กายภาพบำบัดช่วยเหลือเคลื่อนย้ายในผู้ป่วยอ่อนแรงครึ่งซีก

<p>Patients with hemiparesis require special attention to safety during support and transfer to prevent injury, which can lead to inflammation of muscles and joints on the weak side, especially when transferring patients from bed to wheelchair and moving patients in and out of vehicles.</p>
<h2 style="color: #008080;"><span style="color: #00826a;">3 Watch Points During Transfer in Patients with Hemiparesis</span></h2>
<p><span style="color: #00826a;"><strong>1. Preparation steps before the patient gets into the wheelchair</strong></span> At this stage, the caregiver must help the hemiparetic patient sit with their feet dangling on the edge of the bed before moving to the wheelchair. This is a moment when the patient, who may not have good sitting balance yet, could fall from the bed if the caregiver turns away to adjust the wheelchair. Therefore, it is recommended to arrange the wheelchair properly first, then assist the patient to sit up to avoid the risk of falling from the bed.</p>
<ul>
<li>When transferring from bed to wheelchair, place the wheelchair at about a 45-degree angle to the edge of the bed. After the patient sits on the edge of the bed, the wheelchair should be positioned on the patient&#8217;s normal side. Lock the wheelchair wheels securely and fold up the footrests. Once the patient is seated, the caregiver should stand on the patient&#8217;s weak side, hold the belt or waist strap at the back of the patient to support them, then have the patient slide to the edge of the bed until both feet are on the floor. Next, the patient should use their normal hand to hold the far armrest of the wheelchair and stand up. The patient then slowly turns and sits down in the wheelchair. After the patient is seated, lower the footrests and place the patient&#8217;s feet on them.</li>
<li>Wheelchair to bed: Conversely, if transferring the patient from the wheelchair to the bed, position the wheelchair at a 45-degree angle to the edge of the bed, with the patient&#8217;s normal side close to the bed. Place the patient&#8217;s feet on the floor and fold up the wheelchair footrests. The caregiver stands on the patient&#8217;s weak side, holds the waist strap at the back to support the patient, and helps the patient use their normal hand to hold the wheelchair armrest or bed edge while pushing themselves up to stand. Position the patient sitting with feet dangling on the bed edge or help the patient lie down on the bed.</li>
</ul>
<p>&nbsp;</p>
<p><span style="color: #00826a;"><strong>2. Proper sitting posture while in the wheelchair</strong></span> During the process of transferring the patient from the bed, the caregiver must ensure the patient is sitting correctly. What is the correct sitting posture when sitting in a wheelchair?</p>
<ol>
<li>Have the patient sit with their buttocks close to the wheelchair backrest because sitting too far from the backrest may cause the patient to slip and fall out of the wheelchair.</li>
<li>Check the patient&#8217;s trunk balance to ensure they are not leaning to one side.</li>
<li>A torso strap should be fastened to the wheelchair backrest to prevent the patient from falling out. Importantly, the patient should maintain a good and appropriate posture to prevent abnormal muscle spasticity and avoid improper twisting of the shoulder or wrist while sitting in the wheelchair.</li>
<li>Do not let the patient&#8217;s feet hang off the footrests. During wheelchair movement, the caregiver must regularly check that the patient&#8217;s feet remain on the footrests to prevent wounds. Since the patient may have sensory loss, they might not realize if their feet or ankles are injured. Some patients may have foot spasms or tremors, so foot straps should be used to prevent the feet from falling off the footrests.</li>
</ol>
<h2 style="color: #008080;"><span style="color: #00826a;">Joint Physical Therapy to Prevent Contractures and Facilitate Transfers</span></h2>
<p>For patients who cannot walk or stand yet, caregivers must provide physical therapy or exercises to prevent joint stiffness by stretching muscles and moving joints to support good recovery in the future.</p>
<ol>
<li>Shoulder joint exercise: Have the patient use their normal hand to hold the weak hand, then slowly raise the arm to full stretch as far as possible. Hold the position and count 1-10, then slowly lower the arm.</li>
<li>Elbow joint exercise: Use the patient&#8217;s normal hand to hold the weak hand and bend the elbow, hold and count 1-10, then straighten the arm forward, hold and count 1-10. Repeat alternately until 10 times are completed.</li>
<li>Wrist joint exercise: The patient presses both hands together and pushes the weak side outward to bend the wrist, stretch the wrist to feel tension, then grasp the fingers tightly. Follow with finger bending exercises. These physical therapy exercises should be done only when the patient does not feel pain and as much as they can tolerate.</li>
</ol>
<h2 style="color: #008080;"><span style="color: #00826a;">Precautions During Physical Therapy</span></h2>
<ol>
<li>Joint movements should be done slowly.</li>
<li>Each movement should be done slowly, 10-20 times per set, twice a day.</li>
<li>Avoid movements immediately after a full meal or when the patient has a fever.</li>
<li>During joint movements, the caregiver should ask the patient if they feel pain. If any problems occur, stop and consult a doctor or physical therapist.</li>
<li>Do not let the patient exert more effort than their muscle strength allows, as this can increase muscle spasticity.</li>
<li>Be careful not to pull or jerk the patient&#8217;s shoulder joint, as this can cause injury due to weakness in the scapular and shoulder muscles.</li>
</ol>


In cases where the patient is still unable to walk or stand, the caregiver must have the patient undergo physical therapy or exercise to prevent joint stiffness by stretching various muscles and moving the joints to support the patient's good recovery.

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Physical therapy assists with mobility in patients with hemiparesis

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