anti-infection
loses control of body temperature to varying • Physical cooling is mainly used such as ice
degrees and there is poikilothermia, which means bag and lukewarm bath. In hot weather, heat
body temperature is influenced by environment dissipation should be noticed.
temperature. Hypothermia is common in the • Drug cooling: When the patients are with high
early phase after injury, which can lead to fever, the effect of drug therapy is poor.
decrease of body function, especially in old Indometacin suppositories can be used in rec-
patients. Because basal body temperature is low, tum. The hands and anus can be washed clean.
sometimes 35 °C and the body temperature of the Conical head of the drug points to the anus
patients reaches 37.5 °C, it can be defined as high and is pushed by the index finger until it enters
fever. Therefore, the body temperature should be into anus. The space between the tail and anus
measured at regular intervals. In addition, in the is about 2 cm. The dose is 50–100 mg per time
hot season, function disorder of sweat gland can (half or one tablet, once a day). The dose of
induce high fever of the patients with spinal cord every day cannot exceed 200 mg and the effect
injury. is good.
• Anti-infection: For fever of undetermined ori- technique that can establish autonomous control
gin, infection is the first factor that should be training technique of specific physiological
considered. Because there is sensory disorder reflex. The effect is verified preliminarily [9].
in the patients, fever is the earliest or the only Biological feedback technique has been applied
manifestation of infection. The doctors should for clinical rehabilitation therapy for more than
find the source of infection as soon as possible 20 years [10]. Rehabilitation therapy of spinal
and do bacterial culture test and drug sensitiv- cord injury is very limited and the results are var-
ity test. In allusion to infection source, the ious [11]. The author observes the therapeutic
doctors adopt sensitive antibiotics for the effect of biological feedback on spinal cord
therapy. injury. The author wants to verify whether this
therapy can increase autonomous electromyo-
graphic signal and myodynamia of all muscles in
13.3.6 Tardive Neurological upper limbs of the patients with obsolete spinal
Deterioration cord injury above C6 on the basis of various origi-
nal electromyographic signal and myodynamia.
Several years after spinal cord injury, there may
be neurological deterioration. Some reports 13.4.1.1 Materials and Methods
showed that the patients with neurological dete- 1. Subjects: There are 139 patients with spinal
rioration account for 12.1% 3–5 years after cord injury. There are 108 males and 31
injury. There are changes in sensation, motor or females. Male female ratio is 3.5 versus 1.
both, which affects self-care ability of the patients The age range is from 8 to 68 years old. The
greatly. average age is 32.8 (SD is ±11.12). Injured
Therefore, examination and assessment of the segments are from C1 to C6. There are 59
entire sensation and motor function of the patients patients with spinal cord injury at C5, which
should be done periodically. Compared with the accounts for 42.45% of all the patients. There
last assessment results, the results are good for are 32 patients with spinal cord injury at C4,
the early detection of neurological deterioration. which accounts for 23.02% of all the patients.
The cause of tardive neurological deteriora- There are 28 patients with spinal cord injury
tion is unknown at present. It may be the result of at C6, which accounts for 20.14% of all the
degeneration or disuse. However, someone think patients. There are ten patients with spinal
that it is related to overuse. The author thinks that cord injury at C3, which accounts for 7.19% of
it may be related to disuse. all the patients. There are six patients with spi-
nal cord injury at C2, which accounts for
4.32% of all the patients. There are four
13.4 Clinical Application patients with spinal cord injury at C1, which
of Neurological Training accounts for 2.88% of all the patients. There
for Paraplegia are 111 patients due to motor traffic accidents
(79.86%), 15 patients due to sport injury
13.4.1 Observation of Therapeutic (10.79%), four patients due to gunshot wound
Effects of Chronic Cervical (2.88%), nine patients due to other causes
Cord Injury (6.47%). The disease history is 0.5–20 years
and the average is 4.07 years (SD is ±4.02).
In the past, 1 year after spinal cord injury, the There are 57 patients (41%) whose disease
patients lost the hope of further functional recov- history is from 0.5 to 1 year, 37 patients
ery. In recent years, some literatures [6–8] (26.6%) whose disease history is from 1 to
showed that the patients with obsolete spinal cord 5 years, 32 patients (23%) whose disease his-
injury had the potential to be recovered further. tory is from 5 to 10 years, 13 patients (9.4%)
Biological feedback is an operant conditioning whose disease history is more than 10 years.
13.4 Clinical Application of Neurological Training for Paraplegia 413
The longest disease history is 23 years. All the est point is defined as the new baseline. The
cases have no further functional recovery after patients are asked to make new EMG signal
various kinds of rehabilitation method ther- surpass this baseline in next movement. The
apy. All the patients in this group complete rest can be done in the same manner until the
one therapy course of biological feedback EMG signal cannot surpass the baseline.
therapy with EMG. The therapy time is 50 min Usually, the process requires 6–8 movements,
and there are 15 times in a day. which is defined as one therapy. There are 15
2. Instruments: Four-lead Neuroeducator II and times in one therapy course. The data of the
3M Ag-AgCl surface electrode are produced highest EMG signal is recorded.
by Therapeutic Alliances in America.
Neuroeducator II is used to analyze EMG sig- 13.4.1.2 Observational Index
nal and provides EMG signal for feedback. • Myodynamia assessment: According to
This signal is analyzed from analysis of EMG improved Lovett myodynamia assessment
signal that is the square root of mean value of method, myodynamis of all muscles can be
potential whose noise level is lower than assessed and graded before therapy.
0.2 μV. The bandwidth is from 10 to 1000 Hz • EMG data collection: The highest EMG signal
and the noise is less than 140 dB. If the com- data of all muscles are collected before ther-
bination time of EMG signal exceeds 0.1 s, it apy and are used for statistical analysis. These
can be standardized into μVs. The data in one standard EMG data can be converted accord-
tenth second is displayed in color screen in a ing to conversion that the percentage of
continuous curve form. The scan time limit in Brucker in normal electromyographic signal
every screen is 20 s and the data can be stored (Table 13.8).
in soft disk.
3. Therapeutic method: In a quiet and lucifugal 13.4.1.3 Results
therapy room, the patients sit in the front of According to injured segments, injured degree
the display. Two 3 M surface electrode are and clinical manifestations, there are 108 del-
attached on the skin surface of the two termi- toids, 89 bicipital muscles of arm, 220 triceps
nals of muscle belly separately. Ground sur- muscles of arm, 194 wrist extensors, 234 wrist
face is placed between the two electrodes. flexors, 234 finger extensors and 205 finger flex-
Surface electrode is connected to the corre- ors in 139 patients who receive therapy. The sta-
sponding lead of Neuroeducator II through tistical results of electromyographic signal and
wire. This method can be used to treat one myodynamia of all muscles refer to Table 13.9
group (agonistic muscle and antagonistic before therapy. T-test showed that after therapy
muscle) or two groups of muscles. The there are significant difference of electromyo-
patients are guided to observe the change of
EMG signal in display. Meanwhile, the
patients try to do shoulder abduction, elbow Table 13.8 The percentage of standard electromyo-
graphic signal in normal electromyographic signal
flexion and extension, wrist flexion and exten-
sion, finger flexion and extension actively. Electromyographic The percentage of normal
signal (μV) electromyographic signal
The highest EMG signal collected from this
0 0
movement is the primary data and is recorded. 1 1
The highest EMG signal is marked as a base- 3 2
line and the patients are asked to make EMG 10 5
signal surpass the baseline. The patients are 80 15
asked not to concentrate on joint motion and 160 25
muscle contraction, but should observe the 320 50
change of EMG signal curve in display. If 480 75
EMG signal surpasses baseline, the new high- 640 100
Table 13.9 Statistical analysis results of EMG and myodynamia before and after therapy ( X ± S )
Name Number Electromyographic signal (μV) Myodynamia (0–5)
Middle deltoid 108 Before therapy 233.95 ± 221.33 2.48 ± 1.51
After therapy 464.44 ± 264.77a 2.96 ± 1.53a
Bicipital muscle of arm 89 Before therapy 173.25 ± 192.38 2.42 ± 1.65
After therapy 396.64 ± 284.59a 3.01 ± 1.68a
Triceps muscle of arm 220 Before therapy 119.07 ± 142.52 1.96 ± 1.16
After therapy 356.47 ± 218.11a 2.49 ± 1.19a
Wrist extensor 194 Before therapy 171.44 ± 179.75 2.65 ± 1.51
After therapy 419.70 ± 256.87a 3.13 ± 1.58a
Wrist flexor 234 Before therapy 113.01 ± 164.66 1.60 ± 1.35
After therapy 289.41 ± 231.78a 2.04 ± 1.40a
Finger extensor 234 Before therapy 56.78 ± 100.06 1.12 ± 1.26
After therapy 162.16 ± 162.26a 1.41 ± 1.40a
Finger flexor 205 Before therapy 52.33 ± 73.34 1.07 ± 1.22
After therapy 153.54 ± 165.44a 1.43 ± 1.41a
a
P < 0.01. The comparison before and after therapy
graphic signal and myodynamia (P < 0.001). between human central nervous cells, the con-
EMG of deltoid after therapy is increased 36% duction pathway of information, is changed and
than that before therapy EMG and myodynamia perfected in lifetime. After the death of central
is increased 12%. EMG of bicipital muscle of nervous cells, the axon is not dead. The undead
arm is increased 36.5% and myodynamia is axon can regenerate central nervous cells when
increased 20.1%. EMG of triceps muscle of arm the condition is complete. Just like a dead tree,
is increased 37.1% and myodynamia is increased the undead bud grows up and becomes a tree. All
11.5%. EMG of wrist extensor is increased these showed that central nervous system has
38.5% and myodynamia is increased 20.4%. compensation ability and can recover or improve
EMG of wrist flexor is increased 27.6% and myo- functions through proper therapy and training.
dynamia is increased 5.5%. EMG of finger exten- Therapeutic mechanism of biological feed-
sor is increased 16.5% and myodynamia is back of EMG is that through observation of
increased 2.9%. EMG of finger flexor is increased autonomous signal displayed in display in a
15.8% and myodynamia is increased 3.6%. smooth curve by the patients and central ner-
Compared with before therapy, EMG of all the vous system integration of this signal through
muscles are increased 29.8% averagely after visual afferent pathway feedback, it can be over-
therapy and myodynamia is increased 10.9% lapped in the next efferent autonomous electro-
averagely. myographic signal and the signal intensity is
increased [15]. Therefore, the patients are asked
13.4.1.4 Discussion to increase autonomous electromyographic sig-
In the past, they think that central nervous system nal and concentrate on the changed curve in
has no regeneration capacity. Therefore, there is monitor. The patients are asked to forget joint
no further functional recovery in 1 year after cen- motion and muscle contraction and concentrate
tral nervous system injury [12]. Recently some on increasing autonomous electromyographic
research showed that human central nervous sys- signal in monitor. The subjects in this group
tem has compensation and regeneration capabil- require 6–8 blocks to reach the highest point of
ity [13], even in adult. In addition, undead cells in this training. After that, the patients can train
injured area (penumbra cells) [14], are able to other muscles. In next therapy, autonomous
recover functions through improving local condi- electromyographic signal of this muscle can
tion. The more important is that the connection still be increased.
The average history of the patients is 4.07 years it is used properly, biological feedback is an
and disease history of some patients is more than effective method to treat spinal cord injury and
10 years. The longest disease history is 23 years. recover functions.
All the cases have no further functional recovery
through other therapeutic methods. After therapy,
the results showed that biological feedback ther- 13.4.2 Multiple-Course Observation
apy of EMG can obviously increase autonomous of Curative Effect of Treating
electromyographic signal and myodynamia obso- Obsolete Cervical Cord Injury
lete cervical cord injury. The recovery has no rela-
tion with the disease history after injury. The The good functional recovery of long-term spinal
recovery is related to the position of upper limbs’ cord injury is proved preliminarily [17, 18].
muscle. The functional recovery of muscles of However, the patients are the first time to receive
hand is lower than that of muscles of upper arm. this therapy and just one therapy course. The
The author thinks that the recovery of autonomous effects of multiple-course of biological feedback
electromyographic signal is more than that of therapy require further verification.
myodynamia and it is related to biological feed- The purpose of this study is to observe the
back therapy of EMG. The increase of autono- effect of four coursed of biological feedback
mous electromyographic signal is dependent on therapy. On the basis of electromyographic signal
functional recovery of central nervous cells and and myodynamia in the previous therapy course,
reestablishment and improvement of conduction autonomous electromyographic signal and myo-
pathway between central nervous cells, which is dynamia of all muscles in upper limbs are
not proportional to the intensity of muscle contrac- increased obviously further in the patients with
tion. This was verified in the therapy. Biological obsolete spinal cord injury above C6.
feedback therapy technique is to recover functions
of central nervous cells to establish and improve 13.4.2.1 Materials and Methods
the conduction pathway between central nervous Subjects: There are 39 patients with cervical cord
cells, but not to recover myodynamia. Therefore, injury who come from orthopedics or rehabilita-
the recovery of autonomous electromyographic tion department of Miami University in America.
signal is earlier and more than that of myody- There are 31 males and 318 females. Male female
namia. The recovery of myodynamia can be ratio is 3.9 versus 1. The age range is from 11 to
increased in the training of myodynamia through 62 years old. The average age is 33.1 (SD is
biological feedback of EMG after therapy. ±11.8). Injured segments are from C1 to C6. There
The results of this research are the same as are 14 patients with cervical cord injury at C4,
some other reports [16]. It indicated that chronic which accounts for 35.9% of all the patients.
central nervous system injury is possible to be There are 11 patients with cervical cord injury at
recovered further. In addition, understanding and C5, which accounts for 28.2% of all the patients.
use of biological feedback therapy of EMG is There are nine patients with cervical cord injury
important and its purpose is to use modulated at C6, which accounts for 23.1% of all the
conditional feedback technique to establish and patients. There are two patients with cervical
consolidate specific physiological reflex of cord injury at C3. There is one patient with spinal
autonomous signal. It usually is mistaken that cord injury at C2. There are two patients with cer-
biological feedback is a simple visual and audio vical cord injury at C1. There are 31 patients due
physiological reflex phenomenon for the patients. to motor traffic accidents (79.5%), eight patients
Without using actual feedback technique, the due to sport injury (20.5%). The disease history
effect of biological feedback therapy may be is 0.5–19 years and the average is 4.5 years (SD
influenced. This is why the effect is not good in is ±4.5). All the cases have no further functional
some reports [11]. In short, there is further func- recovery after various kinds of rehabilitation
tional recovery in long-term spinal cord injury. If method therapy.
Therapeutic method: In a quiet and lucifugal 13.4.2.2 Observation Indicators

therapy room, the patients sit in the front of the • Myodynamia assessment: According to
display. Two 3M surface electrode are attached on improved Lovett myodynamia assessment
the skin surface of the two terminals of muscle method [19], myodynamis of all muscles can
belly separately. Ground surface is placed between be assessed and graded before therapy.
the two electrodes. Surface electrode is connected • EMG data collection: The highest EMG signal
to the corresponding lead of Neuroeducator II data of all muscles are collected before ther-
through wire. The patients are guided to observe apy and are used for statistical analysis. The
the change of EMG signal in display. Meanwhile, comparison is done between the data of the
the patients try to do shoulder abduction, elbow first therapy course after therapy and raw data
flexion and extension, wrist flexion and extension, before therapy. The comparison is done
finger flexion and extension actively. The highest between the data of every therapy course after
EMG signal collected from this movement is the therapy and the highest data of previous ther-
primary data and is recorded. The highest EMG apy course after therapy.
signal is marked as a baseline and the patients are
asked to make EMG signal surpass the baseline. 13.4.2.3 Statistical Analysis
The patients are asked not to concentrate on joint T-test is done using SPSS 6.0.
motion and muscle contraction, but should observe
the change of EMG signal curve in display. If 13.4.2.4 Results
EMG signal surpasses baseline, the new highest According to injured segments, injured degree
point is defined as the new baseline. The patients and clinical manifestations, there are 12 deltoids,
are asked to make new EMG signal surpass this 10 bicipital muscles of arm, 18 triceps muscles of
baseline in next movement. The rest can be done in arm, 17 wrist extensors, 17 wrist flexors, 20 fin-
the same manner until the EMG signal cannot sur- ger extensors and 21 finger flexors in 39 patients
pass the baseline. Usually, the process requires who receive therapy.
6–8 movements, which is defined as one therapy. The data of electromyographic signal and
The therapy time is 50 min and there are 15 times myodynamia data of all muscles before ther-
in one therapy course. The data of the highest apy refer to Table 13.10 and statistical analy-
EMG signal is recorded. All the patients in this sis results refer to Tables 13.10, 13.11, and
group complete four therapy courses in 4 years. 13.12.
Table 13.10 Mean value and standard deviation of raw EMG signal data and EMG signal data of every therapy course
after therapy
Name Numbera Raw 1 2 3 4
Middle deltoid 12 Mean value 290.17 472.42 501.25 511.92 516.75
Standard deviation 246.83 246.83 251.01 276.48 289.17
Bicipital muscle of arm 10 Mean value 87.90 333.40 428.70 455.90 430.61
Triceps muscle of arm 18 Mean value 106.17 315.39 434.56 451.28 431.61
Wrist extensor 17 Mean value 172.25 381.76 516.94 570.65 552.47
wrist flexor 17 Mean value 159.47 277.88 364.24 374.88 373.94
finger extensor 20 Mean value 88.22 195.90 236.00 297.41 361.23
finger flexor 21 Mean value 74.71 213.76 236.95 339.67 376.38
Number of muscles
a
Table 13.11 Mean value and standard deviation of raw myodynamia data and myodynamia data of every therapy
course
Name Numbera Raw 1 2 3 4
middle 12 Mean value 2.86 3.08 3.12 3.22 3.29
deltoid Standard 1.50 1.52 1.51 1.61 1.62
deviation
bicipital 10 Mean value 2.00 2.43 2.80 2.86 3.23
muscle of Standard 1.56 1.59 1.54 1.61 1.75
arm deviation
triceps 18 Mean value 1.87 2.33 2.52 2.54 2.85
muscle of Standard 1.23 1.29 1.32 1.41 1.44
arm deviation
wrist 17 Mean value 3.13 3.69 4.07 4.04 4.13
extensor Standard 1.14 1.29 1.38 1.36 1.34
deviation
wrist flexor 17 Mean value 1.04 1.68 1.76 1.59 1.88
Standard 1.38 1.92 1.19 1.31 1.18
deviation
finger 20 Mean value 1.67 1.80 1.73 1.95 2.22
extensor Standard 1.47 1.60 1.52 1.54 1.54
deviation
finger flexor 21 Mean value 1.62 1.97 2.00 2.09 2.40
Standard 1.36 1.60 1.58 1.63 1.64
deviation
Number of muscles
a
1. Comparison with raw data: After every ther- sor myodynamia between the beginning of
apy course, electromyographic signal and the third therapy course and raw data
myodynamia are compared with raw electro- (P < 0.05 in the third therapy course and
myographic signal and myodynamia of the P < 0.001 in the fourth therapy course).
first therapy before therapy. There is signifi- There is significant difference of raw grading
cant difference between electromyographic score of myodynamia in the beginning of the
signal data from the first to the fourth therapy first therapy (P < 0.05 or 0.01). At the end of
course and raw electromyographic signal the fourth therapy, there is significant differ-
date (P < 0.05 or P < 0.001). In the grading ence between electromyographic signal and
scores of myodynamia, there is no significant myodynamia and raw grading score of elec-
difference of deltoid between the end of the tromyographic signal and myodynamia
fore three therapy courses and raw data, but (P < 0.001).
there is significant difference of deltoid 2. Comparison with the first therapy course: The
between the end of the fore four therapy comparison between the end of the first ther-
courses and raw data (P < 0.05). There is no apy course and the end of the second, the third
significant difference of bicipital muscle of or the fourth therapy course. Except for elec-
arm between the end of the first therapy and tromyographic signal of finger extensor, fin-
raw data, but there is significant difference of ger flexor of the second therapy course, middle
bicipital muscle of arm between the end of deltoid of the first or the third therapy course,
the second therapy and raw data (P < 0.01). there is significant difference of all the other
There is no significant difference of finger muscles between the end of every courses and
extensor myodynamia between the end of the the first therapy course after therapy (P < 0.05
fore two therapy courses and raw data, but or 0.01). There is significant difference of tri-
there is significant difference of finger exten- ceps muscle of arm between the end of the
418
Table 13.12 T-test results of electromyographic signal and myodynamia data between raw and every therapy course using biological feedback after therapy
Name Classes 0–1 0–2 0–3 0–4 1–2 1–3 1–4 2–3 2–4 3–4
Middle deltoid Myoelectricity 3.90** 4.59*** 4.50*** 4.17** 1.66ns 2.36* 1.49ns 0.60ns 0.59ns 0.29ns
12 Myodynamia 1.80ns 1.94ns 2.04ns 2.54* 0.47ns 0.83ns 1.62ns 0.72ns 1.89ns 0.70ns
Bicipital Myoelectricity 3.45** 3.44** 3.90** 3.49** 2.62* 3.22** 2.72* 1.56ns 0.55ns 1.36ns
muscle of arm
10 Myodynamia 1.85ns 3.77** 4.46** 6.20** 2.90* 3.54** 4.27** 1.00ns 3.88** 3.98**
Bicipital Myoelectricity 5.84*** 5.61*** 5.60*** 5.03*** 3.10* 3.41** 2.73* 1.25ns 0.17ns 1.88ns
muscle of arm
18 Myodynamia 2.53* 3.98** 3.86* 6.29*** 1.61ns 1.83ns 3.44** 0.15ns 2.63 3.45**
Wrist extensor Myoelectricity 7.88*** 8.44*** 7.54*** 6.92*** 4.51** 4.51** 4.10** 1.64ns 1.04ns 1.01ns
17 Myodynamia 5.36** 6.36*** 5.28*** 5.62*** 3.32** 2.40* 2.98** 0.42ns 0.68ns 1.63*
Wrist flexor Myoelectricity 4.31*** 5.04*** 4.85*** 4.81*** 3.68** 3.67** 3.35** 0.81ns 0.62ns 0.08ns
17 Myodynamia 4.10*** 4.05*** 3.12** 5.29*** 1.17ns 0.81ns 1.54ns 1.53ns 0.81ns 2.43
Finger extensor Myoelectricity 5.64*** 7.41*** 4.72*** 5.99*** 1.88ns 2.29* 3.51** 1.60ns 2.87** 2.21*
20 Myodynamia 1.14ns 0.63ns 2.55* 4.01*** 1.28ns 1.38ns 3.20** 2.46* 4.04** 2.32*
Finger flexor Myoelectricity 3.76** 3.86** 5.31*** 6.17*** 1.01ns 3.38** 3.73** 2.67* 3.39** 2.07ns
21 Myodynamia 2.80* 2.75* 2.91* 3.97*** 0.46ns 1.40ns 3.34** 1.82ns 4.11** 3.80**
*p < 0.05; **p < 0.01; ***p < 0.001; Ns: no significant difference
13 Rehabilitation Therapy of Neurological Training of Paraplegia
second or the third therapy course and the end and leads to the death of neural cells. Uninjured
of the first therapy course (P < 0.01). nerve cell axon can protrude from the branch and
3. Comparison with the second therapy course: establish axon connection with neural tissue in
The comparison between the end of the sec- target area to replace the neural axon that loses
ond therapy course and the end of the third or functions. Rehabilitation training can change
the fourth therapy course. Except for electro- gene expression of some proteins in central ner-
myographic signal of finger extensor of the vous system, promote axon budding, synaptic
fourth therapy course, and finger flexor of the reestablishment and repair or compensation of
third or the fourth therapy course (P < 0.05 or tissue in necrosis area. The peripheral tissue
0.01), there is no significant difference of all around injured area can replace the functions of
other muscles between the end of every course offside brain cortex and promote motor function
and the end of the second course (P > 0.05). recovery [21]. These functions are called the neu-
There is significant difference of the grading ral plasticity of central nervous system, which is
score of myodynamia of bicipital muscle of proved in anatomy [22]. In addition, undead cells
arm, triceps muscle of arm and finger extensor in injured area (penumbra cells), are able to
between the fourth therapy course and the end recover functions through improving local condi-
of the second therapy course. There is signifi- tion. The more important is that the connection
cant difference of the grading score of myody- between human central nervous cells, the con-
namia of finger extensor between the end of duction pathway of information, is changed and
the third or the fourth therapy course and the perfected in lifetime. All these demonstrated that
end of the second therapy course (P < 0.05 or central nervous system has regeneration ability
0.01). There is no significant difference of and the functions of injured central nervous sys-
myodynamia of the other muscles between the tem can be improved or recovered through proper
end of the second therapy courses and other therapy and training. In-depth exploration should
therapy courses (P > 0.05). be done for the better method that can promote
4. Comparison with the third therapy course:
plasticity of central nervous system and recover
There is significant difference of electromyo- injured central nerves.
graphic signal of finger extensor between the The exercise method of functional rehabilita-
end of the fourth therapy course and the end of tion includes active method and passive method.
the third therapy course (P < 0.05). There is Passive functional exercise can move joints and
no significant difference of electromyographic prevent adhesion through passive movements.
signal of all other muscles between the end of Active functional exercise not only can move
the fourth therapy course and the end of the joints and enhance myodynamia, but also can
third therapy course (P > 0.05). Except for promote functional recovery of nervous system.
myodynamia grading of deltoid, there is sig- The author think that active functional exercise
nificant difference of the value of electromyo- method is better for brain functions and func-
graphic signal of all other muscles between tional recovery of brain cells, which can activate
the end of the fourth therapy course and the reserved conduction pathway and synapse.
end of the third therapy course (P < 0.05 or The therapeutic mechanism of biological
0.01). feedback therapy of operant conditioning EMG
designed by the author is different from biologi-
13.4.2.5 Discussion cal feedback therapy of EMG at home at present.
There are many latent neural conduction path- Biological feedback therapy at home at present is
ways and synapses in human body. Proper train- one kind of electrical stimulation without feed-
ing method can activate them and make them back of bio-electricity signal. EMG biological
play functions to compensate injured conduction feedback therapy of operant conditioning EMG
pathways and synapses [20]. The damage can is a new technique of modern physiotherapy,
destroy the soma of neurons or proximal synapse which is related to many subjects such as physi-
cal medicine, Contrology and Physiology. In this because this method can activate functional
sense, it is a new technique that is related to com- recovery of injured neural cells, potential con-
prehensive application of multiple subjects. duction pathway and synapse.
Feedback is a word that is created by Norner The average disease history of the patients in
Winner (an American mathematician). Feedback this group receive biological feedback before
is that efferent signal of control system return to therapy is 4.5 years. There are 13 patients whose
control system through some way in order to con- disease history is more than 5 years. The longest
trol control system. Biofeedback means the sub- disease history is 19 years. All the patients have
jective initiative of the patients. When the patients no further functional recovery using other thera-
do autonomous movements, skin surface elec- peutic methods. Comprehensive results of elec-
trode of the contracted muscle can receive this tromyographic signal and myodynamia before
kind of voluntary slight electrical signal. Through and after four-course therapy refer to Fig. 13.4.
a series of overlay treatment, the signal is dis- From the therapeutic results, we can conclude
played in monitor in a smooth curve form. The the following key points: Recovery speed and
patients observe this smooth curve. The signal degree of electromyographic signal and myody-
gives feedback to central nervous system through namia of all muscle of upper limbs are related to
visual afferent pathway and is integrated. The the nerve innervation level. Electromyographic
next efferent autonomous electromyographic sig- signal and myodynamia of muscles dominated by
nal is modulated and the accuracy and intensity is higher nerve segment can be recovered faster and
increased. The generation of this kind of electro- better. For example, the functions of deltoid dom-
myographic signal is dependent on the functional inated by C4 and finger flexor and extensor domi-
state of central nervous cells and the soundness nated by C6 can be recovered faster and better.
of neural conduction pathway from nerve cells to The intensity of electromyographic signal is
motor end plate. Therefore, this kind of electrical related to the strength of myodynamia. For cen-
signal received from tissue surface actually tral nervous injury, myodynamia is stronger than
reflects electroencephalogram of motor neuron in electromyographic signal. For peripheral nerve
brain cortex. This kind of signal can be strength- injury, electromyographic signal is stronger, but
ened quickly and continuously in the therapy, myodynamia is very weak. Electromyographic
Fig. 13.4 Comparison 500

sketch map of 3.0 electromyographic signal
electromyographic
muscle strength
signal and myodynamia
before and after
2.8 400
four-course therapy
electromyographic signal (µV)
2.6
muscle strength
300
2.4
2.2 200
2.0
100
0 1 2 3 4
Treatment
signal is mainly recovered in the fore three bio- age age is 31.7 (SD is ±9). Injured segments
logical feedback therapy courses and myody- are from C1 to C5. There are 40 patients with
namia is mainly recovered in the fourth therapy spinal cord injury at C5, which accounts for
course. Electromyographic signal is recovered 51.9% of all the patients. There are 19 patients
faster than myodynamia recovery. For highly with cervical cord injury at C5, which accounts
paralytic muscles, there is no significant differ- for 24.7% of all the patients. There are 60
ence between the results of single therapy course patients due to motor traffic accidents (77.9%),
and raw electromyographic signal and myody- eight patients due to sport injury (10.4%). The
namia. There is significant difference between disease history is 0.5–20 years and the aver-
the results at the end of the second therapy course age is 4.2 years (SD is ±4.3). All the cases
or the third therapy course and raw electromyo- have no further functional recovery after vari-
graphic signal and myodynamia. If the therapeu- ous kinds of rehabilitation method therapy.
tic effect of single therapy course is not obvious, All patients in this group complete biological
the patients should not give up therapy. feedback therapy of EMG in one therapy
Accumulated therapeutic effect can induce mean- course. The therapy time is 50 min and there
ingful functional recovery. are 15 times in one therapy course.
2. Instruments: Four-lead Neuroeducator II and
3 M Ag-AgCl surface electrode are produced
13.4.3 Therapeutic Effect Analysis by Therapeutic Alliances in America.
of Muscles with Zero Neuroeducator II is used to analyze EMG sig-
Myodynamia in the Patients nal and provides EMG signal for feedback.
with Obsolete Cervical Cord This s ignal is analyzed from analysis of EMG
Injury signal that is the square root of mean value of
potential whose noise level is lower than
For biological feedback therapy of long-term spi- 0.2 μV. The bandwidth is from 10 to 1000 Hz
nal cord injury, multiple therapy courses can pro- and the noise is less than 140 dB. If the com-
mote further functional recovery on the basis of bination time of EMG signal exceeds 0.1 s, it
therapeutic effect of previous therapy course, can be standardized into μVs. The data in one
which is proved. For the muscles with zero myo- tenth second is displayed in color screen in a
dynamia, whether biological feedback therapy continuous curve form. The scan time limit in
can recover autonomous signal and myodynamia every screen is 20 s and the data can be stored
and whether zero myodynamia equals to zero in soft disk.
electromyographic signal, all these require 3. Therapeutic method: In a quiet and lucifugal
confirmation. therapy room, the patients sit in the front of the
The author do biological feedback therapy of display. Two 3M surface electrode are attached
343 muscles with zero myodynamia of upper on the skin surface of the two terminals of
limbs in the patients with obsolete spinal cord muscle belly separately. Ground surface is
injury above C5, observe the relationship between placed between the two electrodes. Surface
muscles with zero myodynamia and autonomous electrode is connected to the corresponding
electromyographic signal, analyze therapeutic lead of Neuroeducator II through wire. The
effect and find out the therapy experience of mus- patients are guided to observe the change of
cles with zero myodynamia. EMG signal in display. Meanwhile, the
patients try to do shoulder abduction, elbow
13.4.3.1 Materials and Methods flexion and extension, wrist flexion and exten-
1. Subjects: There are 77 patients with spinal sion, finger flexion and extension actively. The
cord injury. There are 62 males and 15 highest EMG signal collected from this move-
females. Male female ratio is 4 versus 1. The ment is the primary data and is recorded. The
age range is from 11 to 64 years old. The aver- highest EMG signal is marked as a baseline
and the patients are asked to make EMG signal 61 wrist flexors, 97 finger extensors and 89 finger
surpass the baseline. The patients are asked not flexors of 343 muscles with zero myodynamia of 77
to concentrate on joint motion and muscle con- patients. Analysis results of electromyographic sig-
traction, but should observe the change of nal and myodynamiastatistical of all muscles before
EMG signal curve in display. If EMG signal and after therapy refers to Table 13.13.
surpasses baseline, the new highest point is Statistical analysis of electromyographic sig-
defined as the new baseline. The patients are nal and myodynamia of 343 muscles with zero
asked to make new EMG signal surpass this myodynamia before and after therapy is done.
baseline in next movement. The rest can be Electromyographic signal: t = 14.17, myody-
done in the same manner until the EMG signal namia: t = 13.52. There are significant differ-
cannot surpass the baseline. Usually, the pro- ences of electromyographic signal and
cess requires 6–8 movements, which is defined myodynamia before and after therapy (P < 0.001).
as one therapy. The therapy time is 50 min and In 343 muscles with zero myodynamia, there
there are 15 times in one therapy course. The are only 11 muscles with zero myoelectricity. At
data of the highest EMG signal is recorded. the end of one therapy course, the myodynamia
of 11 muscles with zero myodynamia is recov-
13.4.3.2 Observational Index ered to 0.15, but there is no significant difference
• Myodynamia assessment: According to before and after therapy (P > 0.05). The myoelec-
improved Lovett myodynamia assessment tricity is increased to 8.01 μV and there is signifi-
method, myodynamis of all muscles can be cant difference before therapy and after therapy
assessed and graded before therapy. (P < 0.05). In 343 muscles with zero myody-
• EMG data collection: The highest EMG signal namia, there are 121 muscles whose myoelectric-
data of all muscles are collected before ther- ity is lower than 10 μV. At the end of one therapy
apy or at the end of the therapy and are used course, the myodynamia of is recovered to 0.32
for comparison and statistical analysis. and there is significant difference before and after
therapy (P < 0.01). The myoelectricity is
13.4.3.3 Results increased to 45.34 μV and there is significant dif-
There are 16 middle deltoids, 21 bicipital muscles of ference before therapy and after therapy myo-
arm, 28 triceps muscles of arm, 31 wrist extensors, electricity (P < 0.001, Fig. 13.5).
Table 13.13 Mean value of EMG signal after therapy in every therapy course and raw data
Numbera Electromyographic signal (μV) Myodynamia
After therapy Before
Name Before therapy therapy After therapy
Middle deltoid 16 Mean value 27.69 134.81a 0.00 0.67a
Standard deviation 28.72 69.95 0.00 0.54
Bicipital muscle of 21 Mean value 26.10 105.76a 0.00 0.74a
arm Standard deviation 41.08 124.79 0.00 0.58
Triceps muscle of arm 28 Mean value 21.39 165.21a 0.00 0.92a
Wrist extensor 31 Mean value 24.19 120.45a 0.00 0.46a
Wrist flexor 61 Mean value 34.59 95.69a 0.00 0.75a
Finger extensor 97 Mean value 16.89 78.96a 0.00 0.27a
Finger flexor 89 Mean value 24.75 70.04a 0.00 0.39a
p < 0.01
a
Fig. 13.5 Comparison 50
of 343 muscles with
zero myodynmaia before 3
and after therapy muscle strength
40
electromyographic signal (EMG)

EMG
2 30
muscle strength 20
1
10
0
before after
Operational myobiofeedback therapy
13.4.3.4 Discussion symptoms between different myodynamia

According to manual muscle test, zero myody- grades, better quantification, strong compara-
namia means the patients are required to contract bility and repeatability. No specific equipment
certain muscle and the examiner cannot feel mus- is required and the method is easy to memo-
cle contraction on skin surface of this muscle rize and master. MMT is one of the most cred-
using hands, which indicates that this muscle is ible and subjective methods for assessment of
completely paralytic without denervation. Under motor function loss due to pain in lower limbs
this circumstance, except for the muscles with and waist. MMT is usually used in rehabilita-
zero myodynamia due to spinal shock in acute tion area. Bohannon [24] deemed that myody-
phase that can be recovered after shock phase, for namia grades of lower limbs are consistent
the patients in chronic phase, it is impossible to with the range of joint motion. Some reports
recover autonomous muscle contraction and the point out that MMT is less sensitive in the
patients may give up therapy and functional exer- myodynamia assessment below grade four
cise, especially for the muscles with zero myody- than myodynamometer. In the assessment of
namia due to obsolete nerve injury in the patients myodynamia that is no less than grade four,
whose disease history is more than 1 year. It is MMT is better than myodynamometer. In the
impossible to recover autonomous innervation myodynamia comparison after spinal cord
and the patients lose functional recovery and injury through isokinetic myodynamia assess-
improvement of life quality ability. The disease ment, MMT is not sensitive for myodynamia
history in this group is 0.5–20 years after injury assessment. MMT is less sensitive than iso-
and the average is 4.2 years. After therapy, there kinetic myodynamia assessment method [25].
are significant increases of electromyographic Operant biological feedback of myoelectricity
signal and myodynamia, which is related to the is analyzed from analysis of EMG signal that
following factors. is the square root of mean value of potential
whose noise level is lower than 0.2 μV. The
1. MMT is not sensitive. MMT is an essential bandwidth is from 10 to 1000 Hz and the
assessment method for diagnosis, therapeutic noise is less than 140 dB. It is highly sensitive.
schedule formulation and therapeutic effect In 343 muscles with zero myodynamia
assessment. MMT is widely used [23] in through clinical assessment, there are only 11
clinic because of obvious distinctive muscles with zero myoelectricity. Coincidence
rate is 3‰. It proved that MMT is less sensi- 3. Providing objective target for learning and
tive than biological feedback signal reception functional training. Objective indicator is
equipment of myoelectricity. If the muscle essential for learning and functional training.
can receive autonomous electromyographic In daily life, there is a truth that archery ath-
signal, the functions of this muscle can be lete aims at arrow target to practice archery
recovered to varying degrees. so that degree of accuracy in archery can be
2. The effect of weak electrical signal. The dis- increased. Otherwise, the degree of accuracy
abled patients are usually pessimistic and with in archery cannot be increased without tar-
severe mental disorder, especially the patients get. This is because archery is a motor pro-
who are not recovered after rehabilitation ther- gram that is constructed in cortex motor
apy or who are impossible to be recovered. center. Through repeated practice, the
Therefore, if the patients can see the progress archery skill will be promoted continuously.
of the therapy timely, their rehabilitation desire When archery athlete aims at arrow target to
and confidence can be further activated. The practice archery, the first arrow may be shoot
effective method of autonomous muscle con- in the above of the bull’s-eye. The archery
traction and joint motion is to induce the result is sent to the brain and the brain will
appearance or enhancement of autonomous analyze numerous factors (altitude of arrow
nerve signal through active movements. The target, distance, wind direction, bow weight,
autonomous contraction and joint motion of arrow weight, arm strength and emotion)
muscles with zero myodynamia cannot be comprehensively. After calculation, the ges-
observed. The patients try their best, but can- ture of the second arrow can be decided such
not see the progress. They may lose confidence as lowering the arrowhead. The second arrow
and feel absent. They may give up the therapy. may be shoot in the below of the bull’s-eye.
Under the monitor of operant biological feed- The archery result is sent to the brain and the
back equipment of bioelectricity, when the brain will know the arrowhead is too low.
patients actively do autonomous contraction The gesture of the third arrow can be decided
and joint motion of muscles with zero myody- such as raising the arrowhead. The third
namia, weak electromyographic signal can be arrow is shoot in the bull’s-eye. After
received. Through amplification and computer repeated training, the speed and accuracy of
processing, the signal can be displayed in the movements are controlled precisely by
monitor in a smooth curve. At this time, the the brain so that the speed and accuracy of
therapists must explain the origin and meaning the movements will be increased. During this
of this curve to the patients. Some researchers process, arrow target is the subjective indica-
found that the intensity of electromyographic tor for illustration and feedback, which make
signal is not proportional to the strength of the brain know the mistake, rectify it timely
myodynamia. The received electromyographic and set clear objective. Therefore, arrow tar-
signal is a mixed signal that is mainly electro- get is essential external conditions for
encephalogram. This curve means the func- increasing the degree of accuracy in archery
tional level of the muscle dominated by brain. and constructing archery motor program.
The therapists tell the patients to observe the After repeated training, the motor program is
change of the curve and increase the height. consolidated.
The patients are asked not to concentrate on 4. There is residual partial neural conduction
contracted muscle and moved joint. Therefore, pathway. Some reports demonstrated that the
it is easy to induce innervation signal of auton- occurrence rate of complete spinal cord
omous nerve. The patients and the therapists injury, which is related to the anatomy of spi-
can see the therapeutic progress at any time nal cord. Generally, after spinal cord injury,
and the rehabilitation confidence is further if there is one third of normal spinal tissue
increased. left, the spinal cord can have normal func-
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of Pulmonary Dysfunction
14.1 Respiratory Movement 14.1.1 Pulmonary Ventilation

and Pulmonary Function Function
There are many types of pulmonary dysfunction. Pulmonary ventilation is the gas exchange pro-
In this chapter, we mainly introduce voluntary cess [2] between pulmonary alveoli and environ-
movement dysfunction of breathing [1] and its ment. The structures of pulmonary ventilation
rehabilitation therapy of neurological training. include respiratory tract, pulmonary alveoli, tho-
In the entire life course, gas exchange between racic cage and pleural cavity.
human body and environment is required to main-
tain relative stability of O2 and CO2. Therefore, the 14.1.1.1 G as Exchange and Power
metabolism and physiological functions of tissue of Pulmonary Ventilation
and cells can be maintained. The process of gas Gas exchange includes pulmonary gas exchange
exchange is called respiration. and gas exchange in tissues through diffusion.
The entire process of respiration includes Gas molecule always moves from high pressure
three stages. to low pressure. When intrapulmonic pressure is
External respiration is the process of gas lower than barometric pressure, gas enter into
exchange between environment and pulmonary pulmonary alveoli. Conversely, when intrapul-
blood, which includes pulmonary ventilation and monic pressure is higher than barometric pres-
pulmonary gas exchange. sure, gas flows from pulmonary alveoli to external
The transportation of gas in blood includes the atmosphere until the pressure is equal. Barometric
O2 transportation from lung to tissue and CO2 pressure is relatively constant, but intrapulmonic
transportation from tissue to lung. pressure fluctuates with the changes of pulmo-
Internal respiration is the gas exchange process nary volume. The volume change is induced by
between blood in capillary and tissue cells. dilation and shrink of thoracic cage that is due to
If there is respiration disorder, there are histan- contraction and relaxation of respiratory muscle.
oxia and carbon dioxide retention, which can Therefore, contraction and relaxation of respira-
influence metabolism of tissue cells to varying tory muscle is the source power of pulmonary
degrees, even endanger vital movements. ventilation.
https://doi.org/10.1007/978-981-13-0812-3_14
428 14 Rehabilitation Therapy of Neurological Training of Pulmonary Dysfunction
14.1.1.2 Respiratory Movement cles such as sternocleidomastoid and pectoralis

and Modulation major constrict to further enlarge thoracic cage
Respiratory movement is rhythmic dilation and and pulmonary volume in order to inhale more
shrink of thoracic cage that is due to contraction gas. When the patients put forth their strength to
and relaxation of respiratory muscle, which exhale gas, except relaxation of inspiratory mus-
includes inspiratory movement and expiratory cles, expiratory muscles such as internal inter-
movement. costal muscles and abdominal muscles are
relaxed to further reduce thoracic cage and pul-
1. Muscles involved in breathing include respi- monary volume in order to exhale more gas.
ratory muscle and auxiliary respiratory mus- In the process of forced respiration, both res-
cle [3]. These muscles are the same as muscles piration and expiration are active movements.
that drive joint motion, which belong to vol-
untary skeletal muscle. 2. Respiratory movements include abdominal

• Respiratory muscle includes diaphragm respiration, thoracic respiration and combined
and external intercostal muscles. respiration.
Diaphragm: when the person inhale gas, Abdominal respiration is a respiration pro-
diaphragm contracts, diaphragmatic dome cess completed by diaphragm movement.
decreases, abdominal organs decline, tho- Diaphragm contraction makes abdominal
racic cage enlarges, pulmonary volume organs move downward. The external mani-
increases, pulmonary negative pressure festation is apophysis of abdomen in inspira-
increases and gas flow into lung. When the tion and return of abdomen in expiration.
person exhale gas, diaphragm relaxes, dia- Therefore, respiration process mainly com-
phragmatic dome increases, abdominal pleted by diaphragm movement is called
organs move up, thoracic cage shrinks, pul- abdominal respiration [4].
monary volume decreases, intrapleural Thoracic respiration is a respiration pro-
pressure increases and gas flow out of lung. cess completed by external intercostal mus-
External intercostal muscles: when the cles. When people inhale gas, external
people inhale gas, external intercostal mus- intercostal muscles contract, rib moves
cles contract, rib moves upward and out- upward and outward, thoracic volume
ward, pulmonary volume increases, gas enlarges. The external manifestation is that
flow into lung. When the people exhale gas, thoracic cage enlarges and returns to home
external intercostal muscles relaxes, rib position in respiration. The manifestation is
moves downward and inward, pulmonary fluctuation of chest? Respiration process
volume decreases, gas flow out of lung. mainly completed by external intercostal
In this process, inspiratory movement is muscles is called thoracic respiration.
active movement and expiratory movement Combined respiration: Generally, the mani-
is passive movement. festation of respiratory movement in normal
• Auxiliary respiratory muscle is the muscles person is thoraco-abdominal combined respira-
that are involved in respiratory movements tion. Abdominal respiration is mainly observed
except diaphragm and external intercostal in infants because the thoracic cage is not
muscles in forced respiration. developed. When the patients with pleuritic or
pleural effusion, thoracic cage movement is
Auxiliary respiratory muscles include inter- limited so that abdominal respiration is the
nal intercostal muscles, muscles of the back, main respiration process. For the pregnant
muscles of chest and abdominal muscle. When women in the late phase, or the patients with
the patients put forth their strength to inhale gas, huge abdominal mass or ascites, the r espiration
except the contraction of diaphragm and external movement mainly is thoracic respiration
intercostal muscles, Auxiliary respiratory mus- because abdominal movement is limited.
14.1 Respiratory Movement and Pulmonary Function 429
Human thoracic cage is flat cone with short 14.1.1.3 Potential Capacity
anteroposterior diameter, long right and left of Respiratory Function
diameter, small top and big bottom. The dis- Potential capability of respiratory system and
placement induced by upward and outward respiratory function is the key for pulmonary
movement of rib is limited. The enlargement function rehabilitation training and functional
of thoracic cage volume is small. Diaphragm improvement through training.
at the bottom of thoracic cage contract and In fact, pulmonary function is the same as the
viscera decline. Slight displacement can functions of other tissues and organs. They all
induce big change of thoracic volume. have great functional potential. The main mani-
Therefore, abdominal respiration is a more festations are as follows:
effective respiration form. If there is eupnea,
diaphragm contraction can increase thoracic 1. Tissue reservation is the histological basis of
volume, which equals to fourth fifth of total potential capability. There are 300 million [6]
lung ventilation. Diaphragm contraction plays Alveoli in the two lungs. The total diffusion
an important role in pulmonary ventilation. area is about 70 square meter. In resting state,
3.
Regulation of respiratory movement: the number of alveoli of gas diffusion is about
According to different regulation mode, respi- 180 million. Respiratory membrane area is
ratory movement includes rhythmic respira- about 40 square meters. Therefore, reserved
tion and voluntary respiration. Rhythmic area of respiratory membrane is huge.
respiration is the main regulation way [5]. Moreover, when in movements, open number
• Rhythmic respiration is non-voluntary res- and open degree of pulmonary blood capillary
piration, which is respiratory movement are increased and effective diffusion area is
completed by rhythmic excitability of greatly increased.
respiratory center located in pons and 2. Respiratory muscle of voluntary movement
medulla oblongata. The depth and fre- can increase respiratory function through
quency can change with the change of developing neural potential and enhancing
internal and external environments in order myodynamia. Respiratory muscle and auxil-
to adapt to the requirements of body metab- iary respiratory muscle are skeletal muscle at
olism. Peripheral chemoreceptor located in will. Through training, on the basis of devel-
carotid body and aortic body and central oping neural potential of dominated muscle,
chemoreceptor located in ventrolateral muscle contraction ability is increased and
superficial part of medulla oblongata can pulmonary respiratory function is improved.
detect the change of oxygen partial pres- Through training, respiratory function of ath-
sure and partial pressure of carbon dioxide letes can meet the requirements of oxygen
in blood and regulate respiration rhythm supply in strenuous exercise.
through feedback mechanism in order to 3. We can increase pulmonary function through
maintain physiological dynamic balance. changing respiratory form. Of the entire gas,
• Voluntary respiration: respiratory move- partial gas in respiratory tract, weasand and
ment is controlled by brain consciousness. pulmonary alveoli that cannot be used for gas
For example, people can hold their breath exchange is called dead space. The more func-
in swallowing, speaking, defecation and tions Dead space plays, the less oxygen con-
diving. Strenuous exercise requires deep tent in blood is. According the part of dead
and fast respiration to ensure the normal space, it divided into three parts. Anatomical
process of these movements. dead space: in every respiration, gas in upper
In short, respiratory movement is com- respiratory tract to respiratory bronchiole
pleted through interaction of various grades cannot be used for gas exchange between pul
of respiratory centers and regulation of monary alveoli and blood. The space is about
peripheral afferent impulse. 150 mL in adult. Dead space of pulmonary
alveoli: the gas flows into pulmonary alveoli is equal to anatomical dead space, which
but not used for gas exchange. Physiological means the gas that flows into pulmonary alve
dead space: in every respiration, gas in physi oli can be used for gas exchange entirely.
ological dead space cannot be used for gas The volume of valid gas exchange in every min
exchange, which includes anatomical dead ute is alveolar ventilation volume. The formu
space and dead space of pulmonary alveoli. lation is:
For healthy people, physiological dead space
Alveolar ventilation volume = ( tidal volume − dead space volume ) × respiratory frequency.

Under normal circumstances, minute ventila- external force. Big Elasticity means the tissue is
tion volume is 8 L. Tidal volume is0.5 L (inhaled easy to dilate and small elasticity means the tis-
or exhaled gas every respiration). The relation- sue is difficult to dilate. Small elastic resistance
ship between respiration frequency and alveolar makes it easy to dilate and big elastic resistance
ventilation volume refers to Table 14.1. makes it difficult to dilate.
Therefore, deep and slow abdominal respira- Through deep and slow abdominal respiration
tion can obviously improve alveolar ventilation training, pulmonary tissue can be dilated fully
volume, increase volume of gas exchange. Shallow and relaxed fully. Therefore, suppleness of elas-
and fast respiration can decrease ventilatory effi- tic fiber in pulmonary tissue is increased gradu-
ciency of pulmonary alveoli. ally to increase elasticity of pulmonary tissue and
improve respiration quality.
4. Improving compliance of pulmonary tissue

and reducing respiratory resistance Exercise
can improve suppleness of elastic fiber in pul- 14.1.2 Evaluation of Pulmonary
monary tissue. In a certain range, the more the Ventilation Function
lung expands, the stronger the lung elastic
recoil is, the stronger the inspiratory resis Pulmonary ventilation is an important link for
tance is. gas circulation between pulmonary alveoli and
environment, which can refresh gas in pulmonary
Elastic resistance can confront shape change, alveoli. The change of lung volume and pulmo-
which is the elastic recoil. Its intensity can be nary ventilation volume are the indicators of
manifested by elasticity. Elasticity is the dilation assessing pulmonary ventilation function.
difficulty of elastic tissue under the influence of
1. Lung volume: lung volume is the gas volume
in lung. The change of lung volume is closely
Table 14.1 The effect of different respiration form on
ventilation volume (L/min) related to the depth of respiration.
Minute
• Tidal volume: If there is eupnea, gas volume
ventilation Alveolar ventilation that is inhaled or exhaled is called tidal vol-
Breathing form volume volume ume. Tidal volume of normal people is 0.4–
Eupnea 0.80 0.56 0.6 L and the average is about 0.5 L.
(0.50 × 16) [(0.50 − 0.15) × 16] • Inspiratory reserve volume: At the end of
Shallow and 0.80 0.32
inspiration, people try their best to inhale
fast (0.25 × 32) [(0.25 − 0.15) × 32]
respiration gas, which is called inspiratory reserve vol-
Deep and 0.80 0.68 ume. Inspiratory reserve volume of normal
slow (1.00 × 8) [(1.00 − 0.15) × 8] people is 1.5–2.0 L and it is the reserved
respiration capacity of inspiration.
14.2 Pulmonary Motor Dysfunction and Rehabilitation Therapy of Neurological Training 431
• Inspiratory capacity: The sum of inspira- • Total lung capacity is the most gas volume in
tory reserve volume and tidal volume is lung. It is the sum of vital capacity and resid-
inspiratory capacity, which is an important ual volume. Total lung capacity of male adult
indicator to assess potential ability of max- is about 5.0 L and of female adult is about
imal ventilation. 3.5 L.
• Expiratory reserve volume: At the end of 2. Pulmonary ventilation volume.
expiration, people try their best to exhale • Minute ventilation volume is the gas that
gas, which is called expiratory reserve vol- flow in or out of lung in every minute. It is
ume. Expiratory reserve volume of normal the tidal volume plus respiration frequency.
people is 0.9–2.0 L and it is the reserved If there is eupnea in adult, minute ventila-
capacity of expiration. tion is 6–9 L.
• Vital capacity: After maximal inspiration, • Alveolar ventilation volume: during respi-
people try their best to exhale gas and the ratory movement, the gas volume into pul-
exhaled gas volume is called vital capacity. monary alveoli in every minute is called
The sum of tidal volume, inspiratory alveolar ventilation volume.
reserve volume and expiratory reserve vol-
ume is vital capacity. The vital capacity in
male adult is about 3.5 L and in female 14.2 Pulmonary Motor
adult is about 2.5 L. Dysfunction
• Forced expiratory volume: at the end of and Rehabilitation Therapy
forced inspiration, when people try their of Neurological Training
best to exhale gas as soon as possible, the
gas volume exhaled in the first several sec- 14.2.1 Assessment of Pulmonary
onds is called forced vital capacity, which is Motor Dysfunction
manifested by the percent of vital capacity
in forced expiration. At the end of the first Motor dysfunction of lung is mainly due to paral-
second, forced expiratory volume accounts ysis of respiratory muscle, which is commonly
for 83% of FVC. Forced expiratory volume observed in injuries of central nervous system
reflects the fluency of air tract and elasticity such as brain trauma, brain infarction and spinal
of pulmonary tissue in respiratory process, injuries. It is also observed in neural diseases
which is a good indicator of pulmonary such as myasthenia gravis and motor neuron
ventilation function. degeneration that affect respiratory muscle in one
• Residual volume and Functional residual side or two sides, paralysis and brain damages
volume: at the end of maximal expiration, that usually affect respiratory muscle in one side,
the gas volume in lung that cannot be exhaled neurological disease and paraplegia that affect
is called residual volume. Residual volume respiratory muscle in two sides.
of normal person is 1.0–1.5 L. Poor pulmo- In clinic, international general assessment
nary ventilation function can attenuate pul- method is usually used to assess pulmonary func-
monary elasticity and increase residual tion and dysfunction degree.
volume. Functional residual volume is the
gas volume in lung at the end of respiration. 1. Exercise test is used to assess cardiopulmo-
It is the sum of expiratory reserve volume nary function and motor capacity of the
and residual volume. Functional residual patients with pulmonary disease.
volume of normal person is about 2.5 L. Because of dyspnea, cardiopulmonary
Functional residual volume can buffer function is weakened to varying degrees and
the change of oxygen partial pressure in maximal oxygen consumption is decreased,
pulmonary alveoli in expiration process, which restricts endurance and motor ability.
which is good for pulmonary gas exchange. Exercise test is one of the important methods
to assess the disability of the patients with 14.2.2 Rehabilitation Therapy

pulmonary disease. Heart and lung are one of Neurological Training
functional unit. The following materials can
be obtained through exercise test. Both respiratory muscles and auxiliary respira-
• Maximal oxygen uptake (VO2max) is the tory muscles are skeletal muscles involved in vol-
important indicator to reflex physical activ- untary movements, which are dominated by
ity ability and cardiopulmonary function. central nervous system and can be used for reha-
The specific method can be referred in bilitation training of neurological training.
rehabilitation evaluation books. In addition, respiratory function is the basis to
• Oxygen consumption of quantitative move- work on productive labor and competitive sports.
ment: in resting state, after quantitative However, respiratory function training is accom-
exercise and in the middle of recovery, panied with productive labor or physical exer-
oxygen consumption can be tested and cise. Special respiratory function training is not
heart rate and minute ventilation volume universal. The effects of special training and
are recorded. Because the motor intensity accompanied training are different.
is small, it is easily accepted by the patients.
It is safe and convenient. 1. Signal enhancement training of neurological
• O2 pulse: the ration of V O2 to HR can be training: Its purpose is to develop neural
used to assess the entire pulmonary potential and recover motor function of respi-
function. ratory muscle.
• Anaerobic threshold: when energy require- • Rehabilitation training of neurological
ment exceeds oxygen supply, ATP can be gen- training of diaphragm: diaphragm is the
erated by anaerobic metabolism to meet main muscle to complete abdominal respi-
energy requirements. However, this cannot ration. Fourth fifth of gas is inhaled through
last long. At this time, acid metabolite such as diaphragm movements. Therefore, dia-
lactate is increased, which is the beginning of phragm is the important inspiratory muscle
anaerobic metabolism (anaerobic threshold). for training.
2. The assessment of dyspnea: according to the Diaphragm is dominated by nervus
third edition of permanent injury evaluation phrenicus that is composed of C4 nerve
guideline amended by American Medical root. Only C4 and spinal nerve above it can
Association in 1990, the dyspnea is divided lead to paralysis of diaphragm. Spinal cord
into three degrees (Table 14.2). injury below C4 usually doesn’t influence
the function of this muscle. In the patients
Table 14.2 Assessment of dyspnea with hemiplegia induced by cerebral hem-
Degrees Characteristics
orrhage, cerebral infarction and cerebral
Slight It may appear when the patients are trauma, it usually induces paralysis of dia-
walking in the flat ground or climbing phragm to varying degrees in one side.
gentle slope. If the patients walk in the Neurological training technique is
flat ground, walking speed is the same as applied for rehabilitation training of dia-
healthy people of the same age and
physique, but they may fall behind when phragm. According to the attachment point
climbing gentle slope or stairs of diaphragm in the inner surface of tho-
Moderate When the patients walk in flat ground or racic cage, surface electrode is pasted in
climb stairs with the healthy people of the corresponding part of thoracic cage.
the same age and physique, there will be
Two groups of electrodes (three electrodes
dyspnea
Severe In flat ground, the patients walk 4–5 min in each group, Fig. 14.1) are pasted in two
using their own speed, there is dyspnea. sides of sixth intercostal space in midcla-
If the patients put forth their strength vicular line, 8th intercostal space in midax-
slightly, there is dyspnea, even in rest illary line and tenth intercostal space in
Specific method: normal Daoyin tech-

nique or six-step Daoyin technique of
guiding collaterals through meridians in
traditional Chinese medicine is used. Main
and collateral channels are operated by
guiding collaterals through meridians.
Stomach meridian of foot-yangming: wing
of nose (Yingxiang), inner canthus
(Jingming), upper teeth and ring lip
(philtrum), supraclavicular fossa (Quepen),
2 in. besides xiphoid (Burong). On the
basis of regulation of mind and breathing,
the patients are required to inhale gas with
force using abdominal respiration. The
therapists put palm on the upper abdomen
and increase resistance according to the
patients’ condition (Fig. 14.3). The
therapists encourage the patients to try
Fig. 14.1 Training electrode placement sketch map of their best to increase signal intensity of
diaphragm diaphragm. The patients insist for 6 s and
enter into the process of guiding collaterals.
After diaphragm contraction, the patients
are guided to relax. The mind goes
downward along 2 in. besides midline of
abdomen (Guanmen), inguen (Qichong),
hip joint (Biguan), outside of tibia
(Zusanli), the anterior of thigh (tibialis
anterior muscle), acrotarsium (Chongyang),
inside of middle toe (Neiting) and finally
arrives at outside of the second toe (Lidui).
Fig. 14.2 Control display of diaphragm signal in two

sides
linea scapularis or posterior axillary line.

Two groups of electrodes are connected to
the first and the third lead of neurological
training equipment. One screen is used to
display diaphragm signal in two sides
(Fig. 14.2). Control training of diaphragm
in two sides is done to provide visual
surpassing goal (the healthy side) for the Fig. 14.3 Anti-resistance training of neurological train-
patients. ing of diaphragm
After that, the patients relax, take a deep

inspiration and exhale it slowly.
In the second training, signal intensity
induced in the first training is used to make
an elevation line, which is the surpass goal
of the second training. The patients are
guided to make signal intensity surpass the
elevation line. The rest can be done in the
same manner. Signal intensity of dia-
phragm dominated by central nervous sys-
tem is increased gradually to recover motor
function of diaphragm.
The training time is 25 min (once a day)
and there are 30 time in one therapy course. Fig. 14.4 Sketch map of paste part of surface electrode
• Rehabilitation training of neurological on external intercostal muscles
training of external intercostal muscles:
External intercostal muscles are the main and Burong to activate contraction
inspiratory muscles, which is dominated by movements of external intercostal muscles.
intercostal nerve. There is cross dominance The therapists put one hand on the
phenomenon in intercostal nerve. For corresponding part of thoracic wall, exert
example, the fourth external intercostal resistance inward and upward properly use
muscles not only dominated by the fourth count method to encourage the patients to
intercostal nerve, but also innervated by the enhance continuous contraction intensity
branches of the third and fifth intercostal of external intercostal muscles. The specific
nerve. Therefore, the training of external method is the same as diaphragm training.
intercostal muscles can be done separately. The training time is 25 min (once a day)
The fourth, sixth, eighth and tenth external and there are 30 time in one therapy course.
intercostal muscles can be trained. • Rehabilitation therapy of neurological
There are two groups of surface elec- training of auxiliary inspiratory muscles:
trode that receive signal in left and right when the patients inhale gas, pectoralis
sides. There are three electrodes in each major contraction enlarges thoracic cage
group. The paste parts of fourth external and pulmonary volume to inhale more gas.
intercostal muscles are as follows: the first Rehabilitation training of neurological
electrode is placed in intercostal space of training of pectoralis major: pectoralis
midclavicular line. The second electrode is major is from inside of clavicle, the anterior
placed in intercostal space of anterior axil- of sternum, the first to the sixth costicarti-
lary line. The third electrode is placed in lages and the upper of the anterior wall of
intercostal space of posterior axillary line vagina musculi recti abdominis to spine of
(Fig. 14.4). The rest can be done in the greater tubercle of humerus. The function
same manner. of pectoralis major is to adduct and intort
Specific method: the normal Daoyin shoulder joint in proximal fixation. In distal
technique or six-step Daoyin technique of fixation, the trunk is stretched to upper arm
guiding collaterals through meridians in and the rib is elevated for inspiration.
traditional Chinese medicine is used for The paste part of received electrode:
training. When the training of guiding col- surface electrodes are placed in two fingers
laterals through meridians is used for the in the level of anterior axillary line in infra-
fourth, sixth and eighth external intercostal clavicula, four fingers below midclavicular
muscles, Qi is guided to Wuyi, Ruzhong line, six fingers in infraclavicula and two
fingers besides sternum. Reference of internal intercostal muscles and

electrode are between upper and lower abdominal muscles shrink thoracic cage
electrodes (Fig. 14.5). and pulmonary volume to exhale more gas
Upper arm adduction induces autono- and decrease residual gas volume in
mous motor program signal of pectoralis pulmonary alveoli.
major and anti-resistance enhances the sig- Rehabilitation training of neurological
nal intensity (Fig. 14.6). Other trainings are training of internal intercostal muscles:
the same as the methods mentioned above. internal intercostal muscles are in
The training time is 25 min (once a day) intercostal space and in deep layer. The
and there are 30 time in one therapy course. direction of diagonal muscle fibers is
• Rehabilitation training of neurological contrary to that of external intercostal
training of auxiliary expiratory muscles: muscles. Muscle fiber is from the upper rib
when the patients put up their forth to besides sternum to the lower rib besides
exhale gas, except the dilation of inspiratory spinal cord. The contraction of internal
muscles, contraction of expiration muscles intercostal muscles decrease sternum. The
rib inclines downward and rotates inside to
shorten the anteroposterior and left and
right diameter of thoracic cage to generate
expiration effect.
Electrode paste place and training
method of rehabilitation training of neuro-
logical training of internal intercostal mus-
cles are the same as these of external
intercostal muscles training (Fig. 14.7).
During the anti-resistance of internal inter-
costal muscles, the therapists use palm to
exert resistance inward and downward
from costal margin to resist the shortening
of anteroposterior diameter of thoracic
cage. The training of internal intercostal
Fig. 14.5 Sketch map of paste part of surface electrode muscles refers to Fig. 14.8. The training
on pectoralis major time is 25 min (once a day) and there are 30
time in one therapy course.
Fig. 14.6 Sketch map of anti-resistance part of Fig. 14.7 Sketch map of paste part of surface electrode
pectoralis major on internal intercostal muscles
enhance the strength of rectus abdominis.

and there are 30 time in one therapy course.
3. Abdominal respiration training: the patients
can train diaphragm and breathe in a deep and
slow way to increase vital capacity. There are
many ways of respiration exercises, such as
diaphragm respiration, anti-resistance
respiration, segmentation respiration, deep
and slow respiration, and retraction lip
respiration. They have certain therapeutic
effects, but there is no special equipment for
Fig. 14.8 Sketch map of anti-resistance part of internal respiration training and there is no visual real-
intercostal muscles time objective indicator of inspiratory
capacity. In some hospitals, home-made paper
2. Potential development training of neurologi- bag is the tool for respiration training, but the
cal training: Auxiliary respiratory muscles can patients cannot insist on it, which can influence
be used for potential development training. exercise effect.
• Potential development training of pectora- Pulmonary function exercise device
lis major: With the help of potential devel- developed by the author is a kind of
opment training equipment of upper limbs, exercise device of active movements of
the patients knee in training equipment and inspiratory muscles (Fig. 14.9). It is made
wear weight support band. According to from non-toxic medical plastics. It is
the condition of the patients, the weight equipped with main measurement barrel to
can be decreased. Six-step Daoyin tech- measure inspiratory capacity and flow
nique is used to guide the patients to do measurement barrel to measure gas volume
pushing up and down of upper limbs. in unit interval. The main measurement
During pushing up and down with upper barrel is equipped with scale and float. The
limbs, fluctuation of the trunk requires pec- float can fluctuate flexibly. Therefore, the
toralis major and latissimus dorsi. Through users can know their progress of exercise
decreasing weight support or increasing and get inspired. Flow measurement barrel
resistance gradually, the patients can is marked with three gears that include
recover neural functions and strengthen the good, better and best. When the floater in
muscles. The training time is 25 min (once flow measurement barrel is on good gear,
a day) and there are 30 time in one therapy the gas volume in unit time is big and the
course. inspiratory time is short, which belongs to
• Rectus abdominis training: sit-up is used to shallow and fast respiration mode. When
train rectus abdominis. With the help of the floater in flow measurement barrel is on
potential development training equipment best gear, the gas volume in unit time is
of upper limbs, the patients knee in training small and the inspiratory time is long,
equipment and wear weight support band. which belongs to deep and slow respiration
According to the condition of the patients, mode. The users observe the inspiratory
the weight can be decreased and lower capacity and flow volume in the process of
limbs are fixed. Six-step Daoyin technique exercise. Through biofeedback mechanism,
is used to guide the patients to sit up and lie they can keep gas flow at minimum and
down. Through decreasing weight support inspiratory capacity at maximum and the
or increasing resistance gradually, the deep and slow abdominal respiration mode
patients can develop neural potential and is formed gradually.

of pulmonary function
measuring
exercise device
cylinder
Small
measuring
cylinder
cursor
dobber
plunger
aspirating
tube
• Pulmonary function exercise device: is 20 min (2–3 time a day) and there are 30
through objective and motive mechanism, times in one therapy course. It can be used
the users can strengthen diaphragm and for a long time as health care.
turn the breathing to deep and slow • Indications: pulmonary function exercise
abdominal respiration mode to increase device is widely used to replace traditional
alveolar ventilation volume, increase respiration exercise modes such as
oxyhemoglobin saturation, prevent blowing paper bag and retraction lip
pulmonary alveoli collapse and re-inflate respiration. It can be used for prevent or
the collapsed pulmonary alveoli. treat pulmonary atelectasis, obstructive
• Application methods and therapy course: emphysema and chronic bronchitis. It can
application methods: the patients usually be used for the old weak patients, the
are in sitting position or lying position. The patients with lung and heart disease, chest
patients in sitting position should keep trauma, respiratory muscle paralysis,
their heads up. The patients lying in bed various kinds of surgery especially
should be in semireclining position. At thoracotomy and respiration that is
first, they should do deep inspiratory influenced to varying degrees. It can be
practice for several times and then use used for the patients lying in bed for a
pulmonary function exercise device. The long time, the patients with stroke, spinal
patients should concentrate when in injury, myodystrophy and abdominal wall
exercise. According to individual physical relaxation after birth. All the patients have
truth, they adjust scale Vernier of inspiratory pulmonary alveoli collapse. Rehabilitation
capacity. At the time of inspiration, the of respiratory function disorder is
patients observe the vernier change in flow significantly meaningful to respiratory
measurement barrel and keep the floater in diseases. Arthritis and Ankylosing
flow measurement barrel at best gear. In the Spondylitis can affect breathing to varying
next exercise, on the basis of keep the degrees so that these are the indication of
floater in flow measurement barrel at best pulmonary function exercise device.
gear, the patients try to make the inspira- • Contraindications: There is no obvious
tory capacity surpass it. The new capacity contraindication. It should be used under
is marked by floater and the rest may be the instructions of the doctors in the
deduced by analogy. The inspiratory capac- patients with severe cardiopulmonary
ity is increased gradually. The therapy time dysfunction, ascites and late pregnancy.
• Cautions: in order to get better training 14.3.2 Postural Drainage

effect, there are some announcements.
The expiratory speed should be slow. The According to different anatomical position in
ration of inspiration and expiration is one lung, the patients are in proper position and use
to two. The patients should bulge abdo- fluid mechanics to make sputum flow from higher
men in exercise to guarantee the exercise position to lower position and decrease energy
of diaphragm. The exercise should be step consumption [7].
by step. The patients should be preserved
to obtain good therapy and prevention 1. Position and procedure: Pillow, elevating bed
effect. Pulmonary function exercise or tailor-made therapy bed is used to place the
device is the equipment for inspiratory patients. There are five basic positions.
training. It is forbidden to blow it. The • The position of inclined prone position and
water in expiratory gas can make floater in lowering head at 45° is suitable for drain-
measure barrel get wet and lose flexibility. age of rear back area in lobus inferior
Under this circumstance, pulmonary func- pulmonis.
tion exercise can be placed in shade until • The position of inclined lying on one side
the water in measurement barrel evapo- and lowering head at 45° is suitable for
rates completely. drainage of outer back area in lobus inferior
pulmonis.
• The position of inclined supine position
14.3 Rehabilitation Methods and lowering head at 45° is suitable for
of Keeping Fluency drainage of forward back area.
of Respiratory Tract • The position of inclined semi-lateral posi-
tion and lowering head at 30° is suitable for
The premise of normal ventilation is the fluency ligule drainage of middle lobe of right lung
of respiration tract. Elimination of secreta timely and superior lobe of left lung.
and effective in trachea is an important method to • The position of semi-lateral position and
keep the fluency of respiration tract, prevent and backward position is suitable for drainage
decrease respiratory system infection. of superior lobes of two lungs. Inclining
forward position is suitable for drainage of
apex pulmonis of two lungs and extensive
14.3.1 The Control and Adjustment lung diseases.
of Cough 2. Drainage procedure and time: Postural drain-
age should be done before meal to prevent
Shallow and frequent cough and fulminant gastric reflux. The drainage time of each part
cough must be controlled timely. The control is 5–10 min and the total time cannot exceed
method is that the patients should relax fully, sit 45 min (2–4 times a day).
comfortably, incline their body and inhale gas 3. Indications and contraindications.
deeply using abdominal respiration. Inhaled gas • Indications: The sputum is more than
can reach deep part through trachea with secreta. 30 mL a day or the sputum is medium, and
After holding breath for a while, the patients other methods cannot excrete sputum.
shrink abdominal muscles and cough for 2–3 • Contraindications: Postural drainage is for-
times. There is usually sputum. If there is still bidden in the patients with myocardial
difficulty, the patients can use two hands to infarction, cardiac insufficiency, pulmo-
compress the lower part of chest and upper nary edema, pulmonary embolism, pleural
abdomen to cough forcedly in order to excrete exudation, acute chest trauma and hemor-
sputum. rhagic disorders.
14.4 Development and Clinical Application of Pulmonary Function Exercise Device 439
During postural drainage, if there is cyano- aerosol inhalation, bronchodilators can be added
sis, dyspnea exacerbation, oxygen partial to prevent bronchospasm.
pressure that is less than 6.6 kPa (50 mmHg), Aerosol inhalation therapy: the therapy time is
partial pressure of carbon dioxide that is more 20 min (3–4 times a day). It can be done after get-
than 8 kPa (60 mmHg), the drainage should be ting up and before going to sleep.
stopped and handled.
14.3.5 Mucus Lytic Agent

14.3.3 Patting and Chattering
to Excrete Sputum Mucolytic medicine is a kind of medicine that
can change viscous ingredient in sputum,
The therapists grasp hollow arc and use finger pulp decrease viscosity of sputum, reduce cough fre-
or palm side to pat the dorsal part of chest, or use quency, relieve thoracic discomfort, excrete spu-
one hand to press the other hand to vibrate the dor- tum and improve general body state. It is applied
sal part of chest. Secreta in trachea may fall off to in bronchial or lung diseases such as cough,
big trachea and is easy to be excreted. During this expectoration and sticky sputum. It includes
process, the patients are asked to do slow abdomi- bromhexine, acetylcysteine and chymotrypsin.
nal respiration and the therapists use hand to pat Mucolytic medicine can destroy gastric mucosal
and vibrate the dorsal part of chest from lower to barrier. It should be used with caution in the
upper in expiration for several times. Patting and patients with medical history of gastric ulcer.
vibrating should be gentle to avoid pain. The thera- In addition, in the health care of respiratory
pists should keep away from regio scapularis and system, the patients should keep away from stim-
upper abdomen. Sputum excretion vibrator can be ulation substance of respiration tract such as
used to excrete sputum and the effect is better. toxic gas, dust fog, lampblack in kitchen and
smog in smoking.
14.3.4 Aerosol Inhalation Therapy

14.4 Development and Clinical
Aerosol inhalation can make 90% medicine Application of Pulmonary
particles whose diameter is less than 3 pm dis- Function Exercise Device
perse in bronchus and bronchiole. The water in
aerosol gas whose dose is more than 50 mL/L 14.4.1 Design Principle of FG-01
can wet respiration tract and are good for liqui- Pulmonary Function Exercise
dation and excretion of secreta. Antibiotics and Device
mucus lytic agent can be added to aerosol to
liquidate sputum and prevent infection or resist Oxygen is required for human life. Human body
infection. acquires oxygen through gas exchange. Through
During aerosol inhalation, the patients do respiration, inhaled oxygen required for human
deep and slow abdominal respiration to make physiological activities. The exhaled metabolite is
aerosol reach the bottom of the lung extensively carbon dioxide. Respiration is one of the basic life
and deeply. Several minutes after inhalation, it processes to maintain body metabolism.
contributes to sputum excretion with the help of Respiratory arrest means death. The patients who
cough. Aerosol inhalation therapy is given to the stay in a position for a long time, especially in an
patients before postural drainage to increase the inhibitory state because of disease, are easy to
effect of sputum excretion. catch pneumonia. For the patients who lie in bed
Inhaled particles can stimulate respiration for a long time, the old weak patients, the patients
tract and may induce bronchospasm. For the with lung and heart disease, chest trauma, respira-
patients who are tendentious to bronchospasm, in tory muscle paralysis, various kinds of surgery
especially thoracotomy and respiration that is is passive movement. Thoracic cage is bid in
influenced to varying degrees, oxygen saturation the bottom and small in the upper part. Minor
in blood is decreased, tissue oxygen supply is diaphragm movement can induce large vol-
poor, the energy is insufficient, functions are ume change of thoracic volume. In a resting
decreased due to lack of required energy. state, fourth fifth of inhaled gas is completed
Mechanical movement of chest and lung is by diaphragm movement. Therefore, the key
decreased, which can affect returned blood vol- point of pulmonary function exercise is to
ume, decrease ejection blood volume and block enhance diaphragm function, which is exer-
the excretion of secreta that induce pulmonary cise of inspiratory muscles.
atelectasis. Secreta retention can make the bacteria 2. Gas volume contained in lung is the basis of
grow in lung, which can lead to pulmonary infec- capacity of pulmonary function exercise
tion, increase resistance of pulmonary ventilation, device. Lung volume can be measured by vital
decrease gas diffusion speed, further influence capacity.
ventilation and gas exchange volume. It forms a Vital capacity is the maximal volume that
vicious circle. It can delay the cure of the disease people can exhale after forced inspiration. It is
and rehabilitation time, even endanger life. the sum of tidal volume, inspiratory reserve
Rehabilitation of pulmonary function is impor- volume and expiratory reserve volume. There
tant for preventing pulmonary complications and is individual difference in vital capacity that is
increasing visceral functions. Western developed related to stature, gender, age, position and
country attaches great importance to pulmonary strength of respiratory muscle. Generally,
function rehabilitation and accumulates enriched vital capacity of male adult is 3500 mL and
experience. Special equipment of pulmonary vital capacity of female adult is
function training is used. In our country, some 2500 mL. Therefore, the volume of pulmo-
medical books introduce rehabilitation knowl- nary function exercise device should be con-
edge of pulmonary function, but clinical applica- sidered by the patients to meet the requirements
tion is rare. There is no specialized rehabilitation of different crowds. It can be divided into dif-
training equipment and apparatus of pulmonary ferent types according to the difficulty and
function. Development of rehabilitation training volume.
equipment of pulmonary function with special 3. Deep and slow respiration can reduce dead
proprietary intellectual property rights is good for space effectively.
promotion and popularization of rehabilitation The inhaled gas into lung is not all used for
work of pulmonary function in China. gas exchange between pulmonary alveoli and
blood. There are 150 mL gas left from respira-
14.4.1.1 Design Principle tion tract to respiratory bronchiole, which is
Pulmonary function exercise device is designed called anatomical dead space. Only the gas
according to human respiratory physiology that flow into pulmonary alveoli can be used
function. for gas exchange. Only deep and slow respira-
tion can decrease dead space and increase
1. The mechanism of formation of respiratory alveolar ventilation volume. Shallow and
movement: respiratory movement is formed rapid respiration is on the contrary.
by dilation and shrink of thoracic cage induced The design of pulmonary function exercise
by respiratory muscle contraction and device must contribute to the formation of
relaxation. deep and slow abdominal respiration.
When there is eupnea, inspiratory move-
ment is completed by contraction of inspira- 14.4.1.2 Main Structure
tory muscles. Expiratory movement is induced In order to meet the physiological requirements,
by relaxation of inspiratory muscles. FG-01 pulmonary function exercise device is
Inspiration is active movement and expiration equipped with exercise devices to measure inspi-
ratory capacity and inspiratory flow measure- 3. Performance index.

ment. The users can use them to train diaphragm, • The materials of pulmonary function exer-
form deep and slow abdominal respiration and cise device are made from qualified medi-
increase alveolar ventilation volume. cal plastics. This medical plastic is in
accordance with medical standard and non-
1. Inspiratory capacity measurement system is toxic. There is no radioactive substance,
equipped with measurement barrel. The vol- non-carcinogenic and no sensitization.
ume is 2500 and 3500 mL separately. There is • Floater in measurement barrel is flexible
surpassing goal. and can reflect minor gas volume change.
In order to measure the inhaled gas vol- • It is equipped with gas infiltration device
ume, the barrel is equipped with floater that that can prevent dust effectively.
can fluctuate with inhaled gas volume. The 4. Functions.
outside of measurement barrel is equipped FG-01 respiratory function exercise device
with movable Vernier. The users can set the is an active inspiratory muscles exercise device.
gas volume at the first time according to their Inspiratory muscles can get better exercise and
own conditions and increase it with the functional recovery. The respiration form is
increase of gas volume. The merit of it is that transformed to deep and slow abdominal respi-
the users can see their own progress of inspiration to increase alveolar ventilation volume,
ratory capacity at any time and there is always increase oxyhemoglobin saturation, prevent
a new surpassing goal for the users. Through pulmonary alveoli collapse and re-expand col-
objective and motive mechanism, it has a lapsed pulmonary alveoli.
feedback role that contribute to enhancement 5. Discussion.
of rehabilitation confidence of pulmonary Rehabilitation consciousness of medical
function and acceleration of rehabilitation staffs and the patients is increased, but the
process. development of rehabilitation work of pulmo-
2. Gas flow measurement system: Flow mea-
nary function is limited. Except some profes-
surement barrel is equipped with floater. Flow sional departments such as respiration medicine
measurement barrel is marked with three and chest surgery, other departments seldom
gears that include good, better and best. notice the rehabilitation of pulmonary function,
This barrel can help the users to control even in department of rehabilitation medicine.
the gas volume in unit time. When the floater For the patients with poor pulmonary function,
is at good gear, gas volume in unit time is most physicians use oxygen uptake to deal with
huge, inspiration time is short and respiration pulmonary ventilation insufficiency and hyox-
process is easy to be completed. When the emia. Oxygen uptake is an emergent measure,
floater is at better gear, gas volume in unit but is not the common measure to deal with
time is small, inspiration time is long, chronic pulmonary ventilation insufficiency
respiration process is difficult to be completed, and hyoxemia. The physician may ignore reha-
but alveolar ventilation volume can be bilitation exercise of pulmonary function of the
increased and diaphragm may be trained well. patients. Hyperoxia environment is artificial
When the floater is at best gear, gas volume in and can inhibit respiratory center. Long-term
unit time is minimum, inspiration time is the hyperoxia environment can injure pulmonary
longest and respiration process is the most function. The people who live in hyperoxia
difficult to be completed. At this time, deep environment don’t adapt to plateau section with
and slow respiration can make the alveolar low oxygen content. Insufficiency of pulmo-
ventilation volume reach the maximum. nary function can lead to severe hyoxemia.
Diaphragm may be trained best. The users Therefore, it is very important to pay attention
can have deep and slow respiration using to rehabilitation training of pulmonary function
abdominal respiration. of the patients.
Pulmonary alveoli collapse and hypostatic pneu- training of deep and slow respiration form is
monia are the common complications of the old required. Tidal volume and respiration frequency
weak patients, the patients who lie in bed for a long have different impacts on pulmonary ventilation
time, the patients with lung diseases or after thora- capacity and alveolar ventilation volume. When
cotomy. The early phase after surgery, vital capacity tidal volume is reduced by half and respiration
of the patients is decreased 50–60% and ventilatory frequency is doubled, alveolar ventilation volume
capacity in one time is decreased 25% [8]. These is decreased obviously. When tidal volume is
problems cannot be solved by oxygen uptake. double and respiration frequency is reduced by
Oxygen uptake cannot increase ventilation capacity, half, alveolar ventilation volume is increased
but may decrease ventilation capacity because of obviously [15] in spite that pulmonary ventilation
high oxygen content. Insufficiency of ventilation volume is constant. The key point of pulmonary
capacity cannot prevent pulmonary alveoli collapse function exercise is active diaphragm exercise
and cannot re-expand collapsed pulmonary alveoli. and training of deep and slow respiration mode.
Only active pulmonary function exercise can FG-01 pulmonary function exercise device is
increase pulmonary ventilation volume to prevent an active inspiratory muscles exercise device that
and treat pulmonary complications. is equipped with inspiratory capacity and gas
The rehabilitation of respiratory dysfunction is flow measurement device. The users can learn
meaningful to many diseases. Many diseases can deep and slow abdominal respiration form to
lead to pulmonary dysfunction. Poor pulmonary increase alveolar ventilation volume [16], acti-
function is an important factor to induce and vate reserved respiratory membrane area, expand
aggravate many diseases. Tockman [9] and his pulmonary alveoli, promote gas exchange and
colleagues found that the decreased percentage of prevent lung complications. In addition, deep
forced inspiratory volume to predicted value is one of inspiration training can contribute to negative
the risk factors of coronary heart diseases. Singh [10] pressure increase in pleural cavity, which can
and his colleagues found that there is restricted promote backflow of venous blood and lymph
ventilatory dysfunction in the patients with type 2 and increase blood circulation volume.
diabetes mellitus. Lung is one of the most common It is needed to be mentioned that rehabilitation
involved organs in uremia. Pulmonary dysfunction methods of pulmonary function in some hospitals
may be induced by direct or indirect factors of uremia are home-made simple expiration practice device.
[11]. Arthritis, ankylosing spondylitis, myodystro- Some reports found that expiration exercise
phy, weak, stroke and spinal cord injury can lead to method cannot prevent or treat pulmonary atelec-
ventilation insufficiency. The pulmonary tasis, but can aggravate pulmonary atelectasis
complication is the main reason of death, especially [17]. Only inspiration practice can prevent or
in the patients with quadriplegia. In addition, treat pulmonary atelectasis. The effect of it on the
pulmonary function in healthy people may be sober patients is better than interval positive-
changed greatly with age. Human pulmonary pressure respiration method.
function reaches the peak at the age of 25. There is
regeneration change at the age of 30 and there is
obvious regeneration change at the age of 60. The 14.4.2 The Therapeutic Effect
degeneration changes include diaphragm of FG-01 Pulmonary Function
hypomotility, increase of airway resistance and Exercise Device on Pulmonary
decrease of alveoli number [12]. From this, we can Function Rehabilitation
see the close relationship between pulmonary dys- of the Patients
function and other diseases and the meaningfulness with Pulmonary Fibrosis
of respiratory function exercise [13, 14].
Increasing alveolar ventilation volume is the The main pathological features of severe acute
key to increase gas exchange, expand pulmonary respiratory syndrome are hypoimmunity and pul-
alveoli and prevent pulmonary complications. In monary fibrosis, which greatly affect pulmonary
order to increase alveolar ventilation volume, the function. In order to explore rehabilitation meth-
ods of pulmonary function damage after SARS, 14.4.2.2 Exercise Method

the author developed pulmonary function exer- According to application method and announce-
cise device according to respiration physiology. ments introduced in the second section is this
Approved by the state administration of tradi- chapter, the patients in training group use FG-01
tional Chinese medicine, the author chooses the pulmonary function exercise device to do active
patients with coalworker pneumoconiosis whose inspiration training. The training time is 20 min
manifestation is pulmonary fibrosis as subjects. (twice a day) and therapy course can last 4
The manifestation of coalworker pneumoconio- months.
sis is similar with SARS. Pulmonary function At first, rehabilitation physicians give training
exercise device is used for the patients to do to physicians in ward about application method
inspiration function training to observe its effect and assessment method of pulmonary function
on vital capacity and daily life of the patients. exercise device. After that, physicians explain the
importance of pulmonary function exercise and
14.4.2.1 General Conditions application method and assessment method of
Seventy-two patients with coalworker pneumoco- pulmonary function exercise device to the
niosis are all from pneumoconiosis and tuberculosis patients. The key point of explanation is to teach
department of Beijing Jingmei group general hospi- the patients to learn to observe the floater in
tal from August 2003 to December 2003. All the measurement barrel, data reading method in

patients are diagnosed of coalworker pneumoconio- inspiration, the effect of gas measurement floater
sis complicated with tuberculosis by diagnosis on deep and slow abdominal respiration. The
group of occupational disease in Beijing Jingmei patients master it and can do exercise by
group. The pulmonary fibrosis is diagnosed in anti- themselves. The patients should try to increase
tuberculosis therapy. All the patients are male. The inspiratory capacity in each time and record it.
age is from 51 to 81 years old. The average is The patients in control group not only receive
69.9 years old. They are diagnosed in I–II phase of antituberculosis therapy, but also do exercise by
tuberculopneumoconiosis. The disease state is themselves. The physicians should explain the
stable and there is no severe complication. The importance of pulmonary function exercise and
patients don’t need continuous oxygen uptake. The deep and slow abdominal respiration to the
patients are randomly divided into training group patients.
and control group. There are 36 patients in each
group. There are 19 patients in I phase of 14.4.2.3 Assessment Criteria
tuberculopneumoconiosis and 14 patients in II
1. Pulmonary function measurement: CHEST
phase of tuberculopneumoconiosis in training GRAPH HI-101 portable pulmonary function
group. There are 20 patients in I phase of apparatus made in Japan is used. Orifice plate
tuberculopneumoconiosis and 12 patients in II flowmeter is used for flow measurement. Flow
phase of tuberculopneumoconiosis in control group. integral method is used for volume assessment.
The patients in two groups all receive antitubercu- Volume accuracy is ±3% or ±50 mL. Flow
losis therapy. There is no significant difference of range is 0.05 ± 14 L/s. Volume range is
general condition between two groups (Table 14.3). 10 L. The functions are measured at the
Table 14.3 Comparison of general condition in two groups

Stages of Breathlessness activity grade of
Group pneumoconiosis Vital capacity breathe hard daily living
I II (L) I II III IV V 0 I II III IV V
Training 19 14 2.24 ± 0.64 0 18 11 3 1 0 2 12 18 1 0
group
Control 20 12 1.97 ± 0.74 0 14 12 6 0 0 0 17 14 1 0
group
beginning of the experiment, 1 month after the 14.4.2.4 Results

experiment and at the end of the experiment. Vital capacity in different stages of experiment
2. Grading assessment of self-awareness of short includes self-awareness of short of breath and
of breath and breathlessness. According to the breathlessness, blood gas analysis and daily life
methods provided by Diagnosis and Treatment ability assessment.
norms of Chinese rehabilitation medicine [18] In the 4-months experiment, there are three
grading assessment of self-awareness of short patients in training group and four patients in
of breath and breathlessness is done control group who quit the experiment because of
(Table 14.4). economic condition. There are 33 patients in
3. Assessment of daily life ability: According to the training group and 32 patients in control group
methods provided by Diagnosis and Treatment who complete the experiment.
norms of Chinese rehabilitation medicine, daily The results demonstrated that there is signifi-
life ability is assessed (Table 14.5). cant difference of vital capacity between training
4. Blood gas analysis: The blood are draw from group and control group 1 month after experi-
the patients in training group and control ment and at the end of the experiment (P < 0.05).
group at the beginning and the end of the There is significant difference of self-awareness
experiment. The blood is used to assess of short of breath and breathlessness between
arterial partial pressure of oxygen, partial training group and control group (P < 0.05).
pressure of carbon dioxide in artery and There is no significant difference of daily life
arterial oxygen saturation. ability between two groups.
5. Statistical analysis: Experiment data is analyzed
by SPSS6.0 software. T-test is used for 14.4.2.5 Discussion
comparison between groups and within group. Pulmonary interstitial fibrosis can influence pul-
monary gas exchange and decrease oxyhemoglo-
Table 14.4 Grading standard of self-awareness of short bin saturation, reduce metabolic rate, affect
of breath and breathless functions of various organs and lead to disease
Grade Grading standard [19, 20] It can decrease movement ability and life
I No short of breath and breathlessness quality of the patients. There is pulmonary alve-
II Slight short of breath and breathlessness oli collapse in obstructive pulmonary disease
III Mild short of breath and breathlessness such as chronic bronchitis, the patients who are
IV Obvious short of breath and breathlessness long-term in bed or after thoracotomy.
V Severe short of breath and breathlessness, Increasing alveolar ventilation volume, func-
Cannot endure
tional residual capacity and replacement rate of
functional residual capacity can increase gas
Table 14.5 Assessment standard of daily life assessment exchange rate and oxyhemoglobin saturation.
Grade Grading standard There are several methods to increase these.
0 The patients are with lung diseases to varying
degrees, but their movements are the same as 1. Decreasing dead space: The anatomical space
normal people. It has no effect on daily life
and there is no short of breath in respiratory system that cannot be used for
I There is short of breath in labor gas exchange is about 150 mL. In every respi-
II There is no short of breath in walking in flat ration, dead space can play function once. The
ground. When the walking speed is fast or change of tidal volume and respiration fre-
climbing stairs or uphill, the healthy people quency have different effects on pulmonary
with the same age cannot feel short of breath,
but the patients feel short of breath ventilation volume and alveolar ventilation
III There is short of breath within one hundred volume.
steps Tidal volume and respiration frequency
IV There is short of breath when the patients do have different impacts on pulmonary ventila-
minor movements such as speaking or dressing tion capacity and alveolar ventilation volume.
When tidal volume is reduced by half and res- In short, diaphragm exercise can increase tho-
piration frequency is doubled, alveolar venti- racic capacity and promote the formation of deep
lation volume is decreased obviously. When and slow abdominal respiration pattern, which
tidal volume is double and respiration fre- can increase alveolar ventilation volume, increase
quency is reduced by half, alveolar ventilation oxyhemoglobin saturation and prevent lung
volume is increased obviously in spite that complications.
pulmonary ventilation volume is constant. FG-01 pulmonary function exercise device is
Diaphragm movement can induce big change a portable active inspiratory muscles exercise
of thoracic volume. In resting state, fourth device. Inspiration volume measurement barrel
fifth of inhaled gas is completed by diaphragm can make the patients see their own progress of
movement. Therefore, the key point of respi- inspiration volume in exercise. The progress can
ratory function exercise is on diaphragm, be marked with Vernier. The patients can encour-
which means the exercise of inspiratory mus- age themselves to increase inspiration volume.
cles. The manifestation of diaphragm Gas flow limited device can help the patients to
movement is abdominal respiration mode. form deep and slow respiration. Long-term exer-
2. Activating reserved lung volume: Human
cise can increase alveolar ventilation volume and
respiratory membrane area is the important oxyhemoglobin saturation. Overseas, in clinic,
factor to influence gas exchange. there is an equipment called pulmometer that is
Under normal circumstance, there are 300 used for respiratory function rehabilitation of the
million Alveoli in the two lungs. The total dif- patients in preoperative preparation and postop-
fusion area is about 70 m2. In resting state, the erative rehabilitation of surgeries [21] in heart,
number of alveoli of gas diffusion is about lung, abdominal cavity or thoracoabdominal
180 million. Respiratory membrane area is combined surgery and the patients with neuro-
about 40 m2. Therefore, reserved area of respi- muscular diseases.
ratory membrane is huge. When there is pul- Researches show that inhaled gas volume dis-
monary atelectasis, lung consolidation, played in exercise device in inspiration exercise is
pulmonary emphysema or pulmonary capil- significantly correlated [22] two with vital capac-
lary close or obstruction, diffusion area of ity and inspiratory reserve volume measured by
respiratory membrane is decreased. Through pulmonary function apparatus. Through exercise,
training, reserved lung capacity is activated to myodynamia and endurance of inspiratory mus-
compensate the functions. cles can compensate the defect of inspiratory
3. Prevention of pulmonary alveoli collapse to function restriction induced by pulmonary inter-
promote re-expand of pulmonary alveoli and stitial fibrosis. In recent years, pulmonary quanti-
alleviate pulmonary fibrosis. fier is used for inspiration practice, which is
In the process of formation of pulmonary important for prevention or treatment of pulmo-
fibrosis, through respiratory function training, nary atelectasis. Its effect is better than intermit-
the increase of alveolar ventilation volume not tent positive pressure ventilation and other
only can prevent pulmonary alveoli collapse obsolete methods such as blowing bottle that may
and promote re-expand of collapsed pulmo- aggravate pulmonary atelectasis. From the weak
nary alveoli, but also can interfere the process patients or the patients who lie in bed for a long
that fibrinogen in pulmonary alveoli wall time to the patients with stroke, spinal cord injury
forms fibrin because the increase of alveolar or myodystrophy, they all can obtain support from
ventilation volume can increase the dilation these devices, because all the patients have pul-
degree of pulmonary alveoli, which can allevi- monary alveoli collapse. In the early phase after
ate the effect of fibrosis on the dilation degree surgery, pulmonary function of the patients is
of pulmonary alveoli. injured obviously and vital capacity is decreased
greatly. Respiratory dysfunction rehabilitation is
meaningful for respiration tract diseases. Arthritis, 9. Tockman MS, Pearson JD, Curb JD. Rapid cliclin in
FEM:a new risk factor for coronary heart disease mor-
ankylosing spondylitis, myodystrophy, weak, tality. Int J Hypertens. 1995;151(02):121–6.
stroke and spinal cord injury can lead to ventila- 10. Singh S, Sircar SS, Singh KP. Are ventilatory imprie-
tion insufficiency. The pulmonary complication is ments related to early onset and long history of diabe-
the main reason of death. Therefore, respiratory tes? Int J Hypertens. 1995;93(12):7–10.
11. Guorong L. Study on the relationship between pulmo-
function exercise has preventive and therapeutic nary function and extrapulmonary disease. Med Rev.
effect on lung complications of the patients. 2002;8(7):400–1.
12. Nianqiu H, Shan L. Modern elderly respiratory dis-
ease. Beijing: People’s Military Medical Publishing
House; 1998. p. 109–12.
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M, Damaso AR. Evaluation of respiratory muscle 18. The Medical Department of Ministry of Health of the
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of Cognitive Disorder
15.1 T
he Concept of Cognitive functions that are injured, it may influence daily
Disorder and the Mechanism movement or social ability, which is called
of Memory Formation dementia.
There are many types of cognitive disorders,
The basis of cognition is one of the normal func- including disorders of attention, memory and
tions of brains. Any factor that can induce abnor- problem handling. There are subtypes in each
mity of cortex function and structure can lead to type. The type of cognitive disorder is closely
cognitive dysfunction. For example, after brain related to the part of cerebral injury. Right pre-
disease or brain injury, except motor and sensa- frontal lobe injury can lead to difficulties in atten-
tion dysfunctions, there is cognitive dysfunction tion, short-term memory and plan, indifference
to varying degrees, which can affect self-care and lags in response. Injuries of left parietal lobe
ability, life quality and self-security [1] directly. association area and callosum can lead to apraxia
The structure and function of brain are compli- in different areas. Right parietal lobe injury can
cated and there is relationship among different lead to spatial relationship disorder. Injuries in
cognitive disorders. Therefore, cognitive disorder junctional zone among parietal lobe, temporal
is one of the most difficult clinical problems. At lobe and occipital lobe can lead to various kinds
present, there is no effective therapy method and of agnosia.
rehabilitation measure.
15.1.1.2 The Common Types
of Cognitive Disorder
15.1.1 Basic Concept of Cognitive 1. Aphasia: if there are no visual and auditory
Disorder defects and no muscles paralysis of vocal
organs such as mouth, pharynx and throat and
15.1.1.1 Concept ataxia, the patients cannot understand the
Cognition is the process that human brain speech of others and themselves. They cannot
acquires information from the outside world and declare the meanings. They don’t understand
forms functions such as understanding, memory, or write the sentence they mastered before.
speech and execution to acquire knowledge and 2. Agnosia: after brain injury, if there is no

apply them through processing such as acquisi- visual, auditory and touch defects, intelli-
tion, code, manipulation, extraction and use [2]. gence or consciousness disorder, they cannot
Cognitive disorder means there are one or several recognize the objects that they are familiar
functions that are injured. If there two or more before, but they can recognize them through
https://doi.org/10.1007/978-981-13-0812-3_15
448 15 Rehabilitation Therapy of Neurological Training of Cognitive Disorder
other senses. For example, the patients see the 15.1.2 The Mechanism of Memory
glasses, but they don’t know it is glasses. Only Formation
if they touch the glasses or they use it to watch
books, they know it is a glasses. Memory is the basic physiological function,
3. Apraxia: after brain diseases, if there is no including memorization, storage, recognition and
motor and sensation dysfunction, intelligence reminiscence. If any part of the four processes is
or consciousness disorder, the patients cannot damaged, or they are all damaged at the same
complete the movements they do before time, there is memory impairment.
through habitual movements. For example,
they cannot blink, bulge cheek, dress and 15.1.2.1 The Definition of Memory
drink water, but they can complete these Memory is the process that the objects that are
movements carelessly. storage by the brain through perception, analysis,
4. Dementia: This is the most severe type of cog- understanding and handling can be retrieved
nitive disorder. It is an acquired and continu- when required.
ous disturbance of intelligence syndrome
induced by chronic brain function deficiency. 15.1.2.2 T he Process of Memory
Formation
Cognitive disorder has an effect on ability of The process of memory formation can be divided
daily life of the patients to varying degrees. into several stages.
Because understanding and memory ability
decline, the patients require other people or spe- 1. Registration is the process that the objects are
cial care to live [3]. Sometimes, the influence of marked in the brain through perception and
cognitive disorder is bigger than the influence of learning.
physical dysfunction on the patients [4]. If the 2. Storage and consolidation is the memory that
cognition function is normal, the patients with is transformed from short-term and unstable
motor dysfunction can figure out problems with state to long-term stable state.
the help of assistive device, but they don’t lose 3. Recognition is the process that the perceived
the abilities of communication and brainwork. and experienced objects are recognized when
On the other hand, cognition function has an they are perceived or experienced again.
effect on the rehabilitation effect of motor func- 4. Retrieval is the process that the trace in the
tion, because the patients with cognitive dysfunc- brain reappear.
tion are hard to cooperate with rehabilitation
training that are mainly active movements and 15.1.2.3 The Types of Memory
are hard to promote plasticity and functional According to the duration time, memory is
reorganization of central nerves. The effects are divided into three types.
not ideal.
Therefore, early prevention, early detection 1. Sensory memory is also called instant mem-
and early therapy are meaningful for promotion ory, which is formed with instant impression.
of rehabilitation effect of cognitive dysfunction, 2. Short-term memory is also called short-term
enhancement of rehabilitation of motor dysfunc- storage or the first memory, which is formed with
tion of limbs and improvement of life quality. experienced events with some mild stimulation.
There are many types of cognitive disorder. In 3. Long-term memory is also called long-term
this chapter, we only discuss the mechanism of storage or the secondary memory, which is
memory and understanding ability disorder and formed with experienced events with some
rehabilitation training method of neurological strong stimulation. There are two types of
training. long-term memory.
15.1 The Concept of Cognitive Disorder and the Mechanism of Memory Formation 449
• Declarative memory is the memory of fact, long-term and short-term memory, declarative
pilot and materials that are related to spe- memory, and semantic memory.
cific time, location. 3. Neural circuits of memory
• Nondeclarative memory is also called pro- (a) Inside limbic system: areas parolfactoria
gram memory that is related to actual opera- and gyrus subcallosus—cingulate
tion or practice. It includes episodic memory gyrus—hippocampus—fornix—corpus
and semantic memory. Episodic memory is albicans of hypothalamus—tractus
individual experience associated with time mamillothalamicus—nucleus anterior
and location. Semantic memory is the mem- thalami—cingulate gyrus
ory of organized knowledge such as con- (b) Basolateral limbic system: pars orbitalis
cept, formula, semantics and grammar. cortex of frontal lobe—prefrontal cor-
tex—amygdaloid nucleus—dorsal medial
15.1.2.4 Amnesia nucleus of thalamus—pars orbitalis cor-
The patients are completely or partially unable to tex of frontal lobe
retrieve the objects in brain, which is called The first loop is associated with spatial
amnesia. memory and the second is associated with
emotional memory. Both are associated
1. Anterograde amnesia is that the memory after with declarative memory. The loop of
attack cannot be formed. non-declarative memory includes the loop
2. Retrograde amnesia is that the patients cannot of extrapyramidal system between brain-
recall the experience in previous period. stem and cerebellum including
3. Post-traumatic amnesia (PTA) is that the
epencephalon.
memory from cerebral injury to recovered 4. Memory characteristic of left and right cere-
continuous memory are totally lost. bral hemisphere: Generally, left hemisphere
process language, concept, symbol, time and
15.1.2.5 B rain Functional Orientation conceptual work such as calculation and infer-
of Memory ence. Left hemisphere is usually associated
There are many areas in brain associated with with semantic memory. Right hemisphere is
memory. associated with spatial discrimination, music
understanding and imaginal thinking. Right
1. Association cortex is the cortex that doesn’t hemisphere is associated with episodic
include sensation and motor areas. memory.
(a) Frontal cortex is associated with short-
term memory. 15.1.2.6 The Mechanism of Memory
(b) Parietal lobe is associated with location The mechanism of memory is closely associated
memory. with neurotomy, neurophysiology and
(c) The bottom of groove temporalis superior neurophysics.
is associated with face memory.
(d) Lateral surface of temporal cortex is asso- 1. Neurotomy: some research found that the neu-
ciated with history memory. ral basis of memory is mainly local neuronal
(e) Gyrus temporalis superior is associated circuit formed by loop structure of short axon
with music memory. neurons. It is associated with learning and
(f) Amygdaloid nucleus is associated with memory. Mental retardation may be induced
expression memory. by the abnormity of these structures.
2. Hippocampus: Hippocampus is an important 2. Neurophysiological mechanism: the plasticity
structure associated with memory such as of neurons or synapses.
(a) Neural circuit of memory is neural cells tive assessment, the degrees of cognitive disorder
connected by synapses. Under certain are analyzed and classified. Specific rehabilita-
circumstance, the transmission efficiency tion schedule is designed to highlight the purpo-
of synapse can be changed or the new siveness and interest.
synapse can be formed, which is plasticity In the process of rehabilitation training,
of neurons or synapses. The synaptic according to the progress of the patients with
plasticity usually exists in chemical syn- cognitive impairments and the principle of step
apses and is the potential basis of infor- by step, rehabilitation physicians adjust training
mation storage. difficulties and content repeatedly to get satisfy-
(b) The types of synaptic plasticity: combina- ing clinical effect.
tion plasticity includes synaptic morpho-
logical change, formation of new synapses
and establishment of conduction function. 15.2.1 Assessment of Cognitive
It is associated with long-term memory. Disorder
Transmission plasticity is the change of
transmission efficiency. It is associated There are four kinds of neuropsychology exami-
with memory process that lasts several nation to assess cognitive disorder such as screen-
hours or several weeks. ing method, special inspection method, test of
(c) Establishment of conditioned reflex: Ivan battery and functional examination method. All
Petrovich thought that conditioned reflex these are introduced in associated books of reha-
is the results of connection of two stimu- bilitation assessment. We only introduce screen-
lus in brain. It is one of the basis of neuro- ing method and behavioral memory examination
physiology of memory. in this chapter.
3. Physical mechanism includes bionic memory
and submolecule mechanism of memory. 15.2.1.1 Screening Method
Screening method is a rapid examination method
Some physicists deemed that computers use of neural comprehensive functions. Generally,
ferromagnetic material to store information and screening method can detect whether there is
its common physical features are many kinds of cognitive disorder or not in the patients, but the
oscillation with the same oscillation frequency. results cannot be the basis of specific diagnosis.
Ferromagnetic material and DNA macromole- Clinical rehabilitation physicians cannot diag-
cule have this nature. Therefore, DNA is the nose the patients with certain type of cognitive
memory molecule and it can storage and play- disorder through screening method or merely
back information. using the results of screening. Through screen-
In addition, memory is related to neurobio- ing, we can find out whether there are organic
chemistry mechanism. For example, in learning pathologic changes of brain or not, which can
and memory, RNA synthesis is increased. provide basis for further examination.
Inhibition of RNA synthesis has an inhibitory The common cognitive function screening
effect on memory. scale includes mini mental state examination
(Table 15.1) and cognition capacity screening
examination.
15.2 Rehabilitation Therapy
of Neurological Training 1. Mini mental state examination is suitable for
of Cognitive Disorder simple screening of cognitive disorder, which is
the diagnosis basis of cognitive function impair-
Most cognition rehabilitation training methods ment. There are 30 questions in MMSE [5]
are used for cognitive impairment in one aspect. includes orientation, short-term memory, instant
Before training, according to the results of cogni- memory, attention, calculation, language and
15.2 Rehabilitation Therapy of Neurological Training of Cognitive Disorder 451
Table 15.1 Mini mental state examination (MMSE)

Number Question Right Wrong Number Question Right Wrong
1. What year is this? 1 0 16. 86—7 (79) 1 0
2. What season is this? 1 0 17. 79—7 (72) 1 0
3. What’s the date today? 1 0 18. 73—7 (66) 1 0
4. What day is today? 1 0 19. Recall: ball 1 0
5. What month is this 1 0 20. Recall: national flag 1 0
6. Province (city) 1 0 21. Recall: trees 1 0
7. County (district) 1 0 22. Identification: watch 1 0
8. Village and town 1 0 23. Identification: pencil 1 0
(street)
9. Which floor are we at? 1 0 24. Repeat: 44 Chinese guardian 1 0
lions
10. What is here? 1 0 25. Close eyes according to card 1 0
11. Repeat: ball 1 0 26. Hold the paper using right hand 1 0
12. Repeat: national flag 1 0 27. Fold the paper 1 0
13. Repeat: trees 1 0 28. Put on the thigh 1 0
14. 100–7 (93) 1 0 29. Say a complete sentence 1 0
15. 93–7 (86) 1 0 30. Picture making 1 0
operation. Each examination takes 5–8 min. The 2. Cognitive capacity screening examination

patients get one mark through one right answer (CCSE) is a new examination. Because cogni-
and the total scores are 0–30 marks. tion includes consciousness, attention, presen-
tation, memory, language and thinking, and
Assessment standard: The patients with the cognitive disorder is usually the disorders in
mark that is less than 17 are in illiteracy level. these aspects, CCSE [6] can be used for the
The patients with the mark that is 17–20 are pri- assessment of cognitive disorder. The specific
mary school level and the patients with the mark contents refer to Table 15.2.
that is 20–24 are in middle school level.
Announcements: there are some key points in Assessment standard: one score for one right
assessment. Year, month and season: the solar or answer. The total score is 30. The score that is no
lunar chronology are all right. Continuous subtra- more than 20 is defined as abnormity.
hend: if the previous answer is wrong and the
next answer is right, the answer is right. When 15.2.1.2 Behavioral Memory Test
the subjects repeat the words such as balls, Rivermead behavioral memory test (RBMT [7])
national flag and trees, the examiners only say it is used to assess memory ability of daily life with
once and the subjects repeat them out of order. higher reliability and validity. There are eleven
Under this circumstance, the answer is right. practical tests.
When repeating 44 Chinese guardian lions, the
examiners only say it once and the subjects repeat 1. Remember the surname and given name: the
the words clearly. Under this circumstance, the examiners let the patients see a picture and tell
answer is right. In the 25th item, the card is given them the surname and given name on this pic-
to the subjects and the subjects are asked to do ture. A moment later, the examiners ask them
movements according to the card. In order to the surname and given name on this picture.
avoid someone’s taboo, the movement “please During this process, the examiners let the
raise your left leg” can be changed to “please patients see other things to distract them.
open your month”. If the subjects answer that Score: if the patients answer the right sur-
they won’t do it, the answer is wrong. If the sub- name and given name, they can get two
jects are illiterates, the score of 25th item is zero. scores. If they only answer surname or given
Table 15.2 Cognitive capacity screening examination (CCSE)

Serial number Content Serial number Content
1 What day is today? 16 What is the opposite of big? What
is the opposite of hard?
2 WHAT month is now? 17 If orange and banana belong to
fruit, what red and blue belong to?
3 WHAT’S the date today? 18 What is five scores and two scores?
4 WHAT year is this? 19 What is the first word I want you to
remember just now?
5 Where is this place? 20 What is the second word?
6 Please say 872 21 What is the third word?
7 Please say the three numbers reversely 21 What is the fourth word?
8 Please say 6371 23 110 Minus 7 equals?
9 Please listen to 694, please count the 24 Then minus 7 equals?
numbers from one to ten and repeat 694
10 Please listen to 8143, please count the 25 Then minus 7 equals?
numbers from one to ten and repeat 8143
11 Count from Sunday to Monday 26 Then minus 7 equals?
12 9 Plus 3 equals? 27 Then minus 7 equals?
13 Plus 6 equals? 28 Then minus 7 equals?
14 18 Minus 5 equals? Please remember 29 Then minus 7 equals?
these words “cap, car, tree and 26” and I
will ask you a moment later
15 If the opposite of quick is slow, what is 30 Then minus 7 equals?
the opposite of upper?
name, they will get one score. Otherwise, lope, walk a path that can be divided into
they only get zero. five segments such as chair-door-before
2. Remember the hidden objects: the examiners the window-therapy desk-book table, and
lend personal tissue, key chain, teacup and ther- put the envelop on the book table. The
apy card to the patients, hide them into drawer examiners take the envelop from the table,
or therapy car and do some movements to dis- put it in front of the patients and ask them
tract the patients. A moment later, the examin- to do it.
ers ask the patients where these objects are. Score: if the patients can do it in the same
Score: if the patients can point out the way, they can get one score. Otherwise, they
right location, they can get one score. only get zero.
Otherwise, they only get zero. 5. A moment later, remember a short path: The
3. Remember the appointed application: The method is the same as the fourth. A moment
examiners tell the patients the appointment later, the patients are asked to repeat the
time is 20 min before see the doctor. The path. During this process, the examiners talk
examiners set the alarm clock 20 min later. with the patients to distract them.
Twenty minutes later, when they hear the Score: if the patients can memorize all of
alarm, the patients make an appointment. these, they can get one score. Otherwise,
The doctors can say “could you tell me when they only get zero.
you can come to see me from now on?” 6. Remember one mission: the patients are
Score: if the patients answer correctly asked to observe the right place of the
when the bell rings, they can get one score. envelop.
Otherwise, they only get zero. Score: whether the patients answer the
4. Remember a short path: under direct vision question immediately or later, they can get
of the patients, the examiners take an enve- one score. Otherwise, they only get zero.
7. Learn a new skill: the examiners use calcula- drawings that them watched before from all
tor or electronic watch that can be set with the twenty drawings.
time and date for the patients to learn the Score: If the patients answer all the ques-
method of ascertaining month, day and hour. tions correctly, they can get one score.
The procedures are as follows: pressing the Otherwise, they only get zero.
setting button, inputing month, inputing day, Except the maximal score is two in the first
pressing the date button, inputing time, item, the maximal score of other items is one.
pressing the time button, pressing time but- The total score is 12.
ton, and press reset button to eliminate all For normal people, the total score is 9–12.
inputs. The patients can try three times. The average is 10–12. The up-down error is 1.16.
Score: if the patients can succeed once in The patients with brain injury cannot com-
three times, they can get one score. plete at least three items. The total score is
Otherwise, they only get zero. 0–9. The average is 3.76. The up-down error is
8. Orientation: the examiners ask the patients 2.84.
the following questions: What year is this?
What month is this? What day (of the week)
is it today? What’s the date today? Where are 15.2.2 Rehabilitation Therapy
we now? Which city are we in? How old are of Cognitive Disorder
you? When is your birthday? Who is the
prime minister? Who is the state president Rehabilitation therapy of cognitive disorder is
now? difficult and the therapeutic effect is not ideal, but
Score: if the patients can answer all the there are many therapeutic methods. In the clini-
questions correctly, they can get one score. cal practice for more than 10 years, the author use
Otherwise, they only get zero. rehabilitation therapy in three aspects and obtain
9. Date: the examiners ask the patients the some experience. The author introduced these
fourth question in the eighth item and write experiences to everyone to start a discussion.
down whether the answer is right or wrong.
Score: if the answer is right, the patients 15.2.2.1 The Mechanism
get one score. Otherwise, they only get zero. of Rehabilitation
10. Face discrimination: The examiners let the of Neurological Training
patients to see five pictures of face (5 s for of Cognition
one picture). After that, the examiners asked There are three aspects in the mechanism of reha-
the patients questions. What is the gender of bilitation of neurological training of cognition.
the face? What is the age of the face, more
than 40 years old or less than 40 years old? 1. Development of neurons and synapses poten-
The examiners show the patients ten pictures tial to recover memory capacity.
of face and there are five picture that the Neurons and synapses involved in memory
patients watched before. The patients are have plasticity ability. Reinforced memory
asked to pick the five out. training induced by Daoyin technique can
Score: if the patients answer all the ques- promote neurons and synapses around injured
tions correctly, they can get one score. area to play functions in order to replace the
Otherwise, they only get zero. functions of injured cells and recover lost
11. Picture recognition: The examiners let the memory.
patients to see ten object drawings of bar (5 s 2. Open the gate of memory and unblock mem-
for one drawing). After that, the examiners ory loop.
asked the patients to say the name of the There are many links such as memorization,
object in each drawing. A moment later, the storage, recognition and reminiscence to form
examiners ask the patients to pick out ten memory, especially the neural circuit of memory
such as inside limbic system: areas parolfactoria 15.2.2.2 Rehabilitation Method

and gyrus subcallosus—cingulate gyrus—hip- of Neurological Training
pocampus—fornix—corpus albicans of hypo- of Cognition
thalamus—tractus mamillothalamicus—nucleus It includes reinforced memory training, motor
anterior thalami—cingulate gyrus. If there is potential development training, physical therapy
any loop is in disorder, there will be memory and acupuncture.
loss or memory function disorder to varying
degrees. Therefore, the author think that if we 1. Reinforced memory training: The mechanism
take memory loop as memory electricity, mem- of memory includes neural circuits and DNA
ory electricity flows through every part, which memory protein theory. The memory is
can be defined as gate. When the gate is with formed with some kind of matter. Easy for
pathological lesion, the gate closes and mem- discussion, we called the matter that can store
ory electricity cannot flow through it, which memory “memory matter.” The cells that can
can induce memory impairments to varying produce memory matter are called memory
degrees. Potential development and functional cells. The formation and the quantity of mem-
recovery to promote incomplete injured cells ory are closely related to the stimulation
can re-open the gate to make memory electric- degree of event on memory cells. The stronger
ity flow again. After that, memory can be the stimulation is, the longer the memory
recovered to varying degrees. lasts.
Not only cognition reinforcement training Reinforced memory training can reinforce
of neurological training can open memory the steps in the memory process such as mem-
gate, but also active movement to develop orization, storage, recognition and reminis-
central neural potential may promote the open cence through reinforcing the training of
of memory gate and recover memory func- intended memory in order to promote undead
tion, because there is positive correlation rela- central neural memory cells to recover func-
tionship between motor function and memory tions and promote normal memory cells
capacity. around injured area to play functions to
3. The physical and biochemical mechanisms to replace the functions of injured cells.
recover ionic balance inside and outside mem- The memory formed by brain cells is the
ory cells and maintain permeability and elec- same as joint motion formed by muscles dom-
tric activity of cell membrane. inated by brain. They are one kind of effi-
Memory cells are DNA macromolecules ciency. Six-step Daoyin technique can be used
with magnetism that can be used for memori- to promote brain potential development and
zation, storage, recognition and reminiscence. recover lost motor function. Therefore, on the
In addition, functions of central nervous cells basis of regulation of mind and breathing,
can be achieved by electrical activity. Under memory training can recover memory
some pathological circumstances, the func- functions.
tions of proton pump are injured and the per- Six-step Daoyin technique combined with
meability of cell membrane is changed. biological feedback technique achieved
Potassium ion overflows and sodium, chlo- objective indicator display of the effects of
ridion and calcium flow into the cells, which Daoyin technique. Therefore, the patients can
can induce cell injury. do the training with purpose and the patients
can see their training progress. Through set-
According to physical and biochemical charting surpassing goal, training interest can be
acteristics of memory cells, electricity and mag- increased and the training effects are
netic wave interference can change permeability enhanced.
of cell membrane to promote the recovery of On the basis of this ultimate principle, cog-
intracellular physiological status. nition training system of neurological training
is developed, which is called cognition train- completing all the three pictures such as great
ing equipment for short. This system is wall, Mount Huang and the Imperial Palace.
equipped with automatic and manual memory There are three selection boxes under the
training and can store plenty of pictures such picture. There are three words such as tower,
as scenery, objects and person. It can be used great wall and the top of the wall under the
for the training of reinforced instant memory, picture. The patients click the box and choose
short-term memory, sequential memory, atten- the word. The selection system can be
tion, figure, relative figure, memory game, compared in the system. If the result is right, it
reading, restatement and commander execu- is displayed in twinkled curve. Exploded
tion. Moreover, the system with self-compari- fireworks are showed in the screen and the
son can display the results on the fluorescent voice “congratulations, you are right” is
screen in twinkled curve real-timely. played to the patients. If the result is wrong,
The specific training method: in a quiet and the voice “never mind, try again” is played to
lucifugal warm room, the patients sit in front the patients. The patients get 33.3 scores for
of cognition training equipment (Fig. 15.1). each right answer. The total score of three
The therapists choose the content and music right answers is 100. In the second training,
in the operation screen (three pictures in one on the basis of the first training, a baseline is
group). For example, the therapists choose the displayed in one side of fluorescent screen and
great wall picture and light music. The the other side of fluorescent screen show the
therapists guide the patients to regulate mind pictures in the second training that are totally
and breathing to eliminate distracting different from these in the previous group.
thoughts. The therapists concentrate on the The curve will increase one third after
great wall picture on the screen and tell the answering one question. If all the questions
patients this is great wall. The therapists guide are answered correctly, or the curve surpasses
the patients to notice the characteristics of the the baseline, exploded fireworks are showed
picture such as serpentine wall, tower, crenel in the screen and the voice “congratulations,
and the surrounding mountains. The patients you are right” is played to the patients.
are asked to keep their eyes away from the The training time is 30 min (once a day)
picture twice, then regulate mind and and there are 30 times in one therapy course.
breathing and stare at the panorama and The patients can do multiple courses of
characteristics of pictures for 1 min. The therapy.
therapists use the same method to train the 2. Reinforcing autonomous movement training:
patients in the next two pictures. After Exercise can improve functions of nervous
system, make the brain clear and make the
action smart. Exercise can enhance the func-
tions of various systems such as digestion, cir-
culation and respiration. Exercise can meet
the oxygen requirements of the body, promote
tissue metabolism, and supply sufficient nutri-
tion for all the parts including nervous system.
Meanwhile, the brain needs the stimulation of
movements to enhance reaction and judge-
ment and increase memory and intelligence.
Therefore, exercise can build the body and
enhance intelligence.
Psychologists deemed that intelligence is
Fig. 15.1 Independently developed cognition training developed with body movements. There is
equipment close relationship between exercise and intel-
ligence. Generally, the movement is normal in nistic muscle is set at the level that the
the children with normal intelligence or more. patients are easy to reach. For example, in
If the body movements of children are later the training of wrist extension, the base-
than the children in the same age, the children line of wrist extensor is set at 60 μV and
have the danger of mental retardation. that of wrist flexor is at 20 μV. The patients
In fact, almost all rehabilitation methods of are guided to make the curve of wrist
neurological training are based on the recov- extensor surpass 60 μV and make the
ery of central nervous system to recover lost curve of wrist flexor under 20 μV. The
motor function. In the actual work of clinical patients are encouraged to maintain in this
rehabilitation, we noticed that there is position level for 25–30 s. During the training pro-
correlation between rehabilitation effect and cess, the patients are asked to use brain to
the understanding of the patients and there is control wrist extension, analyze the pro-
positive correlation between learning ability cess and find the way to meet the training
and memory capacity. Rehabilitation training requirements in order to develop intelli-
of active movements not only can recover lost gence and recover memory.
motor function, but also can improve cogni- After completing joint motion training,
tive status. the patients are guided to watch the alti-
(a) Potential development training: Potential tude and duration time of agonistic mus-
development training devices of upper cles and antagonistic muscles curves.
limbs, lower limbs, the trunk, balance, After completing the next training of joint
tibialis anterior muscle, hamstring mus- motion, the patients are helped to recall
cles and walking balance are used. On the altitude and duration time of signal curve
basis of regulation of mind and breathing, to enhance memory effect.
six-step Daoyin technique is used to do The training time is 50 min (once a
neural potential development training of day) and there are 30 times in one therapy
the corresponding parts (the second sec- course. The patients can do multiple
tion of the third chapter). When the courses of therapy.
patients are guided to surpass the designed 3. Transcranial magnetic stimulation and electri-
goal, the training not only promote plas- cal therapy: cell functions are that cell mem-
ticity of motor center in brain cortex, and brane permeability and change of ion
also promote memory cells in these areas, concentration inside and outside cell mem-
because the patients use willpower and brane can maintain normal membrane poten-
intelligence to overcome difficulties. tial through polarization, depolarization and
The training time is 25 min (once a repolarization. External electrical field and
day) and there are 30 times in one therapy magnetic field can recover cell functions
course. The patients can do multiple through recovering normal permeability and
courses of therapy. polarization of cell membrane.
(b) Motor program reestablishment training: The frequently used magnetic stimulation
Neurological training equipment is methods for brain in clinic are as follows:
applied and normal method or Daoyin (a) Transcranial magnetic stimulation (TMS):
technique of guiding collaterals through In recent years, the physiological effect of
meridians in traditional Chinese medicine TMS on brain functions is highly focused.
is used to do motor program reestablish- TMS can change physiological process in
ment training of all joints and associated brain through generating painless induced
movements. In the process of establishing current to activate cortex. On the other
single joint motor program training, the hand, TMS can treat nervous system dis-
time limit of every screen is 40 s. The eases through changing the excitability of
baseline of agonistic muscle and antago- local cortex, cortex metabolism and blood
flow. In clinic, it is used to treat motor dis- (b) Cranial electrotherapy stimulation (CES):
order diseases, Parkinson’s disease, myo- Low intensity minor electricity is used to
dystony, epilepsia, aphasia, cognitive stimulate brain through temporal skull.
disorder and depression. TMS has positive Research indicated that positive pole
effect on peripheral nerve disease. In addi- stimulation can excite brain cortex and
tion, it is suitable for the treatment of uro- negative pole stimulation can decrease the
clepsia, uroschesis and frequent excitability of brain cortex. Both positive
micturition. pole stimulation and negative pole stimu-
With proper stimulation, transcranial lation contribute to functional recovery of
magnetic stimulation is safe. Frameless the patients with stroke. It can be used to
stereo positioning and navigation tran- treat anxiety, depression, insomnia and
scranial magnetic stimulation can increase children disease. There is no side effect.
accuracy of stimulation part, which is Some reports demonstrated that CES can
good for increase of therapeutic effect. promote secretion of acetyl choline and
This research is done by Wangyong in 5-hydroxytryptamin. Acetyl choline can
Integrated Traditional and Western promote conduction speed of central nerves,
Medicine Department of Jinan Military enhance memory ability and improve brain
General Hospital. functions. 5-Hydroxytryptamin is involved
The action principle of transcranial mag- in many physiological functions and patho-
netic stimulation is that rapid pulse current logical states.
that is generated by induced electric field The therapy time is 20–60 min (once a
due to time varying magnetic field can stim- day) and one therapy course takes 4
ulate coil to generate instant high-intensity weeks.
magnetic field that can penetrate skull and 4. Acupuncture therapy to restore conscious-

induce secondary current in peripheral neu- ness, regulate mind, and promote blood circu-
ral tissue. The intensity of magnetic field lation to remove meridian obstruction.
depends on stimulation frequency, the (a) Basic therapy takes governor meridian,
intensity, coil shape and coil orientation. Foot shaoyang and Foot shaoyin. The
Spatial resolution of TMS is 1 cm and depth main major acupuncture points are
of penetration is about 2 cm. Repeated TMS ophryon, Baihui acupoint with
(rTMS) generates different effects because Sishengcong, Shangxing with Shenting,
of different stimulation frequencies, even Fengchi, Taixi, Xuanzhong, Hegu and
opposite effect. Low frequency rTMS (less Taichong. Adjunct acupuncture points are
than 1 Hz) stimulation can inhibit excitabil- Neiguan and Keshu in the patients with
ity of neural cells and cortex activities. High collateral obstruction by blood stasis
frequency rTMS (5–25 Hz) stimulation can syndrome. Acupuncture manipulation:
increase cell excitability and cortex Catharsis is used in Hegu and Taichong.
activities. Tonifying method is used in Taixi and
At present, the maximal side effect of Xuanzhong. mild Reinforcing-reducing
TMS is epileptic seizure. Potential long- method is used in other acupuncture
term safety problem requires further points. Interval entwisting needle or acus-
investigation. The therapeutic effect of ector is used in acupuncture points of
cognitive disorder, especially long-term head.
effect requires further observation. The mechanism: Governor meridian
The therapy time is 20–40 min (five lead Luonao, Baihui, Shenting, Sahngxing
times a week) and one therapy course and ophryon to restore consciousness and
takes 2 weeks. regulate mind. Fengchi regulates Qi and
blood in head. Taixi and Xuanzhong can
benefit brain. Hegu and Taichong promote Memory training is the movement exercise of
blood circulation to remove meridian brain cells. This kind of exercise can prevent
obstruction. Sishencong is the acupuncture brain aging. Epidemiological investigation found
point to strengthen brain and benefit that occurrence rate of cognitive disorder in old
intelligence. patients with high standard of culture is higher
(b) Other therapies: head needle method: the than that in old patients with low standard of cul-
therapists choose the top middle line, ante- ture. For the old patients with cognitive disorder,
rior oblique line of vertex-temporal, the memory training should emphasize on training
oblique line of vertex-temporal and use two process. The key point is the training process of
inches acupuncture needle to penetrate into thinking and memory, but not the content. The
galea aponeurotica. The therapists manipu- common training methods are as follows:
late the needle quickly to make the point
warm. Electroacupuncture stimulation can 1. Maintain or repeat: Memory method of read-
also be used. The needle is retained for ing, memorization and rehearsal.
40 min. Auricular needle method: the thera- The therapists read the content aloud,
pists choose subcortex, forehead, occipital read it silently, analyze and memorize it.
part, temporal part, heart, liver, kidney, The therapists ask the patients to retell the
endocrine and Shenmen and use acupunc- content. Rehearsal enhance his attention,
ture needle to stimulate 2–4 acupuncture which is good to keep the information in
points. Hvacupoint-injection therapy: the short-term memory and promote short-term
therapists choose Fengfu, Fengchi, Shenshu, memory to long-term memory. For example,
Foot Three Li, Sanyinjiao and use com- if the patients hear a car marker, they can
pound angelic powder for injection, memorize it through recitation or rehearsal.
Danshen injection, citicoline or aceglu- The more frequently the patients retell the
tamide for injection. Every acupuncture content, the shorter the time spent in
point is injected 0.5–1.0 mL (once on alter- rehearsal is, the better the effect is. In every
nate days). rehearsal, the patients can understand the
content deeper and the memory is further
15.2.2.3 Other Training Methods consolidated. If the time spent in rehearsal is
of Rehabilitation shorter, it demonstrates that the patients are
of Cognitive Disorder more familiar with the content and it cannot
The patients with cognitive disorder should do induce fatigue. The maintain or rehearsal
comprehensive rehabilitation training as soon as memory method requires the patients’ coop-
possible to alleviate symptoms and postpone eration, or else the therapeutic effect is poor.
progress of symptom. It includes memory train- If the memory information is less, the effect
ing, thinking training, attention training and per- is better.
ceptive training. According to the damage 2. Recall is reminiscence of events that hap-

condition of the patients, proper individual train- pened to the patients before.
ing schedule is designed, which can be applied The patients are asked to try to recover the
with rehabilitation training of neurological train- events that happened to themselves before
ing of cognitive disorder to obtain better effect. including environment, motion and physical
Memory impairment is the prominent clinical state in order to obtain reminder and promote
manifestation. There is short-term memory memory. This method is applied to train the
impairment in the early phase. There is long-term patients with poor comprehending capacity
memory impairment in the middle phase. There after cerebral injury. The patients are guided
is memory loss in late phase. Memory training to find the hint or the therapists give the hint to
can maintain original memory or alleviate the the patients to help the patients to recall the
decrease of memory. happened event.
3. Internal law or internal strategies: if there are lar meaning are in union. Association: the
obvious defects in the patients, they can use patients associate semantics, voice and
normal or less injured functions to memorize word with similar image to enhance mem-
new information. If the linguistic memory of ory. For example, semantic association is
the patients is poor, they are encouraged to use from walking stick to crutch. Auditory
visual memory, and vice versa. association is from fragrance to sound
(a) General requirement: Potential develop- (the two words are similar pronunciation
ment: The patients use the good functions in Chinese). Visual association is from
to replace injured functions. The rate of Shen to Jia (the two words are similar
progress is slow. The mission is divided image in Chinese). Sequence of Time and
into several segments and then linked Space: the patients used events that hap-
gradually. If the therapists ask the patients, pen with the information to recall the
the patients are asked to answer a moment memory. Causal relationship: the patients
later. The difficulty can be increased grad- use causal relationship between the event
ually. The patients are asked to establish and information to recall memory.
the increasing goal. Self-suggestion and Significance and recency: the important
instruction: the therapists ask the patients and new events are easier to recall than
to ask themselves. Do I remember? What the unimportant and obsolete event. The
is the meaning? Do I need to ask again? patients use this characteristic to recall the
How can I link this to the events I know? memory. Elaborate processing: the
What should I do? Do I stray from the patients are asked to memorize the infor-
point? What am I going to do? The ques- mation, analyze it, find out the character-
tions can be written in card so that the istic and detail, and link it to the given
patients can refer to it frequently. The information. Compatibility: the patients
therapists communicate with the patients are asked to form a concept that can be
frequently. Every once in a while, the compatible with their given information
therapists and the patients analyze the and link them together. Self-control: the
condition together to find out the gap, patients are asked to analyze the relation-
clarify misunderstanding and rectify mis- ship between the given information and
takes. The therapists should pay attention themselves. Making up stories: the
to reward. If the patients succeed, they patients are asked to make up a familiar
should be rewarded or get oral story using the given information accord-
commendations. ing to their habit and hobby. Sunlight
(b) Specific methods include verbal mne-
graphical method of new information
monics and visual imagery techniques. classification: the patients are asked to
Verbal mnemonics is suitable for the compare the given information to the sun
patients with poor imaginal memory or and ask six questions such as what, who
right hemisphere. The first word memory or whose, how, where, when and why.
method: the patients are asked to remem- This way can promote information encode
ber the first word of the information and and resurgence.
compile it into phrase or sentence. Visual imagery techniques is suitable
Memory chunking: the information for the patients with poor verbal memory
should be adapted to memory span of the capacity and left hemisphere injury. The
patients. For example, if memory span of interaction of image logic is used to pro-
the patients is two items, the memory mote the memory effect. Verbal memory
chunking is two items. When the patients method: the chunking and association
do the training of verbal memory chunk- methods in visual image memory are used
ing, the information groups with the simi- to promote recovery of verbal memory.
Place location method: the patients link (b) Environment modification: The environ-
new information to geometric position ment should be arranged to eliminate the
with permanent order. The patients can factors to distract the patients’ attention.
recall objects in order, which is suitable Concentration training is the basic condi-
for the patients can memorize building or tion to obtain good effect. The amount of
geometric position in permanent order. information and condition of the environ-
The connection or chained method: it is ment should be controlled properly. The
similar with association. The patients are amount of information should be mini-
asked to link the given information to mized and the information should be pres-
associated image. Classification: the ently as frequently as possible. The
patients should classify the information interval between the information presen-
for recall. tation should be long. The stability of the
4. External strategy is that external adminicle or internal environment should be main-
hint is used to recover memory. tained to keep constant repeated conven-
(a) Information storage: The calendar is the tion and environment for the functional
method to memorize time. For example, if recovery of the patients’ memory. The
the patients will do something in the external environment should be changed
future, the patients can tear one corner or for environment recovery of the patients.
fold one corner in the calendar to remind For example, the door should be pasted
themselves. Big calendar with large grid with bright-coloured label and the event
has the similar effect. The patients can use needed to be remembered. Tips: the ver-
pencil to mark the event on small calen- bal and visual tips associated with mem-
dar, but the effect is poor. Notebook can ory can be provided. For example, when
help the patients to memorize the past. If the patients memorize one thing, the ther-
the page is large enough, the patients can apists ask the patients questions and let
write down all the details. The patients are them see the associated picture to recover
asked to write page number on the diary memory.
and make an index on the last page. The Various memory aids used in external
place of the diary should be fixed. measures are compensatory measures to
Memorandum: every week, the patients figure out permanent memory disorder and
write a book and look up the memoran- increase the patients’ memory capacity.
dum every day. Schedule: the patients 5. Psychotherapy to eliminate psychological dis-
should design an organized schedule order of the patients and enhance therapeutic
including therapy and rest. The patients effect.
use movable target to move along the ori- Approximately 30% of the patients with
entation or use pencil to cross off the fin- cognitive disorder are accompanied with
ished thing. The patients wear electronic depression. Although they lost a lot, even dig-
watch that can give out signal and are nity, they are not sober and can realize that
asked to look for the unfinished thing in their intelligence declines and there are cold
the schedule when the watch rings. The receptions. Therefore, all the person who con-
watch should be big and marked. Obvious tact with the patients should protect and
sign: large map, big number, big arrow respect their own value and self-esteem. The
and obvious sign are used to instruct the patients should be treated with courtesy.
patients to the common place. Picture: Obviously, if the patients are sloppily dressed,
name, event and date are written on the it can damage self-image and influence the
back of the picture. Because there are disease state badly. Maslow’s hierarchy of
imagery and verbal tips, the information needs are suitable for the patients with cogni-
is plenty and easy to recall. tive disorder.
Therefore, the therapists should give psy- ease state and physical truth of the patients,
chological counseling to the patients with the therapists select proper background music
cognitive disorder in patience to eliminate to relax the environment, delight patients’
inferiority complex. The therapists should mood and enhance therapeutic effect.
create an environment of respecting the 7. There are several considerations in the train-
patients, friendly affection and no discrimina- ing process of memory:
tion to make the patients devote to rehabilita- (a) The training difficulty should be mild.

tion training joyfully. According to actual condition of the
6. Music therapy can transform sound energy patients, it is important to select proper
from regular sound vibration to the power that difficult training content. The training
can promote the functional recovery of disor- principle should be from easy to difficulty.
dered brain cells. If the therapists choose the difficult ther-
Aristotle is the first person who proposed apy item, the patients cannot complete it,
the relationship between music and body- which can aggravate mental burden of the
mind and think that music can go deep into patients. The patients usually refuse the
soul, purify spirits, keep the balance between training, even generate unhealthy
body and mind and promote body health. psychology.
After World War II, American military hospi- (b) The selection of picture type should be
tal use music to help the therapy of insomnia, proper. According to the memory disorder
depression and psychoneurosis in soldiers. In type of the patients, the therapists choose
medical field, music is combined with physi- proper picture to do specific training. For
ological phenomenon to promote therapeutic the patients with figure memory disorder,
effect. the therapists choose figure picture to do
Hebb proposed that music can act on non- memory training. For the patients with
specific reflecting system under brain cortex memory disorder of daily supplies, the
and reticular formation of brain stem through therapists should choose picture of daily
auditory system to influence cortex functions supplies to do the training.
in order to regulate nervous system functions. (c) Picture type and difficulty are proper.

Sound energy from regular sound vibration According to the memory disorder type of
can be transformed into the power that can the patients, the therapists choose pictures
promote functional recovery of disordered with proper type and difficulty. For the
brain cells. Therefore, different kinds of music patients with slight memory impairments,
have different therapeutic effects. Song at the the therapists can select some scenery and
Frontier, moonlight of spring river and waltz animal pictures. For the patients with
can be used for the patients with unstable severe memory impairments, the therapists
mood. can select some pictures of daily supplies.
Clinical experience demonstrated that For the patients with severe memory dam-
music therapy can enhance the feeling of real- age, the therapists can choose family pic-
ity in the patients with cognitive disorder. The ture, because this kind of picture can
feeling of reality can provide real information, strongly stimulate the patients, which is
improve self-perception and increase inde- good for the memory function recovery of
pendence. The patients are asked to listen to the patients.
or sing the songs associated with current time, (d) Familiar and unfamiliar pictures can be

season, environment and event to change con- mixed for training. The recovery effect of
fusion of the patients. In addition, music can familiar pictures is poor, but unfamiliar pic-
improve long-term memory, short-term mem- tures have better stimulation effect.
ory and other cognitive functions of the However, the difficulty can make the
patients. During the training, according to dis- patients lose confidence. Therefore, the
therapists combine them and utilize them to increase cognitive function of the patients. On the
keep the effect of memory training and the basis of that, the author developed training device
confidence and enthusiasm of the patients. for Daoyin technique cognitive training in tradi-
(e) Focus on error-free learning method: error- tional Chinese medicine.
free is the method to eliminate error in
learning. The learner should start from the 1. Design principle of cognitive training device:
item that is easy to discriminate and the device can use plasticity of central nervous
increase the difficulty gradually to let system to display the results of cognitive
themselves learn the content without fail- training with Daoyin technique real-timely to
ure. The important characteristics are as further enhance the effect of Daoyin technique
follows: Error-free learning is a technique. through biofeedback function.
Error-free learning is not some kind of At present, in cognitive training method at
therapeutic method, but a training tech- home and abroad, scenery pictures or pictures
nique that run through the learning pro- of daily supplies are used for memory train-
cess. When receiving this kind of learning, ing. The method is single and not interesting.
the therapists shouldn’t give the trainee Existing cognitive training device is mainly
opportunity to make a mistake. In tradi- used for cognitive function examination and
tional learning process, the wrong reaction assessment. The therapy is presenting pictures
can be avoided. The patients should try not and there is no biofeedback function. The
to make mistakes. The therapists can give training is at will. Without the process of regu-
the right answer to the learner directly or lation of mind and breathing in Daoyin tech-
let the patients easy to complete it without nique, the training effect may be affected. If
make a mistake. the equipment can enhance the effect of cog-
nitive training on the basis of regulation of
Standardized error-free learning is that the mind and breathing in Daoyin technique and
therapists directly tell the patients the right make the patients do the training with purpose
answer and ask them to remember it. Improved through biofeedback, it can increase the inter-
error-free learning is that the therapists use ests of the training and enhance the training
abundant semantic words to describe the ques- effects.
tion and use semantic words to induce the Cognitive training system of neurological
patients to say the right answer. This process training is that in an environment with light
avoids the interference of correct information music, the therapists display the results of
on wrong information and makes the patients cognitive training with Daoyin technique in
are engaged in learning training. The more the previous training on screen in a horizontal
correct information the patients get in the line and use this as surpassing goal. The
learning, the better the effect of improving patients are guided to surpass the goal, just
memory capacity. like archery training that the archer should
shoot at the center of the target. The system
provides the patients visual feedback
15.2.3 Cognitive Training Device information real-timely to make them do the
Development of Neurological training with purpose. When the patients meet
Training the requirements, twinkling curve, exploded
fireworks and congratulatory sound are given
Researches show that biofeedback therapy (BF) to the patients to encourage them and increase
is a training method to recover neurons and syn- training interests. Clinical applications indi-
aptic conduction function, which may improve cated that although the system requires some
cholesterol metabolic disorders in hippocampus improvements, it reaches the goal and obtains
and injury of synaptic plasticity in order to satisfying effect.
(a) Design principle of the system: BF is an the control information cannot affect trainee
independent interdisciplinary subject in the system control process. The specific
including physical medicine, contrology, functions of the system are as follows:
physiology, anatomy, psychology and (a) Medical record processing: DELPHI is
other rehabilitation medicine knowledge. applied to process text and call external
The system is based on biofeedback. program technique and various functions
During the training process, the system in text of windows to realize the functions
can provide the patients real-time bio- of input, modification, save and print of
feedback signal to enhance cognitive medical record file.
training with a purpose. Positive feedback (b) Assessment of cognitive disorder: the sys-
addition technique can increase cognitive tem use cognitive dysfunction examina-
capacity of the patients, develop central tion simple scale released by ministry of
neural potential and enhance training health. The therapists input the questions
effect (Fig. 15.2). into database and then the questions are
(b) Developing plasticity of nervous system called randomly by computer program in
and achieving functional reorganization: the functional assessment of the patients.
After cerebral injury, the adults have the After examination, the computer calcu-
ability to reorganize in structure or func- lates the score automatically and realizes
tion to replace lost function, which can the function of assessment of cognitive
complete functional reorganization. In disorder.
this process, orient induction proper (c) Biofeedback cognitive training: memory
method can complete the process. training is a very important part in the
Biofeedback cognitive training system is therapy of the patients with cognitive dis-
designed according to this goal. order. The key point of memory training
(c) Basic function of system: according to of the patients with cognitive disorder is
clinical requirements, functional block the brain development of the patients. In
diagram refers to Fig. 15.3. addition, the training difficulty shouldn’t
2. The content of cognitive training device
be too high. The therapists should select
includes three parts. the difficulty according to the actual con-
The content of operation and design of dition of the patients. In the process of
cognitive training device are compiled in the memory training, this system adopts
Chinese interface software that can be oper- improved error-free learning method. The
ated in Windows through DELPHI 7 program- therapists use abundant semantic words to
ming language. According to the requirements describe questions and use semantic tips
of clinical training, the functions of three parts to induce the patients to say the right
are achieved. There are two displays so that answer. The patients can actively involve
in the training and get more correct stimu-
lus from the learning and better memory
Improve the symptoms of the patients
The patients capacity. In order to assure the flexibility
of memory training, the system provides
automatic memory training and manual
Training
memory training. Training content
+ + includes pictures, numbers, family image
Display the memory training and memory training
Visual feedback Activate potential
training results auxiliary game. The methods include
Auditory feedback
instant memory training, short-term mem-
Fig. 15.2 Sketch map of cognitive training device: posi- ory training, sequential memory training,
tive feedback of enhancing effect attention training, rehearsal, commander
Fig. 15.3 Functional
encryption Add new medical record
block diagram of function
cognitive training device
medical Extract old medical record

records
management
Inquire medical record
Automatic memory training
memory
training Manual memory training
System
function
Memory training game
Exercise for intellect
Intelligence Cognitive function training game

training
Common sense of life training
nominal aphasia training

speech training
Detection
motor aphasia training
Training
execution. The information is added to the tem provides some games for functional
training gradually. Intelligence recovery training of right hemisphere such as mah-
training can promote improvement of jong, Ninth-Game, Chinese checkers and
memory capacity and memory capacity Chinese chess. The patients can do excita-
improvement can further promote the tion training of brain to give sensory stim-
recovery of the patients with cognitive ulation to right hemisphere to improve
disorder, which enters into a good circle. functions.
Intelligence training in this system is In addition, the system designs verbal
divided into outsight, natural things group rehabilitation training such as anomic
ability, figure and mathematical calcula- aphasia and motor aphasia. In the training
tion ability, visual spaces identification process of verbal rehabilitation of the
ability and imagination. In order to patients with motor aphasia, there are sev-
increase pertinence and validity of the eral procedures: the detection of phonic
training and increase the enthusiasm of function, phonic basic training of the
the patients in the training, the therapists patients, phonic training of words and
complied a series of Flash animation that phonic training of single sentence. The
are used for the daily life ability of the training standard is that the accuracy rate
patients with cognitive disorder. The sys- of phonic training in every step is 80%.
After that, the patients can do the next (d) Indications: it is suitable for the patients
training. with cognitive disorder, including the
3. Background music to enhance training effect. patients with senile dementia. It is also
The effects of music therapy mainly come suitable for cognitive dysfunction induced
from environmental atmosphere to alleviate by cerebrovascular diseases, cerebral
uneasy and nervous mood of the patients in trauma, cerebral palsy, encephalitis,
order to enhance training effect. Music therapy Parkinson’s disease, cerebral degenera-
is integrated into rehabilitation training of the tive disease and carbon monoxide toxic
patients with cognitive disorder. The patients encephalopathy and rehabilitation train-
are asked to listen to or sing the song associated ing of the patients with verbal disorder.
with current time, season, environment and
(e) Contraindication: there is no obvious
event to ease body-mind and stabilize mood. contradiction.
In addition, music can stimulate the (f) Problems to be solved: announcements:
patients to recover long-term memory of the the response and disposition of the
patients and improve short-term memory and patients: because the users of the system
other cognitive functions. Therefore, the sys- are the patients with cognitive disorder,
tem is equipped with many kinds of back- the operation is very important. Generally,
ground music. According to the condition of the patients with cognitive disorder make
the patients, the therapists choose proper an oral account and the therapists help
music to enhance therapeutic effect. them to click the mouse to answer the
4. System function, operational approach, indi- questions. In order to let the patients
cations, contraindications, therapy course and answer the questions by themselves,
problems to be solved. touch screen is a good method. Voice set-
(a) Function: the system includes 340 ting: our country is a multiracial country
selected pictures, 30 cognitive function and there are many regional dialects. The
training games and 30 well-designed flash ideal way is to use mother tongue to train
animation for daily life ability training of the patients with aphasia. At present, this
the patients with cognitive disorder. The system is attached to the system with
patients do the training in an easy, imag- mandarin pronunciation. With technique
ery, vivid environment. development, the therapists can change
(b) Operational approach: there are two dis- voice setting to adapt to the training of the
plays in the system. One screen displays patients with different dialects. Tone
control menu and the other displays pic- training: Chines is a kind of tone lan-
tures of therapy training and feedback of guage. Same pronunciation with different
the results. In the therapy process of the tones means different meanings.
patients, the patients can see a perfect pic- Therefore, tone is an important part of
ture without interference of the control rehabilitation training of motor aphasia in
menu. During therapy process, improved the patients with cognitive disorder.
error-free learning method is used to help Because of technical reason, there is no
the patients to establish a normal thinking tone training in the rehabilitation training
model through effective induction way to of aphasia in this system. With the devel-
avoid the interference of the wrong infor- opment of computer technology, tone
mation on correct information. training is certain to be integrated into this
(c) Therapy course: the training way is one- system. Teletherapy: with the develop-
to-one. The training time is 30 min (once ment of computer and network technol-
a day) and one therapy course takes 3 ogy, network resource and clinical
months. The patients can receive multiple resources can be applied and some
therapy courses. patients in remote and border areas can
receive some instructions from famous tive disorder may be more scientific, rational and
doctors through network resources to systematic to enhance the effect of rehabilitation
increase application rang and cognitive training of cognitive disorder.
training effect.
In short, according to the degrees and types Reference

of cognitive disorder and the process of reha-
bilitation training, the system is compiled. The 1. Brand M, Labudda K, Markowitsch HJ.
Neuropsychological correlates of decision-making
interface is clear, the structure is rational and the in ambiguous and riskv situatioas. Neural Netw.
content is integral. It fully considers the charac- 2006;19(8):1266–76. https://doi.org/10.1016/j.
teristic of the patients with cognitive disorder. neunet.2006.03.001.
Rehabilitation training is classified. According 2. Prigatano G. Neuropsychological rehabilitation after
brain injury. Baltimore: Johns Hopkins University
to the requirements of different users, the sys- Press; 1986. p. 29–50.
tem is divided into single-screen display and 3. Pennington C, Newson M, Hayre A, et al. Functional
double-screen display. Single-screen display cognitive disorder: what is it and what to do about it?
system is suitable for family use and double- Pract Neurol. 2015;15(6):436–44.
4. Brook N, Campsie L, Symington C, et al. The five
screen display is suitable for rehabilitation years outcome of severe blunt head injury: a relatives
department. view. J Neurol Neurosurg Psychiatry. 1986;49:764–70.
When the system is applied in clinic, the 5. Wade DT. Measurement in neurological rehabilita-
author will summarize the suggestions and tion. Oxford: University Press; 1990. p. 135.
6. Jacobs JW. Screccrning for organic mental syn-
requirements from the patients with cognitive dromes CCSE in the medically ill. Ann Intern Med.
disorder, their family, rehabilitation therapy phy- 1997;86:89.
sicians and doctors. The author rectifies short- 7. Wilson BA, Cockburn J, Baddeley A. The Rivermead
comings, enriches content, and improves Behavioural Memory Test second edition. London:
Thames Valley Test Company; 2003.
functions so that rehabilitation training of cogni-
of Swallowing Dysfunction
16.1 T
he Mechanism of Swallow Swallowing dysfunction is induced by true bul-
and Dysphagia bar paralysis and pseudo bulbar paralysis. True
bulbar paralysis is induced by nuclear lesion or
16.1.1 The Mechanism of Swallow sub nuclear lesion of glossopharyngeal nerve,
vagus nerve and hypoglossal nerve and pseudo
Swallow is an essential functional movement for bulbar paralysis is induced by injuries of bilat-
eating and drinking. It is a combined movement eral cerebral cortex or corticobulbar tract. Pseudo
of voluntary and involuntary movement domi- bulbar paralysis is more common [3, 4] in clinic.
nated by central nerves. Finally, manducatory The main manifestations of swallowing dysfunc-
food and liquid in mouth are delivered into stom- tion are start time delay of voluntary tongue
ach for food digestion and nutrition supply movement and coordination decrease of swallow
through esophagus [1]. Swallow is one of the movement. There are feed difficulty, bucking
basic vital movements of human. and asophia in the patients. Water and electrolyte
Randomness of swallow movement means disturbance and other nutrition insufficiency,
whether the person want to swallow or not. For even albumin decrease are induced by insuffi-
example, the people can keep food or liquid in ciency of intake. Astray food and water can
the mouth, don’t push them to posterior pharyn- induce aspiration pneumonia, even suffocation.
geal wall to avoid swallow reflex and put food or Researches show that in the patients with clear
liquid into stomach. For the swallow movement, consciousness in acute phase, 64–90% of the
bolus formed by chewing the food is pushed to patients have dysphagia, 22–42% pf the patients
posterior pharyngeal wall and then into stomach have miss inhalation, which are the important
[2]. This is an involuntary reflex that is induced factors to increase the case fatality rate of the
by specific stimulus. During swallowing, bolus patients with stroke.
stimulate pharyngeal receptor, soft palate rise
and posterior pharyngeal wall protrude to seal 16.1.1.1 M uscles and Nerves Involved
nasopharynx in order to avoid foot enters into in Swallow
nasal cavity. Meanwhile, vocal cords adduct, 1. Muscles involved in swallow include suprahy-
throat rises, and move forward to epiglottic carti- oid muscles and infrahyoid muscles.
lage to seal throat and stop breathing in case of (a) Suprahyoid muscles is located between
astray food and water. hyoid and lower jawbone with basis cra-
Swallowing dysfunction is one of the com- nii. There are four muscles in each side
mon complications in the patients with stroke. including digastric muscles, mylohyoid
https://doi.org/10.1007/978-981-13-0812-3_16
468 16 Rehabilitation Therapy of Neurological Training of Swallowing Dysfunction
muscle, stylohyoid muscle and geniohy- of throat, trachea and thyroid. There are
oid muscle. deep layer and superficial layer. They are
The functions of suprahyoid muscles all named by the starting and ending
are to life hyoid to elevate tongue and help points. Infrahyoid muscles include sterno-
bolus enter into pharynx. When hyoid is hyoideus, musculus omohyoideus, sterno-
fixed, mylohyoid muscle, geniohyoid thyroid 和 thyrohyoid muscle.
muscle and muscle belly of digastric mus- The functions of infrahyoid muscles
cles pull lower jawbone downward to are to lower hyoid and throat. When in
open mouth. swallow, musculus thyrohyoideus lift
(b) Infrahyoid muscles are located in anterior throat to hyoid.
region of the neck. There are four muscles 2. The phase and movement of swallow: The
in each side. It is located in the two sides involved muscles and nerves refer to
of the middle line under hyoid, in the front Table 16.1.
Table 16.1 The phase and movements of swallow

The phase and movements of swallow Muscles Dominant nerves
Oral cavity phase
Lip closes Orbicular muscle of mouth VII
Control cheek Buccinator VII
Chew vertically Temporalis V
Masseter V
Interior alary muscle V
Chew horizontally Exterior alary muscle V
Mix food by tongue Lingual intrinsic muscles XII
Genioglossus XII
Styloglossus XII
Pharynx phase
Tongue and palate close Styloglossus XII
Velamen closes Staphylinus externus V
Velamen closes Levator muscle of velum palatinum IX, X
Pharynx oppress Styloglossus XII
Musculus hyoglossus XII
Stylopharyngeus IX, X
Upper stegnosis muscles IX, X
Middle stegnosis muscles IX, X
Lower stegnosis muscles IX, X
Epiglottis inclines Aryepiglotticus IX, X
Throat moves upward Thyrohyoid muscle XII
Musculus hyoglossus VII
Stylohyoid muscle VII
Posterior digastric muscles XII
Move forward Geniohyoid muscle CI–3
Genioglossus XII
Glottis closes Cricoarytenoid muscles IX, X
Airflow stops Intercostal muscles (inhibition) T1–12
Diaphragm inhibition C3–4
Pharynx and esophagus reflex Cricopharyngeus muscle inhibition IX, X
Esophagus phase
Esophagus contracts Striated muscle fiber X
Smooth muscle fiber X
The list of the involved muscles and nerves
16.1 The Mechanism of Swallow and Dysphagia 469
16.1.1.2 The Mechanism of Swallow through chewing, mixed with saliva and form
Swallow movements are divided into three time bolus for swallow.
phases in mouth, pharynx and esophagus and six
stages. In the mouth, food mixed with saliva, form-
ing bolus that is easy to swallow. The process
1. Cognition of food is the process to distinguish is different because of the shape of the food.
food and select eating ways. Liquid diet is easy to swallow. Semiliquid
food such as jelly and porridge form bolus
The information is feedback to brain through through pushing and chewing. The body of
visual sense to distinguish the food kinds such as tongue fluctuates to make the food are pushed
solid, fluid and soft or hard. According to the and grinded between tongue and hard palate.
information, people decide to eat the food or not Solid food not only requires pushing and
and adjust consciousness. The person who is in chewing, but also requires teeth to chew and
low level of consciousness, cannot concentrate grind to form bolus. During chewing, lower
on something, or are indifferent to the food, there jaw fluctuates and rotate. Meanwhile, cuff
is aspiration in eating. segment between soft palate and root of
tongue is closed to prevent food into pharynx.
2. Eating is the process to intake food into mouth. If masticatory movement, the formation and
maintenance of food cannot be completed, the
People adjust mouth, lip and foretooth to adapt food may be swallowed without thinking and
to the form of food and tableware. After that, peo- flow into pharynx before inducing swallow
ple take food into mouth. The patients with lips reflex.
closure disturbance cannot take food into mouth.
The food is easy to leak out even taken into mouth. 4. Food enters into pharynx, which is called

phase of oral cavity. It is the process that bolus
3. Food chewing and bolus forming is the pro- enter into the part that can induce swallow
cess that food in the mouth are grinded reflex (Fig. 16.1).
Fig. 16.1 Phase of oral

cavity: the process of
bolus formation
Nasal cavity
Hard palate
The soft palate lifts to
enclose the nasal cavity
Tongue Bolus
Epiglottis
Ventriculus laryngis
Weasand
Esophagus
After formation of bolus, tongue rises to push into trachea during inspiration or incoordination
bolus to root of tongue through hard palate until of swallow reflex leads to incomplete lockout of
bolus reaches the part that can induce swallow trachea, which induce erroneous deglutition.
reflex. Lips close and lower jaw holds still, which
generate swallow movement. If bolus cannot 6. Bolus goes through esophagus which is called
reach root of tongue, the patients can throw their esophagus phase. It is the process that bolus
head back or be in supine position to make bolus enters into stomach through esophagus.
enter into pharynx using action of gravity.
After bolus enters esophagus, smooth muscles
5. Bolus goes through pharynx, which is called of esophagus start peristalsis to make bolus enter
pharyngeal phase. It is the process of inducing into stomach through esophagus. Until now, the
swallow reflex and bolus enters into esopha- swallow process is completed.
gus (Fig. 16.2). Just as the above mentioned, swallow is the
same as respiration, urination and defecation.
Pharyngeal phase is an important stage to They are all voluntary movements and compli-
induce erroneous deglutition. After bolus reaches cated movements. Before esophagus phase, swal-
pharynx, soft hip seals the channel between phar- low is voluntary movement. The patients can
ynx and nasal cavity and epiglottis seals the start, accelerate or stop swallow at will. When
channel between pharynx and trachea, which bolus induces swallow reflex and enters into
immediately induce instant swallow respiratory esophagus phase, swallow is involuntary reflex
arrest. Meanwhile, root of tongue oppresses pos- movement.
terior pharyngeal wall and pharyngeal wall gen- During esophagus phase, esophagus peristal-
erates peristalsis to push bolus into esophagus. sis is reflex impulse induced by stimulation of
The above process is swallow reflex. The time receptors in soft palate, pharynx and esophagus
of completing the reflex in normal people is about by bolus. Afferent nerve of this reflex is sensory
0.5 s. Incapacity of swallow leads to incomplete fiber of pharynx and esophagus mucosa, includ-
food swallow and food left on pharynx enters ing branches of glossopharyngeal nerve, nervi
Fig. 16.2 Pharyngeal phase:

the process that bolus enter
into esophagus
Bolus entered the

esophagus
Epiglottis close larynx
16.1 The Mechanism of Swallow and Dysphagia 471
trigeminus, nervi vagus and its upper throat and tongue function. There is hypaesthe-
branches. Motor nerve includes hypoglossal sia of posterior pharyngeal wall, but stim-
nerve, nervi trigeminus, glossopharyngeal nerve, ulation of posterior pharyngeal wall can
nervi vagus and accessory nerve. They dominate induce vomiting reflex.
the muscles involved in swallow. Its center (b) Moderate: the patients cannot eat liquid
locates in medulla oblongata. food or drink water, but can eat solid food.
There is usually irritating cough, even
erroneous deglutition. Chewing function
16.1.2 Dysphagia and tongue function decline. There is
hypaesthesia of posterior pharyngeal
16.1.2.1 The Definition of Dysphagia wall, but only strong stimulation of poste-
Dysphagia is the clinical manifestation after dis- rior pharyngeal wall can induce vomiting
order in the process that food enters into stomach reflex.
through oral cavity. Except for the diseases of (c) Severe: The patients are difficult to eat
mouth, pharynx and esophagus, the inducing fac- solid food and cannot complete swallow.
tors include cranial nerve lesion, medulla oblon- If there is irritating cough or erroneous
gata lesion, pseudobulbar paralysis, deglutition, difficulty of chewing and
extrapyramidal diseases and myopathy. tongue movement, unconspicuous sensa-
tion of posterior pharyngeal wall, strong
16.1.2.2 Classification of Swallowing stimulation cannot induce vomiting
Disorder reflex.
1. According to the disorder part, dysphagia is
divided into oropharynx dysphagia and esoph- 16.1.2.3 Assessment of Swallowing
agus dysphagia. Disorder
2. According to handicapped degree, swallow dis- General inspection includes myodynamia, move-
order includes lesion, disability and handicap. ment and swallow reflex.
(a) Lesion: central functions disorder of the
structure, power, motor, afferent nerve, 1. Inspection of muscles and joint in oral cavity:
efferent nerve, involuntary movement or Movements of lower jaw, lips, tongue, soft
voluntary movement is induced by patho- palate and buccinators; occlusion and power
genic factors. The patients are afraid of of teeth.
swallow, but the swallow function is 2. Inspection of swallow: the patients simulate
normal. swallow movement or swallow saliva and
(b) Disability: lesion has certain or irrevers- the therapists inspect chewing movement,
ible effects on the individual swallow lips close, whether there is throat uplift, time
function. limit and neck movement or not during
(c) Handicap: because of lesion and swallow swallow.
function disorder, the patients cannot 3. Swallow ability test: The patients are in sitting
have meals with friends and colleagues. position. The patients should relax if they are
They cannot meet the requirements of in bed. The therapists put thumb and index
regular work and society. finger on the two sides of neck, Adam’s apple
3. According to therapeutic requirements, there and hyoid of the patients and let the patients
are three feeding classifications of dysphagia. swallow saliva quickly and repeatedly. The
(a) Mild: when the patients eat liquid food or therapists observe the Adam’s apple and hyoid
drink water, there is irritating cough, even cross the fingers and go down with swallow
erroneous deglutition. The patients can movement and record the times of swallow in
eat semiliquid food or solid food. There is 30 s it is normal that there are three times of
no obvious disorders of chewing function swallow in 30 s.
4. Swallow provocative test [5]: The therapists –– Motor ability and sensation: motor control
put index finger between thyroid cartilage and ability of head, neck and tongue and sensa-
hyoid and use iced cotton swab with ice water tion of tongue, palate and face.
to dampen lips, the tip of the tongue, lingual –– Swallow ability of different food: swallow
surface, back of the tongue and mucosa of oral ability of liquid, semiliquid and solid food.
cavity. After that, the therapists slightly stimu- –– Others: whether there is food retention in
late pillars of fauces, root of tongue and poste- the mouth or not and there are salivation
rior pharyngeal wall to induce swallow reflex. and choking.
If thyroid cartilage crosses the fingers, it is –– Through functional assessment, the thera-
defined that there is swallow movement. pists can judge the following items:
5. Water drinking test is the most commonly
–– The best position of swallow training: the
used identification method [6]. The patients patients sit erectly and put the head for-
are in sitting position. The therapists take ward slightly.
30 mL warm water, ask the patients to drink, –– The best location of food in the mouth: the
observe the drinking process and record the patients push the food to the side with
time. There are five conditions. complete sensation and motor function.
–– The patients drink off and there is no irri- –– The kinds of food tolerance: solid, liquid
tating cough. and stickiness of liquid.
–– The patients drink it for two times and
there is no irritating cough.
–– The patients drink off and there is irritating 16.2 Rehabilitation Therapy
cough. of Swallowing Disorder
–– The patients drink it more than two times
and there is irritating cough. 16.2.1 Principle and Method
–– There is irritating cough for many times of Rehabilitation
and the patients cannot drink the water. of Neurological Training
–– Diagnostic criteria: of Swallowing Disorder
–– Normal: the patients drink it in 5 s.
–– Suspicious: the patients drink it more than 16.2.1.1 Principle of Rehabilitation
5 s or drink it off and there is irritating cough. of Neurological Training
–– Abnormal: the patients drink it more than of Swallowing Disorder
two times and there is irritating cough or Through the training of active movement, central
there is irritating cough for many times and nerve system potential can be developed and
the patients cannot drink the water. autonomous contraction ability of swallow mus-
6. Imaging examination: X-ray photo and X-ray cles is recovered gradually. The training can
video examinations can be used to know the loose tissue adhesion, recover the range of joint
structure and movement of swallow. They not motion, enhance myodynamia, prevent erroneous
only can be used for analysis of dysphagia deglutition, recover or improve swallow
degree, but also can be used for analysis of the function.
reasons of dysphagia and erroneous degluti- In order to prevent aspiration pneumonia, for
tion such as tongue function decline, swallow the severe patients with erroneous deglutition,
reflex attenuation, poor closure of throat, cri- eating and drinking are forbidden. Liquid food is
copharyngeus muscle hypotonia. given through stomach tube. After recovery of
7. Other assessments: swallow function, eating and drinking can be
–– Normal reflex: vomiting reflex and cough recovered gradually. For the patients with swal-
reflex. lowing disorder and cognitive disorder, gastros-
–– Abnormal reflex: occlusion, sucking and tomy can be considered and the patients can eat
swallow reflex. through fistula.
16.2 Rehabilitation Therapy of Swallowing Disorder 473
16.2.1.2 Rehabilitation Method

of Swallowing Disorder
According to assessment results, dysphagia site
and degree, different methods are used for the
training.
1. Rehabilitation of neurological training of

swallowing muscles: Neurological training
device is used for the training. The patients are
in sitting position or semireclining position.
The therapists paste surface electrode and use
normal method or the method of guiding col-
laterals through meridians to guide the patients
to enhance the intensity of motor program sig-
nal of suprahyoid muscles and infrahyoid
muscles, develop central nerve potential and
reestablish motor program of swallow.
(a) Electrode place of suprahyoid muscles Fig. 16.3 Sketch map of electrode place part of suprahy-
training: these muscles are located oid muscles
between hyoid and lower jawbone and
basis cranii. These functions are to life
hyoid, elevate tongue and push bolus into
pharynx. When hyoid is fixed, these mus-
cles pull down lower jawbone to make the
mouth open. The antagonistic muscle of
opening mouth is masseter. Therefore,
during the training of suprahyoid mus-
cles, surface electrode is placed on the
bottom of lower jaw. The other electrode
is on the same part of uninjured side
(Fig. 16.3). The purpose is that the train-
ing goal of injured side is the signal inten-
sity in uninjured side. The electrode can
Fig. 16.4 Sketch map of electrode place part of suprahy-
also be placed in masseter on the same
oid muscles such as masseter
side (Fig. 16.4). The purpose is that the
antagonistic muscles of opening mouth
motor program reestablishment is masse-
ter. The anti-resistance methods of two
forms are the same, which are that palm is
used to support lower jawbone (Fig. 16.5).
During training, the patients should
enhance motor program signal of supra-
hyoid muscles and decrease motor pro-
gram signal intensity of masseter.
(b) Electrode place of infrahyoid muscles:

These muscles are before neck and there
are four muscles in each side. These mus-
cles are in two sides of middle line under Fig. 16.5 Sketch map of anti-resistance of suprahyoid
hyoid. Its function is to life throat during muscles in swallow
swallow. Reception electrode is below at the same side (Fig. 16.8). The patients
hyoid and beside trachea (Fig. 16.6). The should enhance motor program signal
anti-resistance way is to use index finger intensity of infrahyoid muscles and
and finger pulp of thumb to press on attenuate motor program signal intensity of
Adam’s apple. When the Adam’s apple suprahyoid muscles to reestablish motor
moves upward in the beginning of swal- program of swallow in order to recover
low, the patients exert resistance slightly swallow function.
without affect respiration and inducing The training time is 50 min (once a day)
other discomfort (Fig. 16.7). and there are 30 times in one therapy course.
When the patients do motor program The patients can do multiple therapy courses.
reestablishment training of infrahyoid (c) Virtual reality training of neurological

muscles, suprahyoid muscles are training: virtual reality training system is
antagonistic muscles. Electrodes are used for potential development and motor
separately placed on the skin surface of program reestablishment of suprahyoid
suprahyoid muscles and infrahyoid muscles muscles and infrahyoid muscles.
The training time is 50 min (once a
day) and there are 30 times in one therapy
course. The patients can do multiple ther-
apy courses.
2. Actual swallow training the therapists ascer-
tain the optimum eating pattern through
assessment and then give the patients actual
swallow training.
The specific method: the patients use the
optimum eating position such as sitting posi-
tion or semireclining position. The patients
concentrate to open mouth and contain one
spoon of powdery apple in the mouth. On the
basis of regulation of mind and breathing, the
Fig. 16.6 Electrode place part of infrahyoid muscles
Fig. 16.7 Sketch map of anti-resistance of infrahyoid Fig. 16.8 Sketch map of swallow training of suprahyoid
muscles in swallow muscles and infrahyoid muscles
patients are guided to induce suprahyoid placed between lower jaw before neck and cri-
muscles contraction to make bolus reach coid cartilage. Electrode slice is fixed with band
pharynx, induce infrahyoid muscles and the tightness is proper. Square-wave pulse
contraction to lift head and extend neck in stimulation is used to get value A and triangular
order to induce swallow reflex. Therefore, form wave pulse stimulation is used to get value
bolus can enter into esophagus and swallow B. The formula is as follows.
movement is completed. Injury degree of swallow muscles ∝ = B/A.
When the patients can smoothly complete According to exact value of ∝, the therapists
the swallow movement of powdery apple and select the ration of low-frequency time (T) and
there is no irritating cough and erroneous rest (R). The stimulation time is usually 1 s and
deglutition, the patients used the same method the rest time is 3 s. Current intensity vary with
to do the swallow training of eating mushy each individual. It is optimum that the patients
apple swallow. When the patients can can tolerant the current and it can induce swallow
smoothly complete the swallow movement of movement. During stimulation, the therapists ask
mushy apple and there is no irritating cough the patients try to do swallow movement.
and erroneous deglutition, the patients start Current intensity should not be too strong lest
the training of eating apple juice until they use the patients feel uncomfortable or it induces
liquid for swallow training. throat spasm.
The training time is 20 min (once a day) The training time is 20 min (1–2times per day)
and there are 30 times in one therapy course. and there are 15 times in one therapy course. If
The patients can do multiple therapy courses. there is no excessive muscle excitability, the
3. Electrical stimulation to increase the excit- patients can receive the next therapy course.
ability of swallow muscles, improve blood cir-
culation of muscle and promote functional (b) Medium-frequency electrical stimulation:

recovery [7]. Suprahyoid and infrahyoid muscles are sepa-
Conventional wisdom may suggest that rately stimulated. The electrode is placed in
electrical stimulation is not suitable for neck suprahyoid infrahyoid muscles on the same
because it may lead to throat spasm. In addi- side. The electrode can also be placed beside
tion, when electrical stimulation act on inter- trachea in the level of Adam’s apple to
nal carotid sinus and nerve plexus around enhance excitability of swallow related mus-
branches of carotid artery, it may lead to bra- cles and improve swallow function.
dycardia. Therefore, the electrode should be
placed vertically in two sides of middle line of The training time is 20 min (once a day) and
neck, but not away from middle line in case of there are 15 times in one therapy course. If there
stimulation carotid artery. is no excessive muscle excitability, the patients
(a) Swallow stimulation device therapy: its
can receive the next therapy course.
mechanism is to stimulate suprahyoid mus-
cles with medium-frequency electricity to 4. Infrared therapy infrared lamp is used to irra-
induce muscle contraction to lift tongue and diate submentum and throat to increase blood
make saliva enter into throat and pharynx and circulation of swallow muscles.
then induce swallow reflex. Meanwhile, it The training time is 20 min (once a day)
can stimulate salivary gland and salivary and there are 15 times in one therapy course.
glands to secret saliva that enter into pharynx The patients can do multiple therapy courses.
to induce swallow reflex. 5. Loosen of tissue adhesion manipulation is

used to loose tissue of tongue, mouth and neck.
Electrode place part: after ungrease treatment (a) Adhesion release of tongue muscles and
of skin, the positive electrode is placed in the sev- perioral muscles: through traction, malax-
enth cervical vertebra and negative electrode is ation and passive movement, the adhesion
of lingualis and masseter is loosened to inserted inward and is twirled for

increase the movement range and flexibil- 5–10 s. The needle cannot be inserted
ity of tongue, alleviate adhesion of man- outward in case of injuring superior thy-
dibular joint, promote movement of roid artery.
mandibular joint and recovery of chewing • Lianquan: the needle is inserted oblique
function. 1.2 Cun deep towards root of tongue
(b) Adhesion release of suprahyoid and infra- andis twirled for 10 s.
hyoid muscles and their peripheral tissue: • Zhiqiang (extra nerve points): it is
manipulation traction, strings, malaxa- between hyoid and incisura thyreoidea
tion, active and passive movements can superior. The needle is inserted 0.5 Cun
increase range of submandibular joint deep towards root of tongue and is
motion, degree of excursion of Adam’s twirled for 5–10 s. if there is facial flush
apple and flexibility of movement, loosen and dyspnea, the needle should be with-
adhesion of submandibular tissue and drawn immediately.
throat tissue to recover movements of (b) Massage: soft and slight massage manipu-
submandibular joint and swallow. lation is used for the massage of facial
The training time is 20 min (once a muscles, tongue muscles, suprahyoid mus-
day) and there are 15 times in one therapy cles and infrahyoid muscles to loosen
course. The patients can do multiple ther- adhesion, increase blood circulation and
apy courses. promote functional recovery of muscles
6. Acupuncture and massage acupuncture can
involved in swallow movement.
dredge the channel and regulate of qi and
blood and massage can tease muscles and
loosen adhesion. 16.2.2 Other Common Rehabilitation
(a) Acupuncture: The acupuncture points are Training Methods
different. According to the condition of the
patients, the therapists select points through 16.2.2.1 Therapeutic Purpose
different syndromes and treat people Recovering swallow function: the patients try to
individually. eat food with mouth but not through nasal tube,
Major acupuncture points: pharynx fistulization, esophagus fistulization,
• Double Fengchi: The point of a needle is stomach fistulization or jejunal fistulization.
inclined downward and is inserted into Improving swallow function of food with dif-
the skin towards Adam’s apple about ferent consistence.
1.5 Cun (one third d ecimetre). The nee- Avoid aspiration.
dle should not be inserted too deep in
case injuring medulla oblongata. 16.2.2.2 Methods
• Double Gongxue acupoint (extra nerve 1. The training of indirect eating induces swal-
points): 1.5 Cun below Fengchi in the low movement: It is the training method that
level of lips, the point of a needle is swallow movement is induced not through
inserted into skin about 1.5 Cun deep eating.
towards offside lips. Indirect eating training is the training
• Double Yiming: the point of a needle is methods that swallow movement are induced
inserted into throat 1.5 Cun deep. not through eating. This method is impossible
Adjunct acupuncture points: to induce erroneous deglutition and choke.
• Double Tunyan: they are located Therefore, it is safe. Rehabilitation training
between hyoid and Adam’s apple, in the method of neurological training belongs to
sunken 0.5 Cun beside middle line. The this kind of method and can be used for swal-
therapists use hand to push arteria caro- lowing disorder to varying degrees. The
tis communis outward. The needle is specific methods are as follows:
(a) Movement training of perioral muscles: tively to induce swallow reflex. The
The training of oral cavity and facial specific methods are as follows: the thera-
muscles: the patients can do expression pists use small mirror that was soaked in
movement training such as frown, closing cold water for 10 sec used for ear-nose-
eyes, blowing cheek and smiling. The throat department to press on soft palate
patients can also do self-exercise before arch or use iced wet cotton swab to stimu-
the mirror. late soft palate, pillars of fauces, posterior
Movement training of submandibular pharyngeal wall and the back of the tongue
joint: active movement training of sub- for 5–10 times. The therapists can also let
mandibular joint is good for masticatory the patients swallow small iced cube or
movement. The patients use cheek tooth swallow stomach tube for 2–3 times a day
to chew gum to enhance the myodynamia from oral cavity to accelerate swallow
of masseter. reflex. For the patients who are already eat
Movement training of tongue: move- food from oral cavity, cold stimulation
ments of tongue protraction, retraction cleaning of oral cavity before meal not
and lateral movement; active movements only can improve sensitivity of pharynx to
of cheek massage, cleaning teeth and bolus, but also can induce swallow reflex.
scrolling with tongue; anti-resistance (d) The training of opening and closing vocal
movement of tongue, the therapists use cords is to increase femininity of vocal
tongue depressor to oppress and slide on cords, sensitivity of opening and closing,
the tongue and do anti-resistance training. and strictness of closing to prevent erro-
Pronunciation training can promote neous deglutition. The specific method
movements of lingual muscles. are as follows: the patients press on the
Adhesion release of lingual muscles wall or desk and yell out or hold their
[8]: traction and malaxation: the thera- breath. The patients cross their hands
pists use wet saline gauze to wrap the tip before the chest, use hands to push the
of the tongue, use one hand to hold the chest, yell out or hold their breath.
tongue, tract it to all the directions slowly, (e) Swallow training above glottis is the train-
use the other hand to hold the tongue and ing of simulating swallow. The patients
malaxate the tongue from the tip of the take a deep breath, hold their breath, swal-
tongue to root of tongue to loosen adhe- low saliva, expire and cough. It is suitable
sion of lingual muscles. The therapists use for the patients who are easy to have erro-
the convexity surface of the spoon to neous deglutition.
oppress the center of tongue to loosen For the patients whose throat is diffi-
tongue tissue and deepen the sunken, cult to move upward during swallow, thy-
which is good for the formation, mainte- roid cartilage can be moved passively. The
nance and delivery of bolus. patients are asked to swallow saliva and
(b) The training of improving the range of lift throat.
cervical joint motion: the patients do (f) The method to promote swallow: for the
myodynamia enhancement and relaxation patients who cannot swallow with food in
training of cervical flexor to improve the the mouth, the therapists use fingers to rub
degree of flexion and extension and flexi- the skin from thyroid cartilage to lower jaw,
bility of neck. Flexed position of the neck which is good for up-and-down motion of
is easy to induce swallow reflex and relax- lower jaw and front and back motion of the
ation of the neck is good for prevention of tongue and then induce swallow reflex.
erroneous deglutition. (g) Respiratory training and cough training:
(c) The training of improving swallow reflex: abdominal respiration training can increase
cold-stress stimulation can increase sensi- myodynamia of diagram, enhance control
tiveness of soft palate and pharynx effec- respiration breath and increase glottis
closure. Voluntary cough training can patients eat too little in one mouth, food is
enhance glottis closure, which is good for difficult to form bolus and cannot induce
cough up the food of erroneous deglutition. swallow reflex. For the patients who are easy
2. Swallow movement training during eating is to have erroneous deglutition, the eating
the training that food induce swallow reflex speed should be too fast during training.
directly. (c) The training method to eliminate food reten-
If the patients are conscious, stable, with tion in pharynx: during training, there is usu-
pharyngeal reflex and can cough at will, the ally food retention in pharynx. The following
training can be done. methods can be used for dealing with this
According to the assessment results, the condition: empty swallow repeatedly: empty
patients choose the position for safe eating swallow is that the patients swallow saliva
and do eating training of various kinds of without food. When there is residual food in
food gradually. The sequence of food eating pharynx, if the patients continue to eat, it is
is soft food, semisolid, solid and liquid. All easy to induce erroneous deglutition.
kinds of food refer to Table 16.2 and the spe- Therefore, after swallowing food every time,
cific training methods are as follows: empty swallow can make the bolus enter into
(a) The position of eating: when the patients stomach in order to eliminate food in phar-
start eating, the trunk is inclined backward ynx. Alternative swallow: the patients are
and the neck is ante flexed. asked to swallow solid food and liquid food
(b) Time-phased eating training: the therapists alternatively. When there is residual food, the
choose movable food in oral cavity and the patients can drink a little bit water (1–2 mL)
food is difficult to induce erroneous degluti- after every swallow, which is good for induc-
tion for training. Jelly-like and homogenous ing swallow reflex and eliminating residual
pasty food is the best such as soft egg cus- food. Nodding swallow: there is usually
tard, homogenous paste and congee. The residual food in epiglottic vallecular. When
patients should use this kind of food for the neck is inclined backward, the epiglottic
training and then use normal food and water. vallecular becomes narrow, which can
The amount of eating should be started squeeze out residual food. After that, the
from a little bit about 3–4 mL and the patients patients ante flex neck, lower their head and
can find proper amount for training. if the swallow saliva to eliminate residual food.
patients eat too much in one mouth, bolus Lateral swallow: Piriform recess beside
retention in pharynx can aggravate the dan- pharynx is the most common place for resid-
ger of erroneous deglutition. However, if the ual food. The patients are asked to rotate chin
to two sides or incline neck to do lateral
Table 16.2 Liquid and solid food used for the training of swallow, which make the offside piriform
the patients with dysphagia recess become narrow to squeeze out residu-
Classification Degree als. Meanwhile, piriform recess on the other
Solid Single ingredient: bread, steamed bun, side becomes shallow to eliminate residual
muddy flesh, mashed potato, banana, food in piriform recess.
egg salad
Particle: roast fish, chicken salad,
Hamburger 16.2.2.3 Considerations
Multiple ingredients: roast potatoes, 1. Reducing the risk of aspiration: When the

carrot, pea, rice and noodle, bottled patients eat food through oral cavity, the ther-
Fruits Liquid sparseness: clear soup, coffee, apists should know the actual condition of the
fruit juice, tea, milk, gelatin
patients thoroughly and choose optimum
Viscosity: nectar, hot frumentum,
cream soup, milk and egg alcohol, swallow method and safe food. Acid food and
viscous drink lardy food are easy to induce pneumonia after
Viscosity: porridge, sour cream, erroneous deglutition. The therapists try not to
pudding, milk cake select this kind of food.
2. Keeping oral cavity clean to reduce aspiration deepen the sunken, which is good for the for-
and gastric regurgitation. After eating, the mation of bolus.
patients raise their head and keep in sitting The above methods can be used repeatedly
position for 20–30 min to prevent esophagus and alternatively. The therapists oppress on the
backflow and erroneous deglutition. part of root of tongue in the lower jaw and use the
3. Improving general body state to prevent
back of the hand to slap lower jaw to stimulate
pneumonia: for the patients who eat too less, swallow.
they should use nasal feeding or intravenous (c) Hypaesthesia of oral cavity: Hypaesthesia of
drip to supply nutrition in order to prevent oral cavity is bad for chewing and saliva
malnutrition. secretion. The patients can malaxate exterior
face of gingiva, inner surface of chin or
16.2.2.4 Disposition of Special oppress on tongue to improve the sensation
Problems of oral cavity.
During training, there are some unwieldy prob- (d) Irritability of oral cavity: the therapists

lems that can influence training effect directly should oppress on the most insensitive area
and are the key point of training. and decrease unhappy reaction to touch. The
patients close lower jaw and malaxate lower
(a) Poor occlusion of lips and lower jaw: when jaw towards the orientation of lips closure.
there is poor occlusion of lips and lower jaw, After the patients can tolerate it, the thera-
the patients cannot keep bolus in oral cavity pists put finger into mouth and use force to
and are difficult to do swallow training. In rub gingiva from outside to inside. Pressure
this case, the therapists use one hand to sup- on tongue can increase desensitization.
port lower jaw to make it close and use the (e) Abnormal reflex: cough hyperreflexia: for the
other hand to stimulate perioral tissue. If the patients who are with cough hyperreflexia,
lips close asymmetrically, the therapists can desensitization should be used for the therapy.
stimulate the unclosed side. If buccinators Vomiting dysreflexia: for the patients who are
spasm influences lips closure, the therapists easy to inhale food or liquid, malaxation of
can put index finger on the inner surface of gingiva and inner surface of chin and oppres-
chin, thumb on the out surface, malaxate the sion of tongue are used for therapy.
chin inward and tract it towards the orienta- Hypaesthesia of uvula and soft palate: banister
tion of lips closure. brush or cotton swab is used to stimulate the
(b) Tongue movement and poor swallow: the
uvula and soft palate. Cotton swab stimulation
patients can lift the last third of the tongue to should be cooperated with closure training of
push bolus into pharynx. If there is poor lips and lower jaw. Positive occlusion reaction:
tongue movement, the therapists use index after putting bite block, the therapists use fin-
finger to press and push backward the first ger to rub the outer surface of gingiva for
third of the tongue to stimulate the elevation desensitization. During eating, the therapists
of the last third of the tongue and closure of cannot press the bottom of lower jaw in case of
posterior oral cavity. Under normal circum- inducing occlusion reaction. Difficulty in
stance, outer edge of the tongue rolls up to opening mouth: the therapists use thumb to
make food form bolus. In order to stimulate oppress temporomandibular joint continuously
the outer edge of the tongue roll up, the ther- or malaxate it from nose to mouth.
apists can use middle finger to support outer (f) Poor facial expression: through facial mas-
edge of the tongue and press and vibrate it sage, adhesion tissue release and active
towards diagonal orientation, which is good movement training of facial muscles, poor
for stimulating the outer edge of the tongue facial expression can be alleviated.
roll up. The therapists use the convexity sur- (g) The method to help the patients to eat and
face of the spoon to oppress the center of drink: before meal, the food should be
tongue to stimulate lingualis contraction and provided from middle line and the patients
can smell it and see it in order to make a References

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slightly flex head for swallow. The food 3. Work SS, Colamonico JA, Bradley WG, et al.
should be delicious and fragrant, which is in Pseudobulbar affect: an under-recognized and
accordance with the eating habit of the under-treated neurological disorder. Adv Ther.
2011;28(7):586–601.
patients. Viscous food is safe and can stimu- 4. Teasell R, Foley N, Dohetty T, et al. Cinicai char-
late the touch and pressure sense of tongue acteristics of patients with brainstem strokes admit-
and oral cavity, saliva secretion. It is easy to ted to a rehabilitation unit. Arch Phys Med Rehabil.
swallow. The therapists can put gum into 2002;83(7):1013–6.
5. Martino R, Pron G, Diamant N. Screening for oropha-
cheek tooth to stimulate chewing. Liquid is ryngeal dysphagia in stroke: insufficient evidence for
easier to be inhaled into trachea than solid. guidelines. Dysphagia. 2000;15(1):19–30.
The patients should use plastic cup with 6. Smith HA, LeeSH, O’ Neill PA, et al.The combina-
curved lip for drinking liquid. The patients tion of bedside swallowingassessm ent and oxy-
gen saturation monitoring of swallowing in acute
flex the head slightly, use lower lip to touch stroke:a safe and humane screening tool.Age Ageing,
the cup lip, drink a little bit liquid, close lips 2000,29(6):495–499.
and lower jaw for swallow. If there is incom- 7. Burnett TA, Mann EA, Cornell SA, et al. Laryngeal
plete lips closure, cup lip can be used for elevation athieved by neuromuscul ar stimulation at
rest. J Appl Physiol. 2003;94:128–34.
stimulation. If possible, the patients are 8. Langmore SE, Miller RM. Behavioral treatment for
asked to eat by themselves for promoting fur- adults with oro-pharyngeal dysphagia. Arch Phys
ther functional recovery of swallow. Med Rehabil. 1994;75:1154–60.
of Sphincter Dysfunction
17.1 Micturition Dysfunction Bladder and urethra belong to the same unit in
structure and function. When bladder detrusor
Micturition dysfunction is the common compli- relax and urethral sphincter shrink, urine in blad-
cation of the paraplegic patients. It belongs to der cannot flow out. During micturition, when
neurogenic bladder including dysfunction of bladder detrusor shrink and urethral sphincter
sphincter vesicae and urethral sphincter. The relax, urine is expelled from bladder through ure-
early manifestation is retention of urine. The final thra. When the volume of urine exceeds 400–
manifestation is uroclepsia or urinary retention 500 mL in bladder, the tonicity of detrusor is
with overflow incontinence. It is difficult to be increased with rhythmic contraction and relax-
treated in clinic [1]. ation, which can induce micturition. Physiological
characteristics of detrusor make the bladder store a
certain volume of urine without innervation and
17.1.1 Innervation of Micturition induce automatic micturition. However, out of
control of neural center bladder, urine in bladder
Micturition is the process that urine generated in cannot be drained and there is always 200–300 mL
kidney is stored in bladder to a certain capacity urine in bladder, which is residual urine volume
and discharged out under the control of central that is the important factor to induce urinary sys-
nervous system through urethra. tem infection and renal dysfunction.
17.1.1.1 Functions of Bladder 17.1.1.2 Nerves of Micturition

and Urethra There are three pairs of composite nerve trunks to
There is net detrusor interweaved by smooth innervate bladder and urethra. Every trunk is
muscle fibers in outer layer of bladder wall. In the composed of afferent fiber and efferent fiber.
joint between bladder and urethra, muscular loop
interweaved by smooth muscle fibers is called 1. Hypogastric nerve: The efferent fibers are

internal urethral sphincter. It function is sphinc- from funiculus lateralis in T12–L1–2 of spinal
ter, but it is not circular sphincter. Urethra is cord and belong to sympathetic nerve. They
wrapped by circular striated muscle fiber to form mainly innervate bladder detrusor and internal
striated muscle loop when it goes through uro- urethral sphincter. Their function is to shrink
genital diaphragm, which is called external ure- internal urethral sphincter and relax bladder
thral sphincter. detrusor to store urine in bladder. The afferent
https://doi.org/10.1007/978-981-13-0812-3_17
482 17 Rehabilitation Therapy of Neurological Training of Sphincter Dysfunction
fiber is responsible for the conduction of blad- information: micturition center competi-
der algesia. tion and micturition information can
2. Pelvic nerve: The afferent fiber is responsible induce contraction of detrusor and inter-
for the conduction of sensation of bladder and nal urethral sphincter through pelvic
internal urethral sphincter. The efferent fiber nerve. Posterior urethra is broadened and
is from funiculus lateralis in S2–4 of spinal the resistance is decreased, which press
cord and belongs to parasympathetic nerve. urine in to posterior urethra.
They mainly innervate bladder detrusor and (b) Afferent and efferent information of para-
urethral sphincter to shrink detrusor and relax sympathetic nerve: Afferent information:
urethral sphincter in order to expel urine and urine enters into posterior urethra and
empty bladder. stimulates receptor. Impulse information
3. Pudendal nerve: The afferent fiber is responsi- enters into micturition center of spinal
ble for the conduction of urethral sensation cord through pelvic nerve. The informa-
including algesia. The efferent fiber is from tion is integrated in spinal micturition
anterior horn motor neuron in S2–4 of spinal center and give out information to inhibit
cord and belongs to somatic nerve to innervate anterior horn cells located in S2–4. Tonic
external urethral sphincter and striated muscle efferent impulse of pudendal nerve
of perineum. Its function is to shrink external decreases and external urethral sphincter
urethral sphincter and stop bladder micturi- relaxes, which expel out urine through
tion. During micturition, catatonic excitement urethra.
of pudendal nerve is inhibited to weaken tonic- After transverse injury of inferior spinal
ity of external urethral sphincter. Urine is cord, detrusor relaxes in the beginning, blad-
driven by detrusor and flow out through der dilates, micturition reflex disappears and
relaxed urethra. During micturition, people urine is in bladder. However, if there is com-
can excite it consciously at any time and shrink plete neural connection between micturition
external urethral sphincter to stop micturition. center of sacrum and bladder and urethra,
After stopping micturition, this nerve can micturition reflex can be recovered and there
recover catatonic excitement to maintain tonic is frequent micturition [2]. One hundred and
contraction of external urethral sphincter. fifty milliliter urine in bladder can induce mic-
4. Micturition reflex: Primary irritation of mictu- turition, but cannot be expelled out. During
rition is from dilated bladder. The stretch micturition, there is no micturition desire and
receptor in bladder wall is stretched to gener- the patients cannot control micturition at will,
ate distention. With the increase of urine vol- which is called uroclepsia. Therefore, plenty
ume, stretch tension is increased and distention of urine reservoir and complete evacuation in
becomes stronger. In addition, hyperinflation bladder, micturition desire and voluntary con-
and contraction of bladder can stimulate blad- trol of micturition are all controlled by higher
der algesia ending to induce pain, micturition center in the brain.
reflex, bladder evacuation, uncomfortable 5. The regulation of micturition by brain and
feelings such as distention and pain. voluntary movement in micturition.
Basic reflex center of micturition is located Detrusor contraction enhances the stimula-
in spinal cord is composed of two associated tion of interoceptor in bladder and urine
reflex movements. enhances the stimulation of interoceptor in
(a) Afferent and efferent information of sym- posterior urethra. Impulse is conducted into
pathetic nerve: Afferent information: sen- spinal through pelvic nerve, hypogastric nerve
sory impulse information of bladder and pudendal nerve, and then is projected to
distention is introduced into micturition brain through spinothalamic tract and thala-
center located in lateral column of S2–4 of mus. It is the conduction pathway of voluntary
spinal cord through pelvic nerve. Efferent movement in micturition [3].
17.1 Micturition Dysfunction 483
Micturition process is inhibited voluntarily increases, people sweat more and urine
by brain cortex. If the situation is improper, volume decreases.
people can suppress the urine. Human can (c) Micturition habit: micturition time is
suppress urine to 600 mL without pain and related to work and rest time such as mic-
can suppress urine to 800 mL painfully. turition when getting bed and before
During micturition, human can shrink external sleep. If the micturition gesture or mictu-
urethral sphincter and perineum muscles at rition environment is not proper, they will
will to close posterior urethra, inhibit micturi- influence micturition movement.
tion reflex induced by stimulation of posterior (d) Therapeutic factors: diuretic can increase
urethra by urine, push urine back to bladder urine volume. Anesthetic in surgery and
and relax bladder detrusor gradually. pain after surgery can lead to retention of
However, inhibitory area of micturition urine.
cannot be located in brain exactly. Its down- (e) Diseases: Disturbance of consciousness
ward pathways are corticospinal tract and of neural conduction and control induced
extrapyramidal pathway. It can inhibit mictu- by damage of nervous system can lead to
rition center in spinal cord and excitability of urinary incontinence. Kidney disease can
motor neuron to inhibit micturition. lead to dyspoiesis of urine, oliguria or
Cerebral function of children is not devel- anuria. Lithiasis in urinary system, tumor,
oped well so that the inhibitory effect on basic stenosis can lead to tract disturbance of
micturition center is weak. Therefore, there is micturition, even retention of urine.
micturition frequency. There is usually enure- (f) Psychological factors: emotion changes
sis at night, even urinary incontinence. For the such as tension, anxiety and fear can lead
adult in coma or old people with cerebral to frequent micturition, urgent urination
hypofunction, they are easy to have urinary or retention of urine because of inhibition
incontinence. of micturition. Implication can also influ-
6. The factors of micturition: There are many ence micturition. Auditory sense, visual
factors to influence micturition such as age, sense and sensory irritation of other parts
weather and habit. can induce micturition.
(a) Age and gender: Micturition in baby is
a reflex movement and cannot be con-
trolled consciously. After 3 years old, 17.1.2 Classification of Micturition
they can control it by themselves. For Dysfunction
old people, there is usually frequent
micturition because of bladder tension Traditional neurogenic bladder is divided into
decrease. Benign prostatic hyperplasia sensory paralytic bladder, motor paralytic blad-
in old male can oppress urethra and lead der, reflex bladder and uninhibited bladder. At
to urine drip and micturition difficulty. present, the classification can be done according
In the menstrual period and gestation to the combination of urodynamics with the func-
period, micturition morphology is tions of bladder and urethra.
changed.
(b) Diet and weather: if there are a lot of 1. Superexcitation type of detrusor and sphincter:
water in food or people drink a lot of Sphincter excitation usually lead to big blad-
water, urine volume can increase. Diuretic der volume. Meanwhile, detrusor excitation
action of coffee, tea and alcohol can can male urine flow out when there is a certain
increase urine volume. More sodium salt urine volume in bladder, which is called over-
in food can lead to water and sodium flowing urinary incontinence (reflex bladder).
retention and decrease urine volume. If 2. The type of detrusor excitation and sphincter
the temperature is high, respiration rate relaxation: the urine cannot be stored in
ladder and the ability of storing urine

b the filling process of bladder, people have the
decreases, which lead to small bladder, even feeling of micturition when the urine volume
contracted bladder. is 100–200 mL. The total bladder volume is
3. The type of detrusor relaxation and sphincter 400–500 mL. People can control micturition
excitation: Dysuresia lead to big bladder vol- at will.
ume or retention of urine. High tension in 3. Urethral pressure distribution: major parame-
bladder leads to increase of urethral pressure. ters include maximum urethral occlusion
Long-term pressure increase can lead to pyel- pressure: The normal is 50–130 cm/H2O (60–
ectasis and hydronephrosis. When it is severe, 70 cm H2O in female). Functional urethral
it can damage kidney function. This type is length is 5.4 ± 0.8 cm in male and 3.7 ± 0.5 cm
also called motor paralytic bladder. in female.
4. Relaxation type of detrusor and sphincter: This Sphincter electromyography: Surface elec-
type is called uninhibited bladder. Cerebral cor- trode can be inserted into anus to test the myo-
tex lesion makes spinal micturition center electric activity signal of sphincter ani. Pin
break away from inhibition of cerebral cortex electrode can be directly inserted into external
center, which can lead to uninhibited bladder. urethral sphincter through perineum to record
Lesion is located in paracentral lobule of two electromyographic signal of external urethral
hemispheres or its descending tractus pyrami- sphincter. People should know the coordina-
dalis. The main clinical manifestations are fre- tion movement of external urethral sphincter
quent micturition, urgent urination, small urine during detrusor contraction.
amounts every time and urinary incontinence. 4. In the filling period of bladder of the normal
This type is difficult to be treated. micturition cycle, external urethral sphincter is
activated continuously and the myoelectric
activity is stopped during micturition. After
17.1.3 Assessment Method micturition, myoelectric activity reappears.
of Micturition Dysfunction Abnormal conditions include: when detrusor
shrinks, electromyographic signal of sphincter
Urodynamics is the important method to assess is enhanced at the same time, which demon-
bladder function. Hydromechanics, electrophysi- strates that the coordination movement between
ology and neurophysiology are used to assess detrusor and sphincter is lost. During the filling
bladder function [4]. period of bladder, electromyographic signal of
sphincter suddenly disappears, which means
1. Urine flow rate: The exhaust urine volume in there is involuntary urine leakage in bladder.
unit time (mL/s). It is the manifestation of the 5. Urodynamics, B ultrasonic or X-ray: diluted
interaction between detrusor and urethral iodine solution is used to replace saline to ful-
sphincter during micturition, which is the total fill bladder for understanding the morphology
function condition of lower urinary tract. Major of urodynamics, bladder and urethra in the
parameters include maximum urine flow rate, urodynamics test.
urine flow time and urine volume. Urine flow
rate is affected by gender, age and micturition.
2. Bladder pressure-volume includes bladder
17.1.4 Rehabilitation Therapy
pressure, rectum pressure (abdominal pres- of Micturition Dysfunction
sure) and detrusor pressure (bladder pressure
minus rectum pressure). Normal pressure- 17.1.4.1 T he Main Purpose
volume: There is no residual urine. Internal of Rehabilitation Training
pressure is maintained at 5–15 cm H2O in fill- of Micturition Dysfunction
ing period of bladder with good elasticity. The main purpose of rehabilitation training is to
There is no uninhibited contraction. During recover voluntary skeletal muscles dominated by
motor center in brain cortex, including external In addition, defecation and micturition time
urethral sphincter, urethrovaginal sphincter mus- overlap. External urethral sphincter and pelvic
cle and musculus sphincter ani externus. Reflex floor muscle are called spring bed of pelvic floor.
center of involuntary muscles such as internal They are like a net to support pelvic organs such
urethral sphincter and musculus sphincter ani as bladder, uterus and rectum. The muscles can
internus is located in spinal cord just as that of control micturition, defecation and compressicity
patellar tendon reflex and Achilles tendon reflex. of vagina. Therefore, male can use sphincter ani
They all belong to lower neural center. In most signal and female can use sphincter vaginae sig-
cases of micturition and defecation dysfunctions, nal or sphincter ani signal to replace external ure-
this center is not injured. Therefore, recovering thral sphincter signal for neurological training.
the function of involuntary muscles is the funda- During training, the patients are guided to con-
mental measure and ultimate rehabilitation goal centrate on the contraction and relaxation of ure-
of recovering functions of defecation and thral sphincter.
micturition.
Although there are different nerves to domi- 17.1.4.2 Therapeutic Principle
nate micturition and defecation, the two pro- Rehabilitation therapeutic principle of micturi-
cesses can be controlled separately. There is close tion dysfunction is to keep the bladder volume at
relationship between the two processes. For 300–500 mL through recovering autonomous
example, defecation is easy to induce micturi- contraction of external urethral sphincter and
tion. Because the reception of signal of external recovering coordination movement of bladder
urethral sphincter is difficult through skin surface detrusor and sphincter in case of urinary inconti-
electrode, for the male with long urethra, internal nence, retention of urine and urinary system
electrode is hard to be placed exactly and is easy infection.
to induce injury of urethral mucosa.
Urethral sphincter, sphincter vaginae and 17.1.4.3 Rehabilitation Training
sphincter ani of perineum belong to pelvic floor Methods
muscles and are controlled by pudendal nerve. Rehabilitation training method of micturition
The perineum is generally defined as the sur- dysfunction includes rehabilitation training
face region in both males and females between method of neurological training, the common
the pubic symphysis and the coccyx. The rehabilitation training method and electrical
perineum is below the pelvic diaphragm and stimulation.
between the legs. It is a diamond-shaped area
that includes the anus and, in females, the 1. Rehabilitation therapy of neurological train-
vagina. Its definition varies: it can refer to only ing of external sphincter dysfunction: Six-step
the superficial structures in this region, or it can Daoyin technique combined with biofeedback
be used to include both superficial and deep is used for the training of external sphincter,
structures. The perineum corresponds to the development of neural potential of external
outlet of the pelvis. There is urogenital muscles sphincter to recover voluntary self-control
to seal foramen of pelvic diaphragm, enhance ability of external urethral sphincter.
pelvic floor and perineal central tendon such as Main and collateral channels of six-step
superficial transverse muscle of perineum, Daoyin technique of guiding collaterals
ischiocavernosus, bulbocavernosus muscle, through meridians is Ren channel (Fig. 17.1).
deep transverse muscle of perineum, external Ren channel is on the center of chest and
urethral sphincter around urethral membrane. abdomen. The top is chin. It can regulate Qi of
In female, urethral sphincter is around vagina, Yin channel in the whole body. The pathway
which is called urethrovaginal sphincter mus- of regulation of mind with six-step Daoyin
cle. Urethral sphincter contractions can crimple technique is that Qi from Chengqi goes down
urethra and vagina. along anterior middle line of the trunk through

of Ren channel
chéng jiang
Liánquán CV23
Tiantu CV22
Xuánji CV21
Yùtáng CV18
Zigiong CV19
Huágài CV20
Dànzhong CV17
Zhongting CV16
Jiuwei CV15
Jùquè CV14
Shàngwan CV13
Zhongwan CV12
Jiànli CV11
Xiàwan CV10
Shuifen CV9
Shénquè CV8
Yinjiao CV7
Qihai CV6
Shìmén CV5
Guanyuán CV4
Zhongjí CV3
Qugu CV2
Huìyin CV1
conceptional vessel
Chengjiang and reach Huiyin through Xuanji,

Tanzhong, Jiuwei, Zhongwan, Yinjiao and Head
Qugu to stimulate the contraction and relax-
ation training of urethral sphincter.
(a) Bare hand training of external sphincter: Body
Before therapy, the patients should defe-
cate. The patients are in knee-chest posi-
tion, separate two legs to expose anus. The Tail
therapists wear sterilized gloves, use
thumb and index finger of left hand to Fixture Belt
separate anus akin, insert index finger of Plastic Fixture
right hand with liquid paraffin into anus Plate
and extend around to relax sphincter ani.

After that, the therapists insert sterilized
anus training probe with liquid paraffin
into anus slowly (Fig. 17.2). The patients Fig. 17.2 Sketch map of training probe of sphincter ani
are help to lie in lateral position for the
training. mind and breathing. The patients are asked
The training is divided into two proce- to concentrate on external urethral sphincter.
dures. Contraction training: the therapist The specific method is to shrink urethra.
should use normal of six-step Daoyin tech- After deep inspiration, the patients are
nique of guiding collaterals through merid- asked to try to shrink urethra and clamp
ians to guide the patients after regulation of anus training probe for 6 s. After that, the
patients take a deep breath and expire

slowly. The ratio between inspiration time
and expiration time is 1–2. Relaxation
training: after regulation of mind and
breathing, the therapists guide the patients
to concentrate on external urethral sphincter.
After taking a deep breath, the patients try
to adjust body and mind. During the process
of relaxing external urethral sphincter, the
patients relax musculus sphincter ani
externus for 6 s. After taking a deep breath,
the patients expire slowly. The ratio between
inspiration time and expiration time is 1–2.
Contraction training and relaxation train- Fig. 17.4 Training position of sphincter ani of neurologi-
ing is done alternatively and repeatedly. cal training
and there are 30 times in one therapy course.
The patients can do multiple therapy courses. The training is divided into two procedures.

(b) Rehabilitation training of neurological Contraction training: After regulation of mind
training of external sphincter: Before and breathing, the therapists guide the patients
therapy, the patients should defecate. to concentrate on external urethral sphincter.
Signal reception probe of neurological The specific method is to shrink urethra. After
training is inserted into anus (Fig. 17.3). taking a deep inspiration, the patients are
The operational approach is the same as guided to try to shrink urethra and anus. The
the mentioned above. The patients are in patients are asked to stare at the signal curve
lateral position or knee-chest position on the screen to increase signal intensity for
(Fig. 17.4). Reception electrode is 6 s. After that, the patients take a deep
connected with the first lead of neurological inspiration and expire slowly. The ratio
training device. Motor program signal of between inspiration time and expiration time
sphincter ani from central nervous system is 1–2. Signal intensity of the first time is the
is displayed in single screen and the baseline (Fig. 17.5) and is used as surpassing
training can be started. target. In the next training, the patients are
guided to make signal intensity surpass the
previous time (Fig. 17.6). The rest can be done
in the same manner. Relaxation training: if the
Head
patients have external urethral sphincter
spasm, the signal intensity is stronger than
Body
that of baseline and cannot be reduced to zero.
The patients can do this training. After
Electroplate
regulation of mind and breathing, the thera-
Tail pists guide the patients to concentrate on sig-
Fixture Belt nal curve on screen. After taking a deep
Plastic Fixture inspiration, the patients are guided to regulate
Plate body and mind to relax external urethral
sphincter and musculus sphincter ani externus
in order to decrease curve for 6 s. After that,
Fig. 17.3 Sketch map of sphincter ani used for neuro- the patients take a deep inspiration and expire
logical training slowly. The ratio between inspiration time and
time is 25 min (once a day) and there are 30

times in one therapy course. The patients can
do multiple therapy courses.
(c) Virtual reality training of neurological

training: Before, the patients should defe-
cate. Training probe of sphincter ani is
inserted into anus. The patients lie in lat-
eral position or knee-chest position. The
placement of training probe and training
method are the same as these of rehabilita-
tion training of neurological training of
external sphincter. The only difference is
virtual reality training device.
The training time and therapy course: dou-
ble training of contraction and relaxation: The
Fig. 17.5 The signal is zero at the beginning of training
training time is 50 min (once a day) and there
are 30 times in one therapy course. The
patients can do multiple therapy courses.
Single training of contraction: The training
time is 25 min (once a day) and there are 30
times in one therapy course. The patients can
do multiple therapy courses.
Every week, neurological training device is
used to detect the signal of external urethral
sphincter to know the actual therapeutic effect
and instruct therapeutic schedule.
(d) Self-exercise method of pelvic floor mus-
cles: the patients who received rehabilita-
Fig. 17.6 The surpassing goal is the signal intensity tion training of neurological training of
of the previous time external urethral sphincter in rehabilita-
tion department of hospital are already
expiration time is 1–2. Contraction training know the method of training active move-
and relaxation training is done alternatively. If ment of external urethral sphincter with
there is no external urethral sphincter spasm in Daoyin technique and are impressed by
the patients, the patients can merely do the relationship between contraction and
contraction training. Contraction training can signal line. After discharge or during the
enhance the training feeling and is good for therapy internal, the patients can do self-
the effect. In addition, recovering active exercise of external urethral sphincter. On
contraction function of muscles is the premise the basis of regulation of mind and breath-
and basis of active relaxation of muscles. ing, the patients shrink external urethral
The method of guiding collaterals through sphincter and imagine the signal curve
meridians can be used for the training. change in the previous therapy course for
The training time and therapy course: dou- 6 s. During the training, training probe
ble training of contraction and relaxation: The can be placed in anus to consolidate
training time is 50 min (once a day) and there therapeutic effect.
are 30 times in one therapy course. The The time of self-exercise is 30 min and
patients can do multiple therapy courses. there are 2–3 times a day. The patients can
Single training of contraction: The training do it for a long time.
(e) Acupuncture therapy: Acupuncture can Because there is tolerance in electrical

treat difficult urination or urinary inconti- stimulation, the therapists should increase
nence. The therapists can select Huiyin of electrical stimulation parameter in the thera-
Ren channel. Huiyin is located at the mid- peutic process to achieve better effect. The
point between scrotum root and anus in increased range should be 1–5%.
males. In females, it is located at the inter- Similarly, electrical stimulation is passive. In
section of the midpoint of labium majus the early phase of disease, it can activate undead
pudenda posterior commissure and anus. cells in injured area and promote functional
The therapy frequency is once a day recovery of shock cells, which has a certain
and there are 15 time in one therapy course. therapeutic effect. In the late phase of disease,
2.
Other rehabilitation therapeutic methods electrical stimulation can increase excitability
include biofeedback therapy and clean ure- of muscles, but it is not active movement so that
thral catheterization technique. it cannot develop central neural potential and
(a) Electromyographic biofeedback therapy: the therapeutic effect is poor.
biofeedback therapy is that through gather- The training time is 20–30 min (once a
ing electromyographic signal of musculus day) and there are 15 times in one therapy
sphincter ani externus, when signal inten- course.
sity cannot reach contraction threshold, the (c) Timing and quantitative drinking water
major processor of biofeedback therapy and timing micturition: The drinking
device in pelvic floor can change into stim- water volume is 400 mL every time and
ulation mode automatically to stimulate the patients should urinate 2–4 h after
nervous system intermittently through reg- drinking water.
ulation technique of micro-current in order (d) Clean catheterization technique: Clean

to make motor neurons generate action catheterization is also called intermittent
potential. The action potential is conducted catheterization. Non-medical staffs such
to muscular tissue and the contraction as the patients, family or caregiver do
movement is completed [5]. Repeated catheterization method without indwell-
stimulation can decrease spasm of pelvic ing catheter to prevent urinary system
floor muscles and recover autonomous infection, decrease the dependence of the
contraction function. patients on medical staffs and increase
However, because the electrical stimula- life independence of the patients. It is
tion helps the patients to complete contraction widely applied abroad.
movement, the patients cannot try to develop Indications: the patients cannot urinate
central nerve potential by themselves and the autonomously or the patients can urinate
therapeutic effects may be affected. autonomously but the micturition is not suffi-
The training time is 20–30 min (once a cient (residual urine exceeds 80–100 mL). The
day) and there are 15 times in one therapy patients with spinal cord injury or other neural
course. paralysis are conscious and can cooperate
(b) Electrical stimulation therapy: in the elec- with therapy actively.
trical stimulation therapy of pelvic floor Contraindications: the patients with
muscles, according to specific condition, severe urethral injury, infection or urethral
the therapists choose proper electrical pressure sores; the patients with uncon-
stimulation schedule and tome. The sciousness or who don’t cooperate with the
patients should tolerate the electrical therapy; the patients who are receiving a
intensity and don’t feel painful. If the great quantity transfusion; the patients with
patients are not sensitive to electrical general infection or extremely low immu-
stimulation, the therapists cannot increase nity; the patients with notable bleeding ten-
electrical intensity blindly, but should dency; the patients with notable prostatic
increase pulsative index. hyperplasia or tumor.
Specific operation: the minimum catheter (e) Bladder control training: bladder control
or specific catheter with enough length is cho- training is used for rehabilitation training
sen and the procedures are as follows: 0.9% of the patients with upper motor neuron
sodium chloride solution or other medical dis- injury syndrome accompanied with blad-
infectant without mucosa irritation such as der dysfunction.
benzalkonium bromide is used to wash cathe- Indications: it is used for the patients with
ter for preparation. Soap or cleaning solution is upper motor neuron injury syndrome accom-
used to wash the patients’ perineum and the panied with bladder dysfunction including
operators wash their hands. The patients hold spinal cord injury, stroke and cerebral trauma.
the catheter and insert it into slowly until urine When the patients’ hand function is well, the
flows out from catheter. For male patients, the patients can do it by themselves or it can be
therapists should make urethra orifice towards completed by caregivers with active coopera-
abdomen in case of urethral isthmus injury. tion of the patients.
Before insertion, the outer surface of catheter Contraindications: the patients with uncon-
should be smeared with lubricating oil such as sciousness or who don’t cooperate with the
paroline to reduce resistance. After completing therapy; the patients with severe bladder or
catheterization, the catheter should be removed urinary infection; the patients with notable
immediately. The catheter should be washed prostatic hyperplasia or tumor.
with clean water and then is put into medical Specific methods: bladder sphincter control
disinfectant without mucosa irritation or 0.9% training: the patients usually use exercise
sodium chloride solution. It can also be disin- method of pelvic floor muscles to shrink
fected with boiling method. Frequency of utili- sphincter ani actively for ten times (10 s per
zation: if the patients cannot urinate time). The training can be done 3–5 times a day.
autonomously, catheterization can be used 3–4 Micturition reflex training: the patients can find
times every day. If the patients can urinate par- out or induce trigger point and use reflex
tially, catheterization can be used 1–2 times mechanism to induce detrusor contraction and
every day. Urine volume after every catheter- promote active micturition. The common trigger
ization is about 400 mL (physiological bladder points of micturition reflex are tapping
volume). If residual urine volume is less than suprapubic area, pulling pubes, rubbing inner
80–100 mL, the catheterization is stopped. thigh or squeezing penis and glans penis. The
If the patients can urinate more than patients can use auxiliary measures such as
100 mL between two catheterizations and listening to bicker, hot drinks and lukewarm
residual urine volume is 300 mL or less, the bath. Tapping should be soft and quick in case
catheterization can be used once 8 h. If the of heavy tapping. Heavy tapping can induce
patients can urinate more than 200 mL bladder and urethra dysfunction or bladder
between two catheterizations and residual mucosal hemorrhage. The tapping frequency is
urine volume is less than 200 mL, the cathe- 50–100 times per min. The total tapping number
terization can be used once half a day. If the is 100–500. Reflexive micturition usually can
residual urine volume is less than 80–100 mL, be recovered in higher spinal cord injury. The
the catheterization should be stopped. therapists use hand to stimulate rectum. The
Precautions: the patients should drink electrical stimulation is used. The acupuncture
water on time and quantitatively, urinate on points of the first group include Sanyinjiao,
time can choose proper catheterization time. Shenyu, Weiyang and Xiajiaoyu. The second
The patients drink water that is less than group is Shuidao. The two groups are used
2000 mL every day and the urine volume alternatively. High-frequency modulated
should be maintained at 800–1000 mL/day. impulse electricity is used for the therapy.
When the catheter is inserted, the movement (f) Compensatory micturition training: the
should be gentle. The catheter cannot be patients use manipulation and increasing
inserted violently in case of urethral injury. abdominal pressure to promote micturition.
Valsalva method: the patients are in sitting (g) Disposition of lithangiuria: Bladder stone
position, relax abdomen, incline body, is usually observed in paraplegic patients.
hold the breath for 10–12 s, use force to The forming reason is related to infection
make abdominal pressure reach to bladder, and micturition difficulty.
rectum and pelvic floor, flex hip joint and Therapeutic principle: upper urinary tract
knee joint to make thigh close to abdomen calculi: extracortoreal shock wave lithotripsy
in order to prevent abdominal bulge and percutaneous pyeloscope calculus removed.
increase abdominal pressure to help urine Bladder stone: cystoscope is used for electric
flow out. Credè manipulation: the patients hydraulic broken stone. A few patients require
put two thumbs on crista iliaca, put other calculus removed by surgery. Medicine:
fingers on the top of bladder (below the Cholinergic preparations such as carbamoyl
navel), press inward and downward methylcholine (40–100 mg/day) can increase
gradually. The patients can also use fist to detrusor tension and promote bladder contrac-
press from umbilical region to pubis, but tion, which can be used to treat detrusor relax-
compression should be slow and gentle in ation. Anticholinergic drug such as atropine
case of compression on the pubis with can decrease detrusor tension, promote blad-
violence. If bladder pressure is too high, der contraction and sphincter tension, which
the bladder may be injured or urine may can be used for the patients with bladder
flow back to kidney. The control training of spasm. Baclofen can be also used to inhibit
intake and output water volume: the system bladder spasm. Sphincter relaxant: α adrener-
of timing and quantitative drinking water gic agents and β receptor stimulant such as
and timing micturition should be ephedrine (25–100 mg/day) can be used to
established, which is the basic measures of increase sphincter tension.
bladder training. Because the physiological (h) Bacteriuria and urinary system infection:
bladder volume is about 400 mL, water Bacteriuria and urinary system infection
intake volume is 400–450 mL to make are the common complications of the
bladder volume reach about patients with spinal cord injury. Bacteriuria
400 mL. Interval time between drinking and urinary system infection can also be
water and micturition is usually 1–2 h and observed in the old patients who are older
is related to body position and temperature. than 65 (10–25%) and the patients who
When the patients are in clinostatism and receive home nursing (25–40%). If there
the temperature is low, interval time of is no symptom in the patients with bacteri-
micturition is short. Otherwise, the interval uria, antibiotic therapy is not required and
time is long. The total urine volume is preventive use is not advocated.
800–1000 mL every day. If there are symptoms in the patients with
Considerations: when the patients start urinary system infection, the therapists should
training, the therapists should watch bladder ascertain bacterial species and sensitive
residual volume to avoid retention of urine. The medicine in urine culture and use powerful
therapists should avoid that bladder overfilling antibiotics intravenously. Four hundred
or manipulation compression induces urine milliliter normal saline is used to wash bladder
backflow. The appearance of bladder reflex for 10–15 min. During the therapy, there is
requires a certain time. The training should be slight tremor in bladder area of lower
step by step. Especially, the therapists should abdomen, which is good for eliminating
explain the training to the patients and their precipitates and infectious materials.
family. When the patients are accompanied (i) Surgery: According to bladder dysfunc-
with spasm, there is close relationship between tion, sacral posterior rhizotomy, transure-
bladder evacuation and convulsive seizure. The thral resection of the bladder neck, Y-V
therapists should the relationship between bladder cervicoplasty and artificial sphinc-
micturition and relieving muscle spasm. ter implantation are used in clinic.
17.2 The Mechanism defecation reflex, stop excretion, induce colon

of Defecation Dysfunctions anastalsis and make faeces return to colon
descendens and colon transversum. After a period
17.2.1 The Process of Forming of time, faeces in rectum can return to colon sig-
Defecation Reflex moideum and colon descendens under the pres-
sure of colon peristalsis and then induce the next
17.2.1.1 Faeces Reaction defecation reflex.
Before inducing defecation reflex, there is faeces Colon anastalsis is a protective mechanism to
reaction. prevent excretion in improper time. If people
After eating, the food are digested and assimi- frequently inhibit desire to defecate, the stimulation
lated by stomach and intestinal tract. sensitivity of rectum to faeces is decreased. The
Unassimilated residue form faeces and enter into induction of defecation reflex is difficult. Faeces
colon to stimulate colon peristalsis and stays in large intestine for a long time and becomes
contraction so that faeces is pushed to distal hard and dry because of water hyperabsorption,
colon. This kind of peristalsis is started from which can induce difficult defecation and is one of
hepatic flexure and is pushed to (2–3 time a day the causes of constipation. Therefore, people
and 1–2 cm/min) left semi-colon until the faeces should defecate in definite time. Getting up in the
is left in colon sigmoideum. morning easily induces postural reflex and post
After eating or getting up in the morning, gas- jentaculum may induce gastrocolic reflex. Both can
trocolic reflex or body position easily induce promote the generation of colon peristalsis rush
colon peristalsis rush. Peristalsis rush can move and induce defecation reflex. Therefore, people
forward with the speed of 10 cm/h and the pro- should defecate in the morning or after breakfast,
pulsive force is strong. It can push faeces stored which can prevent diseases of anal tube and rectum.
in colon sigmoideum into rectum. When faeces
reaches a certain quantities (about 300 g) in rec-
tum, it can generate great pressure on intestinal 17.2.2 Pathogenesis
wall and induce defecation reflex. and Classification
of Defecation Dysfunctions
17.2.1.2 Defecation Reflex
When the rectum is full of faeces, it can stimulate Defecation dysfunctions include constipation and
receptor in intestinal wall and impulse is con- incontinence of feces. Constipation is usually
ducted into lower defecation center in sacral observed in the patients with intestinal motility
cord. Meanwhile, impulse is transmitted into disorder to varying degrees after spinal cord injury.
cerebral cortex and generate desire to defecate. Incontinence of feces usually is induced by central
Cortex gives out impulse to enhance the excit- nervous system diseases, sphincter injury and
ability of defecation center and generate defeca- intestinal system disease. The most common
tion reflex. Colon sigmoideum and rectum complications are perineum, inflammatory change
contract and sphincter ani relax. The patients can of sacrococcygeal region and perianal skin. There
increase thoracic pressure consciously, lower dia- are retrograde urinary tract infection, kysthitis,
gram, shrink abdominal muscles to increase skin red and swollen and skin fester in some
abdominal pressure to discharge faeces out of the patients [6]. All these are induced by stimulation
body through anus. of skin by faeces. If they are not handled properly,
If the surroundings is not proper, impulse they can induce retrograde urinary tract infection
from hypogastric nerve and pudendal nerve or kysthitis through urethra.
induces external sphincter of anal tube contrac-
tion to stop excretion. Because compression 17.2.2.1 Constipation
force of external sphincter is 30–60% stronger 1. The definition of constipation: Constipation
than that of internal sphincter, it can antagonize means that excretion time is decreased but
17.2 The Mechanism of Defecation Dysfunctions 493
faeces is hard and dry, which is difficult to (c) Long-term constipation complications:
defecate. If there are two or more symptoms, Long-term constipation may lead to
it can be diagnosed as symptomatic constipa- abdominal distention, abdominal pain,
tion. If the disease history is more than lacking in strength and loss of appetite.
6 months, it can be diagnosed as chronic Long-term lying in bed may slow intesti-
constipation. nal peristalsis and induce dry stool, which
Constipation is rectum dysfunction induced can induce constipation. The early mani-
by neurogenic rectum (neurogenic bowel). festation of constipation is hyperactive
The injury of central nerve that control rectum bowel sounds to promote defecation. In
function or peripheral nerve can induce con- the late phase, intestinal muscular fatigue
stipation. The patients with fecal incontinence leads to hypoactive bowel sounds.
are rare. 3. The cause for judgement or assessment of

The manifestation of constipation is defe- constipation: There are many methods to
cation frequency decrease. The patients usu- judge or assess the cause and degree of
ally defecate once in 2–3 days or more time constipation.
(defecation time is less than three times a (a) Sphincter ani tension examination: Digital
week), which is called constipation. The fae- rectal examination is used to determine
ces are half molded or sausage-like. Therefore, the function of sphincter ani. The sensa-
the doctors can make a correct diagnosis tion of anus and perineal region can helps
according to the characteristic of faeces, indi- to ascertain the level of neural injury and
vidual defecation habit and defecation injury degree. Bulboanal reflex is used to
difficulty. judge whether there is spinal shock or not.
2. Cardinal symptoms of constipation include
(b) Rectum touch: There is anus relaxation in
lack of desire to defecate, abdominal disten- complete incontinence. When the patients
sion, abdominal pain, lacking in strength and shrink anal tube, the contraction of
loss of appetite. All these symptoms are sphincter ani and anorectal circular mus-
related to the following causes. cle is not obvious or completely disap-
(a) Sphincter ani spasm and lack of desire to pear. In incomplete incontinence,
defecate: Most patients are lack of desire contractility of sphincter ani weakens.
to defecate who are with abnormal defe- (c) Splanchnoscopy is used to watch defor-
cation autonomic regulation and sphincter mity of anal tube, morphology of skin
ani spasm, which can lead to intestinal mucosa in anal tube and anal occlusion.
peristalsis evacuation disorder and Fiber enteroscopy can be used for coloni-
increase defecation resistance. Faeces tis, Crohn’s disease, polyp and cancer.
stay in large intestine for a long time and (d) Defecography (DFG): Contrast medium
become hard and dry because of water is injected into rectum and is expelled in
hyperabsorption. defecation. Combined with anorectal
(b) Neural injury and defecation motility dis- dynamic and static examination, it can
order: in spinal shock, the early phase of show the functional and pathological dis-
cerebral injury and perineal nerves injury, ease in anorectal area and provide the
defecation motility disorder make faeces basis of diagnosis and therapeutic method
in intestinal tract for a long time and of clinical constipation.
induce constipation. If the constipation is (e) Anal manometry: The pressure of inter-
accompanied with sphincter ani inconti- nal, external sphincter and puborectalis
nence and intestinal tract irritation such as muscle should be examined. The thera-
infection or injury, there may be fecal pists should know anorectal inhibition
incontinence. reflex, anorectal basic pressure, contrac-
tion pressure and rectal distention toler- (c) Anal trauma is mainly sphincter injury,
ance capacity. Basic pressure and which is usually observed in anorectal
contraction pressure of anal tube in the surgery and birth injury, especially high
incontinence patients decrease. Internal anal fistula surgery. In addition, when the
sphincter reflex disappears and rectum surgeries of internal hemorrhoids, anal
distention tolerance capacity decreases. fissure, rectal prolapse and rectal tumor
(f) Electromyography measurement can be are not handled properly, or the tissue of
used to measure envelop of sphincter anal tube is suffered with external vio-
function and assess voluntary muscles, lence, medicine injection, burn and cold
involuntary muscles, their neural injury injury, all these can lead to sphincter ani
and recovery degree. injury and then induce incontinence of
(g) Ultrasonic inspection of anal tube can
feces.
show anorectal submucosa, internal and (d) Anorectal congenital malformation is one
external sphincter, and peripheral tissue of the causes for incontinence of feces.
clearly, which is good for injury degree of 2. The classification of incontinence of feces: The
incontinence of feces and sphincter. classification is according to incontinence
degree, severity and pathological lesion degree.
17.2.2.2 Incontinence of Feces (a) Incontinence degree: complete inconti-
If the patients are in clear consciousness, incon- nence: the patients cannot control defeca-
tinence of feces is that there is involuntary tion at will and the defecation time is not
exsufflation and loose stools. Incontinence of definite. If there is intestinal peristalsis,
feces is one of the symptoms of defecation faeces flows out of anus, even in cough,
dysfunction. The patients lose control of squatting, walking or sleeping. Incomplete
exsufflation and defecation. If it is not handled incontinence: if the faeces is wishy-washy
properly, it is easy to induce complication, and cannot be controlled, there may be
cause pain in body and spirit and influence life incontinence. Otherwise, there is no con-
quality [7]. tinence. Sensory incontinence: if faeces is
wishy-washy and the movement is slow
1. Pathogenesis of incontinence of feces: The before defecation, faeces may flow out
common causes of incontinence of feces are unconsciously.
nervous system diseases, sphincter injuries (b) Severity:
and intestinal system diseases [8]. –– First degree: Faeces flow out by acci-
(a) Nervous system diseases such as central dent and involuntarily.
nervous system diseases, spinal and sacral –– Second degree: the patients cannot
nerve injuries, infection, spinal cord control faeces. Faeces usually flow out
tumor, tractive injury of pudendal nerve in the incontinence patients accompa-
and anorectal neural dysfunction nied with exsufflation.
(b) The diseases of anal tube, rectum and –– Third degree: the patients are with
colon are usually observed in the complete incontinence. The patients
patients with rectum tumor and inflam- cannot control defecation and exsuf-
matory diseases. Tumor can infiltrate flation voluntarily. Faeces flow out
and destroy sphincter. Inflammatory involuntarily. During sleeping, faeces
diseases such as ulcerative colitis and are expelled.
Crohn’s disease can induce rectal (c) Pathological lesion degree: both internal
inflammation and lead to long-term sphincter and puborectalis muscle are
diarrhea. Complete rectal prolapse can injured, which can induce complete
lead to anal relaxation and the defeca- incontinence. Miopragia of external
tion control ability is lost. sphincter and puborectalis muscle can
induce stress incontinence. When abdom- Baihui point and then go downward to Suliao
inal pressure is suddenly increased such in apex nasi through forehead and nasal sep-
as cough or sneezing, there are loose tum. After passing through Renzhong, it
stools or liquid. reaches Yinjiao point (Fig. 17.7).
The pathway of regulation of mind in six-
step Daoyin technique: the method of guiding
17.2.3 Rehabilitation Therapy collaterals through meridians is used. The
of Defecation Dysfunctions idea of regulation of mind is started from the
endpoint of collaterals but not the starting
17.2.3.1 T he Main Purpose point of meridians. The patients are guided to
of Rehabilitation Training make mind from Yinjiao of Du channel to
The purpose is to recover voluntary movement Changqiang through Suliao, Shenting, Baihui,
and defecation control ability of musculus Dazhui, Zhiyang, Xuanshu, Yangguan and
sphincter ani externus, maintain regular defeca- Yaoshu. After regulation of breathing, the
tion, decrease persistence time of faeces in intes- patients do contraction and relaxation training
tinal tract, and prevent constipation, fecal of musculus sphincter ani externus.
incontinence and other complications. 2. Rehabilitation methods of constipation treated
by neurological training include bare hand
17.2.3.2 Therapeutic Principle training, Daoyin feedback method, electrical
The main principle of rehabilitation therapy of stimulation and self-exercise method.
defecation dysfunctions is to recover contraction (a) Bare hand training of musculus sphincter
function of musculus sphincter ani externus ani externus: Before therapy, the patients
through rehabilitation training, recover defeca- should defecate. The patients are in knee-
tion coordination movement and prevent fecal chest position, separate two legs to expose
incontinence, constipation and complications. perineum. The placement of anus probe is
the same as the previous segment. The
17.2.3.3 Rehabilitation Training patients are helped to lie in lateral position
Method of Neurological and to start the training. Contraction train-
Training ing: the therapist should use normal of
Rehabilitation training of defecation dysfunc- six-step Daoyin technique of guiding col-
tions includes rehabilitation training of constipa- laterals through meridians to guide the
tion and fecal incontinence. patients after regulation of mind and
breathing along with Du channel. The
1. Main and collateral channels of rehabilitation patients are asked to concentrate on mus-
training of defecation dysfunctions: Six-step culus sphincter ani externus. The specific
Daoyin technique or Daoyin feedback tech- method is to shrink anus. After deep inspi-
nique of guiding collaterals through meridians ration, the patients are asked to try to
is used for the training of musculus sphincter shrink musculus sphincter ani externus
ani externus to recover voluntary autonomous and clamp anus training probe for 6 s.
contraction ability. After that, the patients take a deep breath
Sphincter ani belongs to Du channel. Du and expire slowly. The ratio between
channel is started from uterus in abdomen, go inspiration time and expiration time is
out of perineum, move backward along with 1–2. Relaxation training: after regulation
the center of lumbar spinal cord to Changqiang of mind and breathing along with Du
in sacrococcygeal region. It goes upward channel, the therapists guide the patients
along with spinal cord to Fengfu through the to concentrate on musculus sphincter ani
back of neck and then enters into brain. It goes externus. After taking a deep breath, the
upward along with middle line of head to patients try to adjust body and mind to
relax anus for 6 s. After taking a deep externus. Before therapy, the patients
breath, the patients expire slowly. The should defecate. Signal reception probe of
ratio between inspiration time and expira- neurological training is inserted into anus.
tion time is 1–2. The contraction and The operational approach is the same as
relaxation training can be done the mentioned above. The patients are in
alternatively. lateral position or knee-chest position.
The training time is 30 min (once a Reception electrode is connected with the
day) and there are 30 time in one therapy first lead of neurological training device.
course. The patients can receive multiple Motor program signal of sphincter ani
therapy courses. from central nervous system is displayed
(b) Rehabilitation training of neurological
in single screen and the training can be
training of musculus sphincter ani started.
Baihui GV20
Taiyang bladder
channel of foot Xinhui GV22
Qiangjian Shéngting GV24

Naohu
Fengfu GV16
Yamen
Dàzhui GV14
Táodào GV13
Shenzhù GV12
Heart
Lingtái GV10 Shéndào GV11
Zhiyáng GV9 Jinsuo GV8

Zhongshu GV7 Jizhong GV6
Xuánshu GV5
Kidney
Mingmén GV4
Yaoyángguan GV3
Yaoshu GV2
Chángqiáng GV1
Huiyin CV1
Xinhui GV22
Shàngxing GV23
Shénting GV24
Duiduan
Yinjiao
Sùliáo GV25
Shuigou GV26
governor vessel
Fig. 17.7 Sketch map of Du channel

The training is divided into two proce- Single training of contraction: The training
dures. Contraction training: After regulation time is 30 min (once a day) and there are 30
of mind and breathing along with Du channel, times in one therapy course. The patients can
the therapists guide the patients to concen- do multiple therapy courses.
trate on musculus sphincter ani externus. The (c) Virtual reality training of neurological

specific method is to shrink anus. After taking training: Before therapy, the patients
a deep inspiration, the patients are guided to should defecate. Training probe of sphinc-
concentrate on signal curve on the screen but ter ani is inserted into anus. The patients
not to shrink urethra and sphincter ani. The are in lateral position or knee-chest posi-
patients are asked to increase the altitude of tion. The placement of training probe and
signal curve on the screen to increase signal training method are the same as these of
intensity for 6 s. After that, the patients take a rehabilitation training of neurological
deep inspiration and expire slowly. The ratio training of musculus sphincter ani exter-
between inspiration time and expiration time nus. The only difference is virtual reality
is 1–2. Signal intensity of the first time is the training device.
baseline and is used as surpassing target. In The training time and therapy course: dou-
the next training, the patients are guided to ble training of contraction and relaxation: The
make signal intensity surpass the previous training time is 50 min (once a day) and there
time. The rest can be done in the same are 30 times in one therapy course. The
manner. Relaxation training: if the patients patients can do multiple therapy courses.
have musculus sphincter ani externus spasm, Single training of contraction: The training
the signal intensity is stronger than that of time is 30 min (once a day) and there are 30
baseline and cannot be reduced to zero. The times in one therapy course. The patients can
patients can do this training. After regulation do multiple therapy courses.
of mind and breathing along with Du channel, Every week, neurological training device is
the therapists guide the patients to concentrate used to detect the signal of musculus sphincter
on signal curve on screen but not on the ani externus to know the actual therapeutic
contraction of urethra and sphincter ani. After effect and instruct therapeutic schedule.
taking a deep inspiration, the patients are (d) Self-exercise method of pelvic floor mus-
guided to regulate body and mind to relax cles: the patients who received rehabilita-
musculus sphincter ani externus in order to tion training of neurological training of
decrease curve for 6 s. After that, the patients musculus sphincter ani externus in reha-
take a deep inspiration and expire slowly. The bilitation department of hospital are
ratio between inspiration time and expiration already know the method of training
time is 1–2. Contraction training and active movement of musculus sphincter
relaxation training is done alternatively. If ani externus with Daoyin technique and
there is no external urethral sphincter spasm are impressed by the relationship between
in the patients, the patients can merely do contraction and signal line. After
contraction training. Contraction training can discharge or during the therapy internal,
enhance the training feeling and is good for the patients can do self-exercise of mus-
the effect. In addition, recovering active culus sphincter ani externus. On the basis
contraction function of muscles is the premise of regulation of mind and breathing, the
and basis of active relaxation of muscles. patients shrink external urethral sphincter
The training time and therapy course: dou- and imagine the signal curve change in
ble training of contraction and relaxation: The the previous therapy course for 6 s. During
training time is 50 min (once a day) and there the training, training probe can be placed
are 30 times in one therapy course. The in anus to consolidate therapeutic effect.
patients can do multiple therapy courses.
The time of self-exercise is 30 min and (b) Changing dietary structure: The patients
there are 1–2 times a day. The patients can do should try to eat crude fiber food and
it for a long time. avoid irritant and heavy food so that the
(e) Acupuncture therapy: Du channel governs faeces are soft and easy to be expelled.
the Yang Qi of all the body. If Yang Qi is (c) Improving defecation way and establish-
weak, the therapists can choose proper ing timing defecation habit: There are
acupuncture point in Du channel for ther- several methods as follows: Action of
apy. For constipation patients, the thera- gravity is used for defecation. The patients
pists select Changqiang that is the should use sitting position to defecate.
midpoint between tailbone and anus The old or severe patients can use lying
0.5 in. below tailbone. Acupuncturing this and sitting position. Anus stretching is
point can relieve muscular spasm and diz- used to relieve sphincter ani spasm. For
ziness, clear heat, promote diuresis, solid example, middle finger is put on finger-
doff and cure diarrhea. It is suitable for the stall, is smeared with paroline oil and is
patients with diarrhea, hematochezia, con- inserted into anus slowly. The therapists
stipation, haemorrhoids and rectocele. use middle finger to stretch rectal wall to
The training time is 15 min (once a day) anus slowly. Ring stretching way is used
and there are 15 times in one therapy course. to alleviate sphincter ani internus and
(f) Electrical stimulation therapy: Because of externus and expand rectal cavity to
long-term constipation, intestinal peristalsis induce intestinal tract reflex. Timing def-
of the patients weaken, which can further ecation habit: postural reflex after getting
aggravate the symptoms of constipation. up and defecation reflex easily induce
Medium-frequency electrical stimulation defecation so that the patients should def-
can increase excitability of intestinal ecate in the morning. During defecation,
smooth muscle, promote recovery of the patients should concentrate in case
intestinal peristalsis and defecation. defecation reflex cannot be induced
Electrode placement: the electrodes of because of attention diversion.
medium-frequency electrical stimulation can (d) Appropriate exercise: the patients can do
be placed on left and right abdomen or sepa- appropriate physical activities such as
rately in abdomen and back. The patients swimming, playing ping-pong and
should tolerate the electrical intensity and abdominal massage, which can promote
don’t feel painful. If the patients are not sensi- efferent and afferent reflex of feedback of
tive to electrical stimulation, the therapists intestinal tract sensation and promote
cannot increase electrical intensity blindly, intestinal peristalsis motility to prevent
especially for the patients with hypaesthesia. constipation.
The training time is 20–30 min (once a (e) Defecation tips: Constipation is a com-
day) and there are 15 times in one therapy mon problem, especially in old people.
course. People summarize defecation tip in daily
3.
Other rehabilitation therapeutic method life for personal use. Necessary prelimi-
means the common therapeutic method in nary motion such as intermittent abdomi-
clinic at home and abroad [9, 10]. nal curl movement before defecation is

(a) Electromyographic biofeedback thera- good for induction of intestinal peristalsis
peutic method is the same as that of uri- and moving down of faeces. Abdominal
nary incontinence introduced in the first massage: the therapists put hand on the
segment. peripheral of abdomen and do massage
The training time is 20–30 min (once a clockwise, which is good for intestinal
day) and there are 15 times in one therapy peristalsis and moving down of faeces.
course. Acupressure: the therapists use four fin-
gers of right hand (except little finger) to nerve plexus injury, which can aggravate
press on four spots in rectangle around constipation, but the symptoms disappear
navel. The four spots are located two fin- after drug withdrawal. Gastrointestinal
gers to navel (Up, Down, Left, Right). motility promotion medicine such as
Acupressure can induce defecation reflex. mosapride and itopride can promote gas-
Tail end of finger pressure: the therapists trointestinal motility. Prucalopride mainly
can press two sides of tail end of fingers act on colon and can be used as the cir-
alternatively to induce desire to defecate. cumstances may require.
Intermittent active contraction of sphinc- 4. Rehabilitation therapy of incontinence of

ter ani: the patients sit on closestool to do feces: Incontinence of feces is the same as
active contraction and relaxation of constipation and both belong to defecation
sphincter ani intermittently to induce def- dysfunctions and may be related to different
ecation reflex. parts of neural injury. One of the causes of
(f) Drug therapy includes purgative prescrip- constipation is musculus sphincter ani exter-
tion and gastrointestinal motility promo- nus spasm. The injured segment of spinal
tion drug. Bulk cathartic includes soluble cord cannot transmit: signal from upper cen-
fiber such as pectin, plantain herb and oat tral nerve to the spinal cord segment below
bran and insoluble fiber such as plant fibre the injured segment so that the spinal cord
and lignin. The effect is slow but they are segment below the injured segment are
safe and with less side effect. They are excited because they break away from the
suitable for constipation in gestation or inhibition of upper central nerve. Therefore,
slight constipation, but not suitable for spasm of musculus sphincter ani externus
fast free movement of the bowels. The leads to that faeces in intestinal tract cannot
major effect of lubricant cathartic is to be expelled in time. Water is absorbed too
lubricate intestinal wall and soften faeces much so that faeces becomes hard. One of
so that faeces are easy to be expelled. This the causes of incontinence of feces is muscu-
kind of medicine is easy to use such as lus sphincter ani externus paralysis. When
glycerine enema, mineral oil or liquid spinal cord is injured, the nerve root that
paraffin. Salt cathartic such as magnesium dominate musculus sphincter ani externus is
sulfate and magma magnesiae can occa- injured. Therefore, musculus sphincter ani
sionally induce severe adverse reaction externus is out of control and there is soft
and they should be used with precaution. paralysis, relaxation of musculus sphincter
Osmotic cathartic includes lactulose, sor- ani externus, which lead to that intestinal
bitol and polyethylene glycol 4000. They contents in rectum flow out of anus without
are suitable for faecea block or chronic control.
constipation. They can also be used for Therefore, there is no musculus sphincter
the patients if the therapeutic effect of ani externus spasm in incontinence of feces.
bulk cathartic is not good. Irritant cathar- Rehabilitation training should enhance mus-
tic includes plant cathartic (anthraqui- cular excitability and recover autonomic
none) such a rheum officinale, folium innervation.
sennae and aloe, phenolphthalein, castor (a) Main and collateral channels of rehabili-
oil and diesters bisoxindole. They are tation of neurological training of inconti-
suitable for the condition that other nence of feces: The method of guiding
cathartics are useless and cannot be used collaterals through meridians is used. The
for a long time. Long-term use of anthra- idea of regulation of mind is started from
quinone cathartic may lead to colon the endpoint of collaterals but not the
melena or cathartic colon, atrophy of starting point of meridians. The patients
smooth muscle and intestinal myenteric are guided to make mind from Yinjiao of
Du channel to Changqiang through that after deep inspiration, the patients are
Suliao, Shenting, Baihui, Dazhui, asked to stare at the screen and concentrate on
Zhiyang, Xuanshu, Yangguan and Yaoshu. signal curve to increase signal line altitude but
After regulation of breathing, the patients not concentrate on anus contraction for 6 s.
do contraction training of musculus After that, the patients take a deep breath and
sphincter ani externus. expire slowly. The ratio between inspiration
(b) Bare hand training of musculus sphincter time and expiration time is 1–2. Signal
ani externus: Before therapy, the patients intensity of the first time is the baseline and is
should defecate. The placement of anus used as surpassing target. In the next training,
probe is the same as the previous segment. the patients are guided to make signal intensity
The patients are helped to lie in lateral surpass the previous time. The rest can be done
position and to start the training of in the same manner.
musculus sphincter ani externus. The training time is 50 min (once a day)
Contraction training: the therapist should and there are 30 times in one therapy course.
use six-step Daoyin technique of guiding The patients can do multiple therapy courses.
collaterals through meridians to guide the (d) Virtual reality training of neurological

patients after regulation of mind and training: Before therapy, the patients
breathing along with Du channel. The should defecate. Training probe of sphinc-
patients are asked to concentrate on ter ani is inserted into anus. The patients
musculus sphincter ani externus. The lie in lateral position or knee-chest posi-
specific method is to shrink anus. After tion. The placement of training probe and
deep inspiration, the patients are asked to training method are the same as these of
try to shrink musculus sphincter ani rehabilitation training of neurological
externus and clamp anus training probe for training of musculus sphincter ani exter-
6 s. After that, the patients take a deep nus. The only difference is virtual reality
breath and expire slowly. The ratio between training device.
inspiration time and expiration time is 1–2. The training time is 50 min (once a day)
The training time is 30 min (once a day) and there are 30 times in one therapy course.
and there are 30 times in one therapy course. The patients can do multiple therapy courses.
The patients can do multiple therapy courses. Every week, neurological training device is
(c) Rehabilitation training method of neuro- used to detect the actual signal of musculus
logical training of musculus sphincter ani sphincter ani externus to know the actual ther-
externus: Before therapy, the patients apeutic effect and adjust the therapeutic
should defecate. Signal reception probe of schedule.
neurological training is inserted into anus. (e) Pelvic floor muscle exercise of neurologi-
The operational approach is the same as cal training: it is a modified form of Kegel
the mentioned above. The patients are in method. The specific method is as fol-
lateral position or knee-chest position. lows: The patients are in sitting position
Reception electrode is connected with the or standing-sitting position. In standing
first lead of neurological training device. position, the space between two feet is the
Motor program signal of sphincter ani same wide as two shoulders. The whole
from central nervous system is displayed body is relaxed. The patients are guided to
in single screen and the training can be make mind from Yinjiao of Du channel to
started. Changqiang through Suliao, Shenting,
Contraction training: After regulation of Baihui, Dazhui, Zhiyang, Xuanshu,
mind and breathing along with Du channel, the Yangguan and Yaoshu. After taking a
patients are asked to concentrate on musculus deep inspiration, the patients shrink anus,
sphincter ani externus. The specific method is count for 6 s and relax anus.
The frequency of self-exercise is 15–30 min neoplasty, rectovaginal internal sphincter

per time and there are 2–3 times a day. One neoplasty, plication operation of sphincter,
therapy course takes 2 months and the patients skin transplantation tuboplasty and
can do multiple therapy courses, even do sphincteroplasty.
exercise for a long time as health protection (h) Precautions of incontinence of feces:

measures. establishing normal dietary habit: the
Considerations: during self-exercise of pel- patients should eat less greasy food and
vic floor muscles, there are several key points. eat more light food with vitamin such as
Strength: the patients should try to increase fresh vegetable and fruit including mung
maximum tension of muscle contraction. bean, radish and wax gourd. If the patients
Velocity: the patients should try to shorten the cannot be cured for a long time, they
time to get to maximum tension of muscle should eat more food with high protein
contraction. Duration time: the patients should such as lean meat, beef and mushroom.
maintain the time of maximum tension of The patients should keep anus clean. After
muscle contraction as long as possible. defecation, the patients should wash anus
Repeatability: the patients try to reduce the or they can wash anus morning and eve-
number of times to get to maximum tension. ning to keep anus clean. Timing defeca-
Fatigue: the patients should try to reduce tion: the patients should develop a habit of
fatigue degree after muscle contraction. timing defecation to prevent injuring anal
(f) Acupuncture therapy: Changqiang point tube skin and infection.
is selected and the method is the same as (i) Nursing materials of incontinence of
acupuncture therapy of constipation. feces: disposable urinal pad is nursing
The frequency is once a day and there are material suitable for the patients with
15 times in one therapy course. incontinence of feces. It can shorten damp

(g) Other rehabilitation methods: Electro and pollution scope and decrease injury
myographic biofeedback therapy is the degree of skin. Control valve plug of anus
same as that of urinary incontinence in the is made of polyurethane sponge and is
first segment. The training time is placed between anus and rectum. This
20–30 min (once a day) and there are 15 kind of sponge can swell after encountering
times in one therapy course. Electrical water so that it can prevent flowout of
stimulation is usually set in neurogenic faeces. Anal tube: thick anal tube with
incontinence of feces. Caldwell in 1963 gauge 22 is inserted into anus 18–22 cm in
placed stimulation electrode in musculus depth until it reaches the middle of colon
sphincter ani externus and induce regular sigmoideum. It is not fixed around anus
contraction and sensory feedback of and the exposed terminal of anal tube is
sphincter ani to improve function. The connected with plastic bag. After
training time is 20–30 min (once a day) and defecation, the patients should change
there are 15 times in one therapy course. plastic bag to keep anus clean. Disposable
Defecation promotion: the patients should gasbag catheter is inserted into rectum
treat inflammation of colon and rectum 16–20 cm in depth. The gasbag is located
actively in case of diarrhea. They should try in the interface of rectum and colon
not to eat irritant food and try to eat food sigmoideum. Gasbag is inflated to prevent
with fruitful fiber. Surgery is suitable for flow of faeces in to rectum. In addition, in
the patients with local defect of sphincter the interface of rectum and colon
induced by surgery injury, birth injury or sigmoideum, there is no receptor of
violent injury. In addition, congenital defecation reflex ao that it is difficult to
disease and anal sphincterectomy require induce defecation reflex, which is good for
surgery. Operation mode includes sphincter the fixation of catheter.
References physiological bases. Ross Fiziol Zh Im I M

Sechenova. 2008;94(5):539–56.
6. Lynch AC, Antony A, Dobbs BR. Bowel dysfunc-
1. Schmidt RA, Jonas U, Oleson KA, et al. Sacral nerve
tion following spinal cord injury. Spinal Cord.
stimulation for treatment of refractory urinary urge
2001;39(4):193–203.
incontinence. J Urol. 1999;162:352–7.
7. Christiansen J. Modern surgical treatment of anal
2. Goodwin RJ, Swinn MJ, Fowler CJ. The neuro-
incontinence. Ann Med. 1998;30:273–7.
physiology of urinary retention in young women
8. Vaizey CJ, Kamm MA, Nicholls RJ. Recent advances
and its treatment by neuromodulation. World J Urol.
in the surgical treatment of faecal incontinence. Br J
1988;16:305–7.
Surg. 1998;85:596–603.
3. Finazzi Agro E, Peppe A, Damico A, et al. Effects
9. Rezvan A, Jakus-Waldman S, Abbas MA, et al.
of subthalamic nucleus stimulation on urodynamic
Review of the diagnosis, management andt reatment
finding in patients with Parkinson’ disease. J Urol.
of fecal incontinence. Female Pelvic Med Reconstr
2003;169(4):1391.
Surg. 2015;21:8–17.
4. Fall M, Lindstrom S. Electrieal stimulation. A physi-
10. Halland M, Talley NJ. Fecal incontinence: mecha-
ologic approach to the treatment of urinary inconti-
nisms and management. Curr Opin Gastroenterol.
nense. Urol Clin North Am. 1991;18(2):393–407.
2012;28:57–62.
5. Bazanova M, M Mernaia EM, Shtark
MB. Biofeedback in psychomotor training. Electro
of Neurological Training of Visual 18
Impairment
18.1 Visual Structure major ingredient is water, which can refract

and the Mechanism of Visual light and support retina. Optic nerve can trans-
Formation mit visual information from retina to neural
pathway of brain. Visual pathway is the neural
18.1.1 Visual Structure impulse conduction pathway from retina to
brain cortex.
Eye is an ocular organ of human and animals. 2. Accessory organs of eye include seven extra-
Eye can be used for reading, learning, watch- ocular muscles of eyeball movements
ing pictures and enjoying the view. Human can (Fig. 18.2). They are all skeletal muscles.
use eye to distinguish different colors and lights There are four rectus such as superior rectus,
and change these visual image into neural signal inferior rectus, medial rectus and lateral rectus.
that are transmitted to the brain to form vision. They all originate from common tendinous
Eye is composed of eyeball and appendant ring around canalis opticus and end forward in
organ of eye. It includes the following important four surfaces (Upward, downward, inward and
parts [1, 2]. outward) of the front of equator of sclera.
There are two oblique muscles including supe-
1. Eyeball includes eyeball wall, intraocular cav- rior oblique and inferior oblique. Superior
ity and contents, nerves and blood vessels oblique originates from common tendinous
(Fig. 18.1). Intraocular cavity includes ante- ring and ends in lateral surface behind the eye-
rior chamber, posterior chamber and vitreous ball through tendon trochlea in anterior and
cavity. Eye contents include aqueous fluid, superior medial wall of orbit. Inferior oblique
crystalline lens and vitreous body. They are all originates from medial part of inferior orbit
transparent materials. They three and cornea and ends in posterior lateral surface of eyeball.
are called refracting media. Aqueous fluid is Levator palpabrae muscle originates from
generated by ciliary processes. It can provide common tendinous ring of aobital apex and the
nutrition for cornea, crystalline lens and vitre- middle part of it ends in the bottom of tarsus
ous body, and maintain intraocular pressure. and corresponding skin tissue. Bilateral fibers
Crystalline lens is elastic transparent body attach to medial canthus ligament zygomatic
behind iris and pupil, and before vitreous tubercle through tendon to elevate upper
body, which is like biconvex lens. Vitreous eyelid.
body is transparent colloid body that occupies The effects of all the muscles: Superior
posterior four fifth of the whole eyeball. The rectus can turn pupil inward and upward.
https://doi.org/10.1007/978-981-13-0812-3_18
504 18 Rehabilitation Therapy of Neurological Training of Visual Impairment
Cornea
Anterior chamber
Posterior
chamber Iris
Ciliary body Sinuses circularis iridis
Crystalline lens
Ciliary zonule
Optical axis
Vitreous body
Retina
Axis oculi
Choroid
Sclera
Optic disc
Central fovea
Optic nerve
Horizontal section of the eyeball
Fig. 18.1 Sketch map of eyeball structure
Fig. 18.2 Peripheral Superior rectus

muscles of eyeball
Superior oblique
Lateral
rectus
Inferior Medial rectus

oblique
Inferior rectus
infeecus
18.1 Visual Structure and the Mechanism of Visual Formation 505
Inferior rectus turns pupil downward and point of accommodation. The distance
inward. Medial rectus turns pupil inward. between the two points is called accommoda-
Lateral rectus turns pupil outward. Superior tion range. The normal near point is about
oblique turns pupil downward and outward. 10 cm away from eye. People see something
Inferior oblique turns pupil upward and in this distance for a long time, which can
outward. generate eyestrain. The manifestations of eye-
The normal movement of eyeball must be strain are eye sour, dry and swell, headache,
completed by the collaboration of many mus- and blurred vision.
cles. During side view, lateral rectus of one
eye and medial rectus of the other eye should Crystalline lens is between iris and vitreous
contract simultaneously to complete it. body (Fig. 18.3), which is like biconvex lens,
3. Distance of distinct vision is that people can elastic and is main portion of refraction system of
read the book in this distance for a long time eyeball. Its periphery is connected to ciliary pro-
but cannot get tired. Distance of distinct vision cesses through ciliary zonular fibers. The better
of emmetropia is 25 cm and distance of dis- the elasticity of crystalline lens is, the stronger
tinct vision of myopic eye is 10 cm. the regulation ability is, the closer people can see
the objects clearly. The maximum adjustment
ability of crystalline lens is expressed by the near
18.1.2 The Mechanism of Visual point.
Formation The near point is the nearest distance that peo-
ple can see the objects clearly when eyes exert
18.1.2.1 Image-Forming Principle maximum adjustment ability. The shorter the dis-
The light form outer objects (the objects we see) tance is, the better the elasticity of crystalline
are refracted through ocular refraction system lens is. The near point of the 8 years old children
and form clear image in retina. Photoreceptor cell is about 8.6 cm. The near point of 20 years old
in retina can receive the visual information and young man is 10.4 cm. The near point of old peo-
transmit it into optic center through action poten- ple is 83.3 cm.
tial of neural fiber. Finally, vision is formed in
optic center of cortex.
In the process of vision formation, because
of the different distance between objects and Ciliary body
eye, refraction adjustment is required through
crystalline lens, pupil and binoculus conver-
gence to make objects form clear image in ret- Sclera
ina. Therefore, people can see these objects
clearly. Therefore, crystalline lens, pupil and
binoculus convergence are important factor to Crystalline lens
affect visual quality, especially crystalline
lens.
1. Crystalline lens: eye can adjust degree of

crook of crystalline lens (refraction) to change
focal length of crystalline lens in order to
obtain upside-down and contractible real
image. The farthest point people can see is
called far point of accommodation. The far
The adjustment of lens and pupil
point of emmetropia is extremely far. The
nearest point people can see is called near Fig. 18.3 Sketch map of crystalline lens structure
The adjustment of crystalline lens is achieved adjustment of pupil. Near reflex of pupil:
through contraction and relaxation of smooth when people see the near objects, it can
muscles in ciliary body. Ciliary body is the reflexively induce contraction of pupil
fleshiest part of middle membrane and is on the sphincter to shrink pupil in order to decrease
inner surface of sclera and cornea migration. spherical aberration and chromatic
There are many protruded plica in the front, aberration of refraction system so that the
which is called ciliary processes that give out image in retina is clearer. Light reflex of
ciliary zonular fibers to connect crystalline lens pupil: under strong light exposure, pupil
(Fig. 18.4). The smooth muscles in ciliary body shrinks and dim light can reflexively induce
are called ciliaris that are dominated by contraction of dilator pupillae to enlarge
parasympathetic nerve of oculomotor nerve. The pupil and increase amount of light. This
contraction and relaxation of ciliaris can lead to reflex can adjust the amount of light in case
relaxation and tension of ciliary zonular fibers retina is injured in strong light and dim light
separately. The contraction of ciliaris leads to affect the quality of vision imaging. The
relaxation of zonular fibers. Crystalline lens can center of light reflex of pupil is in midbrain.
lengthen anteroposterior axis through self- 3. Binoculus convergence: when two eyes stare
elasticity, increase degree of convexity and at an object from far to near, optical axis of
enhance refractive index. When ciliaris relaxes, two eyes close to nasal side under the action
zonular fibers are strained, which make crystalline of ocular medial rectus, which is called
lens become flatten and decrease refractive index. binoculus convergence or convergence reflex.
Refractive index is regulated through adjusting When people see near objects with two eyes,
curvature of crystalline lens. convergence reflex makes image on symmetry
point of retinas of two eyes and form clear
2. Adjustment of pupil: The diameter of pupil single visual objective image but not double
is 1.5–8.0 mm. there are two kinds of image.
Angulus iridocornealis
Cornea
Musculi dilatator pupillae
Atria
Posterior
chamber
Iris
Iridis sphincter
Ciliary zonule
Crystalline lens
Ciliaris
Sclera
Vitreous body
Fig. 18.4 Sketch map of relationship between ciliaris and crystalline lens
18.1 Visual Structure and the Mechanism of Visual Formation 507
18.1.2.2 Eyesight 18.2 Visual Impairment

Eyesight is visual acuity. It is the resolving power
of eye for miniature structure of objects. The Visual impairment is complete or partial struc-
measurement criterion is minimum visual angle ture or function disorder of visual organ and
of eye. Visual angle is that the lights from two visual sense due to congenital or acquired fac-
point of the object enter into eye and form the tors and the eyes cannot distinguish outer
angle through node. The size of visual angle is in objects [3].
direct proportion to the size of objective image in From diminution of vision to blindness, the
retina. range of visual impairment is wide. The
For example, 5 cm before the eye, the lights symptoms include blurred vision, high hyperopia
from two spots whose space is 1.5 mm (the or myopia, colour blindness and tunnel vision.
space between two “E” in 1.0 row of Because there are different nosogenesis, the
international standard visual acuity chart) can severity of symptoms and disease progression are
form 1 min of angle and the objective image in different. For example, rapid diminution of
retina is about 4.5 μm (the diameter of one cone eyesight with normal ocular appearance is usually
cell). If there are three cone cells in one line of observed in the patients with vascular and neural
retina, the cone cells in two end of the line diseases such as central retinal artery and vein
receive light exposure and the cone cell in the occlusion, optic neuritis, disseminated sclerosis,
middle doesn’t receive light exposure. The eye leukemia, retinal detachment, acute methyl
can distinguish two spots. International alcohol and quinine poisoning. Rapid diminution
standard visual acuity chart is designed of eyesight with ocular congestion or infection is
according to this principle. In fact, the eye of usually observed in acute glaucoma, iridocyclitis,
normal people can distinguish smaller visual severe eye traumas, keratitis, keratohelcosis and
angle, which means eyesight can be 1.0, 1.5 or purulent inflammation of entire eyeball. Rapid
bigger. This may be related to the fact that the diminution of eyesight without ocular congestion
diameter of cone cell is merely 1.5–2.0 in is due to cataract, cornea degeneration, vitreous
central fovea of retina. opacity and simple glaucoma, optic nerve
atrophy, retinoblastoma and melanoma in the
18.1.2.3 Binocular Vision early phase. In addition, myopic eye, presbyopia
and Stereoscopic Vision and amblyopia can lead to diminution of eyesight.
The vision is formed when two eyes stare at the Slow diminution of eyesight with ocular
objects at the same time, which is called congestion is usually observed in the patients
binocular vision. When two eyes stare at the with keratitis, keratohelcosis, chronic glaucoma,
objects at the same time, there is a complete chronic iridocyclitis, alkali burn of conjunctiva
objective image separately in retinas of two eyes. and cornea in late phase.
Because exquisite coordination effect of In this chapter, we discuss the cause, mecha-
extraocular muscles, the light from the same part nism and rehabilitation therapy method of myo-
of the object form image in symmetry point of pia, hyperopia and retrogressive hyperopia.
retinas of two eyes and people can see one object
subjectively, which is called haplopia. If there is
extraocular muscles paralysis, oppression of 18.2.1 Ocular Abnormal Refraction
tumor or foreign matter in eye, or displacement
of eyeball pushed by fingers, objective image is 18.2.1.1 Formation Mechanism
on the asymmetric point of retinas of two eyes so of Abnormal Refraction
that the patients can see two overlapping objects The light of object is refracted to retina through
to a certain extent subjectively, which is called refraction system and form objective image so
diplopia. that the eyes can see the object clearly. If there is
abnormity in refraction process, there will be object with different optical density, the trans-
blurred vision. mission orientation will deflect, which is
called refraction phenomenon. It is measured
1. Emmetropia: Without any adjustment, the by diopter. 1D refractive power means that
parallel lights can focus on retina and the parallel lights can focus on 1 m focal length
eye can see the far object clearly. Through behind the object after penetrating it.
adjustment, the eye can see the near object
outside near-point, which is called
emmetropia. 18.2.2 Myopic Eye
2. Non-emmetropia: If there is abnormal refrac-
tion or eyeball paramorphia, without adjust- Myopia is a kind of eye disease with blurred
ment of eye, parallel lights cannot focus on vision of far object and clear vision of near
retina, which is called non-emmetropia or object. The pathogenesis is not clear. Tao
ametropia. Yongjian deemed that genetic factor, adjustment
theory, blurred theory and biochemical criterion
18.2.1.2 Classification of Abnormal are the major causes of myopia formation. At
Refraction present, it is widely accepted at home that adjust-
Abnormal refraction includes myopia, hyperopia ment is the important factor of genesis and
and astigmatism. development of myopia. The major basis of
Myopic eye: if the anteroposterior diameter of adjustment theory is to adjust the effect of intra-
eyeball is too long or refractive index of refrac- ocular muscles, effect of extraocular muscles
tion system is too big, parallel lights focus on the induced by three simultaneous controllable axes
front of retina and there is unclear objective such as pupil shrink, convergence and adjust-
image on retina. The near-point is shorter than ment, convergence reflex and intra-ocular pres-
that of emmetropia. sure change [4].
1. Presbyopia: if the anteroposterior diameter 18.2.2.1 Regulation Theory

of eyeball is too short or refractive index of of Forming Myopia
refraction system is too small, parallel lights Regulation theory shows that the formation of
focus on the back of retina and there is myopic eye is the results that contraction of
unclear objective image on retina. The near- intraocular muscles and extraocular muscles acts
point is longer than that of emmetropia. on sclera to regulate the curvature of crystalline
People with presbyopia can see the far object lens in order to make two eyes focus and imaging
clearly after adjustment and see near object when people see the near object. During this
clearly after adjustment to a great degree. process, intra-ocular pressure is increase. If
Therefore, there is easily eyestrain in people stare at the near object for a long time,
presbyopia. persistent high pressure may lengthen axis oculi
2. Astigmatism: if the curvatures on the surface and increasing axis oculi may affect refractive
of cornea are different in different part, paral- index of crystalline lens to make objective image
lel lights are refracted by this surface and can- before the retina, which is called axis myopia.
not focus on retina. The lights focus on retina
and the planes before or after retina, which 1. The effect of intraocular muscles: if people
generate unclear objective image or metabolic stare at the near object for a long time, in order
objective image. to see the object clearly, people should enhance
3. Diopter. the adjustment of eye. Long-term contraction
Diopter is a unit to measuring refraction of ciliaris leads to tension and spasm and may
phenomenon. Diopter is abbreviated as relax zonular fibers further. Crystalline lens can
D. When light is from one object to another protrude further with its own elasticity to
18.2 Visual Impairment 509
induce myopic eye. On the other hand, in order choroid retinene in order to increase the synthesis
to resist the pressure of ciliaris, choroid is of protein polysaccharide of sclera. Finally, the
stretched excessively and cannot recover the length of axis oculi is changed.
normal state after a long time stretch. The blood Researches show that through changing bio-
vessel in it is oppressed and blood volume is chemical criterion, people can control the growth
decreased, which can induce malnutrition and and development of eyeball to provide basis for
atrophy. Choroid gradually lose elasticity and the medicine therapy of myopia. It is possible
buffer ability. Sclera lack of elasticity starts to that adjustment induces the change of biochemi-
deform and finally lead to elongation of cal criterion through blurred vision to affect the
posterior pole of axis oculi, which can change growth and development of eyeball. In addition,
refractive index and make objective image individual difference, genetic factor, different
focus on retina to form myopia. age, dietary structure and using habit of eye all
2. The effect of extraocular muscles: The con- can affect biochemical criterion of genesis and
traction and relaxation of four rectus attached development of eyeball.
to eyeball surface can complete various kinds
of eyeball movements to generate mechanical 18.2.2.4 Symptoms and Assessment
traction and oppression to eyeball. Especially of Myopia
when two eyes do convergence movement, the 1. Clinical symptoms of myopia: Clinical mani-
contraction of medial rectus can lengthen festations of myopic eye are important evi-
anteroposterior diameter of eyeball to induce dence of diagnosis. After forming myopic eye,
myopia. there are following manifestations:
(a) Distant vision decrease: blurred distant
18.2.2.2 Blurred Theory vision with normal near vision.
In blurred theory, bad imaging quality of retina is (b) Asthenopia: if the patients stare at the

the important cause of genesis of development of object for a long time, there are ophthal-
myopia. Ametropia is the major cause of blurred mic sore, swell and uncomfortable.
vision and severe blurred vision induces binocu- (c) Exophoria or concomitant exotropia:
lar form deprivation. When there is binocular slanting eye is usually one eye of myopia
form deprivation in all distances, it can lead to that is more severe. It is induced by imbal-
myopia [5]. ance of accommodation force due to
excessive adjustment of eyeball by
18.2.2.3 Biochemical Criterion extraocular muscles.
Change Theory (d) Vitreous synchesis and opacity: they are
In recent years, biochemical studies related to usually observed in the patients with high
myopic eye showed that genesis of myopic eye is myopia accompanied with cataract,
related to the change of biochemical substances waved black shadow before eye or eye-
of retina such as retinal neurotransmitter and reti- sight decrease.
nal growth factor. The former includes retinene, (e) Ocular fundus change is usually observed
dopamine and acetyl choline. The latter includes in the patients with high myopia. There
transforming growth factor and alkaline fibroblast are temporal or peripheral ring choroid
growth factors β. Retinene is active metabolite of atrophy of optic nerve papilla in ocular
vitamin A and can combine with nuclear receptor fundus, macular degeneration, haemor-
of transcription factor to regulate the differentia- rhage, posterior scleral staphyloma, reti-
tion and growth of cells. The experiments showed nal tear and retinal detachment.
that the change of retinene metabolism plays an (f) Blunt light reflex is observed in the
important role in the genesis and development of patients with high myopia. It is induced
experimental myopia. It is inferred that retinene by long axis oculi accompanied with deep
of retina decreased the synthesis and release of anterior chamber and big pupil.
2. Assessment of myopia includes the degree of 4. Rehabilitation training and prevention of

eyesight and assessment of diopter. myopia.
(a) Grading of eyesight: The minimum eye-
sight of naked eye in two eyes is the If there are syndromes and symptoms of myo-
criterion. pia, the patients should seek therapy in hospital.
–– Normal eyesight: eyesight is more According to the suggestions of ophthalmolo-
than 5.0. gists, the patients should wear appropriate glass
–– Mild myopia: eyesight is 4.7–4.9. to rectify eyesight or use other methods for ther-
–– Middle myopia: eyesight is 4.4–4.6. apy. In this segment, we only discuss rehabilita-
–– Severe myopia: eyesight is less than 4.3. tion training and prevention of myopia.
(b) Pattern visual evoked potential examina-
tion: this examination is not affected by 1. The mechanism of rehabilitation of neurologi-
subjective response and cognitive compe- cal training of myopia Six-step Daoyin tech-
tence of the patients and can provide nique is used for active movement training of
objective condition of visual function. The ocular muscles to promote synaptic plasticity
wave form of this examination is stable. It and functional reorganization of optic center
is easy to be repeated and is highly corre- in order to develop potential ability, recover
lated to graphic eyesight. It is suitable for coordinated movement ability among ocular
the eyesight assessment of children. muscles, relieve ciliaris spasm and increase
(c) According to diopter, there are three blood circulation of ocular tissue. Virtuous
grades circle of ocular tissue metabolism and adjust-
–– Emmetropia: refraction range is +0.50 ment ability are recovered to alleviate
to −0.25D. myopia.
–– Low and middle myopia: refraction Whether adjustment theory and biochemi-
range is −0.50 to −6.0D. cal change theory of myopia or blurred theory
–– High myopia: refraction range is more and genetic factor, in the early phase of myo-
than −6.00D. pia, blurred objective image on retina leads to
3. Classification of therapeutic effect: It is classi- persistent powerful contraction of ciliaris to
fied according to the eyesight of standard loga- increase convexity of crystalline lens and
rithmic visual acuity chart or score of diopter. increase refractive index in order to make
(a) There are four grades according to objective image on retina. The difference is
eyesight. that there are different causes of blurred objec-
–– Cure: eyesight is recovered to more tive vision. For example, adjustment theory
than 5.0. demonstrated that oppression and traction of
–– Excellent: eyesight is recovered to intraocular and extraocular muscle can
more than 3.0 on the original basis. lengthen axis oculi. Biochemical criterion
–– Effective: eyesight is recovered to change theory thinks there is material defi-
more than 3.0 on the original basis. ciency. Genetic factor thinks that there is
–– Invalid: eyesight is recovered to less developmental defect. Blurred theory thinks
than 0.1 on the original basis. that there are many factors. Some kind of fac-
(b) There are three grades according to
tor make the object not focus on retina clearly
diopter. and blurred objective image is transmitted to
–– Cure: refraction range is recovered to optic center through optic nerve. Through
+0.50 to −0.25D. feedback mechanism, optic center gives out
–– Effective: refraction range is recov- information to activate deep adjustment to
ered to −0.50 to −6.0D. make the objective image clear through tri-
–– Invalid: refraction range is not gemini movements such as pupil shrink,
recovered. convergence and adjustment.
In trigemini movements, there are two mote functional improvement of optic center
kinds of involved muscles. Skeletal muscles and promote functional recovery of intraocular
of voluntary movement include seven muscles muscles.
around eyeball. Smooth muscles of involun- 2. Specific methods of rehabilitation training of
tary movement include ciliaris, sphincter neurological training include neurological
pupillae and dilator pupillae, which are all training, reflexive active movement training
dominated by parasympathetic nerve of ocu- and manipulation massage.
lomotor nerve. (a) Training methods of neurological training
Extraocular muscles are skeletal muscles of extraocular muscles: Neurological
of voluntary movements such as medial training device is used. The placement of
rectus, superior rectus, inferior rectus, inferior button surface electrode is outward and
oblique and levator palpabrae muscle upward of paropia (Figs. 18.5 and 18.6). In
dominated by oculomotor nerve, superior a warm, quiet and lucifugal room, the
oblique dominated by trochlear nerve and patients are in sitting position. The elec-
lateral rectus dominated by abducens. These trode is connected to the first lead of neu-
cerebral nuclei are correlated with each other rological training device. Normal six-step
and are related to cerebral cortex so that they Daoyin technique training: on the basis of
can complete a series of higher eyeball
movements such as voluntary movements of
eyeball and stare function of eyeball. Through
training, people can complete special
voluntary movements of eyeball of cross eye,
showing the whites of one’s eyes and
strabismus.
Voluntary movement function of extraocu-
lar muscles can make eyeball do active move-
ment training to develop neural potential that
dominates extraocular muscles in order to
increase contraction power and suppleness of
muscles. Contraction of muscles can increase
blood circulation of local ocular tissue, pro- Fig. 18.5 The sketch map of the placement is outward
and upward of outer canthus (triangular arrangement)
mote metabolism and decrease oppression of
eyeball to lengthen axis oculi. Special eyeball
movement can rectify esotropia and increase
flexibility and correctness of eyeball rotation.
Sphincter pupillae and ciliaris are involun-
tary muscles dominated by parasympathetic
nerve. Through reflex adjustment, these mus-
cles can complete contraction and relaxation
movements. However, movement training of
conditioned reflex can increase flexibility of
reflex adjustment movement, increase blood
circulation and nutrition of muscles, and
alleviate muscle spasm. Meanwhile, during

the process of active movement training of
extraocular muscles, oppression of eyeball
can be decreased to improve blood circulation Fig. 18.6 The placement is outward and upward of
of ocular tissue, promote metabolism, pro- outer canthus (vertical arrangement)
regulation of mind and breathing, the relax extraocular muscles fully. On the
patients are guided to shrink ocular lateral basis of the signal intensity in the pervious,
rectus to make eyeball turn outward the therapists make a transverse line as the
(
offside eyeball turns inward) until the surpassing goal of the next training. The
eyeball reaches the zenith of ocular therapists can use finger pulp to exert
abduction for 6 s. After that, the patients resistance on the negative direction of
take a deep breath and expire slowly to eyeball movement (outward and upward
relax eyeball. On the basis of the signal of outer canthus) to increase signal
intensity in the pervious, the therapists intensity.
make a transverse line as the surpassing Through electrode of ocular abduction, the
goal of the next training. The therapists patients can do the training of ocular
can use finger pulp to exert resistance on adduction, up and down movement and
the negative direction of eyeball movement convergence movement. The training time is
(Fig. 18.7) to increase signal intensity. The 20 min (once a day) and one therapy course
method of guiding collaterals through takes 3 months.
meridians: the therapists choose Shaoyang (b) Virtual reality of neurological training:

in gallbladder meridian and guide the Virtual reality of neurological training
patients to generate mind from Wuhui device is used for training. The method
point on the same side of the trained eye and therapy course are the same as these
and make Qi upward through Shaoyang in of neurological training.
gallbladder meridian, Yangguan, Huantiao, (c) Reflexive movement training method is
Yuanye, Dazhui and Tianchong to used for ciliaris, sphincter pupillae and
Tongziliao of outer canthus. After taking a dilator of involuntary movement. Through
deep breathing, the patients activate essential condition, conditioned reflex
contraction of extraocular muscles until movement can be induced.
the eyeball reaches the zenith of ocular The conditions to induce reflexive contrac-
abduction for 6 s. After that, the patients tion of ciliaris, sphincter pupillae and dilator
take a deep breath and expire slowly to include the size of objects, the distance to eye
and color. Beijing Xing Cheng Wan You
Technology Ltd. designed training system of
ciliaris (eye protection device) according to the
principle of reversible myopia and hyperopia.
This system is composed of optical imaging
and massage bar of magnet therapy. Optical
imaging is used to exercise adjustment ability
and flexibility of ciliaris, sphincter pupillae and
dilator pupillae through changing distance and
size of dynamic image. Mechanical eye
protection device is equipped with image
turntable and image movement orbit with six
kinds of images that are driven by micromotor
automatic control. When one kind of image is
on the movement orbit, it can do uniform
motion back and forth from far to near or from
near to far. Every back and forth movement
takes 20 s. After completion of one back and
Fig. 18.7 Sketch map of the therapists exert resistance
forth movement, this image gets away from
on negative direction of eyeball movement image movement orbit automatically and then
another image is on the movement orbit. It is in anipulation massage is good for the
M
cycle. Image creates the view from 10 cm to alleviation of adhesion and stiffness of
infinity through optical effect. The patients ocular tissue.
watch image and do the training through Manipulation massage: the therapists use
complex optical lens barrel with the function of hot cotton cushion that the patients can tolerate
eliminating chromatic aberration. Digital eye (the temperature is 40–45 °C) to soak two
protection device is equipped with image eyes. The therapists do massage on one eye at
selection, image quantity and light intensity. first and it is forbidden to do massage on two
Training method of rehabilitation of myo- eyes. The patients close two eyes. The
pia: on the basis of regulation of mind and therapists put pulp of index finger and middle
breathing, the trainees are guided to concen- finger on the other palm and rub them warm.
trate on one spot of image. When the image After that, the therapists put fingers on the eye
is on the blurred critical point from near to and press it for 1 s. The therapists relax and
far, the patients should see the image clearly press the eye with stronger intensity. The
until the object is blurred as far as possible. maximum power is that the patients can
During this process, the patients can train tolerate it and don’t feel uncomfortable. The
adjustment potential of ciliaris controlled by therapists massage the eye clockwise or
brain. Meanwhile, object movement from anticlockwise and the patients don’t feel
near to far can be used for the training of uncomfortable. The massage time of every eye
pupil shrink, relax and convergence adjust- is 5 min and the time of two eyes is 10 min
ment. When the image moves from far to (once a day). One therapy course includes 15
near, the patients can relax and watch pan- times.
orama of the image to do relaxation training During massage, the therapists should pay
of ciliaris in order to increase entire adjust- attention to the force and the feeling of the
ment ability of ciliaris. When the patients patients. If there is nausea or other
watch the image that is from far to near, it discomfortableness, the therapists should stop
can train pupil dilation and convergence massage. Massage cannot be used for the
adjustment. patients with glaucoma, retinal detachment,
Through a certain condition, the contraction ophthalmia, hypertension, diabetes mellitus
and relaxation of ciliaris, sphincter pupillae and severe trachoma.
and dilator are induced to complete actual 3. Other methods to treat myopia include self-
muscle contraction, which is called reflex exercise and surgery [6].
movement and is different from passive (a) Overlook method: The patients can see
movement without muscle contraction. During grassland or green tree 10 m away.
this process, the muscles controlled by central Because wave length of green light is
nervous system can be recovered to different short, it can focus before retina, which
degrees and the myodynamia can be enhanced can relax ciliaris and alleviate eyestrain.
to promote blood circulation and metabolism Eyestrain can induce false myopia.
of muscles and local tissue, alleviate muscle Therefore, avoiding eyestrain is the
spasm, promote good circulation and improve important link to prevention and
functions. alleviation of eyestrain.
(d) Manipulation massage: The ultimate
(b) Crystalline lens exercise is the exercise of
result of myopia is the elongation of axis self-rotation of eyeball. The method is
oculi. Long-term elongation of axis oculi that the patients support cheek with two
leads to adhesion and stiffness of eyeball hands and rotate eyeball up, down, left
wall and tissue around eyeball. This kind and right for ten times. After that, the
of adhesion and stiffness are like the patients can rotate eyeball clockwise or
adhesion of bone and joint, which cannot anticlockwise for ten times (once a day)
be relieved by muscle contraction. and the patients can usually do it.
Fig. 18.9 The sketch map of the patients use thumb and
Fig. 18.8 The sketch map of the patients use thumb to index finger to massage acupuncture points around eye
press on temple and use index finger to massage acupunc-
ture point around eye
4. Prevention of myopia [7].
(c) Massage exercise: The patients press on (a) Eye using time in close range should be
temple and scrape orbit. The patients use controlled, which is a good method to
thumb to press on temple and scrape orbit prevent myopia in children and adolescent
up, outside and up, outside and down, inside in development phase.
and down along with the inside surface of (b)
Invigorating health effectively: the
the second knuckle of curled index finger patients should do exercise persistently to
(Fig. 18.8). The patients can massage keep good body condition, which is an
Zanzhu, Yuyao, Sizhukong, Tongziliao, important condition to prevent myopia.
Qiuhou and Chengqi around orbit. This (c) Paying attention to nutrition and dietary
method can be used for treating false myopia structure: Nutrition has important effect
and preventing aggravation of myopic eye. on occurrence and development of
The therapy time is 10 min (once a day) and myopia. Proper dietary structure is an
the patients can usually do it. effective measure to prevent myopia.
(d) Acupressure: the patients close two eyes (d) Noticing the distance between eye and

and massage Zanzhu, Yuyao, Sizhukong, book and developing good habit: the
Tongziliao, Qiuhou and Chengqi around distance between eye and book is too short,
orbit. Acupoint selection should be which is the important cause to generate
precise and the manipulation should be myopia. The best reading sight distance is
slow. The oppression force makes the 33–50 cm. It is easy to generate myopia if
patients feel sore (Fig. 18.9). The therapy the sight distance is shorter than 20 cm.
time is 10 min (once a day) and the Intermittent look in the distance should be
patients can usually do it. developed. The patients should improve
(e) The patients can wear Ortho-K lenses at visual environment and don’t read books in
night to increase high and far vision and movement or with dim light to prevent
not change physiological structure of eye. fatigue and adjustment function decrease
It is safe and easy to be applied. of ciliaris because of frequent adjustment.
(f) Excimer laser surgery is used to change (e) The patients should use eye scientifically
the molecular connection of eye to recover and don’t use it excessively: Excessive
normal eyesight. eye using can induce tension and fatigue
of ciliaris. The patients should use eye 1. Axile hyperopia is the most common type in
scientifically and don’t use it excessively abnormal refraction.
such as long-term internet game and After birth, the average length of axis oculi
watching TV. Eyestrain should be is about 17.3 mm. It is physiological
alleviated timely and ciliaris spasm can hyperopia. With the development of infant
be relaxed gradually to recover normal body, the anteroposterior axis of eye is
state. lengthened until the length reaches the normal
length or is close to the physiological length
in adult. Genetic and environmental factor can
18.2.3 Presbyopia affect eyeball development and the axis oculi
cannot reach the normal physiological length,
Hyperopia is that some reasons make axis oculi which is called axile hyperopia.
become short. Without adjustment, parallel In addition, axis oculi becomes short
lights focus behind retina through refraction and because of pathological condition: oppression
there is no clear objective image on retina. of tumor or inflammatory mass can induce
Therefore, hyperopia requires adjustment to invagination of posterior pole of eyeball and
enhance ocular refractive index so that the light make it flat. Edema of neoplasm behind
into eyeball can converge and form clear eyeball or eyeball wall can put forward
objective image on retina, which is easy to macular region of retina and oppress posterior
generate eyestrain [8]. pole of eyeball. Retinal detachment induces
However, there are many mistakes in the pre- displacement to oppress the back of eyeball,
vention of presbyopia. People think that myopia even the back of crystalline lens, which can
is better than hyperopia, because people with induce obvious change of diopter.
hyperopia can see far. Wearing glasses is the 2. Curvature hyperopia: Because the curvature
business of myopic eye. These statements are of any refraction object in refraction system of
incorrect. Because the patients with presbyopia eyeball is small and refractive index becomes
cannot see objects clearly whether far or near, it big so that objective image focus behind
requires frequent adjustment. During the process retina, which is called curvature hyperopia.
of convergence adjustment, medial rectus is Cornea is the part where the curvature
involved in it. Super contraction of bilateral becomes small such as congenital flat cornea,
medial rectus may stretch eyeball inward and cornea trauma or cornea diseases.
induce esotropia of two eyes. When hyperopia of 3. Refraction hyperopia is induced by poor

one eye is severe, super contraction of medial refraction of crystalline lens.
rectus in this side can induce unilateral esotropia. The common cause is physiological degen-
There are poor vision, strabismus and amblyopia erative alterations due to age and pathological
in the patients with medium and high presbyopia. changes of cornea in the patients with diabe-
Therefore, the mechanism of hyperopia is tes mellitus [10]. In addition, backward
complicated than that of myopia and there are dislocation of crystalline lens is induced by
more complications. Hyperopia requires congenital factor or ocular trauma, which can
treatment more than myopic eye. form hyperopia.
18.2.3.1 The Classification 18.2.3.2 The Adjustment

and Pathogenesis of Presbyopia
of Hyperopia Adjustment is the result that people want to see
Hyperopia includes axile hyperopia, curvature near or miniature object with eye. Emmetropia is
hyperopia and refraction hyperopia. Axile at resting state. People see far object and the
hyperopia is usually observed [9]. objective image focuses on retina clearly without
adjustment. When people see near object, the in the patients with high hyperopia. There is
objective image focuses on retina clearly with defect of field vision if the wart is big. There
near reflex mechanism, which is physiological is crescent-shaped change below the optic
adjustment. nerve head. In addition, gonioscope can also
The eye is at resting state because of short axis be used for examination.
oculi or poor refractive index due to hyperopia. 4. The grade of hyperopia degree: The grade of
The far and near objects cannot focus on retina the severity is according to refractive index of
clearly. Unclear objective image is the visual hyperopia.
movement stimulation factor of optic center. (a) Mild hyperopia: The refractive index is
Ciliaris, pupil sphincter and medial rectus domi- less than 3D. The patients with mild
nated by the third cranial nerve are activated, hyperopia are adolescent with
which forms associated movement of adjustment, compensatory adjustment function. The
convergence and miosis. The adjustment is prin- far and near eyesight are normal and
cipal and is non-physiological. people can see objects in any distance
clearly. This kind of presbyopia is called
18.2.3.3 Clinical Manifestations false presbyopia.
1. Hypopsia: The degree of hypopsia depends on (b) Moderate hyperopia: The refractive index
hyperopia degree and the intensity of is no less than 3D but less than 6D. The
adjustment ability. adjustment ability of moderate hyperopia
2. Eyestrain: There are blurred vision, swell of or elder patients is poor and cannot be
geisoma, headache, drowsy, insomnia and compensated. The residual part after
hypomnesis. compensation is called dominant
3. Esotropia: excessive adjustment and conver- hyperopia.
gence movement induce near reflex disorder (c) High hyperopia: The refractive index is
and then induce esotropia. more than 6D. The adjustment ability of
the patients with high hyperopia is bad,
18.2.3.4 Assessment of Presbyopia which is called dominant hyperopia.
Except the examination method to assess
myopia, there are many examinations such as Both recessive and dominant hyperopia are
ocular appearance and adjustment ability of called entire hyperopia.
presbyopia.
18.2.3.5 Rehabilitation Therapy
1. Ocular appearance examination: in diffused and Prevention
light, the therapists examine the size of of Presbyopia
eyeball, symmetry of face or not, esophoria or If there are signs or symptoms of hyperopia in
not, esotropia or exotropia. eye, the patients should go to hospital for
2. Eyesight examination: Correct examination
diagnosis and therapy in time and wear proper
and flexible analysis of far and near eyesight glasses to rectify eyesight according to the
are good for the rapid diagnosis of hyperopia. instructions of ophthalmologists or use other
The teen-age eyes are capable to adjust. In methods for t herapy. We only discuss
mild hyperopia, the far and near eyesight are rehabilitation training and prevention of
normal. There are hypopsia of far and near presbyopia.
eyesight in the adolescent with high hyperopia
and middle age patients with moderate 1. The mechanism of the rehabilitation of neu-
hyperopia. rological training of hyperopia: The mecha-
3. Ophthalmoscopy examination: The symptoms nism is the same as that of rehabilitation of
include small, red and dim optic nerve head. myopia. Six-step Daoyin technique is used
There is faint yellow transparent choroid wart for active movement of ocular muscles to
promote plasticity and functional shrink, relax and convergence adjustment.

reorganization of optic center in order to When the image moves from far to near,
develop potential ability, recover coordinated the patients can relax and watch panorama
movement ability between ocular muscles, of the image to do relaxation training of
alleviate ciliaris spasm, increase blood ciliaris in order to increase entire
circulation of ocular tissue and recover adjustment ability of ciliaris. When the
virtuous circle of ocular metabolism and patients watch the image that is from near
adjustment ability of eye. Therefore, the to far, it can train pupil dilation and
aggravation of hyperopia can be alleviated or convergence adjustment.
stopped. The differences between this method
2. Specific methods of rehabilitation of neuro- and training method of myopia are as
logical training include neurological train- follows: myopic eye: When the image is
ing, reflexive movement training and on the blurred critical point from near to
manipulation massage. far, the patients should see the image
(a) The training method of neurological
clearly until the object is blurred as far as
training of extraocular muscles are the possible. Presbyopia: When the image is
same as these of myopic eye. on the blurred critical point from far to
The training time is 20 min (once a near, the patients should see the image
day) and one therapy course takes 3 clearly until the object is blurred as near
months. as possible.
(b) Virtual reality training of neurological
The training time is 15 min (once a
training: Virtual reality training device of day) and the patients can usually do it.
neurological training is used for the (2) Manipulation massage of eyeball: Short

training. The methods and therapy course axis oculi and abnormal refraction are the
are the same as neurological training ultimate result of hyperopia. Long-term
methods. short of axis oculi leads to adhesion and
(c) Reflexive movement training method is stiffness of tissue of eyeball, ocular wall
used for ciliaris, sphincter pupillae and and eye area. The adhesion and stiffness are
dilator of involuntary dominance. difficult to be loosened through muscle
Through essential condition, adjustment contraction. Manipulation massage is good
reflex movement is induced. for adhesion of ocular tissue and alleviation
The conditions to induce reflexive con- of stiffness.
traction of ciliaris, sphincter pupillae and
dilator include the size of objects, the dis- Manipulation massage: the therapists use hot
tance to eye and color. The specific cotton cushion that the patients can tolerate (the
method of training with eye protection temperature is 40–45 °C) to soak two eyes. The
device is the same as that of myopia. On therapists do massage on one eye at first and it is
the basis of regulation of mind and forbidden to do massage on two eyes. The
breathing, the trainees are guided to patients close two eyes. The therapists put pulp
concentrate on one spot of image. When of thumb, index finger and middle finger on the
the image is on the blurred critical point other palm and rub them warm. After that, the
from far to near, the patients should see therapists put fingers on the eye and press inner
the image clearly until the object is wall of orbit into eye socket from inward and
blurred as near as possible. During this upward, outward and upward, downward. The
process, the patients can train adjustment therapists put eyeball among the pulps of three
potential of ciliaris controlled by brain. fingers (Fig. 18.10) and press it slightly. The
Meanwhile, object movement from far to maximum power is that the patients can tolerate
near can be used for the training of pupil it and don’t feel uncomfortable.
(c) Massage exercise: The exercise method is

the same as that of myopic eye. The ther-
apy time is 10 min (once a day) and the
patients can usually do it.
(d) Acupressure: The exercise method is the
same as that of myopic eye. The therapy
time is 10 min (once a day) and the
patients can usually do it.
4. Prevention of presbyopia: Self-exercise of

ocular muscles is an effective measure to pre-
vent visual impairment. On the basis of meet-
ing the daily functional requirements or
existing athletic ability, special additional
movement increase functional ability of tissue
and organ to supplement the deficiency of
functional ability or prepare for the rainy day.
Fig. 18.10 Sketch map of the therapists put eyeball
among the pulps of three fingers and press it slightly (a) The patients should use eye scientifically
and don’t use it excessively: Excessive eye
The massage time for one eye is 5 and 10 min using can induce tension and fatigue of
for two eyes (once a day). There are 15 times in ciliaris and medial rectus. Excessive
one therapy course. adjustment oppresses eyeball and elongates
During massage, the therapists should pay axis oculi. The patients should use eye
attention to the force and the feeling of the scientifically and don’t use it excessively
patients. If there is nausea or other such as long-term internet game and
discomfortableness, the therapists should stop watching TV. Eyestrain should be alleviated
massage. Massage cannot be used for the patients timely and ocular muscle spasm can be
with glaucoma, retinal detachment, ophthalmia, relaxed gradually to recover normal state.
hypertension, diabetes mellitus and severe (
b) Paying attention to eye using environ-
trachoma. ment: people watch books or use eyes in a
bad environment or condition such as
3. Other methods to treat myopia include self- moving position, clinostatism, dim light,
exercise and surgery. near vision and too small object, which all
(a) Overlook method: The patients can see lead to excessive adjustment of eye. Long-
grassland or green tree 10 m away. term excessive adjustment easily leads to
Because wave length of green light is change of ocular structure, and then
short, it can focus before retina, which can induces refractive index and eyesight
relax ciliaris and alleviate eyestrain for change. People should watch books in an
prevention and alleviation of hyperopia. adequate and mild light with stable sitting
(b) Ocular muscles exercise is the exercise of position and proper distance between
self-rotation of eyeball. The method is book and eye. People should see far inter-
that the patients support cheek with two mittently and do eye exercises.
hands and rotate eyeball up, down, left ( c)
Invigorating health effectively: the
and right for ten times. After that, the patients should do exercise persistently to
patients can rotate eyeball clockwise or keep good body condition, which is an
anticlockwise for ten times (once a day) important condition to prevent myopia
and the patients can usually do it. visual impairment.
(d) Paying attention to nutrition and dietary Presbyopia is also called functional decline
structure: Nutrition has important effect syndrome of visual acuity or presbytia, which is
on occurrence and development of myo- usually observed in the people who age is more
pia. Proper dietary structure is an effective than 40 years old. People whose age is 40–50 are
measure to prevent hyperopia. not called old people so that many people are
(e) Acupressure: The patients are in sitting reluctant to wear presbyopic glasses even if they
position or horizontal position, close two are presbyopic. Mentally, people in this group
eyes naturally and massage acupuncture don’t recognize and feel they are old. Therefore,
points around eye. The acupuncture point the author called presbyopia as retrogressive
selection should be precise and soft until hyperopia, which demonstrate that presbyopia is
there is sour and swell in this point. induced by physiological degeneration of ocular
People use two thumbs to massage tissue and show respect to the patients and their
Tianying that is on the interface between family. For example, dementia is called cognitive
the bottom of brows and lateral-superior disorder, which can protect the pride of the patients
orbit. People use thumb of one hand to and their family effectively. It is widely accepted
squeeze and press Jingming acupuncture by academic world and all sectors of society.
point that is in nasal root and beside inner In addition, researches show that retrogressive
canthus of two eyes. People should press hyperopia is related to the job of people and
downward at first and squeeze upward. reading habit. Therefore, it is very important to
People use index finger to massage Sibai cultivate and maintain good reading habit.
that is in the center of cheek one trans-
verse finger below inferior margin of 18.2.4.2 Clinical Symptoms
orbit. of Retrogressive Hyperopia
1. Early symptoms: if people cannot see the

small handwriting clearly, they can move
18.2.4 Presbyopia reading target far to alleviate blurred vision
and eyestrain. Even if the patients can see the
Presbyopia is the condition that elder people are object clearly without moving the object far,
difficult to read or work gradually with age in this can also generate eyestrain.
near vision, which is one of the phenomenon of 2. Symptoms of formation period: after forma-
human function aging. tion of degenerative presbyopia, the direct
manifestations are eyestrain, sour and swell,
18.2.4.1 Pathogenetic Mechanism hyperdacryosis, photophoby, aningeresting
of Presbyopia and headache that can be relieved after rest
Presbyopia is induced by many causes such as when they cannot see object clearly in near
crystalline lens sclerosis due to increase of age vision or reading.
that can make the flexibility and elasticity 3. Late symptoms: Frequent eyestrain and head-
weaken. Meanwhile, the contraction ability of ache usually decrease work efficiency, even
ciliaris decreases, which can slow down adjust- people cannot do the work with small sight
ment ability of eye and move far the near-point. distance. Just as many chronic diseases, retro-
People cannot or are difficult to see near object gressive presbyopia in early phase is not taken
clearly, which is the result of comprehensive fac- into account. When it is developed to cataract
tors such as recession of intraocular and extraoc- and severe decrease of eyesight, they receive
ular muscles and deformability decrease of therapy. This may induce other complications
crystalline lens. and increase difficulty of healing.
18.2.4.3 T he Difference Between through training, the potential ability of ocular

Retrogressive Hyperopia muscles, tissue and nerves is developed to coun-
and Hyperopia teract or compensate functional defect induced
Although the common symptoms of presbyopia by ocular tissue regression. Protecting eye and
and retrogressive hyperopia include blurred enhancing self-exercise of eye can alleviate aging
vision of near object and people regard and regression of ocular tissue.
retrogressive presbyopia as presbyopia, there is In daily life, there are many examples that
qualitative difference between two diseases. exercise delays senescence. For example, the
Retrogressive hyperopia is normal physiological face of the actors who use mimetic muscles fre-
phenomenon with age and is the manifestation quently is younger than the peer. The body flex-
of human function aging. Whereas, hyperopia is ibility of the old person whose age is 70 years
induced by ametropia and its mechanism is old is similar to that of the adolescent because of
totally different. unremitting exercise. Just as mentioned above,
Actually, it is easy to distinguish the two dis- exercise is additional movement on the basis of
eases. People with hyperopia cannot see far and movements required for daily life. Therefore,
near objects clearly. People with retrogressive exercise can enhance neural functions and
presbyopia only cannot see near object. The dif- myodynamia, maintain tissue vitality and

ferences between the two are as follows: elasticity, and increase functions of organ and
tissue.
1. Age: Retrogressive hyperopia is usually

observed in the middle and old aged whose 1. The mechanism of the rehabilitation of neuro-
age is more than 40. Presbyopia is usually logical training of retrogressive hyperopia:
observed in children and adolescent. The The entire training can recover contraction
degree of retrogressive presbyopia is increased ability and coordination ability of muscles
with age (50° per 5 years) until 60 years old comprehensively, release adhesion of ocular
when the degree is increased to 250–300°. tissue, maintain and recover flexibility of ocu-
After that, the degree isn’t increased. lar tissue. Six-step Daoyin technique is used
2. Pathomechanism: Retrogressive hyperopia is for active movement training of ocular mus-
normal physiological phenomenon with age cles to develop their potential ability, promote
and is the manifestation of human function synaptic plasticity and functional reorganiza-
aging. Presbyopia is that some causes shorten tion of optic center, recover coordinated
axis oculi and it is an abnormal state. movement ability between ocular muscles,
3. The ability to see far: when people with retro- alleviate ciliaris spasm, increase blood circu-
gressive presbyopia see far, with no need for lation of ocular tissue, recover virtuous circle
excessive adjustment of ocular muscles, of ocular tissue metabolism and ocular adjust-
objective image can focus on retina clearly. In ment ability, rectify the difficulty of seeing
presbyopia, anteroposterior diameter of eye- near object in retrogressive presbyopia, allevi-
ball becomes short, curvature of crystalline ate or delay the disease.
lens becomes short, and refractive index 2. The specific methods of rehabilitation training
decreases. Therefore, objective image can of neurological training include neurological
focus behind retina. People with presbyopia training, ciliaris reflexive movement training
cannot see far object clearly. and manipulation massage.
(a) The training method of neurological train-
18.2.4.4 Rehabilitation Therapy ing of extraocular muscles is the same as
and Prevention rehabilitation training of neurological
of Retrogressive Hyperopia training of presbyopia. The training time
The key points of rehabilitation therapy and pre- is 20 min (once a day) and the therapy
vention of retrogressive hyperopia are as follows: course takes 3 months.
(b) Virtual reality training of neurological

(b) Ocular muscles exercise: active rotation
training: Virtual reality training device of of eyeball can exercise muscles around
neurological training is used for the train- eye. The patients are in sitting position,
ing. The method and therapy course are support cheek with two hands and rotate
the same as the training method of neuro- eyeball up, down, left and right for ten
logical training. Combined with rehabili- times. After that, the patients can rotate
tation training of neurological training of eyeball clockwise or anticlockwise for ten
extraocular muscles, this method has times (once a day) and the patients can
good training effect. The training time is usually do it.
20 min (once a day) and the therapy (c) Massage exercise is the same as that of
course takes 3 months. presbyopia. The frequency is once a day
(c) Ciliaris reflexive movement training and the patients can usually do it.
method: through essential condition, (d) Acupressure is the same as the exercise
reflexive movement training of ciliaris, method of presbyopia. The frequency is
sphincter pupillae and dilator pupillae of once a day and the patients can usually
involuntary dominance is induced. do it.
(d) Eye protection device is used for the train- (e) Wearing correct glasses: if people wear
ing. The basic method is the same as improper glasses, it may deepen the
training method of presbyopia. The train- symptoms. Therefore, optometry should
ing time is 15 min (once a day) and the be precise before wearing glasses. The
patients can insist on it for a long time. patients should receive optometry every 5

(e) Manipulation massage of eyeball: the years. Progressive glasses are scientific.
method is the same as the training method The upper part of progressive glasses is
of myopic eye. The training time is 5 min used to see far object, middle part of it is
for one eye and 10 min for two eyes (once used to see object in middle distance and
a day). There are 15 times in one therapy near part of it is used to see near object.
course. The degree is from high to low in these
During massage, the therapists should pay three areas gradually so that the patients
attention to the force and the feeling of the can see far and near objects.
patients. If there is nausea or other discom- The patients cannot buy glasses randomly.
fortableness, the therapists should stop mas- Traditional retrogressive hyperopia eye only
sage. Massage cannot be used for the patients helps the patients to see near object.
with glaucoma, retinal detachment, ophthal- 4.
Prevention of retrogressive presbyopia:
mia, hypertension, diabetes mellitus and Frequent self-exercise of ocular muscles is
severe trachoma. effective measure to prevent ocular muscles
3. Other Therapy Methods of Retrogressive
and ocular structure degradation. The patients
Hyperopia Include Self-Exercise and Wearing should insist on it so that they can obtain
Glasses desired effect.
(a) Near vision method: in an environment (a) The patients should use eye scientifically
with sufficient light, the patients use two and don’t use it excessively: Excessive
hands to hold paper or newspaper with eye using can induce tension and fatigue
colorful character and move it from far to of ocular tissue. The patients should use
near slowly. When the object reaches the eye scientifically and don’t use it exces-
critical point of blurred vision, the patients sively to alleviate eyestrain and maintain
stop the movement and concentrate to see blood circulation and elasticity of ocular
the object clearly for 6 s after regulation tissue in order to delay aging of ocular
of mind and breathing. The training time tissue.
is 15 min (once a day) and the patients can (b) Paying attention to eye using environ-

insist on it for a long time. ment: people watch books or use eyes in a
bad environment or condition such as habits in visual environment. In our country, the
moving position, clinostatism, dim light, patients with myopia usually wear glasses and
near vision and too small object, which all receive medicine and surgery therapy, but there is
lead to excessive adjustment of eye. Long- no effective rehabilitation training measures. In
term excessive adjustment easily leads to our study, we used ciliaris training method. In
change of ocular structure, and then Huajiadi Experimental Primary School Chaoyang
induces refractive index and eyesight District Beijing, from May 22th 2006 to
change. People should watch books in an September 27th 2006, we did a 4-month’s
adequate and mild light with stable sitting experiment to observe the rehabilitation effect of
position and proper distance between early myopia. The results are as follows:
book and eye. People should see far inter-
mittently and do eye exercises.
(c) Invigorating health effectively: The 18.3.1 Materials and Methods
patients should do exercise persistently to
keep good body condition, which is an 18.3.1.1 Clinical Materials
important condition to prevent In Huajiadi experimental primary school
retrogressive hyperopia. Chaoyang district Beijing, we choose class five in
(d) Paying attention to nutrition and dietary fourth grade and class four in fifth grade. They are
structure: Nutrition has important effect on randomly divided into two groups. The training
occurrence and development of myopia. group is class five. There are 39 people (22 males
Proper dietary structure is an effective and 17 females) and the average age is 10.4. The
measure to prevent visual impairment control group is class four. There are 37 people (21
including retrogressive hyperopia. males and 16 females) and the average age is 10.3.
(e) Acupressure is the same as the method of
presbyopia. 18.3.1.2 Training Method
(f) Self-exercise: the patients should fre- 1. Training group: OO brand SU-001 eye protec-
quently be in green environment such as tion device produced by Beijing Xingch
grassland and forest and concentrate to enwanyou Science and Technology Ltd. is
see the objects from far to near until they used for ciliaris training. Every student have
can see the object clearly in the nearest an eye protection device and do ciliaris train-
distance. The distance should be ing (15 min per time, twice a day in moon
recorded. After repeated exercise, they break and before sleep. The total training time
should compare the distance to see the is 4 months.
object clearly. This method can develop In order to guarantee training quality, the
ciliaris potential and improve retrogres- teachers and parents should examine and
sive hyperopia. instruct the training and give the students
training notebook. Under the supervision of
the parents, the students should fill in the
18.3 Clinical Application training notebook.
of Rehabilitation Training 2. Control group: The students only receive pro-
of Ciliaris in Pupil with Early paganda and education of prevention of
Myopia myopia.
Myopia is a somatopsychic illness to harm the

teen-age. The morbidity of myopia in the students 18.3.2 Observational Index
of our country is increased consistently, which is
the second in the world. The cause of formation is International universal index is used for
related to such as long-term near vision and bad assessment.
18.3 Clinical Application of Rehabilitation Training of Ciliaris in Pupil with Early Myopia 523
18.3.2.1 Eyesight Detection 18.3.3 Results

Standard logarithmic visual acuity chart of light
box is used to test eyesight of naked eye of one 18.3.3.1 Data Analysis
eye in 5 m away. There are 78 eyes of 39 students in training group.
After training, the average eyesight is 1.20 ± 0.56
18.3.2.2 Refraction Test from the eyesight before training (0.71 ± 0.36的).
NIDEK-AR600 auto refract keratometer pro- There is significant difference of eyesight before
duced by Beijing Xueliang Glasses Company is and after training (P < 0.01, Table 18.1). There are
used to test diopter and astigmatism of every eye. 74 eyes of 37 students in control group. The
average eyesight is 0.71 ± 0.37. Four months later,
18.3.2.3 Data Collection the average eyesight is 0.71 ± 0.63. There is no
and Statistical Analysis significant difference of eyesight before and after
Eyesight and diopter are tested before and after the training (P > 0.05, Table 18.2. There is
training. The data is recorded and stored. significant difference of eyesight between two
SPSS12.0 statistical software is used for T-test. groups (P < 0.01). Two eyes have myopia in
Before training, there is no difference of age control group.
and myopia between the two groups (P > 0.05). After training, the number of the eyes with
normal eyesight is 52 from 27 before training.
18.3.2.4 Classification of Eyesight The increase rate is 92.6%. The number of the
and Evaluation Criterion eyes with mild myopia is decreased to 17 from 31
of Therapeutic Effect before training. The decrease rate is 45.2%. The
International universal classification and evalua- number of the eyes with moderate myopia is
tion criterion. decreased to 8 from 10 before training. The
decrease rate is 20%. The number of the eyes
1. Classification of eyesight is according to the with severe myopia is decreased to 1 from 10
lower eyesight of naked eye. before training. The decrease rate is 90%.
(a) Normal eyesight: Eyesight is more than In control group, the number of normal eyes is
5.0. 31 from 33 before intervention. The number of
(b) Mild myopia: Eyesight is 4.7–4.9. myopic eye is increased to 43 from 41. The
(c) Moderate myopia: Eyesight is 4.4–4.6. increase rate is 12.5%. The number of moderate
(d) Severe myopia: Eyesight is less than 4.3. myopia is increased to 20 from 17. The increase
2. Classification of therapeutic effect is accord- rate is 17.6%. The number of severe myopia is
ing to eyesight from standard logarithmic decreased to 5 from 8 before training. The
visual acuity chart. decrease rate is 37.5%.
(a) Cure: eyesight is recovered to more than
5.0. 18.3.3.2 Classification of Therapeutic
(b) Excellent: eyesight is recovered to more Effect
than 3.0 on the original basis. Therapeutic effect is measured by the eyesight
(c) Effective: eyesight is recovered to more that is lower than 5.0 before training. There are
than 0.1 on the original basis. 51 eyes.
(d) Invalid: eyesight is recovered to less than Healing: eyesight of 25 eyes is recovered
0.1 on the original basis. more than 5.0. The cure rate is 49%.
3. There are three grades of according to diopter. Excellent: eyesight of 24 eyes is recovered
(a) Cure: refraction range is recovered to more than 0.3. The excellent rate is 47.1%.
+0.50 to −0.25D. Effective: eyesight of 50 is recovered more
(b) Effective: refraction range is recovered to than 0.1. The effective rate is 98%.
−0.50 to −6.0D. Invalid: eyesight of one eye is recovered less
(c) Invalid: refraction range is not recovered. than 0.1. The invalid rate is 2%.
Table 18.1 Comparison table before and after training of rehabilitation training of eyesight in training group
Degree
Side Normal Mild Moderate Severe
Left eye pre-test 14 16 4 5
Left eye post-test 28 7 4 0
Right eye pre-test 13 15 6 5
Right eye post-test 24 10 4 1
Total pre-test 27 (34.6%) 31 (39.7%) 10 (12.8%) 10 (12.8%)
Total post-test 52 (66.7%) 17 (27.8%) 8 (10.3%) 1 (1.3%)
Table 18.2 Comparison table before and after training of eyesight in control group
Degree
Side Normal Mild Moderate Severe
Left eye pre-test 19 6 8 4
Left eye post-test 16 8 11 2
Right eye pre-test 14 10 9 4
Right eye post-test 15 10 9 3
Total pre-test 33 (89.2%) 16 (43.2%) 17 (45.9%) 8 (21.6%)
Total post-test 31 (83.8%) 18 (48.6%) 20 (54.1%) 5 (13.5%)
Table 18.3 Refraction change in training group before widely accepted that long-term near vision is the
and after training major factor to form myopia. Excessive near
Low and vision induces excessive adjustment of ciliaris
moderate High and finally leads to spasm, which elongates long
Emmetropia myopia myopia ocular axis, increase refractive index of crystalline
(+0.50 to (−0.50 to (>
lens. Therefore, objective image focus before
−0.25D) −6.0D) −6.00D)
Before 61 11 0
retina and the manifestation is myopic optical
training defocus. However, with further research, the
After 63 7 1 scientists found that there is no excessive
training adjustment but adjustment lag in human eyes.
When people see the object in a certain distance,
After training, the number of the eyes with if adjustment of ciliaris is insufficient, objective
normal diopter in training group is increased to 63 images focus behind retina and the manifestation
from 61 before training. The increase rate is 3.3%. is hyperopic optical defocus. Atropine eyewash,
The number of low diopter of myopia is decreased muscarinic cholinergic receptor blocker, can
to 7 from 11 before training. The decrease rate is control myopia, which demonstrated that myopia
36.4%. One eye is developed to high diopter of is related to ciliaris spasm. Atropine eyewash has
myopia before training (Table 18.3). an effect through alleviating ciliaris spasm. Some
researches show that there is adjustment lag of
ciliaris in near vision. Marco found that in near
18.3.4 Discussion vision ciliaris seldom adjust even don’t adjust.
Long-term no-adjustment of ciliaris leads to
18.3.4.1 M yopia Can Be Recovered retrogressive change and disuse myasthenia,
Through Increasing which can decrease adjustment function,
Adjustment Ability After aggravate myopia and form vicious circle.
Ciliaris Training The author deemed that two paradoxical con-
There is no method to cure myopia in modern clusions are the results of ciliaris damage to vary-
medicine and there is no effective measure to ing degrees in different phase of myopia
inhibit the progress of myopia effectively. It is development. In the early phase of myopia,
18.3 Clinical Application of Rehabilitation Training of Ciliaris in Pupil with Early Myopia 525
because of long-term near vision, persistent adjustment ability. For example, if a person wants
excessive contraction of ciliaris can make the to lift up 100 kg, he must do special exercise.
objective image on retina, which may induce Skeletal muscles are voluntary muscles. The
insufficient blood supply of ciliaris, metabolite joint motion generated by contraction and relax-
accumulation and muscle fiber injury. These can ation is obvious, but people are difficult to feel
induce ciliaris spasm. In the early phase of myo- the movement of crystalline lens generated by
pic eye, there are eyestrain, discomfort, sour and contraction and relaxation of ciliaris. Therefore,
headache in the patients, which are related to they think that there is no way to train ciliaris.
spasm after ciliaris injury. For example, people This is a misunderstanding. Although ciliaris is
feel muscular soreness after long-distance run- dominated by parasympathetic nerve of oculo-
ning and there are sternocleidomastoid spasm and motor nerve and belongs to involuntary muscle,
soreness after stiff neck. Because ciliaris is small reflexive movement can increase its function.
and in the deep of eye socket and the sensory loca- The cure rate is 49% and effective rate is 97.4%
tion is not accurate, the symptoms are slight. This in training group, which demonstrates the
is why Atropine, spasmolytic, is effective in the effectiveness of this training method.
early phase of myopia. With the development of
myopia, people should wear glasses. Although 18.3.4.2 A djustment Ability of Ciliaris
glasses can alleviate myopia, it decreases adjust- Is the Important Factor
ment change of crystalline lens. After a long time, of Negative Refraction
it may induce disuse myasthenia of ciliaris and Induced by Elongation
worsen adjustment function. Therefore, in the late of Axis Oculi
phase of myopia, there are tension decrease and In all the 78 eyes in training group, there are only
lacking in strength of ciliaris. 27 eyes with emmetropia measured by logarith-
The author deemed that the common charac- mic visual acuity chart and there are 61 eyes with
teristic of ciliaris whether with spasm in early emmetropia measured by refraction test. The
phase or tension decrease in late phase is adjust- number of difference is 34. After training, the
ment ability decrease of crystalline lens. Major cure rate measured by logarithmic visual acuity
performance of adjustment ability includes two chart is 49% and the cure rate measured by
aspects such as adjustment range and adjustment refraction test is only 7.4%. There is significant
flexibility. Adjustment range is the change of difference between the two methods. This phe-
crystalline lens due to contraction and relaxation nomenon is related to adjustment ability of cilia-
of ciliaris. Adjustment flexibility is the times of ris and the change of axis oculi.
changed curvature of crystalline lens regulated Near vision leads to elongation of axis oculi
by ciliaris in unit time. The researches show that and the mechanism remains unclear. Someone
ocular refractive error is significantly related to think that it is a process of active remodeling of
adjustment range of ciliaris, and has no relation- eyeball regulated by neural and bioactive sub-
ship with adjustment flexibility. By this token, stance. Some researchers think that it is trigem-
the training of adjustment function of ciliaris, iny reflex mechanism of near vision such as
especially adjustment range has good effect on adjustment, pupil shrink and convergence.
the prevention and rehabilitation of myopia. Intraocular and extraocular rectus of eyeball
Magnet therapies, medicine such as atropine and oppress eyeball. Linzhi proposed that elongation
hot compress have some effect on myopia in the of axis oculi is because ciliaris contraction regu-
early phase. These methods can alleviate ciliaris lated by brain decreases ocular pressure and ocu-
spasm and ocular sourness and promote excre- lar pressure is too high because this regulation
tion of metabolite. In the late phase of myopia, fails. Only elongation of axis oculi can change
these methods have no obvious therapeutic effect. diopter. In the early phase of myopic eye, adjust-
Only training can develop neural potential of ment ability of ciliaris decreases, but the axis
nerve that dominates ciliaris and increase its oculi are not elongated. Although the refraction is
normal, because adjustment ability of ciliaris prevent myopia, recover myopia and keep the
decreases, eyesight measured by visual testing therapeutic effect.
chart is lower than the normal. In the late phase of Rehabilitation training has short-term effects
myopic eye, the adjustment ability of ciliaris on the pupils with myopia in the early phase.
decreases with elongation of axis oculi, the eye- Long-term therapeutic effects are related to
sight is lower than the normal measured by whether the pupils can keep the exercise or the
refraction test and visual testing chart. The for- near vision habit can be overcome. For the pupils
mer myopia is called adjustment myopia and the with moderate and high myopia and elongation
latter is called refractive myopia, which is one of of axis oculi, the effectiveness of ciliaris training,
the criterions to distinguish false and true myo- visual environment changes and unsynchronized
pia. Ciliaris training can recover and increase longitudinal massage of two eyes requires further
adjustment ability of ciliaris, but cannot shorten verification. In addition, criterion of cure is that
elongated axis oculi. Therefore, eyesight is the eyesight reaches 5.0 in the assessment of ther-
increased significantly measured by visual test- apeutic effect, but excellent criterion is that the
ing chart and eyesight is not increased obviously eyesight is increased by 0.3 on the original basis.
measured by diopter test. The author think that If the eyesight is from 4.9 to 5.0, it belongs to
static refraction is not the only golden standard to curative case but not excellent case. The reason-
assess the therapeutic effect of myopia. When ableness that cure rate is higher than excellent
one condition is stable, changing another condi- rate requires further investigation.
tion can achieve the goal. For example, a person
in severe environment can increase his own via-
bility to survive without changing the environ- References
ment. In addition, potential ability training of
ciliaris recovers adjustment myopia and prevent 1. Bill A. Blood circulation and fluid dynamics in the
eye. Physiol Rev. 1975;55(3):383–417.
refractive myopia. 2. Becker B, Neufeld AH. Pressure dependence of uveo-
scleral outflow. Glaucoma. 2002;11(6):545–9.
3. Troster H, Brambring M. The play behavior and play
18.3.4.3 C orrecting Bad Reading materials of blind and sighted infants and preschool-
Habit Is the Fundamental ers. J Vis Impair Blind. 1994;88(5):421–33.
Guarantee for the Prevention 4. Jiang BC. Accommodative vergence is driven by the
and Rehabilitation of Myopia phasic component of the acconmodative controller.
Vision Res. 1996;36(1):97–102.
The distance between eye and book is too short, 5. Grosvenor T, Goss DA. Role of the cornea in emme-
which is the important cause to generate myopia. tropia and myopia. Optom Vis Sci. 1998;75(2):
The best reading sight distance is 33–50 cm. It is 132–45.
easy to generate myopia if the sight distance is 6. Hamelin N, Glacet-Bernerd A, Brindeau C, et al.
Surgical treatment of subfoveal neovasculariztion in
shorter than 20 cm. If people cannot overcome myopia: macular translocation vs surgical removal.
near vision habit, it cannot maintain the therapeu- Am J Ophthalmol. 2002;133(4):530–6.
tic effect of myopia rehabilitation. After wearing 7. Tano Y. Pathologic myopia: where are we now? Am J
glasses, myopia is worsened in the eye whose Ophthalmol. 2002;134(5):645–60.
8. Sawada A, Tomidokoro A, Araie M, et al. Refractive
eyesight is rectified. Therefore, the u nderstanding errors in an elderly Japanese population: the Tajimi
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adjustment. It is also the fundamental measure to
Corollary Equipment
of Rehabilitation Training 19
19.1 T
he Guiding Ideology bullet can damage or kill the target about 200 m
of Developing Corollary away. If guided missile is used, it can hit any target
Equipment of Rehabilitation on the earth and damage the target greatly. In this
Training example, the method is hit. Because the instru-
ment is different in the hit, the hit distance and the
19.1.1 The Implication damaged degree are double. Instrument amplifies
of Rehabilitation Training the application of method.
Equipment In daily productive labor, there are many
instruments such as pliers and wrench to cut off
Broadly speaking, at present, the definition of steel wire or screw nut that human cannot
equipment is that machine and device can be complete.
used for a long time in industry or enterprise and These show that instrument can extend the
the matter form and material goods are main- effect of the method to varying degrees to com-
tained in use. Equipment is the physical means to plete the mission that human cannot complete. All
create wealth, is material and technological foun- the instruments or equipment are good for the bet-
dation of social production and is one of the ter implement of the method, making use of the
marks of progress of modern productivity. method, extending the effect of the method to
Except for the performances mentioned above, varying degrees and achieving the goal of the
the author thinks that equipment is the instrument method. Therefore, advanced extent of instrument
of implementation method. It can implement the and equipment stands for technological develop-
method better and make the best use of the method. ment of modern society and is the important fac-
In a way, it can broaden the application range of tor to promote production and development and
the method to varying degree, even complete the progress of all walks of life.
job or mission that human cannot finish. For There are many kinds of equipment with vari-
example, if people want to hit a target far away ous uses. Medical apparatus and instruments can
from their body, the fist can only be used to hit the be uniquely or combined used for human body to
target in the distance of arm length and the power obtain certain therapeutic effect or support thera-
is limited. Slingshot can be used to hit the target peutic efficacy, including instruments, equipment,
30 m away and the power is big to harm the target apparatus, materials or other goods. At present,
to a certain extent. If bow and arrow are used, peo- medical equipment [1] is divided into diagnostic
ple can hit the target 100 m away. The arrow is equipment, therapeutic equipment and auxiliary
more powerful than mud ball. If rifle is used, the equipment in medical industry. There are many
https://doi.org/10.1007/978-981-13-0812-3_19
528 19 Corollary Rehabilitation Equipment of Neurological Training
subtypes in each class. According to the effect of of recovering motor function at first. CNS injury
the equipment, rehabilitation training equipment may lead to motor function loss of corresponding
belongs to therapeutic equipment. part of the body such as limbs and trunk, which
Except for the similarity, rehabilitation train- demonstrates that CND dominates the body
ing equipment can make full use of training movement. The root of the problem is in CNS
method and show the therapeutic effect. It can but not the limbs or the trunk. Because there is
make the people who receive the training know no problem in limbs or trunk, lost motor function
the training mechanism, relieve labour intensity is the external manifestation of CNS dysfunction.
of the therapists and decrease treatment cost to Therefore, the premise of recovering lost motor
enhance training effect. function is to recover injured CNS function at
Therefore, the definition of rehabilitation first. CNS is lack of regeneration ability, but with
training equipment is summarized as follows: plasticity, functional reorganization and skillful
rehabilitation training equipment can make full use and dependence. Only active movement of
use of training method, show the therapeutic the body dominated by brain can promote
effect and extend the effect of the method to vary- plasticity and functional reorganization of brain
ing degrees. It is special instrument that can com- so that the effective rehabilitation method must
plete the job or mission that human cannot finish be active movement. Developed corollary
including machine, device and instrument for equipment according to the method must meet
long-term use. It can relieve labour intensity of the application requirements of active movement
the therapists and decrease treatment cost to rehabilitation training method. Therefore, active
enhance training effect. It can be used repeatedly movement is the method to recover lost motor
and the original form and material can be main- function. The mechanism and theoretic basis are
tained in use. plasticity and functional reorganization of
CNS. The normal method and six-step Daoyin
technique of guiding collaterals through
19.1.2 Development Mechanism meridians used in neurological training are the
of Corollary Equipment training methods of active movement that the
of Rehabilitation Training therapists encourage the patients to do according
of Neurological Training to these mechanisms.
The author found that methodology promotes
Just as mentioned above, rehabilitation training CNS plasticity, which is not equal to functional
equipment is to implement rehabilitation method reorganization of CNS. On one hand, it is unclear
better, make full use of method and increase the that how active movement training is used for
effect of rehabilitation training. On the basis of the disabled without motor function, how to
rehabilitation training method, the developed make full use of and enhance the effect of active
training equipment has actual clinical application movement and what is the major effect of active
value and can enhance effect of rehabilitation movement. On the other hand, is the motor
training. The equipment must originate from function recovered by potential development,
method. replacement of injured cells by normal cells
In that way, what is the root of method? around injured area, or reserved conduction
Method must originate from theory. pathway is activated? Practice demonstrates that
For example, we use rehabilitation training the answer is no. one joint motion should require
method to recover lost motor function after several muscles and associated movement of
injury of central nervous system [2]. The major many joints requires more muscles. These
purpose is to recover lost motor function and muscles are dominated by many CNS cells and
then we should consider the rehabilitation conduction pathways. Through coordinated and
method to achieve goal. In the method selection, orderly work, these cells can promote or achieve
we should analyze the process and mechanism functional reorganization. The process of
19.1 The Guiding Ideology of Developing Corollary Equipment of Rehabilitation Training 529
coordinated and orderly work includes motor of the research. The defect is obvious in the auto-
program proved in animal experiment and its mation, complication and expensiveness of the
external manifestation, motor pattern. The equipment.
method of promoting cerebral functional Rehabilitation equipment of neurological
reorganization must reestablish motor program training is made according to the mechanism that
and remodel motor pattern to recover motor equipment must originate from method. All the
function. equipment are developed according to the actual
Rehabilitation method of neurological train- requirements of rehabilitation method. After clin-
ing is that on the basis of regulation of mind ical application for more than 10 years. We
and breathing, the patients are guided to com- obtained satisfying effects and develop the idea
plete active joint motion and neurological train- of realizing rehabilitation training equipment. In
ing device is used to receive the motor program order to highlight the characteristics of corollary
signal real-timely and display is in a curve equipment of rehabilitation training of neurologi-
form. Through the biofeedback mechanism [3] cal training according to the above law and main-
of practicing archery towards target, on the tain the original innovation of the inventor, we
basis of rectifying disordered motor program, registered the brand Wenru (Fig. 19.1). The pur-
normal motor program is reestablished. On the pose is that we hope the brand can stand for the
basis of reestablishing motor program, the ther- sign of rehabilitation technique of neurological
apists can adopt the training method that can training, symbol of rehabilitation technique inno-
restrain unnecessary joint motion in body vation, promise of social honesty, guarantee of
movement effectively and gradually remodel technique and product quality and the brand rec-
normal motor pattern to realize cerebral func- ognized by public. Meanwhile, it stands for the
tional reorganization and recover lost motor
function.
Therefore, neurological training is the method
to realize the theory of CNS functional reorgani-
zation, display the effect of Daoyin technique
real-timely and do reestablishment training of
motor program. Neurological training device is
the corollary equipment to fully implement this
method and make full use of it.
In short, effective rehabilitation training
equipment must originate from method so that
the rehabilitation method can be implemented
well to give full play to the effect of method.
Rehabilitation method must originate from the-
ory and the method is the practice of theory. All
the methods must meet the requirements of the-
ory so that they become effective methods.
At present, in the research of rehabilitation
method and equipment at home and abroad,
there is no mechanism of developing method
according to theory and developing equipment
according to method. Especially in the equip-
ment research, there is no some kind of rehabili-
tation method and it is not based on some
rehabilitation theory or the theory has some
defects so that there is blindness in the beginning Fig. 19.1 Registered Wenru brand
expectation of renaissance of rehabilitation training that they cannot finish or are difficult
technique in traditional Chinese medicine and to finish.
footstone of serving as a modest spur to induce
someone to come forward with his valuable This kind of equipment provides essential
contributions. condition to help the therapists to use normal or
six-step Daoyin technique of guiding collaterals
through meridians to develop CNS potential
19.2 T
he Major Function through active movement training in the safe
and Classification imminent danger state created by posture change
of Corollary Equipment and speech.
2. Goal training equipment of active movement:
The basic method of rehabilitation of neurologi- the surpassing goal of the patients in the pro-
cal training is six-step Daoyin technique. The cess of neurological training is set in the sys-
basic method of Daoyin technique is the entire tem of the equipment and the rehabilitation
active movement of regulation of movement on training can be used to develop neural poten-
the basis of regulation of mind and breathing. tial [4], reestablish motor program, remodel
Therefore, rehabilitation equipment of neurologi- motor pattern and recover lost motor function
cal training developed according to the method with the goal and motive mechanism and
must meet the requirements of all active move- Daoyin technique. However, this goal requires
ment training. the therapists to set through the computer sys-
tem of the equipment or select virtual goal
stored in the equipment. Anti-resistance
19.2.1 Major Function requires the therapists to exert in the orienta-
tion of joint motion.
The major function of corollary equipment of
rehabilitation training of neurological training is This kind of equipment usually is equipped
the common function that all corollary equip- with neurological training device (receiving
ment of rehabilitation training of neurological equipment of bio-electricity signal) to receive
training has. If there is no such function, this motor program signal real-timely and display it
equipment cannot meet the requirements of reha- on the fluorescent screen. The setting digital sur-
bilitation training of neurological training. This passing goal is showed in a transverse line. The
equipment cannot be used for rehabilitation train- transverse line of agonistic muscle is green and
ing of neurological training and the training that of antagonistic muscle is pink. During the
effect is not satisfying. training process, the therapists use six-step
Daoyin technique repeatedly to guide the
19.2.1.1 Active Movement patients to do anti-resistance training to varying
Active movement is the fundamental measure to degrees to make signal intensity of agonistic
promote plasticity and functional reorganization muscle surpass the green transverse line and sig-
of CNS is the basic guarantee to recover lost nal intensity of antagonistic muscle lower than
motor function after CNS injury. According to pink transverse line in order to make motor pro-
the training way of active movement, the training gram gradually return to the normal. On the
equipment of active movement can be divided basis of that, motor program of associated move-
into three classes. ment that multiple joints are involved in are rees-
tablished and lost motor functions are recovered
1. Auxiliary training equipment of active move- to varying degrees.
ment can provide safe protection to help the
patients to keep some kind of gesture and lose 3. Automatic equipment of active movement can
weight so that the patients can complete the provide surpassing goal, anti-resistance,
19.2 The Major Function and Classification of Corollary Equipment of Neurological Training 531
speech guideline of Daoyin technique and limbs to promote plasticity and functional reor-
instruction of main and collateral channels ganization of cortex motor center [5] that domi-
according to training program automatically nates lower limbs.
after the training is activated so that the Through weight support system of the equip-
patients can be guided to do rehabilitation ment, the therapists use hanging belt of thorax
training to develop neural potential, reestab- and hip to exert upward traction force to the body
lish motor program, remodel motor pattern of the patients. In the process of weight support,
and recover lost motor function through goal the equipment can prevent falling off or bumping
and motive mechanism. of the patients effectively and avoid training acci-
dent so that the training can be safe and reliable.
Automatic equipment of rehabilitation train- It can alleviate or eliminate the fear or anxiety of
ing of neurological training of active movement the patients, which is good for training effect.
realizes the function of man-machine conversa-
tion so that people can do one-to-one training 19.2.1.3 A voiding Unnecessary Joint
with the machine. The method of rehabilitation Motion in Limbs Movements
training of neurological training is basically Effectively
implemented. Therefore, it is possessed with the Single joint movement is the basis of limbs
basic elements of the robot of rehabilitation train- movements. There is no functional movement
ing, which is called robot equipment of rehabili- with actual significance. Limbs movements with
tation training of neurological training. multiple joints and actual significance are the
basis of motor pattern of limbs. Abnormal single
19.2.1.2 Weight Support joint movement is the important cause of abnor-
and Protection mal motor pattern of limbs. Therefore, avoiding
Weight support and protection is the premise and unnecessary joint motion in limbs movements
basic condition of implementation of rehabilita- effectively is the important link of remodeling
tion method of neurological training, is the guar- motor pattern.
antee of safe training, is the important channel to In all the equipment of rehabilitation training
alleviate or eliminate the fear or anxiety of the of neurological training, abnormal joint motion
patients, and is the effective method for success- should be prevented in the potential development
ful implement of the training that cannot be com- training, motor program reestablishment and
pleted in normal condition. motor pattern remodeling. In the training of
The purpose of weight support is to lose the abnormal gait rectification weight support device,
weight of the patients according to their actual weight support stride and gait shifting of weight
condition through the weight support system of device, weight support walking balance device or
the equipment in order to reduce the bear load of motor pattern remodeling [6] device, abnormal
the lower limbs or the trunk so that the patients joint motion should be rectified and prevented.
can stand, support or walk from the condition
that they cannot stand, support or walk. Therefore, 19.2.1.4 Daoyin Technique Speech
the training can be implemented successfully. For Guide and Setting
example, the patients with paralysis of two lower Surpassing Goal
limbs who cannot stand, cannot do potential Six-step Daoyin technique in traditional Chinese
development training of lower limbs under nor- medicine is used. In order to realizing standard
mal circumstances. However, through weight application of Daoyin technique, give full play to
support system of potential development training therapeutic effect and alleviate labour intensity of
of lower limbs, the patients use hanging belt of the therapists, we recorded tape of Daoyin
thorax and hip to bear the partial body weight of technique, put it into the training items of equip-
the patients so that the patients are kept in stand- ment software and play it automatically accord-
ing position. The therapists are guided and helped ing to training program. Through operational
to do potential development training of lower system of equipment, according to the specific
condition of the patients, we can set different equipment. They can be divided according to the
therapeutic items, and establish surpassing goal way of active movement, the source of feedback
such as archery to the target and high jump with signal, major function and mechanical degree.
cross bar to guide the patients to do the training
with purpose and increase training effect. 19.2.2.1 The Way of Active Movement
It can be divided into three classes such as auxil-
19.2.1.5 Automatic Tracking of Main iary active movement, goal active movement and
and Collateral Channels autonomous active movement. There are several
and Animation Spot Display subtypes in each class.
The basic method of rehabilitation training of
neurological training is six-step Daoyin tech- 1 . Auxiliary active movement training equip-
nique, especially guiding collaterals through ment are training device of neurological train-
meridians in six-step Daoyin technique according. The main equipment are as follows:
ing to main and collateral channels. Therefore, (a) Training equipment of potential develop-
whether rehabilitation training device of neuro- ment include potential development train-
logical training is set up independently or is the ing device of upper limbs, lower limbs,
part of the equipment, automatic tracking of main trunk, tibialis anterior muscle and ham-
and collateral channels and animation spot dis- string muscles.
play are used to keep Qi in the correct main and (b) Training equipment of gait and shifting of
collateral channels. body weight include stride and gait shift-
One of the key techniques of guiding collater- ing of body weight training device, abnor-
als through meridians and guiding meridians mal gait rectification weight support
through collaterals is to keep Qi guided in six- training device, motor pattern remodeling
step Daoyin technique in correct main and col- training device, weight support walking
lateral channels. Whether the therapists or the training device and gait training footpath.
patients, doctors or the patients’ family, they (c) Training equipment of balance include
know little about correct main and collateral weight support balance training device,
channels. Correct main and collateral channels air or water bag standing balance training
are the basis of implementing the methods of device and walking balance training
guiding collaterals through meridians. Animation device.
spot blink technique is used in virtual body. The (d) Induction equipment of active movement
speed of spot follows the speed of automatic include induction training device of roll-
guide speech of Daoyin technique. Animation ing active movement, induction training
blink technique is used to mark the Qi in main device of weight support crawling auto-
and collateral channels and its pathway. The nomic movement, active standing training
patients guide Qi around their body according to bed, induction training device of auto-
the instruction of the spot to clear and activate the nomic movement of lower limbs and
channels and collaterals. upper limbs.
2. Goal active movement training equipment are
neurological training device that can provide
19.2.2 The Classification of motor program signal, pressure signal or
Rehabilitation Corollary analogue signal to do surpassing goal training
Equipment of Neurological through biofeedback mechanism.
Training (a) Potential development equipment include
potential development training device of
Neurological training is composed of training upper limbs, potential development train-
methods that aim at different diseases or symp- ing device of lower limbs, potential devel-
toms. Therefore, there are many kinds of c orollary opment training device, potential
19.2 The Major Function and Classification of Corollary Equipment of Neurological Training 533
development training device of tibialis program reestablishment of central nervous sys-

anterior muscle, potential development tem that dominate wrist and hand joint to recover
training device of hamstring muscles, autonomic movement, enhance myodynamia and
Daoyin device of myodynamia, Daoyin prevent adhesion of soft tissue and joint, muscle
device of balance potential and Daoyin atrophy and tendon contracture. Rehabilitation
device of sphincter. training robot of neurological training of head
(b) Motor program reestablishment equip-
and neck is suitable for the neural potential devel-
ment include neurological training device opment and motor program reestablishment of
and Daoyin device of muscle tension. central nervous system that dominates head and
(c) Motor pattern remodeling equipment neck movement to recover autonomic movement,
include neurological training device of enhance myodynamia and prevent adhesion of
motor pattern remodeling, neurological cervical tissue. Rehabilitation training robot of
training device of stride gait shifting of neurological training of lumbosacral spinal cord
body weight and neurological training is suitable for the neural potential training of cen-
device of weight support walking, neuro- tral nervous system that dominates lumbosacral
logical training device of animation gait movement to recover autonomic movement,
training footpath, neurological training enhance myodynamia, alleviate and prevent
device of abnormal gait rectification adhesion and pain of lumbosacral tissue
weight support walking and neurological Rehabilitation training robot of neurological
training device of weight support training of hip and knee is suitable for the neural
walking. potential development, motor program reestab-
(d) Comprehensive type includes virtual real- lishment and motor pattern remodeling of central
ity training device of neurological train- nervous system that dominate hip and knee joint
ing indicating instrument of guiding to recover autonomic movement [8], enhance
collaterals through meridians. myodynamia and prevent adhesion of hip joint,
3. Autonomous active movement training equip- knee joint and peripheral tissue. Rehabilitation
ment are robot equipment of rehabilitation training robot of neurological training of foot and
training of neurological training. The equip- ankle is suitable for the neural potential training
ment can provide feedback signal and sur- of central nervous system that dominates ankle
passing goal. It is equipped with automatic joint to recover autonomic movement, enhance
speech guide of six-step Daoyin technique, myodynamia, alleviate and prevent adhesion of
speech guide of main and collateral channels, ankle joint and peripheral tissue and tendon
and automatic tracking indication system of contracture.
animation spot. It can do anti-resistance
training. 19.2.2.2 T he Source of Feedback
Signal
It is divided into several types according to the It is the source of feedback signal provided by the
training part. Rehabilitation training robot of equipment and can reflect the effect of Daoyin
neurological training of shoulder and elbow is technique. It includes motor program signal, anti-
suitable for the neural potential development and resistance signal and analogue signal guided in
motor program reestablishment of central ner- real-time.
vous system that dominate shoulder and elbow
movement to recover autonomic movement, 1. Motor program signal equipment: When

enhance myodynamia and prevent adhesion of Daoyin technique is used to induce autono-
soft tissue and joint [7], muscle atrophy and ten- mous joint motion, the reception equipment of
don contracture. Rehabilitation training robot of bio-electricity signal can receive the signal
neurological training of wrist and hand is suitable intensity and proportion of agonistic muscle
for the neural potential development and motor or antagonistic muscle involved in joint
motion form CNS and display it in a curve involved is reestablished such as motor pro-
form. The surpassing goal is set on the basis gram reestablishment of balance, gait and
of the intensity of motor program signal. motor pattern, and training device and neuro-
Through biofeedback and goal-motive mech- logical device of function transformation.
anism, the patients are guided to surpass the
goal, develop neural potential and reestablish 19.2.2.4 Mechanical Degree
motor program. This classification method is simple, intuitional,
2. Resistance signal equipment: The objective clear easy to memorize and understand. There are
indicator is the strength of resistance. When four classes.
Daoyin technique is used to induce autono-
mous joint motion and exert anti-resistance to 1. Training appliance: In order to keep the thera-
develop neural potential, the signal source is peutic effect of the patients in hospital and at
the strength of resistance and the signal is dis- home and improve functions, the training
played in a curve form real-timely. The resis- appliance is designed for self-exercise. It is
tance in the previous training is the surpassing portable, inexpensive, and simple. It is in
goal of the next training. Through biofeed- accordance with the theory and physiological
back and goal-motive mechanism, the patients mechanism of active movement and the thera-
are guided to surpass the goal. peutic effect is good.
3. Analogue signal equipment: virtual reality
2. Training device belongs to mechanical device
training system of the equipment provides without electric appliance and software. The
analogue motor program signal, surpassing functions include weight support and safe pro-
goal and the patients are immersed into virtual tection. This kind of equipment can be used to
environment through immersed technique. do active movement, auxiliary active move-
Six-step Daoyin technique is used to guide the ment and compulsory active movement.
patients to surpass goal. 3. Training instrument is equipped with recep-
tion system of bio-electricity signal or muscle
19.2.2.3 Major Function tension signal. It can use digital subjective
According to training goal and major function of indicator to display the effect of Daoyin tech-
the equipment, the equipment includes the equip- nique and provide surpassing goal for the
ment of neural potential development, motor pro- patients. Through biofeedback and goal-
gram reestablishment and motor pattern motive mechanism, the patients are guided to
remodeling. do the training of neural potential develop-
ment, motor program reestablishment, stride
1. Potential development equipment this kind of gait shifting of body weight, gait balance and
equipment is named with the body part such motor pattern remodeling.
as potential development training device or 4. Training robot is equipped with the function
neurological training device of upper limbs, of man-machine conversation. In this robot,
lower limbs, the trunk, tibialis anterior muscle there are many training items for selection,
and hamstring muscles. automatic speech guide of Daoyin technique,
2. Motor program reestablishment equipment
automatic tracking and display of animation
this kind of equipment can receive guided spot of main and collateral channels and
motor program signal, enhance signal inten- anti-
resistance function with different
sity of agonistic muscle and decrease signal strength. The results of comprehensive effects
intensity of antagonistic muscle in order to are that this robot can realize or approach the
reestablish motor program. actual operation level of the therapists.
3. Motor pattern remodeling equipment: on the
basis of reestablishing motor program of sin- Particularly, all corollary equipment rehabili-
gle joint movement, motor program of associ- tation training of neurological training is devel-
ated movement that multiple joints are oped to cooperate with six-step Daoyin technique
19.3 Introduction of Partial Corollary Equipment of Rehabilitation of Neurological Training 535
including normal method and the method of technique, in active joint motion, elastic
guiding collaterals through meridians. It is a recoil of elastic band is used unlimitedly.
method to implement Daoyin technique and give One end of elastic band is fixed on the limbs
play to Daoyin technique in order to increase the or some objects such as table leg and trunk
effect of corollary equipment. Equipment play a and the other end is fixed on the limbs of
supporting role and Daoyin technique is the movable joint so that the therapists can exert
major therapeutic method. Formulation of reha- resistance in joint motion. Moreover, the
bilitation goal and establishment of rehabilitationstrength of resistance is increased with the
principle are strategic measures to implement increase of joint motion angle. Therefore,
rehabilitation of neurological training. Specific Daoyin technique can be used to induce anti-
rehabilitation method is that various kinds of resistance training of active movement,
methods are used properly to obtain the best ther- which is good for the development and utili-
apeutic effect. Daoyin technique can clear and zation of central neural potential. The results
activate the channels and collaterals, and develop of comprehensive effects are that it can clear
cerebral potential. Equipment can guarantee the and activate the channels and collaterals,
implementation of the method to increase the develop cerebral potential and recover lost
effect of Daoyin technique, develop cerebral motor function.
potential and recover lost motor function. 2. Essential structure: Multifunctional training

However, if we use equipment alone or empha- box of limbs is composed of elastic training
size on the equipment excessively and don’t for- bands that are suitable for active movement of
mulate strategies and tactics of neurological all joints. Training band is black or brown
training, the method cannot be used correctly and elastic band with 6 or 11 cm in width. Elastic
the anticipated training effect cannot be achieved.tensile elongation is 2.4 times. The elastic is
monolayer except for double layer elastic
Rehabilitation training of the disabled is like a
battle. Advanced weapons are not the key of vic- band of hip abduction. The band is cut into
tory. The prerequisite of victory is correct appli-elastic strips with 15 cm in length. The two
cation of strategies and tactics. Advanced ends are sewed with black canvas with the
weapons are the instruments to keep the imple- same width. The two ends of canvas are fixed
mentation of strategies and tactics. with son thread of nylon and mother gluing
thread.
Manufacture of training appliance for spe-
19.3 Introduction of Partial cial part: for the proximal and distal ends of
Corollary Equipment the training joint that cannot be fixed or is dif-
of Rehabilitation ficult to be fixed, the part of fixing training
of Neurological Training band such as hip adduction, foot dorsiflexion,
strephexopodia and wrist extension, should be
19.3.1 Training Appliance fixed on the contralateral limbs for fixing
point of training band. Elastic training cush-
Pulmonary function exercise device. ion is made or elastic band is fixed on the
The detailed content refers to Chap. 14.2. training board for anti-resistance of active
Multifunctional training box of limbs. movement.
(a) Training cushion of hip adduction: the
19.3.1.1 Design Principle therapists select cardboard sponge with
and Essential Structure 11 cm in depth and cut it into trapezoid
1. Design principle: Neurological training is
(the top edge is 10 cm, the bottom edge is
composed of Daoyin technique, active move- 22 cm and the height is 18 cm) with two
ment and anti-resistance. A series of self- arch sides. The shape is suitable for the
training band is developed. Under the thigh. The outside is wrapped with cordu-
instruction of speech guidance of Daoyin roy soft cloth.
(b) Training board of wrist and hand: The ther- make it like shoe sole. Elastic bands are
apists choose wood board (30 cm × 15 cm fixed on the groove and two sides 8 cm
× 1 cm). The front is like palm. After pol- away from the front after polishing. It is
ishing, five rubber bands are fixed on the suitable for the anti-resistance training of
front edge. Training elastic band of wrist active movement of foot dorsiflexion and
flexion and extension is fixed on the meta- strephexopodia. During the training of
carpophalangeal joints part of training left foot, the patients use right foot to step
board. Fixing band of forearm is fixed on on the training board for foot dorsiflexion
the wrist joint of training board. It can be and strephexopodia, vice versa.
used for the training of wrist extension, The training bands of shoulder abduction,
wrist flexion, finger flexion and finger elbow extension and flexion, hip adduction, knee
extension. extension and flexion, and foot plantar flexion
(c) Training board of foot dorsiflexion and and training board of special part are sealed in
strephexopodia: the therapists choose box (Figs. 19.2, 19.3, 19.4, 19.5, 19.6, 19.7, 19.8,
wood board (30 cm × 25 cm × 1 cm) and 19.9, 19.10, 19.11, 19.12, 19.13, 19.14, and
dig a herringbone groove in the middle of 19.15). There are video of application method
the front. The therapists cut two sides and and dub disk of Daoyin technique.
Fig. 19.2 Training band of hip abduction Fig. 19.3 Training cushion of hi adduction
Fig. 19.4 Training band of knee extension
Fig. 19.6 Training band of foot dorsiflexion
Fig. 19.5 Training band of knee flexion
19.3.1.2 Application Method

The patients can do self-training according to the
video of application method. Fig. 19.7 Training band of foot plantar flexion
According to the training part, the patients
choose corresponding training band, wear it and 2. Regulation of breathing: The patients sit up,
fix it. The training procedures are as follows: lift the chest, regulate breathing and make the
body and mind in ready state.
1. Regulation of mind: The patients relax body 3. Regulation of movement: The patients should
and mind, meditate and concentrate on the confirm the goal point at first. For example,
contralateral brain. During the training of during the neurological training of foot dorsi-
right limbs, the patients concentrate on left flexion, the patients’ goal point is tibialis ante-
hemisphere, vice versa. rior muscle. On the basis of regulation of
Fig. 19.8 Training band of strephexopodia
Fig. 19.11 Training band of elbow flexion
Fig. 19.9 Training band of shoulder abduction

Fig. 19.12 Training band of wrist extension
Fig. 19.10 Training band of elbow extension Fig. 19.13 Training band of wrist flexion
(a) Limbs motor dysfunction induced by CNS

injuries such as hemiplegia due to cerebral
hemorrhage, cerebral infarction, cerebral
embolism and subarachnoid hemorrhage,
cerebral trauma, acroparalysis after brain
surgery, incomplete hemiplegia after spi-
nal cord injury and child cerebral palsy
(b) Muscle paralysis induced by peripheral
Fig. 19.14 Training band of finger extension nerve injury such as brachial plexus injury
and cauda equine injury
(c) Bone and joint inflammatory diseases
such as scapulohumeral periarthritis
and pain in waist and lower extremities
2. Contraindications: There is no obvious con-
traindications. For the people with bone frac-
ture, articular ligament injury, tendon injury
and muscle injury, they can do the training
with the permission of the doctors.
3. Announcements
(a) Training environment: The training
should be done in a warm and quiet room
and the patients should concentrate on the
training.
(b) Training amount: There should be inter-
nals in the training and the training fre-
quency shouldn’t be too high. The limit
Fig. 19.15 Training band of finger flexion is that the patients sweat slightly and
breathe smoothly or the training can be
mind and breathing, the patients use trigger done according to the video and tape.
way to shrink tibialis anterior muscle sud-
(c) Set goal point: During training, the
denly and increase the angle of foot dorsiflex- patients should concentrate on the agonis-
ion to the summit for 6 s. After that, the tic muscle of movable joint, feel slight
patients take a deep breathing and expire hotness of muscle contraction and relax
slowly. They try to relax body and mind to antagonistic muscle.
alleviate fatigue. After a break, they start the (d) The patients should persist in the

next training. The training of the same part training.
can be done for 6–8 times. If there is difficulty
with the training, the patients can do the train- 19.3.1.4 Moulding Training Aids
ing with the help of physical therapists, family of Limbs Motor Pattern
or caregiver. The training time is 30 min (1–2 Abnormal motor pattern is the common motor
times a day) and they should persist in it. dysfunction after CNS injury and is difficult to be
treated in clinic. At present, rehabilitation method
19.3.1.3 Clinical Indications, widely used at home and abroad cannot effec-
Contraindications tively restrict unnecessary joint motion in limbs
and Announcements movements, which affect the training effect of
1. Indications include CNS injury, peripheral
rectifying abnormal motor pattern.
nerve injury, bone and joint inflammatory The author developed motor pattern moulding
disease. training aids of upper and lower limbs to
t ransform previous training results such as neural type (Figs. 19.16a, b and 19.17) to restrict
potential development and motor program rees- abnormal joint motion for that the patients can
tablishment into motor ability required for daily wear it comfortably.
life through restricting unnecessary joint motion 2. The mechanism of moulding training aids of
in limbs movements effectively and Daoyin tech- motor pattern of lower limbs: Motor program
nique that can clear and activate the channels can interact with motor pattern. Motor program
and collaterals, and develop brain potential. decides motor pattern and long-term movement
Therefore, it can improve motor function of with abnormal motor pattern can modify forma-
limbs, decrease energy consumption and prevent tive motor program in motor center of cortex.
joint deformity. On the contrary, normal motor pattern under
Moulding training aids of motor pattern are limitation can restrict abnormal joint motion
divided into upper limbs and lower limbs. induced by abnormal muscle contraction effec-
tively and decrease myodynamia gradually.
Moulding Training Aids of Motor Pattern Meanwhile, it can force the patients to use the
of Lower Limbs muscle associated with normal joint motion and
It is suitable for the motor pattern remodeling strengthen myodynamia. After a long time, on
training on the basis of normal motor program the basis of clearing and activating the channels
reestablishment of lower limbs. and collaterals and brain potential development,
myodynamia balance [9] involved in normal
1. The composition of moulding training aids of joint motion can be reestablished. Normal
motor pattern of lower limbs: Motor pattern motor program of joint motion can be
moulding training aids of motor pattern of established in cortex.
lower limbs are composed of waistline, joint Moulding training aids of motor pattern of
motion limitor of hip-knee-ankle, aluminium lower limbs can limit abnormal joint motion
alloy lattice framing, foot orthosis and fixing of lower limbs through rigid lattice framing
band. Joint motion limitor can limit the motion and one-way motion of assistive joint to keep
range and original angle (15° flexed position) normal motor pattern. In order to use the mus-
of hip, knee and ankle joints. This limitor only cles of correct movement frequently and not
allow the joint motion in the sagittal plane. The to use the muscles of abnormal joint motion,
hip, knee and ankle joints are connected with normal motor pattern can be reestablished and
double-layer aluminium alloy lattice framing. solidified and then the patients can walk
There is a groove in the center that can be slid- without assistance.
able upward and downward. Therefore, the The development of moulding training aids
length can be adjustable and can be fixed with of motor pattern of lower limbs allows the
adjustable bolt for the patients with different patients to walk with the help of weight
statures. The bottom of artificial ankle joint are support and assistance. During the training of
connected to aluminium alloy foot orthosis potential development [10] and motor pro-
(the domestic type is high temperature thermo- gram reestablishment in the early stage, the
plastic board). Bilateral hip joints are fixed on patients should do the training of motor pat-
the two sides of waistline made of high tem- tern remodeling as soon as possible. It not
perature thermoplastic board through lattice only can transform developed potential and
framing to support and limit adduction and established motor program into motor func-
abduction of lower limbs. Foot orthosis can tion, but also can meet the requirement and
rectify foot drop, strephenopodia and desire of the patients to walk to activate the
strephexopodia, and don’t affect the ankle enthusiasm of the patients, increase the effect
joint motion in sigittal surface. of rehabilitation training and shorten thera-
According to the specific condition of the peutic course. In addition, moulding training
patients, the therapists select corresponding aids of motor pattern of lower limbs in domes-
Fig. 19.16 (a) Moulding

training aids of motor
a b
pattern of hip and knee
joints (the front). (b)
Moulding training aids of
motor pattern of hip and
knee joints (the back)
tic use can guarantee the correctness of self- heavy weight. It is difficult to wear and it
exercise of the patients, which is good for the is suitable for the neurological training of
solidification of normal motor pattern and pre- rehabilitation hall in the hospital.
vention of relapse of abnormal motor pattern. Domestic moulding training aids of motor
3. The classification of moulding training aids of pattern of lower limbs is a portable lim-
motor pattern of lower limbs is accordance ited device to maintain formative motor
with usage, limbs part and size. pattern during the process of self-exercise
(a) According to usage, it includes training of the patients at home who are with
type and domestic type. The training type abnormal motor pattern due to incorrect
is composed of double-layer assistive alu- method. It is composed of single-layer
minium alloy lattice framing with strong magnesium alloy. Waistline and foot
anti-bending capacity. There is a groove orthosis are made of thin high tempera-
in the center that can be slidable upward ture thermoplastic board. The characteris-
and downward to adjust the length. The tics of this type are as follows: it can
length can be adjusted with adjustable restrict unnecessary movements in lower
bolt for the patients with different stat- limbs movements effectively, but don’t
ures. This type is firm and durable with affect the joint motion in correct orienta-
limbs of trunk type, single limb of trunk

type and local type (Figs. 19.18, 19.19,
19.20, 19.21, 19.22, and 19.23).
(c) According to the size, it is divided into
children type and adult type. Children type
is made of magnesium alloy lattice framing
and thin high temperature thermoplastic
board to reduce weight and wear.
The principle and structure of various
types are the same. They restrict abnormal
position and movement of joint motion
through joint motion limitor and lattice
framing.
The difference between training type
and domestic type moulding training aids
of motor pattern are as follows: the train-
ing type is used in the early phase of the
training for the patients who just start
moulding training aids of motor pattern
with severe abnormal motor pattern.
Moulding training aids of motor pattern is
made of double-layer aluminium alloy
Fig. 19.17 Moulding training aids of motor pattern of

hip, knee and ankle joints (the unilateral)
tion. It can rectify abnormal joint position

such as foot drop, talipes varus and val-
gus. The weight of magnesium alloy lat-
tice framing is small, which is one third of
that of aluminium alloy lattice framing. It
can be assembled or taken apart as
requirements. It can be weared in trousers
and is easy to wear. It can be weared for a
long time, even 6–12 months. The anti-
bending ability of this type of training
device is poor, which is suitable for self-
exercise of the patients whose normal
motor pattern is established through the
training of motor pattern remodeling.
(b) According to parts, it is divided into dou- Fig. 19.18 Moulding training aids of motor pattern of
ble limbs type, single limb type, double bilateral waistline type
(a) Preparation before training: the patients

wear moulding training aids of motor pat-
tern of lower limbs and do the training in
the abnormal gait rectification weight
support training device and gait mark foot
path. According to movement prescrip-
tion, the amount of weight support is
adjusted. According to the specific condi-
tion of the patients, the therapists can
stand one side, the front or the back of the
patients. The patients can use two hands
to grasp the handrail of weight support
device or can walk without grasping the
handrail.
(b) The training includes assistive motor

and autonomous motor walking training
(Figs. 19.24 and 19.25). Assistive motor
walking training: exercise therapists
push weight support device forward and
the patients can step forward according
to the footprint on the footpath.
Autonomous motor training: during the
process of pushing weight support
device forward by themselves, the
Fig. 19.19 Moulding training aids of motor pattern sin- patients practice stepping forward.
gle limb of waistline
Daoyin technique gait disassembly slow
motion training: exercise therapists use
lattice framing that is firm and can sup-
Daoyin technique of six-step method in
port and limit joint motion. It can totally
traditional Chinese medicine (normal
limit abnormal joint motion and is suit-
method or guiding collaterals through
able for the training in rehabilitation hall
meridians) to guide the patients to do
of hospital. It can be weared outside of the
gait disassembly training on the basis of
clothing. Domestic type is a portable and
regulation of mind and breathing. The
formative limitation device of normal
specific procedures are as follows: the
motor pattern suitable for the patients
patients are guided to regulate breathing,
whose normal motor pattern is established
concentrate, put the center of the body
through the training of motor pattern
on one side, try to flex hip joint of
remodeling in order to prevent the relapse
stepping forward, bend the body forward
in the process of self-exercise. The anti-
to move foot forward, make the heel
bending ability of magnesium alloy lat-
touch the ground on the footprint of the
tice framing is poor whose weight is one
foot path and the foot on the footprint.
third of that of single layer aluminium
The center of the body moves to this
alloy lattice framing. Other accessories
side and the same method is used to do
can meet the requirements that they can
the contralateral stepping disassembly
restrict abnormal motion. It can be weared
training. The training of control ability
in trousers and is easy to wear. It can be
of limbs: under the condition of weight
weared for a long time, even 6–12 months.
support, the patients are guided to do
Training method: According to the fol-
the training of hip flexion, knee flexion
lowing procedures, the patients do the
and foot dorsiflexion on the spot. The
motor pattern remodeling training.
Fig. 19.20 Moulding training

aids of motor pattern of double
limbs
specific procedures are as follows: the oneus longus and brevis of the patients,
patients are in standing position, move the patients can decrease the amount of
the center of the body to one side. On weight support and start walking
the basis of regulation of mind and independently.
breathing, the patients are guided to flex Self-exercise at home: after abnormal
hip joint, dorsiflex ankle joint and put motor pattern is rectified and normal
the foot in the footprint of the footpath motor pattern is established, in order to
after the heel touches the ground. The shorten the hospital stays, the patients
purpose of this training is to increase wear domestic moulding training aids of
the flexibility, starting speed and motor pattern to do exercise after hospital
accuracy of limbs movements. During for 6–12 months to maintain the therapeu-
training, the patients are asked to relax tic effect and normal motor pattern. After
and don’t exert the force excessively in the normal motor pattern is consolidated,
case of associated reaction. They are the exercise can be stopped.
asked to shorten the time of completing 4. Clinical indications, contraindications and

the movements. The training time is announcements
30 min (once a day) and there are 90 (a) Indications: It is suitable for motor pattern
times in one therapy courses. remodeling training of lower limbs of the
With the increase of walking ability, patients in recovery phase of hemiplegia,
limbs control ability, autonomous control cerebral palsy and paraplegia. It is also
ability and myodynamia of hip flexor, hip used for the abnormal motor pattern train-
abductor tibialis anterior muscle and per-
Fig. 19.21 Moulding training aids of motor pattern of Fig. 19.22 Moulding training aids of motor pattern of
single limb simple knee joint
ing of lower limbs of the patients whose the training should be stopped. The thera-
rehabilitation method training is invalid. pists should find out the cause and deal
(b) Contraindications: If there is any one of with it. The therapists can control the
the following contradictions, the patients training intensity through reducing the
should stop or use moulding training aids amount of weight support or shortening
of motor pattern with caution. The patients the training time. During the training, the
with uncontrolled high blood pressure therapists should use six-step Daoyin
and diabetes mellitus; the patients with technique in traditional Chinese medicine
unstable state after stroke and cerebral correctly, activate the enthusiasm of the
trauma; the patients with unhealed bone patients fully, activate training atmo-
fracture of lower limbs, joint cartilage and sphere, use encouraging words and avoid
ligament injuries; the patients with using scolding words.
unhealed pelvic fracture or pelvic soft tis-
sue injury Moulding Training Aids of Motor Pattern

(c) Training considerations: The training of Upper Limbs
should be step by step and it is forbidden Moulding training aids of motor pattern of upper
to increase training intensity without pur- limbs is used rehabilitation training device in the
pose. The training time should be 30 min. process of rectifying the walking to rectify the
If there is any discomfort in the training, incoordination of swing movement of double
Fig. 19.23 Moulding training aids of motor pattern of

simple ankle foot type
Fig. 19.25 Wear the lower limb motion mode shaping

device for training
upper limbs, prevent flexion and spasm of upper

limbs and remodel normal motor pattern of upper
limbs.
1. Essential structure. It is composed of hand

tray, should-elbow joint limiter, lattice fram-
ing, movement orientation switch gear, trans-
mission shaft and fixing vest (Fig. 19.26).
The role of hand tray is to rectify the defor-
mity of hand in flexion position. Should-
elbow joint limiter can keep the joint in a
normal position and range. The role of lattice
framing is to connect hand tray with should-
elbow joint. Movement orientation switch
gear can transform the movement of upper
limb in healthy side into the opposite orienta-
Fig. 19.24 Wear pattern shaping device under the lose tion movement of upper limb in injured side.
weight walking training equipment for training Transmission shaft can conduct the power of
Fig. 19.26 Moulding 98 7 6 1. Wrist pad

training aids of motor 2. Forearm support
pattern of upper limbs strip
3. Elbow restrictor
4. The upper arm support
5 strip
4 5. Shoulder restrictor
6. Drivepipe
10
7. Transmission shaft
8. Shift gears
3
11 9. Drive bearing
2
12 10. Drive shaft support
1
strip
11. Fixed vest
12. Linkbelt
13 13. Upper limb fixed
plate
limb swing in healthy side to movement orien- ture, which can lead to motor function loss,
tation switch gear. Fixing vest can fix move- hypofunction or uncoordinated movement of
ment orientation switch gear and transmission upper limbs.
shaft on chest and back. Moulding training aids of motor pattern of
In short, the characteristics of moulding upper limbs can restrict joint deformity posi-
training aids of motor pattern of upper limbs tion through rigidity of lattice framing. The
are summarized as follows: the power from connection of lattice framing only allows the
upper limb swing in healthy side can drive the single orientation of joint motion and restrict
limb in injured side to the opposite orienta- unnecessary joint motion of upper limbs
tion. Therefore, the patients can swing double movements effectively. Movement orientation
upper limbs coordinately during walking. It switch gear can transform the movement of
can restrict unnecessary movements in the upper limb in healthy side into the opposite
joint motion effectively such as upper limbs orientation movement of upper limb in injured
flexion, wrist joint flexion and finger flexion side. Therefore, during walking, the patients
in walking. It can rectify adduction of injured can keep the swing coordination of double
limbs, elbow flexion and wrist flexion. It is upper limbs and normal posture of injured
easy to put on and off according to the require- upper limbs. Through repeated training,
ments. It doesn’t affect the normal autonomic abnormal motor pattern can be rectified and
movement of upper limbs. coordinated motor pattern of upper limbs can
2. The mechanism of moulding training aids of be recovered gradually.
motor pattern of upper limbs. When there is The training time and therapy course: the
flexion and spasm of upper limbs [11] and training time is 20–30 min (twice a day) and
walking, no-swing of injured upper limbs or there are 60 times in one therapy course.
uncoordinated swing of double upper limbs is 3.
Indications, contraindications and
the common abnormal motor pattern of upper announcements.
limbs, which is usually observed in the (a) Indications: It is suitable for the patients
patients with hemiplegia, cerebral palsy and with hemiplegia, cerebral palsy and spinal
spinal cord injury. The cause is that CNS cord injury accompanied with abnormal
injury leads to paralysis of some muscles of motor pattern of upper limbs.
upper limbs and the patients’ upper limbs are (b)
Contraindications: the patients with
in flexion contracture because of muscle unhealed pelvic fracture or pelvic soft tis-
paralysis, muscle spasm or tendon contrac- sue injury; the patients with unhealed
bone fracture of upper limbs, joint carti-

lage and ligament injuries; the patients
with unhealed rib fracture or injuries of
chest, spinal cord and pelvis; the patients
with unstable state after stroke; the
patients with uncontrolled high blood
pressure and diabetes mellitus

(c) Considerations: the training should be
step by step. It is forbidden to increase the
training intensity without purpose. The
therapists should activate the enthusiasm
of the patients fully, activate training
atmosphere, use encouraging words and
avoid using scolding words.
Gait footprint training footpath.
Gait footprint training footpath is devel
oped according to biofeedback mechanism.
Biofeedback mechanism includes goal and
motive mechanism and the mechanism that
archery accuracy can be increased through
practicing the archery towards the center of
the target. It is the assistive device developed
for the gait rectification training. The foot
path is made of transparent and soft plastic
board with the width of 2 mm. The width is
30–50 mm. The length is decided by the size
of the rehabilitation hall. Different strides
and footprints of adult and children are
printed in the footpath (Fig. 19.27). The foot
print can be drawn on the floor directly so
that the footpath of gait training for different Fig. 19.27 Sketch map of footpath of gait footprint
age and stature. training
During the gait training, the therapists use
Daoyin technique to guide the patients to do hip
flexion. When the feet step forward, the patients devices. These devices not only can be used for
are guided to put feet on the footprint of footpath the walking training of sober patients, but also
so that the patients can do gait remodeling train- can be used for the walking training of the
ing with a purpose to develop CNS potential and patients in coma or low conscious state. These
promote recovery of normal gait. devices not only can be used for the patients with
mild symptoms, but also can be used for the
severe patients who even cannot sit. These
19.3.2 Training Device devices broaden the range of rehabilitation train-
ing, alleviate the labor intensity of the therapists
There are many kinds of rehabilitation training and play an important role in the clinical rehabili-
devices of neurological training including CNS tation therapy of neurological training.
potential development, motor programs of all It is noticeable that all rehabilitation corollary
joint motions, the balance of sitting, standing and equipment of neurological training is the assis-
walking and motor pattern remodeling training tive device for the application of six-step Daoyin
technique of guiding collaterals through meridi-

ans. It is the method to carry out Daoyin tech-
nique better and increase the effect of Daoyin
technique. Because there are many kinds of
devices, we only introduce the representative
training device.
Potential development training device of
upper limbs.
They are specially used for the application of
Daoyin technique to develop the CNS potential
of autonomic movement of upper limbs, pro-
mote CNS plasticity and functional reorganiza
tion and recover more and more lost motor
function.
19.3.2.1 Essential Structure

and Design Principle
1. Essential structure: Potential development

training device of upper limbs is composed of
(Fig. 19.28) expansion board of hand, bearing
support system, control training system of
pedestal and limbs, hammock and suspension
system, weight support system and weight
support sandbag or handle. The role of expan-
sion board of hand is to make the flexed wrist
and finger joint in extension position in case
of wrist and finger injuries under bearing.
Weight support system of sandbag and pulley
can alleviate the bearing of limbs. Through
increasing or decreasing the number of sand-
bags, the patients can be kept in pushing up Fig. 19.28 Sketch map of Potential development training
device of upper limbs
position.
2. Design principle: Through frame support and
weight support system, with the help of chest 19.3.2.2 Operational Approach
hammock of the patients, partial body weight 1. Preparation before training: The patients wear
of the patients are subtracted so that the hammock, put expansion board of hand on the
patients can be kept in pushing up position injured hand and are in pushing up and down
using double upper limbs to support the trunk. position. Two legs are on the sponge cushion
The therapists can use Daoyin technique to of pedestal. This position can make the
guide the patients to push up and down with patients put their hands on the vertical line of
sudden change of position to create safe immi- weight support pulley on the middle of the top
nent danger state. The patients are encouraged of braced frame and the hammock is con-
to overcome the difficulties due to position nected with the hook of weight support sys-
change. The comprehensive effect can clear tem. The therapists stand in the injured side of
and activate the channels and collaterals, the patients. According to exercise prescrip-
develop brain potential and recover motor tion, the therapists hang sandbag of weight
function of upper limbs. support or exercise therapists can use hands to
hold the knob. According to the specific con- 3. Clinical indications, contraindications and

dition of the patients, the therapists give the announcements.
proper assistance. Indications: This device is suitable for the
2. Training procedure includes pushing up and stable patients with motor dysfunction [12] of
pushing down. upper limbs in acute and chronic phase after
(a) Pushing up training: The patients’ elbow CNS injury, bone and joint, muscle injuries,
joints are in flexion position and they such as hemiplegia, cerebral palsy, children
move the center of the body to paralyzed cerebral palsy, incomplete paraplegia, peripheral
upper limb. The patients are guided to take nerve injury, joint and muscle dysfunction. It is
a deep breath and expire slowly. After that, also suitable for the patients whose motor
they concentrate on the breathing and hold function of upper limbs cannot be improved
their breath. They concentrate on triceps after traditional rehabilitation method.
muscle of arm in the paralyzed side and (d) Contraindications: The unstable patients
feel the contraction of triceps muscle of in acute phase; the uncontrolled severe
arm during the slow pushing up. When the hypertension or diabetes mellitus; severe
patients cannot push up themselves, exer- heart disease and pulmonary dysfunction
cise therapists help the patients. When the with low cardiovascular response.
angle of elbow extension is no less than
(e) Considerations: The weak patients of
90°, exercise therapists can decrease the long-term bed should do the acclimatiza-
assistive force suddenly according to the tion training before this training to
condition and use the words “push up, or increase the stress ability of cardiovascu-
you will fall and hold on, or you will lar stress. When the patients can stand
bump” to create imminent danger erectly and the blood pressure is stable
atmosphere and encourage the patients to after 30 min, the patients can do this train-
push up by themselves. ing. The training should be step by step.
(b) Pushing down training: The patients’
The training can be regulated through
elbow joints are in straight position. The weight support and training time. It is for-
patients are guided to take a deep breath bidden to increase training intensity with-
and expire slowly. After that, they concen- out a purpose. During the training, the
trate on the breathing to push down them- therapists should activate the enthusiasm
selves slowly. They concentrate on triceps of the patients and atmosphere and use
muscle of arm in the paralyzed side and encouraging words. It is forbidden to use
feel the contraction of triceps muscle of rebuke and critical words.
arm during the slow pushing down. When
the patients cannot push down themselves, 19.3.2.3 Potential Development
exercise therapists help the patients. When Training Device of Lower
the angle of elbow extension is no more Limbs
than 90°, exercise therapists can decrease The device is used for the application of Daoyin
the assistive force suddenly according to technique to develop CNS potential of autonomic
the condition and use the words “hold on, movement of lower limbs, promote CNS plastic-
or you will fall and hold on, or you will ity and functional reorganization and recover lost
bump” to create imminent danger atmo- motor function as much as possible.
sphere and encourage the patients to keep
in this position for 6 s. Essential Structure and Design Principle
(c) Training time and therapy course: The
1. Essential structure includes weight support
training time is 20–30 min (once or twice system, sandbag, frame support system, scale
a day) and there are 60 times in one ther- pedal and hammock (Fig. 19.29). Sandbag and
apy course. weight support system can decrease bearing of
limbs. Through increasing or decreasing the to squat up, squat down and control the lower
number of sandbag, the amount of weight limbs with sudden postural change to create
support can be adjusted. Hammock have the safe dangerous state and encourage the
weight support and protective effect through patients to overcome the difficulties due to
suspension function of the root of thigh and postural change. Scale pedal provides the
waist. Through sudden postural change, the training condition of goal and motive
therapists use Daoyin speech to create a safe mechanism. The comprehensive effects can
dangerous state. With the increase of the clear and activate the channels and collaterals,
training difficulties, the training can develop develop brain potential and recover motor
the motor ability of lower limbs and conduction function of lower limbs.
speed. There are footprints in the scale pedal
with three marks such as 60 (outside), 80 Operational Approach
(middle) and 100 (the center of the circle). 1. Preparation before training: The patients wear
Through goal and motive mechanism, the hammock and hang sangbag according to the
patients can do control training of lower limbs. amount of weight support. According to the
2. Design principle: Through the weight support specific condition, the therapists stand in one
and protection effects of the device, the side, the front or the back of the patients. The
patients are able to stand up. The therapists patients use two hands to grasp the handrail in
can use Daoyin technique to guide the patients the lateral wall of potential training device.
2. Training procedure includes squat up, squat
down and control ability training of lower
limbs.
(a) Squat up training: The patients are in
kneeling-squatting position and try to
move the center of the body to paralyzed
side. The patients are guided to take a
deep breath and expire slowly. After that,
the patients concentrate on taking a deep
breath and hold their breath. The patients
concentrate on the quadriceps femoris in
the paralyzed side and feel the contraction
of quadriceps femoris during the standing
up. If the patients cannot stand up by
themselves, exercise therapists should
help them. When the angle of knee exten-
sion is no less than 90°, exercise thera-
pists can decrease the assistive force
suddenly according to the condition and
use the words “stand up, or you will fall
and hold on, or you will bump” to create
imminent danger atmosphere and
encourage the patients to keep in this

position for 6 s and stand up by themselves.
(b) Squat down training: Exercise therapists
guide the patients to concentrate on taking
a deep breath and hold their breath.
Fig. 19.29 Sketch map of potential development training
During the slow squat down process, they
device of lower limbs move the center of the body to lower
limbs in the paralyzed side and feel the training before this training to increase the
tension of quadriceps femoris. If the stress ability of cardiovascular stress.
patients cannot squat down by them- When the patients can stand erectly and the
selves, exercise therapists should help blood pressure is stable after 30 min, the
them. When the angle of knee joint fl exion patients can do this training. The training
is no more than 90°, exercise therapists should be step by step. The training can be
can decrease the assistive force suddenly regulated through weight support and
according to the condition and use the training time. During the training, the
words “hold on, or you will fall and hold therapists should activate the enthusiasm
on, or you will bump” to create imminent of the patients and atmosphere and use
danger atmosphere and encourage the encouraging words. It is forbidden to use
patients to keep in this position for 6 s. rebuke and critical words.
(c) Control ability training of lower limbs:
under the weight support and protection Except for potential development training
condition, the patients put two foots on device mentioned above, there are a series of
the center of the circle and move the cen- training equipment such as potential develop-
ter of the body to healthy side. The thera- ment training device of the trunk (Fig. 19.30),
pists guide the patients to try to flex hip potential development training device of tibialis
and knee, elevate injured limbs, put foot anterior muscle (Fig. 19.31), potential develop-
in the injured side on the center of the
circle and complete these movements.
(d) The training time and therapy course: The
training time is 30 min (once or twice a
day) and there are 60 times in one therapy
course. At the end of one therapy course,
the therapists should re-evaluate the train-
ing effect and decide whether to do the
next training or not.

considerations.
(a) Indications: This device is suitable for the
stable patients with motor dysfunction of
lower limbs [13] in acute and chronic
phase after CNS, bone and joint, muscle
injuries, such as hemiplegia, cerebral
palsy, children cerebral palsy, incomplete
paraplegia, peripheral nerve injury, joint
and muscle dysfunction. It is also suitable
for the patients whose motor function of
lower limbs cannot be improved after tra-
ditional rehabilitation method.
(b) Contraindications: The unstable patients
in acute phase; the uncontrolled severe
hypertension or diabetes mellitus; severe
heart disease and pulmonary dysfunction
with low cardiovascular response.
(c) Considerations: The weak patients of long- Fig. 19.30 Sketch map of potential development training
term bed should do the acclimatization device of the trunk
ment training device of hamstring muscle be used for the assistive device. For the severe
(Fig. 19.32), potential development training patients with children cerebral palsy, they do
device of balance (Fig. 19.33) and potential rehabilitation training according to standing in
development training device of walking early period and walking development, the
(Fig. 19.34). The training should be guided by device can be used for potential development
six-step Daoyin technique of guiding collaterals training and walking training to increase the
through meridians or normal method. With the excitability of walking center of sacral cord in
increase of training difficulty, the training can order to recover walking and standing ability.
clear and activate the channels and collaterals, For the patients with severe hemiplegia or motor
develop brain potential, increase the control abil- dysfunction of limbs, they do rehabilitation
ity of brain and conduction speed of nerve. training according to standing in early period
and walking development. Their purpose is to
19.3.2.4 A bnormal Gait Rectification recover assistive standing and walking function
Weight Support and Walking through abnormal gait rectification weight sup-
Training Device port and walking training in the early phase.
According to rehabilitation therapeutic princi- That whether motor pattern is abnormal or not is
ple of neurological training, we developed spe- not the key point.
cial training equipment to rectify abnormal gait
and remodel normal gait. For the patients with Essential Structure and Design Principle
mild symptoms, they do the training according 1. Essential structure: Abnormal gait rectifica-
to the three-stage rehabilitation method. When tion weight support and walking training
they do the third stage training, the device can device is composed of bearing, weight sup-

of potential development
training device of tibialis
anterior muscle

training device of
hamstring muscle

training device of
balance

training device of
walking
port and protection system, abnormal gait rec-

tification system and normal gait training
system (Fig. 19.35).
(a) Bearing, weight support and protection
system is composed of bearing frame,
weight support winch, pulley, handrail and
weight support hammock. Bearing frame
is a rectangular frame (180 cm × 150 cm)
that is made from double curved hot draw-
ing welded steel tube. The diameter is
36 mm and the wall thickness is 4 mm.
There are two layers and the space is
50 cm. In the middle of the frame, two
U-shaped tubes are welded in parallel
(190 cm × 150 cm). In the middle of the
top of two U-shaped tube, fixed pulley and
its back plate are welded. Fixed pulley and
winch are welded separately in one corner
of the top of U-shaped tube and the mid-
point of the wall on the same side. Steel
wire (diameter is 3 mm) connects ham-
mock connecting rod in frame and weight
support winch on the lateral wall. At the
bottom of rectangle frame, four universal
wheels are fixed. In the middle of the
front, handrail is fixed and the height is Fig. 19.35 Sketch map of abnormal gait rectification,
adjustable. The back is connected to dis- weight support and walking training device
mountable protection bar. Weight support
hammock is divided into swimsuit type waistcoat type. The stress parts are chest-
and waistcoat type. The stress parts of back and pelvis. According to the specific
swimsuit type are iliac region and chest- condition of the patients, the patients
back. Hammock connects two thighs in select the proper type. The dressing
should be comfortable without oppression patients, the therapists stand in one side, the
of local soft tissue and affecting joint front or the back of the patients. The patients
motion. use two hangs to grasp the front handrail.
(b) Abnormal gait rectification system: the
According to the degree of lower limbs adduc-
therapists select elastic band with differ- tion and foot drop [14], the tightness of the
ent width and thickness to produce elastic rectification band is adjusted so that the
rectification band of lower limbs abduc- patients can walk with the affection of lower
tion and foot dorsiflexion with different limbs adduction and foot drop.
elasticity. Abduction band of lower limbs 3. Training procedure.
can prevent excessive adduction of lower (a) Auxiliary power walking training:
limbs in walking. One end is connected to Exercise therapists move training device
steel tube in upper layer of bearing frame forward and the patients practice stepping
and the other end is connected to the infe- forward with the movement of the train
rior of knee joint through nylon thread ing device.
gluing. Elastic band of foot dorsiflexion (b) Autonomous power training: The patients
can prevent foot drop and strephenopodia. move training device forward and prac-
One end is connected to the top of bearing tice stepping forward at the same time.
frame and the other end is connected to (c) Disassembled slow movement training of
the front of injured foot. The tightness of gait of Daoyin technique: exercise thera-
rectification band cannot affect walking in pists use six-step Daoyin technique in tra-
adduction of lower limbs and foot drop. ditional Chinese medicine to guide the
The training should be done on the gait and patients to do disassembled gait training
footprint training footpath. on the basis of regulation of mind and
breath.
Design Principle (d) Control ability training of lower limbs:
1. Through weight support and suspension of the Under the condition of weight support
device, the patients can be kept in standing and protection, the patients are guided to
position. The device can provide safe condi- do the training of hip flexion, foot dorsi-
tion to prevent falling down and bumping. The flexion and hip abduction in situ. The spe-
patients use two hands to grasp the handrail so cific procedures are as follows: the
that they can walk stably. Rectification band therapists are in standing position, move
of foot drop and lower limbs adduction can the center of the body to one side and
rectify lower limbs adduction, foot drop and guide the patients to flex hip joint as quick
strephenopodia through elastic recoil. During as possible on the basis of regulation of
walking, the patients can use their own force mind and breathing. If there is adduction
to rectify lower limbs adduction, foot drop of lower limbs, the patients are guided to
and strephenopodia. If they are not rectified abduct hip joint, dorsiflex ankle joint and
completely, elastic band can keep the normal then put the heel of the foot on the foot-
gait. With the help of gait and footprint train- print of the footpath. The purpose of this
ing footpath, the patients can do the training training is to increase the speed and flexi-
with a purpose. bility of limbs. The patients are asked to
2. Operational approach. relax, not to exert excessive force in case
Preparation before training the patients can of excessive associated reaction. The
wear hammock in sitting or standing position. patients should shorten the time of com-
According to exercise prescription, the pleting the training gradually.
amount of weight support can be adjusted. 4. The training time and therapy course: The

According to the specific condition of the training time is 30 min (once a day) and there
are 30 times in one therapy course. At the end 19.3.2.5 S tride, Gait and Shifting
of one therapy course, the therapists should of Weight Support Training
re-evaluate the training effect and decide Device
whether to do the next training or not. According to the rehabilitation therapeutic prin-
With the increase of myodynamia of hip ciple of neurological training, stride, gait and
flexor, hip abductor, tibialis anterior muscle shifting of weight support training device is
and peroneus longus and brevis of the patients, developed, which is the basis of gait training.
autonomous dominant ability, control ability
of limbs and walking ability, the patients Essential Structure and Design Principle
should reduce the amount of weight support Essential structure of stride, gait and shifting of
and traction force of rectification band gradu- weight support training device is composed of
ally. After that, they can walk independently two parts (Fig. 19.36).
without weight support, traction and hand.

announcements.
(a) Indications: This device is suitable for the
stable patients with severe motor dysfunc-
tion of lower limbs in acute and chronic
phase who cannot do normal weight sup-
port walking training after CNS injury,
such as hemiplegia, cerebral palsy, chil-
dren cerebral palsy, incomplete paraple-
gia, peripheral nerve injury, joint and
muscle dysfunction. It is also suitable for
the patients who are difficult to do normal
weight support walking training because
of adduction of lower limbs or foot drop
due to muscle spasm or paralysis.
(b) Contraindications: The unstable patients
in acute phase; the uncontrolled severe
hypertension or diabetes mellitus; severe
heart disease and pulmonary dysfunction
with low cardiovascular response.

(c) Announcements: the weak patients of
long-term bed should do the acclimatization
training before this training to increase the
stress ability of cardiovascular stress.
When the patients can stand erectly and the
blood pressure is stable after 30 min, the
patients can do this training. The training
should be step by step. The training can be
regulated through weight support and
training time. During the training, the
therapists should activate the enthusiasm
of the patients and atmosphere and use
encouraging words. It is forbidden to use Fig. 19.36 Sketch map of stride, gait and shifting of
rebuke and critical words. weight support training device
1. Essential structure is composed of weight

According to different stature of different peo-
support and training system. ple, stride, gait and shifting of weight device can
(a) Weight and frame support system: It can be divided into five grades with different stride
reduce the bearing of limbs. The patients and stride width. Only after the center of weight is
can use manual pulley to adjust the transferred, the patients can do the training of
amount of weight support and use stride and gait according to goal and motive
suspension hammock to elevate trunk and mechanism. The training should be guided by six-
waist to protect them and make them in step Daoyin technique of guiding collaterals
standing position. through meridians or normal method. With the
(b) Stride, gait and shifting of weight support increase of training difficulty, the training can
training system: During movement, it can clear and activate the channels and collaterals,
rotate like an oval and adjust resistance develop brain potential, increase the control
through control system in machine. With ability of brain and conduction speed of nerve.
the increase of training difficulty, the
patients can do the training of control ability Operational Approach
of limbs and conduction speed of nerve. 1. Operation procedure: Quick start—the thera-
pists press the ST/STOP button and start the
Design Principle training. During the training, the therapists
Stride, gait and shifting of weight are the basic can use upward and downward arrow to adjust
training of gait training. There are several ele- the resistance. Set goal: the therapists press
ments to form normal gait. Consistent stride: the MODE button and select manual function.
stride of limb in the healthy side is bigger than Display frame (the lower part) of resistance
that of limb in injured side in the patients with grade blink automatically. The therapists can
hemiplegia because of short bearing time due to use upward and downward arrow to select
weak force of injured limbs, which induces training grade (1–16) and press ST/STOP but-
abnormal gait. Consistent bearing time: short ton for the training.
bearing time of injured limb may lead to abnor- Auxiliary instructions: computer on board
mal gait. Consistent stride width: when there is can record nine users’ training data. The ther-
adductor tension or spasm and contracture of apists can set individual training goal and
lower limbs, adduction in the steeping forward store it for the next training. The therapists
of injured limbs can lead to abnormal gait can set the goals of time, distance or quantity
because the stride width is different between of heat. The control program of heart rate can
healthy limb and injured limb. Consistent leg adjust the resistance automatically to increase
speed: because it is difficult to start stepping for- or decrease the training amount of the patients
ward of injured limbs, the leg speed is different in order to reach the setting goal of heart rate.
between two sides, which is manifested as 2. Training procedure: Retentive fitness or warm-
abnormal gait. up: the 10 min after the beginning, the patients
On the basis of previous training such as neu- can increase training intensity gradually.
ral potential development and motor program Aerobic exercise: the patients can do mild exer-
reestablishment, before gait training, the patients cise persistently for a long time (35–60 min).
should do the basic movement training such as There is a little sweat after training, but there is
stride, gait and shifting of weight and focus on no gasp in any case. Endurance and aerobic
the training of stride width in the stride training. exercise is the consistent intensive training
Shifting of weight is that during the process of (20–40 min). Stride and shifting of weight
stepping forward, the patients should make the training: on the basis of regulation of mind and
stepping forward leg without load bearing so that breath, the patients are guided to move the cen-
the leg can reach the required height as soon as ter of weight to one side and then move it to the
possible. other side when the body is moved forward. If
necessary, the patients can use upper limbs to technique of guiding collaterals through meridi-
pull the rod for help. The training can be done ans. Therefore, they cannot be used for the
in circles. The patients feel the shifting of training with a purpose and are not suitable for
weight and stepping forward. the training of motor program reestablishment.
3. The training time and therapy course: The
Because there is no definite surpassing goal, goal
training time is 30 min (once a day) and there and motive mechanism cannot enhance the train-
are 30 times in one therapy course. At the end ing effects of neural potential development and
of one therapy course, the therapists should motor program reestablishment.
re-evaluate the training effect and decide Corollary equipment of neurological training
whether to do the next training or not. is developed to solve the problems mentioned
above. It can display curve, sound or digit of
announcements. Daoyin technique on the screen through different
(a) Indications: This device is suitable for the ways and increase the functions of therapeutic
patients with motor dysfunction of lower item selection, training method mechanism
limbs in acute phase, especially for reha- explanation, setting of surpassing goal, Daoyin
bilitation training of gait, stride and shift- technique automatic speech instruction, main and
ing of weight of the patients with obsolete collateral channels instruction, data storage and
hemiplegia, incomplete paraplegia, analysis.
peripheral nerve injury and joint and mus- This kind of equipment is developed to allevi-
cle dysfunction after the other methods ate the labour intensity of the therapists, increase
are invalid. the training effect of rehabilitation technique of
(b) Contraindications: The unstable patients neurological training and increase the clinical
in acute phase; the uncontrolled severe application value of rehabilitation training of
hypertension or diabetes mellitus; severe neurological training to a new level.
heart disease and pulmonary dysfunction On the basis of training device, this kind of
with low cardiovascular response, dizzi- equipment is developed to add the real-time
ness and blood pressure decrease in detection and display function of effect of Daoyin
standing position. technique. According to the effect of Daoyin

(c) Announcements: During training, the technique, it can be manifested as the strength of
patients should concentrate and wear motor program signal from brain to muscle, the
sports shoes. During the training, after the intensity of muscle contraction, the strength of
patients complete all the movements of resistance, the size of joint motion. After that,
shifting of weight, they should move the through biofeedback mechanism [15], the
center of weight to the other side. The patients are guided to do the training with a pur-
training should be step by step. It is for- pose. Therefore, there are many kinds of equip-
bidden to increase the training intensity ment. According to the clinical application of
suddenly. During the training, the thera- neurological training, they can be used for the
pists should activate the enthusiasm of the training of neural potential development, motor
patients and atmosphere and use encour- program reestablishment, motor pattern remodel-
aging words. It is forbidden to use rebuke ing, balance, stride, gait and shifting of weight,
and critical words. speech recognition, sphincter, virtual reality
training device.
In this chapter, we only introduce the major
19.3.3 Training Device training device used for motor function rehabili-
tation and introduce the common training device
Neurological training appliances and devices are of speech recognition.
not equipped with the objective indexation dis- The common characteristics of neurological
play function of the effect of six-step Daoyin training device.
1. Six step Daoyin technique in traditional

uncompleted movements at ordinary times. It
Chinese medicine is used. According to the can prevent the falling down and bump of the
pathway of main and collateral channels, Qi is patients, which is good for the training safety.
guided from meridians to collaterals or from
collaterals to meridians, which is the method 19.3.3.1 Basic Neurological Training
of guiding collaterals through meridians. Device of Neurological
2. It is equipped with the functions of real-time Training
detection and digital display of the effect of This kind of equipment can extract some kind of
Daoyin technique. It can detect and display signal and display the instant effect of Daoyin
the consistent curve, sound, number or image technique. Therefore, the patients can do the
in digit. training with a purpose. It is the important and
3. Different therapeutic items and surpassing
essential part of all kinds of training device.
goals can be set, just like practicing archery
towards target to increase accuracy and prac- 1. Neurological training device of guiding col
ticing jumping with transverse bar to increase laterals through meridians: Neurological
the jump height. Therefore, the patients are training devices of guiding collaterals through
guided to do the training with a purpose meridians give out motor program signal to
through biofeedback and goal and motive agonistic muscle and antagonistic muscle of
mechanism. joint motion through Daoyin technique and
4. Data storage and auto-analysis. clearing and activating the channels and col-
5. Animation spot instruction of meridian point laterals. The intensity of this signal is real-
and automatic speech Daoyin function can time objective indicator of the degree of
guarantee the correctness of Qi in main and clearing and activating the channels and col-
collateral channels. One of the key techniques laterals and is the promoter of clearing and
of guiding collaterals through meridians or activating the channels and collaterals. It can
guiding meridians through collaterals is to be used for the training of CNS potential
guarantee Qi guided by six-step Daoyin tech- development, single joint movement and
nique to go through correct main and collat- motor program reestablishment of associated
eral channels. Both exercise therapists and the movement in which multiple joints are
patients know little about correct main and involved. It can also be assembled in other
collateral channels. Qi in the correct main and neurological training device. With objective
collateral channels is the basis to implement indicator of instant effect of various kinds of
the method of guiding collaterals through trainings, the patients can do the training with
meridians correctly. On the basis of meridian a purpose.
points animation developed previously and (a) Design principle: Motor program is bio-
key meridian points, animation spot blink logical drive signal given out from CNS
technique is used in virtual human body. The cells to the muscles (agonistic muscle and
spot speed is synchronized with automatic antagonistic muscle) of joint motion pro-
speech instruction of Daoyin technique. portionally and sequentially. The coordi-
Flicker is used to mark the pathway and nated and orderly movement can complete
meridian point to guarantee the correctness the instruction of some kind of actual func-
and uniformity of the pathway, which pro- tional movement. In traditional opinion,
vides condition for the standard application of the received electrical signal in muscle
the technique of guiding collaterals through contraction is generated by muscle con-
meridians. traction itself. Our experiment demon-
6. Weight support and protection function:
strated that electromyographic signal is
Weight support system of the equipment can motor program signal [16], which is driven
help the patients to stand up and complete the by the drive signal from CNS to muscle. It
is generated before muscle contraction, but active movement of limbs. With the coop-
not generated by muscle contraction itself. eration of expiration and inspiration, the
This provides scientific basis for the train- patients can control the limbs movement
ing of motor program signal detection, dis- gradually. Many clinical control studies
play and reestablishment. Therefore, only verified that this kind of technique has
developing neural potential and activating good therapeutic effect. This method is
CNS cells are not enough. Some methods used as the key technique to form new
should be used to make the cells work kind of rehabilitation method.
coordinately and orderly so that the lost (b) Characteristics: On the basis of the gen-
motor function can be recovered. eral characteristics of training device,
Neurological training device neurological training device has the fol-
(Fig. 19.37), electrical signal detection lowing characteristics.
and reception system is used to detect the High sensitivity: Neurological training
control signal from CNS to agonistic device can extract motor program signal
muscle and antagonistic muscle and dis- of cortex motor center from the skin sur-
play it on fluorescent screen in a continu- face of muscle and display motor program
ous curve. Therefore, the Daoyin signal of agonistic muscle and antagonis-
technique effect is clear. The therapists tic muscle in different colored curves. The
and the patients can observe the progress therapists can use computer program to
and shortcoming of the therapy. According set different therapeutic items and sur-
to the requirements, computer program passing goals. Through goal and motive
allows the therapists to set therapeutic mechanism, motor program of coordi-
items with different degree of difficulty. nated movement in cortex motor center
The patients should have continuous, def- can be trained.
inite, new surpassing goal and improved The guarantee of standard application
direction. Through goal and motive mech- of Daoyin technique of guiding collaterals
anism, feedback condition can be adjusted through meridians: There are several func-
and the patients are guided to do the train- tions such as automatic speech instruction
ing with a purpose. The method can acti- cooperated with Daoyin technique of
vate the enthusiasm of the patients to do guiding collaterals through meridians,

of neurological training
device of guiding
collaterals through
meridians
therapeutic mechanism d emonstration of exercise therapists and lower limb in

motor program reestablishment and ani- healthy side. When the patients are able to
mation spot instruction of meridian points walk, they can do motor program reestab-
to guarantee the correctness, standardiza- lishment training of knee extension in
tion and normalization of main and collat- walking. The initial data is the highest
eral channels. signal from motor center to quadriceps
The equipment has four leads that can femoris and hamstring muscles at the first
be used for single and combined applica- time. The highest signal is used as the
tion. It is suitable for single joint move- base point to make two elevation lines.
ment motor program reestablishment Daoyin technique is used to guide the
training of multiple joint associated patients to make the signal surpass the
movements. baseline in the next training of quadriceps
(c) Operational approach: we use knee exten- femoris. The signal intensity of hamstring
sion as an example. In a warm, quiet and muscles is lower than the baseline except
lucifugal room, the patients lie, semi-sit for this signal of hamstring muscles.
or sit before the neurological training During therapy, when the signal of quad-
device. Surface reception electrode is riceps femoris almost reaches the summit,
pasted. The placement of quadriceps fem- the therapists say the words “hold on, or
oris electrode: the first surface electrode is you will fall and higher, or you will bump”
placed on 6 cm above patella, skin surface to create the imminent dangerous condi-
of the belly of quadriceps femoris. Twelve tion to make the patients feel dangerous.
centimeter upward the first electrode, the Therefore, the signal of quadriceps femo-
second electrode is placed. The ground ris can surpass the baseline as much as
electrode is placed between the two elec- possible. Meanwhile, the patients don’t
trodes. Surface electrode is connected to increase or decrease the signal intensity of
the first lead of biofeedback device hamstring muscles. After that, the new
through wire. The placement of hamstring highest point is the baseline. The same
muscles electrode: the first surface elec- method is used to guide the patients to try
trode is placed 2 cm above popliteal to make the signal of quadriceps femoris
space, skin surface of the belly of ham- surpass new baseline and the signal of
string muscles. Six centimeter upward the hamstring muscles lower than the new
first electrode, the second electrode is baseline. The rest can be done in the same
placed. The ground electrode is placed manner and the training can be done
between the two electrodes. The surface repeatedly.
electrode is connected to the third lead of (d) The training time and therapy course: The
biofeedback device through wire. The training time is 50 min (once a day) and
therapists use six-step Daoyin technique there are 30 times in one therapy course.
of guiding collaterals through meridians in At the end of one therapy course, the ther-
traditional Chinese medicine to encourage apists should re-evaluate the training
the patients to do knee extension in sitting effect and decide whether to do the next
position, standing position and walking training or not.
actively for 15 min separately. If the (e) Indications, contraindications and
patients cannot extend knee actively, the announcements.
patients can do knee extension training Indications: This device is suitable for
with help. The patients are in kneeling- the patients with motor dysfunction of in
squatting position, move the center of acute and chronic phase such as obsolete
weight to injured side and is encourage to hemiplegia, incomplete paraplegia, chil-
stand up by themselves with the help of dren cerebral palsy, incomplete paraplegia,
facial paralysis, peripheral nerve injury, ments of joint can be completed. At this time,
joint and muscle dysfunction. Especially it can manifest the driven ability of brain to
the other therapeutic methods are invalid. agonistic muscle in joint motion. This is the
Contraindications: The patients are in objective indicator of effect of Daoyin
acute phase, which affect the salvage. It is technique. Through real-time detection and
not suitable for the patients who are not display of myodynamia and biofeedback, the
allowed to do exercise after surgery of patients can do the training of neural potential
bone, joint or muscle injury or with development with a purpose.
unhealed wound. 2. Basic structure: The intensity of myodynamia
Announcements: the patients should can be tested through tension sensor, mainly
concentrate on the training. During train- the intensity of agonistic muscle contractility.
ing, the patients should focus on the Therefore, myodynamia guided device of
intensity and proportion of motor pro- guiding collaterals through meridians is single
gram signal, but not on the range of joint channel. It can real-timely detect the intensity
motion and strength of muscle contrac- of myodynamia and display it in curve or
tion. The training should be step by step digit. The surpassing goal can be set with this.
and it is forbidden to increase anti-resis- Through biofeedback and goal and motive
tance without a purpose. The anti-resis- mechanism, central neural potential is devel-
tance time should not be more than 6 s. oped to increase the active contraction and
This kind of training is not the training to myodynamia of muscles (Fig. 19.38).
enhance myodynamia, but the training of 3. Operational approach of myodynamia guided
developing brain potential through mus- device: operational approach, therapy time,
cle contraction dominated by brain. The therapy course, therapeutic item, indications,
degree of muscle contraction is the exter- contraindications and announcements of
nal manifestation and objective indicator myodynamia guided device of guiding
of the intensity of motor program signal. collaterals through meridians are the same as
Long-term muscle contraction can lead to these of neurological training device of
fatigue, which cannot manifest the motor guiding collaterals through meridians.
program signal and its strength. Therefore, However, myodynamia guided device is only
the patients cannot do the training of used for the training of potential development,
motor program reestablishment. During but not for the training of motor program
the training, the therapists should activate reestablishment and motor pattern
the enthusiasm of the patients fully, acti- remodeling.
vate training atmosphere, use encourag-
ing words and avoid using scolding 19.3.3.3 Muscular Tension Guided
words. Device of Guiding Collaterals
Through Meridians
19.3.3.2 M yodynamia Guided Device The signal source of muscular tension guided
of Guiding Collaterals device is the muscular tension change of agonis-
Through Meridians tic muscle and antagonistic muscle in joint
The signal source of neurological training device motion.
is the change of myodynamia (traction).
1. Design principle: When Daoyin technique is
1. Design principle: When Daoyin technique is used to guide the patients to do active move-
used to guide the patients to do active movement training, the signal from brain to agonis-
ment training, the signal from brain to agonistic muscle should be strong and the contraction
tic muscle should be strong and the contraction force should be strong so that active move-
force should be strong so that active movements of joint can be completed. At this time,

of myodynamia guided
device of guiding
collaterals
strong contractility of agonistic muscle leads 19.3.3.4 Virtual Reality Training

to increase of muscular tension (hardness Device of Neurological
increases). Antagonistic muscle must relax or Training
slightly contract so that the muscular tension It is the reception equipment for actual bio-
is small. It can manifest whether the motor electricity signal. Because of high sensitivity, it
program that dominates joint is normal or not is easy to be influenced by external signals such
from the other side. This is the objective indi- as cellphone signal and automobile engine sig-
cator of effect of Daoyin technique. It can nal. Actual signal detection of training effect
real-timely detect and display the change of cannot be increased for a long time. If the actual
muscular tension and the patients can do the signal cannot be increased for a while, the
training of neural potential development and patients, the patients and their family may lose
motor program reestablishment. the confidence of further therapy and give it up.
The change of muscular tension can be Rehabilitation equipment of neurological train-
received by the reception electrode on the skin ing is developed according to virtual reality
surface of the muscle and then is conducted to human body training. It can simulate motor pro-
the computer through pressure sensor. After gram signal and elevation. Daoyin technique is
analysis and processing, the data is showed on used for the training of active joint motion of
the screen in curve or digit. actual resistance to develop brain potential and
2. Basic structure: Except for using reception reestablish motor program.
pressure as signal source, the other designs
are the same as these of neurological training 1. Design principle: Virtual human body and

device (Fig. 19.39). animation technique are used to explain the
3. Operational approach, therapy time, therapy relationship between CNS and motor func-
course, therapeutic item, indications, contra- tion of limbs and the pathway and mechanism
indications and announcements of muscular of motor function recovery after CNS injury
tension guided device of guiding collaterals with dub. Animation technique is used to sim-
through meridians are the same as these of ulate the motor program signal of various
neurological training device of guiding collat- kinds of movements. According to goal and
erals through meridians. motive mechanism, simulated agonistic

of muscular tension
guided device of guiding
collaterals through
meridians
uscle signal intensity is set. According to

m how to complete limbs movements.
the step by step mechanism, simulated motor Although CNS cells are lack of regenera-
program and elevation are arranged from tion ability, through developing neural
weak to strong. Dynamic image of reestab- potential and activating reserved conduc-
lishment training of simulated motor program tion pathway, the functions of the injured
signal is made or recorded separately. Six- cells can be replaced and the lost motor
step Daoyin technique in traditional Chinese functions can be recovered through motor
medicine of guiding collaterals through program reestablishment. Active move-
meridians is made for dub. Vista software ment, willpower and emergent state are the
programming management program is used good conditions to develop neural poten-
for the operating personnel to call all kinds of tial. Six-step Daoyin technique in tradi-
training package. tional Chinese medicine of guiding
2. Essential structure: Virtual reality training
collaterals through meridians is used to
device or system of neurological training is guide the patients to develop neural poten-
composed of five parts (Fig. 19.40). tial through active movement and creating
(a) Mechanism explanation of virtual therapy: safe imminent dangerous state. Only prac-
Animation dub technique is used to explain ticing the archery towards target can
why CNS injury can lead to motor dys- increase the accuracy. The simulated motor
function of limbs and the mechanism of program signal curve of different intensity
recovering motor function. The anatomical and proportion of all joint motions are the
structure and basic functional orientation reference for the patients to reestablish
of CNS, what is motor program signal and motor program in joint motion.

of virtual reality training
device of guiding
collaterals through
meridians
(b) The therapists should know the actual

(d) Hardware structure: These software are
movement defect and simulate normal installed in the hard disk of the computer.
joint motions. Video is used to know Training screen is used to display mecha-
actual motor dysfunction. According to nism animation and training curve.
the fact that people are not familiar with Operational screen is used for the thera-
their own voice and motor pattern, camera pists to choose therapeutic items.
is used to record the joint motion of motor
(e) Auxiliary function: Background music
dysfunction. The video is played on the selection: the program is equipped with
screen real-timely. The therapists simu- different kinds of music such as slow, light
late normal joint motion and establish and passion to activate therapeutic atmo-
therapeutic mission and target. The sphere and encourage the enthusiasm of
patients are asked to do the same move- the patients. Therapeutic items selection:
ment of identical joints in healthy side to The movement of all parts such as face,
find out the movement difference in upper limbs, trunk and lower limbs, the
injured side and establish preliminary joint motion such as elbow extension, wrist
training mission and target. flexion and foot dorsiflexion and mecha-
(c) Simulation video and virtual animation nism demonstration are established into
are used to explain the mission, target and a database and stored. Vista software is
mechanism of the therapy. Through simu- used to make a management platform.
lation video of normal motor pattern of According to therapeutic requirements, the
identical joint with dub, the training mis- therapists select the therapeutic item and
sion and target are further explained to the press the automatic start. Storage and anal-
patients. Virtual animation is used to ysis: the training item, degree and progress
explain the training of neural potential of the patients can be stored. Virtual train-
development, motor program reestablishing is not the real data so that it can only be
ment and recovery of joint motor used for the inquiry of training condition,
function. but not the analysis data of training effect.
3. Operational approach. the patients can devote themselves into

(a) Therapeutic items selection: According to therapeutic environment, which is the
the actual condition of the patients, the premise of guaranteeing the therapy. The
therapists select the therapeutic item and cooperation between the therapists and
press automatic start for the training. the patients is very important. If the coop-
(b) Background music selection: According eration is not good, the training of the
to the personal favorite of the patients, patients may be not synchronized with
they select slow, light or passional video signal curve. Therefore, the patients
music to activate therapeutic atmo- may wrongly think that the simulated sig-
sphere and encourage the enthusiasm of nal is false and the therapy is invalid.
the patients. Before therapy, the therapists explain the
(c) Autonomous joint motion and anti- therapeutic mechanism to the patients in
resistance training under actual instruc- fact and seek the patients’ recognition,
tion: according to the joint motion such as which are very important. The therapy
elbow extension or flexion and the actual should be step by step. The training
movement ability of the patients, the ther- amount and the degree of anti-resistance
apists select the corresponding intensity should be increased gradually.
of motor program signal and start the ani-
mation video. According to the dub, when 19.3.3.5 Training Device of Motor
the video signal curve increases, the ther- Function Training
apists exert resistance on the orientation It is mainly used for recovering the lost motor
of joint motion so that the patients can function. According to three-stage rehabilitation
find out the signal orientation. Through method of neurological training, except for neu-
anti-resistance, the training of neural rological training device of guiding collaterals
potential development and motor program through meridians used for motor program rees-
reestablishment can be done. tablishment, it can be used for the neural poten-
(d) The training time and therapy course: The tial development of upper limbs, lower limbs,
training time is 50 min (once a day) and trunk, tibialis anterior muscle, hamstring mus-
there are 30 times in one therapy course. cles, stride, gait and shifting of weight and walk-
At the end of one therapy course, the ther- ing balance training device. It can be modified on
apists should re-evaluate the training the basis of equipment and it is added with signal
effect and decide whether to do the next detection and display function. In addition, there
training or not. is training device used for motor pattern

(e) Clinical indications, contraindications remodeling.
and announcements.
Indications: It is suitable for the train- 1. Neural potential development training device
ing of all kinds of motor dysfunction after of guiding collaterals through meridians
CNS injuries such as hemiplegia, cerebral includes potential development training
palsy, paraplegia, children cerebral palsy device of upper limbs (Fig. 19.41) and lower
and facial paralysis, the training of limbs limbs (Fig. 19.42). The role is to recover the
motor dysfunction induced by bone and functions of undead nerve cells in injure area.
joint injuries. Normal nerve cells around injured area can
Contraindications: The patients with replace the injure cells and the conduction
unhealed bone, joint and muscle injuries pathway and reflex arc between neurons or
after surgery who affect the rescue in between nerve and muscle are reestablished to
acute phase. recover lost autonomous motor function.
Announcements: Before training, the In order to meet the requirements men-
immerse technique should be used so that tioned above, potential development equip-
Fig. 19.41 Sketch map of lower limbs neural potential development training device of guiding collaterals through
meridians
Fig. 19.42 Sketch map of upper limbs neural potential development training device of guiding collaterals through
meridians
ment of neurological training of guiding clear and activate the channels and collat-
collaterals through meridians includes the fol- erals and increase training effect.
lowing basic structure and function. (d) The training time and therapy course: The
(a) Weight support and protection system is training time is 30 min (once or twice a
composed of bearing frame, pedestal, day) and there are 60 times in one therapy
weight support and protection system and course. At the end of one therapy course,
weight support sandbag. It can reduce the the therapists should re-evaluate the train-
partial weight of the patients so that they ing effect and decide whether to do the
can complete the required movement. next training or not.
According to the functional improvement, (e) Clinical indications, contraindications
the amount of weight support should be and announcements are the same as these
decreased. The training should be from of upper and lower neural potential devel-
easy to difficulty and step by step. Because opment training device of guiding collat-
of suspension effect of weight support erals through meridians.
system on human body, it can prevent the 2. Lower limbs motor pattern remodeling train-
falling down or bump. The method and ing device of guiding collaterals through
words are used to create safe imminent meridians: Developed neural potential
dangerous state. Because the patients development and reestablished motor pro-
know there is no danger, it can eliminate gram are not equal to recovered motor func-
the fear and tension of the patients. tion. Actual application training is required
Comprehensive effect can create safe to transfer developed potential and estab-
imminent dangerous state good for neural lished motor program into actual daily life
potential development. ability, which is a process of motor pattern
(b) Digital display and feedback system of remodeling. Not only the method of motor
Daoyin technique effects: it can detect, pattern remodeling is required, but also
analyze and display motor program sig- corollary equipment of motor pattern remod-
nals in continuous curve or sound to show eling is required.
the Daoyin technique effect real-timely. This equipment has the following charac-
According to the actual condition of the teristics. Weight support and protection; it
patients, new surpassing goal is set. can extract program signal of CNS motor pat-
Through goal and motive mechanism and tern, display it real-timely and set surpassing
biofeedback, six-step Daoyin technique goal; animation spot instruction and Daoyin
of guiding collaterals through meridians technique automatic speech instruction of
is used to develop CNS potential and pro- guiding collaterals through meridians; it can
mote plasticity and functional reorganiza- prevent unnecessary joint motion in limbs
tion in order to recover lost motor movements and promote remodeling of nor-
function. mal motor pattern effectively; result storage
(c) Animation spot instruction of meridian and automatic analysis; it is easy to operate
points and automatic speech instruction: (Fig. 19.43).
On the basis of important acupuncture Therapy course, indications, contraindica-
points, animation spot and synchronous tions and announcements of motor pattern
tracking Daoyin technique tape, conduc- remodeling training device of guiding collat-
tion pathway and real-time position of erals through meridians are the same as these
flicker of light spot are good for correct of abnormal gait rectification weight support
and standard application of the technique and walking training device.
of guiding collaterals through meridians. 3. Sphincter ani training device of guiding col-
Therefore, the technique of guiding collaterals through meridians. This training
laterals through meridians can be used to device (Fig. 19.44) is specially developed for
Fig. 19.43 Sketch map of motor pattern remodeling training device of guiding collaterals through meridians
Fig. 19.44 Sphincter
ani training device of
guiding collaterals
through meridians
gatism. The characteristics are as follows. power. When sphincter ani (agonistic muscle)
Tailor-made cylinder probe with round head is contracts and anal tube muscle (antagonistic
placed into anus and there is signal reception muscle) relaxes, it is suitable for rehabilitation
electrode in probe. There are sphincter ani and training of the patients with fecal
anal tube muscle electrodes (three electrodes incontinence.
in each group). When anal tube muscle (ago-
nistic muscle) contracts and sphincter ani Specific operational approach, indications,
(antagonistic muscle) relaxes, it is suitable for contraindications and announcements refer to the
the patients with difficult defecation short of second segment of Chap. 17.
19.3.4 Training Robot that is in accordance with training requirements

of active motor function and use the motor dys-
In clinical rehabilitation practices of neurological function as the training target. The robot can give
training, the author found that the therapeutic play to the effect of the method of rehabilitation
effect of this technique not only depends on cor- training of neurological training, overcome the
rect assessment and formulation of therapeutic shortcoming of the technique, guarantee the
schedule, but also is related to correct application safety and correctness of this technique, highlight
of active movement, proper anti-resistance, safe the characteristics of rehabilitation technique in
imminent dangerous state and passional encour- traditional Chinese medicine, increase efficiency
age guided by Daoyin technique. However, even and therapeutic effect and improve life quality of
if a sophisticated rehabilitation doctor or the ther- the disabled.
apists can master these techniques, it is difficult to
encourage the patients and create safe imminent 19.3.4.1 Basic Functions
dangerous state for neural potential development. of Rehabilitation Training
In addition, one therapist can treat one patient of Neurological Training
with passion. If one therapist is asked to treat Robot
more than eight patients, he cannot be full of pas- In order to meet the requirements of different
sion. Moreover, the therapists may be full of pas- training functions and body parts, rehabilitation
sion in one day but cannot be full of passion training robot of neurological training is equipped
every day, even the basic passion for maintaining with the following functions.
the therapy. On the other hand, rehabilitation
therapy is the one-to-one bare-handed operation 1. The training is automatic after starting: The

technique. Treating one patient at least requires training is done automatically according to tech-
one therapist. For the severe patients who totally nical requirements of neural potential develop-
lose motor function, they usually require two or ment, motor program reestablishment and motor
more therapists and auxiliary personnel to com- pattern remodeling of neurological training.
plete it. Besides, over fatigue or operation miss of 2. Entire active movement: Rehabilitation train-
the therapists during training is one of the causes ing robot of neurological training is designed
of accident injuries of the patients. for the training of entire active movement. It
Because of various shortcomings, rehabilitation changed the passive movement training way
technique of neurological training cannot be that robot helps people to do exercise, which
applied correctly. The therapy occupies too many goes against CNS potential development. It is
manpower resources. The labor intensity is strong. good for CNS potential development and
The number of the patients is small. It may induce functional reorganization.
accident of the patients and directly affect the effect 3. It can meet the technology application require-
and clinical application of rehabilitation training of ments of the method of guiding collaterals
neurological training, which is an urgent problem through meridians or guiding meridians
in the development process of rehabilitation tech- through collaterals and normal six-step
nique of neurological training. The purpose of Daoyin technique in traditional Chinese
rehabilitation training of neurological training medicine.
robot is to overcome the shortcoming of clinical 4. It can detect motor program signal, resistance
application of n eurological training and give play signal, joint angle signal or analog signal and
to the therapeutic effect of the method. show the effect of Daoyin technique in a
According to the theory of rehabilitation tech- curve, digit or sound real-timely.
nique, training procedure, training types and 5. Animation spot flicker of main and collateral
training part of neurological training, we devel- channels and acupuncture point, synchronized
oped a series of rehabilitation training of neuro- six-step Daoyin technique automatic speech
logical training robots to promote CNS plasticity instruction tracking display
6. It is with automatic anti-resistance and the 1–2 s when the patients do the training of
resistance is adjustable. The therapists can set potential development to create imminent
therapeutic item and condition and select ther- dangerous state without support or assistance.
apeutic item. Record can automatically encourage the
7. It is with man-machine conversation, wired or patients to overcome difficulty and develop
wireless manipulation, data storage and potential better.
analysis. 2. Rehabilitation training robot of motor pro-

gram reestablishment of neurological train-
19.3.4.2 T he Kinds of Rehabilitation ing: There are three kinds and six types. It can
Training Robot detect motor program signal from CNS to
of Neurological Training muscles real-timely. Automatic speech and
According to training technique and training part, animation six-step Daoyin technique instruc-
rehabilitation training robot of neurological train- tion and resistance are good for recovering
ing can be divided into three kinds. There are two autonomous coordinated motor function in
types in each kind. According to the source of the training of motor program of all joints. It
biofeedback signal, the robot is divided into includes rehabilitation training robot of motor
actual motor program signal and virtual motor program reestablishment of single joint, reha-
program signal. bilitation training robot of motor program
In addition, every type includes normal reestablishment of coordinated multiple joints
method and six-step Daoyin technique in tradi- and rehabilitation training robot of motor pro-
tional Chinese medicine of guiding collaterals gram reestablishment of walking. Every kind
through meridians, which are immersed into of rehabilitation training robot can be divided
every type. The combination forms a series of into actual and virtual motor program signal
rehabilitation training robot of neurological train- types. Two types of signals can be immersed
ing with different functions, which meets the into equipment.
requirements of rehabilitation training. 3. Rehabilitation training robot of motor pattern
remodeling of neurological training: There
1. Rehabilitation training robot of potential
are three kinds and six types. It can do the
development of neurological training: There training of upper limbs, lower limbs and bal-
are three kinds and six types. Rehabilitation anced motor pattern remodeling. They have
training robot of potential development of the following common characteristics: Active
neurological training is divided into upper movement system of movement adjustment
limbs, lower limbs and the trunk. The com- includes bearing frame, automatic weight
mon characteristics are as follows: weight support adjustment, providing resistance
support and protection facility includes bear- automatically, stride or grasping with upper
ing frame, mechanical weight support device limbs. It can restrain unnecessary movements
and protection device. Robot can be con- in the motor pattern remodeling system
nected to the safety belt the patients wear to effectively.
protect the patients away from accident. It
can keep the training safely and adjust the 19.3.4.3 Rehabilitation Training
amount of weight support automatically. Robot of Shoulder
High sensitivity of motor program signal: and Elbow of Neurological
new type of motor program signal device Training
increases the accuracy of extracting motor Rehabilitation training robot of shoulder and
program signal and broadens therapeutic elbow of neurological training is the automatic
range. Function of creating imminent danger- equipment specially used for the active move-
ous state automatically: Through software ment training of shoulder and elbow, which
setting, robot can reduce support suddenly for belongs to the exoskeleton type robot system
with the common characteristics of rehabilitation The seat is with high back to maintain the
training robot of neurological training. patients in a comfortable sitting position.
Support frame of upper limbs is composed of
1. Design principle: This type of rehabilitation lattice framing of aluminium alloy, artificial
training robot of neurological training is com- shoulder joint, elbow joint, wrist and hand. Its
posed of training software, exoskeleton role is to keep upper limbs in suspension func-
system and control system. tion position to provide enough support for
(a) Training software includes: explanation of the forearm so that the patients can do training
rehabilitation therapy mechanism of neu- of shoulder and elbow joint. The upside of lat-
rological training, six-step implement tape tice framing of aluminium alloy is connected
of guiding collaterals through meridians, to artificial shoulder and elbow joint to allow
animation flicker spot automatic tracking protraction, rear protraction, adduction,
and display system of the pathway of main abduction and rotation of the shoulder. The
and collateral channels, motor program middle artificial elbow joint allows flexion
signal detection and display system and and extension of elbow joint in physiological
virtual reality training system. range (shoulder joint: 0–360°; elbow joint:
(b) Exoskeleton system includes seat, sup-
0–180°). Lattice framing in forearm is
port system of upper limbs and resistance equipped with retractor device that is suitable
providing system. for the patients with different arm length.
(c) Control system includes operation inter- Wrist and hand is equipped with handle for
face, training items selection, resistance joint motion and anti-resistance training.
setting, surpassing goal setting, data stor- The anti-resistance force of joint motion is
age and analysis, music selection. provided by electromagnetic clutch that is
After the therapists select the thera- installed in the back of seat (the shoulder part
peutic item and increased resistance of support frame of upper limbs). The strength
through operation interface, on the basis of resistance provided by electromagnetic
of regulation of mind and breath, the clutch is controlled by the computer software
patients are guided by Daoyin technique with different grade. The resistance in the
tape instruction and do extension and same grade is not the equivalent resistance,
flexion autonomous movements of which means the strength of resistance is
shoulder or elbow joint according to the increased with the increase of the angle of
pathway of main and collateral channels joint motion. It can also provide equivalent
displayed by animation spot of human resistance, which means the strength of resis-
body. The system can exert selected tance is constant regardless of the angle of
resistance on the orientation of joint joint motion.
motion in proper time. The system use When the patients do the training of shoul-
six-step Daoyin technique to encourage der joint, electromagnetic clutch provides set-
the patients to make the motor program ting resistance. When the patients do extension
signal surpass goal continuously until it and flexion training of elbow joint, electro-
is close to or reach the actual training magnetic clutch generates resistance to the
level of the therapists. Therefore, it can arm through steel wire in the extension and
develop potential, reestablish motor flexion of elbow joint, which is good for the
program and recover lost motor anti-resistance training of the patients. It can
function. develop neural potential gradually, promote
2 . The basic structure of exoskeleton is com- CNS plasticity and functional reorganization
posed of seat, support frame of upper and realize the anticipated goal of rehabilita-
limbs and training system of shoulder and tion through repeated training (Fig. 19.45).
elbow.
Fig. 19.45 Sketch map of rehabilitation training robot of shoulder and elbow joints of neurological training
3. Operational approach: For example, in the vir- stronger signal to enhance muscle contraction
tual reality training of elbow extension, the for anti-resistance. The patients should make
patients sit in the seat of the robot, put upper motor program signal of agonistic muscle sur-
limbs in the mechanical arm of the robot and pass the previous intensity and make the signal
use fixing belt to fix it. Before training, the of antagonistic muscle lower than the previous
therapists select training item and the strength intensity. After that, the patients enter into the
of resistance force and press the starting but- relaxation process of activating collaterals.
ton. Remote manipulation is also available. 4. The training time and therapy course: The

The robot starts to autoplay six-step voice training time is 50 min (once a day) and there
guidance of guiding collaterals through merid- are 30 times in one therapy course. At the end
ians and use flickering animation spot to track of one therapy course, the therapists should
and display guided Qi, pathway of main and re-evaluate the training effect and decide
collateral channels and acupuncture points in whether to do the next training or not.
virtual human body. Meanwhile, there is simu- 5. Clinical indications, contraindications and

lated motor program signal curve on the announcements.
screen. At this moment, resistance device (a) Indications: It is suitable for motor dys-
installed in mechanical arm can exert selected function of shoulder and elbow joints
resistance to the patients automatically. after CNS injuries such as hemiplegia,
Because of the characteristics of resistance cerebral palsy, paraplegia, children cere-
device, the bigger the range of elbow extension bral palsy. It is also suitable for the motor
of the patients is, the stronger the imposed dysfunction of shoulder and elbow
resistance is. The patients must give out the induced by bone, joint and muscle inju-
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Rehabilitation

Daoyin Technique in Chinese

ISBN 978-981-13-0811-6 ISBN 978-981-13-0812-3 (eBook)

Library of Congress Control Number: 2018956445

Beijing Municipal Rehabilitation Center, Tongren Hospital and

During the years I worked as an orthopedist specializing in the treatment and

In the process of writing this book, I was supported by rehabilitation

Beijing, China Wenru Zhao

1 Basic Theory of Neurological Training Rehabilitation���������������� 1

2.1.2 The Formation and Specific Operational Approach

3.2.2 Classification of Potential Development Training�������� 98

4.3.1 Abnormal Gait Rectification Weight Support

6.2 Rehabilitation Methods of Neurological Training

8 Integrated Method of “Physiotherapy-Physical Exercise

10.3.1 Rehabilitation Method of Neurological

13.1.2 The Common Clinical Syndrome After Spinal

14.3.5 Mucus Lytic Agent �������������������������������������������������� 439

17.2.2 Pathogenesis and Classification of Defecation

Wenru Zhao was born in November

Traditional rehabilitation methods developed in the middle period of last cen-

r­ ehabilitation medicine should run through therapy of all clinical departments

1.1 Abstract through exercise. However, many medical scien-

1.1.1.1 Several Hypotheses without receiving normal afferent impulse from

were compensated by an entirely different sys- Contralateral Transfer

the side of germination

The Main Methods of Brunnstrom 1.1.2.3 Rood Technique

Mechanism Information Processing 6. Therapy is not to strengthen the muscle but

Fig. 1.2 The new babies factory-fresh computers

Chinese English Chinese English

Chinese,creeping, sitting, running, Chinese editing, picture, playing

jumping and English videos and English

large memory space (the basis of potential) memory space(set by human)

• It is short of training equipment for rectifying 1.3.2 T

1.4 Electromyographic 1.4.2.1 Basic Concepts

order to achieve self-control and self-­regulation. Operating Conditions

The Definition of Myoelectric Biofeedback 1.4.3.3 Neuroeducator III

and the bandwidth are 10–1000 Hz, which is 1.4.3.5 Other Equipment

Painless. struction equipment. Because of the movement

2.1 The Modernization 2.1.1 Theoretical Foundation

Taiyang Small Intestine Channel of Hand

musculus levator scapulae

Fig. 2.1 Shrug of six-step of the dredging collaterals through meridians

Yangming Large Intestine Channel of Hand

the end of index finger(Shangyáng LI 1)

the cervical vertebra

the radial side of the forearm(Pianlì LI 6) supraclavicular fossa

lateral of the elbow(Quchí LI 11) large intestine

Shaoyang Sanjiao Channel of Hand

triceps muscle of arm

the end of the ring finger

the upper arm(triceps muscle of arm) Yángchí TE4

Taiyin Lung Channel of Hand

middle-jiao Biceps brachii

chelidon (Chizé LU5)

Chizé LU5 Yújì LU10

oxter (Yúnmén Lu2) Lièque LU7

the upper arm (Biceps brachii) (Shàoshang LU11)

Shaoyang Sanjiao Channel of Hand

end of ring finger

shoulders (Jianliáo TE14)

the back of the wrist ^

(Yángchí TE4) Tianging TE10

forearm (extensor carpi)

Beijing, China Wenru Zhao

1 Basic Theory of Neurological Training Rehabilitation�� 1

2.1.2 The Formation and Specific Operational Approach

3.2.2 Classification of Potential Development Training�� 98

4.3.1 Abnormal Gait Rectification Weight Support

6.2 Rehabilitation Methods of Neurological Training

8 Integrated Method of “Physiotherapy-Physical Exercise

10.3.1 Rehabilitation Method of Neurological

13.1.2 The Common Clinical Syndrome After Spinal

14.3.5 Mucus Lytic Agent �� 439

17.2.2 Pathogenesis and Classification of Defecation

r ehabilitation medicine should run through therapy of all clinical departments

1.1 Abstract through exercise. However, many medical scien-

1.1.1.1 Several Hypotheses without receiving normal afferent impulse from

The Main Methods of Brunnstrom 1.1.2.3 Rood Technique

1.4 Electromyographic 1.4.2.1 Basic Concepts

order to achieve self-control and self-regulation. Operating Conditions

The Definition of Myoelectric Biofeedback 1.4.3.3 Neuroeducator III

and the bandwidth are 10–1000 Hz, which is 1.4.3.5 Other Equipment

2.1 The Modernization 2.1.1 Theoretical Foundation

2.1.3.1 Methods and Data Functional Assessment

wonderful therapeutic effect without the cor- 2.1.5.3 Self-Training

2.2 Therapeutic Methods

2.3.3 Indications, Contraindications

2.3.3.3 Cautions tion. The course of disease is about 1–5 years and

laying ping-pong and the flexibility degree

3.1.2.3 Satisfying the Requirements Passive movement is a process that the people