Where are they treated and recovering from a stroke. Methods of home rehabilitation after ischemic and hemorrhagic stroke

The treatment of stroke patients is a very long and gradual process that must go through a number of successive stages. First, such patients are treated in the intensive care unit, where they are fighting for their lives, then in a neurological hospital, where they are engaged in the restoration of affected cells.

But no less important is the stage of recovery after discharge from the hospital. After all, the neurological deficit that the patient has can no longer be restored by medication, since the brain cells are destroyed.

But you can maximally adapt a person to life at the expense of other neurons that remained unharmed. To achieve this, a lot of time must pass. Naturally, this is possible only thanks to self-recovery after a stroke at home, when both the patient and his relatives are actively interested in this process.

How long does it take to recover after a stroke?

In resolving the issue of the recovery time of the post-stroke period, there can be no unambiguous indicator. It all depends on the size and location of the lesion in the brain, the type of stroke, the time from the onset of the disease to the direct provision of specialized medical assistance. The greater the value of these indicators, the worse the prognosis for the complete recovery of the patient. You have to work with such people for a very long time, almost for life, if only in order not to aggravate the existing neurological deficit. Indicative dates and forecasts can be represented in the form of such a table.

Type of stroke and its consequences	The duration of the recovery period
Ischemic stroke with minimal neurological deficit (mild paralysis of the limbs and face, impaired coordination, vision,)	Partial recovery 1-2 months Full recovery 2-3 months
Any type of stroke with severe neurological deficit (gross, persistent discoordination disorders)	Partial recovery with 6 months self-service option. Full recovery is rare and takes years.
Severe massive ischemic and hemorrhagic strokes with persistent neurological deficit (disability due to paralysis of one side and other defects)	Partial recovery with the ability to sit independently - 1-2 years; Full recovery is not possible

From the above table, it becomes obvious that the more severe the stroke, the longer the rehabilitation treatment should be. Patients who have had an ischemic stroke recover slightly faster than after a hemorrhagic one.

With the existing gross neurological deficit against the background of any stroke, it is not always possible to fully restore a person, which is determined by the necrosis of those important clusters of brain neurons, the function of which is not capable of being taken over by neighboring healthy cells. Therefore, the recovery period after any stroke never ends. It is necessary to engage in restorative procedures for life according to the type of short-term courses or daily. This will not only help in restoring lost abilities, but also prevent new stroke attacks.

You should never lose heart, no matter what type of stroke is suffered, and despite the obvious predictions. After all, each person has a different life resource, especially in relation to the brain. Only constant self-improvement can help you recover more fully and in the shortest possible time after a stroke.

Stroke Recovery Exercises

One of the primary tasks of the recovery period after a stroke is the resumption of the motor function of the limbs. It is on them that the neurological deficit in this disease is closed to a greater extent. It is necessary to begin the restoration of movements almost from the first day after the onset of a stroke.

The general features of the exercises are characterized by the following points:

Decreased muscle tone and tension. Any stroke causes paralysis, characterized by muscle hypertonicity and irritability;

Improvement of microcirculation. A stroke disrupts the innervation of all tissues. As a result - a violation of their blood supply;

Prevention of contracture. Against the background of a long-term neurological deficit and spastic paralysis, additional stiffening of the muscles that are in a state of constant tension occurs;

Protection of the skin of the extremities from bedsores. This is especially true for the legs. In places of greatest pressure and contact, which are the heel areas, bedsores most often occur;

Resumption of subtle movements. They are among the most important functions of the limbs, which, in fact, characterize the complete restoration of the nervous system. This is most relevant in relation to the hands and upper limbs in general.

Before starting any exercise after a stroke, it is advisable to consult with your doctor, and even better with a narrow specialist - a rehabilitation specialist. It will help not only to choose the right set of exercises, but also to tell about all the subtleties and stages of their implementation. In general terms, it is worth pointing out the following feature: all exercises should start from simpler ones with a gradual expansion of their volume depending on the functional abilities of the patient.

Against the background of physiotherapy exercises, even patients with an identical problem and the severity of a stroke can recover in different ways. Therefore, you should not overload a person much. This is as harmful as the lack of therapeutic exercises in general. Before performing any set of exercises, it is better to warm up the tissues to which their action will be directed. If possible, warm water procedures. If there are contraindications or other reasons why this action is not feasible, a light massage for 15 minutes immediately before the exercises will suffice. In extreme cases, you can warm the affected limbs with a heating pad.

All patients after severe strokes with severe neurological deficits must be helped by someone close to them, since they are unable to cope with such a task on their own. It is better if the set of exercises is performed 2-3 times a day in a kind of short courses that take about one hour. They should not cause severe fatigue and overwork in the patient. If any arise, this indicates the incompatibility of the loads and the actual abilities of the patient at a particular stage of the rehabilitation and recovery period.

Strict individual approach with strict observance of the general rules of physical therapy can be called the only right step towards the rapid recovery of patients after a stroke.

Exercise while in bed

Of course, in this case it is extremely difficult to do something on a large scale, since the functional abilities of patients are very limited. Therefore, it is necessary to help people around such patients. This set of exercises should be performed by all persons in the acute period after any stroke, as well as those who have severe spastic paralysis of the limbs with a pronounced increase in muscle tone. Such patients are not able to straighten the limbs, as they are firmly fixed in a bent position. Exercises should be aimed at reducing tone and gradually increasing the range of motion.

A typical gymnastics looks like this:

Simple extension and flexion of the fingers and hands, forearms and elbows, feet and knees, movement of limbs in the shoulder and hip joints;

Rotational movements by specified segments. Performed with the help of those who care for the sick. They must imitate those movements that a healthy person is able to perform;

Hand recovery exercise. Stretching of spasmodic limbs with the help of splints and other devices. Indicated in permanent paralysis. To do this, the bent limb is gradually unbent from the fingers and fixed with a bandage to a hard flat board or other device. The same actions are performed step by step with the overlying parts of the hand (hand and forearm). In this position, the limb is fixed for half an hour, but it can be longer if this does not cause discomfort for the patient;

A towel is hung over the bed. The following exercise can be performed by persons with restored hand function. To do this, grab the towel with it and produce all possible movements (abduction and adduction, raising-lowering in the shoulder, flexion-extension at the elbow). Gradually, the towel is raised higher and the exercise becomes difficult due to the patient's own weight;

From a strip of rubber of medium thickness and width, it is necessary to make a ring with a diameter of 40 cm. With this device, you can perform a large number of exercises. It is thrown between the hands, forearms, arm and leg, hand and any object. At the same time, the elastic is stretched by diluting its ends from each other;

To eliminate muscle spasm of the lower limb, a rigid roller is placed in the popliteal region, the thickness of which gradually increases. Thus, muscle stretching and an increase in range of motion are achieved;

Grasp the legs above the ankle joint with further flexion-extension of the legs in the knee joints by sliding the feet along the bed;

Lying in bed, you need to smoothly raise your hands above your head and try to grab onto its back. After that, incomplete pull-ups are performed with simultaneous stretching of the feet and fingers (as if sipping);

Eye exercises. Restore the function of the mobility of the eyeballs and adaptation of vision. To do this, you need to make eye movements in different sides several times. Circular movements. Repeat the procedure with closed eyelids;

Fixation of the gaze at one point, followed by rotational, nodding and in a circular motion heads without detachment from this fixation point;

Sitting exercises

They are aimed at restoring purposeful hand movements, strengthening the back and preparing the legs for walking. Their technique is:

The patient is transferred to a sitting position, hands grab the edges of the bed. On inspiration, bending in the back is performed while stretching the body in a state of tension. On exhalation, relaxation follows. The cycle consists of 8-10 repetitions;

Starting position sitting on the bed, legs at body level (do not fall). Alternately raise and lower the left, and then the right leg several times;

Starting position sitting in bed. Hands are pulled back. On inspiration, the shoulder blades are brought as close to each other as possible while tilting the head back. On exhalation, relaxation follows;

Standing exercises

Shown after the expansion of the motor regimen and partial recovery of the patient. Their main goal is to restore fine movements to maximize the elimination of neurological disorders. Typical examples look like this:

Picking up a matchbox from the floor or table. Works out purposeful subtle movements;

Starting position standing with arms down. While inhaling, raise your arms up above your head, while stretching and standing up on your fingers. On exhalation, they relax, bending the torso down and lowering. Repeat several times;

Flexion-extension of the hand into a fist with the help of an expander while simultaneously moving the arms away from the body;

In a standing position, feet shoulder-width apart, hands placed on the belt. The torso is tilted to the right-left, forward-backward;

From the previous starting position, perform the scissors exercise (alternately moving the crossed arms extended in front of you to the opposite side;

Squats from the starting position standing with connected feet. During the exercise, it is necessary to keep your back as even as possible and not tear your heels off the floor;

During the exercises related to the stage of recovery of fine movements, you can continue gymnastics from the previous stages, especially if it strengthens the muscles and expands the range of motion in general. Physiotherapy exercises are allowed using light dumbbells and strength exercises.

In order for physical therapy to really be of a restorative nature, it must become part of the patient's lifestyle.

Restorative processes in the brain in relation to speech function are much slower than with movement disorders. They can last for several years. Therefore, it is necessary to deal with patients constantly, starting from the first day of the recovery period after stabilization of the general condition. The main task in this difficult process lies with the patients themselves and their relatives. Only stubborn desire should guide them. You can not stop classes, despite the long absence of a pronounced effect. Sooner or later, all efforts will be rewarded with a gradual improvement in speech.

Recommendations for speech rehabilitation exercises are quite clear. Their main focus is the involvement of nerve cells located in the area of the affected center of speech, to the performance of their lost function. This can be achieved through constant training of speech function and hearing. In order for the patient to restore the ability to speak independently, he must hear speech. Everyone should talk to him constantly. Thus, he will be able to reproduce sounds.

As for the direct pronunciation of words, in the event of a complete loss of speech ability, it is necessary to begin the pronunciation of individual sounds and syllables. To do this, the patient is told part of a word or phrase without finishing the endings. The patient himself must pronounce them. Gradually, the volume of reproduced words should increase. The very last step is the repetition of rhymes and tongue twisters.

Singing has a beneficial effect on the development of speech ability. If the patient hears singing, and later tries to sing together with his relatives, then he will succeed much faster than ordinary speech. Therefore, it is imperative to include this method of rehabilitation of patients after a stroke to restore speech ability.

It is extremely important for the restoration of speech - to resume the ability to pronounce sounds. After all, a person can potentially be able to speak, but due to a long-term violation of the innervation of the facial and masticatory muscles, their peculiar freezing occurs.

In such cases, they should be actively developed by:

Curling lips into a tube;

Grinding of teeth;

Maximum extension of the tongue forward;

Light biting with the jaws alternately of the upper and lower lips;

Licking the lips with the tongue in both directions (left to right and vice versa);

Memory recovery after a stroke

One of the brain functions that is impaired as a result of a stroke is memory. It is very important to properly approach the recovery processes in this regard. Like all other abilities of higher nervous activity, work on it must begin as early as possible. This usually corresponds to the period after the elimination of a direct threat to human life and the phenomena of cerebral edema against the background of a stroke.

The first thing doctors are working on is medical support for the affected neurons. Patients are prescribed intravenous infusions of nootropics (drugs that improve metabolic processes in the brain and memory). Their reception must be continued at the stage of outpatient treatment, but already in tablet form. The most common and effective nootropics include piracetam, lucetam, nootropil, phezam, thiocetam. All of them act rather slowly, so it is important to observe the duration of the intake, which should be at least 3 months. After a short break, the treatment course should be repeated.

In addition to medical correction, functional and restorative treatment should also be performed. It involves constantly exercising the brain's ability to remember. This process is one of the longest of all types of rehabilitation after a stroke and takes many months and even years. It includes memorization and constant repetition of numbers, certain words, rhymes, first short, and then longer. Board games and other activities with elements of the game also have a beneficial effect on memory, when the patient is simultaneously distracted from the outside world and concentrated on a specific action.

Preparations for recovery after a stroke

An extremely important place in the rehabilitation treatment of stroke patients belongs to the drug treatment of brain dysfunction. Be sure to adhere to their course intake with alternating periods of active treatment and breaks between them. It is advisable to administer cerebroprotectors intravenously twice a year (drugs that improve blood circulation and brain activity).

It is important to remember that you should not take blood thinners after hemorrhagic strokes. Not only is this not advisable, but it can also provoke the recurrence of a stroke. All other drugs are prescribed not differentiated, regardless of the type of stroke.

An approximate classification of medications for rehabilitation in the post-stroke period is given in the form of a table:

Drug group	Specific Representatives
Improving the blood supply to the brain	Pentoxifylline; Cavinton; Cerebrolysin; Aspirin-based drugs;
Improving metabolic processes in brain cells	Ceraxon; Actovegin; Solcoseryl; Cinnarizine; Ginkgo fort; Cortexin;
Nootropics	Piracetam;
Combined drugs (consist of several drugs)	Neuro-norms; Thiocetam;
Other drugs	Glycine - reduces the excitability of the nervous system; Sirdalud - eliminates muscle tension, muscle spasm and hypertonicity; Medicinal plants and herbal teas; Antidepressants (gidazepam, adaptol)

With medical restoration of the brain and its functions, a clearly consistent tactic of stepwise therapy is used. It involves the step-by-step administration of drugs, starting with intravenous administration, and ending with taking tablets containing identical active substances. In this regard, modern pharmaceutical companies that produce cerebroprotectors have created various dosage forms of the most common active ingredients. This allows patients to take the same drug, which is especially true when it is ideal for the patient.

To prescribe or replace drugs with others should be exclusively the attending physician or a specialist who monitors the patient. The patient and his relatives should only strictly adhere to the recommendations and not miss taking the drug at the appointed time.

Acute cerebrovascular accident is not a sentence. Is it possible to quickly and completely restore the brain and functionality after a stroke?

With proper rehabilitation after a stroke at home, some body functions (speech, visual, motor) can be partially or even completely restored.

BUT proper care and support improve the quality of life even for bedridden patients.

How to prevent complications during recovery after a stroke? In acute cerebrovascular accident nerve tissue in the affected area dies. There is a violation of functions (speech, motor, visual). But thanks to the phenomenon of neuroplasticity, the nervous system transfers these functions to other cells.

In order for the transfer to take place correctly, neurorehabilitation needed. Otherwise, there is a possibility that the processes will go in a different direction, as a result of which compensatory movements will form, which will cause inconvenience and worsen the quality of life.

The recovery period depends on the type of stroke.

There are three levels of recovery:

true - return to the original state;
compensatory - transfer of functions from affected structures to healthy ones;
readaptation - with a large lesion and the impossibility of compensating for impaired function.

The recovery period is divided into the following periods:

early - up to six months of illness;
late - six months to a year;
residual - after a year.

Restoration of speech, psyche, social rehabilitation takes more time.

The principles of rehabilitation are:

early start;
systematic;
duration;
involvement of doctors and relatives in the process.

Specialists from various fields are working on returning to normal life - neurologists, therapists, speech therapists, physiotherapists, psychologists, etc.

To your attention a video about methods of rehabilitation after a stroke and recovery at home:

Home care for bedridden patients

Even before the arrival of the patient, the following items should be prepared:

vessel;
diapers for adults;
absorbent diapers;
antidecubitus circles, mattresses;
a pole by the bed or reins near the back;
soft carpet near the bed;
chair, etc.

Every day, 2 times a day, the patient is washed, teeth are cleaned, mucous membranes are washed, ears are cleaned 1-2 times a week.

To prevent bedsores, the bed is straightened without leaving wrinkles.. The body is allowed to be lubricated special tool prepared from 200 ml of vodka, 1 tbsp. shampoo, 1 liter of water. Every 2-3 hours the patient is turned on its side.

With the loss of chewing, swallowing function, food is mashed, fed through cocktail sticks. As an alternative food, canned children are used.

Feeding is not forced- it causes vomiting. If the appetite is poor, give your favorite dishes (as part of the prescribed diet). Portions are small, meals - 6 times a day. Before eating, the body of the ward is given a semi-sitting position.

Uncommon - incontinence or urinary retention. In the latter case, there is a need for catheterization. For incontinence, when it is impossible to regulate the process with medication or other methods, use sanitary napkin, diapers.

If the patient is able to move independently, then the first actions are sitting.

The first days - for a few minutes, the time is gradually increased.

The next stage is standing, then walking, mastering the transfer of body weight from one leg to another.

Walking skills return gradually. In order not to turn the foot, wear high shoes.

You need to move with support. A cane or a special attachment with 3-4 legs is used as a support.

Diet and food

The menu includes the following products:

vegetable oils - rapeseed, soybean, olive, sunflower (no more than 120 g per day);
seafood - at least 2 times a week;
vegetables, fruits rich in fiber, folic acid - from 400 g daily;
purified water - up to 2 liters per day (if there are no contraindications).

Blueberries have a beneficial effect on the body, containing a large amount of antioxidants, and bananas rich in potassium.

It is important that the patient receives enough folic acid, vitamins A, E, C, which help to overcome the consequences of the disease and reduce the risk of relapse.

Meat, fish, dairy products are consumed in moderation, low-fat diet varieties. Products are steamed, stewed or boiled. The layer of fat is removed from the surface. If you cook these products correctly, then the fat content is halved.

It is useful to consume legumes - a rich source of folic acid. Meat and potatoes (only baked) are given no more than 2-3 times a week.

In the diet includes cereals - brown rice, oatmeal, bran, durum wheat.

From the menu remove smoked meats, spicy, spicy dishes. Bread and other pastries, sweet, fatty desserts, animal fats are contraindicated.

These foods increase cholesterol. Salt is excluded or reduced to a minimum level.

Under the ban - alcohol. Your doctor may recommend moderate consumption of natural red wine. but exceeding the prescribed dose is life-threatening.

Physical activity, exercise therapy, sex life

The first two weeks after discharge, if there are no other appointments, physical activity consists only in changing the position of the body. , the purpose of which is to relax and prepare the muscles for work.

When the patient moves physiotherapy methods are applied to it- massage, manual therapy, thermotherapy (ozocerite and paraffin applications), magnetotherapy, laser therapy, exercises on simulators, individual and group gymnastics.

The day starts with a warm-up- shallow squats, sips, bends. It is recommended to alternate loads - light running, walking, exercise bike.

The program is compiled individually. It is impossible to change the mode on your own, since a repeated stroke is possible.

Exercises that increase muscle spasticity are prohibited - squeezing the ring, the ball. Sexual desire returns approximately 3 months after the attack. In some cases, the disease provokes an increase in sexual desire., since the hypothalamus and the center responsible for the release of hormones work differently.

There are cases when a person returned to an active sexual life even before speech returned to him. But no matter what scenario is embodied, a doctor is consulted before starting sexual activity.

The program of Elena Malysheva contains interesting information on how to restore movement after an illness:

habits

Correction of habits is necessary for quick normalization of the state. So, give up smoking or minimize the number of cigarettes smoked. No alcohol allowed.

A sedentary lifestyle is contraindicated- need moderate physical activity, which correspond to the condition.

Medical control and treatment

In the treatment of stroke, the following groups of drugs are prescribed:

All patients who have suffered a cerebral stroke, subject to dispensary observation by a neurologist.

Psychological support

Stroke negatively affects the quality of life. So increased likelihood of depression.

Those affected by the disease need communication, moral support, contact with the outside world. These requirements remain even if such a person is not able to speak, but perceives speech by ear. Topics for conversation are varied - from children to politics. It is important for the bedridden to hear that he will recover.

Patients can hardly tolerate dependence on other people, especially those who are distinguished by love of freedom and independence.

Therefore they have personality traits such as grumpiness, irritability may develop. With depression, any help, including medical help, can be rejected.
If contact is interrupted, the help of a psychologist or psychotherapist is needed, as well as drug treatment with antidepressants.

It is forbidden in the presence of the patient to discuss his problems, the negative consequences of the disease, speech difficulties.

But at the same time, rewarding achievements, even if they are insignificant, have a great effect on self-esteem and well-being. Then recovery comes faster.

Relatives should also not forget about psychological relief . They are shown positive emotions, relaxation in the form of sports, meditation, massage, aromatherapy.. You may need vitamin treatment.

How to recover psycho-emotionally, you will be told here:

Disability, group, return to work

Statistically, only about 20% of stroke victims return to work and normal life. In the past five years, doctors have observed a trend according to which the picture of severe cases of the disease is deteriorating.

Terms of temporary disability - 3–6 months. In violation of cerebral circulation, the dynamics of restoration of functions, the state of the mental sphere are important.

If the prognosis is unfavorable, rehabilitation is slow, there are lesions of other organs, in old age the patient is referred to the VTEC (medical labor expert commission).

According to the rules ( the federal law 181-FZ), stroke survivors are eligible for disability registration. To do this, you need to get medical evidence.

Distinguish between disability groups I, II, III. Every year, the patient, who was recognized as disabled, is re-examined.

The exceptions are men and women who have reached the age of 60 and 55, respectively. An extraordinary re-examination is carried out if the condition has changed significantly.

After 3–6 months, with a favorable prognosis and a quick recovery, rational employment is allowed. When choosing a job, take into account contraindications that increase the likelihood of relapse:

increased nervous, psychological, physical stress;
high air temperature and humidity;
contact with neurotropic poisons (arsenic, lead, etc.).

With a slight hemiparesis (paralysis of the muscles of half of the body), it is possible labor activity in which one hand is involved. Among such specialties are a quality checker, quality control inspector, work in the office and etc.

And the treatment of atherosclerosis of the brain with folk remedies, we will tell you separately.

How to restore speech

Speech restoration is one of the most important tasks. Begin classes as soon as the condition stabilizes. A specialist is involved in the process - a speech therapist.

Family members also take an active part in the process. To do this, for example, they read the primer so that the patient pronounces sounds, syllables, whole words.

Speech during communication is quiet, measured, calm. It is useful to ask the victim questions, sing with him, learn tongue twisters. A retelling of the texts he heard is useful.

If speech does not return to the patient for a long time, may need to learn sign language.

Watch a video about methods of restoring speech after a stroke:

Return of sight

With the defeat of the visual centers, the visual function of the cavity is restored in approximately one third of the cases of the disease.

Under such conditions useful gymnastics for the eyes. A popular exercise is with a pencil or other object, which is held at a distance of 40–43 cm from the patient's eyes and is moved alternately up and down, right and left. The patient is asked to follow the object without turning his head.

You can stock up on puzzles, where it is required to spell words, considering the letter matrix. Also on the network are special computer programs.

The best centers and sanatoriums

The best results are achieved if you trust the care of professionals. Where is the best place to undergo rehabilitation after a stroke and what results can be achieved?

The rehabilitation centers provide comprehensive assistance, the patient is under the supervision of specialists around the clock.

The choice of an institution is an individual matter, which takes into account, among other things, the financial factor. Here are a few institutions worthy of attention.

Medical and Rehabilitation Center of the Ministry of Health

The center was founded in 1918. It has a rehabilitation department. It provides a full range of medical services- from outpatient clinic to rehabilitation.

The medical staff has at its disposal diagnostic equipment, a 24-hour neuro-reanimation department.

Rehabilitation of patients who have had a stroke is carried out in the following areas:

restoration and improvement of the vestibular apparatus;
restoration of the function of swallowing and larynx;
development of fine motor skills of the hands;
return of memory, speech, ability to self-service;
psychological and psychotherapeutic consultations;
physiotherapy;
physiotherapy procedures.

Rehabilitation center in Sestroretsk

The center is located in a picturesque resort town, half an hour from St. Petersburg. Created on the basis of the hospital.

Physiotherapists work here there is gym with robotic equipment, swimming pool. A speech therapist deals with patients. Patients who move on their own can not live in a rehabilitation center, but rent a house nearby.

Adeli Center (Slovakia)

Clinic specializes in rehabilitation after a stroke, as well as the treatment of children with cerebral palsy. The center is located in Piestany, a well-known health resort.

The rehabilitation program is drawn up with the expectation that each method enhances the effect of the other.

Adele's suit is used for treatment.

The suit creates a load on the musculoskeletal system and helps to correct postures and movement.

A wide range of physiotherapy procedures are used - massage, manual therapy, mud therapy, mechanical hippotherapy and others.

Sheba State Hospital (Israel)

The hospital is located in Ramat Gan, not far from Tel Aviv. Rehabilitation is carried out in the following areas:

physiotherapy;
occupational therapy;
speech therapy - restores speech skills and understanding of words addressed to the patient;
psychology, neuropsychology;
psychiatry;
rehabilitation.

According to Sheba Clinic statistics, after the end of the course of treatment, 90% of patients fully or partially restore their movement skills.

Measures to prevent relapse

The risk of recurrent stroke in the first 24 months is estimated at 4-14%.

Prevention of recurrent stroke begins in the first days of treatment and continues constantly. Its purpose is correctable factors.

With insufficient secondary prevention, the risk of secondary stroke increases. Every fourth case of acute disorders of cerebral circulation is a relapse of a stroke.

For the purpose of prevention, patients are prescribed preventive treatment:

sick limit the number of cigarettes smoked or ban smoking as well as the use of narcotic substances, alcohol abuse. Weight adjustment is necessary if obesity is the cause of the stroke. In the diet, the proportion of foods containing fats and cholesterol is reduced, replacing them with fresh vegetables and fruits. Moderate exercise is good for the body.

Antihypertensive therapy (treatment of high blood pressure) is carried out with caution to prevent cerebral hypoperfusion (reduction of cerebral blood flow below 50 mm Hg. Art.).

Full recovery after stroke is possible. The main condition for this is the strict observance of medical prescriptions.. And even in severe cases, it is possible to significantly improve the quality of life of the victim of the disease.

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In a stroke, cerebral circulation is disrupted, which leads to cell death. Rehabilitation after a stroke takes place at home. Recovery of the affected brain cells occurs gradually, the process can drag on for months. Early rehabilitation allows patients to quickly return to a full life. Measures to restore functions lost due to a stroke should be carried out regularly until complete recovery. The use of rehabilitation equipment is mandatory.

After stabilization of the general condition of the patient, it is necessary to immediately begin recovery after a stroke. Speech stabilizes gradually. After partial or complete familiarization of the affected cells to normal functioning, the patient begins to pronounce individual sounds, which are converted into words. It is necessary to constantly talk with the patient - hearing training speeds up the recovery process.

Active development of the speech center is carried out with the help of a series of exercises. The patient should regularly stretch out his tongue, alternately bite his lower and upper lips, move his lower jaw, stretch his lips with a “tube” and expose his teeth. With complete loss of speech initial stage the patient is taught to pronounce individual letters and syllables. The stroke man is told part of the word, and he chooses the ending on his own. The volume of reproduced words increases - a person puts words into sentences, repeats tongue twisters and poems.

At the initial stage of the recovery period, the patient should try to play simple songs. Singing trains the ear and helps to restore memory.

How often do you take a blood test?

Poll Options are limited because JavaScript is disabled in your browser.

Only by doctor's prescription 31%, 1962 vote

Once a year and I think it's enough 17%, 1064 vote

Only when I'm sick 16%, 1004 vote

At least twice a year 15%, 940 votes

More than twice a year but less than six times 11%, 720 votes

I monitor my health and take it once a month 6%, 386 votes

I'm afraid of this procedure and try not to pass 4%, 257 votes

21.10.2019

Recovery of the brain after a stroke is aimed at normalizing cerebral circulation. Post-stroke rehabilitation is based on medical support for neurons affected by stroke. Solutions of nootropic drugs are administered intravenously. Medications are taken throughout the recovery period. Functional and restorative measures include regular memory training.

With a complete loss of memory, the patient is regularly shown photographs and talks about significant events from his life. Partial amnesia requires regular repetition and memorization of numbers, words, and tongue twisters. Measures to restore speech functions are often combined with exercises that allow you to restore memory.

Return of sight

The cause of partial or complete loss of vision can be a stroke, rehabilitation at home takes place in several stages. Against the background of intracranial hemorrhage, the ophthalmic and oculomotor nerves atrophy. Stroke recovery procedures include:

taking medications;
surgical intervention;
special exercises.

Surgery refers to radical methods that are used as a last resort. According to reviews, most effective tool consider gymnastics. A set of exercises:

The upper edges of the eyes are clamped with three fingers.
Fingers slowly move to the temples.
Return the fingers to their original position.
The skin of the upper edges of the eyes is moved to the nose.

It is necessary to perform 3-4 approaches. During gymnastics, it is recommended to lightly press on the eyeball. If all medical recommendations are followed, a complete restoration of vision is possible.

Psychological support

The patient after a rupture of a blood vessel becomes closed due to the inability to return to a full life. Psychological support is provided by specialists, relatives and friends of the patient, it helps a person to fully adapt socially. The main goal of psychological support is to teach a stroke patient to control behavior and actions. In the process of rehabilitation, the processes of perception of the surrounding world are improved.

The main tasks of psychological assistance:

to teach the patient to understand, accept and manage psychological patterns;
prevent depression;
morally prepare the patient for the upcoming difficulties.

Diet and food

During the rehabilitation period after a stroke, you must follow a diet. Rough, salty, sour, spicy and smoked foods are removed from the diet. The list of allowed foods includes rye bread, fresh vegetables and fruits, lean meats (turkey, rabbit, chicken). Vegetable oil is consumed in minimal quantities. Dishes are steamed. Meat and vegetables are boiled or stewed, soups and cereals are cooked in water. The fat content of dairy and sour-milk products should not exceed 1%.

- This is a rather long and complex process that takes place in several stages.

Initially, recovery after a cardiovascular accident is carried out in a neurological department. There, the patient is treated with nootropics, non-steroidal anti-inflammatory drugs and metabolic drugs, the action of which is aimed at maximally “developing” the potential of the surviving neurons, because they will have to take on the functions of dead nerve cells. Unfortunately, the abilities of modern medicine do not yet allow to restore dead nerve cells. As a rule, these patients are recommended strict bed rest, many of them are not even able to take a sitting position.

The recovery period, carried out in a specialized neurological rehabilitation center. Here, a whole team of specialists is already working with the patient, which includes not only medical workers, but also professional rehabilitation therapists, masseurs, employees social services. All their actions will be aimed at providing the stroke patient with the fullest possible restoration of all lost functions.

In fact, a person reacquires all skills - from and ending with fine motor skills hands (writing, working with small objects). The essence of the rehabilitation is to perform special exercises (gymnastics), which will help normalize the work of the nervous system. It may take more than one year to complete.

Rehabilitation after a stroke, carried out at home. After sanatorium treatment, patients are discharged when the desired (or possible) result is achieved. At best, this is a complete restoration of lost functions, but this is extremely rare. At worst, the restoration of at least the ability to self-service.

Rehabilitation at home

This stage should be given special attention for the following reasons:

Here, the patient is no longer under round-the-clock supervision of medical personnel, and in case of need for emergency medical care, it does not always make sense to rely on people living with him. That is why a fundamentally important issue is the constant adherence to the prescribed course of treatment, so that acute cerebrovascular insufficiency does not occur.
It is this stage that is the longest - it lasts from the moment of discharge from the rehabilitation center and until the end of the patient's life.
It is necessary to control the patient - in particular, how he takes medicines. The thing is that with a stroke, they also affect: a person thinks worse, cannot analyze incoming information, forgets even the most important information (name, surname, patronymic, residential address, and so on).

That is, the essence of this period is to maintain the patient's condition at the level that he was discharged from the hospital. Blood pressure control is provided (antihypertensive therapy is prescribed, which will have to be taken constantly), dispensary observation of a neuropathologist and a general practitioner is carried out.

It is very important to prevent an increase in blood pressure, neuropsychic stress and excessive physical activity- a recurrence of a stroke will be much more difficult to cure.

Gymnastics in bed

Sometimes the only possible rehabilitation is the restoration of unconditioned reflexes, such as swallowing, chewing, facial expressions, as well as the normalization of speech functions. It can be restored even in those patients whose diagnosis does not even allow them to get out of bed. In addition, they usually recover, thanks to which they will be able to at least partially serve themselves.

Achieving this goal allows special gymnastics, which is carried out at home from year to year, even if the patient, in addition to the symptoms of a stroke, also has manifestations of coronary artery disease.

It must be understood that the exercises carried out do not cause a significant load on the cardiovascular system, and stable angina pectoris is not a disease that will become a contraindication to performing a set of exercises aimed at restoring the normal functioning of the central nervous system.

Another procedure of fundamental importance in patients with ischemic stroke. First of all, attention should be paid to those limbs and other parts of the body, the innervation of which has suffered especially strongly due to the necrosis of the brain that has occurred.

By stimulating them through other physiotherapeutic procedures, it is possible to achieve an improvement in the functioning of the central nervous system, since the generated stream of impulses will in the best possible way contribute to the normalization of the functioning of neuromuscular transmissions.

Relatives themselves can also massage - if it is not possible to hire a professional massage therapist. This procedure takes place in four stages:

Stroking. Movements are performed with the brushes in the direction from the periphery to the center, while the skin should not gather into a fold;
Trituration. This is already a deeper effect, in which the subcutaneous tissue is worked out. With the hands, it is necessary to perform movements with slightly more pressure than when stroking - so that the skin gathers in a fold;
Kneading. The impact on the muscles is performed, therefore it is necessary to work out the limb with maximum pressure in the direction from the fingers to the body;
Vibration. Here, the massage therapist performs vibrational movements that affect structures located deeper than the muscles.

Note. If in the early stages rehabilitation is carried out mainly due to the introduction of neurological drugs, then during the recovery after a cardiovascular catastrophe at home it is realized mainly by performing special exercises and taking antihypertensive therapy.

At the same time, of course, periodic intake of nootropics and metabolic drugs, such as piracetam, L-lysine aescinate and actovegin, is carried out. Please note that the calculation of the dosage, the frequency of administration and the duration of the course of treatment is determined only by the attending physician. In this case, self-treatment is completely excluded, since the approach to is selected in each case purely individually, and serious problems can arise with the slightest violation.

Ideally, of course, to provide nursing care, but not everyone has such an opportunity.

Speech restoration

If the temporal and frontal regions of the right or left hemisphere are affected by a necrotic process, the rehabilitation period will last much longer. This is associated with the severity of brain damage. Another feature of ischemic strokes of similar localization is the need to restore articulation.

In the event that it will not be possible to hire a speech therapist, it is necessary to at least constantly talk with the patient, and demand from him an answer to all questions asked. Let at first it will be incoherent sounds - it is necessary to understand that in this situation the patient restores all his skills from scratch. Like a child, he learns the simplest things from scratch.

Swallowing recovery

It will be much more difficult to care for a patient who simply cannot swallow on his own - he will be able to receive food only through a nasogastric tube. The caregiver will inject liquid food into the nasogastric tube through a syringe, and a specially trained nurse will be required to insert the device. In addition, the nasogastric tube will have to be periodically cleaned or replaced, which is also quite problematic.

Of particular difficulty is that no amount of physical education will help restore the unconditioned swallowing reflex - at this stage of rehabilitation, the work of a neuropathologist will be necessary. Fortunately, a form of stroke in which a person loses the ability to swallow while remaining conscious is extremely rare.

Proper nutrition

If immediately after a stroke (and even more so, in the acute period of the disease), a person, as a rule, receives exclusively parenteral nutrition (that is, solutions that are injected into a vein), then at the stage of subsequent rehabilitation of patients with cerebral ischemia, food enters through the gastrointestinal tract. -intestinal tract. In particular, at the stage of home rehabilitation, a person already fully eats.

The diet should be significantly revised - like all hypertensive patients, these patients should exclude fatty, fried and salty foods from their menu so that extra pounds are not added, which contribute to the growth of problems from the side. of cardio-vascular system. This is especially important in the presence of concomitant coronary artery disease (any form of myocardial ischemia).

Recovery of fine motor skills

Patients with a diagnosis of "consequences of acute cerebrovascular insufficiency of the ischemic type" are taught to perform movements associated with fine motor skills of the hands not only in the rehabilitation center, but also at home, since the disease that has occurred necessitates long-term rehabilitation.

Picking up a matchbox from the floor;
Folding a mosaic (puzzle);
Getting the thread into the eye of the needle (this exercise is the very last, as it is considered the most difficult to perform).

Memory recovery

With the death of brain neurons, not only somatic organs suffer, but also cognitive functions (memory, thinking, analytical functions of the intellect). Yes, if the brain stem or diencephalon is affected by the necrotic process, then the consequences are much more deplorable, but memory loss also requires prompt rehabilitation measures.

Means that are shown in this case will be nootropics (piracetam, thiocetam), slow calcium channel blockers (cinnarizine) and metabolic drugs (actovegin).

They begin to be used already at the stage of inpatient rehabilitation and continue to be taken at home, and for quite a long time.

In addition, it is necessary to restore memory not only with the help of medicines from various pharmacological groups - daily exercises aimed at memorizing information stimulate the activity of the cerebral cortex just as well.

The use of folk remedies in rehabilitation

Regardless of what kind of stroke the patient has - or ischemic, the list of necessary rehabilitation measures remains unchanged. Pharmacological rehabilitation is shown (and no matter how extensive the focus of necrosis occurs), exercise therapy exercises, physiotherapy, massage, and ongoing home therapy aimed at stabilizing blood pressure and reducing the likelihood of recurrence of a cardiovascular catastrophe.

Folk remedies cannot replace medicines in any way. Yes, it may be worth using herbal preparations that have a positive effect on memory, but this should be done only after consulting a neurologist and in no case should it replace the main rehabilitation program.

Forecasts

It is necessary to immediately indicate that there are several forecasts for a patient who has had an ischemic stroke:

For life - in this case, it is understood whether the patient will survive after treatment and rehabilitation, or not;
For recovery - this means how much the lost functions of the central and peripheral nervous system can be restored;
Employability. There are situations when people who have had a stroke return to their jobs (or remain able to work, but they are transferred to other jobs).

The conditions that determine the success of rehabilitation are the following factors:

The prevalence of the lesion of the central nervous system, as well as its localization. It must be understood that even after a large-focal cerebral infarction of the ischemic type, which affected, for example, the cerebellum, the patient will survive and, perhaps, even be able to serve himself. But even a small focus of necrosis that hit the diencephalon or medulla oblongata will lead to the inevitable death of the patient;
Timeliness of delivery. This refers to the time it took for the patient to be taken to the hospital. Unfortunately, patients with hemorrhagic stroke are unlikely to be helped by people who do not have a specialized medical education;
The quality of care and rehabilitation measures, as well as the willpower of the patient. Yes, only those people who, through pain, but performed all the necessary exercises, will be able to count on the restoration of the lost functions of the nervous system. So the success of rehabilitation is determined not only by the qualifications of medical workers, but also by the desire of the patient to get back on his feet.

From all of the above, we can conclude that ischemic stroke is serious disease, after which many people remain profoundly disabled, who even lose the ability to self-service.

But with strict adherence to all the doctor's prescriptions and hard work on oneself at the stage of physical rehabilitation, one can achieve significant results - some patients have achieved that they returned to their official duties.

Content

A stroke occurs when the blood supply to the brain is severely disrupted. The process is formed when the vessels are clogged with a thrombus or hemorrhage. Rehabilitation can be carried out in a medical institution, special centers or at home.

Principles of post-stroke rehabilitation

For the recovery of the patient to be effective, it is necessary to follow the principles of rehabilitation:

Start the process as early as possible (in the hospital and at home).
Follow the rehabilitation program regularly.
Move from one stage of recovery to another consistently and in a timely manner. Each step in the program is designed for a specific category of patients.
Work on regaining lost functions at the same time.
Use the necessary rehabilitation means.
See a neuropathologist and a rehabilitation specialist to monitor the effectiveness of recovery measures.

Is it possible to fully recover from a stroke?

The prognosis of recovery after a stroke depends on the type of pathology and the severity of the neurological deficit. With an ischemic form with mild disorders, complete rehabilitation is possible in 2-3 months. If there is a pronounced neurological deficit, recovery from any form may take several years, and the prognosis is not always favorable. After a massive stroke, accompanied by persistent disorders, it is impossible to rehabilitate.

Stages of rehabilitation treatment

An individual scheme of rehabilitation treatment is formed based on the periods of rehabilitation. The following stages are distinguished:

Acute (the first month after the attack) - maintaining the vital functions of the body.
Early rehabilitation (2-6 months) - teaching the patient basic self-care skills.
Late (7-11 months) - teaching speech, motor, intellectual skills, their restoration.
Residuality period (after 1 year) – development of subtle movements of arms and legs, full-fledged speech, professional skills.

Directions of rehabilitation measures

After a stroke, a neuropathologist and a rehabilitation specialist form a comprehensive recovery program. Main areas of events:

general recommendations for patient care (hygiene, proper nutrition, prevention of bedsores);
memory recovery;
rehabilitation of physical activity;
development of full speech;
drug therapy to maintain bodily functions.

Recovery of motor activity

Movement disorders (paralysis, paresis) are observed in most patients. After rehabilitation, blood circulation improves, the risk of bedsores decreases, the patient can independently satisfy his basic needs. During physical therapy after a stroke, you need to follow the rules:

Coordinate a set of exercises with a rehabilitation specialist, exercise therapy doctor.
Increase the intensity of the loads gradually, based on your physical capabilities.
Gradually complicate the technique of exercises.
Reduce load if pain is felt.
Focus on muscle relaxation.
Avoid overwork. The recommended frequency of classes is 2 times / day, the duration of gymnastics is about 60 minutes.
Breathe smoothly, inhale and exhale in sync with certain charging movements.
Perform exercises with a starting position standing or sitting under the control of another person.
Prevent muscle fixation in the wrong position.
Set the appropriate number of cycles for each exercise, according to your physical condition.

The complex of therapeutic exercises after a stroke is compiled depending on the patient's condition. Exercise examples:

In the supine position. A towel should be hung over the patient's bed. The patient must grab the tissue with his hand, perform any movement with this limb: bending at the elbow, moving to the side.
Sit on the bed without lowering your legs. Raise each limb in turn. Place your hands on the back of the bed. Raise both legs together.
In a standing position. Spread your lower limbs shoulder-width apart. Stretch your arms out in front of you. Cross them, moving to the opposite side.

Recovery of speech skills

Rehabilitation of speech after a stroke can take from 1 to 3 years. To speed up the process, the patient needs to work with a specialist. Classes should become more difficult gradually. For the treatment of dysarthria (speech defects) and aphasia (impairment of understanding), the following methods are used:

reproduction of rhymes, tongue twisters, individual words, sounds and syllables;
listening to correct, detailed speech;
gymnastics for the tongue;
singing and listening to music;
exercises in front of a mirror for the development of facial muscles (grinding teeth, stretching, biting lips, smile).

Recovery of intellectual abilities

For the rehabilitation of intellectual abilities after a stroke, a course of medications is first prescribed, then they proceed to functional recovery. Apply the following measures to normalize memory:

board games and other intellectual entertainment;
listening and playing words, numbers, phrases, rhymes (playing time should be gradually lengthened);
looking at pictures (with the names of the objects depicted), videos (with a retelling of the events that took place).

Medical support for rehabilitation processes

Therapy with drugs after a stroke during the rehabilitation period has the following goals:

normalization of metabolic processes;
activation of the central nervous system, improvement of blood supply to the brain;
decrease in the concentration of cholesterol;
normalization of blood sugar levels;
removal of hypertension;
improvement of the emotional, mental state.

Principles of medical rehabilitation:

Take medicines only as directed by your doctor.
Take systematic breaks after a full course of drug therapy.
Do not take blood-thinning medications for patients with hemorrhagic stroke.
Take a course of intravenous injections of cerebroprotectors 1 time / six months.

Drug group	Purpose of application	Name
Nootropics / neuroprotectors	activation of metabolic processes of the nervous system; memory improvement; increased brain activity.	Piracetam, Cerebrolysin, Glycine.
Muscle relaxants	muscle relaxation; preparation for the rehabilitation of motor functions.	Baclofen, Tizanidine.
Anticonvulsants	reduction in the severity of convulsive syndrome	Carbamazepine
Anticoagulants/antiplatelet agents	prevention of blood clots; decrease in blood viscosity.	Aspirin, Curantyl.
Hemostatic	recovery after hemorrhagic stroke blood viscosity; stop and prevent bleeding.	Vikasol, Aminocaproic acid.
Antidepressants	depression treatment; normalization of the emotional state.	Fluoxetine, Cipramil.

Recovery in rehabilitation centers

A patient after a stroke can stay in special rehabilitation centers for 3-5 weeks. Employees of the institution provide full-fledged care, food, rest. For recovery, kinesiotherapy and exercise equipment, massage, physiotherapy, treatment with medicines and homeopathic preparations, work with a psychologist, a speech therapist are used. The average cost of services is 7,000–10,000 rubles/day. Large rehabilitation centers after a stroke in Moscow:

"Blue";
Medical and Rehabilitation Center of the Ministry of Health of Russia;
"Overcoming";
"Three sisters".

Rehabilitation after a stroke at home

The main recovery after a stroke is carried out at home, since the patient cannot be in medical facilities all the time. The patient needs a lot of time to learn to speak, walk, serve himself on his own. Paralyzed people at home need to be provided with full care, nutrition, hygiene procedures, prevention of bedsores. Available rehabilitation methods:

physiotherapy exercises (use of crutches, simulators, expanders);
work on the development of speech (reading, listening to music);
gymnastics for the eyes, language, facial expressions;
logic games;
memory training.

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