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Psychological recovery after a stroke. Recommendations for mental and social adaptation - after suffering a stroke Psychological support after a stroke

Stroke is an acute vascular catastrophe that ranks first in the structure of disability and mortality. Despite improved medical care, a large percentage of stroke survivors remain disabled. In this case, it is very important to readapt such people, adapt them to a new social status and restore self-service.

Cerebral stroke- acute disturbance of cerebral circulation, accompanied by a persistent deficiency of brain functions. Cerebral stroke has synonyms: acute cerebrovascular accident (ACVA), apoplexy, stroke (apoplectic stroke). There are two main types of stroke: ischemic and hemorrhagic. In both types, the death of the part of the brain, which was supplied by the affected vessel, occurs.

Ischemic stroke arises from the cessation of the blood supply to a part of the brain. The most common cause of this type of stroke is vascular atherosclerosis: with it, a plaque grows in the vessel wall, which increases over time until it blocks the lumen. Sometimes part of the plaque comes off and clogs the vessel in the form of a blood clot. Blood clots are also formed during atrial fibrillation (especially in its chronic form). Other more rare causes of ischemic stroke are blood diseases (thrombocytosis, erythremia, leukemia, etc.), vasculitis, some immunological disorders, taking oral contraceptives, hormone replacement therapy.

Hemorrhagic stroke occurs when a vessel ruptures, during which blood enters the brain tissue. In 60% of cases, this type of stroke is a complication of hypertension against the background of vascular atherosclerosis. Modified vessels (with plaques on the walls) rupture. Another cause of hemorrhagic stroke is rupture of arteriovenous malformation (saccular aneurysm), which is a feature of the structure of the cerebral vessels. Other reasons: blood diseases, alcoholism, drug use. Hemorrhagic stroke is more severe and the prognosis is more serious.

How to recognize a stroke?

A characteristic symptom of a stroke is a complaint about weakness in the limbs... You need to ask the person to raise both hands up. If he really has a stroke, then one arm rises well, and the other may either not rise, or the movement will work out with difficulty.

With a stroke, there is asymmetry of the face... Ask the person to smile, and you will immediately notice an asymmetrical smile: one corner of the mouth will be lower than the other, the smoothness of the nasolabial fold on one side will be noticeable.

Stroke is characterized by speech impairment... Sometimes it is obvious enough that there is no doubt about the presence of a stroke. To recognize less obvious speech impairments, ask the person to say "333rd Artillery Brigade." If he has a stroke, impaired articulation will become noticeable.

Even if all of these symptoms appear mildly, do not expect them to go away by themselves. It is necessary to call the ambulance team at the universal number (both from a landline phone and from a mobile) - 103.

Features of a female stroke

Women are more susceptible to developing a stroke, recover longer and die more often from its consequences.

Increase the risk of stroke in women:

- smoking;

- the use of hormonal contraceptives (especially over the age of 30);

- hormone replacement therapy for menopausal disorders.

Atypical signs of a female stroke:

  • an attack of severe pain in one of the limbs;
  • a sudden attack of hiccups;
  • an attack of severe nausea or abdominal pain;
  • sudden tiredness;
  • short-term loss of consciousness;
  • sharp chest pain;
  • an attack of suffocation;
  • a sudden increase in heartbeat;
  • insomnia (insomnia).

Treatment principles

The future prospects depend on the early start of stroke treatment. In relation to stroke (however, as in relation to most diseases), there is a so-called "therapeutic window" when the treatment measures carried out are most effective. It lasts 2-4 hours, then the part of the brain dies off, unfortunately, completely.

The system of treating patients with cerebral stroke includes three stages: prehospital, inpatient and rehabilitation.

At the prehospital stage, a stroke is diagnosed and the patient is urgently delivered by an ambulance team to a specialized institution for inpatient treatment. At the stage of inpatient treatment, stroke therapy can begin in the intensive care unit, where urgent measures are taken to maintain the vital functions of the body (cardiac and respiratory activity) and to prevent possible complications.

Particular attention should be paid to the consideration of the recovery period, because often its provision and implementation falls on the shoulders of the patient's relatives. Since strokes occupy the first place in the structure of disability among neurological patients, and there is a tendency to "rejuvenate" this disease, each person should be familiar with the rehabilitation program after suffering a cerebral stroke in order to help their relative to adapt to his new life and restore self-care.

Rehabilitation of patients with cerebral stroke

The World Health Organization (WHO) defines medical rehabilitation as follows.

Medical rehabilitation - This is an active process, the purpose of which is to achieve complete restoration of functions impaired due to illness or injury, or, if this is not possible, the optimal implementation of the physical, mental and social potential of a disabled person, its most adequate integration into society.

There are some patients in whom, after a stroke, partial (and sometimes complete) independent restoration of damaged functions occurs. The speed and degree of this recovery depend on a number of factors: the period of the disease (the duration of the stroke), the size and location of the lesion. Restoration of impaired functions occurs in the first 3-5 months from the onset of the disease. It is at this time that restoration measures should be carried out to the maximum extent - then they will be of maximum benefit. By the way, it is also very important how actively the patient himself participates in the rehabilitation process, how much he realizes the importance and necessity of rehabilitation measures and makes efforts to achieve the maximum effect.

Five periods of stroke are conventionally distinguished:

  • the most acute (up to 3-5 days);
  • acute (up to 3 weeks);
  • early recovery (up to 6 months);
  • late recovery (up to two years);
  • period of persistent residual effects.

Basic principles of rehabilitation measures:

  • earlier start;
  • consistency and duration;
  • complexity;
  • phasing.

Rehabilitation treatment begins already in the acute period of a stroke, during the treatment of a patient in a specialized neurological hospital. After 3-6 weeks, the patient is transferred to the rehabilitation department. If, even after discharge, a person needs further rehabilitation, then it is carried out on an outpatient basis in the conditions of the rehabilitation department of the polyclinic (if there is one) or in a rehabilitation center. But more often than not, this concern is shifted to the shoulders of relatives.

The tasks and means of rehabilitation differ depending on the period of the disease.

Rehabilitation in the acute and early recovery periods of stroke

It is carried out in a hospital setting. At this time, all activities are aimed at saving lives. When the threat to life has passed, activities to restore functions begin. Posture treatment, massage, passive exercises and breathing exercises begin from the first days of a stroke, and the start time of active recovery measures (active exercises, transition to an upright position, standing up, static loads) individually and depends on the nature and degree of circulatory disorders in the brain, from the presence of concomitant diseases. Exercises are performed only in patients in a clear consciousness and in their satisfactory condition. With minor hemorrhages, small and medium heart attacks - on average from 5-7 days of stroke, with extensive hemorrhages and heart attacks - on 7-14 days.

In the acute and early recovery periods, the main rehabilitation measures are the appointment of medications, kinesiotherapy, massage.

Medicines

In its pure form, the use of drugs cannot be attributed to rehabilitation, because it is rather a treatment. However, drug therapy creates the background that provides the most effective recovery, stimulates disinhibition of temporarily inactivated brain cells. Medicines are prescribed strictly by a doctor.

Kinesotherapy

In the acute period, it is carried out in the form of remedial gymnastics. Kinesitherapy is based on posture treatment, passive and active movements, and breathing exercises. On the basis of active movements, carried out relatively later, learning to walk and self-service is built. When carrying out gymnastics, overwork of the patient should not be allowed, it is necessary to strictly dose the efforts and gradually increase the load. Positional treatment and passive gymnastics for uncomplicated ischemic stroke begin on the 2nd-4th day of illness, with hemorrhagic stroke - on the 6-8th day.

Treatment by position. Purpose: to give the paralyzed (paretic) limbs the correct position while the patient is in bed. Make sure that your arms and legs are not in the same position for a long time.

Dynamic exercises are performed primarily for muscles, the tone of which usually does not increase: for the abductor muscles of the shoulder, instep supports, extensors of the forearm, hand and fingers, abductors of the thigh muscles, flexors of the leg and foot. With pronounced paresis, they begin with ideomotor exercises (the patient first mentally imagines a movement, then tries to perform it, while pronouncing the actions performed) and with movements in facilitated conditions. Lightening conditions involve the elimination of gravity and friction forces in various ways, which make it difficult to perform movements. For this, active movements are performed in a horizontal plane on a smooth slippery surface, systems of blocks and hammocks are used, as well as the help of a methodologist who supports the limb segments below and above the working joint.

By the end of the acute period, the nature of active movements becomes more complex, the pace and number of repetitions gradually, but noticeably increase, they begin to carry out exercises for the trunk (light turns, bends to the sides, flexion and extension).

Starting from 8-10 days (ischemic stroke) and 3-4 weeks (hemorrhagic stroke), with good health and a satisfactory condition, the patient begins to learn to sit. At first, they help him to take a semi-sitting position with a landing angle of about 30 0 1-2 times a day for 3-5 minutes. Over the course of several days, monitoring the pulse, they increase both the angle and the time of sitting. When changing the position of the body, the pulse should not increase by more than 20 beats per minute; if there is a pronounced heartbeat, then the landing angle and the duration of the exercise are reduced. Usually, after 3-6 days, the angle of ascent is brought to 90 0, and the procedure time is up to 15 minutes, then learning to sit with lowered legs begins (while the paretic hand is fixed with a scarf bandage to prevent stretching of the articular bag of the shoulder joint). When sitting, the healthy leg is from time to time placed on the paretic side - this is how the patient is taught to distribute body weight to the paretic side.

Along with teaching the patient to walk, exercises are carried out to restore everyday skills: dressing, eating, performing personal hygiene procedures. Self-service recovery exercises are shown in the table below.

Massage

Massage begins with uncomplicated ischemic stroke on day 2-4 of the disease, with hemorrhagic stroke - on day 6-8. The massage is performed with the patient lying on his back and on a healthy side, daily, starting at 10 minutes and gradually increasing the duration of the massage to 20 minutes. Remember: Vigorous tissue irritation as well as a fast pace of massage movements can increase muscle spasticity! With a selective increase in muscle tone, massage should be selective.

On muscles with increased tone, only continuous planar and grasping strokes are used. When massaging the opposite muscles (antagonist muscles), stroking (planar deep, pincer-shaped and grasping intermittent), slight transverse, longitudinal and spiral rubbing, light shallow longitudinal, transverse and gable-like kneading are used.

Massage direction: shoulder-shoulder girdle → shoulder → forearm → hand; pelvic girdle → thigh → lower leg → foot. Particular attention is paid to the massage of the pectoralis major muscle, in which the tone is usually increased (slow strokes are used), and the deltoid muscle, in which the tone is usually reduced (stimulating methods in the form of kneading, rubbing and tapping at a faster pace). Massage course 30-40 sessions.

In a hospital setting, rehabilitation measures are carried out no longer than 1.5-2 months. If it is necessary to continue the rehabilitation treatment, the patient is transferred to an outpatient-type rehabilitation institution.

Outpatient rehabilitation measures in the recovery and residual periods of stroke

Patients are referred for outpatient rehabilitation treatment no earlier than 1.5 months after ischemic stroke and 2.5 months after hemorrhagic stroke. Patients with motor, speech, sensory, coordination disorders are subject to outpatient rehabilitation. Outpatient rehabilitation given to a patient who has suffered a stroke a year or more ago will be beneficial if there are signs of ongoing recovery.

Basic outpatient rehabilitation activities:

- drug therapy (prescribed strictly by a doctor);

- physiotherapy;

- kinesiotherapy;

- psychotherapy (carried out by doctors of the relevant specialties);

- restoration of higher cortical functions;

- occupational therapy.

Physiotherapy

It is carried out under the supervision of a physiotherapist. Physiotherapy procedures are prescribed no earlier than 1-1.5 months after ischemic stroke and no earlier than 3-6 months after hemorrhagic stroke.

Patients who have had a stroke are contraindicated:

- general darsonvalization;

- general inductometry;

- UHF and MVT for the neck and collar zone.

Allowed:

- electrophoresis of solutions of vasoactive drugs;

- local sulphide baths for the upper extremities;

- constant magnetic field on the cervical-collar region in case of impaired venous outflow;

- general sea, coniferous, pearl, carbon dioxide baths;

- massage of the neck-collar zone daily, a course of 12-15 procedures;

- paraffin or ozokerite applications on a paretic limb;

- acupressure;

- acupuncture;

- diadynamic or sinusoidally modulated currents;

- local application of d'Arsonval currents;

- electrical stimulation of paretic muscles.

Kinesotherapy

Contraindication for kinesitherapy - blood pressure above 165/90 mm Hg, severe cardiac arrhythmias, acute inflammatory diseases.

In the early recovery period, the following types of kinesitherapy are used:

1) treatment by position;

2) active movements in healthy limbs;

3) passive, active-passive and active with the help, or in facilitated conditions of movement in the paretic limbs;

4) relaxation exercises combined with acupressure.

Direction of the exercises: shoulder-shoulder girdle → shoulder → forearm → hand; pelvic girdle → thigh → lower leg → foot. All movements must be performed smoothly, slowly in each joint, in all planes, repeating them 10-15 times; all exercises must be combined with correct breathing (it should be slow, smooth, rhythmic, with an extended inhalation). Make sure that there is no pain during exercise. The restoration of correct walking skills is emphasized: it is important to pay more attention to training the uniform distribution of body weight on the diseased and healthy limbs, support on the entire foot, training in "triple shortening" (flexion in the hip, knee and extension in the ankle joints) of the paretic leg without abducting it to the side.

In the late recovery period, there is often a pronounced increase in muscle tone. To reduce it, you need to perform special exercises. The peculiarity of these exercises: during treatment by position, the paretic arm and leg are fixed for a longer time. Removable plaster splints are applied for 2-3 hours 2-4 times a day, and in case of significant spasticity, they are left overnight.

Stroke, or impaired blood circulation in the brain, is one of the most common causes of death and disability among the population of most developed countries. In this case, a lethal outcome is possible not only during the strike itself, but also during the first few weeks after it. About 35% of patients die within three to four weeks after suffering a stroke. About 60% of those who survived become disabled.

Relatives of a patient who has suffered a brainstroke should know that recovery from a stroke is a long, difficult, but very important process. The main goal of rehabilitation measures is, first of all, the restoration of the brain, motor abilities and speech, social adaptation, as well as the prevention of recurrent strokes and their complications. The role of family members can hardly be overestimated. Their participation, patience and correct actions largely determines whether the lost functions can return (and how quickly).

The recovery period after a stroke is a difficult stage in the life of not only the patient, but also his family. The disorders are very serious and depend on how much and which part of the brain is damaged. Patients may have impaired limb movement, coordination, vision, swallowing, speech, hearing, and the ability to control bowel movements and urination. They, as a rule, have difficulty perceiving information, get tired quickly, do not have emotions, and become depressed. Recovery of patients can take more than one month and even more than one year.

It should be said that full recovery is not always possible. Violation of blood circulation in the brain often leads to irreversible consequences. Therefore, you need to be prepared for the fact that you will have to adapt to the defect that has appeared and learn how to do homework in new conditions. It is important to remember that a positive attitude and perseverance can shorten the recovery time, over time, restore fully or partially motor and other abilities.

With the joint efforts of doctors and relatives, the patient has the opportunity to return to his usual life, to become socially active and able to work. The restoration of functions to a large extent depends on how early the activities are started. In addition, it is important not to be lazy and train the affected side. Today, rehabilitation centers are at the service of patients and their relatives, where qualified assistance awaits them.

Recovery levels

There are three levels of recovery after hemorrhagic or ischemic stroke.

  1. The first is the highest. This is a true recovery, in which all functions are completely returned to their original state. This option is possible if there is no complete death of nerve cells in the brain.
  2. The second level is compensation. Functions are compensated by functional restructuring and the involvement of new structures. This is an early recovery period - usually the first six months after a stroke.
  3. The third level is readaptation, that is, adaptation to an emerging defect. In this case, the use of walking sticks, wheelchairs, walkers, orthoses is meant.

Forecast

Unfavorable factors for recovery:

  • a large focus of brain damage;
  • the location of the focus in functionally important areas (for speech and motor functions);
  • poor blood circulation around the site of the lesion;
  • advanced age;
  • emotional disturbances.

Favorable prognostic factors include:

  • early spontaneous recovery of functions;
  • early start of recovery activities.

Main principles of recovery

  1. Early onset of restoration of lost functions.
  2. Adequacy and an integrated approach.
  3. Good organization of events, regularity and long duration.
  4. The patient and family members should actively participate in the rehabilitation process.

Immediately after the patient leaves the acute condition, it is necessary to begin restorative measures. As a rule, programs are developed individually, after the doctor determines how lost certain functions are: walking, swallowing, talking, serving oneself, performing ordinary everyday activities.

As already mentioned, the main burden of recovery falls on the shoulders of close relatives. We must be prepared for the fact that improvement may not come for a very long time, and the recovery time will be delayed. It is important to be patient, maintain a positive attitude, and praise the patient for the slightest achievement. At the same time, help should be dosed so that the stroke survivor strives to become independent faster. The role of the family is as follows:

  • conducting classes with the patient to restore the ability to move, speak, read, write, walk, everyday skills;
  • involvement of the patient in various activities, since inaction leads to blues, depression and apathy;
  • help to re-integrate into society.

Movement recovery

Normalization of physical activity and restoration of muscle strength after a stroke is of paramount importance. Treatment by position is prescribed from the first day of illness. Its duration is set by the doctor individually. The doctor shows the relatives how to lay the affected limb, how to use sandbags or splints to fix it. Treatment is carried out twice a day for half an hour after therapeutic exercises. Avoid laying down the affected limbs while eating or immediately after eating. If you complain of numbness and discomfort, you need to change the position of the arm or leg.

To help the patient recover quickly, on the second day after the stroke, passive movements are made to improve mobility in the joints, which should be unhurried, smooth and in no case cause discomfort and pain. They are usually performed with the help of a physical therapy instructor. Bend and unbend the affected limbs, take them to the sides, rotate.


Recovery of motor activity after a stroke

When the patient is in a supine position, he can do exercises such as eye rotation, blinking, moving his gaze to the sides, up, down.

First, the patient is seated on the bed for a few minutes, gradually increasing this time. He is then taught to stand while holding onto the headboard or the hand of a helper. It is better to buy high shoes so that the foot does not turn up.

Soon you need to move on to learning to walk. This function may not be restored soon. The patient needs to be helped with movement and not to be left alone. Gradually move on to walking with support. It can be a chair, playpen, cane. When the successes are noticeable, it is recommended to go outside.

If the patient uses a wheelchair, then it is necessary to learn how to move him from bed to chair and back.

Recovery of speech

Speech disorders are common with brain damage. The patient may have difficulty expressing his thoughts, as well as understanding someone else's speech. Speech functions are restored for a long time - within 3-4 years. This process requires the participation of a specialist in the field.

Violations can be varied. The patient does not understand what is being said to him. The patient is able to understand what he is being told, but cannot express his thoughts. He may use the wrong words, have difficulty reading and writing.

In this case, you need to be patient, speak slowly, pronounce words well, use simple phrases, give the patient time to understand what was said. Asking questions in such a way that he can answer yes or no.

In addition, after a stroke, violations of the muscles of the tongue and face often occur. At the same time, speech is slow and unintelligible, the voice is deaf. The speech therapist teaches the patient exercises that train the tongue and muscles of the face, and also provides a list of words to improve the pronunciation of sounds. Classes should be carried out regularly. The exercises are best done in front of a mirror.

Swallowing recovery

After an acute disturbance of the blood circulation in the brain, difficulties often arise with chewing, swallowing, and producing saliva. People who are sick do not feel food on one side of the mouth.

To restore the swallowing function, special exercises are also used to restore the strength of the muscles involved in swallowing and improve the mobility of the tongue and lips.

To facilitate the swallowing process, you need to choose food that is easy to chew and swallow. It should not be hot or cold, with a delicious smell. You need to feed the patient only in a sitting position.

Home improvement

The apartment needs changes to make the patient's life safer and more comfortable. The house should not have high thresholds and carpets. It is better to get a special bed with high sides to avoid falls. Handrails and handrails should be provided throughout so that the patient can hold on. The apartment needs good lighting, and in the patient's room the night light needs to be turned on for the whole night.

Prevention of recurrent stroke

After a stroke, it is important not only to recover, but also to prevent a recurrence of the stroke. To do this, you need to lead a healthy lifestyle:

  • Take medication regularly.
  • Normalize weight.
  • Conduct daily pressure monitoring.
  • Do remedial gymnastics.
  • Quit smoking and alcohol completely.
  • Control sugar and cholesterol levels.
  • See a doctor periodically.

Sanatorium rehabilitation after a stroke

A stroke survivor may be referred for treatment to a sanatorium, where various recovery methods are used. They use balneotherapy, mud therapy, physiotherapy, massage, physiotherapy exercises, climatotherapy, and drug treatment.

After an ischemic stroke, radon, hydrogen sulfide, iodine-bromine, carbon dioxide baths, mud therapy in the form of applications are effective.

Physical activity is useful both after ischemic and after hemorrhagic stroke. Physiotherapy exercises are hygienic exercises, dosed walking two to three times a day.

After a hemorrhagic or ischemic stroke, different types of massage are used in the sanatorium. Usually, the procedure is carried out in the morning after breakfast.

In the sanatorium, stroke patients are taught labor skills. For this, mobile and stationary stands with a set of household and household items are equipped. Of the methods of recovery in the sanatorium, auto-training and psychotherapy are also used.

Transcript

1 Psychological rehabilitation after a stroke Psiholoăijas Pasaule 2004, 5 (Lpp) TRANSLATION INTO RUSSIAN Karina Borodulina, Marina Kuznetsova, Liga Kalvane. It is generally accepted that the target audience of psychologists' work is healthy people (meaning mental health). And the main task in the work of a psychologist is psychological support of a person, search and understanding of the reasons for his difficulties, the discovery of internal resources and the development of new ways of behavior. Psychologists also work with people with chronic illnesses. The progress of recovery often depends on the personality of the person and the emotional background of the person. Since the causes of many diseases are of a psychological nature. However, what if a person has had an illness that damages their central nervous system (CNS)? How productive can a psychologist work with such a person? How can a psychologist help him? The tragic incident that happened to the energetic, young and cheerful woman Marina Pavlovna Kuznetsova made me ask myself these questions. It was a stroke and a long recovery from illness. The desire to help a friend became the main reason for exploring the possibilities of psychological assistance for people with stroke. And soon a program of psychological rehabilitation and support for people who had suffered a stroke and their relatives was created. Currently, our community already has the status of a public organization, and is called "Vigor", which translated from Latin means "vitality", "vital energy". In this article, we will introduce you to the theoretical laws of stroke, the course of the disease, the consequences and possibilities of rehabilitation, and also look at the situation through the eyes of a person who has suffered a stroke, Marina Pavlovna Kuznetsova. Three years ago, she suffered a serious stroke, which was localized in the left hemisphere of the brain and caused paralysis of the right side of the body, speech was impaired. In this situation, the search for opportunities for psychological work began with an in-depth study of the medical aspects of the issue, it was necessary to find out the causes and characteristics of the disease process. The theoretical basis makes it possible to understand the mechanisms of recovery, and also gives an idea of ​​the methods of rehabilitation, including psychological. 1

2 What is a stroke? Statistics. Manifestations. According to the World Health Organization (WHO), stroke is the third leading cause of death in the world, right after heart disease, blood vessels and cancer. In this regard, this disease has become an important medical and social problem and requires organized medical, social and psychological assistance. The state rehabilitation center "Vaivari", where medical rehabilitation of patients after stroke is carried out, receives about 500 patients every year (according to unofficial data). In addition, stroke is one of the most common causes of disability, which in most cases is expressed as impaired movement. According to statistics provided by WHO, during an exacerbation of a stroke, 80-90% of patients experience hemiparesis (paralysis, movement and sensitivity disorders), in 40-50% of cases these are sensory sensations (touch, smell, and others). 2/3 of patients suffer from the consequences of a stroke, feeling them on a daily basis. The risk of developing a stroke is increased by arterial hypertension (high blood pressure), diabetes mellitus and other factors in the development of atherosclerosis of the blood vessels, smoking, high blood cholesterol levels, disorders of the blood clotting mechanism, and others. Atherosclerosis is the most common cause of stroke (especially when combined with hypertension). It should be noted that atherosclerosis, including cerebral atherosclerosis, occurs in more and more young people, and doctors are no longer surprised by cases of stroke in people aged 40 and even 30 years. The vessels of the brain damaged by atherosclerosis become fragile and provoke spasmodic conditions, the diameter of the vessels decreases markedly, and this can cause impaired blood circulation in the brain, that is, a stroke. Let's name the main manifestations of a stroke: o disorders of important functions of the organism of consciousness, respiration (rhythm, depth, frequency), activity of the heart and other internal organs; o local neurological symptoms (asymmetry of the face, visual disturbances, incomprehensible speech or its inferiority, partial or complete paralysis of the limbs, convulsions); o Meningeal syndrome (sharp headaches, vomiting, muscle tension when trying to perform any movement). Marina Pavlovna recalls the onset of the disease as follows: “The stroke began unexpectedly. It was Friday, on Saturday we were planning to go mushroom picking. I came from the store with purchases, while my son went out to his friends for a couple of minutes. I remember that I sat down and after a moment I felt that something unusual, incomprehensible had happened to me. At that moment, I wanted to call a friend to come to me, because she realized that I was not well. She picked up the phone and no longer knew how to dial the number. I was probably not scared, something went wrong in the work of the brain. There was only a misunderstanding, I wanted to call, but did not know how to do it. Then there was a pause in my recollections, I remember only the following events came my son, then the doctor, but I did not understand the purpose of his visit. Also, at the hospital, for some time I did not understand where I was and what had happened. " 2

3 Consequences of stroke Despite the development of modern medicine, the disease requires long-term treatment and rehabilitation. And even in cases when timely medical care is provided, stroke patients have only a partial renewal of the functions of the central nervous system, which is expressed as follows: o difficulties in performing complex movements (difficulties in coordinating movements, maintaining balance, etc.); o spatial disorientation; o violation of sensitivity; o speech disorders: o sensorimotor aphasia, when all aspects of speech functions are affected - both the initiation of speech and phonemic hearing; o motor aphasia, when the speech of patients is usually poorly articulated, may not be intonationally colored. The patient speaks in short grammatically incorrect sentences, in which verbs are almost absent (telegraphic style), long pauses are often noted; o sensory aphasia, when there is a loss of phonemic hearing, impaired understanding of oral and written speech, alienation of the meaning of words: the patient is not able to isolate the semantic component from the sounds of speech he hears; o amnestic aphasia, when the recognition of nouns predominantly suffers, which leads to the alienation of the meaning of nouns. The patient does not fully understand the speech addressed to him, the comprehension of the read text is also impaired. His own speech is poor in nouns, which are usually replaced by pronouns. In addition, there are significant difficulties in naming items for display. At the same time, the patient by his behavior makes it clear that he is familiar with the object, can explain its purpose, the hint of the first sounds, as a rule, helps; o violation of articulation and understanding of the speech of others and read while maintaining internal speech; o violation of writing (agraphia) and reading (alexia); o violation of the ability to count (acalculia); o weakening of memory, intelligence and concentration (cognitive impairment); o violations in the emotional and volitional sphere. 3

4 Table 1 Goals of rehabilitation at various stages of the disease after a stroke Disease stage Aggravation (up to 4 weeks) Early recovery period (up to 1 month) Late recovery period (up to 1 year) Residual recovery period (after 1 year) Rehabilitation goal Restoration of lost functions occurs ( return of sensitivity and movement, renewal of blood circulation to damaged organs) Improvement of functions. Adaptive habits are developed that allow you to adjust to a persistent neurological defect (if any). Improving the patient's social and daily adaptation. Prevention of recurrent stroke. These consequences are clearly characterized by the story of Marina Pavlovna about her recovery: “I could not speak. I was in the Gailezers Clinical Hospital, in the very first days a physiotherapist came to me and I was lying in bed doing exercises, because I could not get up. After I was transferred to the Bikernieki hospital, a speech therapist came to me and started teaching me how to speak, showing pictures. I remember that the first picture showed a house, I looked, I knew what it was, but I could not say anything. Then for the first time I was seized by fear, I began to realize that something bad had really happened to me. The fear was intensified by ignorance about my diagnosis, about what happened, about the state of affairs in general, and all this was complemented by the impotence to speak out. Maybe it would be better if I was unconscious, but that's when I became aware of what was happening. The unknown is terrifying. Only after such an experience can one truly understand a stroke patient who is in such despair that he thinks about suicide. I only started talking two months after the stroke. The first word was mom. " Changes in the patient's behavior, which are associated with a violation of emotions and will, depend on the localization of the stroke: o If damage is in the frontal part, the patient has the so-called apato-abulic syndrome (decreased mental activity), which is expressed in a lack of interest in life (apathy) , decreased activity and activity, weak will, also in the weakening of intelligence and critical attitude. o Extensive damage to the left hemisphere of the brain is called the syndrome of emotional lability (decreased activity of the psyche and movements, underestimation of violations of their movements and unwillingness to eliminate them, lack of a sense of proportion and tact, overabundance of emotions, difficult social adaptation). 4

5 Basic principles of psychological rehabilitation Of course, the rehabilitation of patients should take place throughout the entire illness, as indicated in Table 1. Typically, the rehabilitation program for patients after a stroke includes drug therapy, physiotherapy, balanced nutrition, speech therapy correction, kinesitherapy (therapy using various movements), psychotherapy and psychocorrection (psychological development). It is believed that psychological work can begin in the residual period, but in an interview Marina Pavlovna says the following: “The services of a speech therapist and a physiotherapist were available at the Bikernieki hospital. But imagine you are in a hospital, you cannot get up, other movements are also limited, you don’t know what happened to you, you have a presentiment of something bad, you cannot speak, although you understand speech. Relatives come and talk to you, but they don't know much either. In such a situation, in my opinion, the help of a psychologist is needed - a specialist who, without delving into the intricacies of the disease, would tell about its severity, the duration of the damage, and the fact that these injuries are curable, and how I can help myself and the doctors who I'm being treated. Several visits would help reduce anxiety and fear, and promote confidence in recovery. For a stroke patient, every minute of contact with the outside world is important, and the word of a specialist is of great importance. " Marina Pavlovna tells about her experience of rehabilitation in Vaivari: “Medical rehabilitation in Vaivari (classes with a speech therapist, massage, reit therapy, etc.) helped me a lot, I improved my physical functions and continue to do so. I was there six times, but only once took part in a psychological course. I must say that there were some barriers, for example, age. It seems that I have lived for so long that it seemed strange to ask something from psychologists, young girls. But there was a need to talk and consult. " We also believe that a psychologist can join the rehabilitation program already in the early period of recovery, providing psychological support to the patient and setting him up for recovery. When working with a stroke patient, a psychologist can influence a person's speech and other activity. First of all, this means the activity of movements. In modern psychophysiology, there is a view that the resumption of neurological functions depends on: o the time factor (the so-called "therapeutic window" when recovery is possible and effective); o neuroplasticity - the ability of the brain to compensate for structural and functional disorders in the case of organic disorders. 5

6 Studies show that plasticity can be influenced both by pharmacological drugs and by participating in special rehabilitation programs where movement is stimulated. The restoration of activity is one of the most significant areas of rehabilitation, because activity involves the restoration of the most important mechanisms of biological adaptation neurons and the activation of the preserved ligaments of nerve cells. The results of a series of experiments indicate that those structures of the brain, in which 10-20% of the structural elements are preserved, can resume their normal functioning. It has been shown that the activation of parts of the body affected by a stroke affects the functional reorganization of the brain. In this regard, the opinion that a stroke patient can only compensate for the lost functions becomes controversial. By constantly developing the working capacity of the affected organs, a greater effect can be achieved. The emotional state of a patient with a stroke It is known that the emotional state in the first weeks and months after a stroke is unstable, characteristic personality traits are exacerbated: apathy, tearfulness are possible, in others, aggressiveness, impulsivity, problems in relationships with loved ones. These processes are influenced by the above-mentioned brain damage, and long-term debilitating treatment, the need to stay in a hospital, to be supervised, as well as physical pain. The patient realizes that his life has changed for the worse, and these changes will affect his family. In this regard, a person who has suffered a stroke experiences mental anguish, painfully experiences the loss of the usual way of life, feels shame at his helplessness, is afraid of disability and dependence on others. Feelings like this can lead to depression. The patient does not believe in the possibility of recovery, loses interest in life, stops actively participating in rehabilitation measures, and often shows rudeness and irritation in relationships with loved ones. The depression caused by the stroke becomes a hindrance on the path to recovery, the patient himself does not make efforts, and also rejects the help of doctors and relatives. A psychologist can help break out of this vicious circle. Forms of psychological rehabilitation and possible ways of working A prerequisite for rehabilitation is communication with the patient. The professional skills of a psychologist make it possible to establish a relationship with the patient at the required level and consistently provide support. It is important to maintain contact with a person, this stimulates the activity of his speech. 6

8 A special target audience for the work of a psychologist is also the patient's relatives, who need to be helped to understand both the feelings of a loved one after a stroke and their own, as well as to build the right relationship with the patient. The public organization "Vigor" offers for relatives of people who have suffered a stroke, and individual psychological counseling, and the opportunity to visit support groups. When looking for new opportunities for psychological rehabilitation after a stroke, it is necessary to take into account that it is important to combine and coordinated the use of medical and socio-psychological measures that contribute to the restoration of a person's physical, psychological and social activity. Neither the patient's age, nor neurological and somatic diseases, nor the depth of the post-stroke defect exclude an effective rehabilitation process. A few more words from Marina Pavlovna's experience: “After the hospital, my sons and my husband kept urging me to do something. This was very correct, because personal activity helps to recover. A person who has suffered a stroke has only two options: work, seek, use help and progress, or give up possible activity and get stuck at the TV remote control, telephone and regress. There is no third". Translated by Evgeniya Bronislavna Zabelskaya 8

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A stroke is a tragic event that dramatically changes the life of the patient himself and his family for the worse. Therefore, depression is, unfortunately, a common companion for stroke patients.

Some changes in the patient's behavior are caused by the brain lesions themselves - these are syndromes of emotional lability and decreased mental activity.

The emotional state of the patient in the first weeks or even months after the blow suffered is extremely unstable: he can be capricious, tearful, quick-tempered. Do not be offended by him - this syndrome of emotional lability is typical for most patients.

Some survivors tend to be indifferent to their condition. They are engaged in medical gymnastics only under duress, they can lie in bed for hours or mindlessly watch one TV show after another. In such patients, even mild disorders of motor functions are poorly restored. They are often helpless in everything. And this is not explained by laziness, as their loved ones sometimes believe, but by the defeat of certain areas of the brain. With extensive lesions of the right hemisphere, along with impaired movement in the left arm and leg, there is a decrease in mental activity. Such a patient should be patiently prompted to action, by all means try to develop the need for movement, walking, and self-service. He needs to be given as much attention as possible, but if the patient is not feeling well, not in the mood, do not force him to practice at all costs. Be patient, be kind and affectionate to him.

In addition to physical ailments and other direct manifestations of a stroke, the patient also experiences moral suffering: it is hard to experience a break with the usual way of life; Feels ashamed of being helpless fear of being a burden to relatives; anxiety that they will remain disabled forever; longing for immobility and isolation ...

Many patients painfully experience their dependence on others. This is especially true for people who, before the strike, were distinguished by independence and love of freedom, a strong character, a heightened sense of their own dignity. A person who is accustomed to always making decisions on his own and being responsible for his life, it is extremely difficult to adapt to the fact that he is now in the care of his family.

All of these reasons can lead to depression in the patient. This can be expressed in the fact that a person does not believe in his recovery, loses interest in life, and, in particular, in recovery exercises, upset his loved ones with irritability and sometimes rude, grumpy behavior. Now the depression caused by the disease itself is an obstacle to recovery - after all, the patient does not make efforts to restore the impaired functions, rejects the help of doctors and relatives. It turns out a vicious circle from which you need to break out. How?

It is imperative to communicate with the patient. An immobilized person needs moral support, contact with the outside world. Even if the patient does not speak and his center of motor speech is affected, he is usually still able to perceive spoken speech - after all, the center of perception of spoken speech lies in another area of ​​the brain.

Academician A.I. Berg wrote: “A person can think normally for a long time only under the condition of continuous informational communication with the outside world. Complete informational isolation from the outside world is the beginning of insanity. An informational, thought-stimulating connection with the outside world is as necessary as food and warmth. ”

Believe me, communication and conversation with the patient is no less important than medications. Tell him about your work and friends, discuss children, the weather and politics. Do not forget to talk with the patient about his condition, to note the slightest progress. Express your love, your confidence that the situation will change and he will definitely return to an active life.

How to communicate with a patient who cannot answer? In the famous novel by A. Dumas "The Count of Monte Cristo," the paralytic Noirtier expressed his consent - closing his eyes, refusal - by blinking, and when he needed to express any desire, he raised his eyes to the sky. Make an effort to ensure that the patient regularly experiences positive emotions: from delicious food, a flower on the bedside table, pleasant music. However, keep in mind that different people react differently to the same events. For someone, for example, it will be a joy to visit grandchildren, to meet old friends. And perhaps this will only disturb or embarrass the patient in vain.

If the patient is almost constantly gloomy and irritated, it is especially important to try to guess and fulfill his little desires.

If your efforts remain in vain for a long time, then it is worth contacting a psychologist or psychotherapist, who may consider it necessary to use antidepressants to correct the patient's mood. Take the recommendations you receive seriously - after all, the psychological state is no less important for recovery than medications and procedures.

A little effort, a little imagination, a lot of patience and love - and the depression will have to recede.

The patient's relatives also need psychological help.

We have already mentioned that stroke dramatically changes the life of not only the patient, but also his household. They experience what happened no less, and often more than the patient himself. A huge additional load suddenly falls on the shoulders of relatives: in the first month they are torn between home, service and hospital visits, then, after discharge, they begin to master the hard work of caring for a bedridden patient.

If the restoration of the impaired functions in the patient is delayed, freedom of movement, memory, speech, self-service skills do not return for a long time, then the patient's relatives accumulate chronic fatigue, both emotional and physical, and the so-called "responsibility fatigue." Like the patient himself, the family member caring for him experiences a depressing feeling of anxiety, and sometimes he too is abandoned the hope of returning to his old life, which now, from afar, seems safe and carefree ...

There are many rules and techniques to help you deal with stress and fatigue. Here is some of them:

"The driven horses are shot." If you’re close to your limit, stop and rest. This simple rule, oddly enough, is neglected by many, not giving themselves a break until fatigue literally rolls off their feet. Meanwhile, breaks, smoke breaks, breaks and weekends significantly increase the effectiveness of any activity.

Ask other people for help

There is nothing shameful about asking for help in a difficult situation. Help can be very different - a neighbor or friend can sit with the patient while you are resting, go to the store or pharmacy. Someone you know or a charitable organization may be able to help with medicines or patient care supplies. Finally, you might need one too. Moreover, now it can be obtained even virtually, for example, on the website psychology.ru. Try to find or organize a "support group" for people with similar problems. Sometimes it’s very good to just talk. However, in this you need to know when to stop and not get used to constantly complaining about life to everyone around.

Find ways to distract yourself from distressing thoughts and boost your mood

When a traumatic situation lasts for months, it is especially important to be able to enjoy the little things in life. Learn to “turn off” the flow of negative thinking. Be aware of the good things that are always around you - the taste of food, the view from the window, the sounds of your favorite music and the joy that another difficult day is finally over ... Give yourself small gifts, go to visit - this will help you hold out.

Use traditional stress relievers

These include hiking, a variety of water treatments, sports, yoga and meditation, acupressure, aromatherapy, soothing herbal teas and listening to relaxation tapes. Many people are calmed by knitting or fingering a rosary. It is also useful to describe on paper or draw your fear, resentment or fatigue, it does not matter whether you do it professionally or not. Apply self-hypnosis and auto-training techniques

Nowadays, many publications are being published devoted to such techniques. For example, for many years the book of the famous psychologist Vladimir Levy, dedicated to auto-training: “The Art of Being Oneself”, has been invariably popular. Classes can take only a few minutes a day (before bedtime and immediately after waking up), but you will definitely feel the effect.

Choose for yourself a complex of vitamins, adaptogens, fortifying and immunostimulating drugs

Life now makes increased demands on your body and, in particular, on the nervous system. Therefore, you need additional support. In any pharmacy you will find a sufficient assortment of vitamins and fortifying agents. Choose from them the most suitable for you.

Don't lose your optimism

All the methods listed above will only help you if you deliberately set yourself up for victory. Of course, from time to time feelings of hopelessness, irritation and even hostility towards the patient can cover the most patient person, and you should not blame yourself for them. It is only important not to stay in these states for a long time, but to stubbornly return oneself to benevolence, patience, endurance and optimism.

A stroke always becomes a tragic event in the life of not only the patient himself, but also his family. This merciless ailment can dramatically change for the worse not only physical, but also moral condition. The syndrome of emotional lability of such patients, which is present in them already in the first weeks after a stroke, manifests itself in tearfulness, indifference to everything that happens, capriciousness and irascibility over trifles. Some stroke sufferers are indifferent to the need for even physical rehabilitation and perform the necessary procedures only after lengthy persuasion or even under duress. There is a category of patients to whom a lot of mental suffering is caused by their shame for their weakness and confusion of speech. They can spend hours staring at the wall or watching uninteresting TV programs, negatively perceive walks in the fresh air and inadequately react to expressions of concern from relatives, friends or medical personnel.

Psychological recovery program

The condition after a stroke requires mandatory psychological rehabilitation and understanding on the part of others, which are impossible without constant communication and contact with the outside world. Psychological recovery after a stroke is aimed at developing an adequate attitude towards health and illness, focus and firm motivation for a speedy recovery, return to social and work life. An individual psychological rehabilitation program should be drawn up for each patient, which would take into account:

  • state of psychological status, which can be unburdened or aggravated (neuroses, depression, psychopathic character traits, psychosis, etc.);
  • the presence of complications from the psyche caused by a cerebral hemorrhage or a peculiarity of the patient's personality response to the disease.

Explanatory, persuasive and informational conversations are of great importance in communicating with the patient. It is extremely important to teach a weak person to overestimate values, to try to switch his attention to other aspects of life: the interests of friends, family, team, hobbies and social life. In such situations, a rehabilitation doctor works not only with his patient, but also with his environment.

Your home environment helps you recover faster. Patience and gentleness of relatives and friends contribute to the patient's adaptation to their condition and allow avoiding severe depression. The ability to learn to rejoice in life, to enjoy communication, to make plans for a future life helps to tune in to the need to patiently and regularly follow all the recommendations of doctors and to understand that an illness worsens the quality of life, but is not a threat to it, but requires the fight against the consequences of the disease ...

Relatives of a patient after a stroke need to learn to predict the tasks that are given with difficulty to a patient who has not yet fully rehabilitated.

  1. As a rule, it is difficult for such people, especially in the morning, to get up or get out of bed, take large pieces of bread and bring them to their mouths, and drink from a cup. In such cases, you can offer them finely chopped pieces of bread and a drinking straw.
  2. It is important to be able to help the patient maintain self-esteem in any situation and always refrain from criticizing his condition.
  3. The daily routine must necessarily include the usual activities that instill in the patient a sense of security and self-confidence. For example, if he is used to working in the garden, then his initiation according to the measures of his strength will help to normalize his emotional state and bring pleasure from his favorite activity.
  4. Conflicts with the patient should be avoided in every possible way, since this can lead to a deterioration in his health and cause him resentment and isolation. It is imperative to remain calm, try to joke kindly more often, not to argue or criticize in a negative connotation.
  5. Help from friends, family, coworkers, and neighbors should not be avoided. Such communication will benefit both the patient and his loved ones.
  6. You need to leave time for yourself. Such minutes and hours of rest will help to overcome the heavy psycho-emotional and physical stress and continue caring for the patient in a good mood.
  7. To prevent overwork caused by overestimating your capabilities, you need to think in advance about who can help and replace you. Many relatives who care for such patients overestimate their capabilities and patience - this can lead to neuroses, nervous breakdowns and depression.

Psychological recovery activities

  1. individual and group psychotherapy;
  2. autogenous training;
  3. psychotherapy using acupuncture;
  4. book therapy;
  5. psycho-gymnastics with the use of pantomime, rhythm, dancing, singing, etc .;
  6. cultural therapy activities;
  7. work in clubs of "former patients".

How to tune the patient to fight the disease?

  1. Try to concretize each action.
  2. To distract from moral self-torture by comparisons with those who are even worse.
  3. To teach to be aware of the need for resignation to what happened.
  4. Encourage others to help.
  5. Encourage hope and improvement in the future.
  6. Teach the patient to live for today.
  7. Learn to adapt to the existing conditions of life.
  8. Give the opportunity to feel in demand and needed a member of the family and society.
  9. Avoid sloppiness and detachment from society.
  10. Learn to behave with dignity in any situation.

All methods and methods of psychological rehabilitation after a stroke will only help if the patient and his environment are determined to win. Of course, feelings of irritation from one's own weakness, hostility to the current situation will darken this faith, but the ability not to stay in such states for a long time and a stubborn return to benevolence and a positive attitude will help to overcome all adversity.