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Physiotherapy exercises after a mild stroke. The most acute and acute period. The main tasks of exercise therapy after a stroke

In our country has increased in recent years. But about 70 - 80% of all cases are due to the ischemic type of the disease, which is easier to treat. Patients have a good chance to restore fully or partially the injured person to legal capacity. A huge role here is played by exercise therapy after a stroke, which is prescribed by the attending physician.

The main and obligatory stage of rehabilitation is the implementation of special exercises.

There are different types of exercise focused on the respective cases and complications of the seizures. Only a specialist has to decide what training to carry out and with what intensity. You need to engage in active and passive physical activity, competently prepare for classes.

Preparatory stage

Before starting to carry out exercise therapy after a stroke, a person needs a period of adaptation and preparation. Any exercise that is included in physiotherapy exercises will be beneficial. The impact on the paralyzed parts of the body accelerates the blood, prevents its stagnation, and restores muscle memory. Yes, for rehabilitation after a stroke, it is not enough just to periodically engage in various exercises. Recovery is carried out in a comprehensive manner with the inclusion of physiotherapeutic procedures, medications, classes with a speech therapist, etc.

At first, training is carried out in a hospital setting, where the patient is placed after a stroke. Specialists will monitor and assist in the exercise. After discharge, the responsibility rests with the patient himself and his relatives, who will take care of him.


Preparation for exercise therapy after a stroke requires compliance with the following rules:

  1. If after that a person is partially or completely paralyzed, during the first 15 - 20 days, the effect on the muscles will be carried out only by changing the position of the body. This must be done carefully and according to the recommendations given by the doctor.
  2. It is recommended to turn the patient over every 2 - 3 hours. This way it is possible to avoid the formation of bedsores and prevent blood stagnation.
  3. Depending on the current state of the patient, after 1 - 2 weeks, passive remedial gymnastics begins after a stroke. If relatives do not know how to do it, it is recommended to seek the help of a nurse. She will show and tell you how to do this, after which loved ones will be able to do everything on their own. The task of such physical education is to relax the muscles and prepare them for subsequent loads.
  4. When the patient manages to make the first movement of the limb, which was paralyzed, you can proceed to active exercises. At first, only in bed, but gradually a person will be able to walk and move without assistance.

With positive dynamics of recovery and competent adherence to the rules of rehabilitation, even treatment at home will allow. Not always 100%, but the chances after an ischemic attack are good.


Exercises

All exercises for stroke rehabilitation below are approximate. Each case is unique and has its own characteristics. Therefore, a set of exercises is selected based on a specific situation. They can differ in activity, intensity and frequency.

When planning exercise therapy classes for stroke, the set of exercises should include:

  • massage and passive physical activity;
  • mental exercises;
  • exercises in a sitting position;
  • loads in a standing position.

All this is done gradually, moving on to more complex activities with the achievement of positive results at the previous stage. No need to rush and try to get up literally after the first weeks of exercise. It takes time to recover. If you practice correctly and consistently, you will be able to achieve excellent results, the patient will be able to return to normal life and get rid of dependence on other people in their daily activities.


Mental exercises

It's worth starting with mental physical education. Such gymnastics is based on the fact that we control our limbs with the help of muscle memory. The body needs to be helped to remember what it was able to do before the stroke. To act on the affected cells and tissues of your body, you need to repeat the command to them, force your finger to move your finger. These are not some actions related to self-belief. This is a real scientific fact and method that helps in rehabilitation. In addition to the restoration of muscle tissue and limb mobility, mental exercise additionally affects the neurological state of the patient and affects the work of the speech apparatus.

Massage

Here you will need the help of close people who can always be there and help the patient return to normal life. Massage is necessary to prepare the paralyzed limbs of a person for the upcoming stress. There are a few basic rules to follow:

  1. Before each session of exercise therapy, the skin is carefully warmed up so that blood flows to the limbs. You need to massage in circular smooth movements.
  2. When the hands are massaged, the procedure begins from the hand and moves to the shoulder. If these are legs, then the starting point will be the foot, and the massage should be finished on the hips.
  3. When working with the back, more physical effort is applied and sharper movements are used. It is recommended to knock, pinch the skin, but gently.
  4. When preparing the chest area, movements should be circular, directed from the center. Press lightly on the chest, but not hard.

Such a complex is carried out before exercises to prepare the body for subsequent loads.


Relatives or close people will have to do passive exercises after a stroke at home with the patient. Consider a few basic exercises that are aimed at the gradual restoration of limb mobility.

  1. We bend the limbs and smoothly unbend them. These can be arms and legs. The patient is placed on his back. The leg or arm is raised and bent at the joint. This is done so that in the process of unbending the limb slides over the surface of the bed. It helps regain muscle memory.
  2. We use elastic bands or bandages about 40 cm wide. A ring is made of them, the diameter of which will allow both legs to fit there. The elastic is lifted up, while simultaneously massaging the legs. Do the same with your hands, fixing them in an elastic band at the top. With these elastic bands on the hands, the patient needs to bend and unbend the limbs. The impact is exerted on the wrist joint.
  3. As an independent passive gymnastics, the patient can hang the affected limb using a wide band. So he will be able to move or rotate them in a loop.

Such exercises for recovery from a stroke will give results if you adhere to the rules of regularity. In the first 2 weeks, when the doctor allows you to gradually switch to passive gymnastics, it is carried out twice a day. One session lasts 40 minutes. From the beginning of 3 weeks of home rehabilitation, the number of sessions is increased to 3 during the day with the same duration.


Sitting in a sitting position

If physiotherapy exercises after a stroke are successful, and the person manages to sit down, then the stage of seated exercises begins.

  1. We train the eyes. The eye muscles also need to be restored. To do this, the apples (eyeballs) are moved from top to bottom, right and left and in a diagonal direction. Such movements are performed first with closed eyes, and then with open ones. It additionally helps to restore normal blood pressure.
  2. We relieve tension after the previous procedure. Close your eyes tightly and open your eyelids. For the initial stages, 10-15 repetitions are enough.
  3. We rotate our head. Helps to restore the work of the cervical muscles. Rotations are performed alternately in different directions for 5 - 10 repetitions.
  4. If half of the body is paralyzed, with the help of a movable arm, they take a motionless one, making various symmetrical neat movements with it. The patient can lie on his back, try to raise both limbs at the same time, or simply rotate with his hands.
  5. Don't forget about grasping movements. Restore the motor skills of the affected fingers. Expanders will help here. They have different densities. They start with the most elastic ones, gradually increasing the load.
  6. Work on the feet. In a sitting position, the feet are extended and returned to their original position. You need to try to make movements with two limbs at once, if one of them is paralyzed.

If this kind of physiotherapy exercises after a stroke brings positive dynamics, work on the restoration of the body can be complicated. Already without the help of strangers, you need to try to get up on your own, leaning on the headboard or a fixed strap. The limbs are raised gradually. Don't try to do 10 to 20 reps at a time. Start with one full lift, gradually build up the intensity.


Loved ones should always be there to help physically and morally support. When the patient sees how others rejoice at his successes and show sincere interest, this inspires and inspires the person, gives an incentive to do not 5, but 6 repetitions tomorrow. Step by step, you can regain mobility and cope with paralysis.

Standing exercise

There are many more of them than exercises for a sitting position. The transition to a standing position speaks of serious achievements in the recovery of the limbs affected by a stroke. Therefore, this is a reason for the patient to be proud of the progress achieved. Let's take a look at the basic recovery exercises that serve as the basis for creating an individualized exercise routine.

  1. We stand straight, put our hands at the seams, and our feet on the shoulder width familiar from school. When you inhale, your hands go up, while you exhale in a circular motion, they need to be lowered down. In one approach, you need to do 3 - 6 repetitions.
  2. We turn the body to the sides. At the same time, the legs are located at shoulder width. We breathe in once, exhale for two, slowly twisting the torso in one direction. The exercise is repeated at least 5 times in each side.
  3. We squat. A useful and effective exercise. Try to squat as you exhale, keeping your heels parallel to the ground and not lifting them off the floor. In this case, the arms are extended forward. In the position below, we inhale, and on exhalation we rise to the starting position. The main task of such physical education is to maintain balance. Try to repeat at least 4-10 squats.
  4. We tilt the torso. The legs are placed shoulder-width apart, and the hands rest on the belt. Exhaling, we tilt to the right or to the left, while simultaneously stretching up the opposite arm.
  5. Machi. They help to comprehensively affect the arms and legs. Extend your arm, swinging your legs in different directions. Maintain a small amplitude, holding with your other hand on a handrail or bed back. Do not hold your breath while doing the exercise. For each leg, 5-8 reps.
  6. We rise on toes, make rotational movements with our hands, ankles, our hands in the lock, placing them behind our backs. Simple but effective exercises that restore joint mobility.

In addition to the complex of physical education, every day after the return of the ability to move, the patient is recommended to walk. Start with small walks around the apartment and then go outside. Exercises with ski poles help a lot. They give confidence in their abilities, act as additional support and allow you to gradually switch to walking without their help.

But don't overwhelm yourself, even if you see positive dynamics in rehabilitation. Do not strive for some kind of athletic performance. The body needs good rest, combined with the maintenance of body tone.

Good recovery rules

The gymnastic exercises suggested by the doctor for a healthy person will seem elementary. But after suffering a stroke, the patient begins to learn everything again. Therefore, the loads are heavy for him, and it takes time for them to be given easily and naturally, as before the attack.

In order for physiotherapy exercises to bring only benefits, rely on several important rules:


A comprehensive and positive approach to treatment allows you to achieve positive dynamics of recovery. An important role is played by the people surrounding the person who. If they show patience, help psychologically and take part in treatment, the patient himself will want to recover faster. Even small successes should be encouraged. But do not forget to show that there is great success behind every new small achievement. This will give an incentive not to stop.

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Recently, the sad statistics of stroke lesions in our country have increased. However, the overall incidence accounts for about 75-80% of ischemic strokes, which are inherently easier to treat. There is always a return to the patient's legal capacity or at least partially restore the functions of the body. And the exercise therapy prescribed by the doctor will help in this - physiotherapy exercises after a stroke.

Preparatory period for exercise therapy

The benefits of exercise leave no doubt - any movement in a paralyzed part of the body accelerates the blood, prevents its stagnation, and at the same time restores muscle memory.

It cannot be hoped that only the exercise therapy complex, or only medication, will save from a stroke. It is necessary to adhere to a comprehensive course of rehabilitation.

In the early stages of inpatient treatment, physical exercise and patient care are carried out by doctors. However, upon discharge, the daily burden is shifted onto the shoulders of relatives. Therefore, it is recommended to keep or learn the memo on how to properly provide assistance to the patient. Here are the rules for consistent physical impact after a stroke:

  1. If the patient is paralyzed during an ischemic attack (even one side of the body), the first 2 weeks it will be possible to affect the muscle complex only with a competent change in position.
  2. Turn the patient over in bed every 2-3 hours to avoid pressure sores and blood stagnation.
  3. After a week or two, they switch to passive types of load, produced by the influence of a nurse or relatives. Their goal is to relax the muscles and prepare for further stress.
  4. As soon as the patient achieves the first movement in the paralyzed limb, they move on to active exercises. The first time - in bed, then getting up and moving on to slow walks.
In the rehabilitation period after a stroke, the relatives require attentiveness and regular exercise. One must be ready to devote at least 2-3 hours at intervals throughout the day to the patient's recovery program.

It is important to understand that the stroke exercises below as an example are for general use. And for each individual anamnesis, it is necessary to calculate their intensity.

Massage and passive stress after a stroke

Before proceeding to exercise therapy, the patient's paralyzed limbs are subjected to massage. There are rules for conducting massage procedures that are common to everyone:

  • Before exercising, warm up the skin and induce blood flow in gentle circular motions.
  • During the massage, the hands move from the hand to the shoulder, the legs - from the foot to the hips.
  • The back is massaged using slightly sharper movements - tapping and pinching, but without the use of force.
  • Stretching the chest, you need to move in a circular motion from the center outward, applying light pressure.

Now that the patient's body is ready for exercise, they move on to passive physical education. Here are some basic manipulations performed by relatives for paralyzed limbs after a stroke:

  • Flexion and extension of the arms or legs: the patient should lie on his back. The limb should be raised and bent at the joint so that when extended it slides over the bed. Thus, the legs restore motor memory.
  • Exercises with a wide elastic band (width like an elastic bandage, 40 cm) help. A ring is sewn from it along the diameter of the legs and put on both limbs. Then the simulator is moved up, lifting or massaging the legs in parallel. Or the same with the hands, in the upward position, with the elastic band on, the patient must bend and unbend his arms at the wrist joint.
  • The patient can independently do the following: the motionless limb is suspended on a tape or towel so that the patient can wind or even rotate the limb in a loop.

It should be remembered that it is systematic: any remedial gymnastics should be performed for 40 minutes twice, and after the 2nd week three times a day.

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Mental exercise

We must not forget that muscle memory controls the limbs. Remember the film by Quentin Tarantino, in which the paralyzed heroine Uma Thurman lived for hours on end with one thought: to make a toe move on a paralyzed leg. We know the outcome, because by the middle of the picture she was already running along the walls. This example inspires both hope and incentive: you need to engage in not only passive, but also mental gymnastics.

Acting on the regenerating nerve cells in the brain, you need to repeat the command many times. If it is difficult for the patient to master this yet, it is necessary for the relatives to pronounce the command aloud and make the patient repeat it: “I move my toe,” etc. This method of suggestion has one more advantage - rehabilitation of the patient's neurological state and speech apparatus.

The transition to exercise therapy in a sitting position

At about the third week of rehabilitation, it is time to begin exercises when the patient has taken a sitting position:

  1. It is worth starting with the eye muscles - movements of the eyeballs from top to bottom, from right to left and diagonally. Alternate between closed and open eyelids. In addition to muscle memory, it normalizes blood pressure.
  2. After the gymnastics for the eyes is completed, you need to relieve tension by tightly closing your eyes and opening your eyelids, repeat 10-15 times.
  3. Next - head rotations and neck exercises. On each side, at a slow, not sharp pace, repeat 6-8 times.
  4. If one side was affected by a stroke, you need to try to perform symmetrical movements with a motionless hand with a motionless hand. For example, lie on your back and try to raise both arms, rotate your hands at the same time.
  5. Grasping movements are required for finger motor skills. You can get a set of resistance bands of different densities.
  6. The same is true for the feet: pull and contract towards yourself, trying to achieve movement in both limbs.

Gradually, in a sitting position, you can move on to more amplitude options: lifting yourself, using the back of the bed and a belt. Raising the limbs, first 3-4 times. Reduction of the shoulder blades in a sitting position - 5-6 times. And so on, under the supervision of loved ones.

We perform exercise therapy while standing

The options that physical education for arms and legs in a standing position implies are already much more. Therefore, we present a set of "basic exercises" on which all gymnastics is based:

  1. Straight stand - hands at the seams, the position of the legs shoulder-width apart. Raising the arms on inhalation, circular lowering down on the exhale. The course of movements is from 4 to 6 times.
  2. Turns of the body - the legs are spread wider, at the expense of once inhale, two times exhale and slowly twist the torso to the side. Repeat on both sides at least 5 times.
  3. Squats: as you exhale, try to sit down without lifting your heels. The arms are extended forward. At the bottom, inhale and on the second exhale rise. The goal is to maintain balance, stretch the muscle group of the legs. Repetition - 4 to 8 times.
  4. Slopes: feet shoulder-width apart, hands on the waist. On exhalation, tilt to the right or left, the opposite hand stretches up.
  5. A good exercise for the arms and legs at once is swinging: the arm is extended, swinging the legs to the side. The amplitude is small, it is advisable to use your other hand to lean on the headboard, for example. The main principle is not to hold your breath, repeat on each leg up to 7-8 times.
  6. Raising the legs on toes, rotating the hand or ankle, keeping the hands locked behind the back - these exercises are good for kneading the joints.

The set of exercises for a stroke must include daily walking. In order to load your arms and give work to your legs, you can walk with ski poles in your hands. Thus, there is always support and an additional therapeutic cardio load.

Rehabilitation after a stroke at home is an important component of the complex therapy of the disease. After an attack, the patient must follow all the doctor's recommendations.

Medical indications

Stroke is a complex and dangerous ailment that occurs during blockage (plaque, thrombus - ischemic stroke) or rupture (hemorrhagic stroke) of the blood vessels of the brain.

At the same time, an acute violation of blood flow in the organ is noted, causing damage and death of cells of the nerve row.

The treatment of such an ailment is a long process, consisting of many successive stages. Primary therapeutic measures are necessarily carried out in intensive care, then in therapeutic departments, where the emphasis is on recovery. At the end of inpatient treatment, a rehabilitation period must be followed. It minimizes the deficit left after the hospital.

Treating a stroke like this helps the body get used to living off of the remaining intact neurons. All questions about recovery from a stroke are resolved individually with each patient, since there is no unified data for such a condition. In this case, the doctor takes into account:

  • area of ​​changes;
  • localization of the disease;
  • a kind of ailment;
  • timeliness of medical care.

Estimated survival time:

  1. With minimal neurological changes, partial recovery occurs after a few months, and full recovery within 2-3 months.
  2. With a pronounced neurological deficit, partial renewal occurs after six months, complete recovery rarely occurs, and lasts for years.
  3. In severe disorders, partial recovery occurs after a year.

Recovery from ischemic illness occurs faster.

Rarely, after a stroke, the patient recovers completely and in the shortest possible time. Therefore, rehabilitation after a stroke at home usually lasts for life. Often they use the method of short-term courses or daily exercises after a stroke at home. It has been proven that such exercises not only restore lost functions, but also prevent the development of new stroke attacks.

During rehabilitation, stroke recovery exercises focus on restoring limb function.

  • decreased tone of the body (with a stroke, paralysis with hypertonicity occurs);
  • effect on microcirculation (the disease disrupts blood circulation);
  • prevention of contractures - exercise should fight muscle hardening;
  • protection of the skin, exercise (the rehabilitation complex must protect the areas of greatest pressure);
  • resumption of fine movements (these are important functions of the body and nervous structures).

Healing procedures

It is better to treat a stroke with charging after consulting your doctor. With its help, you can choose a set of exercises and learn how to perform them correctly and effectively. The peculiarity of such complexes: they start with simple movements and gradually become more complicated.
Warm up the fabrics before performing. For this, water procedures are suitable. If there are contraindications or other reasons, instead of baths, massage is used for up to a quarter of an hour. For rehabilitation after a stroke of severe patients with gross lesions, help is important; they cannot independently perform such tasks. Each lesson should be done easily, without causing fatigue and overwork.

When such a clinic appears, it is important to suspend classes or reduce the load, since there is a mismatch between the loads and the patient's abilities at a particular stage of the rehabilitation and recovery period.

Exercise

For a quick recovery, physiotherapy exercises after a stroke must be performed strictly according to certain rules.

With bed rest, it is quite difficult to do a large amount of exercise. In this state, the functionality of the weakened organism is very limited. Exercises are performed with assistance.


Therapeutic gymnastics begins to be performed in the acute period of the disease in the presence of spastic paralysis, increased muscle tone. In this case, patients are not able to straighten the limbs, since they are firmly fixed in a bent position. Exercise reduces tone and increases range of motion. An example of gymnastics for rehabilitation:

  1. Extension, flexion of fingers and hands, forearms and elbows, feet and knees.
  2. Rotational movements of damaged segments, performed with assistance. There is an imitation of movements that healthy persons are capable of performing.
  3. Exercises to restore the arm. Spasmodic limbs are stretched using splints or other devices. Similar exercises are indicated for persistent forms of paralysis. The bent limbs gradually unbend, they are fixed to special devices for at least half an hour.
  4. Stroke exercises with a towel are often used. It is attached over the bed, grabbed with the affected hand and performed various movements.
  5. Rubber ring exercises. It is made with a diameter of 40 cm, thrown between the hands, forearms and stretched by spreading the arms.
  6. Exercise after an attack to minimize leg muscle spasm. A hard roller is placed under the knee, the thickness of which is gradually increased. This is how muscle stretching is achieved.
  7. If there is a stroke, home rehabilitation includes grasping the legs over the joint, bending and extending the knees by sliding the feet along the bed.
  8. Lying in bed, you should try to grab its back with your hands. It is necessary to perform a series of incomplete pull-ups while simultaneously extending the feet.
  9. Stroke recovery at home necessarily includes eye training. In this case, the emphasis is on restoring the mobility of the eyeballs, on adapting vision. Often they carry out eye movements in different directions, circular movements. The exercise is done with the eyelids closed and open.
  10. Home treatment for stroke often involves eye gymnastics with gaze fixation and subsequent various head movements without leaving this fixation point.

Physical activity in different positions

Exercise therapy in a sitting position for neurological patients is aimed at resuming precise arm movements, strengthening the back and legs. Exercise is usually done at home after a stroke. An example of a similar technique:

  1. In a seated position, the patients, while inhaling, bend in the back and stretch the trunk. On exhalation, relaxation occurs. The exercise is performed up to 10 times.
  2. In a sitting position, legs are raised and lowered alternately.
  3. Post-stroke treatment includes this kind of exercise. The starting position is sitting in bed. On inhalation, the shoulder blades are brought closer to each other, throwing the head back. As you exhale, you need to relax.

How to Treat Stroke with Standing Exercise? Such gymnastics is indicated after the expansion of the patient's motor regime. It can usually be carried out after it has been partially restored. The purpose of the classes is to resume movements, eliminate the pathology of the neurological plan.

Similar healing gymnastics:

  1. Lifting a small item from the floor or table. Physiotherapy exercises of this kind after a stroke helps to work out fine movements.
  2. While inhaling, raise your arms, stand on your toes. As you exhale, you need to relax, bend your torso and lower yourself. The exercise is repeated up to 5 times.
  3. Using an expander to bend the hands into a fist, extend the arms to the sides.
  4. Tilts of the body to the sides.
  5. Performing the scissors exercise with your hands.
  6. Slow squats. It is required to keep your back straight.

The combined training technique has been used for a long time. When performing new gymnastic techniques, you can continue the gymnastics of the previous stages. They are allowed to use healing physical education with elements of strength exercises. It is recommended to use light dumbbells during training.

Violation of the patient's speech activity

Often, the disease affects the speech centers of the brain. Their recovery is much slower than the motor areas of the brain. This usually takes years. Therefore, the recovery of patients must be carried out constantly from the first day of stability. It is strictly forbidden to stop classes. Over time, there will be an improvement in speech function.


Developed clear guidelines for speech restoration classes. All efforts are directed to the restoration of the structure and functions of damaged cells. For this, constant training in speech and hearing is carried out. Listening to speech is an important element of healing. It is necessary to talk more with patients, to describe the room, nature, the appearance of people and objects. This will allow the patient to start producing sounds more quickly.

Patients first learn to repeat individual sounds, syllables. Gradually increase the number of reproduced words. At the last stage, the patient is taught to repeat rhymes, tongue twisters. It has been proven that singing has a positive effect on the speech abilities of stroke patients. Frequent listening to songs promotes early healing.

For the active development of facial muscles, the following are used:

  • protruding the tongue;
  • slight biting of the lips;
  • licking lips with tongue in different directions.

Memory after seizure

Memory is the first to be affected by a stroke. To restore her, doctors usually use a medication method to support the structures.

Often, nootropic medications are used that improve metabolic processes (memory, attention, speech). Popular nootropics are:

  • Piracetam;
  • Lucetam;
  • Nootropil.

Memory recovery

A feature of their action is considered to be a rather slow effect from their use. Therefore, such medicines are used for at least 3 months. This is followed by a short pause in therapy, and the course of treatment is repeated.

Against the background of medication, functional rehabilitation therapy is carried out. It consists in memorizing words, rhymes. It is helpful for patients to play board games with which they can re-learn how to concentrate.

Drug therapy

An indispensable element of rehabilitation therapy for stroke patients is drug treatment of cerebral dysfunction. Medicines are taken in courses. It is recommended to take parenteral medications twice a year to improve blood flow and brain function. After a hemorrhagic stroke, blood-thinning medications should not be used.

The main groups of drugs used for the rehabilitation of stroke patients:

  1. Improving blood flow (Cerebrolysin, drugs containing aspirin).
  2. Enhancing metabolism (Ceraxon, Actovegil, Solcoseryl).
  3. Other medicines (Glycine, Sirdalud, Gidazepam, Adaptol, herbs, herbal teas).

Drug therapy usually has a stepwise approach. It involves the step-by-step intake of medications (first parenteral, and then pills). It must be understood that the appointment, cancellation or replacement of medications is carried out exclusively by the attending doctor, who constantly monitors the condition of his patient.

Survival, the degree of brain renewal depends on:

  • the extent of organ damage;
  • the quality of primary care;
  • the speed of delivery of the patient to the hospital;
  • timeliness and adequacy of treatment measures.

Since such an ailment is much easier to prevent, you need to take care of your health, lead a correct lifestyle, periodically be examined by a doctor if there are aggravating factors (risk factors).

The relatives and friends of the post-stroke patient must show maximum patience, endurance, understanding and diligence. This will be able to provide the patient with proper care for the entire period of rehabilitation, accelerate his healing.

Video

Stroke- This is a brain damage in acute cerebrovascular accident. This disease is one of the most disabling and socially maladjusted. That is, in many cases, the patient becomes helpless, requiring constant care and attention.

These disorders, as a rule, are the cause of spastic paralysis, as well as paresis of the extremities on the opposite side of the body in relation to the focus of brain damage. At the same time, muscle tone in the flexors of the arm and extensors of the leg increases, and accordingly, the tone in the extensor muscles of the arm and flexors of the leg decreases. Due to this factor, in the hand, there is a contracture with flexion in the elbow joint and pronation of the wrist 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 begin motor rehabilitation, gradually increasing the intensity of therapeutic exercises included in the course of exercise therapy for stroke. It is very important to start doing physical therapy and therapeutic exercises for stroke during the time, because thanks to therapeutic exercises, a number of positive changes occur in the body, 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. Correct breathing is being established.
  3. Locally increased muscle tone is reduced and the development of contractures is prevented.
  4. Healthy muscles are strengthened.
  5. The overall emotional state improves significantly.
  6. The patient adapts to his social functioning, and if possible, he can return to daily duties (this therapy is called occupational therapy).

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

Elementary course of physiotherapy exercises for stroke includes passive movements of the affected limbs, as well as massage. Passive exercise therapy for stroke carried out with the help of an instructor-methodologist. The main purpose of these exercises is to relax the muscles of the affected body part. Massage should be done taking into account the affected muscle. The extensors should be massaged on the arm, and the flexors of the lower leg and foot on the leg. Then you need to smoothly move from passive to active movements. Moreover, at first, active therapeutic exercises for stroke are performed with a healthy part of the body without outside help, and then, with the help of an instructor-methodologist, the muscles of the paralyzed part of the body are gradually involved in the process. Exercises should be performed at a slow pace, gently, smoothly, in no case should they cause acute pain. As a rule, exercises begin in the proximal regions and gradually move on to the distal regions. Exercises must be repeated many times, while it is necessary to ensure that breathing is rhythmic and correct, it is necessary to pause for breathing.

Exercise therapy for stroke has its own rules, which are as follows:

  1. Do exercises for the healthy side of the body first.
  2. Special therapeutic exercises must be alternated with fortifying exercises.
  3. Classes should be regular.
  4. Exercise for stroke should be increased gradually.
  5. During classes, you should maintain a positive emotional background.

We present to your attention one of the possible complexes of physiotherapy exercises for stroke. This complex is recommended to be performed in the early period of treatment of stroke or traumatic brain injury (subject to bed rest):

Exercise number 1

The exercise is performed with your healthy hand. When performing the exercise, it is necessary to use the wrist and elbow joints. Run 4-5 times.

Exercise number 2

Flexion and extension of the sore arm at the elbow. If necessary, you can help with your healthy hand. Repeat 4-8 times.

Exercise number 3

Breathing exercise. Repeat 4-8 times.

Exercise number 4

Raising and lowering the shoulders. Perform the exercise rhythmically, 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 hand and foot (3-5 minutes).

Exercise number 6

Perform active exercises - flexion and extension of the arms in the elbow joints (with the arms bent). The amplitude should be as high as possible. Run 6-10 times.

Exercise number 7

Perform movements with your healthy leg. If necessary, then - to help and strengthen the internal rotation. Do it 4-6 times.

Exercise number 8

Perform movements with a sore leg. Movements should be of medium depth. Run 4-6 times.

Exercise number 9

Perform breathing exercises 4-8 times.

Exercise number 10

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

Exercise number 11

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

Exercise number 12

Perform abduction and adduction of the bent hip (with bent legs). You can also extend and flatten the bent hips. Do it 5-6 times.

Exercise number 13

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

Exercise number 14

Bend the back without lifting the pelvis (with limited tension). Repeat 3-4 times.

Exercise number 15

Breathing exercises. Run 3-4 times.

Exercise number 16

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

Thus, the total time required to perform this set of exercise therapy exercises for stroke is 25-40 minutes.

During exercise therapy for a stroke, it is necessary to pause for rest, at least 1-2 minutes. When the exercises are completed, you need to ensure the correct position of the paretic limbs.

A set of physical exercises exercise therapy for stroke becomes more complicated in the late period of hemiparesis treatment. Physiotherapy exercises and remedial gymnastics are given in sitting and standing positions. Also, the complex of exercises includes walking in various versions and training in self-service. Exercises with objects, elements of games are widely used. When performing exercises of the exercise therapy complex for stroke, special attention should be paid to the development of the functions of the hand and fingers, as well as to muscle relaxation and reduction of rigidity.


1. General characteristics of stroke

2. The mechanism of the therapeutic action of physical exercises

3. Methods of physical rehabilitation at different stages of stroke

3.1 The most acute period

3.2 Acute period

3.3 Early recovery period

3.4 Late recovery period and period of persistent residual manifestations

Conclusion

Bibliography


Introduction


Every year around the world, about 6 million people suffer cerebral stroke, and more than 450 thousand people in Russia. In large cities of the Russian Federation, the number of acute strokes ranges from 100 to 120 per day.

The problem of providing care to patients with cerebral stroke is extremely relevant at the present stage due to high morbidity and disability. The disease is the leading cause of disability in the population. At the same time, there is a "rejuvenation" of stroke and an increase in its prevalence among people of working age. Only every fifth patient returns to work. About 80% of patients who have suffered a stroke become disabled, of which 10% are severe and require constant outside help. Approximately 55% of those affected are not satisfied with their quality of life, and only less than 15% of survivors can return to their work.

It should also be noted that stroke imposes special obligations on all family members of the patient and imposes a heavy socio-economic burden on society. Disability is primarily due to the severity of motor function disorders, the variety of manifestations of which depends on the variety of causes and mechanisms of development of acute focal brain damage, its location and size.

The purpose of the abstract is to study the features of exercise therapy for stroke.

give a general description of the stroke;

to reveal the mechanism of the therapeutic action of physical exercises;

to highlight the methods of physical rehabilitation at different stages of stroke.


1. General characteristics of stroke

stroke physical exercise gymnastics

Stroke (late Latin insultus - attack, from Latin insulto - to jump, jump out), acute circulatory disturbance in the brain with the development of persistent symptoms of damage to the central nervous system caused by cerebral infarction or hemorrhage in the medulla.

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

During a stroke, the following periods are distinguished:

) the most acute (3 - 5 days) - the period of stabilization of hemodynamics and basic vital functions (respiration, swallowing and digestion, excretion). By the end of the period, as a rule, cerebral symptoms regress;

) acute (from 3 - 5 to 21 days) - the period of formation of persistent neurological syndromes: hemiparesis, plegia; the beginning of the development of contractures, pain syndromes, impaired memory, attention, thinking, communications, the formation of anxiety-depressive syndrome;

) early recovery (from 21 days 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, a slower course of recovery processes;

) persistent residual manifestations (more than 1 year).

A stable pattern of impaired motor function accompanying central paresis (spasticity, contractures, pain syndrome), including the Wernicke-Mann posture, is formed, as a rule, by the 3-4th week of the disease, which determines the need for early application of methods, preventing their development. Rehabilitation should begin before the formation of a stable pathological state, the development of pronounced muscle spasticity, the formation of pathological motor stereotypes, postures and contractures.

The earlier rehabilitation measures are started, the more effective they are, therefore, it is of particular importance to introduce into practice an early rehabilitation system aimed at correcting the function of respiration and blood circulation, increasing the general endurance of the patient's body, targeted dosed stimulation and restoration of forms of sensitivity, the possibility of managing the process of actively maintaining the posture and moving in an upright position independently or with the use of auxiliary means, the manipulative ability of the upper limb.


2. The mechanism of the therapeutic action of physical exercise


True restoration of brain functions is possible only in the first 6 months. after a stroke. It is provided by "disinhibition" of functionally inactive nerve cells, including in the "ischemic penumbra" zone, and is due to the disappearance of edema, improvement of neuronal metabolism and synapse activity. However, it has been shown that spontaneous true recovery is ineffective without additional targeted stimulation of the repair and regeneration processes by the methods that make up rehabilitation treatment. Another mechanism is compensation, which is provided by the plasticity of the brain tissue with the reorganization of the functioning of neuronal ensembles.

The organization of human motor functions is presented as a multilevel system with multichannel connections, both direct and reverse, both vertical and horizontal. The development of each motor skill is preceded by the processing of afferent impulses entering the cortex and subcortical ganglia from the periphery. For the development of a motor program, not only impulses from proprioceptors embedded in muscles, synovial membranes, ligaments, joints, but also from other receptors emanating from the environment (sound, light, heat, cold), as well as from receptors of the skin and mucous membranes are important membranes (pain, feeling of pressure, weight, moisture, etc.). These impulses inform the overlying parts of the central nervous system about the need to change the movement, its amplitude, muscle strength, the inclusion of other muscle groups, or a change in the position of the limbs. Subcortical formations, in particular the hypothalamus in combination with the limbic-reticular system, provide a vegetative "coloration" of any motor act: changes in blood supply, the rate of vascular reactions, metabolism, the appearance of pain components, a burning sensation, etc. Thus, in the regulation of motor activity, they are complexly intertwined motor, sensory, cognitive and other functions. All this suggests that approaches to the recovery of movement disorders can be mediated through different systems. Therefore, different methods should be used, providing for an overall systemic effect.

Recovery of motor functions is most active in the first 6 months. after a stroke, ahead of the restoration of deep sensitivity and goes through the same stages as the early psychomotor development of an infant. All this determines the primary focus of early rehabilitation on the motor sphere. In the process of ontogenesis of the functional system of movement in the body, stable proprioceptive-motor connections are formed, the use of which is possible only taking into account the ontogenetic patterns of development of the functional system of movement. The implementation of these mechanisms in patients with cerebral stroke can become the basis for creating a program of rehabilitation treatment.

The functional system of movements is highly sensitive to the effects of such negative factors as hypodynamia, which leads to a decrease or disruption of functional connections and tolerance to physical activity, or as an attempt to learn movements of a higher order, as a result of which “non-physiological”, “non-functional” connections are formed, the effect of muscle traction on the joints of the limbs and trunk, that is, pathological postures and movements are formed. In this regard, when carrying out rehabilitation measures in patients with cerebral stroke, a constant, daily assessment of the state of the motor component and functional state is necessary.

The main principles of the rehabilitation treatment of post-stroke movement disorders are early onset, adequacy, stages, duration, complexity, continuity and maximum active participation of the patient. For the successful implementation of this treatment, it is necessary to correctly assess the state of the impaired function in each patient, determine the possibility of its independent recovery, the degree, nature and duration of the defect, and on the basis of this, the choice of adequate ways to eliminate the disorder.

The following rules should be followed:

individual focus of the impact;

strict dosage of exposure;

the validity of the choice of forms and methods of influence;

purposefulness, orderliness and regularity of the application of the selected impact;

a gradual increase in the intensity of exposure based on effective control;

continuity in the use of the selected forms and methods of physical activity at different stages of rehabilitation treatment.

Contraindications to the appointment of exercise therapy for patients in the acute period of cerebral stroke are: hyperthermia; ischemic changes on the ECG; circulatory failure, significant aortic stenosis; acute systemic disease; uncontrolled arrhythmia of the ventricles or atria, sinus tachycardia above 120 beats / min; atrioventricular block III degree; thromboembolic syndrome; acute thrombophlebitis; uncompensated diabetes mellitus; defects of the musculoskeletal system, making it difficult to exercise.

The use of exercise therapy in patients with cerebral stroke involves active and passive forms.

Active include:

) Remedial gymnastics - breathing, restorative, special, reflex, analytical, corrective, psycho-muscular, hydrokinesis therapy;

) occupational therapy (ergotherapy) - correction of the patient's activity and participation in daily routine activities, active interaction with environmental factors;

) mechanotherapy - simple devices, block, pendulum, with an electric drive, with a mechanical drive;

) treatment with walking (terrenotherapy) - dosed walking, health path, walking with obstacles, dosed walks;

) specialized methodological systems - Clapp, Cabot, Botat, Brunstrom, balance, yoga, suspension therapy, pulley therapy, etc.;

) biofeedback - the use of EMG, EEG, stabilography, spirography, dynamometry, cinematography data;

) high-tech computer technologies - virtual reality computer systems, bio-robotics;

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

Passive exercise therapy includes the following forms:

) massage - medical, classical, reflex, segmental, mechanical, vibration, pneumatic massage, hydromassage;

) robotic mechanotherapy (terrenotherapy) extension therapy;

) manual manipulations - vertebrotherapy, joint manipulations;

) postural therapy (postural therapy) - the use of rollers, pillows and apparatus;

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

) high-tech computer technologies - virtual reality computer systems, bio-robotics.

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


3. Methods of physical rehabilitation at different stages of stroke


1 The most acute period


The tasks of rehabilitation during this period are:

restoration of the normal stereotype of active breathing;

the formation of symmetric sensory afferentation from the pro-prioreceptors of the joints and muscles during the treatment with the position;

the formation of a stable reaction of the autonomic nervous system to the dosed load;

early transfer of the patient to an upright position (passive and active);

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

correction of swallowing disorders;

The following types of exercise therapy are used in the neuroresuscitation unit:

) treatment by position;

) breathing exercises;

) ontogenetically oriented kinesiotherapy (exercise therapy), which includes elements of specialized systems: PNF, Velden-krais, Vojta;

) translation into a vertical position using a robotic rotary table.

Positional therapy aims to give the paralyzed limbs a correct, symmetrical position on both sides while the patient is in bed or in a sitting position in a bedside chair. Despite its simplicity, if done correctly, positional treatment is important and helps to reduce muscle spasticity, level the asymmetry of muscle tone, restore body pattern, increase deep sensitivity, and reduce pathological activity from tonic cervical and labyrinth reflexes. This, in turn, prevents the development of pain syndrome and pathological attitudes in the limbs and trunk, and in the future - contractures. In addition, position treatment can be carried out for all patients, regardless of the severity of the condition and practically from the first hours of a stroke.

Positional treatment involves placing the paralyzed limbs in the following patient positions: on the healthy side; on the paralyzed side; in a position opposite to Wernicke's - Mann; on the stomach. Negative factors of the patient's position on the back are: insufficient respiratory function of the lungs, poor drainage of the bronchi, a decrease in lung volume due to the high standing of the diaphragm, a high risk of saliva aspiration, increased pathological reflex activity of cervico-tonic and labyrinth reflexes, pain in the spine due to prolonged stay in one position. The patient should be in each position from 20 to 40 minutes.

Respiratory gymnastics is aimed at normalizing hemodynamics, restoring oxygenation, stopping hypoxic hypoxia, and forming a stable normal dynamic breathing pattern. Passive techniques include contact breathing (accompanying and stimulating breathing by touching the hands to the chest), vibration with the hands while exhaling, shaking, therapeutic positions of the body (drainage positions, positions that facilitate breathing and aeration that help mobilize the chest), intercostal strokes ( skin and muscle technique).

According to the PNF (Cabot) method, at the first stage, it is necessary to obtain a complex physiological movement in the axial muscles of the patient, then in the girdle of the upper or lower extremities, while simultaneously combining it with movements in the trunk, using the techniques of short stretching, adequate resistance to movement, reversion (changing the direction of movement) antagonists, approximation (increasing the pressure of the articular surfaces against each other) of the joints with tight control of the physiology of the patient's posture.

Since the greatest problem of the acute period is dysregulation of motor function, it is inappropriate to use "normal" active movements (separate flexion, extension, abduction, adduction in different joints), which are complex active movements of a healthy person, which are not yet available to the patient. When carrying out this type of movement, the body uses functioning, preserved, more primitive programs, which, if the tasks do not correspond to the results, contribute to the formation of pathological stable postural attitudes, that is, they contribute to the consolidation or formation of pathological motor stereotypes.

Early transfer of patients to an upright position provides for a set of measures. In case of passive translation 1) a verticalizing table is used according to a special protocol in order to stimulate the receptors of deep sensitivity, the vestibular apparatus, and restore autonomic reactivity; 2) change the position of the head of the bed in the process of daily care of the patient, when eating, give the body an elevated position, gradually lower the lower limbs and transplant the patient. Active verticalization is carried out depending on the functional state and motor capabilities of the patient.


3.2 Acute period


maintenance of symmetric sensory afferentation from pro-prioreceptors of joints and muscles during posture treatment;

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

increased exercise tolerance;

staged restoration of the dynamic stereotype of the trunk and proximal, middle and distal parts of the upper and lower extremities - destabilization of pathological systems;

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

intensification of the processes of restoration and (or) compensation of the defect with the activation of individual reserves of the body due to the formation of new functional connections;

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

inhibition of non-physiological movements and pathological posture attitudes, an increase in the amplitude and accuracy of active movements, the fight against an increase in muscle tone and the alignment of its asymmetry;

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

the beginning of teaching the skills of symmetrical walking with additional support, active independent walking;

correction of swallowing disorders;

correction of speech disorders;

training in safe movement using additional support means;

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

control over recovery processes.

The specialized neurological department uses the following methods: positional treatment; breathing exercises (active techniques); further gradual transfer of the patient to an upright position; ontogenetically conditioned kinesitherapy; mechanotherapy; training on cyclic simulators; training using biofeedback on the parameters of electroneuromyography, stabilometry, goniometry; dynamic propriocorrection, teaching everyday skills (ergotherapy).

The main task of active respiratory gymnastics is the formation of the skill of controlling the ratio of certain phases of the respiratory cycle. The ratio of the phases of inhalation and exhalation should be 2: 3, the ratio of pauses in the breathing act should be -1: 2. If it is necessary to reduce the activity of the sympathoadrenal system, the time for the expiration phase and the second pause in the breathing cycle should be lengthened, and if, on the contrary, it is increased, the time for the inhalation phase and the first pause should be extended. Breathing should not be stressful. After 5 - 6 deep breaths, a break of 20 - 30 s is advisable.

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

Hypoxic training, carried out on special breathing simulators, also contributes to solving the problems of breathing exercises. The principle of operation of these devices is to supply air to a breathing mask with a normal oxygen content and an increased carbon dioxide content.

Dosed impact of rehabilitation measures without overstrain of the cardiovascular and respiratory systems is a prerequisite for the restoration of the vertical position and walking. In the function of body movement, including walking as a method of movement, two points stand out. The first of them is associated with the movement of the body in space and the maintenance of balance in each of the positions occupied, the second - with the possibility of trophic support of this work. The choice of the initial position for the correction of motor function is determined, first of all, by the adequate ability of the cardiovascular and respiratory systems to provide activity in a given position of the body. It is very important to ensure control of the parameters of the general condition of the patient (blood pressure and heart rate) during each stress exercise and in the recovery phase.

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

Passive performance of movements helps to maintain the elasticity of the musculo-ligamentous apparatus, trophism in the limbs and trunk. Passive performance of complex spiral three-plane movements, contributing to the rapid stretching of the musculo-ligamentous apparatus by 20 - 30% of the average physiological position, helps to stimulate the activity of motor units, initiate contractile activity in the paretic muscle.

Since patients with cerebral stroke have a selective increase in muscle tone, massage in these patients should also be selective, that is, different techniques should be used when massaging hypertonic muscles and muscles in which hypotension develops. Any additional afferentation from hypertensive muscles can cause an even greater increase in their tone, therefore, in the method of selective massage of muscles with increased tone, only continuous planar and enveloping stroking is used as the most gentle technique, causing afferentation only from the skin. The acupressure technique combined with acupuncture is aimed at reducing muscle tone and irritating deep receptors. Point massage and acupuncture for patients with post-stroke paralysis and paresis were developed in our country.

The ability to maintain balance in different positions and the ability to walk are most effectively restored when using a complex of ontogenetically conditioned kinesitherapy, simulators and apparatus with biofeedback, robotic mechanotherapy with unloading the patient's body weight.

Along with therapeutic gymnastics, mechanotherapy is the leading remedy for exercise therapy, which has been used for more than 150 years to restore the function of walking. The impact of this method should be dosed, controlled and reproducible. Exercise quality and dosage are controlled using biocontrol parameters.

In accordance with the formula of new rehabilitation concepts "who wants to learn to walk again, must walk", systems with body weight support have been developed to facilitate symmetrical unloading of the lower limbs, which makes it easier for patients who are unable to move under normal conditions with full body weight, as well as unloading and correction suits. This made it possible to minimize obstacles to walking at the initial stages of rehabilitation, i.e., to start walking training as early as possible.

One of the effective methods for restoring motor function is training based on the principle of biological feedback (BFB). These techniques are aimed at correcting muscle tone, improving the sensory support of movements, increasing the amplitude and accuracy of movements, activating the concentration of attention on the sensations of the degree of muscle contraction and the spatial location of the limbs.

Recently, a new direction in the rehabilitation of patients has been actively developing - a method of artificial correction of walking and rhythmic movements by means of programmed electrical muscle stimulation during active movement.

The restoration of motor function in itself does not mean the restoration of the ability to self-service, which is no less important for the patient in his daily life. The priority areas of occupational therapy are the restoration of daily activity (eating, dressing, washing, toilet, bath, personal care, etc.), the development of fine motor skills of the hand, the selection of special wheelchair equipment and auxiliary equipment.


3 Early recovery period


The objectives of rehabilitation are:

maintaining a stable response of the autonomic nervous system to a dosed load of increasing intensity;

increasing the patient's tolerance to physical activity;

staged restoration of the dynamic stereotype of the trunk and proximal, middle and distal parts of the upper and lower extremities - inhibition of non-physiological movements and pathological posture attitudes, development of the amplitude and accuracy of active movements, the fight against increased muscle tone and alignment of its asymmetry;

improvement of sensory support of motor acts (pro-prioceptive, visual, verbal, tactile control);

restoration of the static stereotype of the vertical position;

continuing training in symmetrical walking skills with additional support, active independent walking;

correction of speech disorders and disorders of higher mental functions, psychoemotional state;

continuation of training in safe movement with the help of new means of additional support and movement;

continuing training in the elements of functional adaptation to perform socially significant actions for self-service and restore an active role in everyday life;

control over recovery processes.

Continuing 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 the listed methods, as well as at combating the complications of the acute period: konractures, high tone, pathological installation of the trunk, limbs, fingers, deep vein thrombosis of the lower extremities, urinary disorders function and defecation, arising mostly in violation of the basic principles of patient management.

For self-study, it is widely recommended to perform only those movements that the patient can actively perform himself biomechanically correctly in an accessible volume under the supervision of relatives or caregivers. Recommendations on their own to "develop" 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 patient's tolerance to physical activity, it is advisable to use cyclic simulators that allow you to perform in passive, passive-active, active modes of movement of the upper or lower extremities in an aerobic mode. Training intensity should not exceed 25% of maximum oxygen consumption. The intensity control is carried out according to the indicators of heart rate, oxygen saturation and blood pressure.

The choice of the number of rehabilitation methods used and their sequence depends both on the individual level of the patient's functional capabilities and on the training goals. It should be remembered that the transition to the next level of load is possible only after full 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 impaired functions and, especially, complex motor skills and social rehabilitation. In this regard, in the early recovery period, special attention is paid to the correct choice of means that make it easier for the patient to perform a biomechanically correct function (unloading frames for walking, crutches, walkers, canes, suits, robotic elements of the exoskeleton, medications, orthoses) and provide psycho-emotional support and pedagogical supervision.


4 Late recovery period and period of persistent residual manifestations


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

A feature of the late period of rehabilitation is the persistence of neurological deficits. The patient has manifestations of both central and peripheral paresis to varying degrees due to the "non-use" of body segments and functions in connection with the initial lesion. 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 measures in the late period are:

normalization of tonic-force relationships of the muscles of the regions of the patient's body and the proper range of motion in individual joints of the trunk and extremities;

further continuation of the improvement of motor functions with an emphasis on the process of maintaining an upright position and movement (independent, with additional support, with the help of technical means or another person), improvement of coordination in space, fine purposeful motor skills of the hand and fingers (improvement of gripping, manipulation), coordination of work muscles of the orofacial complex, respiratory muscles;

overcoming contractures;

further increase in the patient's tolerance to stress, both physical and psycho-emotional;

restoration and maintenance of trophism of tissues of the musculoskeletal system;

overcoming pain syndrome;

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

restoration of speech and higher mental functions;

improving the patient's adaptation to the environment through the use of ergotherapeutic technologies and occupational therapy, as well as adapting the environment to the needs of a patient with severe functional limitations;

professional reorientation based on occupational therapy activities;

restoration of interpersonal relationships, social activity of the patient, his role function in a meaningful environment.

As in previous periods of rehabilitation, the patient's day regimen is very important for the formation of persistent and economical proper responses to interventions (classes), taking into account the location of the patient and places of therapeutic measures, the possibilities of moving to the place of study, dietary habits, hygiene and social activity (work , participation in public life, intra-family responsibilities, etc.). The maximum independence of the patient should be ensured. In order to restore motor functions, morning hygienic exercises, exercise therapy and physiotherapy are used.

Morning hygienic gymnastics should include only those exercises that the patient can perform independently in an accessible volume. They are cyclical, symmetrical, and are repeated at least 7 times, including exercises of the orofacial complex. Exercises are performed in a well-ventilated area, preferably in front of a large mirror (self-control), with mandatory measurement of blood pressure and heart rate. The duration of the gymnastics is no more than 10-15 minutes. Self-performed exercises (with the correct recommendations of a specialist) and the possibility of self-control will help to increase the patient's motivation for rehabilitation measures and save time for special kinesitherapy classes. Exercise therapy classes in the late period should be carried out at least 3 times a week.

Massage is an important area of ​​rehabilitation in the late recovery period. As in the earlier stages, they use reflex, segmental, acupressure massage, used in combination with therapeutic exercises, mechanotherapy, drug therapy, and physiotherapy. It prepares fabrics for work, reduces the effects of intense work and promotes more complete and faster recovery.

Conclusion


Among the acute disorders of cerebral hemodynamics, transient disorders of cerebral circulation with the reverse development of damage to cerebral functions and strokes, in which a persistent neurological deficit develops, are distinguished.

For the treatment of the consequences of a stroke, therapeutic exercises, massage, occupational therapy are used, classes are conducted with a speech therapist, a psychologist, etc.

The problem of restoring motor function must be considered in two aspects: neurophysiological (restoration of the structure of movement) and psychosocial (restoration of self-service, adaptation to a defect when restoration is impossible). Both aspects are based on a thorough multidisciplinary diagnosis, are very important for the patient and require specific methods of exposure. Thus, an important role is given to the change in the behavioral strategy of patients, which makes it possible to achieve better adaptation even with the preservation of the motor defect.

The tasks of physiotherapy exercises at each stage of the rehabilitation process will be different depending on the patient's condition, the degree of motor and cognitive deficits, the level of regulation of motor functions, the qualifications of specialists, the availability of the necessary equipment and premises.

Bibliography


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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 care for stroke"

4.Order of the Ministry of Health of Russia dated November 15, 2012 N 928n "On approval of the Procedure for the provision of medical care to patients with acute cerebrovascular accidents"

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