LFC complex after stroke. Control questions and tasks. The main tasks of the flavor after stroke

1. General stroke character

2. The mechanism of therapeutic effects of exercise

3. Methods of physical rehabilitation at different stages of stroke

3.1 The most acute period

3.2 Acute period

3.3 Early Recovery

3.4 Late recovery period and period of persistent residual manifestations

Conclusion

Bibliography

Introduction

Every year, all over the world, cerebral stroke carry about 6 million people, and in Russia - more than 450 thousand in the major cities of the Russian Federation the number of sharp strokes is from 100 to 120 per day.

The problem of assisting patients with cerebral stroke is extremely relevant at the present stage due to high morbidity and disability. The disease is the leading cause of the disability of the population. At the same time, there is a "rejuvenation" of a stroke and an increase in its prevalence among people of working age. Only every fifth patient is returned to the work. About 80% of patients who have undergone stroke are becoming disabled, of which 10% are heavy and need permanent assistance. Approximately 55% of victims are not satisfied with the quality of their life and only less than 15% of the survivors may return to their work.

It should also be noted that the stroke imposes special obligations on all members of the patient's family and lies with a severe socio-economic burden on society. Disability is due primarily, the severity of motor disorders, the diversity of the manifestations of which depends on the diversity of the causes and mechanisms for the development of acute focal brain lesions, its localization and size.

The purpose of the abstract - will explore the features of the FFC at stroke.

give a general characteristic of stroke;

reveal the mechanism of therapeutic effects of exercise;

light physical rehabilitation techniques at different stages of stroke.

1. General stroke character

insult physical exercise Gymnastics

Stroke (Late. Insultus - attack, from lat. Insulto - jump, jump off), acute circulatory disruption in the brain with the development of persistent symptoms of damage to the central nervous system caused by the brain infarction or hemorrhage in the brainstant.

According to the nature of the pathological process, strokes are divided into hemorrhagic and ischemic.

During the stroke, the following periods are distinguished:

) The most acute (3-5 days) is a period of stabilization of hemodynamics and basic vital functions (respiration, swallowing and digestion, separation). By the end of the period, as a rule, the commozoase symptoms are regressing;

) Acute (from 3 - 5 to 21 days) - the period of formation of persistent neurological syndromes: hemipabe, spheres; the beginning of the development of contractures, pain syndromes, memory violations, attention, thinking, communications, the formation of anxious depressive syndrome;

) early recovery (from the 21st day to 6 months) - the period of the most intensive recovery and compensation of functions;

) Late recovery (from 6 months to 1 year) - a period of compensation and functional adaptation to the environment, slower during reducing processes;

) Resistant residual manifestations (more than 1 year).

Sustainable pattern of violation of the motor function, accompanying central paresses (spasticity, contracture, pain syndrome), including the posture of the Wernna - Mann, is formed, as a rule, by the 3--4th week of the disease, which determines the need for early use of methods, impeding their development. Rehabilitation should be started before the formation of a sustainable pathological condition, the development of pronounced muscle spasticity, the formation of pathological motor stereotypes, poses and contractures.

The earlier rehabilitation activities started, the more effective, therefore, the introduction of an early rehabilitation system, aimed at correcting the respiratory function and blood circulation, an increase in the total endurance of the patient's body, purposeful dosage stimulation and the restoration of sensitivity forms, the possibility of managing the process of active maintenance of poses and Displacement in a vertical position alone or using auxiliary means, the manipulative ability of the upper limb.

2. The mechanism of therapeutic effects of exercise

The true restoration of brain functions is possible only in the first 6 months. After stroke. It is provided by the "dislaring" of functionally inactive nerve cells, including in the zone of "ischemic half", and is due to the disappearance of edema, the improvement of the metabolism of neurons and the activities of synapses. However, it was shown that spontaneous true recovery inefficiently without additional targeted stimulation of reparation and regeneration processes by methods constituting rehabilitation treatment. Another mechanism is compensation provided by the plasticity of the brain tissue with the reorganization of the functioning of neuronal ensembles.

The organization of motor functions of a person is represented by a multi-level system with multichannel bonds, both direct and inverse, both vertical and horizontal. The development of each motor skill is preceded by the processing of afferent impulses entering the bark and subcortical ganglia from the periphery. Not only impulses from propriceceptors laid in muscles, synovial shells, bundles, joints, but also from other receptors emanating from the environment (sound, light, heat, cold), as well as skin and mucous membrane receptors shells (pain, sense of pressure, weight, humidity, etc.). These impulses inform the overlying CNS departments about the need to change the movement, its amplitude, muscle strength, including other muscle groups or change the position of the limbs. Double formations, in particular, hypothalamus in a complex with a limbico-reticular system, provide vegetative "color" of any motor act: change in blood supply, velocity of vascular reactions, metabolism, appearance of pain components, burning sensations, etc. Thus, in the regulation of motor activity, they are difficult to intertwined Motor, sensitive, cognitive and other functions. All this indicates that the approaches to the restoration of motor disorders can mediate through different systems. Therefore, various methods involving the overall system effect should be used.

The restoration of motor functions is most actively occurring in the first 6 months. After a stroke, ahead of the restoration of deep sensitivity and passes the same stages as early psychomotor development of the baby. All this determines the priority orientation of early rehabilitation on the motor sphere. In the process of ontogenesis of the functional system of movement in the body, persistent proprioceptive and motor connections are formed, the use of which is possible only taking into account the ontogenetic patterns of the development of the functional system of movement. The implementation of these mechanisms in patients with cerebral stroke can be the basis for creating a rehabilitation program.

The functional system of movements is highly sensitive to the effects of such negative factors as hypodynamia, which leads to a decrease in either a violation of functional bonds and tolerance to physical exertion, or as an attempt to train the movements of a higher order, resulting in "non-physiological", "non-functional" communications, violated The effects of muscle tag on the joints of the limbs and the body, that is, pathological poses and movement are formed. In this regard, when conducting rehabilitation measures, patients with cerebral stroke require a constant, daily assessment of the state of the motor component and a functional state.

The basic principles of reducing treatment of post-high motor disorders are the early beginning, adequacy, staplicity, duration, complexity, continuity, and maximum active participation of the patient. To successfully carry out this treatment, it is necessary to correctly assess the state of the disturbed function in each patient, determining the possibility of its independent recovery, the degree, nature and limitation of the defect and on the basis of this - the choice of adequate ways to eliminate disorders.

The following rules should be followed:

individual orientation of impact;

strict dispensing effect;

the validity of the choice of forms and impact methods;

focus, systematicness and regularity of the application of the selected impact;

gradual increase in the intensity of impact based on effective control;

the continuity in the use of selected forms and methods of motor activity at different stages of reducing treatment.

Contraindications to the prescription of therapy patients in the acute period of brain stroke are: Hyperthermia; ischemic changes to the ECG; blood circulation deficiency, significant aortic stenosis; acute systemic disease; uncontrolled arrhythmia of ventricles or atrial, sinus tachycardia is above 120 ° C. / min; Atrioventricular blockade of the III degree; thromboembolic syndrome; acute thrombophlebitis; noncompensated diabetes; Defects of the musculoskeletal system, impeding exercise classes.

The use of exercises in patients with cerebral stroke provides active and passive forms.

Active include:

) therapeutic gymnastics - respiratory, clothing, special, reflex, analytical, corrective, psycho-homing, hydroenezotherapy;

) Empty therapy (ergotherapy) - the correction of the activity and participation of the patient in everyday habitual activity, active interaction with environmental factors;

) Mechanotherapy - apparators simplest, block, pendulum, with electric drive, with a mehangran;

) Treatment with the help of walking (terrenterepia) - dosage walking, terrenkur, walking with obstacles, dosage walks;

) Specialized Methodological Systems - Clasp, Cabot, Botat, Brunstrom, Balance, Yoga, Suspension Therapy, Pulitherapy, etc.;

) biological feedback - the use of EMG data, EEG, stability, spirography, dynamometry, cinematography;

) high-tech computer technologies - computer virtual reality complexes, bioreobotics;

) Other methodological techniques - "non-use" of the intact side, the effect of "curves" of mirrors, etc.

Passive LFC includes the following forms:

) Massage - therapeutic, classic, reflex, segmental, mechanical, vibratory, pneumatic massage, hydromassage;

) Robotic mehanotherapy (terrenterepia) extension therapy;

) manual manipulations - vertebrotherapy, articular manipulations;

) Position treatment (postural therapy) - the use of rollers, pillows and devices;

) Passive movements carried out by an instructor and a doctor;

) High-tech computer technologies - computer virtual reality complexes, bioreobotics.

Therapeutic gymnastics in patients with cerebral stroke includes use in the therapeutic purposes of different positions, movements and exercises as patients independently and with the help of specialists and additional devices.

3. Methods of physical rehabilitation at different stages of stroke

1 acute period

The tasks of rehabilitation during this period are:

restoration of the normal stereotype of active respiration;

the formation of a symmetric sensory affamentation from the pro-prior artists of the joints and muscles in the treatment of position;

the formation of a stable reaction of the vegetative nervous system on the dosage load;

early translation of the patient in the vertical position (passive and active);

restoration of the static and dynamic stereotype of axial muscles (deep muscles of the spine, neck, back, chest muscles, abdomen, diaphragms);

correction of swallowing disorders;

The neurorentation block uses the following types of exercise:

) Position treatment;

) breathing exercises;

) ontogenetically oriented kinesotherapy (LFC), including elements of specialized systems: PNF, Felden-Crais, Lorats;

) Translation into a vertical position with a robotic turntable.

The treatment of the provision is intended to impart paralyzed limbs of the correct, symmetric position on both sides of the situation during the time while the patient is in bed or in the sitting position in the bedside chair. Despite its simplicity, with proper implementation, the treatment is important and helps to reduce muscle spasticity, align the asymmetry of the muscular tone, the restoration of the body scheme, an increase in the deep sensitivity, a decrease in pathological activity with tonic cervical and labyrinth reflexes. This in turn warns the development of pain syndrome and pathological attitudes in the limbs and torso, and in the future, contractures. In addition, the treatment of the situation can be carried out by all patients, regardless of the severity of the state and almost from the first hours of stroke.

The treatment of the provision includes laying paralyzed limbs in the following patient's poses: on a healthy side; on the paralyzed side; in a position opposite to the pose of the Wernik - Manna; on the stomach. The negative factors of the position of the patient on the back are: insufficient respiratory function of the lungs, bad bronchi drainage, reduction of the pulmonary volume due to the high standing of the diaphragm, the high risk of saliva aspiration, strengthening the pathological reflex activity of cerhythical and labyrinth reflexes, pain in the spine due to prolonged stay in one pose. In each position, the patient must be from 20 to 40 minutes.

Respiratory gymnastics is aimed at normalization of hemodynamics, reduction of oxygenation, relief of hypoxic hypoxia, formation of a stable normal dynamic respiratory stereotype. Passive techniques include contact respiration (maintenance and stimulation of respiratory movements with the touch of the hands to the chest), vibration using hands on exhalation, shaking, therapeutic position of the body (drainage positions, positions that facilitate breathing and aeration, promoting chest mobilization), intercostal strokes ( Skin and muscular technique).

According to the PNF (Cabota) procedure in the first stage, it is necessary to obtain a complex physiological movement in the axial muscles of the patient, then in the belt of the upper or lower extremities, while combining it with movements in the body, using a short stretching techniques, adequate resistance to movement, reversion (change direction changes) antagonists, approximation (increase in pressure of the articular surfaces on each other) joints with hard monitoring of physiological patient's poses.

Since the greatest problem of the most acute period is the violation of the regulation of the motor function, it is inappropriate to use "ordinary" active movements (separate bending, extension, leading, bringing in different joints), which are complex active movements of a healthy person, inaccessible for the patient. In carrying out this type of movements, the body uses functioning preserved, more primitive programs, which, in case of inconsistency, the results contribute to the formation of pathological stable printed plants, i.e. contribute to the consolidation or formation of pathological motor stereotypes.

Early translation of patients in a vertical provision provides a set of events. With passive translation 1), a vertical table is used according to a special protocol in order to stimulate the receptors of deep sensitivity, the vestibular apparatus, the restoration of vegetative reactivity; 2) Change the position of the head of the bed in the process of daily care for the patient, when taking food, attach the elevated position, gradually lowered the lower limbs and transplant the patient. Active verticalization is carried out depending on the functional state and the motor capabilities of the patient.

3.2 Acute period

maintaining a symmetric sensory affamentation from the pro-prior artists of the joints and muscles in the treatment of position;

consistent change in the position of the patient's body;

increased tolerance to physical exertion;

power reduction of the dynamic stereotype of the body and the proximal, medium and distal departments of the upper and lower extremities - destabilization of pathological systems;

concentration of attention on the sequence and correctness of "inclusion" of the muscles into a specific motor act;

intensification of the processes of recovery and (or) compensation of a defect with activation of individual reserves of the body by forming new functional relations;

use of synclosis at the stage of initialization of physiological motor activity;

braking non-physiological movements and pathological positions, an increase in the amplitude and accuracy of active movements, the fight against the increase in muscle tone and aligning its asymmetry;

improving sensory support of motor acts (visual, verbal, tactile control);

start training for skills symmetric walking with an additional support, active independent walk;

correction of swallowing disorders;

speech disorders;

learning safe movement using additional support;

learning elements of functional adaptation to the implementation of socially significant actions for self-service and restore the active role in everyday life;

control over recovery processes.

The following methods are applied in a specialized neurological department: the treatment of the situation; breathing exercises (active techniques); Further gradual translating of the patient in a vertical position; ontogenetically determined kinesotherapy; Mechanotherapy; classes on cyclic simulators; Training using biological feedback in electronicomiography parameters, stabilometry, goniometry; Dynamic proprio-correction, training for household skills (ergotherapy).

The main task of active respiratory gymnastics is the formation of the skill of control over the ratio of certain phases of the respiratory cycle. The ratio of phases inhale and exhalation should be 2: 3, the ratio of pause in the act of breathing -1: 2. If you need to reduce the activity of the sympathetic system, the execution time of the output phase and the second pause in the respiratory cycle should be lengthened, and if, on the contrary, it is increased to extend the time of the phase of the inhalation and the first pause. Breathing should not cause voltages. After 5 - 6 deep breaths, a break by 20 - 30 s is appropriate.

The second task of active respiratory gymnastics is the process of learning to slowly fulfill all the phases of breathing with its gradual deepening. Such exercises will lead to an increase in the consumption of oxygen from inhaled air while maintaining the level of carbon dioxide, which effectively reduces blood pressure and heart rate, will contribute to the establishment of a slow patch of respiration and the "destruction" of the pathological hyperventive and fast respiratory patter.

The solution of the problems of respiratory gymnastics also contributes to the hy-pixel training carried out on special breathing simulators. The principle of operation of these devices is to supply air to a respiratory mask with a normal oxygen content and an increased carbon dioxide content.

The dosage effect of rehabilitation measures without overvoltage of cardiovascular and respiratory systems is a prerequisite for the restoration of the vertical position and walk. In the function of moving the body, including walking as a way of movement, two points are distinguished. The first of them is associated with the movement of the body in space and maintaining equilibrium in each of the occupied provisions, the second - with the possibility of trophic provision of this work. The choice of the original position for the correction of the motor function is determined, first of all, the adequate possibility of cardiovascular and respiratory systems to ensure activity in a given body position. It is very important to ensure control of the parameters of the general condition of the patient (Hell and CSS) during each load exercise and in the recovery phase.

Massage and passive gymnastics begin simultaneously with the treatment of the provision, if there are no contraindications to their use.

Passive performing movements contributes to maintaining the elasticity of the muscular-ligament apparatus, trophic in limbs and torso. The passive performance of complex spiral-shaped three-mobil movements that contribute to the rapid stretching of the muscular-ligament apparatus by 20-30% of the average physiological position, helps stimulate the activity of motor units, initiating contractual activity in a paretic muscle.

Since patients with cerebral stroke have a selective increase in muscle tone, the massage in these patients should also be selective, i.e., different techniques should be used during the massage of hypertensive muscles and muscles in which hypotension develops. Any additional afferentation with hypertensive muscles can cause an even greater increase in their tone, therefore, in the method of selective massage muscles with an increased tone, only continuous plane and clutching stroking as the most gentle reception, causing afferentation only from skin-covering, is applied. The point massage technique in combination with acupuncture is aimed at reducing the muscle tone and the irritation of deep receptors. Point massage and acupuncture in relation to patients with post-pillars and paresis were developed in our country.

The most efficient ability to keep balance in different positions and the cost of walking is restored when applying a complex of ontogenetically determined kinesotherapy, simulators and devices with biological feedback, robotic mechanotherapy with unloading body weight of the patient.

Along with therapeutic gymnastics, the leading facility of the exercise, which is used for more than 150 years to restore the walking function, is mechanotherapy. The impact of this method should be dosage controlled and reproducible. The quality and dosage of exercises is controlled using the bio-control parameters.

In accordance with the formula of new concepts of rehabilitation, "who wants to once again learn to walk, should walk" systems have been developed with body mass support, contributing to the symmetric unloading of lower extremities, which makes it easier to walk patients who are unable to move under normal conditions with a full body weight, as well as unloading and Correctional costumes. This made it possible to minimize obstacles to walk in the initial stages of rehabilitation, i.e., start training in the greatest time.

One of the effective methods for restoring the motor function is the training based on the principle of biological feedback (BOS). These techniques are directed to the correction of muscle tone, improving the sensory support of movements, an increase in amplitude and accuracy of movements, activation of the concentration of attention on the sensations of the degree of muscular reduction and the spatial location of the limbs.

Recently, a new direction is actively developing in the rehabilitation, the method of artificial correction of walking and rhythmic movements through programmed muscle electrostimulation during the active implementation of the movement.

The restoration of the motor function itself does not mean the restoration of the ability to self-service, which is equally important for the patient in his daily life. The priority directions of ergotherapy are the restoration of daily activity (eating, dressing, wash, toilet, bath, care, etc.), development of shallow motility hands, selection of special disabled equipment and accessories.

3 early recovery period

The tasks of rehabilitation are:

maintaining the stable reaction of the autonomic nervous system on the dosage load of increasing intensity;

improving the tolerance of the patient to physical exertion;

the rapid restoration of the dynamic stereotype of the body and the proximal, medium and distal departments of the upper and lower extremities is the braking of non-physiological movements and pathological positions, the development of amplitude and accuracy of active movements, the fight against the increase in muscle tone and aligning its asymmetry;

improving sensory support of motor acts (pro-prousitable, visual, verbal, tactile control);

restoration of the static stereotype of the vertical position;

continued learning symmetric walking skills with an additional support, active independent walk;

correction of speech disorders and violations of higher mental functions, psycho-emotional state;

continued learning to safely move using new tools for additional support and movement;

continued learning elements of functional adaptation to the implementation of socially significant actions for self-service and restoring the active role in everyday life;

control over recovery processes.

The continuational use of all methods that were used at the stationary stage of rehabilitation, depending on the initial state of patients and the results achieved. The early recovery period of rehabilitation is aimed at further expanding the functional and motor capabilities of the patient with a reasonable choice of listed methods, as well as to combat the complications of the acute period flow: with constructs, high tone, pathological installation of the body, limbs, fingers, thrombosis of the deep veins of the lower extremity, urinary disorders Functions and defecates arising mostly in violation of the basic principles of patient management.

For independent studies, it is widely recommended to perform only those movements that the patient can actively perform biomechanically correctly in an affordable volume under the control of relatives or caregoing persons. Recommendations on the "Develop" of the movements performed with a pronounced deviation from the norm, in this category of patients will lead to the consolidation and formation of new pathological stereotypes, an increase in tone and pain reactions.

In order to increase the tolerance of the patient to physical exertion, it is advisable to use cyclic simulators to be carried out in passive, passive-active, active modes of movement by upper or lower limbs in aerobic mode. The intensity of the training should not exceed 25% of the maximum oxygen consumption. Intensity control is carried out according to the indicators of CSS, the saturation of oxygen and blood pressure.

The choice of the amount of rehabilitation methods and their sequence depends on both the individual level of the patient's functionality and the workout goals. It should be remembered that the transition to the next level of load is possible only after complete recovery from the previous one, in the supercompensation phase.

The active participation of the patient in rehabilitation activities, as experience shows, plays a significant role in the restoration of disturbed functions and, especially, complex motor skills and social redependaptation. In this regard, in the early recovery period, special attention is paid to the right choice of funds, allowing to facilitate the patient biomechanically correct implementation of a function (discharge frames for walking, crutches, walkers, canes, costumes, robotic elements of exoskeleton, medication, orthoses) and Provide psycho-emotional support and pedagogical observation.

4 Late recovery period and period of persistent residual manifestations

In these periods, the importance of solving problems of active movement of patients with the help of additional support and special means (strollers), improving walking and self-service skills is increasing. The role of ergotherapeutic and psychotherapeutic methods of state correction increases.

A feature of the late period of rehabilitation is the resistance of neurological deficit. The patient in varying degrees are expressed by the manifestations of both the central and peripheral pack due to the "non-use" of the body segments and the functions due to the original defeat. No less significant are the manifestations of somatic pathology, against the background of which a stroke developed or which manifested itself during the recovery period.

The tasks of rehabilitation activities in the late period are becoming:

normalization of the toned-force relationship between the muscles of the patient's body regions and due volume of movements in separate joints of the body and limbs;

further continuation of the improvement of motor functions with an emphasis on the process of maintaining the vertical position and displacement (independent, with an additional support, with the help of technical means or other person), improvement of coordination in space, fine targeted motility brushes and fingers (improving the grippers, manipulation), coordination of work muscles of the rotorce complex, respiratory muscles;

overcoming contractures;

a further increase in the tolerance of the patient to the loads, both physical and psycho-emotional;

restoration and maintenance of tissue trophies of the musculoskeletal system;

overcoming pain syndrome;

restoration and maintenance of excretory and sexual functions of the patient;

restoration of speech and higher mental functions;

improving the adaptation of the patient to the environment through the use of ergotherapeutic technologies and employment therapy, as well as the enforcement adaptation to the needs of the patient with pronounced limitations of functions;

professional reorientation on the basis of labor processor agents;

restoration of interpersonal relations, social activity of the patient, his role-playing function in a significant environment.

As in previous periods of rehabilitation, the patient's day is very important for the formation of persistent and economical proper reactions to interventions (classes), taking into account the location of the patient and the fields of therapeutic measures, the possibilities of moving to the place of classes, singularities of nutrition, hygiene and social activity (work , participation in public life, intrameal duties, etc.). Maximum independence of the patient should be ensured. In order to restore motor functions, Morning hygienic gymnastics, leafc and physiotherapy measures are used.

Morning hygienic gymnastics should include only those exercises that the patient can perform independently in the available amount. They are cyclic character, symmetrical and reproduced at least 7 times, including the exercises of the rotorce complex. Exercises are performed in a well-carrying room, preferably in front of a large mirror (self-control), with a mandatory measurement of blood pressure and heart rate. The duration of the gym not more than 10-15 minutes. Independent exercises (with the right recommendations of the specialist) and the possibility of self-control will contribute to the improvement of the patient's motivation to rehabilitation measures and save the time of special cinematherapy. LFC classes in late period should be carried out at least 3 times a week.

The actual direction of rehabilitation activities in the late recovery period is massage. As in earlier stages, use reflex, segmental, point massage used in a complex with medicinal gymnastics, mechanotherapy, medication therapy, physiotherapy. It prepares the fabric to work, reduces the effect of intensive work and contributes to a more complete and rapid recovery.

Conclusion

Among the acute disorders of cerebral hemodynamics, transient brain circulation disorders are distinguished with the reverse development of brain-function damage and strokes under which a persistent neurological deficit is developing.

To treat the effects of stroke, medical gymnastics, massage, work therapy are used, conduct classes with a speech therapist, psychologist, etc.

The problem of restoring a motor function must be considered in two aspects: neurophysiological (restoration of the movement) and psychosocial (restoration of self-service, fixture to a defect when recovery is not possible). Both aspects are based on thorough multi-tydisciplinary diagnostics, very important for the patient and require specific impact methods. Thus, an important role is attached to the change in the behavioral strategy of patients, which makes it even when the motor defect is maintained to achieve better adaptation.

The tasks of therapeutic physical culture at each of the stages of the rehabilitation process will be different depending on the state of the patient, the degree of motor and cognitive deficit, the level of regulation of motor functions, the qualifications of specialists, the availability of the necessary equipment and premises.

Bibliography

1.Large Russian encyclopedia. T. 11. - M.: Publishing House Large Russian Encyclopedia, 2008. - 767 p.

.Dubrovsky V.I. Medical Physical Culture: Tutorial for

university students. - M.: Humanit. Ed. Center Vlados, 2008.- 608 p.

3.Order of the Ministry of Health of Russia of 20.12.2012 N 1282n "On Approval of the Standard of Emergency Medical Aid in Stroke"

4.Order of the Ministry of Health of Russia of 15.11.2012 N 928N "On approval of the procedure for providing medical care patients with acute brain circulation disorders"

.Sports medicine, medical physical culture and massage. - M.: Physical culture and sports, 2005. - 351 p.: Il.

.Physical rehabilitation. In 2 tons. T. 2: Tutorial. / Ed. S.N, Popova. - M.: IC "Academy", 2013. - 304 p.

.Physical rehabilitation: textbook. - Rostov N / D: Phoenix, 2008. - 602 p.

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Stroke - This is the defeat of the brain in the acute violation of the cerebral circulation. This disease is one of the most disabling and socially disadvantages. That is, in many cases the patient becomes helpless, requiring constant care and attention.

These violations, as a rule, are the cause of spastic paralysis, as well as paresses of the limbs on the opposite side of the body relative to the hearth leaning the brain. At the same time, the muscle tone in the folders of the arms and extensors of the leg rises, and accordingly, the tone in the muscles-extensor arm and leg flashers decreases. As a result of this factor, there is a contracture with flexion in the elbow joint and the ignition of the ray-tank joint, as for the lower limb - there is a pronounced extension in the knee joint.

After the patient's condition becomes stable, it is necessary to start a motor rehabilitation, gradually increasing the intensity of therapeutic exercises within the course of the exercise. It is very important to begin to study therapeutic physical education and medical gymnastics at stroke, because thanks to therapeutic exercises, a number of positive changes in the body occurs, namely:

1. There is a significant improvement in the work of the cardiovascular system, as well as the functions of other systems and organs.
2. There is a proper breathing.
3. Locally elevated muscle tone decreases and the development of contractures is prevented.
4. There is a strengthening of healthy muscles.
5. The total emotional state is significantly improved.
6. The patient adapts to its social functioning, and if possible, it can return to everyday duties (this therapy is called ergotherapy).

Therapeutic gymnastics in stroke contributes to the fact that, during the study of therapeutic exercises, compensatory mechanisms are involved in the process to restore lost functions. Moreover, multiple repetitions of exercises cause the occurrence of new reflex links.

Elementary the course of therapeutic physical education under stroke Includes passive movements by affected limbs, as well as massage. Passive medicinal exercises in stroke Exercised using the instructor-methodist. The main purpose of these exercises is that the muscles of the affected part of the body relax. Massage need to be done taking into account the affected muscle. On the hand you should massage the extensors, and on the foot - the bends of the leg and feet. Then you need to smoothly move from passive to active movements. Moreover, first, active therapeutic exercises under stroke are performed by a healthy part of the body without assistance, and then, with the help of an instructor-methodist, the muscles of the paralyzed body part are gradually involved in the process. Exercises should be performed at a slow pace, gently, smoothly, in no case they should not cause sharp pain. As a rule, the exercises begin with proximal departments and gradually switch to distal departments. Exercises need to be repeated repeatedly, while it is necessary to ensure that the breathing is rhythmic and correct, it is necessary to make a pause for breathing.

The LFC in stroke has its own rules of the holding, which are as follows:

1. Initially, exercises should be done for a healthy side of the body.
2. Special medicinal exercises need to be alternating with constructions.
3. Classes must be regular.
4. Physical exercise when performing exercises under stroke should increase gradually.
5. During classes, a positive emotional background should be supported.

We present to your attention one of the possible complexes of the healing physical culture at stroke. This complex is recommended to perform in the early period of treatment of stroke or cranial injury (subject to bed mode):

Exercise number 1

Exercise is performed by a healthy hand. When performing the exercise, it is necessary to use the ray-blinding and elbow joints. Run 4-5 times.

Exercise number 2.

Flexing and straightening the sore hand in the elbow. If necessary, you can help a healthy hand. Repeat 4-8 times.

Exercise number 3.

Respiratory exercise. Repeat 4-8 times.

Exercise number 4.

Rimming and lowering shoulders. Exercise perform rhythmic, with a gradually increasing amplitude, combining with rubbing and stroking. Run 4-8 times.

Exercise number 5.

Perform passive movements in the joints of the brush and foot (3-5 minutes).

Exercise number 6.

Exercising active exercises - flexion and extension of hands in the elbow joints (with a bent position of the hands). The amplitude should be the maximum possible. Run 6-10 times.

Exercise number 7.

Perform movements to a healthy foot. If necessary, it is to help and strengthen the internal rotation. Make 4-6 times.

Exercise number 8.

Perform the movement with a sick leg. Movements must be medium depth. Run 4-6 times.

Exercise number 9.

Perform breathing exercises - 4-8 times.

Exercise number 10.

Perform active exercises for the brush and fingers, while the position of the forearm must be vertical (3-4 minutes).

Exercise №11.

Passive movements for all the joints of the affected limb. Perform at a slow pace, gently and smoothly. If necessary - help and facilitate exercise. Run 3-4 times.

Exercise number 12.

Perform an assignment and bringing the bent thigh (with bent legs). You can also resolve and mix bent hips. Make 5-6 times.

Exercise number 13.

Perform the active circular movements of the shoulder (with the help and control of breathing phases). Repeat 4-5 times.

Exercise №14.

Perform the flexing of the back without raising the pelvis (with limited voltage). Repeat 3-4 times.

Exercise №15

Breathing exercises. Run 3-4 times.

Exercise number 16.

Perform passive movements - at a slow pace, gently and smoothly. If necessary, you can help and facilitate exercise. Perform 2-3 minutes.

Thus, the total time required to perform this complex exercise of therapeutic physical education at stroke is 25-40 minutes.

During the exercise of the LFC, a stroke should be paused for recreation, at least 1-2 minutes. When classes are completed, it is necessary to ensure the correct position of the parethous limbs.

Complex of exercise exercise LFK under stroke Completely in the late period of treatment of hemiparesis. Therapeutic physical culture and therapeutic gymnastics are given in the positions sitting and standing. Also, the set of exercises includes walking in various versions and self-service training. Exercises with objects, elements of games are widely used. Special attention When exercising the exercise of the complex of LFC during stroke should be paid to the development of the functions of the brush and fingers, as well as to relax muscles and reduce rigidity.

The stroke occurs in the violation of the blood circulation of the brain, which leads to the dying of some nerve cells.

As a result, the human body loses one or more functions for which the deceased cells were responsible: paralysis may occur, loss of hearing, vision, speech defects.

The indicator of various physical disorders with depends on where the focus has been formed already dead brain nerve cells, on their size and position.

Each brain area is responsible for the various functions of the body, therefore paralysis of the extremities occurs depending on where the motion of cells occurred.

The consequences of stroke are reflected in patients, and all family members. After all that happened, after all the experiences and fears for his life, the patient comes time to temporary peace.

Native man is alive - this is the main thing. And what then? Are the adverse effects of stroke and remain forever?

According to statistics, 20% of the illness could not return the mobility of the hands and feet and until the end of the life depend on the assistance.

In order for a person to recover after stroke, drugs and reacting gymnastics are used.

Move more - live longer

"Your physical education will be engaged in the disease forget" - and another mass of folk wisdom, which is not possible by the way reflects the beneficial effect of the medical gymnastics.

After all, the main task after a stroke is the restoration of sensitivity and ability to move the limbs.

To do this, it is necessary to return the activity of those cerebral cells, which are located near the lesion focus. And it should also be "to force" previously inactive cells to perform the functions of the dead.

All these actions are performed only at the expense of various regenerating exercises and therapeutic gymnastics.

It is the LFC that is the basis of rehabilitation after a stroke.

Restoring the lost body function - all means and forces are directed to it. If there are no contraindications, then the first exercises can be started for 5 days After stroke.

Gymnastic exercises and LFC are one of the most affordable and effective ways to restore.

Complex exercise

There is nothing supernatural in the wellness gymnastics. It can be said that this is a regular charging. But even the most simple exercises will give a positive effect, because all ingenious is simple.

Position lying

This is the very first and simple exercise complex is carried out in the acute period after the disease, when the muscles are fixed in the bent position and the patients are not able to disperse them.

It is aimed at reducing the tone and increase the amplitude of the movement of the limbs after the stroke:

1. Hand exercises. Not so much exercise as the violent straightening of the limbs to reduce spasms. Bending limb to bind starting from the fingers to the brush and the forearm, and brings the bandage to the solid surface (plate). Leave your hand in this position for a minimum for 30 minutes.
2. Eye muscles. Move through the eyes down-up, left-right. Close your eyes and make circular movements in the same way. As a rest to frort down with eyes 5-7 seconds. Make circular movements with open eyes also every side. Sleep the muscles to Pomorgov's eyes.
3. Neck muscles. Carefully perform turns head left left and right at the same time fix his eyes in front.
4. Fingers. In any convenient position, bend and blends the fingers on their hands 10 times. You can do the exercise as alternately on each hand, and at the same time two hands. Over the bed hang a towel in the form of a loop. Still arm (or leg) to go to the loop and simply swing her with a different amplitude. Of the not very thick rubber of the average width to make a loop with a diameter of about 40 cm. Put on your hand or leg and any other item (second hand / foot, backrest, chair, etc.) and stretch the gum with a sore limb.
5. Elbow joints. The whole body is elongated, hands lie along the body. Bend the right hand in the elbow, lower it on the bed, bend the left hand. Exercise by each hand 10 times. Still arm / leg to hang onto a strong fabric (diaper, towel) and then perform all sorts of exercises: bend, blending, turn to the side, rotate. Such an exercise is performed from 10 to 30 minutes, making 3 breaks. Rest time - 2-4 minutes.
6. Round knees. Lying on the back alternately bending the legs in the knees. Try to do so that you do not completely break your feet from bed, as if slipping them. Perform 10 times each foot.
7. "Tightening". Lying on the back grabbed his hands for the back of the bed. Making a "pull-up" straightening shoulders and straightening legs with extended socks. Doing the exercise slow 6 times.

LFK under stroke: a set of exercises in pictures

If the patient can sit independently

The following exercises are designed to restore the movement of hands and legs, strengthen the back and preparation for walking after a stroke. All tasks are performed on 4 or 2 accounts:

1. Deflection number 1. I.P. - Throwing back on the pillow comfortably tunes for the bed on both sides. Feet stretch forward. 1,2 - slowly fade awaying the head back, deep breath. 3, 4 - slowly return to I.P. Do exercise 6 times.
2. Deflection number 2. IP. - Sit, legs straightened, hands are omitted. Shoulderly take your hands back, throw the head and straighten your back, trying to reduce the blades. Fix the position for 1-2 seconds. Return to I.P. And repeat 4 times.
3. Mahi legs. I.P.. - Legs stretched out, hold onto the edge of the bed. Exercises do at a slow pace. 1 - lump up a little upside down, 2 - slowly lower it. 3 - lift left foot, 4 - Return to I.P. Repeat maugh 4 times for each leg without breathing delay.
4. I.P.. - Burn around the pillow, raise hands up, stretch your feet. 1,2 - bend the leg in the knee and clashed her hands, trying to touch the breast knees. In this position, lock, tilt your head and make an exhale. 3.4 - raise your head, remove your hands and slowly return to I.P. Take the same for another leg. Do exercises 4 times.
5. Motoric hands. In a deep bowl, folded objects of different shapes and material. The size should be from small to large, but so that you can hold in your hand. As a "material" can be: buttons, bumps, walnuts, beans, pencils, coils, plastic caps from bottles, etc. It's all these objects from one bowl into another, carrying them one by one.

What is and what manifestations in the behavior and actions of a person she entails. Details in the material.

For the benefits of pine cones at stroke, many have heard. What way to cook pine cones after a stroke -?

Standing standing

A set of exercises in a standing position is performed when the patient feels already confidently and previous exercises sitting and lying easily.

But this gymnastics has its limitations and share for 2 complexes: simple and high load.

Simple physical exercises apply if a person has not yet fully departed after a stroke suffered:

1. Pulling. I.P.. - Hands down, legs on the width of the shoulders. 1 - Hands raise up the palm to turn outward. 2 - stretch in such a position and take a breath. 3 - Hold hands down trying to describe them a circle, exhale. 4 - Return to I.P. Repeat slowly 6 times.
2. Turns. I.P.. - Legs put on the width of the shoulders, hands on the belt. 1 - Rotate the housing to the right, 2 - dilute the hands to the side and take a breath. 3.4 - Return to I.P. and exhale. Similarly, do an exercise with a turn to the left. Do exercises 5 times in each direction.
3. Squats No. 1. I.P. - Hands down, legs apart. 1,2 - to make squats, trying not to tear off the heels from the floor, the body is a little bit tilted forward, the hands take it back. Touch. 3.4 - slowly return to I.P. and exhale. Exercise do not rush 6 times.
4. Squats No. 2. I.P. - Hands are omitted, legs put on the width of the shoulders. Squats do on 2 bills. Deep breath. 1 - sit down, breathed hands in the hips, exhale. 2 - Return to I.P. Sit down 4 times.
5. Slopes. I.P.. - Feet apart, put on the belt. 1 - Make a slope to the left at the same time raise the right hand up, breathe. 2 - Return to I.P. and exhale. Make tilts to the right, repeating 4 times in each direction.
6. Mahi legs. I.P.. - Hands on the belt. 1 - one leg stretch forward, 2.7 - make circular maugh foot. 8 - Return to I.P. Perform mugs 4 times for each leg.
7. Drops. I.P.. - Foot fix on the width of the shoulders, put on the belt. 1 - pull the left hand forward. 2 - make the right naked step forward. 3 - squeeze fists and put hands to the shoulders. 4 - Stand in I.P. Repeat all right hands and left legs. Exercises do not hurry 4 times.
8. Walking in place. About 20 seconds. Do walking in place, then make some exercises to restore breathing.

Complex with an increased load:

With benefit for business

Although the therapeutic gymnastics is relatively simple, but for a patient who, in fact, begins to learn again (teaches new cells), these loads may seem heavy.

So that physical education has benefited and led to the speedy restoration of the body, it is necessary to comply with a number of rules:

1. Adhere to the recommendations of the doctor. Only the doctor can register the right set of exercises, depending on which parts of the brain were amazed. Only the doctor will tell what loads can be applied during the recovery period.
2. Do not overrun. Because Physical culture is purely therapeutic nature, it is impossible to allow fatigue and overvoltage. Starting with the easiest exercises, gradually increasing approaches and connecting new, more complex. After all, the purpose of classes does not pump the muscles, but to make the new cells of the brain work in the right direction.
3. Preheat the skin. This is especially true for lying, sedentary patients. During this period, the first exercises should help them make relatives. To do this, you need at least a peculiar massage. You should stroke, massage your hands and legs towards the feet to the thighs and from the fingers to the shoulders. All this is necessary for heating the skin and inflow of blood.
4. Follow the mood of the patient. Because Many people after stroke fall into depression, feel "curb" and do not want to perform any exercises. It is necessary to gently, but persistently demand and follow, so that everything was performed correctly, constantly praising recovering, noting his progress.
5. Remember about the system. Therapeutic gymnastics should be daily for 40-60 minutes a day per session. At the first stage, this should be 2 times, and then - 3 times a day.
6. Top patience. Time is the best medicine. And in this case, this statement is 100% correct. After all, only daily workouts for several weeks will give a positive trend.

Simulators to help

After improving the condition of the patient, you can proceed to exercises on the simulators.

They allow you to restore different muscle groups, strengthen weakened tissues, resume motion functions, remove stresses in the muscles.

They act on the muscles with adjustable load:

Comprehensive treatment approach

Despite the fact that the LFC gives the most positive results, it will be more effective with a massage, which plays an important role in the prevention of complications.

For the most complete recovery, the patient practices an integrated approach to treatment.

After all, along with paralympus, the consequences of the stroke can be a loss of memory, voice, hearing or speech defects.

To do this, resort to the help of speech therapists, oculist - to help resuming vision and Laura - for rumor regeneration.

How to restore speech after stroke and what methods and exercises are applied in video.

Psychologist participates in hospitals to restore psychological rehabilitation, and at home is a close person. All these measures will help to return the usual lifestyle.

Like a terrible disease, but stroke is not a sentence. The desire for the speedy recovery, the help of loved ones, daily workouts and beliefs provide an opportunity to complete the body's restoration.

The timely started treatment and early use of physical exercises, in particular in the form of passive movements, makes it possible to largely prevent the development of increased tone of muscles, the formation of vicious poses, synclosis. A favorable influence on the patient maybe the body of therapeutic gymnastics in combination with a point massage, as well as with electives for individual groups by the usual massage.

Therapeutic physical culture in a complex with other medical events is used throughout the rehabilitation treatment. In the first 2 stages, the means of therapeutic physical education contribute to the main restoration of disturbed motor functions. At the 3rd stage, they contribute to mainly the formation of relevant compensation.

All the means of therapeutic physical education from the first days of their use should be aimed at restoring control of movements and the normal strength ratio and muscle tone - antagonists. Particular attention should be paid to the normalization of the functions of limbs and preventing the formation of vicious compensation, which appear when trying to independently uncontrolled recovery of patients with defective limb functions.

In accordance with the peculiarities of the course of the disease, the following therapeutic modes are used in patients:

strict bed mode - all active exercises are excluded; All movements of the patient in bed are carried out by medical personnel;

moderately advanced bed regime - the movement and change of the patient's positions in bed is made using medical personnel; When you get acquainted the patient to the mode, independent turns are allowed and the transition to the sitting position;

the steamed mode - the patient with the help of medical personnel and independently with the support (the back of the chair or bed, crutches) moves within the chamber, performs available types of self-service (eats, washed, etc.);

free regime - the patient performs affordable active movements and improves self-service skills, independently walks on the department and rises along the stairs. Therapeutic gymnastics is carried out using the source positions (lying, sitting, standing) allowed by the prescribed mode.

Exercises performed must be simple and accessible. To create a motor dominant, they should be repeated repeated.

When planning rehabilitation programs, the presence of existences existed before stroke (arterial hypertension, diabetes), secondary stroke complications (deep vein thrombosis of the lower limbs, pneumonia), as well as possible decompensation of existing somatic disorders (for example, increased after stroke of angina attacks in patients with ischemic heart disease). At the same time, in some cases, the disadaptation of patients can be due to not so much suffered by stroke and its consequences, as the presence of concomitant diseases. The patient's condition during rehabilitation measures may deteriorate - so about 5- 20% of patients who were in rehabilitation centers, a re-transition was required to separate intensive therapy.

Contraindicationsfor active motor rehabilitation, cordial failure, angina and stress angina, acute inflammatory diseases, chronic renal failure, blood circulation deficiency III degree, the active phase of rheumatism, pronounced changes in psyche, etc.

The presence of aphasia is not a contraindication to prescribe a patient therapeutic gymnastics. With the difficulty of contact with the patient, which is due to speech disorders or changes in psyche, passive movements are selectively used, the treatment of position, point massage.

The main method of rehabilitation of static patients with disorders (paresa, violations of statics and coordination) is therapeutic physical culture (kinesotherapy), the tasks of which include the restoration of the volume of movements, strength and dexterity in the affected limbs, the equilibrium functions, self-service skills.

Early motor activation of patients not only contributes to better restoration of motor functions, but also reduces the risk of developing aspiration complications and thrombosis of the deep veins of the lower extremities. Bedic mode is shown in patients only during the first day from the beginning of the disease. Naturally, this category does not include patients with disorders of consciousness or the progressive increase in the neurological defect.

Classes of therapeutic physical education are beginning in the first days after a stroke, as soon as the general condition of the patient and the state of his consciousness will allow. First, these are passive gymnastics (movements in all joints of the affected limbs do not make a patient, and the methodologist or the relatives or nurse instructors). Exercises are conducted under the control of the pulse and pressure with binding pauses for recreation. In the future, the exercises are complicated, the patient is beginning to plant, and then teach to sit on their own and get up from bed. In patients with severe paresis legs, this stage is preceded by imitation walk lying in bed or sitting in a chair. The patient learns to stand first with the support of the methodologist, then independently, keeping the bedside frame or back of the bed. At the same time, the patient tries to evenly distribute the body weight on the affected and healthy legs. In the future, the patient is hiding walking. Movement over the Chamber (room) at the beginning is carried out using both the instructor of therapeutic physical education. As a rule, the patient is cast from the side of the pares, throwing a weakened hand on his shoulder. First, it's walking on., Place, then walking on the ward with a support on the bedside frame, then independent walking on the ward with a support on four - or a three-way cane. To independent walking without support on the patient's stick can begin only with good equilibrium and moderate or light paresis. The distance and volume of movements gradually increase: walking on the ward (or apartment), then walking along the hospital corridor, on the stairs, exit to the street and, finally, the use of transport.

In addition to movements, patient should be stimulated to household adaptation. The restoration of self-service and other household skills also occurs in stages. Initially, this training is the simplest self-service skills: to take in tertiary hand of everybody, to make food independently; Personal hygiene skills, such as wash, shave, and so on (we are talking about severe patients who have these skills lost); Then learning independent dressing (which is quite difficult with a paralyzed hand), using the toilet and bathroom. Alone to use the toilet and a bathroom with a patient with hemiparem (paralysis of one half of the body) and ataxia (coordination disorder) help various technical devices of the handrail from the toilet bowl, staples in the bathroom walls, wooden chairs in the bath. These adaptations are easy to do both in the hospital and at home.

Thus, patients and members of their families should take an active part in the rehabilitation process (in particular, in the fulfillment of "homework" in the afternoon and on weekends).

The main stages of expansion of the motor regime.Motor mode and changes should be applied by the attending physician strictly individually, taking into account the condition of the patient and the dynamics of the disease. With a favorable development of recovery processes, approximately defined approximate models of the regime expansion. So, in order to prevent congestive phenomena in the lungs and other complications, as well as to prepare for the transition to the sitting position, the rotation of patients on the side is carried out on 2 - 5 days from the beginning of the disease.

Transfer of a patient to the sitting position is assigned to 3 - 4 weeks. Standing and walking is assigned to 4 - 6 weeks.

Change of provisions in the first 3-4 days is carried out only with the help of personnel.

For turning to a healthy side, the patient is necessary:

alone or with the help of staff, move the torso to the edge of the bed towards the parethous limbs.

Put a bent in the elbow paretic hand on the chest.

Bend a pare foot in the knee joint with a healthy leg (or using a cuff with a strap fixed on the ankles of the pareetic leg).

Relying on a healthy hand and footsight of moderately bent legs, turn on a healthy side. If the patient is not able to turn independently, he should help, supporting the shoulders. Subsequently, the patient is taught by turning and towards the paretic limbs. The duration of one-time stay on the side first days should not exceed 15-20 minutes. Change of provisions should be carried out 3-4 times a day.

By the time of transfer to the situation of the patient should be adapted to it, applying the head restraint at an angle of 45 ° - 70 ° for these purposes. Each stay on the headrest is limited to 20 - 30 minutes.

When teaching an independent transition from the position lying on the side to the sitting position and standing the patient should:

put a bent healthy hand under the body;

lower legs with bed (patient with a healthy);

sit, leaning a healthy hand about bed.

In the sitting position (with a support for or without pillows), the patient is initially spent 5-10 minutes. Then staying in this position increases to 20 - 30 minutes. (3-4 times a day).

When teaching an independent transition to the position standing from the position of sitting and prepare for walking, the following exercises are preliminary:

from the initial position, sitting, with legs, bent in the knee joints under an acute angle, feet on the floor, a healthy hand to the edge of the bed - a moderate slope of the body forward with a simultaneous lift of the pelvis;

transplantation on a chair standing sideways to bed;

standing with a healthy hand back chair, with support from the paretic limbs; Distribution of body weight on both legs; Transfer of body weight from one limb to another.

Steps in place, walking with extraneous help or with an additional support for the ward, separation, stairs.

Common-linking and breathing exercises.Long-term hypodynamine of the patient itself causes a significant decrease in the tone of the bark of large hemispheres, cardiovascular, respiratory, other systems, as well as muscles of the musculoskeletal system. Common-line exercises contribute to increasing the activity of the cortex of large hemispheres, improve the conditions for the pulses by nervous ways, stimulate the functions of the cardiovascular system and the respiratory system, prevent possible complications from the light and gastrointestinal tract, activate the metabolism and the activity of the allocation bodies. These exercises are selected in accordance with the motor regime, depending on the overall condition and age of the patient. In bedtime, along with special exercises for paretic limbs, turns on the side, active movements in small and medium-sized joints of healthy extremities with a complete amplitude and in large - with incomplete are also used.

At the subsequent stages (II and III modes and in the late recovery period), the general consequence of exposure increases by expanding the motor regime (translating the patient to the sitting position, standing, increase the duration of walking), movements in all joints of healthy extremities on the full amplitude, adding exercises for muscles Torso, increasing the number of repetitions of exercises and performing active movements in the paretic limbs.

With II-V degrees of violation of motor functions, smooth movements are used in the joints of healthy limbs (the pace of slow and medium), control over the position of the paretic limbs (synclosis). For the correct distribution of physical exercise in the exercise, it should be started with healthy limbs, in small joints, gradually increasing the amplitude of movements and including increasingly large muscular groups.

In acute violation of the brain circulation, the rhythm and the increase in respiration often occurs, reducing the amplitude of respiratory movements and other changes in respiratory activities. Surface breathing exacerbates hypoxia (decrease in oxygen content in tissues). The long-term immobility of the patient is one of the reasons for the occurrence of stagnant phenomena in light and pulmonary complications.

To improve the respiratory function and prevent complications, breathing exercises are used, which contribute to an increase in the diaphragm mobility and respiratory impairment, thereby improving the ventilation function of the lungs.

Breathing exercises are used throughout the course of treatment. When performing these exercises, there should be no respiratory delay, outrunning. After complete exhalation, a short pause is used (1-3 e.) - This ensures a good breath to breathe through the nose. In addition to cases when nasal breathing is difficult. Breathing should be slow, smooth, rhythmic, middle depth, with uniform participation of ribs and aperture, so-called "hard breathing". Inhalation should not be inhaled, it will be involuntarily to deepen as the power of the exhalation increases.

From the first days of classes, attention should be paid to an increase in the mobility of the diaphragm, which is a powerful respiratory muscle. The full participation of the diaphragm in respiratory act provides effective ventilation of the lower lungs, plays a significant role in blood circulation and maintaining the normal function of the abdominal organs.

In the acute treatment period (I-II mode), "static" breathing exercises, performed without a combination with the movements of the limbs and torso. With the expansion of the patient's motor capabilities, the use of<<динамических>\u003e Respiratory exercises accompanied by the movements of the limbs and torso.

It is not recommended to produce forced deep breaths, making a large number of repetitions of respiratory movements in a row (optimally 3 -4 times). Breathing exercises alternate with special and generallyonizable.

Breathing has a significant effect on the state of the muscular tone of the limbs. When inhaling the muscle tone rises, and when exhaling - it drops. The exhalation phase must be used to reduce muscle spasticity. Passive or active exercises for muscles with a sharply increased tone is rational to perform simultaneously with an elongated exhalation. Such a combination increases the efficiency of the use of special exercises.

The use of passive movements. Passive movements cause streams of centripetal pulses from muscle proprigororeceptors, tendons and joints to the cerebral cortex, contributing to a decrease in the development of parabiage in the neighboring cerebral areas. They ensure the activation of the conductivity of the nerve paths, improve blood and lymph appearance, promote the improvement of tissue trophics, a decrease in the increased tone of the muscles and preserving the mobility of the joints, reduce the risk of education of contractures. The use of passive movements also contributes to the restoration of muscular-articular sensitivity and lost active movements.

Passive exercises must be performed smoothly, without causing painful sensations, at a slow pace, isolated in each joint, in all planes. The amplitude of movements must be optimal with gradual increases, without interpreting hypotonic muscle groups. When performing a passive movement to the joints of the entire limb should always be given the position opposite to the posture-mann position.

Passive exercises should be appointed after 3-4 days after the start of the disease. They are performed in all the joints of the parethous limbs daily and repeatedly. Movements in each joint are repeated up to 10 - 15 times.

It is necessary to take into account the patient's reaction to movement, prevent the appearance of pain, breathing delays, increase spasticity. To perform passive exercises, the most favorable pose is the position of the patient lying on the back.

In the acute period of the disease, passive movements should be started with distal departments (brush, stop), given that movements in small joints are almost not reflected on the general blood circulation. A few days later, there should be movements in the elbow, shoulder, and then in the knee and hip joints. In cases where the increased tone and the initial manifestations of contractures and syntincions are observed, movements are recommended to start with large joint joints, moving to smaller. Such a sequence helps reduce the possibility of appearance or enhance synclosis. At the same time, this prevents the increase in the spasticity of the muscles of the paretic arm and legs. Passive exercises for the joints of the upper extremities: 1. Passive exercises for the shoulder joint.

Flexion- Extension.The initial position (and. N.) - lying on the back, hand along the body, forearm - in the middle position. The methodologist keeps the palm of the patient's pareetic hand palm, the other - fixes the elbow joint. Movements are performed with a straightened hand of the patient.

DecommissioningI. p. And fixation the same. Movements are performed with a straightened hand of the patient.

Supination- pronation.I. p. - lying on the back, the hand is straightened and allocated from the body by 15 ° - 20 °, the forearm - in the middle position. Fixation is the same. Supination and pronation are performed with a straightened hand of the patient.

Circular movements.I. p. And fixation the same. When performing this movement, a slight pressure is carried out along the axis of the limb to the articular depressure of the blade.

2. Passive exercises for the elbow joint.

Flexion- Extension.I. p. - lying on the back, the hand is straightened and allotted from the body by 15 ° - 20 °, the forearm is suspended, fingers and brush in a dispere position, with a reserved I finger. The bending of the forearm must be performed without interpreting the three-headed muscles of the shoulder.

Supination- pronationI. p. - Lying, the hand is straightened, it is allocated by 15 ° - 20 ° from the body, the fingers are dispersed, the finger is assigned. The methodologist holds a paretic brush with one hand, the other - the patient's lower third should be fulfilled. Passive supination and forearm pronation are performed.

3. Passive exercises for the ray-tank joint.

Flexion- Extension.I.p. - lying on the back, the straightened hand is assigned to the side, the brush is suspended or is in the middle position. One method of the methodologist holds straightened fingers of the patient, the other - fixes the bottom third of the forearm. Passive bending brushes are performed. Movement should be performed, avoiding redressing the already weakened muscle groups.

Bringing- circular movementsbrush. I. p. The same.

4. Passive exercises for interfalane and plug-in-standing joints.

Flexion- Exteriorin interphalangeal and psyche-phalange joints.

The hand is straightened, the forearm is in the middle position. Movement is recommended separately by each finger and jointly with fingers. Owl- Bringingin bulk-phalange joints. I. p. The same. 5. Passive exercises for the joints of the finger brush. I. p. The same, forearm in the middle position. Flexion- Extension, bringing- Disagreement, opposition and circular movements.

Passive exercises for hip and knee joints. Flexion- Extension.I. p. - Lying on the back, the leg is semi-bent in the knee and hip joints. One hand, the methodologist supports the pareetic foot of the patient in the area of \u200b\u200bthe popliteal fossa, the other - fixes the foot at an angle of 90 °.

Supination- pronation (rotation)in the hip joint. I. p. And fixation the same. Rotary motions are performed bent in the knee and hip felts.

Owl-bringing.I. p. - Lying, the foot is straightened. Support for the lower limb is carried out in the same way. Circular movements in the hip joint. I. p. - Lying, the paretic foot is semi-bent. Leg support is the same.

Circular motionspermanent pressure on the thigh axis on the articular depression.

2. Passive exercises for the ankle joint. Flexion - extension. I. p. - Lying on the back, the foot is bent in the knee joint, in relation to the thigh at an angle of 120 °, the support on the foot. With passive movement, the extension must prevail over the bending of the foot.

The discharge is combined with the pronation (rotation inside) and the subsequent alignment in the average position. I. p. The same.

Restoration of active movements. The main task of therapeutic gymnastics is to promote disgraceing and stimulating the activities of nerve elements in the zone of damage to the central nervous system. Therapeutic measures are aimed at reducing the increased tone of intense muscles, restoring the movements of weak muscle groups and improve their combinations (reciprocal) innervation. The medical gymnastics technique should be directed primarily to countering the formation of contractures and the restoration of isolated active movements. The selection of special exercises for the study of therapeutic gymnastics should be carried out according to the principle: the hand is "long" (dispersed in all joints), the foot is "short" (bent in the knee and hip joints and dismissed in ankle joint).

In the absence of active cuts of muscles, "extending" hand and "shortening" leg, it is necessary to initiate (stimulation) of the reduction of these muscles.

Stimulation of the active movements of the chosen muscle group begins with the fulfillment of passive movement along a small amplitude simultaneously with a volitional package of a sick of the motor pulse to this movement. It is very important to coincide the time of passive movement with the manifested voltage of the exercise muscular group.

Stimulation are usually the following muscle groups:

on the upper limb - extensors of the forearm, reducing shoulder muscles, armor extensors, finger extensors, removal of finger muscles, muscles, disintegrating P, IV, V fingers, muscle - forearm supinator, brachial belt muscles (shoulder belt muscles up and back);

at the lower limb - the muscles - the leg flexors, the muscles - the premonrafts of the thigh, the muscles, distinguishing the thigh, the muscles of the foot extensors (muscles performing the rear feet of the foot), the muscles of the foot Pronators. Muscle stimulation is carried out from and. p. lying on the back on a flat support. On the upper limb, muscle stimulation should be carried out isolated for each level of limb in the horizontal plane. It is necessary to observe the principle of dispersion of the load due to the rapid depletion of cortical centers and in order to restore the processes of concentration of excitation and braking. Muscle stimulation is carried out under conditions of complete "removal" of the mass of the paretical limb, transmitted to the instructor's hands. In order not to create excitement of spastic muscles, the return of the level of limb to the starting position is carried out passively, even if the patient has the possibility of partially actively performing this movement. Stimulate the stimulation on the upper limb better with the three-headed muscles of the shoulder as the main muscle, extending the hand; On the lower limb - from the muscles - leg flexors as the main group, bending the leg. The number of repetitions for one muscular group is -3-6 times. During the classes, it should be returned to the stimulation of the chosen muscular group 2 - 3 times.

Before starting stimulation, it is necessary to combine the explanation of the task with the patient with the show of active movements on a healthy limb and passive - on the paretic. In order to create a better idea of \u200b\u200bthe movement, it is necessary to fully use the auditory, visual, tactile and kinestatic analyzers. When performing stimulation, it is necessary to remember the shainian - tonic reflexes, which, when moving the neck and head, increase the tone of the muscles of the hands: so, when turning the head to the right (left), the tone of the muscles of the flexors of the right (left) hand increases; When flexing the head forward rises the muscle tone - flexors of both hands. Therefore, in stimulating, it is necessary to prevent the bending of the head and its turns towards the parethic limb. During the stimulation, it is necessary to eliminate the factors that distract the patient from the task. All patient's attention is focused on the premise of a volitional impulse to the stimulated muscle group. Stimulation of active movements should begin in the early restorative period. The stimulation is possible only in the presence of a conscious, positive patient's relation to the exercise. With a high muscle tone, it is advisable before stimulation to apply a "brake" method of point massage to relax spastic muscles and "toning" method for stimulating muscle contractions of their antagonists. In order to reduce spasticity, passive movements should be used.

The exercise in the stimulation of the muscular group ends when active abbreviations appear in it that can at least slightly move the limb link. When an active isolated abbreviation of the muscle or muscle group is needed to move to the actual movement carried out using the methodologist.

Active movements are gradually increasing in amplitude, and the patient gets the opportunity to fulfill them more confidently and clearly. The movement rate should be slow. Returns the moving limb link to its original position is passed passively. The number of repetitions is 4 - 6 times.

After the development of an active isolated movement with an extraneous help, you should proceed to the independent execution of the same movement. At the beginning of the class, the return of the limb links to its original position is carried out passively, then - actively. The number of repetitions gradually increases before the appearance of signs of muscle fatigue, which is manifested by a decrease in the amplitude of movements.

The conditions for performing movement are gradually complicated by the use of optimal resistance, from overcoming the minimum counteraction, rendered by the methodologist, to overcoming the resistance rendered by stretching the rubber bandage. The number of repetitions individually - before the appearance of signs of fatigue of the muscular group. The pace is slow. The use of resistance enhances the flow of propriceceptive pulses into the central nervous system, activates the inhibited nerve cells and improves muscle reciprocal innervation.

Restoration of active isolated movements in the same way as stimulation on the upper limb, more efficiently start from the muscle-extensors of the forearm, on the lower extremities - from the muscles-shin flexor.

Active exercises with the help of a methodologist, without help and resistance are carried out for muscle groups, "extending" (external) hand and "shortening" (flexing) legs. Active movements should be avoided for muscle groups that are in a state of an increased tone: finger bentels and brushes, muscles, leading fingers, muscle-flexor and forearm, leading the muscles of the shoulder, hip extensors that supinizing the thigh.

Active free movements performed by the listed muscle groups can be included in the occupation only when the spasticity is significantly reduced, and the antagonist muscles will be able to overcome the strength of the gravity of the limb segment when it moves downwards. According to a 5-point scale of assessing muscle strength, this corresponds to 4 points. Premature inclusion of active movements due to spastic muscles make it difficult and remove the period of recovery, reciprocal relationships of the muscles of the paretic limb. Exercises with items for a paretic hand should not be used in patients with increased muscle tone and weakness of the corresponding antagonist muscle. Much attention should be paid to the restoration of active muscle abbreviations - the extensors of the fingers, the brushes, as well as the removal fingers. Special attention requires the restoration of the movements of the first finger, which has a large zone of representation in the motor field of the cortex of large hemispheres.

Restoring walking skills. After 3 - 4 weeks from the beginning of the disease, taking into account the general state of the patient, it should be proceeded to restore walking skills.

To preserve the dispere position of the hand through a healthy shoulder of the patient, it is put on a strap 5 - 7 cm wide, and a paretic hand in the dispere position rests on the strap from the thigh in the presence of a high tone of muscles or pathological synclosis, it is advisable to apply a two-segment Longeta.

Walking Skills Recovery:

Imitation walk bent legs in the lying position.

Imitation walk bent feet in the sitting position.

Transfer body mass from one foot to another of and. P. Standing, legs - on the width of the shoulders (a healthy hand on the support, the patient - the thigh rests on the strap).

Skipping from foot on foot.

In the standing position - the sick leg in front, then healthy ahead; Body mass is evenly distributed on both legs. Then the body weight is transferred from one foot to another.

Steps in place at the stationary support.

Standing standing on a paretic leg, healthy - raised.

Walking from a fixed support (back of bed, bars) and with a moving support (chair, rod, crutch stick) or without it.

Walking with a healthy hand to the back of the chair (an increase in the additional support area) helps independent movement.

When restoring the walking mechanism, it is necessary to monitor the uniform distribution of the severity of the body to the parethrhetic and on a healthy limb. Steps should be small, the same in length and with a support for the entire foot. The Paretic Leg when carrying it forward should be in the position of sufficient triple "shortening" (flexion in the hip, knee and extension in the ankle joints), without leading it to the side. At the same time, the stop should not touch the floor sock. The paretic hand should be straightened with a support on the strap or located in Longuete. When walking should be maintained (insure) the patient from the Paretic limbs.

At the same time, with the restoration of the walking mechanism, it is necessary to continue the use of exercises to strengthen the bends of the leg and the extensors of the foot.

After mastering the recommended exercises, you can move to the restoration of the walking mechanism in complicated conditions: Walking without an additional support for ahead, backwards and the palm steps to the side; Training turns (standing in place and and the process of walking); walking on the stairs, first with the withdrawal steps (up - healthy, down - patient); walking with overpanding through items, walking at different pace, walking on a narrow track; Walking in combination with various simple hand movements.

Countering pathological synctinesia. Sinknesia - characteristic of a healthy movement movement, accompanying arbitrary, mainly locomotor, movement (squeaks of hands when walking). These are physiological syncinosis.

In case of insufficient concentration of the excitation process in the cortex of the brain, the excitement extends to areas that should not participate in the implementation of this motor act. In such cases, pathological synctaneses are formed.

The following types of pathological syncinosis are distinguished: global, imitation, coordination. Global synctaneses are manifested against the background of spastic hemipreps and hemiplegia. When trying to perform movement with patients with limbs, an increase in the bending of the hand and extension of the legs occurs, i.e. The contracture characteristic of hemiplegia is enhanced. For example: when trying to produce isolated bending or extension in the elbow joint, overexpinable hands are coming: the shoulder is lifted and driven, the forearm is bent and penetrated, the brush bends, the fingers are compressed into the fist; The foot is inflicted at this time. Such synctaneses are also observed with strong muscle tension of the healthy side while walking.

When, along with the pyramid, other paths are affected, simulation synctaneses are observed - movements on the sore side, caused by the identity movements of a healthy side (movement of one (healthy) hand cause similar movements of the other hand).

When coordinating synctaneses, the patient cannot make isolated movements, which are usually produced in a holistic motor act. For example, a patient with a pyramid paresis performs the rear flexion of the foot only when flexing the paretic leg in the knee joint. This is especially clearly detected, if you have resistance to flexing your legs.

During the study of therapeutic gymnastics, it is necessary to achieve the restoration of isolated movements and suppress pathological syncinosis. If you do not counteract the manifestation of global synctaneses they can be fixed. Coordination and simulation syncinosis can be used in therapeutic purposes - to stimulate emerging active movements.

The following methodological techniques should be recommended that can be used to combat synctanes in the treatment of patients with hemipabs: /. Passive Suppression of Sinknesia: Classes of medical gymnastics should be given to the extremities of the patient position preventing the appearance of synctanese. For example: when performing active movements, the foot of the hand is fixed behind your head or along the body, and the hands of the hands are put under the buttocks, etc.;

b) When performing active isolated movements with one finiteness, the other, having a tendency to synclosis, cargo or hands of the methodologist is fixed in the desired position. For example: when performing movement, the hand is dismissed in the elbow and ray-taking joints, supinized, is somewhat allocated and fixed;

c) When performing active movements, the Methodist passively performs anti-agricultural movements. So, with active flexion of a healthy hand in the elbow joint, the methodologist passively extensions the parethrower hand.

2. Active synclosis suppression:

a) The segments of the limbs, the involuntary movements of which should be excluded, are actively held in the desired position by the patients themselves. For example: when flexing the legs with a sick, with a strong force, counteracts the bending of the hand, holding it in a dispere position;

b) During classes, combinations are performed by movements in which limbs produce anti-army actions: extension of hands with simultaneous leg bent in the knee joint; Compression of the fingers of a healthy hand in a fist with the simultaneous extension of the fingers of the sick hand, etc.

Systematic use in occupations of such techniques contributes to a gradual decrease in the severity of pathological synclosis and the restoration of normal physiological coordination.

Exercises for restoring overall coordination of movements. Coordination of movements is a subtle and accurate coordination of the work of all muscles - synergist and antagonists of our body. Coordination movements are placed plastic, measured, economically. At the post-pillars "as a result of the violation of the coherence of braking and initiation processes in the central nervous system, the coordination of movements suffers. In the process of restoring disturbed functions, the active movements appearing in the patient long remain awkward, slow, inaccurate, inconsistent. Restoration of coordination of movements can be started at that time when the patient almost lacks muscle hypertension and synctanese and it becomes possible to perform active, isolated movements in all joints (with I-p degrees of disorders of motor functions).

To restore and improve the coordination of movements, it is recommended to do exercises from various source positions (lying, sitting, standing and when walking), starting with the simplest movements available for patient.

Exercises that improve coordination of movements are characterized by more complex consistency, which for these patients is carried out by performing movements at the same time, alternately, consistently, with the inclusion of more muscle groups:

Simultaneous movement in one direction in the joints of the upper (lower) limbs, such as bending the hands in the elbow joints.

Simultaneous movement in opposite directions of the same joints of the upper or lower extremities, such as the flexion of the right upper limb in the elbow joint with simultaneous extension of the left hand (change of hands).

Simultaneous movement in the joints of the same name (right or left) limbs, such as flexing the right hand in the elbow joint, the right leg is in the knee joint, then their extension.

Simultaneous movement in the joints of the same name - the right upper and left lower, for example, flexing the right hand in the elbow joint, the left foot is in the knee and extension of them.

Alternate movement in the same joints of the upper and lower extremities in one direction, such as flexion and extension of the right hand in the elbow joint, the same - left hand.

6. Sequential execution of various movements on the team, for example, right hand to the side, left hand to the side, right hand up; left hand up, right hand aside, left hand aside; Right hand down, left hand down.

In the future, the exercises are complicated by changing the initial provisions, with the participation of a large number of muscular groups, changes in the tempo, amplitude, movement directions, use of exercises with dosage muscular voltage, etc.

Special attention should be paid to the improved coordination of the movements of the fingers of the brush of the paretic limb applying the following exercises: breeding and mixing the fingers, aid 1 finger, circular movements 1st finger, household skills: take a paretic hand-made item item, to take on their own; Learning personal hygiene skills, such as wash, shave, and so on (we are talking about severe patients who have these skills lost); Then learning independent dressing (which is quite difficult with a paralyzed hand), using the toilet and bathroom. Alone to use the toilet and a bathroom with a hemiparesis and coordination disorder, various technical devices help: handrails from toilet bowl, staples in the bathroom walls, wooden stool in the bath.

Mechanism of therapeutic effects of exercise

Researchers dedicated to studying the impact of muscle activity on disease treatment, the main mechanisms of therapeutic effect of physical exercises are revealed: a tonic effect, trophic effect, functional standards and compensation formation.

In the treatment of patients with the consequences of the acute violation of the cerebral blood circulation, the means of therapeutic physical culture are widely used primarily with a general consequence of the goal, since the tone of the central nervous system in the ballroom with impaired cerebral circulation is significantly reduced. The negative effect of hypodynamine sharply affects. Common-linking exercise are dosed in according to the patient's condition. Initially, their intensity is minimal. Gradually, it increases. At the same time, constant monitoring of the patient's reaction to the load (the calculation of the pulse, the measurement of blood pressure for its well-being and subjective state is carried out.

During classes, the trophic functions are constantly implemented. This is achieved by the use of special exercises, tissue trophics, metabolic processes. Passive and active movements and the treatment of position are used. For the prevention of complications by the internal organs, breathing exercises are widely used.

The streams of centrifugal and centripetal pulses arising from the implementation of passive and active movements contribute to the normalization of neurodynamic processes in the core and subcortex, contribute to the discharge of the inhibitory areas of the central nervous system, accelerate the restoration of disturbed conditionally reflex ties.

Passive movements that cause irritation of proproporeceptors and contributing to the restoration of innervation begin to be applied in early dates and are used during the entire regenerative treatment, given the increased reflector excitability in patients, they must be performed smoothly, at a slow pace, with a gradual increase in amplitude, not allowing repairs of weak muscles .

Stimulation of active movements begins with the parcel of pulses to the voltage of individual weakened muscle groups. Appearing active movements are performed first using a methodologist - from lightweight source positions. Given the rapid depletion of the nervous system, the exercises should be simple. They are performed at a slow pace, without significant voltage, with the optimal distribution of the load between individual muscle groups and body segments.

When active movements appear, attention is first paid to strengthening the most weakened muscular groups (forearm extensors, explosiveness of brush and fingers, shin bends, foot extensors, etc.). Mandatory method of technique is the active isolated execution of movements carried out by the corresponding muscle groups. Return to its original position in the spastic state of the muscle antagonists is carried out passively (dissected exercise).

When the active movements are restored, it is necessary to ensure that they are performed exactly, isolated, since the concentration of pulses flows in the corresponding neurons and their activation occurs. In case of incomprehensible pathological synclosis, it is necessary to counteract them .

Permanent attention is paid to a special exercise for spastically tense muscular groups: slow and smooth muscle stretching, passive movements, elements of a relaxing point massage, volitional relaxation of muscles. Improving the tone of muscles can be reduced by overlaying tires and laying limbs in a favorable position (treatment). At the same time, pulse flows from the periphery contribute to a decrease in the excitability of motioneons, muscle spasticity.

Thus, the LFC forms a new complex stereotype, eliminating pathological, normalizes activities and thereby contributes to the elimination of the focal process with its influence on the body.

LFC also has a stimulating effect on regenerative and trophic processes, prevents the development of muscle atrophy, stagnation of stagnant phenomena, contributes to the restoration of the disturbed functions, the normalization of the function of the gastrointestinal tract and organs of the small pelvis, the development and improvement of compensatory and replacement skills, increases the general and The emotional tone of the patient, instills confidence in recovery. Muscular activity enhances all types of exchange, activates and processes redox processes. Systematic exercise classes restore full-fledged regulation of vegetative functions .

Thus, the LFC forms a new complex stereotype, eliminating pathological, normalizes activities and thereby contributes to the elimination of the focal process with its influence on the body. LFC also has a stimulating effect on regenerative and trophic processes, prevents the development of muscle atrophy, stagnation of stagnant phenomena, contributes to the restoration of the disturbed functions, the normalization of the function of the gastrointestinal tract and organs of the small pelvis, the development and improvement of compensatory and replacement skills, increases the general and The emotional tone of the patient, instills confidence in recovery. Muscular activity enhances all types of exchange, activates and processes redox processes. Systematic exercise classes restore the full regulation of vegetative functions.

Consequently, the biological basis of the processes of recovery after a stroke is different depending on the deadlines for the start of the disease. To reduce the severity of motor disorders, therapeutic measures must be carried out from the first hours of stroke. In the acute period of stroke, treatment should be aimed at reducing the brain edema and restoring the functioning of ischemically damaged, but not destroyed brain tissue. This process proceeds during the first days from the beginning of the disease. Another mechanism, the value of which is particularly large upon completion of the acute stroke period, is plasticity. To enhance the processes of plasticity, special rehabilitation programs are used, aimed at restoring lost functions, as well as various drugs that improve cerebral blood flow and metabolism.

Tasks, purpose of the means, forms, methods and techniques of the exercise under ischemic stroke.

For each stroke period, there are its main tasks of the kinesotherapy. So, in acute periodbasic tasksare: \u003d\u003e Early activation of patients;

\u003d\u003e Preventing the development of pathological conditions (spastic contractures, arthropaths) and complications (thromboflastic, leggings, stagnant phenomena in the lungs) associated with hypokinesia;

\u003d\u003e Developing active movements.

In early restorative periodbasic tasksare:

\u003d\u003e Early activation of patients; => training patients with targeted actions;

\u003d\u003e Preventing the development of pathological conditions (spastic contractures, arthropathies) and complications (thrombophlebitis, laying out stagnant phenomena in the lungs) associated with hypokinesia;

\u003d\u003e stimulation of active movements;

=> contribute to the normalization of neurodynamic processes in the cerebral cortex and subcortex;

\u003d\u003e contribute to the disordering of the sections of the CNS in the oppressed state;

\u003d\u003e accelerate the restoration of disturbed conditionally reflex ties;

\u003d\u003e Prevention of attachment of pathological synclosis;

\u003d\u003e Strengthening of weak muscle groups;

\u003d\u003e Improvement of motor qualities;

\u003d\u003e Restoration of repair and movement skill;

\u003d\u003e generalonizing effect on the body;

=> promoting the improvement of general and local blood and lymphorage, an increase in all metabolic processes;

\u003d\u003e Improvement and normalization of tissue trophics;

\u003d\u003e Prevention of complications by all internal organs.

Maintenance tasksmotor rehabilitation latest recovery periodthere are further development of active movements, reducing spasticity, overcoming synclosis, improving the walking function, increase tolerance to physical exertion, training stability of vertical poses, training in self-service skills.

Main purposethe treatment of therapeutic physical education is to promote the restoration of motor functions, which occurs mainly by reducing the zone of spilled braking.

That is, early motor activation of patients not only contributes to better restoration of motor functions, but also reduces the risk of developing aspiration complications and thrombosis of deep veins of the lower extremities.

If the patient has a phenomena of apraxia (loss of certain motor skills), the process of occupying is carried out special training of the patient with the implementation of "forgotten" movements.

With satisfactory restoration of motor functions, when the patient remains awkwardness and slowdiness of movements, attention is paid to the study of the medical gymnastics. Attention is paid to improving motor qualities - agility, coordination of movements, increase speed. The familiar patient is used. When they are fulfilled, visual and hearing analyzers are mobilized (movements are explained, performed by a command or signal, controlled by vision, etc.) All techniques contribute to improving the quality of movements.

Exercises aimed at strengthening force apply when active movements appear and are used throughout the course of treatment. They are designed to train the extensors of the hands, flexors of the tibia and the extensors of the foot, mainly in the form of movements with optimal resistance.

Gradually, in the process of medical gymnastics, the patient's motor mode is expanding. Initially, the patient is taught by turning into bed, transitions to the sitting position, standing; Then walking training begins. Recovery of each of these skills can be devoted to individual classes. Attention is drawn to the correct statement of the parethic limb, to coordinate the movements of the hands, and the feet, to the posture of the patient. As the task is assimges, the dosage of the exercises performed is increasing.

In the early and later stages of reducing treatment, exercise are used mainly in order to maximize the restoration of disturbed innervation mechanisms.

At the stage of residual disorders of motor functions, the improvement of movements can be carried out by forming the corresponding compensation, since the mechanisms of motor functions are scattered in various parts of the brain cortex. Violations in the core of the brain can be partially compensated for and at the expense of subcortical formations.

Throughout the treatment, control over the change in the functional state of the patient, for its reaction to the proposed loads, their adjustment is performed.

Therapeutic physical culture is used in the treatment of post-pillars with the consequences of an acute brain circulation disorder is therapeutic gymnastics. In addition, hygiene gymnastics, medical walking, game exercises are applied. Claims of therapeutic gymnastics Depending on the degree of impairment of motor functions, the individual or small group method is carried out.

I.- the introductory part of the classes.Tasks:establish contact with the patient, focus on the upcoming classes, to give the parethous limbs "corrected position", moderately activate (toning) the patient's body, prepare for the fulfillment of the main part of the treatment of therapeutic gymnastics.

Funds:active movements with healthy limbs, exercises in muscle relaxation, breathing exercises. Elements of autogenous workout and point massage. In the presence of increased muscle tone and pathological synclosis of the parethous limbs, the position opposite to the pose of Vernika-Mann is attached.

All exercises should be accessible to patients who do not require long explanation. The physiological burden determined by the pulse frequency at the end of the introductory part should not exceed 20% of the initial indicator.

II. - the main part of the lesson.Tasks:promote the restoration of disturbed motor functions; Provide further activation of the patient's body.

Funds:exercises for paretic limbs (passive movements, stimulation of active isolated movements using a methodologist, active insulated movements), exercises with resistance for muscles, "extension" hand and "shortening" leg, in alternating with active free exercises for healthy limbs and muscles torso, breathing exercises and exercises for muscle relaxation. According to the testimony, elements of point massage and autogenic workout are used. In accordance with the ability to transfer the patient to the position lying on the side, sitting, standing, preparation for walking, training the correct walking mechanism, walking workout, restoration of applied domestic movements.

With the resistant restoration of active isolated movements in the paretic limbs, exercises are used that improve the coordination of movements with a gradually increasing degree of complexity.

Physiological burden in the main part of the lesson should not exceed 35% of the initial pulse indicator.

III -final part.Tasks:reduce the load, bringing the functional state of the body to a level somewhat exceeding the source. Secure the achieved results of improving disturbed motor functions.

Funds:active exercises for small muscle groups of healthy limbs at a slow pace, exercises in relaxing groups of healthy limbs at a slow pace, exercises in relaxing muscles of healthy and parethous limbs, breathing exercises, elements of autogenic workout. According to the testimony - the treatment of the position ("corrected position" of the paretic limbs).

In all modes of both the early and late reducing period in the process of studying the medical gymnastics, it is necessary to observe the principle of dispersion of the load (alternation of exercises and exercises in muscle relaxation), given the increased depletion of cortical cells in violations of the blood circulation of the brain.

When conducting therapeutic gymnastics, constant attention should be paid to the preservation of the correct position of the limbs in order to reduce the increased tone of the parethous muscles and counter synctanesia.

Exercises in muscle relaxation are widely used. It is necessary to train the patient to solve muscle relaxation first healthy, and then the tertiary limb.

Active exercises should only be applied to such a degree of difficulty so that when they are fulfilled, the patient did not increase spasticity and syncinesia did not appear.

The patient must be configured to actively participate in the upcoming lesson, to concentrate its attention not to fulfill the tasks.

With the consequences of a acute violation of the cerebral circulation, the psychology of the patient is significantly different from the psychology of healthy. It is necessary to imagine the state of a person, yesterday former at work, communicating with the same, as he, healthy people and lost the ability to move, and sometimes talk. The patient with motor aphasia hears and understands, but, being in the inhibited state, is deprived of the opportunity to answer. In order to avoid gaining braking processes with these patients, it should be told to the floor of the vote.

Patients with apraque makes the wrong actions (combed with a spoon, shirt stretch to feet, etc.). Medical staff should not forget that mentally, these are normal people and treat them needed with a special tact, surrounding attention and care.

Therapeutic physical culture is an active treatment method. The success of restoration of lost functions largely depends on the degree of participation of the patient in the study of the medical gymnastics.

After instilling in the patient, the confidence that it will be done all possible to restore lost functions, it is steadily and stubbornly to force it to systematically deal with the exercises. It is necessary to constantly monitor the execution of tasks. The patient must be sure that his medical personnel surrounding his medical staff did everything, he depends on him to promote his recovery.

Stroke is a serious illness associated with a blood circulation disorder in brain vessels. Often, after stroke, motor and speech skills are broken.

One of the conditions for the return of a person to normal life is the execution during the rehabilitation of exercise.

A set of exercises under stroke is designed to meet the recovery periods. The intensity of training is growing gradually, it favorably affects the restoration of brain functions.

What depends success

The duration and efficiency of the recovery period depends largely on the patient, its positive attitude, purposefulness and patience. It is also important to understand the nature of the disease and the direction of treatment methods. Sometimes the patient and surrounding are not fully aware of the goal of the FFC after a stroke, perceive therapeutic gymnastics as a procedure that strengthens muscle strength. This is mistake. The main goal is to restore the brain ability to manage human movements. In the initial reducing period, the muscles do not need. The following factors are also of great importance:

In the first days after a stroke in a hospital, passive gymnastics are conducted by attending personnel. At the same time, the movements are made instead of a patient so that it does not make efforts.

If there is no possibility of conducting the excession in the hospital, someone from close patients after consulting a doctor can hold a complex at home. When selection of exercises, the doctor takes into account the patient's condition, which parts of the brain were damaged, what functions are broken.

The armor of hands spend, starting with bending and extension of the fingers of the paralyzed limb, and then go to healthy. The next movement is the rotation of the brush in both directions. Then bend and extension their hands in the elbow joints, and in the end we develop shoulder joints - bend and extension down-up, left-right, make a turn.

Therapeutic physical education of the lower extremities also begins with flexion and extension of the fingers, then the stop is rotated. After that, bend and extension legs in the knees, and finally, be flexible movements in the hip joints.

Restoring active movements

The active exercises of the LFC after the transferred stroke first do lying, then attach those that run sitting, and only then include standing exercises. Active exercises are transferred after consulting a doctor. The intensity and frequency of exercises increase gradually, focusing on the councils of the doctor and the health of the patient.

When performing a patient with a complex of exercise, the LFC is preferably the presence of a second person to prevent traumatic dangerous situations. The patient will be captured until it starts to keep confidently.

When switching to individual types of active movements, you need to evaluate the overall health of the patient, and also focus on increasing the mobility of the paralyzed limb. As soon as, for example, begins to move a finger, which was previously fixed, they are trying to do already active movements. That is, at a certain stage, passive, and active gymnastics are performed simultaneously. When the doctor is allowed to move to active exercises, the patient will be independently a healthy hand to perform passive exercises on a paralyzed limb, and then active on healthy limbs. The number of movements start from 3-5 times, gradually increase. Exercises are doing slowly, restrained and diligently.

All exercises are aimed at restoring the mobility of paralyzed limbs: from 1 to 5 - for hands, from 6 to 19 - for the feet. These exercises do not require significant physical efforts, but give an excellent start to return to a normal lifestyle. Hand exercises can be lying lying, sitting and standing. It depends on the well-being of the patient and on what extent the body has already been restored.

If any exercise immediately fails to do correctly, you need to do it as it turns out. Over time, success will surely come. One recovery occurs quickly, others are slower. No need to compare your successes with the achievements of other patients. Even little progress is an important step towards recovery. After all the exercises from this complex are mastered, it is possible with the permission of the doctor's doctor to attach various slopes and turns of the head and body, squats and other movements.