Charging for stroke patients. Remedial gymnastics after a stroke: where to start. Violation of the patient's speech activity

21.06.2019

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, a contracture with flexion in the elbow joint and pronation of the wrist joint is noted in the hand, 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:

There is a significant improvement in the work of the cardiovascular system, as well as the functions of other systems and organs.
Correct breathing is being established.
Locally increased muscle tone is reduced and the development of contractures is prevented.
Healthy muscles are strengthened.
The overall emotional state improves significantly.
The patient adapts to his social functioning, and if possible, he can return to daily duties (this therapy is called occupational therapy).

Therapeutic exercises for stroke contributes to the fact that, during the exercise of therapeutic exercises, compensatory mechanisms are involved in the process to restore the 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, softly, 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:

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

We present to your attention one of the possible complexes of exercise therapy 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 at 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.

About 90% of stroke patients remain disabled. It takes a lot of effort to restore normal brain activity. Rehabilitation takes a long time. It is carried out not only in a hospital, but also at home. Exercise after a stroke is aimed at restoring lost functions.

Why exercise at home after a stroke

As a result of a stroke, a person experiences acute cerebrovascular accident (CVA). The cells in the lesion focus die and can no longer perform their functions. Stroke is one of the most common causes of death after coronary heart disease. If ACVA was noticed and cured on time, then a person has a chance for life, but the dead brain cells are no longer restored.

Depending on the localization of the lesion, the patient suffers from memory impairments, drowsiness, loss of orientation in space, and speech problems. Special restorative gymnastics after a stroke helps to improve the quality of life. It has the following actions on the body:

prevents blood stagnation in paralyzed tissues;
restores muscle memory;
mobilizes the activity of intact neurons, which take on part of the functions of dead cells;
restores the brain's ability to send motor impulses to nerve endings;
stimulates blood flow, thereby improving blood supply to the brain;
prevents the development of a second stroke.

The effectiveness of rehabilitation measures

Exercising after a stroke at home has a positive effect on more than just the brain. It is necessary for a person to master the lost functions, to adapt to self-service. Gymnastics is no less important for the prevention of complications, the danger of which is high due to the patient's long stay in a state of forced immobility. Exercise after a stroke has several functions:

improve blood microcirculation and metabolism;
relieve muscle spasms;
restore the functions of speech, thinking, memory;
improve body balance and coordination of movements;
provide prevention of congestive pneumonia, heart failure, blood clots followed by embolism (thrombosis of vital organs);
help the patient to adapt to the current situation;
restore the sensitivity of the affected parts of the body;
prevent the development of contractures - muscle hardening;
prevent the formation of pressure sores in the back, feet, heels and other places experiencing high pressure in the supine position;
resume fine movements of the hands and upper limbs.

Indications

Performing gymnastics after a stroke has one indication - the presence of disorders of motor, sensitive functions of the body and others. These include:

memory problems;
hearing impairment;
speech defects;
spastic paralysis, increased muscle tone;
paralysis of half or completely of the whole body;
violations of fine motor skills;
increased fatigue;
sudden mood changes;
swelling of the legs;
inability to carry out daily activities and self-care;
dementia (decreased intellectual ability);
poor coordination of movements.

Contraindications

Not all patients are allowed to exercise after a stroke. With a relapse of this pathology in elderly patients, rehabilitation cannot include gymnastics. It is contraindicated in the following cases:

if the patient is in a coma;
the presence of mental disorders;
the presence of symptoms of epilepsy, seizures;
a history of tuberculosis, diabetes mellitus, cancer.

Recovering from a stroke at home

The acute period of a stroke is the first six months after the attack. During this period, some of the brain cells irrevocably die off, while others retain their abilities, but need help to fully restore their functions. This is what exercise is for. When the patient is conscious, they begin to perform gymnastics on the third day after the attack. In order not to harm the body, rehabilitation is carried out in stages and methodically. Scheme for introducing certain exercises into the patient's daily regimen:

At the initial stage, bedridden patients are cared for by a whole team of doctors in a hospital setting. At the first stage, only passive types of loads are used. Practically from the first day, specialists do a massage, turn the patient over every 2-3 hours to avoid the formation of bedsores.
Further, passive gymnastics is carried out by third parties who are close at home. With the help of massage, the patient's skin is warmed up to ensure blood flow to the tissues. The impact should not be too strong. The procedure should be easy and enjoyable. As for the exercises, with passive loads, flexion / extension of the limbs - arms and legs - is allowed. The patient is placed on his back, after which the arm or leg is raised and bent. Such actions are carried out 2 times throughout the day for 40 minutes in the first week, and then 3 times a day. Additionally, it is allowed to perform exercises to restore speech, memory, articulation.
After passive load, breathing exercises are added to normalize gas exchange, oxygenate tissues and improve muscle performance. Additionally, it improves mood and increases endurance, which prepares a person for further active loads.
Physiotherapy exercises (exercise therapy) are prescribed when the patient has the first positive results and he already has self-confidence. This period often coincides with hospital discharge. A change of environment has a beneficial effect on mood and subsequent rehabilitation. First, exercises are performed in bed, then in a sitting position, and then standing.

A set of exercises after a stroke

During recovery from a stroke at home, it is not only physical therapy that is important. Relatives of the patient who are involved in rehabilitation must follow several rules:

start rehabilitation from the first days of hospital stay and continue at home until the lost functions are restored;
exercise regularly, since only regularity will help achieve good results;
carry out recovery in stages, without changing the stages of rehabilitation in places;
restore lost functions in parallel, including speech, memory, movements;
to provide constant supervision of the patient by a neurologist and a rehabilitation therapist, since only they can control the effectiveness of rehabilitation.

For the torso

The main goal of doing these exercises at home is to reduce the risk of falls. It does this by improving the balance and stability of the body position. Rules:

Exercises in this group are suitable for performing at a stage when physiotherapy exercises are allowed.
At this stage, the patient must already carry out any movements himself.
The first few days, it is better to do each exercise for 1-2 sets. Then it is allowed to increase their number to 3-4.

The following exercises are considered effective:

Torso turns. Performed while sitting on a chair. The right hand must be placed on the outer surface of the left thigh. The back should be straight. Leaning on your right hand, you need to make a turn to the left, as if looking back, and then return to the starting position. The movement is performed 15 times in one and the other direction.
Tilts of the body to the sides. Starting position - sitting on a chair. From this position, it is necessary to lower, trying to reach with the left shoulder to the left thigh, while bending to the side. Then the same is repeated with the right half. For each you need to perform 15 repetitions.
Torso bends forward. Starting position - sitting on the edge of the chair. Hands must be clasped, straightened in front of you and not bend them. In this position, it is required to bend forward, trying to reach with the upper limbs to the toes. Next, you need to hold this pose for 10 seconds, and then return to the starting position. The number of repetitions is 10.

For legs

You can restore the functionality of the leg muscles with the help of stretching exercises, improving mobility and increasing muscle strength. Stretching is essential to prevent injury, widen range of motion, and increase blood circulation. Exercises for mobility improve the condition of the joints, and for the restoration of muscle strength - increase endurance. To achieve these goals at home, you must do the following:

Stretching the muscles of the legs. Suitable for the stage of passive loads. The patient is in the supine position. His left leg needs to be bent and thrown over the right, and then held so for 30-60 seconds. The same is repeated with the other limb. For each, you need to do 3-4 approaches 3-4 times.
Turns of the legs to the side. Suitable for the recovery phase with physiotherapy exercises. You need to lie on your back, bend your knees. The feet should be completely flat on the floor. Next, keeping your legs together, tilt them to the right and then to the left. This improves the mobility of the hip joints. You need to do 3-4 approaches 8-10 times.
Walking. This is the easiest physical activity. It is suitable for the stage when a person is able to move independently, even if he does it with a walker or cane. You need to walk for at least 20-30 minutes several times throughout the day.
Squats. You need to stand up straight, legs apart shoulder-width apart. Next, you need to sit down so that the heels do not come off the floor, and the hips are parallel to it. At the same time, the arms are pulled forward. Then they return to the starting position. You need to perform at least 4-10 squats. Exercises are suitable for the stage when the patient is already able to move.

For hands

Passive hand movements at home can be performed with the help of a stranger or a healthy limb. Effective exercise options:

Flexion of the shoulder. Lie on your back, put your hands on your chest. Further, the affected limb with the help of a healthy one is raised to the maximum upward, after which it is slowly lowered back. You need to do 3 sets of 8-10 times.
Strengthening the shoulder girdle. Lie on your back, arms extended vertically above the body. Then tear off the shoulder blades from the surface, thereby slightly raising the upper body. This position is held for a couple of seconds, after which they slowly return to their original position. Repeat the exercise 8 times, do 2 more approaches.

When the patient is already able to perform any actions on his own, then you can start more active exercises that improve muscle control. At home, you can do the following:

Grasp the handle of the refrigerator with the fingers of the affected hand. Close and open the door 10-12 times.
Carry a bag around the house. Increase its weight as it improves.
Turn the light on and off with the affected hand. Perform several times throughout the day.

For brush

After a stroke, special attention should be paid to the restoration of motor skills. To regain control of the brush, you can do the following exercises:

Extension / flexion of the hand. Place your forearms on the table, palms down. The brushes should hang over the edge. Then they need to be moved up and down. It must be done 8-10 times. Then the same is repeated with palms turned up.
Flexion / extension of the thumb of the hand. The palm must be fully opened. Next, the thumb is bent towards the little finger and unbent back. The movement is repeated 8-10 times, after which 2 more approaches are done. Then the thumb of the other hand is trained in the same way.
Other exercises. To improve fine motor skills, it is recommended to squeeze and unclench your fingers, count small objects with your hands, such as coins, unclench laundry chips, collect puzzles, play chess and checkers or other board games.

For eyes

ACVA causes nerve paresis, which can lead to problems with oculomotor function. To restore it, a set of special exercises after a stroke is prescribed at home, which can be performed already on the third day after the attack:

Diagonal eye movement. You need to mow them to the lower left corner, and then move them up in a straight line. The same is done to the right. You need to repeat the movements 8-10 times, and in total perform 3-4 approaches.
For about 30-60 seconds, perform smooth circular movements with the eyes in one direction and the other.
Then you can quickly blink for half a minute, after which you can look forward for the same amount of time, completely eliminating blinking.
Close the eyelids, lightly press on the indentations above the eyeballs, and then sharply release the fingers. Do it 4-5 times.
For 30 seconds, perform eye movements, writing out an eight in the air.

To restore articulation

Articulation is understood as the totality of the work of the pronunciation organs in the formation of sounds. After a stroke, speech may become slurred. To improve pronunciation already in the hospital and then at home, you can perform the following exercises:

Stick out your tongue, pull it first to the chin, then to the tip of the nose. Do it 10-12 times, 3-4 sets.
To protrude the lower jaw forward, capturing the upper lip with the lower lip. This position is held for 7-10 seconds, then there is a return to the starting position. Exercise is done in 3-4 approaches, each for 10-12 repetitions.
For about 30 seconds, perform tongue clicks - clicking up and down movements.
Smile broadly - so that all teeth are visible. Hold the smile for a few seconds, and then do the same, but with closed lips. Perform 2-3 sets, doing 10-12 reps.

To improve coordination

After a stroke, a person begins to stagger, his gait becomes unsteady, which is why falls often occur. Special exercises are performed to restore balance. They are allowed at the stage when the patient is already engaged in exercise therapy. To improve coordination, you can do the following post-stroke exercises at home:

Leading the leg to the side. You need to stand up straight, rest your hand on a table or curbstone. Next, the leg is taken to the side so that the angle between the floor line and the limb is approximately 45 degrees. Then it is slowly lowered. For each leg, you need to do 2-3 sets of 8-10 reps.
Walking in a straight line. A straight line must be drawn on the surface. The patient should walk, stepping on a straight line, while putting the heel of the left leg to the toe of the right and vice versa. You need to walk several times for 3-4 minutes.
Toe stand. Stand up straight, rest your hands on a curbstone or table. Next, you need to rise on your toes, fix the position for 10 seconds, and then lower yourself on your heels. Do it 8-10 times.

To restore memory

To restore cognitive functions, they use the method of mental physical education. It is prescribed to restore muscle memory. The essence of the procedure is that while performing the movements, you need to pronounce them, for example, “I move my fingers, bend my arm,” etc. If the patient is still unable to speak on his own, then a loved one who is involved in rehabilitation should do it for him. To improve normal memory, it is recommended to do the following at home:

talk with a person about his interests, hobbies, lifestyle, traditions;
read and memorize poems together, engage with him memorizing numbers, alphabet, events and facts;
walk in familiar places;
turn on music so that the patient learns the song, and then hums it himself;
to cook the patient's favorite dishes, because the smells and tastes associated with the previous life train the receptors of touch.

What simulators are used after a stroke at home

When, in the course of exercise therapy, a person has already got used to active loads, you can start exercising on special simulators. Their use will help to strengthen the muscle corset and almost completely restore motor function. The following simulators can be used:

Mini simulators. They help in the restoration of fine motor skills of the fingers. Examples of simulators: "Shagonog", "Bud".
"Active-passive". This is the name of simulators designed for active and passive development of the upper or lower extremities. They provide an active workout with variable resistance generated by the motor.
Exercise bikes. They improve the motor functions of the legs, increase endurance in general.
Verticalizer. Also called a stander. The simulator is a device for giving a person an upright position. It can support the patient from the front or back, and even move on wheels. By giving the body an upright position, it is possible to redistribute blood in the body and improve blood supply.
"Lokomat", or exoskeleton. This is the name of a robotic orthopedic trainer designed to restore walking skills. It is used in conjunction with a treadmill. The simulator helps to regain the lost movement skills, "verticalize" and start walking again.

Respiratory gymnastics after a stroke

Exercises to develop breathing are recommended to be performed while still in the hospital. The patient should take deep breaths throughout the day and take them as often as possible. It is allowed to alternate chest and abdominal breathing. When the doctor allows you to sit, you cannot bend your back so that the inhaled air expands the lungs as much as possible. At home, you can do the following breathing exercises to recover from a stroke:

Inhale slowly deeply, hold the breath for a few seconds, then exhale gradually. Repeat 8-10 times, perform 3-4 approaches.
Inflate the balloon several times. Do the exercise 3-4 times a day.
Dip a tube into a cup of water. Exhale several times through it so that the liquid gurgles.

Video

Stroke is a serious disease associated with impaired blood circulation in the vessels of the brain. Motor and speech skills are often impaired after a stroke.

One of the conditions for a person to return to normal life is to perform physical exercises during the rehabilitation period.

A set of exercises for a stroke is designed taking into account the recovery periods. The intensity of training increases gradually, this has a beneficial effect on the restoration of brain functions.

What determines success

The duration and effectiveness of the recovery period largely depends on the patient, his positive attitude, dedication and patience. It is also important to understand the nature of the disease and the focus of treatment methods. Sometimes the patient and others do not fully understand the purpose of exercise therapy after a stroke, they perceive therapeutic exercises as a procedure that strengthens muscle strength. This is mistake. The main goal is to restore the ability of the brain to control human movements. In the initial recovery period, you do not need to pump up muscles. The following factors are also of great importance:

In the first days after a stroke, passive gymnastics is carried out by the attending staff in a hospital setting. In this case, the movements are made instead of the patient, so that he does not make efforts.

If there is no possibility of performing exercise therapy in the hospital, someone from the patient's relatives, after consulting a doctor, can carry out the complex at home. When choosing exercises, the doctor takes into account the patient's condition, which parts of the brain have been damaged, which functions are impaired.

Exercise therapy of the hands is carried out, starting with the flexion and extension of the fingers of the paralyzed limb, and then proceed to the healthy one. The next movement is the rotation of the brush in both directions. Then they bend and unbend the arms at the elbow joints, and at the end they develop the shoulder joints - bend and unbend down and up, left and right, make a turn.

Therapeutic exercise of the lower extremities also begins with flexion and extension of the fingers, then the feet are rotated. After that, the legs are bent and unbend at the knees, and, finally, bending movements in the hip joints are performed.

Revitalizing active movements

After a stroke, active exercise therapy exercises are first done lying down, then those performed while sitting are added, and only after that they include standing exercises. They switch to active exercises after consulting a doctor. The intensity and frequency of exercise is gradually increased, focusing on the advice of the doctor and the patient's well-being.

When a patient performs a set of exercise therapy exercises, the presence of a second person is desirable to prevent traumatically dangerous situations. The patient is insured until he begins to behave confidently.

When switching to certain types of active movements, it is necessary to assess the general well-being of the patient, and also focus on increasing the mobility of the paralyzed limb. As soon as, for example, a finger, which was previously motionless, begins to move, they try to make active movements with it. That is, at a certain stage, both passive and active gymnastics are performed simultaneously. When the doctor permits the transition to active exercises, the patient will independently perform passive exercises on the paralyzed limb with his healthy hand, and then active on healthy limbs. The number of movements starts from 3-5 times, gradually increases. Exercises are done slowly, with restraint and diligence.

All exercises are aimed at restoring the mobility of the paralyzed limbs: from 1 to 5 - for the arms, from 6 to 19 - for the legs. These exercises do not require significant physical effort, but provide a great start to return to your normal lifestyle. Hand exercises can be done while lying, sitting, and standing. It depends on the patient's well-being and on the extent to which the body's strength has already been restored.

If any exercise cannot be performed correctly at once, you need to do it as it turns out. Over time, success will surely come. Some recover quickly, others slower. There is no need to compare your progress with the achievements of other patients. Even small progress is an important step towards recovery. After all the exercises from this complex have been mastered, it is possible, with the permission of the exercise therapy doctor, to attach to it various inclinations and turns of the head and body, squats and other movements.

Stroke refers to severe pathologies that require 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 an important role, since only exercise therapy after a stroke is able to 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 physiotherapy exercises after a stroke are able to “start up” the neurons of the brain and create a natural stimulus to recreate new neurogenic connections.

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

prevention of negative consequences of prolonged immobilization in the form of bedsores, heart failure, muscle atrophy, congestive pneumonia;
improvement of blood circulation in the muscles affected by paresis or paralysis against the background of a decrease in their tone;
reduction of pathologically high tone in muscles in a state of spastic paresis or paralysis;
prevention of muscle contractures and the resumption of physical 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 extensive cerebral hemorrhage, staying in bed can last for several months. During this time, in the absence of exercise, irreversible changes in the level of cellular metabolism will inevitably occur.

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

Basic principles of exercise therapy after stroke - indicators of success

The progress of recovery from a stroke largely depends on how quickly exercise is practiced. In addition, both the patient and his loved ones need to understand that exercise therapy is a means not so much to strengthen muscles, but to restore the ability of the brain to control the body.

The success of remedial gymnastics depends on the following factors:

Timely start - exercises should be done after the patient has emerged from a coma (if any) or at the end of the critical period.
Consistency and regularity - it is necessary to do it daily, regardless of the patient's current state of health. To minimize complications, it is recommended to select exercises according to the level of difficulty for each of the conditions. Even if the patient is not tuned in to classes, it is necessary to force him to do at least a minimal list of passive restorative 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.
Consistency - Initial Stress Stroke recovery exercises involve minimal stress, but they get more complex over time. The transitions from one stage to another should occur at the right moment - it has been proven that prolonging the period does not bring positive results. Greater effect is expected with a gradual build-up of intensity and complexity.
Attention to the patient's well-being - during the exercise, it is necessary to monitor the condition of the ward (this includes blood pressure, pulse rate, breathing). Equally important is the emotional component - even a small success should be accompanied by praise and encouragement to further progress.

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

Exercises for the initial recovery phase

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

posture 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 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 him the correct position. The purpose of the procedures is to prevent complications such as pressure ulcers, contractures and pneumonia.

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

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

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

Passive exercise

Performing 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 carer. At this stage, breathing exercises can be carried out - after a stroke, it is necessary to normalize breathing to exclude 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 on the first day should be minimal with a subsequent increase. It is important not to exceed the maximum physiologically possible amplitude in order to avoid sprains or ruptures of the ligaments, as well as dislocation of the joints. If there is resistance, you can pre-heat the joint with massage.

All passive stroke exercises are divided into 3 subgroups:

Flexor Extension - Suitable for knees, elbows, feet and hands.
Rotational - used for feet, hands, shoulder joints.
Lead-lead - used for the hip and knee, shoulder joints.

The 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 norms, gymnastics with a stroke should first touch the large joints, and only then you can begin to warm up the 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

Respiratory training is carried out only after the patient has finally regained consciousness and can control the maxillofacial joints. For a start, 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 balloons.

Breathing out air forcibly helps to remove congestion in the lungs and free them of phlegm. In addition, these are excellent facial exercises to help eliminate paresis of the facial muscles.

Exercises for the second phase 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 require a certain degree of concentration on the part of the patient.

The following exercises for the 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);
independently bending and extending the arms at the elbows (15-20 times);
raising straightened arms perpendicular to the body and slow lowering (15-20 times);
waving straightened arms to the sides (15-20 times);
flexion and extension of the toes (10-20 times);
pulling the toes towards yourself, as when walking on heels, and away from yourself, as when pressing the pedals (15-20 times on each leg);
flexion and extension of the knees (10-20 times);
breeding to the sides of the legs bent at the knees, followed by mixing (10 times).

If you are physically able, after exercises on the limbs, body gymnastics is performed. It consists of simple movements:

turning the body 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 the chin pressed 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 whole 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 (without support behind the back), raising and lowering the legs, bending them with pulling the knees to the chest and extending.

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 crumpled into a lump, large cereals (beans or beans, for example) for transferring by handfuls or one grain from one container to another.

Exercises for the third stage of recovery

At this stage of rehabilitation, you can start doing exercises in a standing position. First, it is recommended to do them with the support of outsiders, and then on your own. Ideally, special simulators should be used for this, but a standard set of exercises after a stroke at home can be done with the help of improvised means.

To begin with, a stroke survivor must learn to balance. This can be achieved by 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. It can be a headboard of a bed or a chair, or a special machine.

head rotation;
swing legs;
swing your hands;
raising the legs back and forth or to the sides;
turns of the body to the sides.

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

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

A stroke is a violation of blood circulation in one of the parts of the brain. This disease leads to a decrease in the supply of oxygen and nutrients to the brain cells, which provokes paralysis of the right or left extremities, numbness of the face, and difficulty speaking.

In severe cases, the intellect is impaired, a person may fall into a state or.

A patient who has experienced a stroke requires special attention and care. To restore brain function will require a long period of rehabilitation and help from loved ones.
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Preparation period

Caring for a stroke patient requires the constant presence of a caregiver or, if possible, a relative. The interval between procedures is 2-3 hours, so you need to be aware that the rehabilitation process requires a lot of patience.

In order for the patient to recover as early as possible, it is important to follow the advice of the attending physician:

Change of position of the patient	Should occur every 2-3 hours; it is necessary to turn the body from one side to the other in order to avoid hypostasis (blood stagnation) and the appearance of bedsores.
Passive physical exercise	The patient moves with the help of a relative or a nurse; this method of activity will reduce muscle tension.
Breathing exercises	The essence of such exercises is a combination of passive movements with inhalation and exhalation; they allow not only to increase the flow of oxygen to the brain, but also to involuntarily relax and strain the muscles.
Active loads	For a start, this can be exercise in bed, and then walking at a slow pace; this will allow you to regain your physical fitness and reduce the risk of subsequent strokes.

To avoid muscle strain, all exercises should be started with 1-2 sets and gradually increased. The interval between classes should be at least one hour.

Complex of passive loads

Before embarking on passive exercise, it is important to prepare the patient's muscles for physical activity. For these purposes it is used.

There are several rules for its correct implementation:

massage is done in soft circular movements;
the massage therapist should move from the bottom up: from the hand to the shoulder and from the foot to the lower leg;
the back is massaged with tapping and pinching movements;
the chest muscles are kneaded in the direction from the center to the armpits.

After completing the massage, you can start exercise therapy after a stroke at home. Rehabilitation exercises for bedridden patients who have suffered a stroke include several types of basic exercises.

These include:

Leg curl	The limb is bent in such a way that it can straighten on its own, having passed on the bed. This exercise helps restore motor memory.
Leg extension	Another similar exercise has the same effect. The gymnast bends the knee, and the patient tries to unbend it on his own.
The leg or arm is suspended from a towel or wide elastic band and rotates around in a circle	Also, the limbs can be bent, unbent and laid to the side. The patient can independently try to rotate or move the suspended parts of the body. This exercise is performed once a day for half an hour.
Raising and lowering the arm	To develop the shoulder joint, you need to raise and lower the arm, bend and unbend it.
It is equally important to stretch the muscles of the hand.	To do this, the fingers are clenched into a fist and unclenched back. You need to do 10 repetitions.
Small objects are suitable for the development of fine motor skills.	You need to put them in the patient's hand and help hold them with your fingers.

If there are no special instructions for the exercise, then it is performed 2 times, and after the appearance of improvements, 3 times a day for 30-40 minutes.

Mental training

It is very important to engage in mental stress during the period of rehabilitation after a stroke. This will allow the neurons (nerve cells) of the brain to regenerate, which send commands to the muscles throughout the body.

Also, mental training develops the speech apparatus.

During the exercise, the patient must repeat aloud the commands to his limbs many times.

If the speech apparatus is paralyzed, then a relative or a nurse should speak the commands. The main advantage of mental gymnastics is that the patient can do it independently without time limits.

Standing exercises

Once you have the opportunity to switch to active exercise, the healing process will go much faster.

Back straight, arms at the seams, feet shoulder width apart	When you inhale, raise your hands, and when you exhale, lower them. It is performed in one approach 4-6 times.
In a standing position, the patient closes his outstretched arms in front of him	Then he has to catch and throw a tennis ball with his assistant. 6-8 movements are enough.
Hands at the seams, feet shoulder-width apart	Perform one-two-three count: put your foot forward, put back, return to the starting position. It is necessary 6-8 times for each leg.
Stand upright, feet together, hands on the back of a chair	Raise one leg on the chair seat, lower. Raise the other leg, lower it. It is performed in one approach 5 times.

To stretch the joints of the arms and legs, the following movements should be performed: rise on toes with the help of a support, rotate the hands and feet, close the fingers behind the back.

For the first workout, one approach in each exercise is enough. After the improvement occurs, the number of cycles can be increased.

Seated workout

All you need is a chair. Seated remedial gymnastics has one advantage - it can be performed by a patient who has not yet managed to take a standing position.

In this case, the exercises can be done without getting out of bed:

Rotation and tilting of the head	6-8 times in each direction.
Synchronization of movements	Since a stroke usually affects one side of the body, flexion and extension should be performed simultaneously with a paralyzed and healthy arm or leg. It is performed 5-7 times.
Grasping movements	Squeezing and unclenching the fingers of the upper and lower extremities. An expander can be used to increase the effectiveness of the arm exercise. The movements are repeated 5-7 times.
How to use a gymnastic stick as an arm trainer	If one is not at home, a wooden mop handle will do. You should grab the stick with both hands and swing the body back and forth, right and left for 0.5-1 minutes.
Reduction and dilution of the shoulder blades	When inhaling, the patient brings the shoulder blades together, while exhaling, dilutes. The exercise is repeated 4-6 times.

If the patient does not cope with the exercise, you should try to master it after 4-5 days.

Increased load

You can move on to more complex exercises when the patient has mastered simple movements, such as bending and extending the arms and legs, as well as walking.

Gymnastics with increased stress consists of the following exercises performed in a standing position:

Fold your hands into the lock and hold at chest level	Then raise the bound hands up to pull the body behind them. After that, return to the starting position. Repeat 5 times.
Close your legs and raise one hand up	Then simultaneously lower it and raise the other. The exercise should be done 10 times.
The exercise is performed on the left and then on the right half of the body.	Leaning on the back of the chair with your hand, swing back and forth with your leg. Repeat 5 times for each side.
Put your hands on your belt, feet shoulder-width apart	When inhaling, bend the body forward, while exhaling, straighten it. Runs 10 times.
In the same starting position, you can also perform turns to the sides.	On inhalation, the patient spreads his arms and turns the upper body to the side, on exhalation, returns to the original position. The exercise is done 5 times to the right and the same amount to the left.
Back straight, legs closed, arms extended at chest level	In a standing position, inhale, sit down on the first exhale, inhale in a sitting position and stand up on the second exhale. It is performed in one approach 6-8 times.
Arms straight, back straight, legs slightly more apart than shoulder width	It is performed on the count of one-two-three: inhale, exhale, turn the body. For the exercise, one approach of 5 turns in each direction is enough.
The main active loads also include daily walking and jogging.	This exercise takes 5-6 minutes.
Combine an exercise for the back muscles and the development of fine motor skills	To do this, bends with the lifting of small objects lying on the floor will help.
Additional leg exercise	Free jumps for 1 minute.

If the patient copes with the increased physical activity, he can be congratulated on a successful process.

The principle of action of exercise therapy after a stroke

There are 3 ways to restore brain function after illness.

Restoration of damaged nerve cells	Some neurons after a stroke are not destroyed, but simply stop transmitting commands from the motor centers to the muscles. To resume their work, it is necessary to send impulses in the opposite direction, that is, from the limbs to the brain, with the help of physical activity. After a while, the first improvements will be noticeable.
Replacing dead neurons with new ones	Exercise causes blood flow to the muscles involved. Oxygen and nutrients begin to flow to the surviving cells much faster, which causes an acceleration of the growth of new nerve fibers around them and the connections between them. Gradually, the brain begins to control the movements of the body.
Replacement of the functions of dead cells by neighboring neurons	The human body is arranged by nature in such a way that another begins to answer for the functions of a dead organ. So, with loss of vision, hearing and touch are sharpened. The same thing happens in our brains. Under the influence of physical exercise, impulses begin to flow to neighboring parts of the brain, which take on the responsibilities of dead cells.

In addition to restoring brain functions, exercise therapy has a positive effect on the entire body as a whole. Physical activity strengthens the immune system, prevents the appearance of adhesions in the joints, leading to immobility and fusion of cartilage, and also reduces the muscle tone of the injured limbs.

Physical activity depending on the stage of the stroke

Depending on the time when the stroke occurred, there are several stages of this disease. They differ in the features of manifestation and treatment, as well as in exercise complexes.

The most acute and acute period

The most acute stage of stroke lasts the first 72 hours after the attack, and the acute stage lasts up to 28 days. During this period, it is very important to monitor so as to prevent the appearance of complications on the respiratory organs and contractures (restriction of mobility) in the joints. Therefore, recovery should begin already in the intensive care unit under the supervision of a methodologist.

The main helpers in the acute and acute stages of stroke will be breathing and passive exercises, as well as posture treatment:

Breathing exercises	It consists in performing rhythmic inhalation and exhalation by counting, changing the frequency of breathing (acceleration or deceleration), the transition from chest breathing to abdominal breathing and vice versa.
Position treatment	It is performed to relieve increased muscle tone of paralyzed limbs. First of all, these are the muscles of the shoulder, flexors of the arm and foot, adductors of the thigh muscles and extensors of the lower leg. It is necessary to bring the limbs into the correct position every 1.5-2 hours. As an exercise for the hand, the following recommendations should be followed - the hand is placed on the pillow in a horizontal position parallel to the body and gradually withdrawn until an angle of 90 degrees is formed. Then the arm is turned outward and fixed with a splint. The paralyzed leg is bent at an angle of 15-20 degrees and a roller is placed
Passive physiotherapy exercises	It is prescribed strictly after a decrease in the tone of the paralyzed muscles. The exercises are performed first on the healthy side and then on the diseased side.

Early recovery period

The duration of this stage ranges from 28 days to 6 months. During this period, the patient is already at home.

From passive exercises there is a gradual transition to active, voluntary muscle contraction begins. The patient can already sit on the bed, so it's time to start the gymnast in a sitting position.

It is important to start preparing for walking during the early recovery period. In the supine position, the patient must perform movements that imitate steps. This will allow you to quickly master the skills of walking in the future.

Late recovery period

Lasts from 6 months to 2 years.

During this period, exercises to overcome resistance play an important role for the restoration of motor functions:

Rehabilitation simulators

The use of exercise equipment in restorative gymnastics after a stroke allows you to strengthen muscles, relieve tone, and restore physical activity. The latest generation of simulators is equipped with computer sensors that measure the main parameters of the heart. This allows you to monitor the patient's condition and avoid overstrain of the body.

The most effective simulators are "Manuped". It is necessary in case of muscle weakness and movement coordination disorder.

The device consists of a support on which a rotating steering wheel and pedals are fixed. The drive wheel ensures synchronized movements of the handlebars and pedals.

Another trainer of the latest generation is Motomed. It helps to eliminate disorders of the musculoskeletal system, reduce joint stiffness and restore full blood circulation.

"Motomed" allows you to perform both active and passive exercises.

What determines the positive dynamics

Despite the fact that exercise therapy is aimed at strengthening muscles, its main task is to restore brain functions responsible for motor activity.

The success of this process depends on several factors: http: //site/lechenie-insulta.html.

The indications and contraindications for thrombolysis in ischemic stroke are described.

In the process of rehabilitation, the patient and his relatives will have to face a lot of difficulties. And the more courageously they are tolerated, the faster the restoration of all lost functions will occur.