What rehabilitation is needed after a stroke. Recovery of fine motor skills. Prognosis after a stroke

One of the most urgent, actively developed problems of modern medicine is the rehabilitation of patients who have undergone stroke. The main principles of rehabilitation applied by the Center are: early start of rehabilitation activities, regularity and duration, which is possible with a well-organized phased construction of rehabilitation. In solving the problem, medical measures aimed at restoring impaired functions, developing compensatory mechanisms of motor activity, and adapting the patient to self-care and work activity are of paramount importance. Most intense restoration of impaired functions after a stroke occurs during the first six months to a year after the acute period. The tasks of medical rehabilitation are reduced: first of all, to the impact on the inhibited elements of nervous structures (“silent neurons”, “ischemic penumbra”) and their return to functional activity, and secondly, to the achievement of compensatory restructuring of the function.

Medical rehabilitation after a stroke should begin immediately after stabilization of the vital functions of the body (primarily hemodynamic parameters) and neurological status (i.e. only with a completed stroke), be aimed at restoring motor, sensory, coordinating, speech disorders, higher mental functions (memory, attention , thinking).

Methods of rehabilitation after a stroke.

Process in our center rehabilitation after a stroke carried out by a group of specialists (rehabilitation team). This principle of team work facilitates the coordination of care and the simultaneous impact on motor, cognitive, speech disorders in combination with measures aimed at improving the somatic condition of patients. The team is led by a neurologist with special knowledge in the field of stroke rehabilitation, who is the central figure of the team and is responsible for coordinating all its activities, as well as developing the most effective individual program rehabilitation and explanation of it to all members of the team, the patient himself, his family members. The team includes specialists in physical therapy, physiotherapy, and, if necessary, a speech therapist, neuropsychologist, psychotherapist, psychoanalyst, and orthotics specialist.

The most acute problem in patients who have undergone stroke. is a movement disorder. Physical activity is aimed at restoring motor functions. rehabilitation after a stroke in our department

Our center uses the following advanced techniques for the treatment of stroke and other diseases:

• Kinesitherapy for rehabilitation after a stroke- this technique includes three main areas: treatment of stroke by position, massage and active-passive gymnastics.
• Locomat training complex(robotization of walking) a technique that allows you to put patients on their feet even after a spinal injury!
• Massage on the apparatus "Hivamat" And different kinds manual massage helping to establish motor functions organism
• Physiotherapy under the guidance of a personal instructor
• Various types of electrical neurostimulation– a technique that restores the motor function of patients
• Dynamic propriocorrection- wearing special reflex-loading suits, used to restore motor functions in patients who have had a stroke
• Laboratory for the diagnosis and treatment of vertigo- a diagnostic technique that allows for a differential diagnosis between various diseases of the nervous system.
• Balneotherapy– methods of treatment, prevention and restoration of impaired body functions with mineral waters
• Myostimulation (electroneuromiostimulation)– a technique effective for restoring the functions of the spine
• Psychocorrection- a technique aimed at restoring a normal psychostatus for patients who have had a stroke
• stabilometry– a technique for the recovery of patients with vestibular disorders
• Balance therapy after a stroke– motor learning for voluntary control of vertical posture using biofeedback
• Selective vibration stimulation— multi-point stimulating vibration impact on the support zones of the feet in the normal walking mode in the absence or limitation of motor function (modeling the sensory image of walking). Effectively used since the acute period of stroke and heart attack in order to prevent thrombosis.
• Clinical analysis of gait on the "Biomechanics" complex– a technique for restoring movements after a stroke
• speech therapy classes — various methods aimed at restoring speech functions
• Complex «Nicolet»– diagnostic technique for patients with various neurological disorders
• Electromyography- a method for studying bioelectric potentials that arise in the skeletal muscles of animals and humans during excitation of muscle fibers. This technique allows you to judge the state and activity of not only the muscles, but also the nerve centers involved in the implementation of movements.
• Bemer therapy– treatment with an ultra-low intensity electromagnetic field for arterial hypertension, coronary heart disease, spinal osteochondrosis, degenerative-inflammatory diseases of the joints, as well as for stress and sleep disorders
• Cryotherapy- cold treatment
• Polyreceptor therapy– a method of therapeutic and rehabilitation effects on various receptors
• Transcranial magnetic stimulation– techniques for stimulating peripheral nerves and spinal roots, in order to restore nerve functions
• Darsonvalization- a method of treatment with pulsed current of high frequency, high voltage and low strength.
• Hydromassage– massage in the aquatic environment
• Sympathocorrection- a method of exposure to a rotating electric field on the nerve plexuses located near the cervical vertebrae. As a result, the system of regulation of cerebral circulation is normalized.
• Mesodiencephalic modulation- a method in which the functional state of various organs and systems changes with the help of low-frequency pulsed currents, which leads to significant positive changes, obtaining one or another effect (pain relief, stimulation, regeneration, increased blood circulation), increasing therapeutic efficacy and reducing the duration of treatment
• color therapy- color treatment
• audiovisual stimulation– special effect on auditory and visual analyzers, for the treatment of neurological disorders
• Physiotherapy procedures- immersion baths, dry carbonic, Zalman, contrast, whirlpool ozonated, mineral, Biolong baths, turpentine; acupuncture, helium-oxygen inhalations, iontophoresis, etc.
• Multimaster training complex— a technique for restoring motor function in neurological patients.

Physiotherapy

Center for Rehabilitation Medicine and Rehabilitation of the Medical and Rehabilitation Center of ROSZDRAV equipped with modern physiotherapy equipment. To mobilize all the adaptive systems of the body, the following are carried out: mesodiencephalic modulation, electrophoresis of medicinal substances. To reduce the increased muscle tone, heat treatment (ozocerite, paraffin, mud applications), magnetotherapy, laser therapy, and reflexotherapy are used.

One of the most effective latest developments in domestic medicine is multichannel programmable electrical muscle stimulation. This is a method for correcting a person's pathological motor stereotype and serves to consolidate the physiological images of movements that are modeled during sessions of programmed stimulation. The clinical and neurophysiological essence of artificial movement correction lies in the exact temporal correspondence of the programs of artificial and natural muscle excitation in human motor acts.

Electrical stimulation of muscle groups carried out in various phases of walking. The procedure can take place in a stationary mode, when the patient is in a passive state; at the same time, the portable built-in computer, according to the program specified by the doctor, sends pulses to each muscle group in turn, simulating and reproducing the entire walking cycle. At offline the operation of this device, electrical stimulation is more physiological, because. carried out while walking. The phase sending of electrical impulses to the muscles occurs in exact accordance with the rhythm of the patient's walking, which is provided by a sensor attached to the patient.

Vibration stimulation of the reference points of the foot is also used. Alternate phase vibration impact on the points of the foot occurs in the mode of cyclic walking. The device is equipped with headphones that imitate the sounds of steps. Local vibration impact on the supporting zones of the sole in the rhythm of walking is carried out at a speed of 15 to 80 steps per minute. During the vibrostimulation session, the sensory image of walking is recreated.

Using the hardware-software complex " Neuroergometer”, you can quickly assess the energy state of the brain and adaptive systems of the body. This objective method of dynamic observation of the functional activity of the brain, both in general and in its individual sections, serves as a reliable indicator of the effectiveness of the treatment process.

To conduct biomechanical studies, a computer complex for analyzing movements " Biomechanics". A study of human gait is carried out using all classical methods simultaneously: three-dimensional registration of spatial movements in various joints and segments of the body; record of load distribution on the support zones of the foot; functional myography; statokinesiogram - the trajectory of the center of pressure exerted by a person on the support plane; dynamic stabilometry - a study of the support reaction in walking (based on the biofeedback method). The process of collecting and processing information is automated, which allows you to get a complete report on the study immediately after registering the parameters.

Recovery methods after a stroke

Usually, a stroke is an acute circulatory disorder in a part of the brain, and a hemorrhage occurs, and it manifests itself with a sharp increase in blood pressure, which can be the cause of vascular atherosclerosis, kidney pathology, vasculitis, a disease of the endocrine organs and other causes.

Currently, stroke has begun to affect the elderly, and middle-aged people and even young people are often affected by stroke, so mortality from cerebrovascular accident is in third place, second only to tumors and heart diseases. Therefore, it is necessary to apply all methods of recovery after a stroke.

Especially often a stroke affects people with impaired fat metabolism, also people who drink alcohol, smokers, those who lead a passive lifestyle, are exposed to prolonged neuropsychic overstrain, and people with a genetic predisposition are also at risk of stroke.

In this regard, it has been found that people who have the above three adverse factors are more often susceptible to this disease, so they should know all the methods of recovery after a stroke.

Stroke is divided into 2 groups, these are hemorrhagic and ischemic, and hemorrhagic is characterized by hemorrhage into the substance of the brain or under its membranes. Hemorrhage begins in connection with the rupture of the cerebral vessel, especially this phenomenon occurs with an increase in blood pressure, so the main method of recovery after this type of stroke is to immediately lower blood pressure.

Ischemic stroke can occur when there is insufficient blood flow to various parts of the brain due to blockage of the supply vessels. Sometimes there are cases when both types of stroke can appear simultaneously, in which case it is very difficult to save the patient.

Hemorrhagic stroke very often develops in people at any age, both in men and women, and it manifests itself suddenly in the afternoon after overwork, physical overstrain or excitement.

Usually, a stroke is preceded by flushing, headache, and various objects in red hues appear, as well as initial symptoms. hemorrhagic stroke are manifested by vomiting, disorder of consciousness, such as stunning, and there may also be a complete loss of consciousness.

The nature of the attack, especially at first, is almost impossible to establish, therefore, therapy should be aimed at the process of normalizing cardiovascular activity, homeostasis, respiration, and especially at the prevention of pneumonia, thromboembolism and bedsores, and apply recovery methods after a stroke.

It is especially important to observe bed rest in case of hemorrhagic stroke and for at least three weeks, and drug stimulation of respiration in case of cerebral stroke should not be carried out. Ischemic stroke is very common in middle-aged and elderly people, and such phenomena occur after taking a hot bath, physical exertion, emotional factors, and after drinking and smoking.

An ischemic stroke begins at any time of the day, but especially often such phenomena occur at night or in the morning, and the precursors of a stroke can be dizziness, confusion, blackouts, and the patient's condition can be predicted only by determining the affected areas of the brain.

This type of stroke develops in just a few hours and at the same time, the level of numbness and weakness in the lower extremities and arms on one side of the body begins to increase, and speech is also impaired, with damage to the left hemisphere, half of the face becomes numb, headaches and dizziness appear.

For any type of stroke, the patient should be hospitalized in the neurological department in the ward intensive care, and at the same time, the patient should receive drugs that improve cerebral circulation, in addition, drugs that normalize blood pressure should be given.

After the patient's condition improves, he is prescribed physiotherapy exercises, and they also systematically monitor his condition, especially patients with vascular disease, monitor nutrition, sleep and life, especially monitor blood pressure.

From the very first day, the patient is prescribed antibiotics to prevent pneumonia, and during hypertension, cold water or an ice pack is used. With severe psychomotor agitation, the patient is prescribed parenterally diazepam or GHB, and various antihistamines are given to stop hiccups and vomiting.

It is very important to turn the patient every two hours during a stroke to avoid pneumonia and bedsores, as well as to take care of the oral cavity, skin, and feed the patient with easily digestible and high-calorie food.

With a delay in the patient's stool, laxatives should be prescribed, and with urinary retention, a catheter should be placed.

Drugs that can dilate blood vessels in the brain do not always lead to positive result, due to the pathological reaction of the vessels of the affected area, which can lead to aggravation of ischemia in the affected areas, the so-called “steal” syndrome, but, nevertheless, it is necessary to give papaverine, no-shpu, xanthinol parenterally.

It must be remembered that ischemic stroke is an acute violation of cerebral circulation with severe damage to brain tissue, and as a result, its function is impaired, which leads to cerebral infarction, which often ends in disability and even death.

Each person should know the reasons that cause brain damage: a sedentary lifestyle, stress, smoking, drinking in large quantities. Recovery methods after a stroke will help you quickly regain lost health.

Recovery after a stroke

1. Defects in speech;
2. Movement disorders;
3. Memory loss;
4. Loss of visual function;
5. Loss of hearing function;
6. General disorders of autonomic regulation;
7. Cardiac disorders.

The tactics of their treatment and correction involves long-term rehabilitation, carried out in various ways. All work on the restoration of the function is aimed at their compensation or partial rehabilitation, since there can be no talk of a full return of lost opportunities. This is explained by damage at the level of the brain. Therefore, with such a pathology as a stroke, recovery is an extremely complex problem, not always amenable to solution.

Ways to recover after a stroke

A stroke patient cannot perform even simple self-service manipulations for a long period. The important thing here is that he needs to provide care after a stroke, the essence of which is to help with washing, eating and fulfilling physiological needs. While the patient is in the hospital acute period, all this is done by junior medical staff, but after discharge, this task falls on the shoulders of relatives. If it is impossible to arrange care, you should use the services of rehabilitation centers.

Any rehabilitation center after a stroke is a more acceptable option for both relatives and the patient. This is explained by the fact that care will also be provided by junior staff, and the patient himself will be observed by doctors. At the same time, it is possible to professionally approach the issue of rehabilitation by prescribing specialized procedures. With a pathology such as a stroke, recovery is carried out in the following ways:

• Massage and manual therapy
• Ergotherapy;
• Igroreflexotherapy;
• Classes with a psychologist;
• Classes with a speech therapist;
• Exercises and exercise therapy;
• Physiotherapy.

These procedures have a beneficial effect on the patient's body and allow you to relax after a medical hospital. At the same time, the importance of restoring functions in a professional rehabilitation center is also due to the fact that at some point a second stroke can occur in the brain. In the conditions of a rehabilitation center, this pathology will be correctly diagnosed, and the patient himself will quickly go to inpatient treatment. At home, it is not always possible to correctly recognize the disease and quickly transport the patient to the intensive care unit.

Recovery of motor function

Movement disorders are among the most common and difficult to recover. However, despite this, the importance of applying procedures is very high. For this, such activities as massage and manual therapy, physiotherapy, acupuncture are often carried out. All these methods are aimed at the reflex path of influence. At the same time, the probability of compensation of motor functions is quite high. In humans, the entire part of the motor cortex is not always affected, but only some of its area. And the lesion also does not always affect both sides and halves of the body.

With a pathology such as a right-sided stroke left-hand side body suffers from neurological symptoms. The downward influence of the cortex weakens or stops completely for a while or permanently, because of which the muscles cannot receive impulses from the brain. Paresis develops, which leads to the impossibility of performing motor acts. Paresis can affect half of the body, the entire body, or one limb. It is also possible to develop paresis of the nerves that innervate the muscles and skin of the face. Because of this, the motor functions of facial muscles are subjected to correction. In this case, lagophthalmos, which is a sign of facial nerve paresis, can be treated surgically.

The main work on recovery is performed by chiropractors and exercise therapy instructors. Exercises after a stroke are effective complexes of motor acts that allow you to use many muscle groups. In this case, the defeat of the motor cortex leads to central paralysis. It is manifested by muscle hypertonicity. and therefore massage is an integral part of this complex.

Recovery and correction of speech function

With such a pathology as a stroke, the restoration of speech is of great importance due to the fact that it is practically the only means for transmitting information to other people. The loss of this function is provoked by damage to either the auditory lobe, or speech centers, or areas that innervate the muscles of the larynx and pharynx. The last type of aphasia is motor aphasia, and the patient cannot speak articulately and expressively. As a result of attempts to say something, patients get inarticulate sounds that have nothing to do with words. Then the main task of the speech therapist is to focus the patient on gestures and symbols. This type of speech is called audiological and is also used in those people who cannot speak since childhood or because of impaired motor function of the muscles of the pharynx and larynx.

With partial damage to the engine speech center there are violations that are associated with forgetting words and the algorithm for their pronunciation. Restoring speech in this case requires the speech therapist to use a large number of techniques. All of them can be carried out in rehabilitation centers. At the same time, the process of restoring speech in a post-stroke patient can take a long time, from about 3 months to several years, depending on the extent of the lesion. In some patients, it is impossible to completely restore the speech function, and therefore, training in the audiological language is also necessary here.

Loss of vision in a stroke is not the most common consequence, although its importance is very great. And here it is worth contacting specialists who can correctly diagnose the extent of the lesion. For example, it can be localized at the level of the optic nerve or tract, and it can also appear in the cortex. The latter localization is the most frequent and irreversibly leads to loss of vision.

Loss of visual function in stroke is often both unilateral and bilateral. Vision during a stroke is lost due to ischemia or hematoma, and since the areas of the cortex on different hemispheres are very close, the hemorrhagic form of a stroke can lead to bilateral loss of vision. The essence of rehabilitation in this case is reduced to training tactile perception information. All sense organs as a result of this lower the threshold of perception and become valuable sources of information. It is noteworthy that thanks to the tactile sensation, it is possible to read books, as well as recognize banknotes.

Restorative therapy and psychotherapy

As a result of a stroke, the patient is not always different good mood and cheerfulness. Most of them, realizing the presence of defects, have a tendency to suicide. Therefore, the importance of the participation of a psychotherapist in treatment is invaluable. The tactics of his work is based on various teachings that allow you to eliminate the symptoms of depression and correct disorders in the field of mental functions. This is important in several aspects, and in particular, in the suppression of suicidal attempts.

This type of therapy makes adjustments and restorative treatment. Its principles are based on the fact that most procedures allow you to feel muscle strength, as well as allow you to solve problems with self-realization. The category of restorative procedures should include exercise therapy, ergotherapy, massage after a stroke. acupuncture. These manipulations can help the patient open reflex pathways to restore motor function. Wherein the best therapy is a positive trend in treatment: if the patient notices that he is able to perform more manipulations, muscle strength becomes greater, and well-being improves, then there can be no depression and thoughts of a suicidal nature. This is the basis of the whole tactic of working with patients in need of rehabilitation due to various diseases. Therefore, patients in rehabilitation centers, due to an integrated approach, restore functions much faster than with home treatment.

Stroke is an acute vascular accident that ranks first in the structure of disability and mortality. Despite the improvement medical care, a large percentage of stroke survivors remain disabled. In this case, it is very important to readapt such people, adjust them to a new social status and restore self-service.

brain stroke- acute violation of cerebral circulation, accompanied by a persistent deficit of brain functions. There are synonyms for cerebral stroke: acute cerebrovascular accident (ACC), apoplexy, stroke (apoplexy). There are two main types of stroke: ischemic and hemorrhagic. In both types, the death of the part of the brain that was supplied by the affected vessel occurs.

Ischemic stroke occurs due to the cessation of blood supply to a part of the brain. The most common cause of this type of stroke is atherosclerosis of the vessels: with it, a plaque grows in the wall of the vessel, which increases over time until it blocks the lumen. Sometimes part of the plaque comes off and clogs the vessel in the form of a blood clot. Thrombi are also formed during atrial fibrillation (especially in its chronic form). Other rarer causes ischemic stroke are blood diseases (thrombocytosis, erythremia, leukemia, etc.), vasculitis, some immunological disorders, oral contraceptives, hormone replacement therapy.

Hemorrhagic stroke occurs when a vessel ruptures, with which blood enters the brain tissue. In 60% of cases, this type of stroke is a complication of hypertension against the background of vascular atherosclerosis. Modified vessels are torn (with plaques on the walls). Another cause of hemorrhagic stroke is the rupture of an arteriovenous malformation (saccular aneurysm) - which is a structural feature of the vessels of the brain. Other causes: blood diseases, alcoholism, drug use. Hemorrhagic stroke is more severe and the prognosis is more serious.

How to recognize a stroke?

A characteristic symptom of a stroke is a complaint of weakness in the limbs. You need to ask the person to raise both hands up. If he really had a stroke, then one arm rises well, and the other may or may not rise, or the movement will be difficult.

In stroke, there is facial asymmetry. Ask a person to smile, and you will immediately notice an asymmetrical smile: one corner of the mouth will be lower than the other, the smoothness of the nasolabial fold on one side will be noticeable.

Stroke is characterized speech disorder. Sometimes it is obvious enough that there is no doubt about the presence of a stroke. To recognize less obvious speech disorders, ask the person to say: "Three hundred and thirty-third artillery brigade." If he has a stroke, impaired articulation will become noticeable.

Even if all these signs occur in a mild form, do not expect that they will pass by themselves. It is necessary to call an ambulance team at the universal number (both from a landline phone and from a mobile phone) - 103.

Features of female stroke

Women are more susceptible to stroke, take longer to recover, and are more likely to die from its effects.

Increase the risk of stroke in women:

- smoking;

- the use of hormonal contraceptives (especially over the age of 30 years);

- Hormone replacement therapy for menopausal disorders.

Atypical signs of a female stroke:

• an attack of severe pain in one of the limbs;
• sudden attack of hiccups;
• an attack of severe nausea or pain in the abdomen;
• sudden fatigue;
• short-term loss of consciousness;
• sharp pain in the chest;
• asthma attack;
• sudden rapid heartbeat;
• insomnia (insomnia).

Principles of treatment

Future prospects depend on the early start of stroke treatment. In relation to a stroke (however, as in relation to most diseases), there is a so-called "therapeutic window" when the ongoing therapeutic measures are most effective. It lasts 2-4 hours, then the part of the brain dies, unfortunately, completely.

The system of treatment of patients with cerebral stroke includes three stages: pre-hospital, inpatient and rehabilitation.

At the prehospital stage, a stroke is diagnosed and the patient is urgently transported by an ambulance team to a specialized institution for inpatient treatment. At the stage of inpatient treatment, stroke therapy can begin in the intensive care unit, where urgent measures are taken to maintain the vital functions of the body (cardiac and respiratory activity) and to prevent possible complications.

Consideration of the recovery period deserves special attention, because often its provision and implementation falls on the shoulders of the patient's relatives. Since strokes occupy the first place in the structure of disability among neurological patients, and there is a tendency to "rejuvenate" this disease, each person should be familiar with the rehabilitation program after a cerebral stroke in order to help his relative adapt to a new life for him and restore self-care.

Rehabilitation of patients with cerebral stroke

The World Health Organization (WHO) defines medical rehabilitation as follows.

medical rehabilitation - this is an active process, the purpose of which is to achieve a complete restoration of functions impaired due to a disease or injury, or, if this is not possible, the optimal realization of the physical, mental and social potential of a disabled person, the most adequate integration of him in society.

There are some patients who, after a stroke, have a partial (and sometimes complete) self-restoration of damaged functions. The speed and degree of this recovery depend on a number of factors: the period of the disease (prescription of the stroke), the size and location of the lesion. Restoration of impaired functions occurs in the first 3-5 months from the onset of the disease. It is at this time that restoration measures should be carried out to the maximum extent - then they will be of maximum benefit. By the way, it is also very important how actively the patient himself participates in the rehabilitation process, how much he realizes the importance and necessity of restorative measures and makes efforts to achieve the maximum effect.

Conventionally, there are five periods of stroke:

• acute (up to 3-5 days);
• acute (up to 3 weeks);
• early recovery (up to 6 months);
• late recovery (up to two years);
• period of persistent residual effects.

Basic principles of rehabilitation measures:

• earlier start;
• regularity and duration;
• complexity;
• phasing.

Rehabilitation treatment begins already in the acute period of a stroke, during the treatment of a patient in a specialized neurological hospital. After 3-6 weeks, the patient is transferred to the rehabilitation department. If, after discharge, a person needs further rehabilitation, then it is carried out on an outpatient basis in the conditions of the rehabilitation department of the polyclinic (if any) or in a rehabilitation center. But most often such care is shifted to the shoulders of relatives.

The tasks and means of rehabilitation vary depending on the period of the disease.

Rehabilitation in acute and early recovery periods of stroke

It is carried out in a hospital setting. At this time, all activities are aimed at saving lives. When the threat to life has passed, measures to restore functions begin. Treatment with position, massage, passive exercises and breathing exercises begin from the first days of a stroke, and the time for the start of active recovery measures (active exercises, transition to a vertical position, standing up, static loads) is individual and depends on the nature and degree of circulatory disorders in the brain, from the presence of comorbidities. Exercises are performed only in patients in a clear mind and in their satisfactory condition. With small hemorrhages, small and medium heart attacks - on average from 5-7 days of a stroke, with extensive hemorrhages and heart attacks - for 7-14 days.

In the acute and early recovery periods, the main rehabilitation measures are the appointment of medications, kinesitherapy, and massage.

Medications

In its pure form, the use of drugs cannot be attributed to rehabilitation, because it is rather a treatment. However, drug therapy creates the background that provides the most effective recovery, stimulates the disinhibition of temporarily inactivated brain cells. Medications are prescribed strictly by a doctor.

Kinesiotherapy

In the acute period, it is carried out in the form of therapeutic exercises. The basis of kinesitherapy is positional treatment, passive and active movements, and breathing exercises. On the basis of active movements carried out relatively later, training in walking and self-care is built. When carrying out gymnastics, overworking of the patient should not be allowed, efforts should be strictly dosed and the loads should be gradually increased. Treatment with position and passive gymnastics for uncomplicated ischemic stroke begin on the 2-4th day of illness, for hemorrhagic stroke - on the 6-8th day.

Position treatment. Purpose: to give the paralyzed (paretic) limbs the correct position while the patient lies in bed. Make sure that your arms and legs do not stay in one position for a long time.

Dynamic exercises performed primarily for muscles, the tone of which usually does not increase: for the abductor muscles of the shoulder, supinators, extensors of the forearm, hand and fingers, abductor muscles of the thigh, flexors of the lower leg and foot. With pronounced paresis, they begin with ideomotor exercises (the patient first mentally imagines a movement, then tries to perform it, while pronouncing the actions performed) and with movements in facilitated conditions. Facilitated conditions imply the elimination different ways gravity and friction forces, which make it difficult to perform movements. For this, active movements are performed in a horizontal plane on a smooth slippery surface, systems of blocks and hammocks are used, as well as the help of a methodologist who supports the segments of the limb below and above the working joint.

By the end of the acute period, the nature of active movements becomes more complex, the pace and number of repetitions gradually but noticeably increase, they begin to carry out exercises for the body (light turns, tilts to the sides, flexion and extension).

Starting from 8-10 days (ischemic stroke) and from 3-4 weeks (hemorrhagic stroke), with good health and satisfactory condition of the patient, they begin to teach sitting. At first, he is helped to take a semi-sitting position with a landing angle of about 30 0 1-2 times a day for 3-5 minutes. Within a few days, while controlling the pulse, increase both the angle and the time of sitting. When changing the position of the body, the pulse should not increase by more than 20 beats per minute; if there is a pronounced heartbeat, then reduce the angle of landing and the duration of the exercise. Usually, after 3-6 days, the angle of elevation is adjusted to 90 0, and the procedure time is up to 15 minutes, then they begin learning to sit with their legs down (at the same time, the paretic arm is fixed with a scarf bandage to prevent stretching of the articular bag of the shoulder joint). When sitting, a healthy leg is sometimes laid on the paretic one - this is how the patient is taught the distribution of body weight on the paretic side.

Along with teaching the patient to walk, exercises are carried out to restore household skills: dressing, eating, performing personal hygiene procedures. Self-service recovery exercises are shown in the table below.

Massage

Massage begins with uncomplicated ischemic stroke on the 2-4th day of illness, with hemorrhagic - on the 6-8th day. Massage is carried out when the patient lies on his back and on a healthy side, daily, starting from 10 minutes and gradually increasing the duration of the massage up to 20 minutes. Remember: vigorous tissue stimulation, as well as a fast pace of massage movements, can increase muscle spasticity! With a selective increase in muscle tone, massage should be selective.

On muscles with increased tone, only continuous planar and encircling strokes are used. When massaging opposite muscles (antagonist muscles), stroking is used (planar deep, forceps-like and intermittent encircling), slight transverse, longitudinal and spiral rubbing, light shallow longitudinal, transverse and forceps-like kneading.

Direction of massage: shoulder-scapular girdle → shoulder → forearm → hand; pelvic girdle → thigh → lower leg → foot. Special attention they give massage to the pectoralis major muscle, in which the tone is usually increased (slow strokes are used), and the deltoid muscle, in which the tone is usually reduced (stimulating methods in the form of kneading, rubbing and tapping at a faster pace). Massage course 30-40 sessions.

In a hospital, rehabilitation measures are carried out no longer than 1.5-2 months. If it is necessary to continue rehabilitation treatment, the patient is transferred to an outpatient rehabilitation facility.

Outpatient rehabilitation measures in the recovery and residual periods of a stroke

Patients are referred for outpatient rehabilitation treatment no earlier than 1.5 months after ischemic stroke and 2.5 months after hemorrhagic stroke. Patients with motor, speech, sensory, coordinating disorders are subject to outpatient rehabilitation. Outpatient rehabilitation for a stroke patient who has had a stroke for a year or more will have a positive effect, provided there are signs of ongoing recovery of functions.

Basic outpatient rehabilitation measures:

- drug therapy (prescribed strictly by a doctor);

– physiotherapy;

– kinesitherapy;

– psychotherapy (conducted by doctors of relevant specialties);

- restoration of higher cortical functions;

- occupational therapy.

Physiotherapy

It is carried out under the supervision of a physiotherapist. Physiotherapeutic procedures are prescribed not earlier than 1-1.5 months after ischemic stroke and not earlier than 3-6 months after hemorrhagic.

Patients who have had a stroke are contraindicated:

- general darsonvalization;

– general inductometry;

- UHF and MBT on the cervical-collar zone.

Permitted:

- electrophoresis of solutions of vasoactive drugs;

– local sulfide baths for the upper extremities;

- a constant magnetic field on the cervical-collar region in case of violations of the venous outflow;

- general sea, coniferous, pearl, carbonic baths;

– massage of the cervical-collar zone daily, course 12-15 procedures;

- paraffin or ozocerite applications on the paretic limb;

- acupressure;

– acupuncture;

- diadynamic or sinusoidally modulated currents;

- local application of d'Arsonval currents;

- electrical stimulation of paretic muscles.

Kinesiotherapy

Contraindication for kinesitherapy - blood pressure above 165/90 mm Hg, severe cardiac arrhythmias, acute inflammatory diseases.

In the early recovery period, the following types of kinesitherapy are used:

1) treatment by position;

2) active movements in healthy limbs;

3) passive, active-passive and active with the help, or in facilitated conditions of movement in the paretic limbs;

4) relaxation exercises combined with acupressure.

Direction of the exercises: shoulder-scapular girdle → shoulder → forearm → hand; pelvic girdle → thigh → lower leg → foot. All movements must be performed smoothly, slowly in each joint, in all planes, repeating them 10-15 times; all exercises must be combined with proper breathing (it should be slow, smooth, rhythmic, with an extended breath). Make sure that there is no pain during the exercise. Restoring proper walking skills is of particular importance: it is important to pay more attention to training an even distribution of body weight on the diseased and healthy limbs, support on the entire foot, learning to “triple shortening” (flexion at the hip, knee and extension at the ankle joints) of the paretic leg without abducting it to the side.

In the late recovery period, there is often a pronounced increase in muscle tone. To reduce it, you need to perform special exercises. The peculiarity of these exercises: in the treatment of the position, the paretic arm and leg are fixed for a longer time. Removable gypsum splints are applied for 2-3 hours 2-4 times a day, and in case of significant spasticity, they are left overnight.

Acute cerebrovascular accident is not a sentence. Is it possible to quickly and completely restore the brain and functionality after a stroke?

With proper rehabilitation after a stroke at home, some body functions (speech, visual, motor) can be partially or even completely restored.

BUT proper care and support improve the quality of life even for bedridden patients.

How to prevent complications during recovery after a stroke? In acute cerebrovascular accident nerve tissue in the affected area dies. There is a violation of functions (speech, motor, visual). But thanks to the phenomenon of neuroplasticity nervous system transfers these functions to other cells.

In order for the transfer to take place correctly, neurorehabilitation needed. Otherwise, there is a possibility that the processes will go in a different direction, as a result of which compensatory movements will form, which will cause inconvenience and worsen the quality of life.

The recovery period depends on the type of stroke.

There are three levels of recovery:

• true - return to the original state;
• compensatory - transfer of functions from affected structures to healthy ones;
• readaptation - with a large lesion and the impossibility of compensating for impaired function.

The recovery period is divided into the following periods:

• early - up to six months of illness;
• late - six months to a year;
• residual - after a year.

Restoration of speech, psyche, social rehabilitation takes more time.

The principles of rehabilitation are:

• early start;
• systematic;
• duration;
• involvement of doctors and relatives in the process.

Over return to normal life There are specialists from different fields - neurologists, therapists, speech therapists, physiotherapists, psychologists, etc.

To your attention a video about methods of rehabilitation after a stroke and recovery at home:

Home care for bedridden patients

Even before the arrival of the patient, the following items should be prepared:

• vessel;
• diapers for adults;
• absorbent diapers;
• antidecubitus circles, mattresses;
• a pole by the bed or reins near the back;
• soft carpet near the bed;
• chair, etc.

Every day, 2 times a day, the patient is washed, teeth are cleaned, mucous membranes are washed, ears are cleaned 1-2 times a week.

To prevent bedsores, the bed is straightened without leaving wrinkles.. The body is allowed to be lubricated special means prepared from 200 ml of vodka, 1 tbsp. shampoo, 1 liter of water. Every 2-3 hours the patient is turned on its side.

With the loss of chewing, swallowing function, food is mashed, fed through cocktail sticks. As an alternative food, canned children are used.

Feeding is not forced- it causes vomiting. If the appetite is poor, give your favorite dishes (as part of the prescribed diet). Portions are small, meals - 6 times a day. Before eating, the body of the ward is given a semi-sitting position.

Uncommon - incontinence or urinary retention. In the latter case, there is a need for catheterization. In case of incontinence, when it is impossible to regulate the process with medication or other methods, sanitary pads and diapers are used.

If the patient is able to move independently, then the first actions are sitting.

The first days - for a few minutes, the time is gradually increased.

The next stage is standing, then walking, mastering the transfer of body weight from one leg to another.

Walking skills return gradually. In order not to turn the foot, wear high shoes.

You need to move with support. A cane or a special attachment with 3-4 legs is used as a support.

Diet and food

The menu includes the following products:

• vegetable oils - rapeseed, soybean, olive, sunflower (no more than 120 g per day);
• seafood - at least 2 times a week;
• vegetables, fruits rich in fiber, folic acid - from 400 g daily;
• purified water - up to 2 liters per day (if there are no contraindications).

Blueberries have a beneficial effect on the body, containing a large amount of antioxidants, and bananas rich in potassium.

It is important that the patient receives enough folic acid, vitamins A, E, C, which help to overcome the consequences of the disease and reduce the risk of relapse.

Meat, fish, dairy products are consumed in moderation, low-fat diet varieties. Products are steamed, stewed or boiled. The layer of fat is removed from the surface. If you cook these products correctly, then the fat content is halved.

It is useful to consume legumes - a rich source of folic acid. Meat and potatoes (only baked) are given no more than 2-3 times a week.

In the diet includes cereals - brown rice, oatmeal, bran, durum wheat.

From the menu remove smoked meats, spicy, spicy dishes. Bread and other pastries, sweet, fatty desserts, animal fats are contraindicated.

These foods increase cholesterol. Salt is excluded or reduced to a minimum level.

Under the ban - alcohol. Your doctor may recommend moderate consumption of natural red wine. but exceeding the prescribed dose is life-threatening.

Physical activity, exercise therapy, sex life

The first two weeks after discharge, if there are no other appointments, physical exercise consist only in changing the position of the body. , the purpose of which is to relax and prepare the muscles for work.

When the patient moves physiotherapy methods are applied to it- massage, manual therapy, thermotherapy (ozocerite and paraffin applications), magnetotherapy, laser therapy, exercises on simulators, individual and group gymnastics.

The day starts with a warm-up- shallow squats, sips, bends. It is recommended to alternate loads - light running, walking, exercise bike.

The program is compiled individually. It is impossible to change the mode on your own, since a repeated stroke is possible.

Exercises that increase muscle spasticity are prohibited - squeezing the ring, the ball. Sexual desire returns approximately 3 months after the attack. In some cases, the disease provokes an increase in sexual desire., since the hypothalamus and the center responsible for the release of hormones work differently.

There are cases when a person returned to an active sexual life even before speech returned to him. But no matter what scenario is embodied, a doctor is consulted before starting sexual activity.

In the program of Elena Malysheva interesting information about how to restore movement after an illness:

habits

Correction of habits is necessary for quick normalization of the state. So, give up smoking or minimize the number of cigarettes smoked. No alcohol allowed.

A sedentary lifestyle is contraindicated- need moderate physical activity, which correspond to the condition.

Medical control and treatment

In the treatment of stroke, the following groups of drugs are prescribed:

All patients who have suffered a cerebral stroke, subject to dispensary observation by a neurologist.

Psychological support

Stroke negatively affects the quality of life. That's why increased likelihood of depression.

Those affected by the disease need communication, moral support, contact with the outside world. These requirements remain even if such a person is not able to speak, but perceives speech by ear. Topics for conversation are varied - from children to politics. It is important for the bedridden to hear that he will recover.

Patients can hardly tolerate dependence on other people, especially those who are distinguished by love of freedom and independence.

Therefore they have personality traits such as grumpiness, irritability may develop. With depression, any help, including medical help, can be rejected.
If contact is interrupted, the help of a psychologist or psychotherapist is needed, as well as drug treatment antidepressants.

It is forbidden in the presence of the patient to discuss his problems, the negative consequences of the disease, speech difficulties.

But at the same time, rewarding achievements, even if they are insignificant, have a great effect on self-esteem and well-being. Then recovery comes faster.

Relatives should also not forget about psychological relief. They are shown positive emotions, relaxation in the form of sports, meditation, massage, aromatherapy.. You may need vitamin treatment.

How to recover psycho-emotionally, you will be told here:

Disability, group, return to work

Statistically, only about 20% of stroke victims return to work and normal life. In the past five years, doctors have observed a trend according to which the picture of severe cases of the disease is deteriorating.

Terms of temporary disability - 3–6 months. In violation of cerebral circulation, the dynamics of restoration of functions, the state of the mental sphere are important.

If the prognosis is unfavorable, rehabilitation is slow, there are lesions of other organs, in old age the patient is referred to the VTEC (medical labor expert commission).

According to the rules ( the federal law 181-FZ), stroke survivors are eligible for disability registration. To do this, you need to get medical evidence.

Distinguish between disability groups I, II, III. Every year, the patient, who was recognized as disabled, is re-examined.

The exceptions are men and women who have reached the age of 60 and 55, respectively. An extraordinary re-examination is carried out if the condition has changed significantly.

After 3–6 months, with a favorable prognosis and fast recovery rational employment is allowed. When choosing a job, take into account contraindications that increase the likelihood of relapse:

• increased nervous, psychological, physical stress;
• high air temperature and humidity;
• contact with neurotropic poisons (arsenic, lead, etc.).

With a slight hemiparesis (paralysis of the muscles of half of the body), labor activity is possible, in which one hand is involved. Among such specialties are a quality checker, quality control inspector, work in the office and etc.

And the treatment of atherosclerosis of the brain with folk remedies, we will tell you separately.

How to restore speech

Speech restoration is one of the most important tasks. Begin classes as soon as the condition stabilizes. A specialist is involved in the process - a speech therapist.

Family members also take an active part in the process. To do this, for example, they read the primer so that the patient pronounces sounds, syllables, whole words.

Speech during communication is quiet, measured, calm. It is useful to ask the victim questions, sing with him, learn tongue twisters. A retelling of the texts he heard is useful.

If speech does not return to the patient for a long time, may need to learn sign language.

Watch a video about methods of restoring speech after a stroke:

Return of sight

With the defeat of the visual centers, the visual function of the cavity is restored in approximately one third of the cases of the disease.

Under such conditions useful gymnastics for the eyes. A popular exercise is with a pencil or other object, which is held at a distance of 40–43 cm from the patient's eyes and is moved alternately up and down, right and left. The patient is asked to follow the object without turning his head.

You can stock up on puzzles, where it is required to spell words, considering the letter matrix. Also on the network are special computer programs.

The best centers and sanatoriums

The best results are achieved if you trust the care of professionals. Where is the best place to undergo rehabilitation after a stroke and what results can be achieved?

The rehabilitation centers provide comprehensive assistance, the patient is under the supervision of specialists around the clock.

The choice of an institution is an individual matter, which takes into account, among other things, the financial factor. Here are a few institutions worthy of attention.

Medical and Rehabilitation Center of the Ministry of Health

The center was founded in 1918. It has a rehabilitation department. It provides a full range of medical services- from outpatient clinic to rehabilitation.

The medical staff has at its disposal diagnostic equipment, a 24-hour neuro-reanimation department.

Rehabilitation of patients who have had a stroke is carried out in the following areas:

• restoration and improvement of the vestibular apparatus;
• restoration of the function of swallowing and larynx;
• development of fine motor skills of the hands;
• return of memory, speech, ability to self-service;
• psychological and psychotherapeutic consultations;
• physiotherapy;
• physiotherapy procedures.

Rehabilitation center in Sestroretsk

The center is located in a picturesque resort town, half an hour from St. Petersburg. Created on the basis of the hospital.

Physiotherapists work here eat gym with robotic equipment, swimming pool. A speech therapist deals with patients. Patients who move on their own can not live in a rehabilitation center, but rent a house nearby.

Adeli Center (Slovakia)

Clinic specializes in rehabilitation after a stroke, as well as the treatment of children with cerebral palsy. The center is located in Piestany, a well-known health resort.

The rehabilitation program is drawn up with the expectation that each method enhances the effect of the other.

Adele's suit is used for treatment.

The suit creates a load on the musculoskeletal system and helps to correct postures and movement.

A wide range of physiotherapy procedures are used - massage, manual therapy, mud therapy, mechanical hippotherapy and others.

Sheba State Hospital (Israel)

The hospital is located in Ramat Gan, not far from Tel Aviv. Rehabilitation is carried out in the following areas:

• physiotherapy;
• occupational therapy;
• speech therapy - restores speech skills and understanding of words addressed to the patient;
• psychology, neuropsychology;
• psychiatry;
• rehabilitation.

According to Sheba Clinic statistics, after the end of the course of treatment, 90% of patients fully or partially restore their movement skills.

Measures to prevent relapse

The risk of recurrent stroke in the first 24 months is estimated at 4-14%.

Prevention of recurrent stroke begins in the first days of treatment and continues constantly. Its purpose is correctable factors.

With insufficient secondary prevention, the risk of secondary stroke increases. Every fourth case of acute disorders of cerebral circulation is a relapse of a stroke.

For the purpose of prevention, patients are prescribed preventive treatment:

sick limit the number of cigarettes smoked or ban smoking as well as the use of narcotic substances, alcohol abuse. Weight adjustment is necessary if obesity is the cause of the stroke. In the diet, the proportion of foods containing fats and cholesterol is reduced, replacing them with fresh vegetables and fruits. Moderate exercise is good for the body.

Antihypertensive therapy (treatment high blood pressure) is carried out with care to prevent cerebral hypoperfusion (reduction of cerebral blood flow below 50 mm Hg).

Full recovery after stroke is possible. The main condition for this is the strict observance of medical prescriptions.. And even in severe cases, it is possible to significantly improve the quality of life of the victim of the disease.

Stroke- acute cerebrovascular accident remains one of the main causes of death and disability in patients with cerebrovascular diseases.

The outcome of the disease depends on the speed and quality of the medical care provided, because a stroke is a clinical syndrome characterized by rapidly emerging symptoms of loss of focal brain, and sometimes cerebral functions; these symptoms are accompanied by structural changes in the brain, if they last more than 24 hours, they lead to death. If neurological symptoms lasted less than 24 hours, then such cerebrovascular accidents can be restored.

Stroke Symptoms

Focal cerebral stroke symptoms include:

• movement disorders (weakness or paralysis in the limbs of one half of the body),
• decrease or increase in pain sensitivity,
• crawling sensations,
• speech disorders (the patient cannot speak or understand speech),
• disorders of coordination of movements (unsteadiness when walking),
• visual impairment, memory impairment, etc.

Cerebral symptoms of a stroke are manifested by headaches, nausea, vomiting, impaired consciousness, psychomotor agitation.

With age, the frequency of cerebrovascular accidents increases, especially in people who lead a sedentary lifestyle. The metabolism in the brain proceeds with high intensity, so it needs great amount oxygen. The mass of the brain is approximately 1400 g, which is 2% of the total mass of a person, but the brain absorbs 20% of all oxygen and 17% of all glucose entering the body. The brain does not have a reserve supply of oxygen, and irreversible damage to its nerve cells develops even as a result of local anemia (ischemia) lasting more than five minutes.

Blood supply to the brain provided by its vascular system. A stroke, or apoplexy, occurs as a result of the cessation of the normal supply of blood to the brain. This occurs either due to rupture of the vessel, which leads to cerebral hemorrhage, or due to blockage or spasm of the vessel, resulting in local bleeding of the nervous tissue - cerebral ischemia.

During a stroke, some brain cells die and some are damaged. In the acute period of a stroke, the damaged areas are significant in size due to both damage and tissue edema. In the subacute period - after a few weeks - the area of ​​brain damage decreases. Stroke requires emergency care in a specialized hospital, in the future - the supervision of a neurologist.

What should be done to prevent a stroke, and how to rehabilitate the patient?

Stroke treatment, rehabilitation at home

For stroke rehabilitation at home use and folk remedies.

• In the people, a stroke is treated with lemon and orange. Pass 2 lemons and 2 oranges through a meat grinder, removing the seeds, mix them with 2 tbsp. spoons of honey. Keep overnight in a glass jar room temperature and store in the refrigerator. Take 1 tbsp. spoon 2-3 times a day with tea.
• The consequences of a stroke in the people are treated with a special balm. To do this, mince 5 peeled lemons and 2.5 heads of peeled garlic through a meat grinder. Mix this mass with 0.5 l of honey, leave for 30 days in a cool place, shaking from time to time. Take 1 teaspoon 30 minutes before meals, sucking it.
• Naturopaths offer such a recipe for curing the effects of a stroke: 5 mature pine cones with seeds, pour a glass of 70% alcohol or water, leave in a dark place for 2 weeks. Strain and take 1 teaspoon in a glass of weak tea 1 time per day after meals.

Pine cones contain vitamins, phytoncides and tannins, which are very useful for stroke, as they do not allow cells to die.

Bedsores are common in stroke patients. To prevent this complication, I use a special mattress with a thickness of at least 1 cm, filled with millet. Helps prevent bedsores mattress stuffed with hay. The back of the patient should be wiped with camphor oil. and then grease castor oil. If bedsores still form, they can be treated like this. Take 2 chopped onions and 2 tbsp. tablespoons of vegetable oil and simmer them in an enamel bowl for 20-30 minutes. Then select the onion with a slotted spoon, and dissolve a quarter of the wax church candle into the remaining oil. Lubricate bedsores with the resulting ointment 2 times a day.

Celandine grass is able to dissolve scars in the heart muscle after a heart attack, as well as scars in the brain after a stroke.

• Take 1 tbsp. a spoonful of celandine grass, pour a glass of boiling water in a thermos and leave for 15 minutes, no more. Strain and drink 1 tbsp. spoon 3 times a day before meals.
• Take the whole bean plant with pods, leaves, roots, stems and pour boiling water so that the contents are completely covered with water, and, wrapping up, leave for several hours. You can drink an infusion of beans in unlimited quantities, and after 3-4 weeks a person will get out of bed, and after six months there will be no trace of a stroke left.

With a stroke, special rubbings that are easy to prepare at home will help.

• Take 30 g of bay leaf, pour a glass olive oil and insist 2 months in a warm dark place, strain, bring to a boil, cool. Rub into paralyzed limbs. And another recipe for ointment from bedsores.
• Boil a glass of vegetable oil, cool and pour the egg white into it, beat until smooth. Lubricate bedsores 3 times a day. After 2-3 days, the wounds should heal.

Recovery after ischemic stroke at home

For those whose families have directly suffered such a misfortune, treatment becomes the hope for a return to normal life. That is why rehabilitation, as the most important process of recovery after a stroke, should become a priority for the patient and his environment. How to competently approach this process in order to get results? This article describes in detail.

The overall chances of the patient for rehabilitation

It is quite reasonable to start with whether the treatment of stroke will bring a 100% effect, or is the patient's chances negligible? Turning to statistics, ischemic stroke is considered a less severe form of the course of the disease than hemorrhage, but it also occurs more often. On average, 75-80% of all recorded calls are related to ischemic disease.

However, the chances of recovery depend on the lesion, its size and localization. So, for example, if a stroke is unilateral and affects only one zonal area of ​​the cerebral cortex, the patient partially loses his legal capacity, for example, he does not orient himself in space or sees poorly.

The most common consequence of a unilateral stroke, in which recovery is actually considered possible, is left-sided or right-sided paresis, i.e. partial loss of function of the limbs of one side. Rehabilitation usually takes from 3 months to a year.

Finally, the determining factor in the return of capacity lost during a stroke is the timeliness of assistance. Remember: from the moment of convulsions or thrombosis of the vessel and the cessation of oxygen supply to the brain until the complete necrosis of cells, an average of 3 hours pass. If blood circulation is not restored within this period, the chances of successful treatment are close to zero.

In what cases, besides this, rehabilitation is unlikely?

• In case of damage to the vital centers of the cerebral cortex during a stroke, especially the stem nerve bundle. In this case, coma or instant lethality occurs in 99%.
• With too large lesions. For example, in the case of lacunar ischemic stroke, the diameter of the lacuna exceeds 5 mm.
• In elderly patients - from 70 years.
• Patients with severe forms of chronic diseases, bad condition organism due to the use of narcotic and alcoholic substances.

Goals of rehabilitation in the long term

However, you should not despair, because treatment depends on timely and comprehensive assistance to the patient. In order to maximize the effect, the doctor will advise relatives or other caregivers to adhere to a rehabilitation plan for a year (shorter period).

Rehabilitation in the first 3 months

Treatment of a stroke during this period implies stabilization of the patient's condition. As soon as the body copes with the primary consequences of a stroke, relatives can take the person from the hospital to home treatment. At first, of course, peace and care is needed. But it’s not worth delaying, as soon as the patient himself feels that he is ready to start the “recovery” program, he should devote enough time per day to it:

• Independently take a sitting, and then a standing vertical position. By the end of the period, the patient should be able to at least partially independently dress and serve himself, go to the toilet and take a shower.
• In this period great importance has been treated with a course of rehabilitation exercise therapy and massage. Atrophied limbs need to be developed at least in 2-3 sets per day.
• By the end of 2 months, the patient is usually on his feet and learning to balance.

Use mandatory support, provide the person with a walker and stick, other types of supports. The object or supporting hand of the escort must be on the injured side after the stroke.

Rehabilitation from 3 to 6 months

So, when a person has learned to at least partially independently serve himself, he can move separately from the satellite on short distances, go to public transport. The restoration of motor functions continues, long walks are allowed. fresh air and climbing stairs.

It is imperative for a person to have a phone with emergency dialing with one button, so that in case, God forbid, a fall or a repeated ischemic stroke, there is a connection with him.

Rehabilitation from 6 months to a year

The treatment of ischemic stroke is already bearing visible results: the patient can overcome obstacles and move long distances by exercising his legs. Speech functions recover more slowly, but speech should become less incoherent.

A good set of exercises for this period will be the development of fine motor skills of the fingers: fastening buttons, washing dishes, knitting or playing a musical instrument, collecting a Rubik's cube.

According to statistics, 85% of victims of ischemic stroke completely return to a more or less normal life after 18 months. Of these, 2/3 of people are cured in the first 3-4 months in conditions of constant work on themselves.

As you can see, the tasks posed by the treatment of stroke are quite serious and require constant monitoring by a number of specialists. Among them are the attending therapist and neurologist, physio- and ergotherapists, massage therapists and exercise therapists, speech therapist and psychologist, up to the intervention of a nutritionist.

Where to start recovery

As it was said, the first days after a person has recovered from a stroke should be devoted to rest and adjustment to a normal lifestyle. While the sleep and nutrition regimen is being put in order, while the patient is bedridden (and this can take from several days to months), urgent supervision and care is required for him.

Treatment and rehabilitation begin with taking the right position for paralyzed limbs. The patient's position should be constantly changed, turning him over in bed every 2 to 2.5 hours. Warming up the limbs will not only help to avoid bedsores, but also preserve muscle tone and muscle memory during the period of inactivity.

Keep in mind that your blood pressure will be an indicator of how your treatment is progressing after a stroke. Regularly measure blood pressure on an empty stomach and at bedtime in order to keep statistics on the state of the body and determine the norms of the rehabilitation load.

The nutrition of the patient after a stroke should contain as much as possible a balanced menu and mandatory medications prescribed by a doctor. From the very first weeks, recovery involves active relaxation and physiotherapy, communication with a psychologist and speech therapist. Remember, the patient should not be plunged into a state of depression, let him know that he is a burden. The positive attitude of the inner circle will give hope to the most affected.

What should be followed after a stroke?

And these parting words are directed to the patients themselves and should help them to endure the treatment:

• Excessive fatigue is bad for the body. Set small goals and work towards them consistently.
• If a motionless limb becomes numb in a dream, try to place a pillow or roller under it.
• Stand as often as possible on the injured leg, use your "non-working" arm and always try to give the same load on both sides of the body.
• Do not be distracted at the time of training by external irritating factors. This is especially true for classes on the restoration of mental and speech functions.

A set of rehabilitation exercises after a stroke

Leg exercises

The most acceptable treatment is the transition from simple exercises to their more complex variations, with a gradual increase in operations. For example, in the first weeks the patient tries to stretch the ankle and knees, making simple movements back and forth and to the sides. In the next couple of weeks - starts walking, the main task is to maintain balance.

When this goal is achieved, it's time to perform more complex coordination exercises, such as squatting or curb walking, as well as working out on simulators to gain muscle mass.

A popular exercise for treating stroke from rehabilitators is called "swing" - the patient sits on a swing and tries to push off with a sore leg without lifting his toe off the ground.

Hand exercises

Following the same pattern, start with simpler warm-up exercises for the hand, shoulder, elbow. Gradually develop fine motor skills. It is very suitable for patients after a stroke to sort out small objects - laying out cards, a rosary, collecting puzzles, etc. At the same time, the grasping reflex is trained, the functions of handling instruments are restored.

Rehabilitation with the help of folk remedies

At home, the treatment of stroke with medications and physiotherapy is supported by traditional medicine recipes. Only this way and not otherwise! Because folk remedies, as a rule, can only act as an auxiliary tool of influence. A few effective and proven recipes just in case, for those who are ready to defeat a stroke:

1. Citrus fruits are a well-known antioxidant that restores work vascular system after a stroke. Take half a lemon and an orange each, pass through a meat grinder and chop them with 2 tbsp. honey. Store the medicine in the refrigerator, taking with tea twice a day for a tablespoon.
2. Treatment of paresis of the extremities after a stroke may accompany the reception of a balm: peeled 2 lemons are passed through a meat grinder with 2.5 heads of garlic, honey is added to make a homogeneous mixture. The balm is taken on an empty stomach, 1 tsp.
3. Alcohol tincture on pine cones containing fintocides and tannins avoids necrosis of nerve cells during a stroke.

Another effective remedy from bedsores during a stroke - a mattress or a special bedding at least 10 mm thick, filled with millet or salt. If the trouble in the form of bedsores still made itself felt, the ointment from bedsores helps. You should take 2 onions and chop them, adding vegetable oil. Simmer the onion in oil for 20-30 minutes, then remove and add wax to the oil. You get an ointment that you need to lubricate the sore spot in case of a stroke twice a day.

conclusions

Thus, after an ischemic stroke, even the most hopeless patient has some chances for rehabilitation. The question of how long it will take depends on an integrated approach. At home, relatives can provide the necessary support to help a person mentally and physically survive a stroke.

Stroke. Rehabilitation at home

Probably most people know about the existence of such a disease as a stroke.

Many even know what exactly provokes this disease and who is in the so-called risk groups. But when trouble in the form of a stroke comes to our home, this knowledge alone is not enough.

Health does not tolerate confusion and delay, therefore everyone should know what to do if a stroke patient appears in the house. How to help the injured person and organize his future life?

From seizure to rehabilitation

It is almost impossible to cope with a stroke without medical assistance, and therefore, in the acute stage of the disease, all patients are sent for inpatient treatment. The goal of treatment is to stop the spread of damage in the brain cells and restore as much as possible the nervous tissue that has already been damaged by the disease. For these purposes, there are special drugs - neuroprotectors and neuroreparants. Neuroprotectors are the protectors of healthy cells, they help stop the so-called vascular catastrophe, preventing it from spreading further to healthy cells. The purpose of neuroreparants is different - to restore those cells that the disease has managed to damage. Despite such a difference in functions, there are drugs that combine the properties of both neuroprotectors and neuroreparants, which makes them indispensable assistants both in the treatment of stroke in its acute phase and in support at an early stage of rehabilitation.

When the acute condition can be removed, the rehabilitation process begins. Both the patient and his relatives need to tune in to long-term and systematic work. The first stage of rehabilitation begins in the hospital. The patient will be shown what exercises need to be performed to restore lost motor functions, what to do in order to regain full-fledged speech, restore all reflexes. The first classes will be held under the supervision of specialists. Only when the doctors are convinced that the danger has passed, and the patient knows and knows how to perform rehabilitation procedures, the patient is allowed to go home.

Home Rehabilitation: Preliminary Arrangement

A stroke brings many changes to a person's life. Alas, the changes are unpleasant. What was done almost without thinking before the illness, after the illness becomes, at times, an impossible task. Therefore, it is necessary to make certain changes in the usual way of life.

The bathroom must be equipped with handrails, and even better - change to a shower. Handrails also need to be installed in the toilet, at the patient's bed and in other places in the apartment where the patient will have to sit down and get up.

The floors in the house must be free of unnecessary things, carpets and wires - they create a risk of falling, which is already high for a person who has suffered a stroke.

Get a bath thermometer - after a stroke, the sensitivity of the skin often decreases, and this device will help to avoid burns.

If the motor functions are severely impaired, you will have to get a wheelchair and make sure that you can easily move around the apartment with it.

What does home rehabilitation include?

1. Therapeutic gymnastics. Carefully follow the exercises that the specialist will show the patient - at home you will need to help him daily in their implementation and make sure that the work is carried out regularly and to the fullest. Exercises "for show" will not bring results.

2. Speech therapy exercises. Restoration of speech is one of the most complex and lengthy processes in a person who has suffered from a stroke, therefore it depends only on strict adherence to all prescribed exercises whether the patient will be able to regain full-fledged speech.

3. Massages. Not everyone can master the technique of therapeutic massage, therefore, it may be necessary to regularly invite a specialist to the house.

4. Often, in order to restore motor activity, it is necessary to lay out and fix the affected limbs in a certain way. You have to remember how this is done, and carry out this procedure daily. And also make sure that bedsores do not form on the patient's body.

5. Remember that medical supervision is necessary at any stage of rehabilitation, and therefore regularly visit the appropriate specialist with the patient. This will help to adjust the rehabilitation course in time.

6. Monitor the patient's condition. A recurrent stroke, alas, is not uncommon, therefore, at the first symptoms of the resumption of the disease, immediately seek medical help.

Remember, life after a stroke is hard in many ways. Provide close person attention and support, instill in him faith in his own strength, remind him that a stroke is not a sentence and you can recover from an illness! Only your confidence and support will help the victim endure all the hardships of post-stroke life and regain their health.

Stroke patients lose their ability to work and take care of themselves. Responsibility for their health falls on the shoulders of relatives. Below we will discuss the question of how the time and speed of recovery depend on various factors.

Duration and stages of rehabilitation

The recovery period after a stroke can last from 2 months to 2 years and is individual for each patient. Here are the main factors that influence it:

After suffering a violation of cerebral circulation, maintenance treatment is prescribed for a period of up to three months. Non-compliance with doctor's prescriptions, lack of control over blood pressure, leads to a deterioration in the general condition and neurological deficit.

stages

The rehabilitation course after a stroke has the following stages:

All of them must continuously follow each other.

In general, the rehabilitation process is long and laborious. Depending on the patient's condition, recovery begins in a neurological hospital and continues at home, rehabilitation centers, spa facilities.

The most important stage is the stationary stage, because it is possible to restore brain function as much as possible in the first 10 days.

After discharge, the tasks of rehabilitation are:

The recovery period must meet the following requirements:

• gradual increase in loads on the limbs;
• the beginning of classes only with a satisfactory general condition;
• the time and difficulty of the workout should depend on the severity of the stroke.

Rehabilitation methods

The complex of rehabilitation measures includes: physiotherapy exercises, massage, electrical stimulation, classes with a speech therapist, a psychologist, the use of exercise equipment, massage beds. For each patient, an individual training plan is selected, which will take into account the time and timing after a stroke.

Excessive physical and mental stress can worsen the condition. Optimal are three sessions during the day lasting 15-20 minutes.

The recovery period is significantly reduced when all procedures are carried out in a rehabilitation center.

The advantage of such rehabilitation is the daily supervision of rehabilitation doctors, stimulation to improve performance through group classes, and the possibility of using medical equipment.

Physiotherapy exercises include relaxing exercises to eliminate spastic phenomena, strengthening exercises for flaccid paresis. The complex of exercise therapy necessarily includes training in fine motor skills of the hands. In the early stages, exercises are carried out only in the prone position, after 2-3 weeks, classes are added in sitting positions, or even standing.

To improve the speech function, the patient should hear conversational speech and try to pronounce the sounds himself. A good effect is given by singing, repeating tongue twisters, poems.

Relatives and medical staff play an important role in all recovery activities. By joint efforts, good results can be achieved when a stroke can be found out only after a neurological examination.

Contraindications

Recovery activities should be postponed for some period if:

• there is a convulsive syndrome;
• severe concomitant pathology - diabetes mellitus;
• manifested mental disorders;
• developed a crisis course of hypertension.

Prevention of relapse

Medical and psychological prevention of recurrent cerebrovascular accident is the key to the return of all brain functions. After a stroke, you should not eat salty foods, coffee, as they increase blood pressure.

Be sure to exclude fatty foods that contribute to the deposition of cholesterol in the vessels of the brain.

The recovery period continues throughout life and includes annual spa treatment.

Medical therapy includes:

• taking antiplatelet agents (Aspekard, Magnikor, Cardiomagnyl in standard doses);
• antihypertensive drugs (ACE inhibitors, diuretics, ARB-II);
• statins (Atorvastatin, Rosurvastatin);
• neuroprotectors (Actovegin, Solcoseryl), etc.

Psychological assistance in the early stages after a stroke is needed to support young patients who want to resume work, as well as for the social adaptation of older people.

In conclusion, it must be said that the rehabilitation course lasts several years. Regular daily activities and work on yourself can give results even with the most disappointing forecasts.