Exercises for the leg after a stroke. Massage and gymnastics after a stroke - Complexes of simple exercises

28.08.2019

Smirnova Olga Leonidovna

Neuropathologist, education: I.M. Sechenov. Work experience 20 years.

Articles written

Stroke is a serious disease that occurs with circulatory disorders of the brain and leads to the death of most of the nerve cells. The consequence of the disease is the loss of some functions that the dead cells performed, as a result, the patient has speech problems, complete or partial hearing loss and paralysis.

Physical therapy after a stroke will help the body restore the lost functions, therefore such a serious ailment is not at all a sentence.

Exercise therapy as an important stage of rehabilitation

The recovery of the body after a stroke is a complex, lengthy, but necessary process, since the period of forced immobility entails an extremely development.

The final recovery of a person takes place at home, under the supervision of loved ones and loving people. The success (in full or in part) of a patient who has lost some of the functions depends on how persistent and purposeful their actions will be, and how precise the rules for performing the exercises will be: the ability to not only serve oneself, but also move.

Rehabilitative gymnastics after a stroke is one of the most effective and affordable techniques aimed at making the inactive nerve cells of the brain work, which are located near the lesions. This allows you to return the lost sensitivity to the limbs, and in the case of positive dynamics, the ability to move.

Exercise therapy for stroke performs certain tasks and prevents the occurrence of:

bedsores;
heart failure;
blood clots, embolism;
muscle atrophy and spasms;
contractures (limitation of mobility in the joints of paralyzed limbs).

Systematically performed exercises for recovery from a stroke have a beneficial effect on metabolism and blood circulation, normalize the work of all body systems, and contribute. In the long term, the patient regains the accuracy of movements, he can write, draw, as well as use household items and serve himself.

Doctor's recommendationsonphysical educatione

When does physical at home start? This will depend on the observations of the attending physician, whose recommendations are based on the individual characteristics of the patient, his ability to recover, the region of the brain, as well as the completeness and effectiveness of the therapy received.

The first 6 months is an acute period, during which one part of the cells dies, the other retains the ability to perform its functions, but in the presence of a stimulating factor, which is a set of rehabilitation exercises for stroke.

If a person is not in a state between life and death, in other words, he is not in a coma, retains consciousness, and on the third day he is shown breathing exercises. This is a necessary condition for rehabilitation in order to prevent congestion in the lungs, increase the secretion of sputum, and eliminate paresis of the muscles of the face.

After being discharged from a medical institution, physical education for the patient is an integral part of recovery, so exercise after a stroke should continue at home.

As soon as the patient can, he is shown restorative walks, the time of which gradually increases.

The late rehabilitation period begins after 6 months. At this time, stroke patients need sanatorium treatment at least 2 times a year. Therapy carried out by medical personnel includes not only physical culture and health complexes, but also additional measures of influence on the body, such as acupuncture, electrosleep, oxygen baths, and others.

To achieve maximum efficiency, physiotherapy exercises must be combined with psychocorrection and classes aimed at social adaptation.

At each stage of rehabilitation, it is very important to support mental activity, when nerve cells receive commands from muscle memory. Every human action must be accompanied by mental orders that stimulate the limbs to move.

Contraindications to physiotherapy exercises after a stroke

Exercise therapy classes are not shown to all stroke patients. There are a number of contraindications that you need to know in order to avoid undesirable consequences. This applies to patients:

in a coma;
having disorders, aggressive changes in behavior;
with in old age;
suffering from epileptiform seizures, seizures;
with severe concomitant diseases (diabetes, oncology, tuberculosis).

If headaches, increased blood pressure, weakness occur during exercise, it is necessary to reduce the load. Relatives will need a lot of patience and endurance to help a loved one adapt to the surrounding reality and master the necessary everyday skills.

In order for the process to progress more intensively, they themselves have to learn the basic movements and their sequence. At the same time, for rehabilitation after a stroke, the patient needs to be encouraged in every possible way, to stimulate in him the desire to recover, because friendly support, participation, attention and good emotions will give him energy and faith in his own strength.

Respiratory gymnastics principles

The simplest exercise at the first stage of the exercise is to exhale through pursed lips or through a tube dipped in a bowl of water. After the patient gets a little stronger, an exercise is shown to improve the respiratory system, which consists in inflating a balloon. These simple manipulations allow the stroke patient to see and hear the results of his activity (increase in the volume of the ball, gurgling of water) and stimulate him to further action.

The basic principles of breathing exercises are to take several deep breaths, hold the breath for a few seconds, and gradually exhale. Exercise should be done frequently, but there should be rest in between. The patient is contraindicated to strain while holding his breath, otherwise he will have dizziness, which will negatively affect his health.

If the patient is allowed to sit, you need to make sure that his back is straight - this way the air will expand the lungs as much as possible.

Recovery after a stroke will be much more effective if you take Strelnikova's technique as a basis when performing breathing exercises.

Exercises in a supine position

As long as the patient is not allowed to stand up, the patient can do post-stroke exercises while lying down, which is limited to movements of the joints of the arms and legs. Then flexion, extension, rotation are gradually introduced, the amplitude of movements also increases. You need to start small, not trying to complete the "maximum" program: 15 movements in each joint 3-4 times a day will be more than enough.

The passive mode assumes that other people will do the exercises for the patient, bending and unbending his limbs. In the active mode, it is performed by the patient himself with the help of a healthy hand. As accessories, a towel is used, which is hung over the bed, or a rubber ring.

When performing the complex, it is important to follow the sequence and develop the joints from the center to the periphery, for example, exercises for the arms are performed starting from the shoulder to the hand.

raising and lowering arms along the body;
flexion and extension of the limbs in the elbow joint;
clenching the fingers into a fist and unclenching;
rotation of fists.

You need to do no more than 20 times in one approach.

Exercises for the legs:

flexion and extension of the knees;

abduction of the limbs to the side, using the hip joint;
pulling up the socks and returning them to their original state (exercise "pedal");
movement of the toes (flexion, extension).

The number of repetitions is 20 times.

For the muscles of the trunk (if physically possible):

without leaving the bed, perform body turns by roll;
lifting the upper body by straining the abdominal muscles;
lifting the pelvis using the shoulder blades, occiput, feet, elbows.

Perform no more than 10 times.

The following muscles also need to be developed: facial, eye, cervical.

Sitting exercises

When the doctor allows the patient to sit down, exercise therapy after a stroke at home includes exercises performed while sitting. They are designed to strengthen the arms, back and prepare for walking.

The complex includes:

head rotation;
raising and lowering legs;
flexion of the lower limbs;
pulling the knees to the chest;
swing legs;
sitting on a bed with lowered legs, without support behind the back.

These exercises should be performed 6-10 times.

Grasping movements can restore fine motor skills of the hands: transferring cereal grains (beans, beans) one by one or by handfuls from one container to another, creasing sheets of paper, pieces of cloth, folding small objects. Various educational games (pyramids, loto, mosaic) are very useful at this stage.

What exercises can be done while standing

A patient who has received permission to stand and move should vary and increase the number of exercises for stroke. In this case, charging should begin with a simple complex. At first, it is performed with the help of outsiders, then independently.

It is desirable to use, however, a standard set of exercises after a stroke at home can be done with the help of aids. Be sure to have a fulcrum behind your back, which, in the absence of a special machine, can serve as the back of a chair or bed. This is necessary so that the sorcerer who is not strong after a serious illness can confidently keep his balance.

The simplest types of exercise therapy include:

swinging limbs;
turning the body to the sides;
lunges with the transfer of weight to the front leg;
rolling from toe to heel;
squats;
tilting the body to the sides;
head rotation.

Gradually, the intensity of training increases. Activities include physical exercises such as jumping, backbending, pivoting boxing, and short walking walks.

The above exercises for hemorrhagic or hemorrhagic are an integral part of the patient's life. It is very important that a person who has suffered a disease does not lose the desire to regain lost functions, including the skills of domestic self-service. Remedial gymnastics is the best way to recover from a serious illness.

Stroke is a disease in which acute ischemia (cerebrovascular accident) occurs as a result of occlusion (blockage) or stenosis (narrowing) of the great vessels of the brain. We are talking about a severe pathology that requires long-term recovery. Rehabilitation after a stroke at home involves exercise, exercise (physical therapy), massage, and medication.

The list of exercise therapy exercises for stroke is selected by the doctor, based on the patient's condition, however, you can give approximate restorative complexes that are safe to perform at home.

About the benefits of exercise therapy

Gymnastics after a stroke has a lot of useful properties:

Physical exercise is indicated to maintain joint mobility and normalize muscle tone (with a stroke, the motor function of the arms and legs decreases).
Prevents the formation of pressure ulcers in the feet, back and those places where the pressure is greatest.
Promotes the restoration of the work of the brushes.
Helps relieve paralysis symptoms by restoring limb and body function.
Relieves muscle hypertonicity, normalizes the work of the affected muscles.

Exercises after a stroke are indicated for persons who have suffered from this terrible disease.

Preparatory activities

Before using the remedies for exercise therapy, it is worth preparing the patient.

How to do it:

It is necessary to constantly change the position of the lying patient (every 2-3 hours). Similar measures are required to prevent blood stagnation.
Then, with the same frequency, it is worth doing passive exercises: making movements with outside help. This technique allows you to relieve muscle tension.
After that, breathing exercises are added. They normalize gas exchange, improve muscle function.
At the end, they switch to active physical activity. This includes walking after a stroke. They make it possible to return to normal form and minimize the likelihood of subsequent relapses of the disease.

The rehabilitation complex is planned so that physiotherapy exercises after a stroke are the final point of the activities. It is indicated only when the patient's condition is stabilized.

The goals of healing charging

A set of exercises for a stroke is designed to achieve several goals:

Prevent pressure ulcers from forming.
Prevent the development of congestive pneumonia.
Relieve spasm of the left and right side of the body with strokes.
Stop the development of heart failure, as well as prevent atrophy of the affected muscles.

In severe cases, a person literally has to re-learn to walk, use household appliances, and self-serve. Exercise therapy after a stroke at home is designed to help solve these problems.

Passive loads

Before performing a complex of passive exercises, the patient is shown to perform massage. In short, it is carried out based on the following principles:

Physical impact is performed with light stroking circular movements.
Massage is done starting from the upper sections (head, collar area). Then they move on to the legs.
The impact on the back is carried out by tapping movements.
The pectoral muscles are affected starting from the center of the chest and moving to the armpits.
Hands and feet are massaged in this sequence. Hands: shoulders, forearms, hands, fingers. Legs: buttocks, thighs, legs, feet, toes.
The massage starts from the healthy side (left side, if the right side is affected and vice versa).

After completing the massage, you can start exercise therapy at home.

Exercises:

Take a rounded object, place it in the patient's hand. Help hold the object in your hands. Such exercises for fine motor skills of the hands should be performed more often, they will help restore the work of the hand and fingers.
Bend and unbend your legs. It is necessary to make movements so that the limb straightens itself, having traveled along the surface of the bed. Even in passive exercises, patient participation is important.
Squeeze and unclench the fingers of the affected hand.
Raise and lower your arms (the movement falls on the shoulder joint).

There is another passive exercise. Hang your leg or arm from a towel or elastic bandage. Now you need to make rotational movements, as well as move the limb to the right and left.

Passive stroke recovery exercises are designed to prepare the patient for proper exercise. They are performed 2-3 times a day (initially 2, then 3). Duration - about half an hour.

Mental training

Treatment after hemorrhagic stroke (and ischemic "fellow") should be comprehensive and systematic. Therefore, one cannot do without mental stress. They help restore damaged neurons, train memory and restore normal thought processes. Patients develop aphasia after stroke. Mental exercises for stroke help normalize speech functions.

Active physical activity

Lying exercises

Classes begin in the acute period.

Grasp a distant object behind (the headboard will do). On a one-to-one count, perform a pull-up, straightening your legs and arms as much as possible. Then return to the original position.
Straighten the affected arm with an effort, starting with the fingers, then moving on to the hands and forearms. Using a splint and an elastic bandage, fix the limb in a similar position for half an hour. This exercise helps to restore hand function after a stroke.
"Slip". It is performed with effort. Lying on the bed, they try to alternately bend the knees so that the feet do not come off the surface of the bed. It is performed 8-12 times.
Make alternate turns of the head left and right. Exercise is necessary to relieve hypertonicity of the cervical muscles.
Lie straight. Hands at the seams. The body is relaxed. By counting "one", bend your right arm at the elbow, fix it in this position for a second or two. Then lower the limb to the bed. On the count of two, bend the other arm. In addition to the above exercise for the hands, you can perform its more complicated version. Hang the limb with a bandage and perform all kinds of movements: flexion, extension, rotational movements.
Bend your fingers into a fist and unbend back. After suffering a stroke, the function of the hands deteriorates sharply. This will restore fine motor skills and gradually return the fingers to their normal state. To restore power characteristics, it is permissible to use a ring expander.

The specified complex of exercise therapy for hypertension and stroke should be performed with great care. Nevertheless, the performance of these exercises is allowed in the acute period of the course of the disease. They are also suitable for people with disabilities.

Complexes from a sitting position

For treatment, they resort to classes at the end of the acute period. The exercise therapy complex for the treatment of stroke includes the following payloads:

Sit down straight. It is advisable to use a chair with a back. On the count of "one", take a breath and bring the shoulder blades behind your back. On the count of "two" return to the original position. This load is designed to develop the muscles of the shoulder girdle.
Rotational movements of the head. 8-10 times in each direction. When doing it, it is important to adhere to safety precautions: dislocation or fracture of the cervical vertebrae is possible, movements are slow and smooth. Exercise is considered part of vestibular gymnastics.
Take a shovel handle or other similar stick. Place it perpendicular to the floor to form a fulcrum. Now you need to grab the "shell" with both hands. Leaning on a stick to make swinging movements back and forth, gradually increasing the amplitude. Breathing is even, you cannot knock it down. After a stroke, this load is designed to relieve excess muscle tone in the back.
Bend and extend the fingers.
Sit on a chair. Try to slowly bend back, bringing the shoulder blades together and pulling your arms and head back. "Freeze" in a bent position for 2-3 seconds.
Take a sitting position on the bed. Legs should hang freely. Swing the lower limbs. You should start at a slow pace, gradually building up strength. Such exercise therapy after a stroke is necessary for the development of the lower extremities.

Complexes from a standing position

These exercises are ideal for the heart and blood vessels, but should be performed in the later stages of rehabilitation, due to their complexity for the patient after ischemic stroke.

Stand up straight. Legs at shoulder level. For such exercise therapy (therapeutic gymnastics), you will need a fulcrum in the form of a chair back or something similar. On a count of "one" raise your leg, put it on a chair. Return to starting position. On a count of two, raise the other leg. Run 3-6 times.
According to the "one" count, slowly raise the upper limbs above the head. Linger in this position. Give up on the count of two. The rise is carried out on inhalation, the lowering of the arms is carried out on the exhale. Such exercise therapy in violation of cerebral circulation is necessary for the development of hands after a stroke and the normalization of breathing.
False steps. Legs at shoulder level. On the count of "one" push the leg forward, making a false step, on the count of "two" put the limb back, on the count of "three" return to the starting position. Repeat 5-7 times for each limb, starting with the healthy one.
Pick up a tennis ball or other rounded object. Toss it from hand to hand. Remedial gymnastics of this kind for stroke helps to restore coordination. It is better if such a load is carried out in conjunction with an assistant.
Stretching. You need to stand on your toes and stretch your hands up, as if wanting to reach the ceiling.
Walking in one place (30 seconds-1 minute).
Stand up. Hands on the belt. Make a twisting turn to the right, spread the upper limbs. Repeat the other way.
Doing squats. This exercise exercise therapy for ischemic stroke should be carried out with caution, since it increases blood pressure.
Stand up. Hands on the belt. Do tilts to the right and left.
Lunge with your feet forward.
Legs at shoulder level. Raise your right leg. Do circular swinging with a limb. Repeat with the other leg.

These exercises after a stroke can be performed at home, but it is better if the exercises are supervised by a doctor, especially if exercise therapy is prescribed for chronic diseases of the cardiovascular system.

Complex for eyes

Exercises of physiotherapy exercises are also indicated for the restoration of oculomotor functions with paresis of nerves and muscles.

The complex includes the following movements:

Left-right.
Up down.
"Eights".
Intense compression of the eyelids.
Circles (first clockwise, then counterclockwise).
Frequent blinking.

Loads for hands

After brain damage, the hands are the first to suffer. To restore motor functions, a set of exercise therapy exercises after a stroke is shown.

Among them:

Squeezing the fingers, followed by unclenching.
Free swinging limbs (exercises like a "mill" or "scissors" in a standing position).
Movements with brushes in a circle.
Flexion of the arms at the elbow joints, followed by extension.
Load on the shoulder joints (up and down).

Loads for legs

A set of exercises for the legs after a stroke includes:

Flexion and extension of the toes.
Abduction of the legs to the sides (movements begin from the hip joints).
Pulling your socks towards you.
Flexion-extension of the lower limbs at the knees.

These complexes of exercise therapy are not contraindicated in cardiovascular diseases.

Complex for articulation

Complex 1

Pulling the tongue forward. In this case, the amplitude of movement should be maximum.
Clicking the tongue (clicking up and down movements are performed).
Curling the lips into a tube.
Biting the upper and lower lips alternately.

It is also necessary to lick your lips with the maximum possible amplitude, first clockwise, then counterclockwise.

Complex 2

Smile, hold the smile on your face for 5-10 seconds.
Try to roll your tongue into a tube.
Make circular movements with your protruding tongue.
Speak the alphabet in order.
Pronounce simple words (mom, dad, etc.).
Pronounce compound words and tongue twisters (in the late rehabilitation period).

These exercises are most effective for restoring speech after a cerebral stroke. Speech therapy advises to perform these complexes 2-3 times a day for 15-30 minutes.

Breathing exercises

Difficult exercise is contraindicated as there is a high risk of an increase in blood pressure. The essence of the only permissible load is to perform rhythmic inhalation and exhalation, change the frequency of respiratory movements, alternate abdominal breathing with chest breathing. Such breathing exercises with a cerebral stroke saturates cells with oxygen and restores normal gas exchange. Inflating balloons is possible.

Simulators

Stroke rehabilitation equipment makes the recovery process faster and more efficient.

Post-stroke simulators include:

Exercise bike. The exercise bike helps to quickly restore the lost motor functions, gently trains the cardiovascular system, preventing the recurrence of acute ischemia of cerebral structures. The task of the exercise bike is not limited to this. It contributes to the overall health of the body through effective aerobic exercise.
Mini trainers for limbs. A hand trainer after a stroke called "Bud". Leg trainer - "Shagonog".
Verticalizer... Suitable for vestibular gymnastics. Gives the body an upright position, allowing you to prepare for "upright posture".
« Active-passive "simulators. You cannot do without them when it comes to restoring the affected limbs.
Exercise machine Lokomat. In essence, it is an exoskeleton that teaches the patient to walk again, facilitating the process of movement.
Walkers after a stroke... Needed to learn to walk again. Their use is indicated for dysfunction of the lower extremities. The mechanism of action is similar to an exercise bike and Lokomat.

Stroke recovery equipment is varied and must be selected by a physician.

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Total information

A stroke occurs when the blood circulation in the brain is disturbed, which inevitably leads to cell death.

During this, a person loses one of the opportunities or several at once, for example:

paralysis of the whole body;
problems with the pronunciation of sounds;
complete loss of the ability to speak;
paralysis of one side of the body;
hearing loss;
inability to see.

What kind of set of exercises after a stroke will be required in a particular case is determined by the doctor, judging by where exactly the lesion occurred and how extensive it is.

If, as a result of this pathology, the left hemisphere is affected, then the following processes occur:

Right-sided paralysis.
Wrong perception of space.
Motor memory is partially absent, for example, the patient cannot properly hold a pen or spoon, and so on.
Impulsive movements.

When the right hemisphere is affected, the following occurs:

Speech problem.
Left-sided paralysis.
Slow behavior.

Variations in defeat

There is also a mild form of stroke - when there is little paralysis or the absence of external signs. In this case, medications and exercise will help you recover in just a few months. But a completely different situation is with ischemic stroke of the brain stem, here the lack of coordination may be completely absent, but the pathology is hidden inside. Then the improvement is often not only visible, but also temporary.

The main task after a stroke is physical rehabilitation, that is, restoration of limb sensitivity. To this end, it will be necessary to return to some extent the activity of the brain cells located in the affected area. But since the dead nerve cells can no longer recover, it is necessary to make others work instead.

But, gymnastics should be carried out exclusively after the approval of a specialist and under his supervision at first.

There is a stroke with gross paralysis, which is much more difficult to cure. With proper effort, the patient can start self-service only after at least six months of treatment. Often it is not possible to achieve complete recovery, or it occurs after several years.

Stroke with acute and rather persistent neurological disorders is very common - this is when complete paralysis of one side of the body occurs. The cure in this case is also difficult, it is limited by the ability to sit and this may happen even after a few years.

What Exercise Can Do

Exercise therapy after a stroke is intended for:

avoidance of muscle atrophy;
partial, or at best, complete return of the accuracy of all movements;
prevention of heart failure;
relief of muscle tension that occurs with paralysis;
return of normal blood supply;
prevention of stagnant pneumonia;
prevention of blood clots;
preventing the formation of pressure ulcers.

If there are no special contraindications for the patient, then he can already begin to work out a set of exercises for a stroke, even on the fifth day.

The decision to authorize a doctor is made up of several factors:

The complexity and timeliness of proper treatment.
The individual ability of the body to rehabilitate.
The vastness of the affected brain tissue.

Gymnastics after a stroke has a positive effect on the ongoing metabolism and blood circulation. Often, even severe strokes can be cured with exercise, people gradually begin to be able to draw, write and work with small details again.

The most acute period is considered to be the first three days after ischemic stroke, five days and seven days. If a person survived these days, then for six months in his body, the processes of cell death continue to occur. But at the same time, help with physical education under the supervision of a doctor is aimed at preserving the ability of other cells to function, the same applies at home, the exercises here will be quite simple, but their effectiveness has been proven.

But classes should be continued at home, here you will need the active help of loved ones, who are obliged to familiarize themselves with how physical exercises should be performed correctly in ischemic stroke. They should help and encourage the patient, noticing all his small victories.

All exercises are similar to how exercises are done in babies, but in this case it is aimed at tremendous progress.

Passive exercise

Although the body is currently motionless, the affected areas require active recovery.

After a stroke, charging is most possible only in a passive form, that is, instead of the patient, extremities must bend and unbend by strangers:

The procedure begins with the fingers of the hand from the side of the paralysis, then bending is done with the healthy hand.
Then rotate with a brush.
Bend your arms in the elbow area.
After that, you need to go to the legs, the technique is the same.

Another warm-up method is a restorative set of simple exercises done with a piece of rubber stitched into a ring. The elastic should be put on alternately, first on the hands, then on the legs, the limbs should be parted and brought together. The rubber ring will also help to restore the functionality of the fingers, for this you should put it on them and stretch it.

All exercises are performed for at least ten minutes, gradually increasing the time to half an hour, but breaks are necessary every ten minutes.

Another exercise partially resembles a bicycle, but without the active participation of the patient.

It is important to pay due attention to the eyes, helping them with a kind of gymnastics:

Move your own eyes in different directions.
Make rotational movements. This must be done first with open eyes, and then with closed ones.

It is necessary to close your eyes and hold them in this position for a longer time, then open and blink. It is necessary to blink hard enough, pinching and unclenching the eyelids.
Turn your head, but your gaze remains in place.

Since stroke sufferers experience limb spasm, straightening the limb by tying it to a stick can help them. But such manipulation is carried out exclusively for half an hour and only if the patient does not feel severe pain at the same time.

Even when a person is not able to move independently, he should imagine that he is doing it on his own during restorative gymnastics after a stroke. This will help organize a signal in the brain that the body does it on its own and visualization helps to re-learn to move.

Sitting exercises

As soon as the doctor permits to sit, then it is necessary to continue to engage in exercise therapy for stroke:

Take a reclining position, then the patient grasps the bed with his hands and straightens his legs as much as possible. Then you should bend a little so that his head rested on the pillow and inhale deeply.
In the same position, but completely sitting, it is necessary to alternately raise each leg, breathe slowly and evenly.
The leg should be bent and with the help of the hands pull it towards you, the head should be tilted slightly forward.
For rehabilitation after a stroke, the following is often used - above the patient's bed, it is necessary to hang a towel for which the person will pull himself up, while stretching his arms, gradually moving on to warm up the back muscles.

At home, exercises can include this - while sitting on the bed, you should bring your hands back as much as possible and at the same time straighten your shoulders, your head should be raised, after such tension, you must return to its original position.

All exercises after a stroke must be carried out, carefully monitoring the breathing and the general condition of the patient, that is, he should not be in pain and the patient should not be very tired.

Exercise after a stroke at home means, first of all, the support of loved ones and their positive attitude towards recovery, as well as active help.

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Preparatory period for exercise therapy

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

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

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

If a patient is paralyzed during an ischemic attack (even one side of the body), the first 2 weeks it will be possible to affect the muscle complex only with a competent change in position.
Turn the patient over in bed every 2-3 hours to avoid pressure sores and blood stagnation.
After a week or two, they switch to passive types of load, produced by the influence of the nurse or relatives. Their goal is to relax the muscles and prepare them for further stress.
As soon as the patient achieves the first movement in the paralyzed limb, they move on to active exercises. The first time - in bed, then getting up and moving on to slow walks.

In the rehabilitation period after a stroke, relatives require attentiveness and regular exercise. One must be prepared to devote at least 2-3 hours at intervals throughout the day to the patient's recovery program.

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

Massage and passive stress after a stroke

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

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

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

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

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

Mental exercise

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

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

The transition to exercise therapy in a sitting position

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

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

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

We perform exercise therapy while standing

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

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

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

Regarding walking: doctors recommend starting walking with the support of a person from the paralyzed side, at intervals of 15-20 seconds at first with a break, then increase the pace. Already in the late stages of rehabilitation, jogging is prescribed for patients as a good means of accelerating blood, normal load on the heart and all muscle groups.

Do not overdo it - do not burden yourself more than the program requires. Rest is important for the body now, not sports achievements. In the future, therapeutic exercises of the legs and arms will be needed for at least another three years. However, it is recommended not to start exercise and after, to lead a healthy lifestyle in order to avoid a second stroke.

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Principles of exercise therapy in neurological patients

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

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

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;
transfer of responsibilities of dead neurons to neighboring nerve cells.

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

Restoration of structures of nervous tissue with reversible damage

Mainly these include the restoration of the conduction of the nerve fibers of the cells, which did not die, but fell into deep biochemical stress. Physical exercises after a stroke, which the patient performs himself or with the help of an instructor, create a powerful stream of nerve impulses going 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 the 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 cerebral infarction and not subject to recovery, but about the proliferation of neuronal outgrowths that remained alive after an attack of the disease. Due to the formation of numerous new nerve fibers, an increase in the number of contacts between nerve cells and the organs controlled by them occurs. All this helps to restore the lost functions even with a small number of surviving neurons.

Exercise after a stroke increases blood flow to moving muscles, which means it increases nutrition and oxygen availability. All this leads to increased growth of new nerve fibers. Constant stimulation of the brain with nerve impulses that arise 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 responsibilities of dead neurons to neighboring nerve cells

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

Exercise therapy depending on the stage of stroke

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

restoration of voluntary movements;
prevention of the formation of adhesions in the area of 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:

the most 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);
the period of residual effects (more than 2 years).

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

The most acute and acute period

Rehabilitative gymnastics after a stroke is indispensable already in the first days of a 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, posture treatment and passive movements are used.

Breathing exercises

Measures to restore correct breathing begin from 2-3 days of treatment at the ICU. Respiratory exercises after a stroke consist in a patient-controlled change in the pace and depth of inhalation and exhalation, following the instructions of the exercise therapy instructor. It can be rhythmic breathing under the count, exercises for an arbitrary decrease in the frequency of respiratory movements; changing 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. The flaccid paralysis observed in patients in the first 2 weeks after a stroke is gradually replaced by spastic paralysis. Due to the increased tone, irreversible changes occur in the joints on the diseased side, which lead to restriction of movement in them. To combat this complication, such a method of exercise therapy as position treatment is used.

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

Position treatment is carried out every 1.5-2 hours, while it is kept until discomfort or pain in healthy muscles occurs.

Passive gymnastics

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

However, despite the apparent 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 the 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 lesson, it is necessary to take breaks of 1-2 minutes, focusing on the patient's well-being. The gymnastics should be finished with the correct laying of the paralyzed limb (position treatment).

Stroke massage can be prescribed 2 weeks after the onset of the disease. It includes the simplest classic 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 contract voluntarily should be used to regain lost motor functions. Training for active muscle contraction must be included in the daily exercise therapy complex.

A complex of exercise therapy with the use of active movements, which includes exercises for the arm after a stroke, looks something like this:

The patient's ability to maintain balance while sitting alone 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 training directly depends on the correct technique. To make it easier to understand how exactly the movements need to be performed, you can view an approximate set of exercise therapy exercises after a stroke video:

Massage after a stroke plays a huge role in the formation of normal muscle tension and acceleration of the processes of returning motor functions. It should be performed several times a year for 10-20 sessions.

The famous expression "nerve cells do not regenerate", unfortunately, is true. However, even having lost a significant number of neurons in the stroke zone, it is possible to achieve good recovery of voluntary movements with the help of physiotherapy exercises.

Exercise after a stroke is an important part of a patient's recovery from this difficult condition. Only thanks to the fulfillment of all the doctor's recommendations, drug treatment, physiotherapy exercises, the patient will gradually recover.

With a stroke, blood flow is disrupted in a specific area of the brain. Oxygen access with nutrients for the cellular structures of the brain is reduced. This leads to paralysis of the right or left side of the patient's body, facial numbness, impaired speech function.

A person who has suffered from this disease requires careful attention to himself, constant care. It takes a long time to restore brain functions.

How to prepare for a patient's recovery

The procedures should be carried out with a period of 2 to 3 hours. Physical rehabilitation of a patient requires great endurance and care of the family caring for the patient.

To restore the patient's lost functions, it is necessary to follow the recommendations of the treating neuropathologist:

The change in the patient's posture should be constant for every 2-3 hours. It is required to change the position of the patient from one side to the other in order to prevent stagnation with pressure ulcers.
The patient is obliged to perform passive gymnastics in the form of movements with outside help in order to reduce muscle spasms.
Perform breathing recovery exercises, combining with passive inhalation and exhalation gymnastics. This will increase the flow of oxygen to the brain, the muscles will involuntarily tense and relax.
The active load consists in the fact that at the beginning of physical exercises the patient performs lying in bed, then walks, slowly walking. After an ischemic stroke, this will restore the patient's health and reduce the likelihood of recurrent strokes.

In order not to overstrain the muscles, each exercise must be performed with one or two approaches, with their gradual increase. The period between each lesson is 1 hour.

How to do passive gymnastics

Before performing passive exercises for recovery from a stroke, you need to prepare the patient's muscles for physical work. For this, massage is used.

Each massage rule must be followed:

Perform movements softly, in a circular manner.
The specialist is obliged to move from bottom to top: first, he massages the brush, goes to the shoulder. On the leg, the foot is first massaged, then the lower leg.
The thoracic spine from the back is massaged with tapping and pinching techniques.
The thoracic myofibers are stretched from the central zone to the axillary regions.

After the massage procedures, they begin exercise therapy after strokes at home. For rehabilitation after a stroke, exercise therapy is performed:

The lower limb is bent so that it then becomes straight itself, having passed along the bed. This exercise will help restore the lost movement memory.
The lower limb is extended in the same way. First, the leg is bent at the knee joint, and the patient tries to extend it.
The upper or lower limb is suspended with a stretching tape and rotated in circles. Also, all limbs are bent, unbent, abducted to the side. The patient tries to twist or perform movements with the fixed limbs himself. During the day, such gymnastics is performed once for 30 minutes.
To restore the movement of the joint in the shoulder, it is necessary to raise and lower the arm, and also perform its flexion with extension.
The carpal muscles are being developed. It is necessary to clench your fingers into a fist and unclench at least 10 times.
To restore fine motor skills, small objects are placed in the patient's hand, they help to hold them with fingers.

Usually, such a set of exercises for stroke is performed at least twice. If improvements are achieved, then this restorative gymnastics after a stroke is performed no more than 3 times a day, at least 33-37 minutes.

How to do it while sitting

Exercises after a stroke at home can be done while sitting. This requires:

Sit down to the patient on the bed, lower the lower limbs to the floor, with the help of your hands you need to hold onto the bed. The patient bends over in the back, protruding the chest. When inhaling, perform a deflection, relaxation occurs when exhaling.
The patient sits with the lower limbs on the bed. It is required to perform lifting of straight legs in turn. At the beginning, one limb is raised, then the next.
To relax your back, you need to put a pillow under it. The patient reaches with his knee to the chest, grasping the leg with his hands. Then you need to raise the leg while inhaling, the movement is delayed near the chest, you need not breathe for 2-3 seconds. Perform in turn for each lower limb.
Sitting on the bed, the lower limbs lie horizontally, and the upper limbs are retracted posteriorly, the palmar surfaces rest against the bed. During inhalation, the patient connects the scapular bones together with the head tilting backward.

Performing such gymnastics after a stroke will gradually strengthen the muscles of the back, improve the patient's well-being.

What exercises do they do while standing

Physiotherapy exercises after a stroke are performed in the following order:

The patient picks up a small object lying on the table; in the future, if you feel better, you can lift the thing from the floor surface.
Raise the upper limbs up and stretch, resting on the toes. Perform when inhaling, relax when exhaling.
The lower limbs are shoulder-width apart, palms are located on the belt. It is necessary to bend forward and backward, to the right and left sides.
The patient stands straight. The upper limbs are extended anteriorly. You need to wave your hands a little in the horizontal plane.
The soles are joined together. The patient squats, keeps his back straight, heels do not come off the floor.
The lower limbs are shoulder-width apart. Palms at the waist. It is necessary to turn the body first in one direction, then in the other direction.
Walk a little in place.
Wave the lower limb, clapping your palms under it.

How to develop a tongue and face

Exercise therapy after a stroke is performed by patients with impaired speech function. More often, speech does not return as quickly as physical activity; it sometimes takes years to fully recover. A major factor in speech recovery is that stroke patients must listen to any real person speaking.

The patient needs communication, then the effectiveness of exercise therapy exercises to restore speech will be higher.

Therapeutic exercises on facial myofibers and tongue are as follows:

The patient shows the tongue, fully pulling it anteriorly to its full length.
Then he licks his lips in circular motions, first in one direction, then in the other direction.
Slightly bites in turn, first the lower lip, then the upper lip.
Performs teeth grin.
Curls her lips into a tube.
Clicks her tongue.

Gymnastics aimed at pronunciation of words is as follows:

First, the patient pronounces some sounds in alphabetical order.
Then he learns to speak a few simple words or the roots of complex ones, there is no need to pronounce the endings.
Then you need to practice correctly pronouncing full words.
At the last stage, you can try to pronounce poetry, a few tongue twisters.

What effect does exercise therapy have

The work of the brain is restored with the help of exercise therapy for stroke in three ways:

Defective neurons are restored. Some nerve cells after the disease are not damaged, but do not function, they do not supply an impulse from the motor center to the muscle fibers. To resume their functions, commands must be sent in a different order, in other words, from the arm or leg to the brain, through exercise after a stroke. Progress will show up gradually.
Dead nerve cells are replaced with new ones. Doing exercises at home provides blood supply to the functioning myofibers. Oxygen supply with nutrients is carried out to living neurons faster. This accelerates the growth of new cellular structures around the surviving neurons, they communicate with each other, and motor activity is gradually controlled by the brain.
The work of dead neurons is replaced by neighboring nerve cells. Thanks to gymnastics, commands are sent to neighboring brain zones, which do the work of dead neurons.

In addition to gradually recovering brain functions during a stroke, exercise therapy has a good effect on the entire body of the patient. The immune system is strengthened, the articular surfaces become mobile, the muscle hypertonicity of the damaged side decreases.

How to perform gymnastics at different periods of stroke

In the most acute (first 3 days) and acute (up to 28 days) period of the disease, breathing and passive gymnastics are performed, and they are also treated using the position:

During breathing exercises, the patient rhythmically inhales and exhales, speeding up or slowing down breathing, breathes in the stomach, then with the chest and vice versa.
With the help of the position, the muscular hypertonicity of the injured limbs is removed. Pay attention to the shoulder muscles, flexors of the arm and soles, the adductors of the femoral myofibers and the calf extensors.
Between 1.5 and 2 hours every hour, bring the affected arm and leg to the correct position.
The upper limb is placed on a pillow, placing it horizontally parallel to the body. Pull back slowly until a 90 ° angle is formed. Then the hand is turned outward, fixed with a splint.
The injured lower limb is bent at an angle of 15 to 20 °, a roller is placed underneath.
The passively performed type of exercise therapy begins only after the tone of the damaged muscle has decreased. Gymnastics is performed first on normal, then on the affected limbs.

With an early recovery period (from 28-29 days to six months), the patient gradually switches from passive gymnastics to active exercises. The muscles begin to contract voluntarily.

The patient is able to be in a sitting position on the bed, so he performs exercises while sitting.

At this time, you need to prepare to walk. In the supine position, the patient seems to be walking, this kind of exercise will help in the future when walking.

In the late recovery period (from six months to 2 years), in order to restore the lost movement skills, exercise therapy is performed after a stroke, aimed at overcoming resistance:

Sitting on a chair, the lower limbs are pressed against the floor surface. Without emphasis on the upper limbs, inhaling the patient gets up, exhaling he sits down.
In a sitting position on a chair, the patient raises the heel zone, pressing his toes to the floor. In a slow rhythm, the lower limbs rise, the ankles rotate for 20 seconds, then lower the legs to the starting position.
Become straight, rest your hands on the back of the chair. The patient rises on his toes, stands for 5-6 seconds and descends into the opposite position.

During the rehabilitation period, the patient and his relatives will face different problems. The more steadfastly they are transferred, the more active motor skills will be restored.

In contact with

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 cells in the brain. 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 goes to intensive care, where doctors do everything to save his life. In case of 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 what kind of 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 the type of stroke. The main criterion that is taken into account is which part of the brain has suffered as a result.

The defeat of the left hemisphere is fraught with the following consequences:

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

Damage to the right hemisphere results in 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 a word).
Behavior becomes cautious, slow.

To eliminate each of the problems, along with the main exercises, gymnastics is done, aimed at training the 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 equally important:

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

First of all, it is important that physiotherapy exercises after a stroke are approved by a doctor and developed individually for a specific patient. A specialist can explain all the subtleties of a particular exercise, choose the most suitable one depending on the type of stroke. You need to start doing gymnastics with the simplest exercises, gradually moving on 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 do the exercises, it is recommended to warm up the part of the body being worked out through massage.

Support and help from loved ones and a positive attitude of the patient play an important role. Those close to him should help him maintain optimism and faith in a successful outcome. The patient needs to be praised, to emphasize his success. To prevent recurrent stroke, exercise will need to be done throughout your life.

Gymnastics after a stroke

In fact, health-improving gymnastics does not have any striking features. In many ways, it resembles regular charging. But even the simplest stroke recovery exercises 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 straighten them. Exercises are aimed at reducing the tone and increasing the range of motion of the extremities affected by a stroke.

Hand exercises after a stroke. They are forcible straightening of the limbs, thanks 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 fasten it with a bandage to the plate, leaving the hand in this position for at least half an hour.
Eyes... Move your eyes up and down, left and right. The eyes must be closed and made in circular movements in both directions. Blink your eyes for 5-7 seconds, also do circular motions with your eyes open. Then the eye muscles can be relaxed and blinked.
Muscles of the neck. Turn your head 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, or alternately. You can also loop a towel over the bed, and pass a motionless arm or leg through it and swing freely. You can put a loop about 40 cm in diameter on the affected limb and stretch it.
Elbow joints. The body should be stretched, the arms are along the torso. The right arm is bent at the elbow, lowers to the bed, the left arm is bent. Do the exercise ten times with each hand. Hang the fixed limb on a strong tissue and do various exercises: flexion, extension, abduction to the sides, rotation. Do this for 10-30 minutes. Up to three breaks of 2-4 minutes are allowed.
Knee bend... While lying down, bend your knees alternately, as if sliding them and not lifting them from the bed. Do ten of these movements with each leg.
"Pull-ups". While lying on your back, grasp the headboard with your hands. Perform pull-ups by straightening your shoulders and legs with your toes extended. Do the exercise slowly, repeat six times.

If the patient is able to sit on his own, 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.

The starting position is sitting. Sit back on the pillow and grasp the bed comfortably on both sides of the bed. Stretch your legs forward. On the count of 1-2, gently bend, taking 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. Smoothly bring your arms back, throw your head back and straighten your back, trying to bring your shoulder blades together. Lock the position for 1-2 seconds. Return to starting position and repeat four more times.
The starting position is with outstretched legs. Grasp the edge of the bed with your hands. Do the exercise slowly. On a count of 1, lift your right leg up a little, on a count of 2, gently lower it, on a count of 3, lift your left leg, on a count of 4, return to the starting position. Repeat the swings for each leg four times without holding your breath.
Starting position - leaning on the pillow. Raise your arms up, stretch your legs. For a count of 1-2, bend your leg at the knee and wrap your arms around it, trying to touch your knee to your chest. Lock in this position, tilt your head forward and exhale. For a count of 3-4, raise your head, remove your hands and slowly return to the starting position. Repeat the same for the other leg. For each, do four reps.
Hand motor skills. You need to take a deep bowl, place objects of various shapes, materials and sizes in it. With your sore hand, transfer items 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 heavy duty. Simple exercises are used if the person has not yet completely recovered from the stroke. They will be as follows:

Starting position - feet shoulder-width apart, arms pointing down. For a count of 1, raise your arms up, palms facing outward. For a count of 2, stretch out in this position and inhale. On the count of 3, lower your hands down, trying to describe a circle with them, exhale. On a count of 4, return to starting position. Repeat six times at a gradual pace.
Starting position - feet shoulder width apart. Place your hands on your belt. On the count of 1, turn the body to the right, on the count of 1, spread your arms to the sides and inhale, on the count of 3-4, return to the starting position and exhale. Repeat the exercise on the left side in the same way. Do it five times for each side.
Starting position - legs apart, arms down. For a count of 1-2, do squats with your heels on the floor, slightly tilting your body forward and pulling your arm back. Breathe in. At 3-4, smoothly return to the starting position, exhale. Repeat 6 times.
Hands down, feet shoulder-width apart. Do squats in two counts. Inhale deeply, for a count of 1, sit down, rest your hands on your hips, exhale, then return to the starting position. Repeat four times.
Slopes. Place your feet 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. Repeat the exercise four times for each side.
Swing your legs Place your hands on the belt, stretch one arm forward. For a count of 2-7, swing your leg in circular swings, then return to the starting position. For each leg, do four swings.
Lunges. Starting position - feet shoulder-width apart, hands on the belt. Extend your left arm forward, then step forward with your right foot. Clench your fists and bring your hands to your shoulders. Return to the starting position and repeat the action, changing arms and legs. Repeat four times.
For 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 a 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 and keep your back straight. The second hand is on the belt. Swing your leg back and forth five times. Swap the arms and do the same for the other leg.
Feet shoulder width apart, place your hands on your belt. Make a shallow bend, exhale, return to starting position. Repeat ten times.
Put your feet together, bend your arms behind your heads. Bend to the right while lunging in the same direction with your right leg. Repeat the same for the other side.
Jumping. Put your feet together, place your hands on your belt. Do free jumps: jump, keeping your feet together and apart, alternately putting your feet forward, and so on. It is recommended to jump for 40 seconds.

People after a stroke have the possibility of complete or partial recovery. Experts insist on carrying out rehabilitation measures within three years.

As a rule, ischemic stroke gives more hope, since it is characterized by less dangerous damage to the cells of the cerebral cortex, the use of "spare" vessels for nutrition. With a hemorrhagic form, physical rehabilitation is limited to the prevention of repeated circulatory disorders, the timing of resorption of the hematoma, and the use of surgical intervention.

Gymnastics after a stroke is part of planned rehabilitation measures along with drugs, physiotherapy, diet, and regimen.

What tasks does exercise therapy solve after a stroke?

Exercise therapy for stroke plays an important role in preventing complications, developing a person's adaptation to self-care, mastering lost functions.

A long period of forced immobility in bed is dangerous with the development of severe consequences. The exercise therapy complex helps to prevent:

the formation of bedsores on the buttocks, back;
stagnant pneumonia;
the occurrence of heart failure;
progressive atrophy of non-working muscles;
blood clots with subsequent embolism in vital organs;
spasm of muscle groups with increased tone with paresis and paralysis of the spastic type, the formation of contractures (change in the shape of the limb).

Gymnastics after a stroke has a positive effect on microcirculation and metabolism in organs and tissues that are reduced as a result of the disease. It allows you to resume active movements, in the future it helps to get the opportunity to draw, write, use dishes and household appliances. Leads to the normalization of the work of internal organs (urination, defecation), helps to restore speech.

When can I start exercising?

The beginning of the use of physical activity, their volume. The target orientation is determined by the attending physician. It depends on the:

the extent of the damage to the brain tissue;
sufficient ability of the body to recover;
timeliness and completeness of treatment.

The acute period is the first 6 months. At this time, changes occur in the ischemic focus: some of the cells irrevocably die off, while the other retains the ability to perform their functions, but needs help. This is what exercises after a stroke are designed for. At the cellular level, there is a special memory that must "remember" the range of movements, restore the pathways of transmission of nerve impulses.

If the patient is not in a coma and consciousness is preserved, then on the third day he is recommended to start breathing exercises. Its purpose is to prevent congestion in the lungs. From the fifth day, physiotherapy exercises (exercise therapy) are prescribed. The exercise complexes include habitual movements, the patient's condition, the ability to sit or stand independently, the degree of loss of motor functions are taken into account.

Continuation of physical education is recommended to be carried out after discharge at home. For this, relatives should learn the necessary exercises themselves, support and encourage the patient's aspiration. Positive emotions and good mood play a significant role in the speed of rehabilitation.

In the late period (after six months or more), the patient needs to use a rehabilitation course of treatment in specialized centers and sanatoriums. It is recommended to repeat the therapy 2 times a year. Here, in addition to the physical culture recovery complex, there are opportunities for extended physiotherapy treatment under the supervision of medical personnel:

oxygen baths;
massage;
acupuncture;
hardware electrical stimulation of paralyzed muscle groups;
pulse magnetotherapy;
electrosleep.

Neurostimulation of the leg muscles is performed

How to carry out breathing exercises?

In the supine position, the patient just needs to take a few deep breaths, repeat as often as possible throughout the day. When the doctor allows you to sit, it is important not to bend your back, but to keep it straight so that the air expands the lungs as much as possible.

Breathing exercises are reduced to a slow deep breath, holding the breath for a few seconds and then gradually exhaling. After each such breath, the patient needs rest. It is necessary to ensure that dizziness does not intensify, do not strain while holding your breath.

There are options for controlling a long expiration:

inflating a rubber ball;
using a cocktail straw dipped in a cup of water.

The patient feels the result of his work by the volume of the ball and the bubbling of liquid. In the future, you can start mastering the course of exercises according to Strelnikova's method.

This is important at any stage of rehabilitation.

Correct physical rehabilitation is impossible without targeted support for mental activity. Muscle memory allows even weakened cortical structures to issue commands. The patient is recommended to accompany all exercises with mental "orders" to move his legs and arms.

This modern approach to recovery allows the patient to become a full participant in the recovery process.

What exercises can you do while lying down?

If the patient is not allowed to sit and stand up or he cannot do this, the exercises are carried out first in a passive mode, then in an active one.

Passive physical education means the lack of participation of the patient, the use of the efforts of another person

Exercise is limited to movements in the joints of the arms and legs. The complex gradually includes passive flexion, extension, rotation, abduction and adduction with increasing amplitude. You should not immediately try to fully fulfill the maximum option. Begin with small fluctuations up to 15 movements in each joint 3-4 times a day.

It is recommended not to forget about the sequence of joint development: from the center to the periphery. In other words, exercises for the hand begin with the shoulder, then move on to the elbow joint, wrist and hand. Similarly on the legs: from the hip to the small joints of the foot.

Passive exercises in the hand with monoparesis can be performed by the patient himself with the help of a healthy hand. As a device for self-study, a loop made of fabric, wide rubber, is used, into which the patient passes a motionless limb and performs movements, clinging to it.

The patient performs active exercises independently. For this, special complexes have been developed. They begin lying down and continue in a sitting position.

Complex of active movements for hands

Hands can do independent movements up to 20 times in one approach:

clench and unclench your fingers into a fist;
circles in both directions in the wrist joint (it is recommended to keep the fist clenched at the same time);
flexion and extension of the elbows;
from a position along the body, slow ups and downs, while the shoulder joints are loaded;
swing to the sides.

In exercises with dumbbells, the study of the flexor muscles and holding by clenching the hand into a fist is used

A set of active exercises for the legs

For legs, exercises can also be started with strict bed rest and continued while sitting. The number of repetitions should not tire the patient and gradually increase up to 20.

Flexion and extension are actively carried out with the toes.
Pull the socks "towards yourself", then take them to the opposite extreme position (it is recommended to mentally imagine the pressure on the pedals).
Slow knee flexion, extension.
Abduction to the side due to the work of the hip joint.

How to develop the muscles of the trunk?

Lying on your back, you can perform the following exercises 5-10 times:

side turns by rolling from one side to the other;
with an emphasis on the shoulder blades, the back of the head, feet with the help of the elbows, raise the pelvis;
try to raise your upper body a little by contracting your abdominal muscles.

What other movements need to be developed?

Physical education after a stroke, in addition to the limbs, requires the development of facial muscles, especially the eyes. To prevent drooping of the eyelid, the following exercises are recommended 5-7 times:

movements of the eyes up and down and to the sides;
describe with your eyes a circle in one direction, then in the other;
blink and squeeze for a few seconds.

To strengthen the muscles of the neck, you must:

make slow turns of the head to the sides;
rest your head against the pillow, then relax.

After a stroke, a person loses the ability to make small movements with the fingers. And this is very necessary in the restoration of self-service. For the development of motor skills, the brush is recommended:

put small items (nuts, buttons, spools of thread, pencils) into a large bowl;
the patient should transfer them with the affected hand from one bowl to another.

In the sanatoriums, games of mosaic, loto, collection of pyramids are used.

Standing exercises

For a patient who is able to stand and move slowly, the amount of exercise should be increased and varied. However, there is no need to rush. You need to start with a simple complex, and then move on to a more complex one with increasing load.

Exercises are considered simple:

stretching with a description of circular movements with the hands and mandatory control of breathing (when moving up - deep breath, down - full exhalation);
alternating rolling from toes to heels with tension in the calf muscles;
turns to the sides (5-6 times each);
squats without lifting the heels off the floor 4–5 times;
bends to the sides with raising the opposite arm above the head 4 times;
swing legs forward and to the sides, 4 each;
alternating forward lunges with a slight transfer of weight to the front leg.

A half-hip with clasped hands is used to increase the load

The complex with increased load adds:

stretching with hands clasped in a "lock";
swinging legs while holding a hand on a fixed headboard or chair;
bends forward and to the sides 10 times, standing on tense legs in a position slightly wider than the shoulders;
“Boxing” with hands when turning the body;
circular rotation in the shoulder joints forward and backward;
arbitrary jumps.

Exercises should be finished with walking in place, with deep breathing movements for 5 minutes.

Contraindications

Restrictions in rehabilitation depend on the patient's condition. Physical activity is not shown in the following cases:

the patient did not come out of the coma;
there are mental changes in behavior, aggressiveness;
repeated stroke in an elderly person;
there are symptoms of epileptiform seizures, cramps in the limbs;
a stroke is accompanied by a severe form of diabetes mellitus, tuberculosis, and cancerous tumors.

An important point in physiotherapy exercises is the patient's comfortable well-being. The appearance of headaches, weakness requires blood pressure control, rest, and a slower pace of increasing the load.

After being able to walk, it is necessary to use air walks with a gradual lengthening of the route. Self-confidence and support from loved ones allows the patient to take stroke therapy as useful as possible, strive for full recovery.