Exercise after a stroke. The need for physical therapy after a stroke

28.08.2019

Therapeutic exercises after a stroke are the most important means of recovery. Destroyed nerve cells cannot be restored, and their functions are assigned to other brain cells. Gymnastics helps with this, but it is important that it is performed in accordance with all the rules and recommendations. Treatment involves several stages. After a stroke, a person ends up in intensive care, where doctors do everything to save his life. With a successful outcome, the patient is sent to the neurology department, where he undergoes initial rehabilitation. The final recovery takes place already at home, and the last stage is the longest, and it determines whether the rehabilitation will be full or partial.

The set of exercises after a stroke may differ depending on the type of stroke, however, most of the exercises are recommended regardless of it. The main criterion that is taken into account in this case is which part of the brain was affected as a result.

Damage to the left hemisphere is fraught with the following consequences:

Paralysis of the right side of the body.
Disturbances in the perception of space.
Problems with motor memory (the patient may not understand how to tie shoelaces).
Quick, impulsive behavior.

The defeat of the right hemisphere leads to the following:

Paralysis of the left side of the body.
Speech disorders.
Problems with language memory (a person understands what he wants to say, but does not remember the word).
Behavior becomes cautious, slow.

To eliminate each of the problems, along with the basic exercises, gymnastics is done, aimed at training impaired functions.

The main task pursued by therapeutic exercises after a stroke is the complete restoration of functions. In addition, there are a number of secondary tasks that are no less important:

Removal of high muscle tone: with paralysis, they are very tense, and it is necessary to relieve excitability.
The return of precise movements.
Warming up helps to improve the blood supply to tissues reduced due to innervation disorders.
Prevention of bedsores, since when the body is in one position for a long time, blood circulation in places of high pressure is disturbed.

First of all, it is important that exercise therapy after a stroke be approved by a doctor and developed individually for a particular patient. The specialist can explain all the subtleties of this or that exercise, choose the most suitable ones depending on the type of stroke. You need to start doing gymnastics with the simplest exercises, gradually moving to more complex ones.

In no case should you overload a person after a stroke, since an excess of load can be no less harmful than its complete absence. Before starting to perform the exercises, it is recommended to warm up the part of the body being worked out through massage.

An important role is played by the support and help from relatives and the positive attitude of the patient. Relatives should help to ensure that he remains optimistic and believes in a successful outcome. The patient needs to be praised, emphasized his success. To prevent a recurrent stroke, exercise will need to be performed throughout life.

Exercise after a stroke

In fact, recreational gymnastics does not have any striking features. In many ways, it resembles a regular charge. But even the simplest exercises for recovery after a stroke will give excellent results.

The first complex is performed in the supine position. It is indicated in the acute period of the disease, when the patient's muscles are fixed in a bent position, and he cannot unbend them. Exercises are aimed at reducing the tone and increasing the range of motion of limbs affected by stroke.

Exercises for the hand after a stroke. They are forced straightening of the limbs, due to which spasms can be reduced. It is necessary to unbend the bent limb, starting with the fingers and ending with the hand and forearms, and also wrap it with a bandage to the plank, leaving the hand in this position for at least half an hour.
Eyes. Move your eyes up and down, left and right. Close your eyes and make circular movements in both directions. Blink your eyes for 5-7 seconds, also make circular movements with your eyes open. The eye muscles can then be relaxed and blinked.
Neck muscles. Make head turns left and right, fixing your gaze in front of you.
Fingers. They need to be bent and unbent ten times. You can do the exercise both on two hands at once, and alternately. You can also hang a towel over the bed with a loop, and pass a motionless arm or leg into it and swing it freely. You can throw a loop with a diameter of about 40 cm over the diseased limb and stretch it.
Elbow joints. The body should be extended, arms are located along the body. The right hand is bent at the elbow, lowered to the bed, the left hand is bent. Do the exercise ten times with each hand. Hang the fixed limb on a strong fabric and do various exercises: flexion, extension, abduction to the sides, rotation. Do this for 10-30 minutes. It is allowed to take up to three breaks lasting 2-4 minutes.
knee bend. In the prone position, alternately bend your legs at the knees, as if sliding them and not taking them off the bed. Do ten of these movements with each leg.
"Pull-ups". While lying on your back, grasp the back of the bed with your hands. Perform pull-ups by straightening your shoulders and legs with your toes extended. Exercise slowly, repeat six times.

If the patient is able to sit independently, he can perform a more complex complex. These are exercises after a stroke to restore walking, arms and legs, strengthen the back and prepare for normal movements in the future. All exercises are done in two or four counts.

Starting position - sitting. Lean back on the pillow and comfortably grasp the bed on both sides with your hands. Stretch your legs forward. On the count of 1-2, gently bend, pulling your head back, take a deep breath, on the count of 3-4, smoothly return to the starting position. Repeat the exercise six times.
Sit down, straighten your legs, lower your arms. Gently move your arms back, tilt your head back and straighten your back, trying to bring your shoulder blades together. Hold the position for 1-2 seconds. Return to starting position and repeat four more times.
Starting position - with outstretched legs. Grasp the edge of the bed with your hands. Do the exercise slowly. On count 1, slightly lift your right leg up, on count 2, gently lower it, on count 3, lift your left leg, on count 4, return to the starting position. Repeat swings for each leg four times without holding your breath.
Starting position - leaning on a pillow. Raise your arms up, stretch your legs. On a count of 1-2, bend your leg at the knee and clasp it with your hands, trying to touch your knee to your chest. Lock in this position, tilt your head forward and exhale. On the count of 3-4, raise your head, remove your hands and slowly return to the starting position. Repeat the same for the second leg. Do four repetitions for each.
Motility of the hand. You need to take a deep bowl, place objects of various shapes, materials and sizes in it. With a sore hand, shift objects from one bowl to another, transferring one at a time.

The following exercises after a stroke at home are performed in a standing position and only when the patient feels confident and can easily perform the previous exercises. However, this gymnastics also has a number of limitations. It is divided into two complexes: light and with increased load. Simple exercises are used if a person has not yet completely recovered from a stroke. They will be as follows:

Starting position - feet shoulder width apart, arms pointing down. On the count of 1, raise your arms up, turning your palms outward. On a count of 2, stretch in this position and inhale. On the count of 3, lower your hands down, trying to describe a circle with them, exhale. On count 4, return to the starting position. Repeat six times at a smooth pace.
Starting position - feet shoulder width apart. Place your hands on your belt. On count 1 turn the body to the right, on count 1 spread your arms to the sides and inhale, on count 3-4 return to the starting position and exhale. Similarly, repeat the exercise on the left side. Do five times for each side.
Starting position - legs apart, arms down. On the count of 1-2, do squats, keeping your heels on the floor, slightly tilting your body forward and moving your arm back. Breathe in. On 3-4 smoothly return to the starting position, exhale. Repeat 6 times.
Hands down, feet shoulder width apart. Do squats for two counts. Inhale deeply, sit down for a count of 1, put your hands on your hips, exhale, then return to the starting position. Repeat four times.
Tilts. Put your legs apart, place your hands on your belt. Lean to the left, raising your right hand up, inhale, return to the starting position and exhale. Then do the same to the right. For each side, repeat the exercise four times.
Swing your legs Place your hands on the belt, stretch one arm forward. On the count of 2-7, make circular swings with your foot, then return to the starting position. Do four swings for each leg.
Lunges. Starting position - feet shoulder width apart, hands on the belt. Stretch your left arm forward, then step forward with your right foot. Clench your fists and place your hands on your shoulders. Return to the starting position and repeat the action, switching arms and legs. Repeat four times.
Within 20 seconds you need to walk in place, then do some exercises that will help restore breathing.

More complex physical education after a stroke at home in a standing position includes the following exercises:

Place your feet at a distance of 20-25 cm between each other, lower your arms. Join your hands in the lock and raise them in front of you. Then raise your arms up and reach for them, return to the starting position and repeat the exercise five times.
Grasp a chair with one hand, keep your back straight. The second hand is on the belt. Swing your foot forward and backward five times. Switch hands and do the same for the second leg.
Feet shoulder-width apart, hands placed on the belt. Make a shallow tilt, exhale, return to the starting position. Repeat ten times.
Put your feet together, bend your arms behind your heads. Tilt to the right with a simultaneous lunge to the same side of the right leg. Repeat the same for the other side.
Jumping. Put your feet together, place your hands on your belt. Do random jumps: jump, keeping your legs together and apart, putting your legs forward alternately, and so on. It is recommended to jump within 40 seconds.

Stroke is a severe pathology that requires long-term treatment and rehabilitation. This disease requires the application of great strength in order for the patient to be able to restore the skills necessary for life. In addition to drug treatment, a special type of gymnastics plays a big role, since only exercise therapy after a stroke can restore damaged nerve cells, as well as restore the normal functional state of the muscular apparatus.

The main negative consequence of a stroke is a neurological deficit caused by a disruption in the connections between nerve cells, nerve cells and muscles, muscles and the nervous system. The restoration of these connections is beyond the power of even modern medicines, while physical therapy after a stroke is able to "start" the neurons of the brain and create a natural incentive to recreate new neurogenic connections.

Among the main tasks of the complex of exercises after a stroke are:

prevention of the negative consequences of prolonged immobilization in the form of bedsores, heart failure, muscle atrophy, congestive pneumonia;
improvement of blood circulation in muscles affected by paresis or paralysis against the background of a decrease in their tone;
decrease in pathologically high tone in muscles that are in a state of spastic paresis or paralysis;
prevention of muscle contractures and resumption of motor activity.

In addition, restorative gymnastics after a stroke helps to establish metabolic processes in tissues - this is necessary even with short-term immobilization. If we are talking about an extensive cerebral hemorrhage, being in bed can last several months. During this time, in the absence of exercise, irreversible changes will inevitably occur at the level of cellular metabolism.

To achieve maximum effectiveness of exercise therapy for stroke, it is recommended to combine it with manual therapy courses, massage, psychocorrection and socialization of patients.

Basic principles of exercise therapy after a stroke - success rates

The course of recovery after a stroke largely depends on how quickly physical exercises began to be practiced. In addition, both the patient and his relatives need to understand that exercise therapy is a means not so much for strengthening muscles, but for restoring the ability of the brain to control the body.

The success of medical gymnastics depends on the following factors:

Timely start - exercises must be done after the patient has come out of a coma (if any) or at the end of a critical period.
Consistency and regularity - it is necessary to practice daily, regardless of the patient's current well-being. To minimize complications, it is recommended to select exercises according to the level of complexity for each of the conditions. Even if the patient is not set up for classes, it is necessary to force him to do at least a minimal list of passive recovery exercises.
Duration - for the appearance of positive dynamics and its consolidation, it is necessary to practice exercises after a stroke for at least six months. This time is enough for the formation of new neural connections in the brain.
Sequence - exercise at the initial stage of the exercise for recovery after a stroke involve a minimum load, but over time they become more difficult. Transitions from one stage to another must occur at the right time - it has been proven that prolonging the period does not bring positive results. A greater effect is expected with a gradual increase in intensity and complexity.
Attention to the well-being of the patient - during the exercise, it is necessary to monitor the condition of the ward (this includes blood pressure, pulse rate, breathing). The emotional component is no less important - even insignificant success should be accompanied by praise and encouragement for further progress.

It is important to understand that with a stroke, a set of exercises cannot replace a full-fledged complex therapy using drugs. These two methods complement each other well, allowing you to go through the recovery period faster and more successfully.

Exercises for the initial stage of recovery

At the first stage of rehabilitation, the use of exercise therapy after a stroke is welcome, but active movements, as well as physical activity, are strictly contraindicated. This stage involves the use of the following therapeutic measures:

body position therapy;
passive exercises for various muscle groups;
breathing exercises;
so-called mental exercises.

For each of them there are special methods, as well as rules and deadlines. The success of the rehabilitation as a whole will depend on the accuracy of their implementation.

body position therapy

This method is based on a systematic change in the position of the patient's body and giving it the correct position. The purpose of the procedures is to prevent complications in the form of bedsores, contractures and pneumonia.

Particular attention should be paid to the affected half of the body:

limbs that are in a state of hypertonicity must be straightened regularly, while doing a light massage (relaxing stroking);
it is desirable to lay the patient on a healthy side.

For each patient, recommendations may differ depending on the degree of damage to the brain tissue and the onset of consequences in the form of a neurological deficit. Before starting care, a consultation with a neurologist and a rehabilitation specialist is necessary.

Passive exercise

The performance of this group of exercises implies a lack of activity on the part of the patient - flexion and extension of the limbs are performed by the caregiver. At this stage, breathing exercises can be carried out - after a stroke, it is necessary to normalize breathing to eliminate congestion in the lungs.

Passive movements must be performed at the earliest stages after an attack, preferably in the first 2-3 days after it. In this case, the amplitude of movements in the first day should be minimal with a subsequent increase. It is important not to exceed the maximum possible amplitude from a physiological point of view in order to avoid stretching or tearing of the ligaments, as well as dislocations of the joints. If there is resistance, you can preheat the joint with a massage.

All exercises for stroke related to passive are divided into 3 subgroups:

Flexion-extension - suitable for knee, elbow joints, feet and hands.
Rotational - used for feet, hands, shoulder joints.
Adductor-abductor - used for the hip and knee, shoulder joints.

Training should begin with 5 movements for each joint. As mobility returns to it, their number can be increased to 15. According to generally accepted standards, gymnastics for stroke should first affect large joints, and only then can you start warming up smaller joints. So, after a stroke, the arms begin to develop from the shoulder, moving towards the hands, and the legs - moving from the hip joint to the foot.

Breathing exercises

Breathing training is carried out only after the patient has finally regained consciousness and can control the maxillofacial joints. To begin with, it is recommended to do simpler exercises - exhaling air through tightly closed lips or through a tube into a glass of water. As the patient recovers, he can strengthen the respiratory system with the help of balloons.

Exhaling air with effort helps to eliminate congestion in the lungs and free them from sputum. In addition, these are excellent exercises for the face, helping to eliminate paresis of the facial muscles.

Exercises for the second stage of recovery

As the patient recovers, he gains the ability to independently do individual exercises after a stroke at home. All of them differ in that they can be performed in a supine position, but at the same time they require a certain degree of concentration on the part of the patient.

The following exercises for arms and legs are considered the most effective:

clenching the hands into a fist (10-20 times);
rotation of the hands clenched into a fist clockwise and counterclockwise (10-15 rotations each);
independently flexion and extension of the arms in the elbows (15-20 times);
lifting straightened arms perpendicular to the body and slowly lowering (15-20 times);
swings with straightened arms to the sides (15-20 times);
flexion and extension of the toes (10-20 times);
pulling the fingers towards you, as when walking on your heels, and away from you, as when pressing the pedals (15-20 times on each leg);
flexion and extension of the legs at the knees (10-20 times);
breeding to the sides of the legs bent at the knees, followed by reduction (10 times).

If there is a physical possibility, after exercises on the limbs, gymnastics for the body is performed. It consists of simple movements:

body turns to the sides without leaving the bed (10 times to the right and left);
lifting the pelvis (5 times is enough);
lifting the head with pressing the chin to the chest (5 times).

The last exercise, if you have physical capabilities, can be complicated - you can raise not only your head, but also your shoulders, and then the entire body. To facilitate the task, you can hang a handle over the patient's bed, which he will hold on to.

After successfully mastering the listed exercises, exercise therapy after a stroke at home is supplemented by exercises in a sitting position. The complex includes head rotations, sitting on the edge of the bed with legs lowered to the floor (necessarily without support behind the back), raising and lowering the legs, bending them with pulling the knees to the chest and extension.

To restore fine motor skills of the hands, grasping movements are recommended. For this, pieces of cloth or sheets of paper can be used, which must be taken and crushed into a lump, large cereals (beans or beans, for example) for shifting handfuls or one grain from one container to another.

Exercises for the third stage of recovery

At this stage of rehabilitation, you can begin to perform exercises in a standing position. First, they are recommended to be done with the support of outsiders, and then on their own. Ideally, special simulators should be used for this, however, a standard set of exercises after a stroke at home can be done using improvised means.

For starters, a stroke survivor must learn to balance. This can be achieved while trying to stand with a straight back for 2-3 minutes. Then you can slightly increase the time.

A prerequisite is the presence of a fulcrum. This can be the back of a bed or chair, or a special machine.

head rotation;
swing your legs;
wave your hands;
lifting legs forward and backward or to the sides;
turning the body to the side.

Then the range of motion is increased by tilting the torso, squats, short walks.

The listed exercises should become an integral part of the patient's life, both in ischemic and hemorrhagic strokes. Often this area of rehabilitation is neglected, as a result of which the patient loses the chance to restore the lost abilities for self-service. That is why the relatives of a person who has suffered from a stroke need to tune in themselves and set the patient up for a long struggle with the consequences of the disease.

Full rehabilitation treatment, exercise therapy and physiotherapy after a stroke are important for the rehabilitation of the patient. For a number of reasons, specialized centers and sanatoriums are not always available, then rehabilitation after a stroke at home is relevant. The patient needs proper care, massage, diet. Many are learning to walk again. All this requires a lot of effort from a person caring for a loved one who has had an attack.

Post-stroke care

Acute circulatory disorders in the brain have serious consequences, up to death, surviving patients often become disabled. In addition to loss of speech, deterioration of vision and memory, immobility, the patient can be tormented by:

insomnia (about 60% of patients complain about it);
hallucinations (more often in the elderly);
dizziness, noise and pain in the head.

All these features of the patient's condition must be taken into account, try to understand what torments him. Often a person cannot express their problems in words until speech is restored at least partially. The possibilities of rehabilitation after a stroke at home are limited compared to treatment procedures in specialized centers. At home, there is no way to install high-tech simulators, but caring care and the presence of close people nearby allow the patient to return to life.

After ischemic

Of all cases of stroke, 80-85%, according to statistics, are ischemic. It is divided into three types:

thromboembolic, arising from thrombosis of cerebral vessels;
hemodynamic, which leads to a prolonged spasm of cerebral vessels caused by a lack of nutrients;
lacunar, manifests itself in the form of disturbances in the patient's sense organs, motor functions.

After a micro-stroke, a stroke of any severity, the patient needs strict bed rest for the first time. An ischemic attack can cause a lesion of a left-sided or right-sided nature, a person is paralyzed. When caring for a bedridden patient, it is important not to let him stay in one position for a long time, you need to turn him over every 2-3 hours.

After hemorrhagic

In this type of stroke, a cerebral hemorrhage occurs. 30-60% of those who have undergone extensive cerebral hemorrhage fall into a coma and die. The main task at the first stage, when recovery from a stroke has just begun, is to avoid bedsores. It is important to learn how to properly turn over, seat the patient, shift and lift him. The patient's behavior is affected by which part of the brain is affected, left or right. The process of returning to a full life after the disease begins in the first weeks and lasts about 1.5 years.

Treatment after a stroke at home

After taking the victim of a brain stroke from the hospital, it is important to continue the prescribed medication. The patient must receive medication to improve blood circulation in the brain. For this, drugs such as Encephabol, Actovegin (in tablets and injections), Vinpocetine, Mexidol are prescribed. With the help of drug therapy, the brain is enriched with glucose and oxygen. In order to restore all functions, a set of measures is needed, a program aimed at the rapid rehabilitation of the patient, including diet, massage, gymnastics, speech therapy classes.

Diet

Nutrition after a stroke in the first two weeks is carried out with a teaspoon. Bring food to a semi-liquid consistency, wipe. When the patient's swallowing is restored, more solid food can be fed. Eliminate foods that increase cholesterol: pastries, pastries, everything fatty. When compiling a menu, try to use the following products:

Cereals half of them should be whole grains (wheat, rice, oats, corn, buckwheat).
Vegetables beans, peas, dark green and orange foods.
Fruit daily, fresh, dried, thawed.
Dairy products (low fat).
Protein lean poultry meat, not daily, sometimes replaced with fish, legumes.
Fat nuts, fish. Do not cook with margarine, lard, give butter in a minimal amount. Vegetable oils are preferred.

Massage

It is started to be done with ischemic stroke on day 2-4, with hemorrhagic stroke on day 6-8. The first procedures last from 5 to 10 minutes, gradually extended to half an hour. The course includes 20-30 daily sessions. After a break for a period of one and a half to two months, the massage is resumed. If it is impossible to invite a massage therapist, you need to perform the procedure yourself, take lessons from a professional or download a suitable technique and consult a doctor.

Stroke exercises at home

After 1-2 weeks, when the patient gets better, you can start doing physical exercises. During rehabilitation after a stroke at home, passive physical education is available and easy to do, all actions are carried out with the patient by the one who cares for him. The following exercises are helpful:

Breathing exercises. The ward must be taught to slowly inhale and exhale through slightly parted lips, while saying “zhzh”. You can blow up a balloon.
Rock action. Roll on its surface the feet, palms of the patient.
Passive charging. Bend and unbend alternately the arms and legs of the patient lying on his back.

Physiotherapy

When the patient succeeds in the first movement of the paralyzed limb, sensitivity begins to recover, it is time to accustom the patient to physical activity, first in bed, sitting, then standing, and then you can move on to slow walks. During rehabilitation after a stroke, gymnastics should take 2-3 hours daily, not in a row, in small complexes: the first week 40 minutes twice, the second - three times a day.

Daily walking is necessary when the patient can get up. You can walk around the apartment with ski poles, as a load on your hands. The beneficial effect of yoga on the rehabilitation of the patient is noted, asanas eliminate disorders of the nervous system. Recovery of vision after a stroke is also accelerated with the help of special exercises for concentration and focus.

Speech restoration

The more the brain is damaged during a stroke, the slower speech is restored. Successful rehabilitation of speech occurs during the first year, then the process slows down. After a stroke, pronunciation defects remain, to which one has to adapt. The patient needs classes in a speech therapy program, constant verbal communication with loved ones, memorizing tongue twisters, reading texts aloud.

Video about restoring movement after a stroke

It can be said with certainty that exercise therapy after a stroke plays the main role in the recovery of patients who have suffered an acute cerebrovascular accident. There is a physiological explanation for this, which is based on the peculiarities of the functioning of the nervous system.

Principles of action of exercise therapy in neurological patients

The brain is a collection of neurons that are connected to the entire body through numerous connections. Each group of nerve cells is responsible for the regulation of a specific function of organs and systems. For example, the motor zone provides the ability of a person to make voluntary movements, the brain center of vision and hearing provides the correct perception and analysis of visual and auditory stimulation.

With a stroke, the death of nerve cells in the area of \u200b\u200bcerebral infarction or hemorrhage occurs. Depending on the control of which functions is located in this place, various neurological manifestations arise: paralysis, speech disorders, movement coordination.

The return of lost functions after a stroke occurs in 3 ways:

restoration of those structures of the nervous tissue that have reversible damage, that is, they have not died, but are in a depressed state;
restoration of completely dead elements by replacing them with new ones;
the transfer of duties of dead neurons to neighboring nerve cells.

Exercise therapy for stroke helps to speed up all these mechanisms and reduce the time to return lost functions.

Restoration of structures of the nervous tissue with reversible damage

These mainly include the restoration of the conductivity of the nerve fibers of cells that did not die, but fell into deep biochemical stress. Physical exercises after a stroke, which the patient performs on his own or with the help of an instructor, create a powerful stream of nerve impulses from the muscles to the brain. Due to this, the oppressed nerve cells are awakened, and new pathways for the transmission of excitation to the central nervous system are formed. Thus, the foundations are laid for the complete control of the brain over the functions of the body: the return of lost voluntary movements, speech.

Restoration of dead elements to new ones

Here it is necessary to clarify that we are not talking about dead nerve cells located directly in the area of hemorrhage or brain infarction and not subject to recovery, but about the growth of neuron processes that remained alive after suffering an attack of the disease. Due to the formation of numerous new nerve fibers, there is an increase in the number of contacts between nerve cells and the organs controlled by them. All this helps to restore lost functions even with a small number of neurons that have survived.

Gymnastics after a stroke increases blood flow to moving muscles, which means it increases nutrition and oxygen supply. All this leads to increased growth of new nerve fibers. Constant stimulation of the brain by nerve impulses that occur in the muscle during movement leads to an increase in the contacts of neurons with each other, which also has a good effect on the control of organs.

Transfer of duties of dead neurons to neighboring nerve cells

As you know, "nerve cells do not recover", so the focus of a stroke later turns into a scar. However, nature has laid in the body an amazing function of transferring the duties of dead cells to neighboring elements. In the brain, after an acute circulatory disorder, the functions of destroyed nerve cells begin to be performed by their healthy neighbors. The transfer of authority occurs solely under the stimulating action of nerve impulses. This is exactly what therapeutic exercises after a stroke are aimed at, because muscle movements are a powerful source of nervous excitation transmitted to the brain.

Exercise therapy depending on the stage of the stroke

The main goals of exercise therapy in patients with stroke are:

restoration of voluntary movements;
preventing the formation of adhesions in the joints;
decrease in muscle tone on the paralyzed side;
strengthening the body.

From how much time has passed from the first signs of a stroke, the following periods of the disease are distinguished:

acute (first 72 hours);
acute (up to 28 days);
early recovery (from 28 days to 6 months);
late recovery (from 6 months to 2 years);
period of residual effects (more than 2 years).

Each of these periods corresponds to a separate set of exercise therapy exercises.

Acute and acute period

Restorative gymnastics after a stroke is indispensable already in the first days of the patient's stay in the intensive care unit. An exercise therapy instructor or a trained relative conducts sets of exercises aimed at preventing respiratory complications and preventing the formation of contractures in the joints on the injured side.

For these purposes, breathing exercises, positional treatment and passive movements are used.

Breathing exercises

Measures to restore proper breathing begin from 2-3 days of treatment in the ICU. Respiratory exercises after a stroke consist in a patient-controlled change in the rate and depth of inhalation and exhalation, following the commands of an exercise therapy instructor. These can be rhythmic breathing under the count, exercises for an arbitrary decrease in the frequency of respiratory movements; change in the type of breathing, for example, from chest to abdominal and vice versa.

Position treatment

It is necessary to prevent the appearance of contractures (stiffness) of the joints. Flaccid paralysis, observed in patients in the first 2 weeks after a stroke, is gradually replaced by spastic. Due to the increased tone, irreversible changes occur in the joints on the diseased side, which lead to limitation of movements in them. To combat this complication, such a method of exercise therapy as treatment with a position is used.

It consists in the following: the diseased limb is laid in such a way that it is maximally extended and in a position opposite to the action of spasmodic muscles. For example, on the arm, increased tone after a stroke is most often observed in the muscles that adduct the shoulder and turn the palm inwards, bending the fingers of the hand. Therefore, the treatment position in this case will be the following: the diseased arm is straightened, laid aside by 30-40⁰ (gradually bringing it to 90⁰), lies on a chair placed next to the bed; the palm is open, the fingers are straightened (to fix this position, a bag of sand placed on the palm is used); the thumb is in the grip position (as if there is a small ball in the palm that he is holding).

Treatment with the position is carried out every 1.5-2 hours, while it is held until the onset of discomfort or pain in healthy muscles.

Passive gymnastics

It is performed only after a treatment session with a position when muscle tone weakens. Classes begin with a healthy limb, in which active movements are carried out (the patient himself performs exercises), covering all types of movements in a particular joint (flexion-extension, abduction-adduction, rotation). Then they move to the diseased side, the movements in the joints of which are performed by the exercise therapy instructor. Passive exercises against stroke begin to be performed from the distal extremities (from the joints of the fingers), gradually moving up.

However, despite the seeming simplicity, the movements must be performed according to certain rules, otherwise they can harm. An excellent illustration of the main methodological approaches of this section of exercise therapy is a video of passive gymnastics after a stroke:

An approximate set of exercise therapy exercises for stroke for bedridden patients

The total duration of the complex is 25-30 minutes. During the session, it is necessary to take breaks for 1-2 minutes, focusing on the well-being of the patient. The gymnastics should be finished with the correct laying of the paralyzed limb (positional treatment).

Massage for a stroke can be prescribed 2 weeks after the onset of the disease. It includes the simplest classical techniques: light stroking on the affected side and moderate rubbing, kneading on healthy muscles.

Early recovery period

Exercises for recovery after a stroke during this period, along with passive ones, include active movements of the diseased limb. Even the slightest ability of muscles to voluntary contraction should be used to restore lost motor functions. Training for active muscle contraction must be included in the daily exercise therapy complex.

The exercise therapy complex using active movements, which includes exercises for the hand after a stroke, looks something like this:

The ability of the patient to maintain balance while sitting independently is a sign that it is necessary to diversify the exercises performed. The exercise therapy complex includes movements in the lower back and neck: tilts, turns.

Preparation for walking begins with imitation of walking movements in the supine position.

late recovery period

A feature of exercise therapy during this period is the addition of exercises to overcome resistance to the complex of daily gymnastics. The effect of classes directly depends on the correct technique. To facilitate understanding of exactly how to perform movements, you can view an approximate set of physical exercise exercises after a stroke video:

A huge role in the formation of normal muscle tension and acceleration of the processes of returning motor functions is played by massage after a stroke. It should be carried out several times a year for 10-20 sessions.

The famous expression “nerve cells do not regenerate” is, unfortunately, true. However, even after losing a significant number of neurons in the stroke area, it is possible to achieve a good recovery of voluntary movements with the help of physiotherapy exercises.

Unfortunately, strokes in our country are diagnosed more often and they affect not only the older generation, but also relatively young people. About 80% of all diagnosed strokes are ischemic strokes, which are a little easier and rehabilitation after them is faster.

It is possible to return a person to the normal functioning of the body thanks to exercise therapy, which is very effective, according to doctors. The most famous is the treatment program according to the method of Dr. Bubnovsky, which is actively used in practice.

The doctor independently developed a theory according to which it is possible to completely restore the motor function of a person by performing a set of exercises by Dr. Bubnovsky.

To speed up the process, you can also use Bubnovsky's special simulators, which have passed all the necessary checks and meet all medical requirements. They can be used not only in specialized centers, but also at home.

Preparing for classes after an attack

Physical exercises are of great benefit to the paralyzed, since any motor activity accelerates the blood, prevents stagnation in the body, and restores muscle memory. However, one should not hope that only doing a set of exercises will help the patient to fully recover.

There must also be medication prescribed by the attending physician. Classes and medicines in the complex will give the expected result.

First, the attending physician will help to care for the patient and help him do certain exercises. But after discharge, all these worries fall entirely on the shoulders of loved ones and relatives. Therefore, they need to thoroughly know the basic principles of caring for a patient after a stroke during rehabilitation:

Rehabilitation after a stroke can be very slow, but at this time the most important thing is attention to the patient, patience, and constant training at home, which last at least 3 hours a day with interruptions, therapeutic exercises.

Remember, the set of exercises that will be discussed below is of a general nature; each case of a stroke must be approached individually.

Before starting a complex of therapeutic training, it is necessary to consult a doctor, get his recommendations, listen to the advice. It will also help to calculate the intensity of classes and the time of training at home.

Massages and passive load on the body after a stroke

Before you start doing exercise therapy at home, you need to undergo a course of massages that will prepare the body for rehabilitation, relieve increased muscle tone, and relax them.

After you have warmed up the body, you can proceed directly to therapeutic passive massage at home. Here are some basic manipulations that relatives with paralyzed limbs of the patient can carry out:

Do not forget also about the systematic exercise of exercise therapy. Gymnastics must be carried out daily, at first 2 times, and after 2 weeks - 3 times a day, for at least 40 minutes.

Exercises after a stroke in a sitting position

The next stage of rehabilitation is the implementation of a complex of physical education while sitting. It is necessary to proceed to it when the patient himself was able to take a sitting position of the body. You can do the following exercises:

As soon as the patient's condition has improved, you can move on to trying to get out of bed using the backrest or tensioned belts. It is also recommended to raise the limbs 3-4 times, reduce the shoulder blades. But all these exercises should be performed only under the supervision of relatives.

A set of exercise therapy exercises in a standing position

After the patient was able to get out of bed on his own, you can start gymnastics for rehabilitation in a standing position. Consider basic gymnastics after a stroke: