A full life after a stroke is quite real. The main thing is not to give in to despair, gratefully accept the help of loved ones and every day take at least a small step towards recovery.

Consultant - Evgenia Kurlenya, therapist

A stroke develops as a result of an interruption in blood circulation in one or more of the blood vessels that supply the brain. When a certain area of ​​the brain receives insufficient oxygen and other nutrients, or even is completely deprived of them, the brain tissue is damaged or even dies. The faster the blood supply is restored, the greater the chance of a full recovery. However, about half of the patients who survived a stroke (and this disease is also fatal) lose their ability to work for many weeks, months, and even years. And yet, in the end, it all depends on you. Life knows many examples when people who had a stroke got back on their feet and even returned to an active lifestyle. It is in your power to help yourself or a loved one who is in trouble!

Blockage in the vessels - a blow to the nerves
Strokes can be classified according to the nature of the course. The least dangerous stroke is a transient ischemic, or small stroke, which is caused by a short-term violation of cerebral circulation. A progressive stroke first causes very slight changes in the nervous system, and worsens after a day or two. With an extensive stroke, the nervous system experiences a strong “hit” from the very beginning.

Symptoms of strokes are very diverse and depend on which artery is affected, the severity of the damage, and whether the lateral branches of the affected vessel sufficiently compensate for the loss. In a left-sided stroke, symptoms appear on the right side of the body. Conversely, with a right-sided stroke, patients complain about the organs located on the left. However, there are exceptions. The classic symptoms of a stroke include headache, vomiting, confusion, seizures, coma, fever, and confusion. Occasionally, before a stroke, the patient complains of drowsiness, dizziness, headache. As a rule, the rate of speech slows down significantly, often the patient cannot even remember his own name and the current day of the week.

First steps to recovery
No matter how severe the stroke is, don't set yourself up for lifelong bed rest. You will have to re-learn how to feel your body and control it. Of course, this will take time. First of all, determine the movements that you can make. Learn to sit, then stand, try to distribute the weight evenly on both legs. At first, try to walk with someone else's help, and then try it yourself. On average, you should master one to three new arm and leg movements in one week.

Even if you are unable to perform some movements on your own, you need to make the muscles work - a long “downtime” is fraught with even greater atrophy. Therefore, daily massage sessions (for one to three months) in a health and rehabilitation institution or at home are desirable.

To recover faster, use some simple tips:
. Go to bed in such a way that when you wake up, you get up exactly on the affected leg. This small load will further stimulate the muscles.
. When sitting, often change the position of the affected hand: put it behind your back, take it to the side, put it on the back of a chair, the armrest of the chair.
. The same applies to the leg. Sitting on a chair, sofa, control its position, evenly load both legs.
. When learning exercises for a sore arm (leg), first do them with a healthy limb - it’s easier to master the technique.
. Choose comfortable shoes that will fix the foot well, but do not squeeze it.
. Remember that you had a brain injury, so avoid negative emotional experiences and stress.

Don't let it happen again!
Often the cause of hemorrhage is an increase in blood pressure. Risk factors include both mild arterial hypertension (pressure of about 140/90) and hypertension (upper pressure figures from 140 to 180 mm Hg and lower pressure from 90 to 105 mm Hg). Every person who has had a stroke needs to have a tonometer at home and monitor pressure fluctuations.

Diet plays an important role in normalizing blood pressure. Limit your intake of animal fats and salt (up to 5-6 grams per day - the sodium found in table salt is undesirable). Exclude rich meat broths, smoked sausages, fish, canned food, pickles from the diet. Do not get carried away with butter, sour cream, eggs. Love unsalted vegetarian soups, dairy products, fruits, vegetables, juices.
Replenish potassium - eat apricots, oranges, bananas, carrots, cabbage, potatoes, radishes and juices from these vegetables. For all hypertensive patients, and especially those who have already had a stroke, extra pounds are extra health problems. Be sure to bring your weight back to normal!

Often, a stroke occurs as a result of a ruptured aneurysm of a cerebral vessel. Aneurysms, as a rule, have the form of a "pouch", a protruding vessel wall. Thinned and stretched, it does not withstand the load and breaks. Is there a guarantee that there is only one such “bag”, that the next one will not burst at the next pressure jump? Unfortunately no. Therefore, after discharge from the hospital, it is necessary to do an angiographic examination of the cerebral vessels, which is carried out in neurosurgical clinics and institutes. The most effective way to prevent recurrent stroke in aneurysms is to remove them. Another risk factor for recurrent stroke is atherosclerosis. The resulting atherosclerotic plaques sometimes sharply limit the lumen of the vessel.

Learn first aid skills. Before the ambulance arrives, the patient must be laid down with a small pillow under his head, shoulders and shoulder blades. Unbutton the collar, loosen the belt. Provide air access - open a window or window. If there is vomiting, turn the patient's head to one side, clean the mouth with a finger wrapped in a clean handkerchief or gauze and fix the tongue. In no case do not resort to self-medication! The only drug that will not harm and alleviate the course of the disease is glycine. In a critical situation, it is given one gram - 10 tablets under the tongue at one time or 5 tablets 3 times with an interval of 30 minutes.

Help from loved ones
After a stroke, it is often difficult for a patient to perform even the simplest actions. In this case, the help of loved ones is especially important!
. In order for the patient to be able to distinguish "right-left", suggest that he wear a watch or bracelet on his left wrist as a guide. In addition, you can make marks on boots, trouser legs or sweater sleeves (use multi-colored stickers).
. If the patient has difficulty orienting in space, draw or mark with colored dots the path along which he moves daily to the toilet. Do not clutter up the surrounding space, keep only a few items on the night table. If necessary, draw posters with arrows and explanatory inscriptions.
. If the patient has difficulty dressing, advise him to fasten the buttons on his shirt or blouse from the bottom up - this makes it much easier to get into the buttonholes.
. For speech disorders, formulate questions so that they can be answered in one word, use gestures to facilitate understanding. Even if the patient outwardly does not react in any way to the appeal, it is possible that he hears everything, so do not forget and do not say too much. Do not correct the patient's speech, do not treat him like a child - this can injure him.
. Stroke survivors can easily forget their way home and get lost even in familiar terrain. Try not to leave the patient unattended. And even if improvements seem obvious, control the movement of the patient. In a special breast pocket there should always be a note with his last name and first name, as well as his home address and telephone number.

In spring, we all feel a surge of strength. Well, how can you not dig up a bed or two! Joyful work is addictive, but it is important to soberly assess your strengths and gradually engage in physical activity.

Recovery Exercises
Getting back on your feet after a stroke is real! The main thing is not to give up (literally and figuratively). As soon as the doctor allows, begin to perform special exercises to restore the affected limb. Training should be gentle, but regular. Remember: the best results are achieved in the first six months after a stroke. The intensity of classes depends on the type of stroke, but there is a general recovery scheme.

leg exercises
. After lying down for a long time, it is difficult to start a “vertical” lifestyle. At first, just sit on the bed.
. Try to stand with your weight on both feet. Dizziness and an itchy sensation in the affected leg are signs that atrophied muscles have begun to work.
. As a result of a stroke, flexor muscles often suffer: the patient cannot bend his leg at the knee. Passive training will help: let the assistant bend your leg, you unbend it with your own effort. After a while, try bending your leg on your own.

Hand exercises
. The recovery of the arm is usually very slow, so at first load the muscles of the shoulder girdle (in most people they are the strongest). Raise your straight arm forward, learn to take it to the side.
. To warm up the joints and stretch the muscles, pick up a small pole (the ends of a large towel) and, without bending your elbows, raise it as high as possible. Then, bending your elbows, try to take the pole behind the back of your head.

When you master the basic movements, start practicing with the help of the Rubik's cube. Scrolling the various planes of the cube trains the fine motor skills of the fingers and the muscles of the entire hand as a whole.

Irreplaceable helpers
Establishing self-catering is not that difficult. Even ordinary cutlery can be improved so that their use will not present a problem for a sick person.

Glasses and cups
Use plastic glasses: plastic is lighter than glass and not as slippery. To make it easier to hold a glass in your hands, you can pull strips of terry cloth over it.

A cup with two handles is more comfortable to hold. You can use a cup with a stand or with a T-handle - it is easier to squeeze it in your hand. Use a cup with a weighted base and you won't have to worry about spilling liquid.

With a stiff neck, cups with a V-shaped cut along the edge are most convenient - you can easily drink the entire contents of the cup without straining your neck.

Drinking straws
Flexible or rigid straws for disposable and reusable use come in a wide variety of sizes. You can drink soup and thick liquids through wide straws. Use a special plastic lid with a slot for a straw.

Dishes
Unbreakable plates are convenient. To prevent the plate from slipping, place it on a napkin, paper towel, stand, rubber circle. Rim-shaped attachments make it easy to use a fork and spoon without fear of dropping food. Attach such a rim to the side of the plate opposite to the hand with which you eat. There are also plates with high edges, part of the surface of which is made in the form of a scoop.

Cutlery
If your arm muscles are weak and your hands are trembling, use cutlery with wooden, plastic or cork handles - they don't slip and are easier to grip than smooth metal ones. You can also use a special belt loop to attach the cutlery to your hand.

A stroke claims millions of lives around the world, leaves people disabled, and not everyone is able to fully recover from an attack. complete or partial paralysis, loss of habitual skills, a person becomes incapacitated and requires regular self-care from the outside. Dependence of the patient on caregivers along with the state of health provokes psychological problems. In this case, the help of a psychologist is required, the patient must be prepared for difficulties on the way to recovery.

Recovery of motor functions is an important stage of rehabilitation.

In addition to supporting close people, the patient himself must make considerable efforts to restore lost functions. The rehabilitation period can last from several months to years. The course consists in the use of comprehensive measures aimed at motor, cognitive functions. When the crisis period has passed, the patient needs a long rehabilitation, because learning to walk again after a stroke can be very difficult. Rehabilitation measures should not be delayed, they should be started immediately after drug therapy to restore cerebral circulation. The patient should not get used to bed rest, the sooner he can get out of bed, the faster the recovery process will start.

Impact of stroke on motor functions

Acute circulatory disorders cause failures of all body systems. In addition to incoherent speech, dysphagia, the patient has numbness of the limbs, paralysis. If time does not take action, these symptoms can flow into a permanent phenomenon. The presence of muscle cramps can be extremely dangerous and herald a recurrence of an attack.

The following signs are characteristic of impaired motor functions:

• there is uncertainty, unsteadiness of gait;
• inability to develop speed of movement;
• the patient cannot bend, straighten or straighten the arm or leg as much as possible;
• painful spasm of the muscles of the legs prevents flexion of the pelvic and knee joints, often occurs in the foot;
• movements of the paralyzed leg may exacerbate arm spasms;
• coordination of movements is broken;
• partial or complete lack of sensitivity of the limbs;
• the patient cannot put his foot on the sole, as a result, when walking, the movements begin with the toe, and not with the heel;
• walking after a stroke can be accompanied by sudden falls.

Rehabilitation measures begin to be carried out on an individual basis, there are no clearly established deadlines for the recovery process, it all depends on the patient's condition. Some patients begin to walk after 2 - 3 months, others need much more time to return the lost functions. In any case, the patient and loved ones need to be patient and work to get a positive result.

Despite the significant influence of the extent of brain damage on the dynamics of recovery, the support of relatives renders a great contribution to the success of the measures. No less important is the psychological attitude of the patient himself. A depressive state caused by a feeling of helplessness, doom and unwillingness to act can ruin all the ongoing rehabilitation work in the bud.

Drug therapy does not end after the acute phase of the pathology. The patient may be prescribed medication for a long period, depending on the condition and symptoms:

• drugs that stabilize normal blood flow through the vessels, normalize the work of the heart;
• funds for in case of its high performance;
• blood thinning drugs that prevent the formation of blood clots in the extremities (not used for hemorrhagic stroke);
• muscle relaxants that relieve muscle spasms;
• neurotrophic drugs that promote motor activity;
• antioxidants to restore brain cells.

How to start walking after a stroke

In order to get a person out of bed as soon as possible, it is necessary, gradually moving on to more serious training. A patient after a stroke is extremely unmotivated and often does not want to do anything to improve his condition. The task of the psychologist and close people is to positively set the patient up for recovery. Despite the length of the rehabilitation period, the patient has a chance to regain all or part of the functions lost as a result of an attack.

Recovery procedures include the following:

1. At the first stage, passive charging is required, which does not require getting out of bed. It is carried out by health workers or relatives of the patient. Gymnastics trains the function of flexion of the joints, for this they alternately raise, bend one or the other arm at the elbow, then carry out similar exercises on each leg.
2. The simulator bed is designed to start the process of learning the correct movement of the legs at the initial stage, it imitates walking.
3. Approximately 4-5 days after the attack, the patient is trying to sit down. A special device helps to achieve a vertical position. First, the patient sits on the bed, then hangs his legs on the floor.
4. Further, you can imitate walking by moving your legs in a sitting position. The need for an upright position is not established by exact terms and depends on the individual condition of the patient.
5. At this stage, preparatory work is underway for the practice of walking, it is effective to use the “bike” movement, since it involves all muscle groups.
6. Hydrotherapy, which involves the use of hydromassage, improves blood circulation.
7. Ozokerite applications, treatment with paraffin compresses.
8. Massages are an effective and integral part of the treatment.
9. Hydrotherapy, ozocerite applications, massages help to get rid of muscle cramps.
10. Rehabilitation is successfully carried out at home, where the patient tries to perform ordinary household activities that develop motor skills.
11. The use of simulators significantly speeds up the recovery process. There are several types of devices for developing walking skills, getting up from a chair, exercise bikes, treadmills.
12. After some time (the rehabilitation period is individual), the patient manages to get on his feet. Standing and walking are not easy for a patient in a post-stroke state. You should start taking the first steps with the support of another person, then independently with the help of supports.
13. You can mark the traces of the patient in order to further correct the gait. To consolidate the skill of correct foot placement, you need to walk along a marked path with steps specially marked on it.

With the beginning of the stage of learning the skill of walking, it will be necessary to acquire:

• orthopedic shoes with wide soles with a slight rise;
• special holders are used to fix the foot;
• It is also advisable to wear knee braces so that the leg does not bend at the knee while walking.

Often, after a stroke, legs do not go well, they know what to do in this case, but not everyone has the opportunity to afford expensive procedures. No less effective can be home walking training according to the principle “I will teach you to walk the way I walk myself”, exercises can be done with the help of loved ones.

Walking Exercises

The number of repetitions will depend on the condition of the patient, if some exercises are beyond his power, the patient can be helped. Too active exercises are best done when the patient feels better.

• in the supine position with bent legs at the knees, the patient straightens one or the other leg, starting with a healthy limb;
• throwing one leg to the other in turn;
• the patient turns the feet inward, then to the sides;
• extension and flexion of the joints of the arms and legs;
• exercise "bicycle";
• abduction of the leg to the side: the exercise is performed lying on your back with legs straightened or bent at the knees;
• lifting the pelvis: the legs are bent at the knees, in the supine position the patient raises and lowers the pelvis;
• transfer of a straightened leg over the other;
• flexion of the legs;
• lying on his side, the patient should raise and lower his leg, then, turning over to the second side, do the same with the second leg.

It is not so easy to regain muscle control, but the efforts made by the patient and his family sometimes achieve incredible results. In medical practice, there are many cases when, it would seem, completely hopeless patients returned to their former lives.

Knee brace with hinges, NKN-149

It happens step by step, the muscles of the legs and torso are gradually strengthened, balance and coordination of movements are trained, along with this, the movements necessary for walking are mastered. Of course, when working with a post-stroke patient, you will strive to restore not only walking, but also all other lost movements, especially self-care skills. In this article, we will talk about how to regain walking after a stroke so that the walking recovery system is clear.The body of a post-stroke patient remembers all the movements that he possessed before the stroke happened, but the connection between the brain and muscles is lost. Our task is to help restore this connection so that the brain "sees" its periphery and begins to control it. Exercise therapy after a stroke plays a huge role in this complex therapy.

Well, if your patient regularly exercised before the stroke, then the recovery of walking and other skills will be easier and faster. It is likely that during exercise therapy with a post-stroke patient you will cope on your own without an assistant.

If the patient is overtrained, overweight, has joint diseases, then you cannot cope alone, since it is very difficult to lift such a person, you will spend a lot of effort and, despite this, get poor results. In addition, there is a danger of dropping it, since such a patient is almost "wooden". Even an experienced exercise therapy instructor alone will not cope.

Preparation for walking begins from the first days after a stroke, when sagging feet, muscle contractures and joint atrophy are prevented. We talked about this in the article.

To enhance the effect of physiotherapy exercises, I highly recommend using - therapy before doing exercises.

Help us passive gymnastics on all joints of the legs and arms with a gradual inclusion of active movements depending on the patient's condition and his ability to understand you.

The combination of passive gymnastics with massage elements has a positive effect on the nervous system and the appearance of neuromuscular impulses.

Do not forget about the need to prevent thromboembolism: during exercise therapy, wear elastic stockings on the patient's legs or use elastic bandages. Leave the tips of the toes open to control blood circulation in the tissues of the feet and lower legs: the toes should be pink and warm.

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Passive gymnastics on the legs begins with the feet (flexion, extension and rotation), then continues to the knee and hip joints. The knee joint flexes and extends. The hip joint requires three-dimensional movements: flexion and extension, abduction and adduction, rotation. It is convenient to perform rotation in the hip joint by bending the patient's leg at the knee joint and holding the foot with one hand and the knee with the other hand. Passive circular movements in the hip joint are made in much the same way as in young children with hypoplasia of the hip joints.

During passive gymnastics, we strive to gradually “turn” passive movements into active ones.

As soon as you start to connect active movements, you should have a creative approach, taking into account the individual characteristics of the post-stroke patient and ingenuity.

The principle of including active movements is based on the activation of the volitional activity of a post-stroke patient.

1). Sending impulses. (Information on the site is sometimes repeated, but it is necessary). The patient mentally represents any movement in the limbs. First, he makes a movement from the healthy side, remembering the feeling of this movement. Then he mentally repeats the same movement on the affected side. The patient can send impulses independently during the day. Mental movements should be simple and short. For example, flexion and extension of the arm in the elbow joint, squeezing and unclenching the hand, raising the straightened arm, and so on. The message of impulses can be strengthened with the help of conscious (mental) weighting of the movement. For example, the patient imagines that a heavy dumbbell is in his hand or a weight is tied to his leg, and you need to lift it.

2). During passive gymnastics, tell the patient: “Help me! I will set the amplitude of the movement, and you do the movement yourself. You must learn to feel when your student can independently perform at least part of the movement. At this time, without taking your hands off the limb, weaken your influence, let the student make maximum efforts. All movements are carried out at a slow pace.

3). The patient cannot perform a full movement immediately. Therefore, you must first master it in parts, then combine the parts of this movement.

Let's take the exercise "Bicycle" as an example, since it is indicative, it involves all muscle groups of the legs.
"Bike". Starting position - the patient lies on his back, legs are bent at the knee joints, feet are on the bed.
1 - tear off the foot from the bed, the thigh of the leg bent at the knee joint approaches the stomach.
2 - straighten the leg up - forward.
3 - lower the straightened leg on the bed.
4 - bend the leg, pulling the foot closer to the pelvis, return to the starting position.

In order for the patient to be able to independently perform the “Bicycle” exercise, we will first apply the development of the first part of the exercise, we will teach you to “walk” in the supine position, alternately tearing off the feet of the bent legs from the bed; then we will separately train the raising and lowering of the straightened legs; and also separately - sliding the feet on the bed, straightening and bending the legs with full amplitude. We moderately help the "sick" leg to perform all these movements, day by day weakening our help until the patient makes the movement completely independently. We connect all parts of the movement into one whole and rejoice in success. If the student performs the exercise "clumsily", then we must set the desired amplitude in order to achieve a full-fledged high-quality movement. (We take the limb in our hands, the student works on his own, and we control and regulate the volume of movement).

We also master all other desired movements in parts, then combine them into one whole with control over the quality of the movement.

We are interested in walking recovery after stroke. Therefore, the following will be listed exercises for learning to walk. These exercises do not need to be applied immediately in one lesson. We are gradually restoring active movements and gradually complicating tasks.

Exercises to restore walking after a stroke.

It does not make sense to indicate the number of repetitions, since it depends on the patient's condition and the complexity of the load (from 4 to 10 repetitions).

1). Sliding feet on the bed. Lying on your back, legs bent at the knee joints, feet on the bed. Alternately straighten and bend the legs back, starting with a healthy one.

2). Foot to foot. The starting position is the same (lying on your back, legs bent at the knee joints, feet on the bed). 1 - Throw a healthy leg over the “sick” one (just a leg over the leg). 2 - Return to the starting position. 3 - Put the "sick" leg on a healthy one. 4 - Starting position.

3). Heel to knee. Starting position lying on your back, legs bent at the knee joints, feet on the bed. 1 - Place the heel of the healthy leg on the knee of the "sick" leg. 2 - Starting position. 3 - The same with the "sick" leg. 4 - Starting position.

4). Leg to the side - on the knee. Starting position lying on your back, legs bent at the knee joints, feet on the bed. 1 - Put the healthy leg on the "sick" leg on the leg. 2 - Take the same (healthy leg) to the side and lower it to the bed so that there is a full range of motion. 3 - Again, put the healthy leg on the “sore” leg on the leg. 4 - Return to the starting position. Repeat the same with the “sick leg”.

5). "Bicycle" with each leg, starting with the healthy one.

6). Feet in - out. Lying on your back, legs straightened and spaced shoulder-width apart. Turn the feet with toes inward, then turn the feet with toes to the sides.

7). Sliding the heel along the front surface of the lower leg. Lying on your back, legs straightened. 1 - Place the heel of the healthy leg on the shin of the "sick" leg closer to the knee joint. 2 - 3 - Slide the heel along the front surface of the lower leg to the foot of the "sick" leg and back. 4 - Return to the starting position. Repeat the same with the “sick” leg.

8).Straight leg raise. Lying on your back, legs bent at the knee joints, feet are on the bed. Straighten your healthy leg, sliding your foot along the bed. Raise and lower it several times, then return to the starting position. Do the same with the "sick" leg.

9). Taking the leg to the side. This exercise can be performed from the starting position lying on your back with both straightened legs and bent at the knee joints. 1 - take a healthy leg to the side and put it down. 2 - Return to the starting position. 3 - 4 - the same "sick" leg.

10). We complicate the previous exercise in the starting position lying on your back with straightened legs. 1 - Take a healthy leg to the side, put it. 2 - Move the healthy leg to the "sick" leg to leg, as if crossing the legs. 3 - Again move the healthy leg to the side, put it. 4 - Return to the starting position. Do the same with the "sick" leg.

11). Raising the pelvis. Lying on your back, legs bent at the knee joints, feet are on the bed. Raise and lower the pelvis, first to a small height, then every day we increase the height of the pelvis.

12). Flexion of the legs. Lying on the stomach, legs are straightened, the foot of the “sick” leg lies on the ankle of the healthy one. Bend and unbend the legs at the knee joints, focusing the student’s attention on the “sore” leg in order to strengthen the impulses. For the "sick" leg, this is a passive exercise.

13). We complicate the exercise "Bending the legs". Lying on your stomach, legs straightened. Alternately bend and unbend the legs at the knee joints, starting from the healthy side. We moderately help the patient to raise the lower leg of the "sick" leg. We strengthen the message of impulses: we instruct to imagine that a heavy weight is tied to a sore leg.

14). Bending the leg to the side. Lying on your stomach, legs straightened. 1 - Bend a healthy leg at the knee joint, sliding the knee along the bed to the side. 2 - Return to the starting position. 3 - The same with the "sick" leg. 4 - Starting position.

15). Leg over leg. Lying on your stomach, legs straightened. 1 - Move the straightened healthy leg over the “sick”, touch the bed with the foot. 2 - Return to the starting position. 3 - 4 - The same with the "sick" leg.

16). We put our feet on our toes. Lying on your stomach, legs straightened. 1 - Slightly raise the shins and put the feet on the fingers (extension of the feet). 2 - Put your feet back in the starting position.

17). Lying on your side, healthy limbs on top, legs straightened. Raise and lower the straightened healthy leg. Then repeat on the other side, for this we turn the student on the “healthy” side.

In the same starting position (lying on your side), bend and unbend the leg at the knee joint, bringing the knee to the stomach, take the straightened leg back, transfer the leg over the leg.

18). "Push me with your foot." The patient lies on his back, the “sick” leg (foot) rests against the chest of the instructor, who, as it were, leans on the student’s leg with his chest. We give the command "And-and-and-time!". At this time, the patient pushes the instructor's foot, straightening the leg.

19).Turn in bed. We teach you to turn on your own in bed, not only in order to restore the turning skill, but also to strengthen the muscles of the body. The patient lies on his back, legs are bent, feet are on the bed. 1 - Tilt your knees to the "sore" side, the patient himself makes an effort to complete a full turn on the "sore" side. 2 - Return to the starting position. 3 - The same with a turn on a healthy side. Remember that you can not pull on the paralyzed arm due to the weakening of the muscular corset of the shoulder joint.

20). Sitting on the edge of the bed. After we have mastered the turn in bed, we train the skill of sitting down on the edge of the bed. After the patient has turned on his side, we lower his legs down from the edge of the bed, the patient pushes himself off the bed with his hand and straightens up. He won't be able to do it without your help. Start mastering sitting down after turning on a healthy side, as it is easier for the patient to push off the bed with a healthy hand. Sit the student on the edge of the bed so that his feet firmly rest on the floor, they need to be spaced a short distance from each other for the stability of the structure. The body of the patient is straightened and slightly leans forward to transfer the center of gravity to the feet so that there is no fall back. (Pause for the patient to adapt to the upright position, ask if the head is spinning). Then you need to return in the reverse order to the starting position lying on your back, but with your head in the other direction. Now we perform sitting down on the edge of the bed after turning to the paralyzed side. Here, more efforts will be required from you to support the student, since it is still difficult for him to sit down after turning to the “sore” side. Again, we create a stable structure so that the patient does not fall: the feet are spaced, firmly resting on the floor, the body is straightened and slightly tilted forward. We hold the patient, we give a little getting used to the vertical position. Then again slowly put into bed on your back.

21). Getting up. Getting up on the floor from a bed or a chair is a difficult exercise. The patient should not be allowed to fall, as this can lead not only to injury, but also complicate further exercise therapy: he will be afraid to do certain exercises, refuse to walk. Therefore, we teach getting up gradually. Now our student can already turn on his side in bed, sit on the edge of the bed, sit on a chair without support.

We begin to train getting up from the edge of the bed. The patient sits on the edge of the bed with his feet firmly on the floor. We clasp the patient with our hands behind the chest, with our feet we create a strong obstacle for the patient's feet so that they do not move while standing up. We sway together with the patient and help him to stand up a little, tearing off the pelvis from the edge of the bed by about 10 cm, we do not linger in this position, we immediately sit back on the bed. We repeat several times, trusting the student more and more independence.

We complicate this exercise: we train getting up with moving along the edge of the bed in one direction, then in the other direction from one headboard to the other. First, we rearrange the patient's legs a little, then we transplant him a little further than the stop point of the feet on the floor. Then again we rearrange the student's feet a little and so on. We moved to the headboard, sat, rested, and again we move along the edge of the bed, now in the other direction. We strive for the patient to perform movements himself as much as possible, we try to keep him intuitively less and less.

It is convenient to train getting up, either by moving the patient to the back of the bed so that he holds on to it with a healthy hand, or by placing a chair with a high back, which the patient can hold on to. We support it and control it so that the feet do not move while standing up. The student is already ready physically and mentally to get up and stand, holding on to a support, because we have strengthened the muscles that are involved in getting up. The muscles are still weak, but they can perform the movement. We show him the technique of standing up on ourselves: we sit on a chair sideways to the patient: we swayed a little back (for a “run-up”), then forward with a separation of the pelvis from the chair, transferred the weight of the body to the feet and gently straightened up. We will do this decisively, since it is difficult to get up slowly. We sit in the reverse order, but slowly: while lowering the pelvis on the seat of the chair, the body is slightly tilted forward. They sat on a chair and straightened the body, not leaning back in the chair. Explain that you need to sit straight, keep the body in an upright position to train the muscles of the body.

The most reliable and convenient support to hold on to with your hands is the Swedish wall. If there is such an opportunity, then the patient holds with both hands the crossbar of the Swedish wall at the level of the shoulder girdle, the “sick” arm can be bandaged to the crossbar with an elastic bandage. The patient can be rolled up to the Swedish wall on a wheelchair, or he sits on a chair facing the Swedish wall. The patient stands up and sits down as described above, holding the bar with his hands. The complication of this exercise is possible by reducing the height of the chair: the lower the chair, the greater the load on the muscles of the legs, the more the arms are straightened. To reduce possible muscle spasticity, we instruct to exhale while sitting down.

22). Trampling in place. Starting position standing, hold on to the support, legs apart shoulder-width apart. To transfer the weight of the body either to a healthy or to a “sick” leg, as if swinging slightly to the sides to transfer the weight of the body from one leg to another (without lifting the feet from the floor). Then we complicate this exercise by lifting the foot off the floor by a few cm. When the feet are lifted off the floor, swinging to the sides is replaced by raising the legs - walking in place.

Next, we teach you to walk in place, raising your knees high.
Let's put it here rolling from heel to toe in a standing position, feet together.
Let's master "Bicycle" alternately with each leg in a standing position,
stepping with one foot forward and then back over a low bar, stick.
Let's practice alternately take the straightened legs back, putting the foot on the toe,
and lapping of the shins back(that is, the patient takes the lower leg back so that the foot is pointing up and the knee joint is down).

1200.00

2100.00

All standing exercises must be done with the protection of the knee joint from overextension back. I recommend purchasing a special orthosis for the knee joint, which allows you to freely bend and unbend the leg in the knee joint, but excludes the overextension of the joint back, which occurs due to the weakness of the muscles of the paralyzed leg.

This orthosis will be useful for your patient while walking for a long time, because even with the appearance of movements in the leg and the restoration of the walking skill, muscle weakness remains. If this is not possible, then at least make a bandage on the knee joint with an elastic bandage.

If the paralyzed arm sags, be sure to fix the arm with a kerchief bandage or use a special arm bandage before the patient assumes an upright sitting or standing position.

23). In the initial position of the patient, sitting on a chair, we train various leg movements:
rolling from heel to toe,
alternate rotation of the feet clockwise and counterclockwise,
sliding feet forward - backward in alternating-oncoming movements,
foot to foot movement
alternately abducting the legs to the sides,
alternately lifting straightened legs forward - up,
"walking" while sitting on a chair.

As soon as the student is able to move the lower leg back, you can start learning to walk. Not immediately, but by warning him in advance that tomorrow (or the day after tomorrow) you will start walking training. This will help your student to mobilize forces for this hard work. He will worry, worry, think about it, wait for you, imagine how he will walk. This is an additional sending of impulses to the muscles of the legs.

Restoration of walking after a stroke.

Finally, the long-awaited moment has come when the patient takes the first steps.
First, do some exercises for the arms and legs while lying on your back and sitting on a chair, practice getting up, shifting from foot to foot, taking your lower leg back while standing and sitting. You already have experience with post-stroke patients and can choose any exercise to prepare the patient for walking. Don't overwork him. Walking will require a lot of strength.

So, the patient sits on the edge of the bed, the feet are slightly apart and firmly rest on the floor. You sit next to him from the healthy side in an embrace, the patient grabs your neck with a healthy hand. You need to stand together on the command "And-and-time!". Stand up, straighten up. Now you make a kind of jerking movement with both the body and the hugging hand so that the “sore” leg of the patient moves forward by inertia. At this time, when the "affected" leg moves forward, remind the student to try to make a stepping motion. Next, the patient steps on the "sore" leg, transfers the center of gravity to it, holding on to you with a healthy hand, and rearranges the healthy leg forward. You again make a pushing movement. The "sick" leg of the student moves forward. And so on.

Having no experience in restoring walking in post-stroke patients, invite an assistant just in case to rule out possible difficulties. The assistant can help the "sick" leg of the patient to move. Just do not need to rearrange the “sore” leg too far, the step forward should be small.

It is necessary to train not only walking forward, but also backward. With each new step, it is necessary to strive for the patient to make a stepping movement with the "sick" leg. Figure out how to attach a wide band to his foot so that you can lift the leg by the tape so that it bends at the knee joint when it rises.

Once you realize that, despite the weakness of the muscles, the patient still walks, this is a great joy. Congratulations! Well done!

The following describes the idea of ​​rational recovery of post-stroke patients, as an option, if you have the necessary conditions for such classes: your enthusiasm is required, the patient should not be significantly overweight, it must be adequate, you need free space in the room for classes on the floor, a large carpet and, of course, a physically strong assistant.

The recovery of movements in a post-stroke patient will go fairly quickly if exercises lying on the floor (on the carpet), which are built in accordance with the stages of the physical development of the infant:
lying on your stomach raise your head,
turn from side to side
roll across the floor from one end of the carpet to the other,
get into a kneeling position
crawl backward in the knee-wrist position, then crawl forward,
crawl in a plastunsky way (lying on your stomach).
If everything works out well, then gradually you can include any exercises.

You need to use this technique only with an assistant, since this work is very difficult for your spine.

After a while, you will see that your student can do more than he could before the stroke.

Let me remind you that you learn to work out all the manipulations on a healthy person who imitates a paralyzed patient, and only then apply them to a post-stroke patient.

Another tip: be prepared for the fact that your patient's bowel function is activated during exercise therapy, he may want to go to the toilet. If it is possible to walk to the toilet and sit on the toilet, then for your patient this is a real holiday, a reward for the work.

How to lift a post-stroke patient from the floor?

Move a stable chair closer, put the patient on his knees in front of the chair (place the chair as convenient), put his hands on the seat of the chair. Next, you need to put the healthy leg of the patient forward on the foot. Now he himself stands up on a healthy leg, leaning his healthy hand on a chair, and straightens up with your support. It remains to put your student on a chair, wheelchair or bed. It's not as easy as it says here. Be aware of the danger of falling backwards when straightening the body. Lift the patient from the floor with two people, do not pull on the paralyzed arm.

Restoring walking after a stroke- not an easy task, but interesting and joyful. To achieve success in restoring movements in post-stroke patients, one needs enthusiasm, sincere desire and interest in this matter, ingenuity and physical strength. Only with your mood you can "ignite" the patient and convince him to fight for his health. There are times when a person after a stroke refuses to do anything to recover, lies and waits for death. This is quite easy to fix. Bring joy and hope into his life, and he will both study and look forward to you every day.

Then it remains to train daily balance, coordination of movements, strengthen the muscles of the trunk, legs and arms. Your student needs to be able to use both hands, so the next article will be about restoring hand movement and self-care skills.

Stroke of any type is a complex disease that affects the basic functions of the body, including speech and musculoskeletal system, memory and heart function. Finding out what not to do after a stroke will be of interest to patients who have been diagnosed with such a diagnosis, and their relatives who are planning a care schedule for them. The speed of recovery depends on the success of rehabilitation and compliance with the recommendations of the doctor. Many patients manage to return to normal life even after severe forms of stroke with additional pathologies.

Recovery after a stroke

It is possible to restore the vital functions of the body by making serious efforts, but this process can take years. According to statistics, patients who have had a stroke recover only partially, since this pathology affects the brain. Their relatives will have to prepare for a long recovery, the timing of which directly depends on the type of disease and the severity of the patient's condition.

Important! The initial stage of treatment takes place in stationary conditions, where the patient is taken out of an unconscious state and hemodynamic parameters are normalized. After discharge, doctors and close relatives should monitor his well-being.

A good effect is given by an additional healing course in a sanatorium or a specialized center, where suitable conditions are created for a full recovery. It is much more difficult to organize recovery and further after discharge, but with proper care, approximately 85% of patients return to their usual life after 1.5 years. The patient can achieve good results if he does not violate the rules and fulfills all the instructions of the doctors.

Recommendations of doctors after a stroke

Classification of recovery periods after a stroke

The duration and sequence of recovery periods depends on the individual condition of a particular patient, changes in the vessels and lesions. If the patient consistently follows the recommendations of doctors, the duration of the rehabilitation period may be reduced.

Recovery phases are distinguished taking into account the results achieved. The early period takes at least six months, the late one lasts up to a year, and you can get a noticeable effect even after a few years. Rehabilitologists distinguish 4 stages:

1. First month. This period is considered the most dangerous, since the survival of the patient depends on it. At this time, repeated heart attacks and strokes can occur, seizures can be recorded and a noticeable deterioration in the condition. Spinning and headache. Treatment consists in eliminating cerebral edema, stimulating collateral circulation and preventing the development of complications.
2. six months after the stroke. In the next six months, the patient will have to adapt to his condition psychologically and develop a clear plan of action. The attitude of the patient is of great importance - if he is ready to resist the disease, improvement will come much faster.
3. next six months. If for seven months the patient kept bed rest and diet, did not refuse to take medications and ruled out possible complications, he manages to partially restore the lost functions, including speech and motor activity.
4. Second year after ischemic or hemorrhagic stroke. A person who has had a disease is able to completely return to a previous life, while he will have to follow the recommendations of a doctor for life after a stroke.

The standard rehabilitation period is three years, but it all depends on changes in the work of the heart, the progression of ischemia and other comorbidities, as well as many other factors. Each organism is individual, and the brain of an individual person has its own characteristics, for this reason, some patients require more or less time to recover.

Stroke Recovery Exercises

List of typical complications after a stroke

Doctors' forecasts make it possible to understand how long it will take to fully or partially restore vital functions. Rehabilitation should be started as soon as possible after stabilization of the general condition of the patient. His relatives should actively participate in the treatment, monitor the implementation of the plan, taking into account changes, increase workloads and set new goals for the patient. Stroke often causes many problems that arise during treatment:

1. Paralysis of the upper and lower extremities, weakness in the legs or hands. More often, the patient paralyzes one part of the body, while he can independently rise to sit and even walk. The elimination of the problem is achieved with the help of physiotherapy and drug treatment, after the onset of visible improvements, the patient will have to train and do exercises.
2. Spasms and increased muscle tone. Often, paralyzed limbs remain in one position for a long time, which provokes problems with mobility. Specialists prescribe special medicines that relax muscles, physiotherapy.
3. Problems with speech. Partial or complete logopedic speech disorder is noted in all patients who have had a stroke. Often such patients lose the ability to write, the restoration of this function occurs under the supervision of a speech therapist.
4. Difficulty in swallowing. Dysphagia, or difficulty swallowing food and liquids, can lead to pneumonia if food enters the windpipe. This is due to damage to the nerves that are involved in the swallowing function.
5. Vision problems. Often, after a stroke, patients' vision is greatly reduced, its partial loss is due to a violation of brain functions.
6. Disorders of the gastrointestinal tract and bladder. Urinary incontinence and constipation are a major problem for bedridden patients. Bowel problems are caused by prolonged bed rest and can be corrected by adjusting the diet, exercising the pelvic muscles, and increasing physical activity.

Another common complication is epilepsy and mental disorders. Stroke patients often experience depression, they are characterized by increased emotionality, anxiety, constant mood swings and an inability to control themselves. Mental disorders can slow down the recovery process, so doctors often prescribe special anti-anxiety drugs. In the period from 6 months to 2 years, some patients develop epilepsy, requiring separate treatment.

Stroke

Constraints in the recovery phase after a stroke

After returning to a normal life, many patients want more independence, for example, to start driving again, go to work and perform normal and daily activities. Unfortunately, a stroke imposes a number of restrictions on many types of activities, such prohibitions greatly complicate the patient's life and negatively affect his emotional background. The ability to again engage in one or another type of activity depends entirely on the individual state of the body.

Sports and physical activity after a stroke

When answering whether it is possible to play sports after a stroke, many doctors recommend including feasible and moderate loads at the second recovery stage. Sports and physical activity restore muscle tissue, help the patient learn to control his body again, strengthen the functioning of the nervous system. While maintaining optimal activity, the likelihood of recurrent strokes is markedly reduced. The first month of therapy is the most important after the illness and includes many procedures.

Important! Intensive fitness classes, visits to the standard sports center and swimming pool are prohibited in the early stages of recovery. The patient should not engage in heavy sports. He is prescribed a specially designed set of exercises taking into account the state and gradually increase the load.

Such classes should be regular, only in this case they will bring real benefits. Swimming in the sea and swimming in the pool during the several months of the rehabilitation period is prohibited.

Light loads have a positive effect on the nervous system, develop the heart muscle, reduce excitability and increase the body's resistance to stress, both in women and men. Feasible exercise has a positive effect on the respiratory system, increases lung capacity and allows the brain to receive more oxygen.

Sports after a stroke

Visiting the bath and sauna after a stroke

Many are interested in whether it is possible to go to the bathhouse after a stroke, and how the steam room will affect the functioning of the brain and other body systems. Doctors allow visiting the bath, but in each individual case, the patient will need to undergo an examination, including an MRI, and receive additional advice. Due to the possible development of complications, water procedures can worsen the condition or lead to a sudden death. During the first year after a stroke, going to the bath is strictly prohibited.

Important! When asked if it is possible to go to the sea after a stroke, doctors usually recommend waiting at least six months. After the onset of the first improvement, a trip to the sea is indicated as a general strengthening therapy, taking into account the requirements of neurology.

If recovery proceeds normally, brain damage is minor, and scarring of necrotic tissue occurs at a rapid pace, short visits to the steam room will do more good than harm. If the patient takes a steam bath and goes to the sauna, observing all safety measures, then in a short time he will notice the effect. The list of advantages of a bath and sauna after a stroke includes vasodilation and relaxation of the motor apparatus, improved blood supply and intensive nutrition of nerve cells.

Bath after a stroke

Nutrition of patients is of great importance and directly affects recovery. Compliance with the diet recommended by the doctor will help to significantly shorten the rehabilitation period and improve the general condition of the patient. The diet should include foods that reduce blood clots and thin the blood. It is recommended to eat lean meat and fish, more boiled or stewed vegetables, fresh fruits, berries and herbs, nuts, bee products, healthy carbohydrates in the form of cereals.

On the question of whether it is possible to drink black coffee after a stroke, doctors usually recommend giving up this drink for a while and giving preference to weak tea or herbal decoctions. The list of prohibited foods includes fatty meat and lard, high-fat dairy products, mayonnaise, smoked meats, spicy, fried and salty foods. They should be abandoned for the entire period of rehabilitation in order to maintain health and speed up the cure. Additional recommendations include:

• the exclusion of alcoholic beverages, coffee and tobacco, which negatively affect the process of restoration of brain cells and the functioning of the immune system;
• minimizing the consumption of sugar and salt, which have a bad effect on blood vessels and the circulatory system;
• exclusion and diet of food containing a large amount of cholesterol and transgenic fats;
• reducing the intake of dishes from wheat flour.

Home meals should be fractional and combined with a schedule for taking medications and medications. Many patients who have had an ischemic stroke have problems with swallowing, which are fixed in the hospital and persist after discharge home. For this reason, the diet in the first days of the recovery period should be gentle. The patient should receive a large amount of liquid and food in pureed or liquid form. Healthy and fresh food, combined with a complete regimen, will help the patient recover faster and return to normal life.

Nutrition after a stroke

Important Limitations for Stroke Patients

The general list of restrictions depends on the severity of the patient's condition, the type of stroke and additional complications that will be recorded at the examination stage. Ignoring contraindications and the advice of the attending physician can cause a disorder in motor and other functions, vision problems, provoke a repeated extensive heart attack or stroke.

The patient is advised to eat right, follow the doctor's advice and not skip medications. Since a stroke is accompanied by a violation of many important functions, the patient often requires constant care.

Patient care

Drinking alcoholic beverages, even in small quantities, is strictly prohibited during the entire recovery period - a drinking person noticeably increases the risk of a second stroke. Alcohol negatively affects the work of the cerebellum, increases pressure, increases pain in the head area, which can put pressure on the neck area. Patients with circulatory disorders develop speech disorders, problems with memory, motor functions and emotions. Such people should be under the supervision of relatives and doctors throughout the entire period of treatment. The list of restrictions includes:

1. Strong emotional stress and nervous strain. The patient should not engage in physical labor and experience stress.
2. Car driving. It is forbidden to drive a car for 3-6 months after the illness. If we are talking about the most severe form of pathology, this prohibition will be permanent.
3. Air travel is prohibited for at least two weeks after diagnosis. In the most severe form of the disease, flights should be suspended for a period of at least one month, and a re-examination will be required before the planned trip.

Walking can be used in some of the most advanced approaches in current recovery research. For example, one of the methods used by researchers to encourage rapid recovery is called specialized training. This means training for recovery in the context of a meaningful task. There are tasks that are more valuable than walking. Walking is also related to another popular concept from rehabilitation research: repeated practice(by repeating the same movement). Researchers believe that repetitive practice is important for mastering lost skills. Another cutting-edge approach to stroke rehabilitation is to add a component rhythm. Walking is inherently rhythmic. It is also related to another method of recovery that researchers love - bilateral training, suggesting the stimulation of the interaction of two legs. Researchers believe that the arms and legs are connected to each other in two ways:

• limbs "communicate" through the brain;
• the limbs "communicate" directly, directly through the spinal cord, without the participation of the brain.

Thus, walking combines four modern concepts:

1. The significance of the task: involves training exactly what needs to be learned.
2. Repetitiveness: involves performing the same movement many times.
3. Rhythm: suggests rhythm. Walking itself provides the rhythm.
4. Bilateral training: based on the relationship between the two legs. During bilateral training, a healthy limb can make the diseased move better and faster.

Walking may be the best exercise available.

• refers to physical exercises with a low impact load, so it slightly strains the joints;
• helps to store energy for the heart and lungs;
• burns calories and helps control weight;
• helps control blood sugar levels;
• increases mental alertness;
• reduces the likelihood of blood clots in the legs, which reduces the risk of another stroke;
• promotes muscle growth;
• improves balance and may reduce the risk of falling;
• strengthens bones;
• ...provides many other benefits.

How it's done?

There are many ways to keep yourself safe while doing brisk walking. You can discuss with your doctor and physiotherapist the use of suitable orthopedic appliances such as orthopedic device "ankle-foot" (OASL), and related walking aids, in particular canes and walkers. However, if you are not yet ready to walk without support, there are other options (other than wearing a belt that two therapists hold you by as you walk). All of the following should be done under the supervision of a physiotherapist.

Treadmill workouts (TBD). They can provide safety and comfort when walking indoors using "endless parallel bars". But running on a treadmill comes with a risk of falling.

Walking with Partial Body Support (CPBT).

• HFPT on a treadmill: You are partially supported by straps. The straps can be pulled up to reduce the weight you're carrying, or lowered so you can carry your full weight, but the straps keep you safe if you fall. This allows you to train your sense of balance without the risk of falls. The simulator commonly used in this type of training is called LiteGait.
• HCPT on a flat surface: This system is the same as the treadmill version, except that you are walking on a flat surface. Machines that fall into this category include the Biodex Unweighing System, the NeuroGym Bungee Walker, and the LiteGait. Contact a physical therapist or local rehabilitation clinic to find equipment in your area that provides CCPT.

The researchers got good results using a new type of walking recovery - interval training on a treadmill. The idea behind this method is simple: your walking will get better and faster if you practice walking faster. Brisk walking improves the quick movements needed for balance control, resulting in smoother, more efficient walking. Interval training on a treadmill was used to double the walking speed of study participants.

What precautions should be taken?

Walking is one of the most natural types of movement performed by humans, but a walking regimen designed to improve gait quality requires more physical and mental effort than normal walking. Because this walking regimen is more intense than normal walking, talk to your doctor and therapist before incorporating therapeutic walking into your overall recovery plan. If you can walk on your own, do so safely. Your doctor and therapist will talk to you about the medical and physical restrictions you need to follow.