How to support yourself after a stroke. Rehabilitation after a cerebral stroke. Man after hemorrhagic stroke

There are two ways to describe them:

1. Single timeline.
2. A "unique" timeline that reflects the recovery of individual stroke survivors.

Both approaches are helpful.

Single timeline

The single timeline is the average stroke recovery process. It gives a general idea of ​​the stage of recovery of a stroke survivor. If a person says: “I had a stroke seven months ago,” then doctors and therapists can make certain assumptions about what stage of recovery he is at. A single timeline is also useful in research, in particular for identifying the group of stroke survivors who are being treated. For example, a study might include "people who have had 3-5 months after a stroke."

The four stages of stroke on a single timeline look like this:

1. Hyperacute: 6 hours from first symptoms.
2. Acute: first 7 days.
3. Subacute: after the first 7 days to 3 months.
4. Chronic: after 3 months until the end of life.

"Unique" timeline

The "unique" timeline is based on studies using brain scans of people with stroke. These scientific studies show that every stroke is different. Stroke survivors go into and out of specific recovery phases at different times.

Choosing the best strategy depends in part on where the stroke survivor is in recovery. Each strategy works at a certain stage.

Finding out what phase a stroke survivor is in is often a matter of simple observation. The way the body moves allows us to understand what is happening in the brain. The stroke survivor himself and those around him can help determine the stage of recovery from illness.

Hyperacute phase

In both forms of the timeline, the hyperacute stage is the same: from the first symptoms to 6 hours after the stroke.

As soon as the first symptom is found, the time has passed! Some stroke survivors do not receive emergency care during a hyperacute period. This is unfortunate because this is the only period in which an aggressive blood clot-breaking drug can be used. This drug, called TAP (tissue plasminogen activator), is a thrombolytic agent ("thrombotic" - thrombus, "lytic" - destructive). (Caution: TAP is contraindicated in hemorrhagic strokes.) Stroke survivors who receive TAP tend to recover better and faster. This is why it is vital to recognize a stroke and receive emergency care. The sooner the stroke survivor can get to the hospital, the more likely they are to receive TAP. Literally: time is the brain. Other medical interventions that can save the brain are also carried out during this phase. Providing emergency care is not only essential to saving as much of the brain as possible, it is often critical to saving the life of a stroke survivor.

What is the best recovery strategy during the hyperacute phase?

The most important thing a stroke survivor and caregivers can do to help recover is to seek emergency medical attention as soon as possible. Call 911. Wasted time is lost brain. No recovery occurs during this period. If the patient is awake, health care providers can perform motion tests that will provide information on the extent of the stroke. However, at this stage, you should focus primarily on two tasks:

1. Saving the patient's life.
2. Saving as much of the brain as possible.

Acute phase

During the acute phase, two areas appear in the brain.

• killed by a stroke;
• all his neurons (nerve cells) are dead;
• Has no chance of rebuilding the brain (neuroplasticity)
• forms a cavity in the brain that is filled with fluid.

Penumbra:

• much larger than the core;
• represents billions and billions of neurons;
• alive, but barely;
• will eventually become a useful or useless area of ​​the brain, depending on what is done during rehabilitation.

A stroke causes the blood supply to the nucleus and penumbra to be cut off because the blood vessels are either blocked (in a stroke with blockage) or ruptured (in a stroke with hemorrhage).

The interruption of the blood supply leads to the death of the nucleus. Penumbra remains alive, but barely. Since the main blood vessel is (at least temporarily) not working, the penumbra uses smaller blood vessels to continue life. The neurons in the penumbra receive enough blood not to die during the acute phase, but less than necessary. Due to the decreased blood supply, the neurons in the penumbra are unable to do their job.

But for the billions of neurons in the penumbra, there is another problem.

Damage to any part of the body causes many body systems to come to the rescue of the affected area. Think of the swelling caused by a tucked ankle or a bruised hand. The same thing happens with penumbra after a stroke. It receives calcium, catabolic enzymes, free radicals, nitric oxide and other chemicals. And this area is flooded with "metabolic soup" designed to promote healing, which causes the swelling. While this mixture of chemicals aids in recovery, it provides a poor environment for neurons to function.

Thus, penumbra experiences two problems caused by stroke:

1. Insufficient blood supply.
2. A mixture of chemicals that interfere with the functioning of neurons.

These two factors render a large area of ​​the brain (penumbra) dormant. The neurons in it are alive, but "stunned". The special term "cortical shock" is used to refer to this phenomenon. For many stroke survivors, this leads to paralysis. But paralysis during the acute phase is not necessarily permanent. In some stroke survivors, the penumbra neurons start to work again. The restoration of the penumbra occurs at the next stage - in the sub-acute phase.

What is the recovery strategy during the acute phase?

Intensive care during the acute phase is a bad idea.

During the acute phase, the brain remains in a very painful state. Penumbra neurons are especially vulnerable. Consider studies in animals that have had a stroke. Those who were forced to do too many tasks shortly after the stroke had more brain damage. In human studies, the results of intensive rehabilitation (a lot of exercise soon after a stroke) have been mixed at best. Scientists continue to look for an answer to the question: "What loads will be excessive during the acute phase?" And until it is found, the rules are simple:

• follow the recommendations of the doctors;
• listen to the advice of therapists and nurses;
• do not strain.

Intense effort during the acute phase will damage recovery. But this does not mean that there should not be any therapy. For many patients, doctors prescribe bed rest for the first 2-3 days after a stroke. However, even at this time, treatment begins. Doctors often make passive (without any effort by the patient) movements of the stroke survivor, that is, move his limbs according to their range of motion. These actions will help maintain muscle length and joint health.

Once the physician lifts bed rest, therapists will use their own clinical judgment to gently and safely restore movement of the stroke survivor. During the acute phase, most of the therapy is carried out “at the patient's bedside” (in the patient's room). Therapists begin to gently restore movement. Physicians who work with acute patients often describe their approach to treatment in a simple phrase: "We do what the patient can do safely."

Before starting therapy in the acute phase, doctors will check:

• good judgment and understanding of safety rules;
• the ability to execute commands;
• orientation in time and space (for example, "Where are you? Who am I? What time of day, season, etc.?) (Many patients may feel offended by such simple questions; however, they are important for determining the degree of safety of therapy.);
• memory;
• ability to solve problems;
• vision;
• the ability to actively move the limbs (amplitude of active movements, or AAD);
• strength;
• fine motor coordination;
• Feel.

Once evaluated, treatment begins with very simple movements and actions. For example, if it is safe, doctors will help stroke survivors:

• reach for objects, touch or take them with a hand / brush from the sore side;
• sit on the edge of the bed;
• change position from sitting to standing;
• walk.

During the acute phase, listen carefully to the recommendations of your therapists. Therapists, as well as doctors and nurses, will advise you on which recovery strategies to use. Caregivers can also be helpful, acting on the advice of a therapist when the stroke survivor is most active. The caregiver's job can include anything from talking to the stroke survivor to encouraging them to perform basic movements (such as unclenching and clenching their arm).

In addition, caregivers are important for recovery during the acute phase because they often spend many hours a day with a stroke survivor and can inform doctors about changes in their ability to move. For example, a person after a stroke is generally unable to bend the elbow on Monday. Then - without any exercise - on Wednesday he can bend his elbow a few degrees. This phenomenon is known as spontaneous healing, and it is extremely important to recognize it for two reasons:

1. This is a sign of a subacute phase (discussed later).
2. This indicates when to start really hard and effective work.

If you are caring for a stroke survivor and see a spontaneous recovery, tell your doctor! The most B8.ZHN8. I phase of recovery (subacute) has begun!

Subacute phase

Begins	Ends
The first neurons of the penumbra begin to function again	All neurons in the penumbra are functioning

For many stroke survivors, the subacute phase is a time of great hope. At this stage, there is a huge influx of neurons, which allows the stroke survivor to recover at a rapid pace. Much recovery is considered spontaneous recovery (significant recovery with little effort). The reason for this rapid, spontaneous recovery is that neurons that have been "turned off" are "turned on" again. Some stroke survivors recover almost completely during the subacute phase. Other stroke survivors are less fortunate. It takes longer for them to turn on the neurons again because they have one problem with the penumbra.

Penumbra problem

The brain obeys the rule “what you don’t use, you lose”. If the penumbra neurons are not forced to work again, they stop doing so. This process (loss of functions by unused neurons) is known as the “forgotten how to use” phenomenon.

But why not use penumbra neurons? Of course, the stroke survivor will be encouraged to move. And the movements performed by the survivor of the stroke will activate the neurons and prevent the “forgotten to use” phenomenon from developing, right? For a minority of people after a stroke, this is exactly the case. These "lucky" stroke survivors quickly recover functional (applicable, practical) movements and never develop the "forgotten how to use" phenomenon.

But many stroke survivors "learn" not to use neurons. Much of the reason for this phenomenon is that the managed care system is forcing therapists into a “meet him, greet him, heal him, and put him on the street” approach. Doctors follow Rule # 1: keep them safe, functional, and send them out the door. Functionality is indeed the ultimate goal. But for stroke survivors who have not yet recovered their functions, there is only one way to "walk out the door": compensation (using the limbs only on the healthy side). Involving the healthy side in performing all movements means that the neurons in the penumbra will not have the load necessary to turn them on. When the neurons of the penumbra become usable, no one asks for anything from them - this is how the "forgotten how to use" phenomenon develops.

What is the best recovery strategy during the subacute phase?

The subacute phase is the most important stage in the recovery process. Its degree is determined by the intensity and quality of efforts at this particular time. Successful passage of the subacute phase provides the highest level of recovery.

During the subacute phase, billions of neurons that survive a stroke are able to return to work. The point at which each neuron becomes ready for action is the onset of the chronic period (which we will discuss next).

Much of the recovery during the subacute phase is due to the "on" neurons that were "off". This is the essence of spontaneous recovery: neurons inaccessible for work at the subacute stage become capable of it. During this phase, many stroke survivors have the opportunity to "ride the wave of spontaneous recovery." Everyone wants to take credit for the cure. A stroke survivor might say something like, “I’m recovering successfully because I’m really working hard on it,” and the therapist will assume that the stroke survivor is recovering from intensive care. But to a large extent, recovery during the subacute phase is due to the fact that billions and billions of neurons become usable again. As the swelling after a muscle injury subsides, so does the swelling after a stroke, as a result of which the neurons are able to return to work.

Chronic phase

At some point, all neurons in the penumbra regain functionality, so the “wave” that can be ridden disappears. This is a sign of the onset of a chronic phase.

When the subacute phase ends and the chronic phase begins, the stroke survivor has two types of neurons. Let's call them "working neurons" and "lazy neurons".

Working neurons

Some neurons feel quite normal and immediately return (during the subacute phase) to what they were doing before the stroke.

For example, neurons can return to ...

• ... flexion of the elbow, then to ...
• ... raising a leg while walking, then to ...
• ... control over mouth movements during speech, then to ...
• ... unclenching your hand ...
• etc.

Working neurons take over their responsibilities again. It is these neurons that are involved in the work during the subacute phase that provide spontaneous recovery.

"Lazy" neurons

These neurons are never asked to do anything after a stroke. As a result of a process known as the "forgotten to use" phenomenon, they temporarily do not work. As is true of the rest of the brain, every neuron obeys the “what you don’t use, you lose” rule. "Lazy" neurons lose connections between themselves and other neurons, which are called "synaptic connections."

Normally, neurons use connections to communicate with other neurons. When this interaction occurs, they remain operational. If a neuron is not in contact with other neurons, connections are lost. This is the essence of the brain's principle of "what you don't use, you lose." In each of these non-working neurons, dendrites are lost - branches that provide connections between neurons. The word “offshoots” is aptly chosen here. In fact, there is a special term "pruning" (or "pruning") to denote the shortening of these branches - like pruning the branches of bushes or trees. Scientists use the expressions "dendritic ramification trimming" or "dendritic pruning". This is exactly what happens to "lazy" neurons under the influence of the "forgotten how to use" phenomenon. They are losing touch.

The chronic period begins when all the neurons of the penumbra have become either working or "lazy". At this point, the stroke survivor no longer shows spontaneous recovery. Doctors can recognize this stage of recovery — it is relatively easy to see. A stroke survivor no longer recovers. Clinicians call this plateau. Due to the requirements of the managed care system (insurance companies), therapists are required to prescribe (complete treatment) for stroke survivors whose condition has reached a plateau. The idea is: “This patient is no longer getting better. Why should we pay for further treatment? "

For many stroke survivors, the plateau may not be permanent. Researchers have discovered two specific methods for overcoming plateaus during the chronic phase.

1. The inclusion of "lazy" neurons in the work.
2. Connecting other neurons in the brain to perform functions lost during a stroke.

Enabling lazy neurons

The reactivation of lazy neurons is known as eliminating the "forgotten to use" phenomenon. The idea is to load the lazy neurons so that they are forced to make new connections with neighboring neurons (here the keyword is "excused"). In fact, one way to force neurons to use unactivated connections is called "forced use." Forced use is part of forced movement therapy in which a healthy limb is prevented from performing any action. This prompts the affected limb to do difficult and uncomfortable work. But it is this kind of work that makes the brain rebuild. Changing the brain (also known as learning) is a difficult task, be it learning a foreign language or learning to play the violin. The key to learning, including transformation after a stroke, is the complexity of the assignments. When we force lazy neurons to reach out to other neurons, this leads to the formation of new connections between them. Forcing lazy neurons to make connections is one way to recover from a stroke during the chronic phase.

Connecting other neurons in the brain to perform functions lost during a stroke

The brain is "plastic" and, like the plastic found in everything from auto parts to plastic bottles, it can change physically. For a plastic bottle to change shape, it needs to be heated. For the brain to change, it needs an intense load. Here is an example of the manifestation of plasticity after a stroke.

Neurons from different parts of the brain are ready to perform tasks they have never been asked to do before. This is the ability to be plastic, and people who have had a stroke may well use it in the chronic phase. Complex tasks force other neurons in the brain to perform functions that are lost during a stroke.

What is the best recovery strategy during the chronic phase?

The following are general guidelines for recovery during the chronic phase. Note that there are various strategies described to help stroke survivors succeed during the chronic phase.

• Recovery requires an independent effort. Sooner or later, there comes a moment after which there is no longer a therapist next to the person who has suffered a stroke. Therapists can help you periodically during the chronic phase (that is, every 6 months, a year, etc.). They look at what the stroke survivor is doing and give advice on further rehabilitation. But in the chronic stage, there is no need for therapists. Once treatment is over, stroke survivors must take control of their recovery. This recovery phase is based on hard independent work. Patients willing to take responsibility for this process need the tools to kick-start and follow the “upward spiral of recovery”. This is facilitated by the presence of a practical need for everything - from coordination of movements to endurance of the cardiovascular system. There are many options for recovery during the chronic phase, from working on muscle strength to using mental training.
• Forget plateaus: it doesn't happen. The word "plateau" literally means "leveling" and is used to describe the period when a stroke survivor stops recovering. Traditionally, the recovery curve has been thought to have one plateau at the end of the subacute phase. Research in recent decades has shown that some stroke survivors can overcome plateaus. During the chronic phase, recovery consists of many plateaus that occur over a number of years.
• Stay in good shape. Everybody gets old. As we age, staying in good physical shape is vital to everything from overall health to being able to continue doing what we love. But stroke survivors consume too much energy. After a stroke, basic daily activities (i.e. walking, dressing, etc.) require twice as much energy, and stroke survivors need even more energy as recovery takes effort.
• Don't let the soft tissue contract. When tissue shortening occurs (i.e. muscle tension is noted), movement recovery can be compromised and / or completely stopped. Even if you do a lot of hard work, but at the same time you do not have enough muscle length, you will not advance further - everything is simple. This is especially true for the tendency to shorten soft tissue in the elbow, wrist, and flexors of the fingers and toes. The main problem in the leg is the calf muscle. Muscle spasticity in the calf muscle keeps the foot tilted downward. If it stays in this position long enough, the calf muscle will contract. But many other muscles are also at risk.

Phase-focused recovery

There are three paths that recovery can take.

Strength increases: You develop muscle strength and endurance in the cardiovascular system (heart and lungs).

• Strength development should be encouraged during the subacute and chronic phases of stroke.
• Strength development during the hyperacute and acute phases will damage recovery.

Penumbra is restored: during the subacute phase, penumbra neurons restore their functions.

The brain is being rebuilt: during the chronic phase, the plasticity of the brain allows another area of ​​it to take over the lost function.

Many people are concerned about the causes of stroke, the symptoms and treatment, and what exactly is the disease. The disease is very dangerous in its course and the existing complications that affect a person after the acute phase of the disease has been eliminated. The only way to save the patient is urgent hospitalization and emergency measures to normalize health.

It is very important to know what the causes of a stroke may be, so that prevention can be carried out in a timely manner and prevent the occurrence of this disease.

Feature of the disease

Regardless of the causes of a stroke, it is a pathological change in blood circulation in the brain, manifested in neurological lesions.

As a result of these processes, some parts of the brain lose their functional abilities, which negatively affects the functioning of organs and systems controlled by these areas.

Classification

Quite broad and includes provoking causes, development mechanism, peculiarity and magnitude of the lesion. It is customary to distinguish such types as:

• ischemic;
• hemorrhagic;
• lacunar;
• extensive;
• spinal;
• spicy;
• microstroke;
• repeated.

Ischemic stroke is one of the most common types of brain damage. It can be caused by impaired delivery of nutrients and oxygen to brain cells, which can occur due to vasoconstriction. Hemorrhagic stroke is a consequence of the rupture of blood vessels in the brain, as a result of which the blood fills the cavities. This leads to the formation of hematoma and edema.

Major stroke is any massive lesion. It has more pronounced symptoms and often leads to the death of the patient or disability for a long time. In addition, they are classified according to their severity.

Ischemic stroke

It is the ischemic brain damage that is most often observed. It is diagnosed mainly in the elderly, over the age of 60. Among the main causes of ischemic stroke are:

• changes in blood properties;
• heart disease;
• arterial pathology;
• diabetes;
• bad habits.

Often, such an attack occurs completely unexpectedly, at night. The mechanism of this process is based on a violation of the patency of blood vessels. This is mainly due to blockage and narrowing of the arteries. In this case, the supply of nutrients and oxygen to the brain cells is disrupted, which provokes their necrosis.

As a rule, the causes of ischemic stroke are closely interrelated with various diseases occurring in the body. When a certain part of the brain is disconnected from the blood circulation, the symptoms of the disease appear already within the first hours and can persist for more than a day. On its own, the disease can occur with the formation of thrombosis as a result of smoking, stress, malnutrition, hypothermia.

It is important not only to know the causes of stroke, but also what are its main types according to the degree of damage. In particular, there are such varieties as:

• transistor;
• small;
• progressive;
• extensive.

The easiest way is a microstroke or a transistor one, since an insignificant area is affected and tissues are restored literally within a day. According to the pathogenesis, the ischemic form of stroke is divided into types such as:

• thromboembolic;
• hemodynamic;
• lacunar.

The thromboembolic type of the disease is characterized by the formation of a thrombus, and is also associated with arterial embolism, as well as atherosclerosis. The pathological process proceeds with an increase in symptoms throughout the day and can have focal lesions of different sizes. The hemodynamic type provokes vasospasm and prolonged nutritional deficiencies. It is often caused by low blood pressure, myocardial ischemia and bradycardia. It can manifest itself in the form of a sharp attack or stepwise.

The lacunar type affects small arteries. It is formed mainly in the subcortical areas and has a small lesion. Among the main provoking factor is hypertension.

Hemorrhagic stroke

Intracerebral hemorrhage may be due to trauma. In addition, among the main causes of hemorrhagic stroke, it is necessary to highlight the abnormal permeability of the vessel walls. As a result of this, their rupture and blood release occurs, which leads to blocking of the function of the brain regions. Basically, the permeability of the vessels changes due to frequent arterial hypertension.

With this type of disease, brain cells are damaged. The causes of hemorrhagic stroke are caused by blood clots and vascular spasms occurring against the background of:

• vitamin deficiency;
• intoxication;
• atherosclerosis.

In addition, the violation can occur under the influence of high blood pressure, triggered by hypertension. Intracerebral hemorrhage occurs completely unexpectedly when the vessels rupture. Often, this condition occurs during the day under the influence of significant psychological and physical stress and stress.

Subarachnoid stroke

The causes of a subarachnoid stroke are associated with a head injury or ruptured aneurysm. Damage to a blood vessel located on the surface of the brain provokes the release of blood into the space located between the meninges.

Among the irritating factors, it is necessary to highlight the use of drugs, anemia, poor blood clotting. Often, this type of hemorrhage is localized in the lower part of the brain, as well as on the surface.

Causes of occurrence

Despite the fact that age is the main provoking factor, however, among the main causes of stroke, one should also highlight such as:

• hereditary factor;
• smoking;
• improper nutrition;
• lack of physical activity;
• the presence of concomitant diseases.

In people who have had a stroke, there are mainly several provoking factors. The elderly are at greatest risk, especially if they often have high blood pressure, are sedentary and overweight. However, young people are also not immune from the occurrence of this disease.

Stroke is often observed in men, but kills more often in women. This is largely due to the average life expectancy. The causes of stroke in women can be associated with contraceptive use and pregnancy.

Race is also important. Most often, the disease affects members of ethnic minorities. The biggest difference is observed in young people. According to the research carried out, socio-economic factors have a great influence.

Tobacco smoking should be singled out among the main causes of stroke in men and women. If a person smokes a pack of cigarettes a day, then his risk of developing the disease is much higher than that of nonsmokers. It can remain very high for up to 14 years after quitting smoking.

The main causes of stroke in young people include alcohol abuse and drug use, especially methamphetamine and cocaine. In addition, anabolic steroids that attach to sports accessories and athletes' clothing significantly increase the risk.

Taking anti-inflammatory drugs and frequent stress can lead to the onset of the disease.

The onset of the disease in childhood

The causes of stroke in children are mainly related to factors such as:

• congenital anomalies of cerebral vessels;
• hemolytic anemia;
• dangerous infectious diseases;
• DIC syndrome.

Since the child's nervous system is able to recover, with proper timely treatment, it is possible to achieve the normalization of well-being and brain functions.

Main symptoms

The first signs of a stroke are very dependent on the location and size of the lesion. It is worth noting that the symptoms of hemorrhage can be more pronounced, and with extensive lesions, the patient's death mainly occurs. In a person who has felt unwell, vascular disorders can be assumed by such signs as:

• numbness in some parts of the body;
• loss of control;
• headache;
• double vision and visual impairment;
• sensory and movement disorders;
• vomiting, dizziness, nausea.

All these symptoms can be recognized only by the patient himself, provided that he is conscious. However, often acute cerebrovascular accident causes from which the patient cannot get out.

It is imperative to know what the causes and symptoms of a stroke are, so that you can provide timely medical assistance to the victim. It is worth remembering that you cannot shake a person in such a state, try to sit down, since such actions will only aggravate the state of health.

In the acute period of any type of stroke, neurologists distinguish cerebral and neurological disorders. The development is based on hypoxia caused by ischemia or increased pressure and hemorrhage. Among the main symptoms are:

• severe headaches;
• violation of consciousness;
• nausea and vomiting;
• convulsions.

Neurological manifestations indicate damage to a specific area of ​​the brain. Among the main symptoms are the following:

• violation or complete loss of motor functions;
• violation of sensitivity on the opposite side of the lesion;
• change in eye position;
• drooping of the corners of the mouth;
• speech disorder;
• the emergence of pathological reflexes.

All these signs are very important in terms of prognosis, as well as determining which part of the brain is affected.

If the lesion has affected the subarachnoid space, then this is accompanied by:

• severe headache;
• severe cerebral symptoms;
• the occurrence of a coma.

Neurologists consider a brain stem damage to be a dangerous condition, since in this area the most important nerve centers are concentrated, ensuring the vital activity of the body. In this case, a stroke becomes the cause of the patient's death, since a very severe hemorrhage occurs. Among the main symptoms, it is necessary to highlight:

• loss of consciousness and coma;
• bilateral paralysis;
• violation of sensitivity;
• violation of swallowing function;
• deterioration of breathing and cardiac activity.

Extensive hemorrhage in the ventricles of the brain poses a very serious threat to the patient's life. Among the main signs, it is necessary to highlight a sharp impairment of consciousness and a coma.

Hemorrhage in the cerebellar region threatens with a very rapid development of edema, which leads to the death of the patient. Among the main signs of such a condition, it is necessary to highlight:

• severe headache in the back of the head;
• vomiting;
• dizziness;
• lack of coordination;
• speech disorder.

Since the frontal lobes are responsible for many functions that determine personality, their defeat leads to mental disorders, as well as seizures. Human behavior changes very dramatically almost beyond recognition, however, paralysis, motor and speech disorders are also observed.

With damage to the temporal region, there are signs such as:

• hearing impairment;
• loss of the ability to perceive sounds;
• the formation of temporal lobe epilepsy;
• hallucinations.

It is imperative to know what the main causes of stroke and the symptoms of the disorder may be, as this will allow timely assistance to the patient, which increases his chances of recovery.

Diagnostics

The causes of a brain stroke can be very different, as well as its symptoms. However, it is very important to carry out timely comprehensive diagnostics in order to detect the disease. The sooner it can be diagnosed, the better the prognosis for the patient and the more chances of recovery. Diagnostics includes:

• physical and neurological examination;
• study of the patient's medical history;
• laboratory tests;
• display tests.

Many of these procedures are used to assess the risk of major strokes in the future. For patients whose lesion is very severe, first of all, it is necessary to determine the type of the course of the disease, since drug therapy is prescribed on the basis of the data obtained and some drugs are most effective only in the first 3-4 hours after the lesion. However, if the disease was provoked by bleeding, then these drugs will only increase it, which will lead to the death of the patient.

To carry out diagnostics, such techniques are used as:

• dopplerography;
• tomography;
• angiography;
• electrocardiogram;
• echocardiography.

Doppler ultrasound examines blood circulation in veins and arteries using ultrasound. This test can detect the presence of blood clots, impaired blood flow, and many other problems. High-frequency sound waves are directed to the desired area of ​​the brain.

Tomography allows you to distinguish between ischemic and hemorrhagic stroke. Angiography is an invasive procedure with deep penetration into the patient's body. It can be used in case of need for an operation, and also allows you to detect an aneurysm.

An electrocardiogram evaluates the activity of the heart muscle and its features, which is important for examining a patient. Echocardiography is used to look at the valves and chambers of the heart. This will help determine if there are blood clots or risk factors for blood clots.

First aid

Regardless of the cause of the stroke, first aid must be provided in a timely and correct manner. The most important thing is to immediately call an ambulance, and before the doctor arrives, you need to take off all excess clothes and unfasten your belt. Then lay the victim on a pillow so that the head is above the level of the bed.

Provide an influx of fresh air into the room, as well as periodically measure the pressure so that the doctor understands the peculiarity of the condition. If the pressure is increased, then it is worth giving the patient the drug that he usually took to lower it. If there are no required medicines in the house, then you just need to lower the patient's feet into hot water.

In case of nausea, you need to take all measures to prevent vomit from entering the respiratory tract. The stroke patient is transported strictly in the supine position.

Treatment

The causes and treatment of a stroke can be very different, it all depends on the individual characteristics of the patient, as well as the type of disease. The most important thing is to take action in the first 6 hours after the attack. Treatment begins with correcting problems with the heart and respiratory system. The normalization of cerebral circulation, as well as stabilization of the blood composition, is of great importance.

For cerebral ischemia, a drug such as "Aktilize" is used. In addition, anticoalulants are required, for example, "Fragmin", "Heparin", neurophrotic drugs - "Glycine", "Piracetam". Since the patient may have blood clots, its thinners are required, for example, Cardiomagnyl, antiplatelet agents - Tiklid, vasoactive agents - Sermion, Trental.

Since the causes of hemorrhagic cerebral stroke are associated with rupture of blood vessels, it is more severe than ischemic. In the presence of hemorrhage, consultation with a neurosurgeon is required, as well as an operation to remove a blood clot or clamp the vessel.

It is worth remembering that there are no effective medications for the treatment of this disease. Drug therapy is prescribed only to prevent complications and prevent recurrent stroke.

Regardless of the causes of stroke in men and women, as well as their age, after treatment, complex rehabilitation is required. Violation of cerebral circulation leads to the formation of a pathological focus in the brain, and the cells around it are in a state of decreased activity or complete inhibition. Timely therapeutic measures will help restore their activity.

It is necessary to start carrying out rehabilitation measures while the patient is in the hospital. Much depends on the psychological mood of the patient. All ongoing recovery activities are monitored by a neurologist or a rehabilitation therapist. Rehabilitation includes:

• medications;
• physiotherapy;
• massage;
• psychotherapy;
• physiotherapy exercises.

It is also important to educate the patient about lost or impaired skills. In patients who have had a microstroke, they recover literally within a month.

It is very important to clearly and systematically perform all the exercises recommended by the doctor, without missing a single day. The peculiarity of carrying out physiotherapy exercises must be coordinated with the treating doctor.

With a long recovery period and a tendency to spasms, massage has a good effect. Its correct implementation significantly improves blood circulation in tissues and helps to reduce congestion. In addition, massage helps to regulate muscle tone.

For the treatment of speech disorders, the help of a speech therapist-aphasiologist is required. Performing training exercises according to special methods, the patient can begin to pronounce words much faster, and then whole sentences. Memory recovery is also required. It is very important to provide psychological comfort for the patient, as this will facilitate faster recovery.

The consequences of a stroke

The causes and consequences of a stroke must be considered first of all in order to prevent deterioration of health and to recover quickly. The consequences depend on a variety of factors, in particular, such as:

• the degree of damage;
• localization;
• speed of assistance.

Some of the effects may be temporary, and the patient quickly bounces back. More severe brain damage provokes various complications. As a result, the patient's movements become difficult or impossible to perform. When gait changes, additional support may be required. In addition, the disease manifests itself in the asymmetry of the face. This affects the cheeks, mouth and lips. This causes very severe discomfort when consuming food or liquids, and also leads to a visible cosmetic defect.

Very often in a person, after a stroke, there is a violation of sensitivity, which is characterized by the lack of the ability to feel heat, cold, pain, or even the part of the body itself. In addition, the consequences can be manifested in the development of pain syndrome, which can be different in intensity and localization.

How long do people live after a stroke

Regardless of the cause of a stroke in women and men, no one can say for sure how long they live after a disease. Each case is different, as is the person affected by this disorder. According to statistics, 35% of deaths occur in the first month after treatment, 50% - in the first year. Sometimes death occurs almost immediately, and in some cases, a person can live for a very long time and almost completely recover.

The most common causes that lead to the death of a patient are:

• smoking;
• diabetes;
• hypertension;
• atherosclerosis;
• heart diseases.

When two or more factors are combined, the risk of death increases significantly. To increase life expectancy, you need to carry out preventive measures and lead a healthy lifestyle. Especially carefully you need to follow all these recommendations in the first months after brain damage, since during this period there is a high probability of relapse.

Possible complications

There are a variety of causes of stroke in men and women, which lead to very dangerous complications, which is why, in order to normalize health, you must strictly follow all the recommendations of the attending doctor. Complications after a previously suffered stroke are associated mainly not with the disorder itself, but with the patient's prolonged stay in a supine position.

As a result, bedsores are common. Their development begins with the formation of blue-red areas and gradually tissue necrosis occurs. This is a very painful process and difficult to treat.

In addition, pneumonia is considered another dangerous complication. Its development is due to the fact that the process of expectoration is disrupted. Due to stagnation, it accumulates and becomes infected.

Thrombosis in bedridden patients is often hidden under the edema of paralyzed limbs, which significantly aggravates the situation. When a blood clot is torn off, the consequences can be very dangerous. Lack of movement often leads to deterioration of intestinal motility, which can lead to the development of an inflammatory process, as well as intestinal obstruction.

Coma is a common complication of stroke. The prognosis for this condition can be different and strictly individual, however, it is worth preparing for a long rehabilitation period and making every effort to recover.

Prophylaxis

Since the reasons for the elderly can be very different, it is important to carry out comprehensive prevention in order to prevent the development of such a condition. This disease is much easier to prevent than to cure for a long time. Preventive measures include:

• correct organization of work and rest;
• sleep regulation;
• good nutrition;
• prevention of stress;
• limiting salt in the diet;
• timely treatment of cardiovascular diseases.

The best way to avoid stroke is to prevent atherosclerosis and other heart disease. Monitoring your blood pressure and getting tested for diabetes is very important. If necessary, the doctor will prescribe medications that normalize the microcirculation of the cerebral vessels, and it is also possible to take medications that prevent the development of hypoxia.

After suffering a stroke, it is important to prevent its recurrence. The risk is significantly increased with hypertension, heart valve pathology, arrhythmias, diabetes, heart failure. Prevention should be continued for at least 4 years and a healthy lifestyle should be maintained.

Vascular dementia is one of the most unfavorable variants of the course of chronic ischemic brain disease. Our consultant: Nina Minuvalievna Khasanova, angioneurologist at the First City Hospital in Arkhangelsk.

It is noticed that this disease occurs, as a rule, in old age. The cause of dementia after a stroke is associated with damage to the part of the brain that is responsible for memory or the performance of any skills.

Vascular dementia (dementia) is a combination of signs that are manifested by a deterioration in memory, thinking, a decrease in the ability to perform skills in everyday life, which either stops or significantly complicates the patient's independent life and his usual work.

Vascular dementia after a stroke is not necessarily an emerging symptom. This condition occurs with severe damage to the brain tissue or as a result of repeated stroke against the background of uncontrolled arterial hypertension.

If a person after a stroke becomes apathetic, tearful, quickly emotionally depleted, his mental abilities deteriorate, he ceases to be interested in the life of his family, friends, this may be the first sign of advancing dementia, which requires a doctor's examination for timely treatment.

The onset of post-stroke dementia, unlike, for example, Alzheimer's disease, is acute. For example, even on Wednesday a person behaved normally, and on Thursday morning he became aggressive, uncontrollable, his memory sharply deteriorated. It is very important not to look at the patient with a second stroke: it can hide behind such a sharp deterioration in well-being. Therefore, each such situation is an indication for a medical examination and an ambulance call.

Vascular dementia as a disease can occur with light intervals. This disease, as it were, erases the skills that a person has acquired throughout life.

Dementia after a stroke is necessarily combined with coronary heart disease, diabetes mellitus, and arterial hypertension. In this case, there are always changes in the vessels of the brain, neck, fundus. Patients must periodically be examined by a cardiologist to provide assistance and the selection of concomitant therapy.

The risk of developing post-stroke dementia depends on how closely relatives or the patient himself monitors his blood pressure, cholesterol and low density lipoprotein levels and their correct ratio, blood viscosity, how carefully all the recommendations of the attending physician are followed.

Unfortunately, modern medicine does not have the ability to effectively treat dementia and prevent its progression. Prescribed drugs can only relieve or weaken certain unpleasant manifestations of the disease, partially slow down its development. Therefore, the leading role in helping patients with dementia belongs to the daily full-fledged care for them.

The most important thing:

1.Try to prevent the development of infectious diseases and the worsening of the course of the somatic illness of your loved one, as this negatively affects the course of dementia;

2. Create a comfortable and simple environment: familiar favorite items, their location. In a familiar environment, the patient feels most comfortable. The appearance of strangers in the house, the move sharply worsen his condition. In the room where the patient is, there must be a firmly established and habitual order for placing clothes, shoes, and other everyday items;

3. Monitor the regimen of taking prescribed drugs. Their irregular intake or overdose can dramatically worsen the patient's condition.

Patience is required!

When communicating with a loved one, a patient with dementia, never forget that you are communicating with a sick person who has a mental disorder, many character traits that attracted you have been lost, and behavior has changed (alas, not for the better). Remember that against the background of rare temporary improvements, the disease, as a rule, will intensify, the patient's condition will worsen. Personality change progresses, emotional attachments to loved ones and the ability to empathize weaken, grumpiness, stubbornness and resentment increase.

In the future, the orientation in time, space, environment is disturbed. Patients do not know the date, can get lost in a familiar place, do not always understand where they are, do not recognize friends and relatives. And although such a person can serve himself, he copes with personal hygiene, but he already loses the skills to use everyday household appliances, such as a telephone, gas stove, TV remote control, etc. Then he can no longer be left alone unattended.

Vascular dementia rarely reaches the degree of deep total disintegration of the psyche., but over time, a sick person becomes a heavy burden for others and relatives. Here are some excerpts from relatives' stories about their loved ones with dementia.

“After the stroke, the mother-in-law changed a lot, became unkind, suspicious, capricious. A person simply cannot be recognized! Her general health is now quite good, she even goes out to breathe on the bench at the entrance. There he tells all sorts of fables to his neighbors: either I was going to poison her, then we don't let her sleep at night, then we lock her in the toilet. Her husband talks to her, shames her, but she either denies her stories, even yells at him or cries that we are slandering her. Once I came home from work - it smells strongly of gas. The burner valve on the stove is open. Now we shut off the gas and leave the food in thermoses ”.

“I’ll give my mom some food, which we eat right away, and she says that it’s not a pig to eat something like that, but throws a plate away. I take her hand to lead her into the room or the kitchen - she starts to twitch, screaming that I am hitting her. After a stroke, my mother has been living with us for almost three years, but recently she wants to return home. We have to, when we leave, lock it with a key, since I left once. We missed it literally 15 minutes later, but she's gone! Searched all evening, night, morning. They called all her relatives, friends, hospitals, morgues. We went around all the neighboring yards. Almost crazy! Well, an acquaintance works in the police, it was he who helped us (and the statement about the disappearance of a person is accepted only after three days). The next day, at 12 o'clock, they found her on the other side of the city. "

“Mom started talking a lot. Now he talks to an imaginary woman, then he calls me mom, then sister. She has completely stopped reading, she often cries. "

In such cases, do not try to persuade the sick, prove your case, appeal to their conscience, reason, logic. The person's personality has already been changed by the disease. This is not the same mother, mother-in-law, wife, not the same father, husband, whom you have known all your life. You just need to remember: everything that your loved one does and says is not due to his malicious intent, cunning, harmfulness. This is a manifestation of the disease. Therefore, try to be patient with his "whims", "antics", be attentive, benevolent and sensitive in communicating with him, because he still remains your loved one!

Also, keep in mind that dementia is one of those
diseases that need to be treated before the first signs appear, therefore
medical supervision and implementation of recommendations for the treatment of chronic
diseases affecting the vascular system is the key to high-quality
and a fulfilling life at any age.

Stroke prevention steps

Finishing the story about the consequences of a stroke, I would like to remind you once again: in many cases, a vascular catastrophe can be avoided; for this, the main attention should be paid to prevention. The most significant factors that can be corrected include arterial hypertension, coronary heart disease, diabetes mellitus, smoking, increased body weight, and high cholesterol levels.

• Physical activity is an effective factor in the prevention of obesity, type 2 diabetes mellitus, and arterial hypertension. During physical education, the properties of the blood improve, the risk of thrombus formation decreases.
• Diet aimed at preventing atherosclerosis: limiting foods containing cholesterol and animal fats. Eat more fruits, vegetables and grains, vegetable oil, and sea fish.
• Smoking cessation: Nicotine causes vasoconstriction and stimulates the progression of atherosclerosis.
• Blood pressure control: arterial hypertension and atherosclerosis are closely related diseases, therefore, their treatment and prevention must be carried out in parallel.
• Control of blood fats: a violation of the lipid composition of the blood leads to the development of atherosclerosis, which increases the risk of stroke.
• Combating diabetes mellitus: This disease is associated with an increased risk of vascular damage and intense development of atherosclerosis.

Material: Irina Shaposhnikova

Stroke is a serious disease that often leads to death or disability. This is not surprising, because with a hemorrhage in the brain or an interruption in the supply of oxygen to it, part of the nerve cells irreversibly die. Recovery from a stroke is possible thanks to the plasticity of the brain - the ability to assign lost functions to previously unused cells and form new neural connections. The effectiveness of this process strongly depends on the time that has passed since the crisis; therefore, efficiency at each stage of treatment is important.

Initially, patients are admitted to the intensive care unit, then to a neurological hospital. After that, the longest and most directly dependent on the patient and his loved ones stage - the rehabilitation period - passes.

The effectiveness of rehabilitation after a stroke and its duration depend on many things: the timely detection of symptoms and the initiation of treatment, the type and severity of the stroke, the general health of the patient, the presence of concomitant diseases or senile dementia, the patient's age. The mental state of the patient and his willingness to make efforts to recover from a stroke, in order to return to a full life, and the support of relatives are also important.

The recovery period after a stroke can range from 1 month to 2 years. Some are able to rehabilitate almost immediately, others remain permanently lying disabled, and they are not even assigned rehabilitation measures. Therefore, the referral to rehabilitation should be assessed as luck. 85% of those who have suffered an ischemic stroke manage to return to full life in a year and a half, and two-thirds of these people recover in the first 3-4 months.

Is it possible to completely restore the brain after a stroke? Unfortunately no. Instead of damaged areas of nerve tissue, fluid-filled voids are formed, which affects the loss of certain functions. A stroke leads to impaired memory and speech, coordination, especially fine motor skills, mental disorders, loss of control over one side of the body. From here we get the answer to the question of how to recover from a stroke - you need to return the lost abilities or compensate for them with new ones. You should not hesitate - neural connections are most easily formed if you start classes immediately after overcoming the crisis. It is important not to give up until the functions that require prolonged exercise are restored, to continue taking the necessary medications.

Complex of rehabilitation measures

Stroke recovery includes the return of psychological and physical health, speech and memory functions, and prevention of relapse through blood pressure control, healthy eating, giving up bad habits and making lifestyle changes for the better. How long the rehabilitation will last depends on the sequence of the patient regarding the instructions of the supervising doctors.

Physical component

Physical rehabilitation for stroke includes active (physiotherapy exercises, or exercise therapy) and passive measures (massage, magnetotherapy, physiotherapy) to restore motor functions. The latter often seems preferable to patients, but it is not able to replace physical exercise. If there is a financial opportunity, rehabilitation after a stroke at home may include an invitation to an exercise therapy specialist, however, visiting a rehabilitation center and exercising with other patients will give the maximum effect.

Some of the exercises are available while still in bed. Often, stroke survivors have excessive toned limbs, which can become stiff in an awkward position. In such cases, you need to gradually increase the range of motion and relieve muscle tension. Passive gymnastics with a gradual connection of the patient's efforts is possible. The following measures are available:

After a stroke, the arm needs to be exercised, bending and unbending the fingers, the hand.

By moving the limbs in the joints, you can gradually regain control of the body.

Rotational movements, available to a healthy person, help the patient to perform the caregiver.

Stretching the limbs bent with spasm is a measure of combating paralysis, when the fingers, and then the whole hand, are fixed with bandages to a flat object for half an hour or more.

A patient who has succeeded in restoring his arm after a stroke can perform manipulations with a towel hanging over the bed, making all possible movements with it. After that, the towel is lifted and the exercise is made more difficult by the patient's weight.

The rubber ring can be stretched between the limbs in different combinations.

An ever larger roller, placed under the knee, serves to restore the functions of the leg.

The patient can help himself with his arms in flexion and extension of the legs, alternately grabbing the lower legs and leading the feet along the bed.

Reaching out to the back of the bed, the patient can, as it were, pull himself up, while simultaneously stretching the feet and toes.

Another set of exercises available to bedridden patients is gymnastics for the eyes (movements from side to side, circular movements, focusing on near and distant objects, blinking, strong shutting their eyes).

A stroke survivor undergoes gradual recovery, then proceeding to gymnastics in a sitting position. It focuses on the transition to targeted movements and preparation for walking. Patients perform:

• alternate leg raises;
• joining the shoulder blades and tilting the head back on inhalation with relaxation on the exhale;
• arching the back back on inhalation with relaxation on exhalation.

After that, it is the turn of standing exercises and returning to subtle movements. The complex includes:

• lifting small items from the floor or table;
• stretching with raising the arms while inhaling and returning to the starting position while exhaling;
• torso tilts;
• exercises for hands, including with an expander;
• exercise "scissors";
• squats.

Finally, the patient can actually go to exercise therapy. It is worth working out diligently, since the length of stay in a rehabilitation center is short. You should not even allow overwork: all exercises must correspond to the current capabilities and condition of the patient.

Before the lesson, the muscles are warmed up with a warm-up, warm water procedures, a heating pad or massage. The presence of loved ones in the classroom will have a positive effect, who can not only help the patient to perform the exercises, but also convince him of the benefits of diligent practice.

Exercise therapy is aimed at restoring movements in the same volume, maintaining balance, walking, performing household operations and switching to self-service. After all, the habitual dressing or eating for stroke survivors suddenly becomes difficult operations.

In the early stages, passive measures can be used. They will not replace exercise therapy, but they will help prepare the patient for gymnastics. These include electrical stimulation, massage, magnetotherapy and physiotherapy. Currently, an effective tool is the method of biofeedback, when a patient, using a computer program or a game, performs tasks, receiving, together with a doctor, sound or visual signals about the functioning of the body.

Mental component

Not surprisingly, a stroke is an ordeal, often causing depression or apathy. Patients become irritable, hot-tempered and aggressive, having lost their former ability to control emotions. Often they themselves do not notice how difficult they have become in communication. The patience of relatives, their warmth and support are important in order to avoid the crisis and undergo psychological rehabilitation after a stroke.

It is necessary to maintain good spirits and optimism, and if you notice the symptoms of depression, start treatment. Modern medicine will cope with it with the help of dietary supplements or psychotherapy. However, all drugs must be prescribed by a doctor, including antidepressants. A good option would be a specialized sanatorium, which allows you to change the setting and conduct complex therapy.

Recovery of speech and memory

If the corresponding centers of the brain are damaged, the return of functions will be gradual. A speech therapist should deal with a patient who has lost speech, and relatives should constantly talk. Another obstacle on the way to full-fledged communication is the "freezing" of facial muscles, eliminated by the following exercises:

• grinning;
• folding the lips into a tube;
• light biting of the lips;
• pushing the tongue forward;
• licking lips in different directions.

First, the pronunciation of sounds is returned, then - of words. Singing heard by the patient and trying to reproduce it will be an excellent help. The patient can say part of the word so that he ends it. A good effect is the repetition of rhymes and tongue twisters.

Taking certain medications helps to restore memory. The rest of the process resembles working with children and includes memorizing and repeating numbers and phrases, activities in a playful way, board games that allow the patient to focus on one action. It is useful for a stroke survivor to remember and describe what happened to him over the last day, week, month, etc.

Return to normal life

Someone gets the opportunity to return to home conditions almost immediately, but much will inevitably undergo changes. New restrictions will appear, and familiar things will require re-getting used to them. It will be necessary to constantly measure blood pressure and adhere to all the recommendations of doctors. How to live after a stroke to stay healthy and avoid relapse?

Diet

The patient's diet should be balanced. There are no significant restrictions, but it may be advisable to predominate in food products that do not linger in the intestines and do not cause constipation, that is, vegetables, fruits, cereals. Less salty, acidic and spicy foods will reduce the load on the urinary system. Avoiding coffee and tea from the diet will have a beneficial effect on blood pressure, and avoiding fatty foods and fast carbohydrates will help keep blood sugar levels normal, which will also reduce the risk of another stroke. Refusal of only one thing - alcohol should be uncompromising.

Citrus fruits and pine cone tincture are shown for those who have suffered a stroke - a folk remedy, phytoncides of which maintain a good state of nerve cells. It is also useful to drink an increased amount of liquid, 2-3 glasses per day.

Dwelling

After taking the patient home, relatives must strictly follow the recommendations of specialists on how to care for a patient after a stroke. Changes to an apartment can take a long time. We'll have to remove all dangerous objects that can fall on the patient. Carpets, wires, etc. may result in a fall. If the patient uses a walker or a wheelchair, it is necessary to provide him with free access to all rooms, to think about overcoming steps or thresholds.

More independence will be provided by handrails in the bathroom, a bench in the shower, a special toilet seat. A shower, by the way, is preferable to a bath. A thermometer in it will save a patient with decreased heat sensitivity from burns. Consider unbreakable dishes and small chairs for the patient to lean on. It will also be useful to install the handrails by the bed and in general in any place where a stroke survivor will get up and sit down.

When walking outside the home on their own, it is worth equipping a person with a mobile one with a one-button call function in case of a fall or repeated stroke.

Work

Here we are dealing with a double-edged sword. On the one hand, returning to this part of life will be an important part of socialization. On the other hand, mental changes and physical limitations may require early retirement or mastering a remote profession. It is important not to rush back to the workplace, to make sure that the necessary features are fully returned. If this is not the case, you should be optimistic about the time that is free for your favorite hobby and communication with your family.

Personal life

Sex for stroke survivors is not only acceptable, but also beneficial in terms of rehabilitation. Violation of motor skills, apathy, and troubles from the genitourinary system may affect (potency and sensitivity decrease). However, with a successful coincidence of circumstances, an active sex life will help to establish an emotional state and make the patient happy again.

Update: October 2018

Currently, not only mortality from strokes, but also a high percentage of disability is a huge problem. Rehabilitation for people who have suffered a stroke is very important, as it allows you to reduce this percentage, as well as reduce the depth of neurological deficit.

Rehabilitation measures can reduce the patient's dependence on outsiders, which improves his quality of life, and is also important for his relatives.

In this article, we will consider what exactly the consequences of a stroke may be, what opportunities exist for their correction. You will become aware of the benefits of undergoing rehabilitation measures in a hospital, as well as what are the contraindications for this and what you can do at home.

Neuroplasticity or why you can recover from a stroke

The task of neurorehabilitation is to restore or, in the absence of the possibility of complete recovery, to partially compensate for the impaired functions of the nervous system.

This is based on complex mechanisms of neuroplasticity. Neuroplasticity is the ability of a nervous tissue to rearrange itself after damage.

It should be remembered that in this way the area of ​​the brain that has suffered as a result of an ischemic or hemorrhagic stroke is not restored. Those nerve cells that have died will not recover. New neurons also don't appear. Therefore, restoration is possible only due to the fact that other neurons will take over the function of the lost ones. This happens due to those neurons located near the lesion, in which irreversible changes have not occurred. This process is long, at this time various rearrangements occur both at the structural and biochemical levels. It should also be borne in mind that with a large brain damage, complete recovery should not be expected, since the possibilities of neurons for neuroplasticity are not unlimited.

It is believed that these processes can go on during the year, after a stroke, most actively, in the first months. Therefore, rehabilitation measures should begin as early as possible, even in the acute period of a stroke, already in the first days, as far as the patient's condition allows.

Restoration of lost functions

The consequences of acute disorders of cerebral circulation can be different, it depends on where the focus of the brain damage is located. With the defeat of the centers responsible for the movements, the ability to move the limbs from the side opposite to the focus will be completely or partially lost. If the speech center is damaged, speech will be impaired or may be absent altogether. All other neurological disorders resulting from a stroke can be correlated by the same principle. Further, we will more specifically consider the possible neurological syndromes.

• Hemiparesis or hemiplegia is a violation of motor function.
• Hemiparesis is a partial loss of strength in the limbs on one side (only on the right or only on the left).
• Hemiplegia is a complete loss of the ability to move the limbs on one side.

Impaired motor function can be manifested by muscle weakness, leading to a limitation of the range of movements up to their complete immobility in the affected limbs. In mild cases, impaired motor function can be manifested by awkwardness of movements and rapid fatigability.

Muscle atrophy in the affected limbs can often develop. This is due to the fact that the muscles of these limbs do not have the necessary load, as a result of which they atrophy, which complicates the rehabilitation process. Therefore, from the first weeks, it is necessary to carry out active or passive gymnastics, if it is impossible to carry out active gymnastics due to deep paresis, cognitive impairment or impairment of the level of consciousness. The best option for such gymnastics is a physical therapy doctor.

Also, spasticity is a violation of motor functions. This is an increase in muscle tone in the affected limbs. This aspect also requires attention, since it has a negative impact on the implementation of movements, restoration of walking and self-care.

With severe spasticity, the usual pathological position of the limb is formed. With increased muscle tone, it is difficult to straighten a limb or, for example, fingers of the hand. It also threatens the appearance of flexion contacts - limitation of passive movements in the joint. When this problem is identified, regular therapeutic exercises are necessary, prevention of the formation of the usual position of the limb, for example, if, due to spasticity, the fingers of the hand are constantly bent, it is necessary with a healthy hand or with the help of an outsider to unbend them and fix them in this position. The use of orthoses is also effective.

In some cases, the attending physician may prescribe some drugs that help to temporarily reduce the increased muscle tone, but this will be ineffective or not effective at all with formed contractures.

Most often, with a hemispheric stroke, the restoration of movements occurs first in the lower limb, then in the upper limb, later in the hand, this is due to the peculiarities of the blood supply to the brain. But this pattern is not 100%. Everything can be individual. Movement recovery can begin as early as the first days after a stroke. However, if there is no dynamics during the month, then the forecast for further recovery of movements is highly doubtful. The most effective time for motor rehabilitation is the first 3-6 months after the onset of the stroke.

Basic methods of motor rehabilitation

Physiotherapy

Therapeutic gymnastics includes physical exercises aimed at general body training, exercise tolerance training, as well as special exercises aimed at restoring lost functions.

The complex of physical exercises carried out by the exercise therapy doctor is selected individually based on the motor deficit of a particular patient. Exercises are aimed at increasing muscle strength, increasing the range of motion in the joints, reducing muscle tone, improving coordination, learning to stand and walk.

The restoration of walking takes place in several stages: imitation of walking while lying down, sitting, training in standing and maintaining balance, training in walking with a 4-support cane within the ward, training in walking on stairs, walking outdoors. During the recovery of walking, the important point is the correct positioning of the leg. It is not uncommon that as a result of a stroke, the walking skill is lost; in this case, it is necessary to control the position of the foot, knee and hip joints. Physicians of physiotherapy exercises know how to do it correctly.

A person with severe motor impairment should not be expected to be able to walk immediately. This requires a long time, the work of specialists and the work of the patient himself. The restoration of walking function is not always possible, it depends on many factors - from the patient's motivation to the extent of the brain damage. It is often possible to meet a person who, even years later, still does not walk well after a stroke, often the deficit can persist for a lifetime. But rehabilitation helps to reduce this deficit to the minimum possible.

Verticalization

Verticalization implies bringing the patient into an upright position as far as the motor deficit allows. The minimum level of verticalization is considered to be the raising of the head end of the bed. Next, a half-sitting position in bed, then a sitting position in bed, then sitting in a bed or chair with lowered legs. It is necessary to start verticalization from the first days and continue it continuously, if the general condition of the patient allows it to be done.

The importance of these activities can hardly be overestimated. With a prolonged stay in a horizontal position, there is no work of the muscles of the back, limbs, the tone of the vessels changes, and the longer the patient is only in the horizontal position, the more difficult it will be in the future to teach him to sit and “accustom” his vessels to the vertical position.

Orthosis therapy

Orthosis therapy is the use of special fixation functional devices. They are necessary for the temporary immobilization of individual segments of the musculoskeletal system. They are effective in treating contractures and to facilitate movement recovery and stability while improving gait function, such as protecting the knee or ankle. The need for this method is determined by the exercise therapy doctor.

Massage

Massage can help to combat spasticity in the limbs, as well as to improve tissue trophism. But this method is only auxiliary. Since it has been proven that the methods used in rehabilitation, in which the patient does not take an active part, have practically no effect.

Physiotherapy

Physiotherapy includes electrical stimulation. This method is used to prevent atrophy and reduce spasticity. Provides a training effect. This method will not teach muscles to contract voluntarily, it only prevents muscle tissue atrophy. This should not be assumed to restore movement.

Full or partial restoration of motor functions is possible with the joint work of a patient, a physical therapy doctor and a neurologist.

Hypesthesia - impaired sensitivity

When the area of ​​the brain responsible for sensitivity is affected, hypesthesia develops - a decrease in sensitivity. Its decrease will manifest itself in the limbs opposite to the side of the lesion.

Sensitivity, as a rule, takes longer to recover than movements in the limbs, this is due to the structural features of the sensitive nerve fibers.

To restore sensitivity, tactile stimulation can be used - irritation with cold temperature, vibration, pressure. Therapeutic gymnastics also plays a role, contributing to the awareness of the position of the limb in space.

Coordination disorders

When the cerebellum is damaged, coordination disorders develop - the accuracy and consistency of movements. They can manifest themselves in different ways: impaired stability when standing or walking, impaired coordination of movements, tremors. In a number of patients, there is a pronounced dysfunction of walking due to damage to the cerebellum. At the same time, the strength in the limbs can be completely preserved, the range of movements is full, but when performing purposeful actions (walking, getting up, trying to independently bring a spoon to the mouth), significant violations are revealed.

Rehabilitation of such patients consists in motor activation, balance training, motor skills training, fine motor skills training. Remedial gymnastics plays an important role in solving this problem. A special set of exercises is used to:

• Improving the accuracy of movements
• Improved coordination of movements
• Balance training and walking training
• Training fine motor skills and various hand grips

With concomitant dizziness, drug therapy is used to improve blood circulation in the brain and to suppress the excitability of the vestibular centers. The drug, doses and dosage regimen are prescribed exclusively by the doctor.

Speech disorders

It is often possible to face the fact that a person does not speak after a stroke, speech disorders appear in most patients, to one degree or another. Speech disorders occur when the speech areas of the cerebral cortex, subcortical structures or pathways are affected.

There are different types of such violations:

• Aphasia- a systemic disorder of speech activity that occurs when the speech center of the left hemisphere is damaged in right-handed people and the right one in left-handed people. Aphasia is often accompanied by impaired writing (agraphia) and reading (alexia). Aphasias are also divided into several types, in this article only the main ones will be indicated, the most common:
• Motor aphasia- violation of speech activity, manifested in the difficulty or impossibility of pronunciation of sounds, syllables, words. Secondarily, it may be accompanied by a violation of the understanding of another person's speech.
• Sensory aphasia- manifests itself in a violation of the distinction of specific speech sounds, respectively, manifests itself in a misunderstanding of the speech of others. As a result, the patient answers incorrectly to the questions posed, speech is disorganized, consists of a set of unrelated words.
• Amnestic aphasia- violation of the naming of objects, a person can describe why this object exists, but does not remember its name.
• Dysarthria- violation of the pronunciation of words due to insufficient innervation of the speech apparatus. The decay of the speech system does not occur, but the clarity of sound pronunciation, articulation, phonation and intonation coloration of speech suffer. Violations can be expressed to the point that others will not be able to understand the patient's speech.

Only a professionally trained speech therapist should be involved in the rehabilitation of such patients. Specialists conduct correctional sessions with such patients, selecting exercises individually based on the type of speech impairment. In some cases, "disinhibition" and stimulation techniques are needed, in others, on the contrary, it is necessary to slow down some processes. In parallel with classes on the restoration of speech, exercises are also carried out to restore reading and writing. The speech therapist teaches correct articulation, understanding of speech.

Gymnastics of the pharyngeal and pharyngeal muscles, articulatory muscles, massage of these muscles, training in the coordination of respiratory movements can also be performed.

Rehabilitation measures to correct speech should be started as early as possible, even in the acute stage of the disease. This promotes faster speech recovery. You should tune in to the fact that in case of gross violations, the restoration of speech function is a long process. If the patient does not speak after a stroke, then it will take a lot of time, recovery will not be limited by the time spent in the hospital, but will also require the involvement of specialists at the outpatient stage. Possible classes at home or in the clinic with a frequency of at least 2-3 times a week.

Swallowing disorders

Dysphagia is a violation of the act of swallowing, accompanied by choking when taking liquid or solid food.

This problem is very relevant for stroke patients, but not always enough attention is paid to it. The condition when the patient does not swallow after a stroke or swallows with difficulty is dangerous with a number of complications, which will be discussed below.

If the swallowing center is damaged, dysphagia of varying degrees occurs and requires different measures to correct the violation and ensure the safety of the patient.

Swallowing should be assessed in every stroke patient. In difficult cases, endoscopic techniques can be used to diagnose dysphagia.

In case of choking or any discomfort that occurs while drinking or eating, it is necessary to consult a specialist and select an individual diet.

The diet consists of a specific consistency of food suitable for a particular patient. When choking on the thickest food, a nasogastric tube is installed and feeding occurs only with its help. Special food mixtures are used. In this case, you cannot take anything by mouth! The patient receives all food and drink only through the probe. In the absence of correction of the violation, surgical techniques are used for a long time, a gastrostomy is installed.

In case of moderate or mild swallowing disorders, the consistency of food and drink is selected and strictly observed. Soups can be in the form of cream or mashed potatoes, drinking in the form of jelly, if this consistency is suitable according to the results of examination by a specialist. If necessary, special thickeners can be added to the food to create a thicker consistency.

With dysphagia, you should never give ordinary liquid (water, tea, juice) without a thickener!

The great importance of this issue is associated with the possibility of food and drink getting into the respiratory tract - aspiration. Choking is the evidence of aspiration.

Complications associated with dysphagia include:

• Tracheobronchitis
• Pneumonia
• Empyema of the lung
• Breathing disorder
• Exhaustion, dehydration of the body
• Sinusitis

In conditions of a resected stroke, especially if the patient's condition does not allow him to actively move independently, the likelihood of inflammatory complications is very high. That is why great attention should be paid to the nutrition of such patients. Preparation of food for them should be taking into account the degree of dysphagia and selected by a specialist.

Rehabilitation of patients with dysphagia does not have many options. These include:

1. Individual selection of food and liquid consistency.
2. Exercises aimed at training the muscles of the pharynx, mouth, larynx, which should be carried out by a specialist.
3. Physiotherapy - electrical stimulation of the muscles involved in the act of swallowing.

The possibility of changing the consistency of the consumed food is determined by the doctor or specialist in swallowing, and not by the patient or his relatives!

Cognitive impairment

One of the consequences of a stroke is cognitive impairment. The frequency and depth of such disorders correlates with the age of the patient. If the violation of cerebral circulation occurred against the background of the existing cognitive deficit, then there will be an aggravation of the existing symptoms and, probably, the appearance of new ones.

Cognitive impairments include:

• Deficit of attention, impairment of the ability to quickly orientate in a changing environment.
• Decreased memory, often short-term.
• Rapid exhaustion of mental processes.
• Slowness of thinking.
• Narrowing the circle of interests.

There are 3 degrees of cognitive impairment:

1. Mild degree - minimal cognitive deficit, the patient follows instructions, is oriented in place and space, controls his behavior, but there are disturbances in concentration, memorizing new material, and decreased mental performance.
2. Medium - orientation in place, space, a moderate decrease in RAM, mistakes in the execution of two-stage instructions can be violated.
3. Severe degree - dementia. Pronounced impairment of memory, intelligence, attention, social maladjustment.

A neuropsychologist examines such patients more thoroughly and selects the necessary exercises to train memory and thinking for a particular patient. If necessary, antidement drugs may be prescribed that require long-term administration.

Emotional volitional disorders - post-stroke depression

Depression is often one of the consequences of a stroke. Many relatives of patients consider this problem insignificant or deny its existence altogether; it is much more important for them to restore movement and speech. But this attitude to this problem entails consequences. Very often, against the background of depression, the restoration of lost functions is slow, classes become ineffective. With depression, motivation decreases up to its complete absence, existing cognitive impairments increase, the patient cannot and does not want to understand tasks and instructions. The patient becomes adynamic, inhibited. With the passive participation of the patient, the effectiveness of rehabilitation is minimal.

Appetite may also decrease, but if the patient does not eat after a stroke, this leads to nutritional deficiencies, which also complicates the rehabilitation process.

The cause of post-stroke depression can be both damage to certain areas of the brain, and awareness of the depth of the problem with continued criticism.

In this situation, not only the help of a psychologist is required, but also the use of antidepressants. The course of treatment should be at least 6 months long.

Occupational therapy

Ergotherapy is an area of ​​physical rehabilitation that helps a person to adapt to environmental conditions, as well as to restore movements in the upper extremities, by working with special simulators and game tasks (constructors, mosaics, "lacing"). Also, the task of an occupational therapist is to teach lost everyday skills.

A person who has suffered a stroke, who has insufficient strength and range of motion in his hand, is limited in everyday possibilities, which negatively affects the quality of his life. Therefore, the restoration of the functions of the upper limb, and especially the hand, is one of the most important tasks.

An occupational therapist teaches the skill of self-dressing, this is possible even with a complete lack of movement in one hand. Also teaches food intake, cutlery and dishes are adapted for such patients. They are taught daily hygiene skills - washing, shaving, brushing teeth. The use of familiar objects also requires attention - a mobile phone, a pen (learning to write, training handwriting), an iron, a remote control. Training is conducted taking into account the capabilities of each patient. Ergotherapy allows the patient to adapt to environmental conditions, taking into account the existing neurological deficit, which makes it possible to reduce dependence on others and improve the quality of life.

Pain syndrome

Sometimes you can come across a complaint that after a stroke a paralyzed arm hurts or a paralyzed leg hurts. Pain can be of both central origin and due to the formation of contractures. If in the first case, only a certain kind of drugs prescribed by a doctor can help, then the formation of contractures can be prevented by the early onset of exercise therapy. If contractures began to form, then it is necessary to continue physiotherapy exercises or start, if, for some reason, exercise therapy was not started earlier. In his free time from exercise, the patient himself or his relatives can passively make movements in the joints where contracture is formed, this will allow him to get rid of it sooner.

How to recover from a stroke at home

At the beginning of this paragraph, I would like to immediately draw attention to the fact that complete or meaningful recovery only at home is impossible!

Restoration of lost functions as a result of a stroke is possible only in a hospital setting, where many specialists will work with the patient.

All the possibilities of rehabilitation treatment must be used. Only a doctor can determine the presence of rehabilitation potential and the point of application of work.

After going through all possible courses of treatment, the patient returns home, unfortunately, the recovery does not always take place completely, moreover, there is almost always a deficit.

In this situation, we need to talk about the possibilities of home care.

• In case of impaired motor functions, the task of relatives is to activate the patient as much as possible, not to let him lie down for a long time, to sit in a chair for as long as possible, to do exercises, if possible, to walk - to move such distances that the patient can.
• In case of speech disorders, help to complete the tasks of a speech therapist (a set of exercises must be issued home), continue classes with a speech therapist on an outpatient basis.
• It is also very important to prevent various complications that may occur in bedridden patients, such as bedsores, pneumonia, nutritional deficiency, and constipation. For the prevention of bedsores, special mattresses are used, or the patient is turned over every 2 hours and the maximum possible activation.
• For the prevention of pneumonia - adherence to the recommended consistency of food with persisting swallowing disorders, and with normal swallowing function - breathing exercises and percussion chest massage.
• Food should be complete and varied, but according to some restrictions (reduced salt content in food, animal fats, etc.).
• Laxatives can be used to prevent constipation.

Relatives also need to pay special attention to adherence to the doctor's recommendations for taking medications, including for the prevention of recurrent stroke. Such drugs must be taken in strictly specified doses, constantly, without gaps. If the patient cannot cope with this on his own, then the relatives must ensure that the medication is taken in a timely manner.

In conclusion, I will say that in modern medicine, much attention is paid to the problems of stroke and recovery after it. The possibilities for neurorehabilitation are great, but it is worth remembering that a lot depends on the patient's condition, his concomitant pathologies, the volume of brain damage, so many patients do not recover completely, but any possibility of rehabilitation treatment must be used.