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Physical therapy and exercises after a stroke. Therapeutic physical training after a stroke: rules, set of exercises

As a result of a stroke, certain areas of the brain are damaged. Most often, the consequences are loss of mobility of one half of the body, deterioration of speech, and problems with brain activity. It is possible to recover from a stroke! Speech, good memory and brain activity can be restored by daily practice of singing, reading, solving crosswords, and so on. Body mobility will help return exercise therapy.

Exercise therapy – therapeutic physical culture. Many different sets of exercises have been developed that help to cope with certain problems, recover from serious illnesses and simply keep yourself in good shape. Therapeutic exercises do not need to be performed under the supervision of a doctor; they can be done at home. However, consultation in the case of exercise therapy after a stroke is simply necessary.

Recovery rules

A stroke and its consequences are quite serious, so it is important not to overdo it during recovery. It is imperative to consult a doctor, follow his recommendations and increase the intensity of exercise gradually. Remember the following rules:

Any new exercise should be done gradually. If the patient can only sit independently, exercises in sitting and lying positions are suitable for him, which must be taught to do gradually and correctly. It is better if a doctor observes the process at first.
Regularity is important. Only with constant exercise is progress in recovery possible. You can't stop doing the exercises. A smooth increase in the number of repetitions and intensity is welcomed as the patient’s condition improves.
The best time for recovery exercises at home is in the morning. By evening, blood flow worsens, and the patient’s body becomes less susceptible to any influences. Morning exercises help you recover faster, this is a fact confirmed by doctors.
The path to recovery should include not only exercise therapy, but also conservative therapy, massage and proper nutrition. Only an integrated approach will give good and quick results.
If the condition worsens during exercise therapy, it is necessary to take a break from exercise. If a patient experiences dizziness during exercise, headaches after exercise, or blurred vision or loss of consciousness, this is an alarming sign that must be paid attention to.

By following all the rules, you can quickly and effectively restore the mobility of the patient’s limbs and return him to a full life, if this is possible with existing brain lesions.

Exercises for stroke

Physical exercises that need to be performed by patients who have had a stroke are divided according to the degree of intensity. They also differ for those who can walk and for sedentary patients. Hand exercises can be performed successfully by both.

Lying down

In a supine position, the patient first of all needs to warm up the skin and muscles. His relatives can help him with this. A gentle massage of the limbs is an excellent solution. It will help prevent swelling and numbness in your arms and legs and prepare them for exercise.

This group of exercises will help patients in the first time after a stroke tone their body muscles, strengthen muscle-brain impulses and increase blood supply to the extremities.

To prevent your hands from becoming stiff in a bent position, they must be straightened, starting from the phalanges of the fingers, and fixed for 30-60 minutes a day.
Eye exercises will help cope with the problem of poor blood supply. Standard movements in a circle, right and left, blinking and figure eight are the required minimum.
To warm up and tone the neck muscles, you need to turn your head, fixing your gaze in front of you. You need to do the exercise as smoothly as possible.
Spend 10-15 minutes on your fingers several times a day. They quickly lose tone and mobility. They need to be bent and unbent, shaken.
To warm up the knee and elbow joints, you need to flex and extend them for each arm and leg at least 20 times. Do the exercise smoothly.

These simple movements will help prevent the joints and muscles from becoming “stagnant” at first, which will facilitate subsequent recovery when the patient is able to sit or stand independently.

By the way, don’t forget about the interesting method of “mental physical training”. This is done with the aim of regaining or preserving muscle memory and to some extent is a suggestion. The action consists of constantly repeating a mental command, for example: “I raise my leg” or “I move my fingers.” Perhaps in your particular case this will be an effective method. As they say, in war all means are good.

In a sitting position

When the patient can sit independently without back support, you can move on to more intense and complex exercises. Exercise therapy after a stroke involves a gradual and regular impact on all muscles, so make sure you are constantly doing it and increasing the load.

Sitting in a stable position, bring your hands back, clasping them. Try to squeeze your shoulder blades together by tilting your head back. Repeat 20 times.
Holding your hands on a stable support, bend your knees, slightly lifting them. Do 20 times for each leg.
Clasping your hands in front of you, raise them up, holding them for a few seconds, and lower them smoothly.
Bend your arm at the elbow joint and rotate it in different directions 10 times. The same can be done by bending your wrist.
It is useful to do exercises for your hands and fingers using an expander and elastic balls. They perfectly help restore muscle tone and develop fine motor skills.

All these exercises are effective in the second stage of recovery, when the body is more or less stronger and ready for small regular loads.

Standing

Such exercises can be performed if the patient stands confidently on his feet and has good coordination of movements. You can do recovery exercises in a standing position only if you are not dizzy.

Body rotations. Clasp your hands in front of you, place your feet at shoulder level or wider, and make smooth body turns to the right and left.
Swing your arms. Raising and bringing your arms in front of you, vertical and horizontal swings can easily be performed after a stroke. This will help improve blood circulation.
Partial squats will help restore tone to the muscles of the legs and back. Your hands should be in front of you, you need to squat without lifting your heels from the floor. Try not to lower your head down to avoid sudden dizziness.
Spread your legs wider than shoulder level and bend to the right, left and down, keeping your hands on your waist.
Walking in place: March in place, bending your knees and raising them as high as possible at the moment of bending.

These exercises are very effective in the last stage of recovery. They will help cope with the remaining consequences of the stroke and finally restore the tone and mobility of all muscles of the body.

After recovery

When the patient can fully walk and move, regular exercise is necessary. An excellent option is the popular Nordic walking. It will help keep the body in good shape and maintain normal blood circulation throughout the body. In addition, Nordic walking is performed in the fresh air, which is also a definite plus. Choose poles of optimal length and comfortable sportswear and shoes and go for a walk.

Don't forget to do 20 minutes of exercise for your whole body every morning. It is not necessary to perform heavy exercises at a fast pace. Your task is to stretch your muscles and joints so that they do not lose their mobility. Perform basic exercises smoothly and measuredly.

An excellent solution for those who have suffered a stroke is yoga. This is a good way to completely recover, return to complete harmony and agreement with your own body, and even expand its capabilities. Of course, you need to get approval from your doctor for classes.

As an option - exercises on simple simulators. A stepper, an elliptical, an exercise bike and a treadmill (for walking only) are best suited for these purposes. Low-intensity exercise with these machines can also help you stay mobile and active after a stroke. Do not forget that a rich diet, regular brain activity and taking medications that support health should go in combination with exercise therapy.

A stroke occurs when blood circulation in the brain is disrupted, which leads to the death of some nerve cells.

As a result of this, the human body loses one or more functions for which the dead cells were responsible: paralysis, loss of hearing, vision, and speech defects may occur.

The indicator of various physical disorders depends on where the focus of already dead nerve cells of the brain has formed, on their size and position.

Each area of the brain is responsible for different body functions, so limb paralysis occurs depending on where the cells die.

The consequences of a stroke affect both the patient and all family members. After everything that has happened, after all the worries and fears for the patient’s life, the time for temporary peace comes.

The loved one is alive—that’s the main thing. What then? Will the adverse effects of a stroke remain forever?

According to statistics, 20% of patients were unable to regain mobility of their arms and legs and depend on outside help for the rest of their lives.

In order for a person to recover after a stroke, medications and rehabilitation exercises are used.

Move more - you'll live longer

“If you do physical education, you will forget about illnesses” - and a lot of folk wisdom, which very appropriately reflects the beneficial effects of therapeutic exercises.

After all, the main task after a stroke is to restore sensitivity and the ability to move the limbs.

To do this, it is necessary to return activity to those brain cells that are located near the lesion. It is also necessary to “force” previously inactive cells to perform the functions of dead ones.

All these actions are performed only through various restorative physical exercises and therapeutic exercises.

It is exercise therapy that is the basis of rehabilitation after a stroke.

Restoring lost body function - all means and efforts are aimed at this. If there are no contraindications, then The first exercises can be started on day 5 after a stroke.

Gymnastic exercises and exercise therapy are among the most accessible and effective ways of recovery.

Set of exercises

There is nothing supernatural in health-improving gymnastics. We can say that this is a normal charge. But even the simplest exercises will give a positive effect, because everything ingenious is simple.

Lying position

This is the very first and simplest set of exercises performed in the acute period after the disease, when the muscles are fixed in a bent position and patients are unable to straighten them.

It is aimed at reducing tone and increasing the range of motion of the limbs after a stroke:

Hand exercises. Not so much an exercise as forcefully straightening the limbs to reduce spasms. Unbend the bent limb starting from the fingers to the hand and forearm, and wrap it with a bandage to a hard surface (board). Leave your hand in this position for at least 30 minutes.
Eye muscles. Move your eyes up and down, left and right. Close your eyes and make circular movements in one direction and the other. As a rest, blink your eyes for 5-7 seconds. Make circular movements with your eyes open on each side as well. Relax your muscles by blinking your eyes.
Neck muscles. Carefully turn your head left and right while fixing your gaze in front of you.
Fingers. In any comfortable position, bend and straighten your fingers 10 times. You can do the exercise either alternately on each hand or with both hands at the same time. Hang a towel in a loop over the bed. Place your stationary arm (or leg) through the loop and simply swing it with different amplitudes. Make a loop with a diameter of about 40 cm from not very thick rubber of medium width. Throw it over your arm or leg and any other object (second arm/leg, headboard, chair, etc.) and stretch the elastic with the affected limb.
Elbow joints. The whole body is elongated, arms lie along the body. Bend your right arm at the elbow, lower it onto the bed, bend your left arm. Perform the exercise with each hand 10 times. Hang the motionless arm/leg on a strong cloth (diaper, towel) and then perform all kinds of exercises: bend, straighten, move to the side, rotate. This exercise is performed from 10 to 30 minutes, taking 3 breaks. Rest time - 2-4 minutes.
Bend your knees. Lying on your back, alternately bend your knees. Try to do so as not to completely lift your legs off the bed, as if sliding them. Perform 10 times with each leg.
“Pull-ups.” Lying on your back, grab the headboard of the bed with your hands. Do “pull-ups” by straightening your shoulders and straightening your legs with your toes pointed. Do the exercise slowly 6 times.

Exercise therapy for stroke: a set of exercises in pictures

If the patient can sit independently

The following exercises are designed to restore movement in your arms and legs, strengthen your back, and prepare you for walking after a stroke. All tasks are performed on 4 or 2 counts:

Deflection No. 1. I.p.. — lean back on the pillow and comfortably grasp the bed on both sides with your hands. Stretch your legs forward. 1.2 - slowly bend over, moving your head back, take a deep breath. 3, 4 - slowly return to SP. Do the exercise 6 times.
Deflection No. 2. I.p.. - sit down, legs straight, arms down. Slowly move your arms back, throw back your head and straighten your back, trying to bring your shoulder blades together. Hold the position for 1-2 seconds. Return to i.p. and repeat 4 more times.
Swing your legs. I.p.. - legs extended, hands holding onto the edge of the bed. Do the exercises at a slow pace. 1 - slightly lift your right leg up, 2 - slowly lower it. 3 - raise your left leg, 4 - return to the i.p. Repeat the swings 4 times for each leg without holding your breath.
I.p.. - lean on the pillow, raise your arms up, stretch out your legs. 1.2 - bend your leg at the knee and clasp it with your hands, trying to touch your chest with your knee. Fix in this position, tilt your head forward and exhale. 3.4 - raise your head, remove your hands and slowly return to the standing position. Do the same for the other leg. Do the exercises 4 times.
Hand motor skills. Place objects of different shapes and materials into a deep bowl. The size should be from small to large, but so that you can hold it in your hand. The “material” can be: buttons, pine cones, walnuts, beans, pencils, spools, plastic bottle caps, etc. Transfer all these items from one bowl to another with your sore hand, transferring them one at a time.

What is it and what manifestations does it entail in human behavior and actions? More details in the material.

Many people have heard about the benefits of pine cones for stroke. How to brew an infusion of pine cones after a stroke?

Standing position

A set of exercises in a standing position is performed when the patient already feels confident and the previous exercises while sitting and lying down are easy for him.

But this gymnastics also has its limitations and is divided into 2 complexes: simple and increased load.

Simple physical exercises are used if a person has not yet fully recovered from a stroke:

Stretching. I.p.. - arms down, feet shoulder-width apart. 1—raise your arms up while turning your palms outward. 2 - stretch in this position and take a breath. 3 - lower your hands down, trying to describe a circle with them, exhale. 4 - return to IP. Repeat slowly 6 times.
Turns. I.p.. - Place your feet shoulder-width apart, hands on your waist. 1 - turn your body to the right, 2 - spread your arms to the side and inhale. 3.4 - return to IP. and exhale. Do the same exercise with a left turn. Do the exercises 5 times in each direction.
Squats No. 1. I.p.. - arms down, legs apart. 1.2 - do squats, trying not to lift your heels off the floor, tilt your body slightly forward, and move your arms back. Take a breath. 3.4 - slowly return to the position. and exhale. Perform the exercise slowly 6 times.
Squats No. 2. I.p.- arms down, feet shoulder-width apart. Do squats for 2 counts. Deep breath. 1 - squat down with your hands on your hips and exhale. 2 - return to IP. Sit down 4 times.
Tilts. I.p.. - legs apart, hands on the belt. 1 - tilt to the left while raising your right hand up, inhale. 2 - return to IP. and exhale. Bend to the right, repeating 4 times in each direction.
Swing your legs. I.p.. - hands on the belt. 1 - stretch one leg forward, 2.7 - swing your leg in a circular motion. 8 - return to IP. Perform swings 4 times for each leg.
Lunges. I.p.. - Fix your feet shoulder-width apart, put your hands on your belt. 1 - extend your left arm forward. 2 - take a right naked step forward. 3 - clench your fists and place your hands to your shoulders. 4 - stand in IP. Repeat with the right arm and left leg. Perform the exercises slowly 4 times.
Walking in place. About 20 sec. walk in place, then do several exercises to restore breathing.

Complex with increased load:

Useful for business

Although therapeutic exercises are relatively simple, for a patient who, after a stroke, essentially begins to learn again (trains new cells), these loads may seem heavy.

In order for physical education to be beneficial and lead to a speedy recovery of the body, it is necessary to follow a number of rules:

Follow your doctor's recommendations. Only a doctor can prescribe the correct set of exercises, depending on which parts of the brain are affected. Only the doctor will tell you what loads can be used during the recovery period.
Don't overwork yourself. Because Physical education is purely therapeutic in nature; fatigue and overexertion should not be allowed. Start with the easiest exercises, gradually increasing approaches and adding new, more complex ones. After all, the goal of training is not to pump up muscles, but to force new brain cells to work in the right direction.
Warm up the skin. This is especially true for bedridden, sedentary patients. During this period, relatives should help them do the first exercises. To do this, you need to at least carry out a kind of massage. You should stroke and massage your arms and legs in the direction from the feet to the hips and from the toes to the shoulders. All this is necessary to warm up the skin and blood flow.
Monitor the patient's mood. Because Many people become depressed after a stroke, feel like a “burden” and are unwilling to do any exercise. You should gently but persistently demand and ensure that everything is done correctly, and constantly praise the recovering person, noting his successes.
Remember to be systematic. Therapeutic gymnastics should be daily for 40-60 minutes per day per session. At the first stage this should be 2 times, and then 3 times a day.
Be patient. Time is the best medicine. And in this case, this statement is 100% true. After all, only daily training for several weeks will give positive dynamics.

Simulators to help

After the patient's condition improves, you can begin exercises on simulators.

They allow you to restore different muscle groups, strengthen weakened tissues, restore movement functions, and relieve muscle tension.

They act on muscles with adjustable load:

An integrated approach to treatment

Despite the fact that exercise therapy gives the most positive results, it will be more effective together with massage, which plays an important role in the prevention of complications.

For the most complete recovery, patients practice an integrated approach to treatment.

Indeed, along with paralysis, the consequences of a stroke can be loss of memory, vision, hearing or speech defects.

To do this, they resort to the help of speech therapists, an ophthalmologist to help restore vision, and an ENT specialist to help regenerate hearing.

How speech is restored after a stroke and what methods and exercises are used for this is discussed in the video.

To restore psychological rehabilitation, a psychologist takes part in hospitals, and a loved one at home. All these measures will help you return to your normal lifestyle.

No matter how terrible the disease is, a stroke is not a death sentence. The desire for a speedy recovery, the help of loved ones, daily training and self-confidence make it possible for the body to fully recover.

Treatment of patients who have suffered an ischemic stroke is a difficult and lengthy process, consisting of several successive stages. Initially, treatment takes place in the intensive care unit, and then in the neurological department, where doctors restore the affected cells. Then comes the third stage - rehabilitation after discharge from the hospital. The entire neurological deficit observed in the patient cannot be restored with medications, since the brain cells are destroyed.

But you can “teach” a person to live off other neurons that have not been damaged. This requires a lot of time and it is quite obvious that results can only be achieved through independent practice, when both the patient himself and his relatives are interested in this.

Ischemic cerebral stroke - treatment and rehabilitation

There cannot be any specific figures in this regard, since much depends on the type of ischemic stroke, its size and location, as well as on the time elapsed between the onset of the disease and the provision of medical care. Prognosis for rehabilitation directly depends on these indicators. In such cases, you have to work with patients for a long time (almost until the end of your life).

Table. Approximate time frames and forecasts for restoration

Type of ischemic stroke	Duration of rehabilitation
Stroke with minor neurological deficit (deterioration of vision, mild paralysis, dizziness, impaired coordination).	Partial recovery requires one to two months, complete recovery requires two to three months.
With a pronounced deficiency (accompanied by severe paralysis and severe incoordination disorders).	For partial recovery (so that the patient has the opportunity to self-care) it takes six months. Full recovery is extremely rare and requires many years of rehabilitation.
A serious illness accompanied by persistent deficiency (paralysis on one side leads to disability and other defects).	Partial recovery requires an average of one to two years, but complete recovery is impossible in this case.

As you can see, the more severe the ischemic stroke, the longer the rehabilitation takes. But, characteristically, with such a stroke, recovery occurs faster than with any other.

On a note! Not in all cases, complete recovery is possible due to necrosis of brain neurons, the functions of which neighboring undamaged cells cannot perform. Here the only thing that remains is to do special exercises (every day or small courses) for the rest of your life to avoid new stroke attacks.

But, despite the type of disease and obvious prognosis, you still shouldn’t despair, because each body has its own vital resource, and simple exercises will help in recovery.

Ischemic stroke rehabilitation at home

The main goal of rehabilitation is to restore limb mobility. You need to get down to business in the first days after a stroke. Below are the features of all exercises.

On a note! First, you need to discuss the exercises with a doctor, who will not only select the optimal complex, but also inform you about all the nuances and stages. Roughly speaking, the peculiarity of the exercises is as follows: it all starts with simpler movements, the volume expands gradually and depends on individual characteristics.

You should not overload the patient - this is as bad as lack of exercise.

Before starting the lesson, it is necessary to warm up the muscles (this can be done, for example, with warm water treatments or a light fifteen-minute massage). Obviously, one of the relatives should help the patient with all this. The prescribed set of exercises should be performed two to three times a day (each course should last about an hour). At the same time, a person should not be overtired. If overwork is still observed, it means that the loads were selected incorrectly.

Gymnastics during bed rest

Of course, in such cases, due to functional limitations, it is not easy to do anything fully, so the patient must be helped. The complex described below is designed for the acute post-stroke period or for spastic paralysis with increased muscle tone. The patient himself in such conditions is unable to straighten his limbs, therefore, someone else must do it instead.

Fingers, hands, elbows and other joints are bent alternately.
These same segments perform rotational movements. Here the movements that an ordinary person can perform are imitated.
The spasmodic arm is stretched (for example, with the help of a splint), which is prescribed mainly for severe paralysis. The bent arm smoothly extends and is attached to the board with a bandage. These manipulations are performed gradually with all parts of the limb (hand, forearm). The hand is fixed for 30 minutes, but if the patient does not feel discomfort, then it can be longer.
The next exercise is intended for those who have already restored hand function. The towel is hung over the bed, then the hand is grabbed with it and various movements are made (the hand is abducted/adducted, bent/unbent, raised/lowered). The towel gradually rises.
A ring with a diameter of approximately 40 cm is made from rubber - such a device helps to perform many exercises. The ring can be placed between the hand and some other object, leg and arm, forearms, etc. The rubber should be stretched by retracting its ends.
Spasms of the hamstring muscles can be eliminated by placing a hard cushion (the thickness of the latter should gradually increase). This way the muscles will stretch, and the range of their movements will increase.
The shins are clasped with the hands, after which the legs are extended and bent at the knees by sliding the soles along the bed.
The patient raises his hands and tries to grab the headboard. Then he pulls himself up (not all the way), extending his toes and feet in parallel (something similar to stretching).
To restore the functionality of the eyeballs, they need to be rotated several times in different directions. The movements should be circular. After this, the procedure is repeated, but with eyes closed.
The gaze is fixed on some object. The patient should rotate and nod his head without moving away from the fixation point.

Gymnastics to perform while sitting

Such exercises help restore targeted movements of the upper limbs, strengthen the back muscles and prepare the legs for future walking.

The man sits down and grabs the edges of the bed with his hands. Inhaling, he arches his back and simultaneously stretches his torso. Exhaling, he relaxes. The exercise must be performed nine to ten times.
The patient sits on the bed, does not lower his legs - they should be at the level of the body. The legs rise and fall one by one, the procedure is repeated several times.
The body position is the same. Pillows should be placed under the patient's back so that it is relaxed, and the lower limbs should be extended. The legs are bent in turn and brought to the chest, while inhaling, the knees are clasped with the hands, the breath is held for a short time, after which the patient exhales and relaxes.
The patient sits in bed, puts his arms back. Inhaling, he moves his shoulder blades as much as possible, simultaneously throwing back his head. Exhaling, he relaxes.

Gymnastics for standing

The patient's recovery continues. Below are typical exercises.

The patient picks up a matchbox from the table or floor - this will help practice fine movements.
The patient stands with his arms down. Inhaling, he lifts them above his head, simultaneously standing on his toes and stretching. Exhaling, he relaxes and bends his torso. The procedure is repeated several times.
With the help of an expander, the hands are bent (into a fist) and extended, while the arms are moved away from the body.
The body position is the same. The patient performs the “Scissors” exercise with his hands.
The patient squats with his feet together, keeping his back straight and without lifting his feet from the floor.

On a note! While performing these exercises, you can continue to perform the procedures of the previous stages. You can also resort to strength exercises and use light dumbbells. It is important that gymnastics becomes part of your lifestyle.

How to restore speech

Restoration of processes related to speech function occurs much more slowly. Rehabilitation may even take several years. The main thing here is not to lose heart, to continue studying, even if there is no result for a long time. Sooner or later your speech will improve.

All exercises are aimed at restoring the functionality of nerve cells in the speech center. Both speech and hearing need to be constantly trained. It is necessary to talk to the patient all the time so that he himself can reproduce sounds.

If speech is completely lost, then you should start with the pronunciation of individual syllables. To do this, you can, for example, pronounce parts of words without endings (the latter must be pronounced by the patient). Over time, the volume of words increases. The final stage is the repetition of tongue twisters and poems.

Speech restoration - repeating poems and tongue twisters

On a note! Singing is very useful: if a person hears it, and then sings with loved ones, then the speech apparatus will recover faster than if normal speech were trained.

Also, the patient must again learn to pronounce sounds correctly; to develop muscles, he needs:

curl your lips into a tube;
lick them with your tongue from one side to the other;
bare teeth;
alternately bite the lower and upper lips;
push your tongue out as much as possible.

Sometimes after a stroke, patients feel food only on one side of the mouth. In such cases, you have to relearn how to eat, while simultaneously performing exercises aimed at restoring swallowing.

Such exercises include:

simulated swallowing;
drawing out the sound “and” with parallel tapping of the fingers on the larynx;
imitation of yawning (mouth should be wide open);
puffing out your cheeks (at least for five to six seconds);
gargling with water.

A few words about proper nutrition

The essence of the diet during the period of post-stroke rehabilitation is to give up (at least partially) animal fats and salt. This will help lower cholesterol levels and, as a result, prevent relapse, as well as normalize blood pressure. As a result, recovery will occur faster, and new areas of the brain will not be affected.

Particular attention should be paid to plant fiber, dairy products, juices and vegetarian soups. And potatoes, apricots, carrots and citrus fruits contain a lot of potassium, which has a beneficial effect on health after an ischemic stroke.

The use of folk remedies in rehabilitation

The first time after a stroke you need to adhere to bed rest.
Instead of tea, it is better to drink mint infusion.
The patient should eat as many lemons as possible.
At night he needs to drink a glass of warm milk.

In addition, there are several recipes that will speed up the body's recovery.

Several cones are crushed and filled with vodka. The resulting mixture is poured into a jar and placed in the refrigerator for several weeks. You should take 1 tbsp. spoon after breakfast.

Decoction

To prepare the decoction you can use:

Before taking the decoction, you should definitely consult your doctor, because taking herbs incorrectly can be harmful to your health.

Video - Rehabilitation after a stroke

Gymnastics after a stroke is an important part of the patient’s rehabilitation from this serious condition. Only by following all the doctor’s recommendations, drug treatment, and physical therapy will the patient gradually recover.

During a stroke, blood flow to a certain area of the brain is disrupted. Oxygen access with nutritional components for the cellular structures of the brain is reduced. This leads to paralysis of the right or left side of the patient’s body, facial numbness, and impaired speech function.

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

How to prepare a patient for recovery

Procedures should be carried out over a period of 2 to 3 hours. Physical rehabilitation of a patient requires great endurance and care from relatives caring for the patient.

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

The change in the patient's position should be constant every 2-3 hours. It is necessary to change the patient's position from one side to the other in order to prevent stagnation with bedsores.
The patient is required to perform passive exercises in the form of movements with assistance in order to reduce muscle spasms.
Perform breathing rehabilitation exercises, combining them with passive gymnastics on inhalation and exhalation. This will increase the supply of oxygen to the brain, the muscles will involuntarily tense and relax.
Active exercise consists in the fact that at the beginning of physical exercises the patient performs lying in bed, then walks, walking slowly. After an ischemic stroke, this will restore the patient’s health and reduce the likelihood of recurrent strokes.

To ensure that the muscles do not overstrain, each exercise should be performed with one or two approaches, with a gradual increase. The period between each lesson is 1 hour.

How to perform passive gymnastics

Before performing passive exercises for recovery after a stroke, it is necessary to prepare the patient’s muscles for physical work. Massage is used for this.

Every massage rule must be followed:

Perform movements gently, in a circular manner.
The specialist must move from bottom to top: first massages the hand, then goes to the shoulder. On the leg, the foot is massaged first, then the shin.
The back of the thoracic spine is massaged using tapping and pinching techniques.
The pectoral myofibers warm up from the central zone to the axillary areas.

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

The lower limb is bent so that it then becomes straight, moving along the bed. This exercise will help restore lost memory of movements.
The lower limb is extended in the same way. First, the leg is bent at the knee joint, and the patient tries to straighten it.
The upper or lower limb is suspended using a stretch band and rotated in circles. Also, all limbs are flexed, extended, and abducted to the side. The patient tries to twist or perform movements with fixed limbs. This gymnastics is performed once a day for 30 minutes.
To restore movement of the joint in the shoulder, you need to raise and lower the arm, and also perform flexion and extension.
The wrist muscles are developed. You need to clench your fingers into a fist and unclench them at least 10 times.
To restore fine motor skills, small objects are placed in the patient’s hand and help to hold them with the fingers.

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

How to do while sitting

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

The patient should sit on the bed, lower his lower limbs to the floor, and use his hands to hold on to the bed. The patient arches his back, protruding his chest. When inhaling, perform a deflection, relaxation occurs when exhaling.
The patient is sitting, the lower limbs are located on the bed. It is required to lift straight legs one at a time. First, one limb is lifted, then the next.
To relax your back, you need to place a pillow under it. The patient reaches his chest with his knee, clasping his leg with his hands. Then you need to raise your leg while inhaling, hold the movement at the chest, and don’t breathe for 2-3 seconds. Perform in turn for each lower limb.
Sitting on the bed, the lower limbs lie horizontally, and the upper limbs are retracted posteriorly, the palmar surfaces rest against the bed. During inhalation, the patient connects the scapular bones together with tilting the head back.

Performing such exercises after a stroke will gradually strengthen the back muscles and improve the patient’s well-being.

What exercises do you do while standing?

Physical therapy after a stroke is performed in the following order:

The patient lifts a small object lying on the table; in the future, when the state of health improves, the object can be lifted from the floor surface.
Raise your upper limbs up and stretch, resting on your toes. Perform while inhaling, relax while exhaling.
The lower limbs are positioned shoulder-width apart, palms are placed on the waist. You need to bend forward and backward, to the right and left.
The patient stands straight. The upper limbs are extended anteriorly. You need to wave your arms a little in the horizontal plane.
The soles are joined together. The patient squats, keeps his back straight, and does not lift his heels off the floor.
The lower limbs are positioned shoulder width apart. Palms on the waist. You need to turn the body first in one direction, then in the other.
Walk around a bit.
Swing your lower limb, clapping your palms underneath it.

How to develop tongue and face

Exercise therapy after a stroke is performed by patients with impaired speech function. More often, speech does not return as quickly as motor activity; complete recovery sometimes takes years. The main factor for speech recovery is that stroke patients must listen to any real person speak.

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

Therapeutic gymnastics for facial myofibers and tongue is as follows:

The patient shows his tongue, extending it completely forward to its full length.
Then he licks his lips in a circular motion, first in one direction, then in the other.
Lightly bites the lower lip in turn, then the upper lip.
Bares his teeth.
Curls his lips into a tube.
Clicks his tongue.

Gymnastics aimed at pronouncing words proceed as follows:

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

What effect does exercise therapy have?

Brain function is restored with the help of exercise therapy for stroke using three methods:

Defective neurons are restored. Some nerve cells are not damaged after the disease, but do not function; they do not send impulses from the motor center to the muscle fibers. To restore their functions, commands must be sent in a different order, in other words, from the arm or leg to the brain, through exercises after a stroke. Progress will appear gradually.
Dead nerve cells are replaced with new ones. By performing exercises at home, blood supply to functioning myofibers is ensured. Oxygen supply with nutritional components is carried out to living neurons faster. This accelerates the growth of new cellular structures around the surviving neurons, they communicate with each other, and the brain gradually controls motor activity.
The work of dead neurons is replaced by neighboring nerve cells. Thanks to gymnastics, commands are sent to neighboring brain areas that perform the work of dead neurons.

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

What gymnastics to perform during different periods of stroke

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

During breathing exercises, the patient inhales and exhales rhythmically, speeding up or slowing down breathing, breathing with the stomach, then with the chest and vice versa.
Using the position, muscle hypertonicity of the damaged limbs is relieved. Pay attention to the shoulder muscles, arm and plantar flexors, femoral adductors and ankle extensors.
From 1.5 to 2 hours, the affected arm and leg are brought to the correct position.
The upper limb is placed on a pillow, positioning it horizontally parallel to the body. Slowly retract until a 90° angle is formed. Then the arm is turned outward and fixed with a splint.
The damaged lower limb is bent at an angle of 15 to 20°, and a cushion is placed.
The passively performed type of exercise therapy begins only after the tone of the damaged muscle has decreased. Gymnastics are performed first on normal limbs, then on affected limbs.

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

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

At this time you need to prepare to walk. In a lying position, the patient seems to be walking; such exercises will help in the future when walking.

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

Sitting on a chair, the lower limbs are pressed to the surface of the floor. Without emphasis on the upper limbs, inhaling, the patient stands up, exhaling, he sits down.
While sitting on a chair, the patient raises the heel area, pressing his toes to the floor. The lower limbs are raised in a slow rhythm, the ankles rotate for 20 seconds, then the legs are lowered to the starting position.
Stand up straight, rest your hands on the back of the chair. The patient rises on his toes, stands for 5-6 seconds and lowers to the opposite position.

During the rehabilitation period, the patient and his loved ones will face various problems. The more persistently they are tolerated, the more actively motor skills will be restored.

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Recovery after stroke: directions, approaches, prevention of relapse

Despite the fact that the prevalence of acute vascular disorders in the brain (stroke) and mortality from them are quite high, modern medicine has the necessary treatment methods that allow many patients to stay alive. What then? What conditions and requirements does the patient face in his future life after a stroke? As a rule, most of them remain disabled forever, and the degree of restoration of lost functions depends entirely on timely, competent and comprehensive rehabilitation.

As is known, when cerebral circulation is impaired with brain damage, there is a loss of various body abilities associated with damage to one or another part of the central nervous system. In most patients, motor function and speech are most often impaired; in severe cases, the patient cannot stand up, sit, eat food on his own or communicate with staff and relatives. In such a situation, the possibility of at least a partial return to the previous state is directly related to rehabilitation after a stroke, which should be started, if possible, from the first days after the onset of the disease.

Directions and stages of rehabilitation

It is known that the number of neurons in the brain exceeds our daily needs, however, in conditions of unfavorable conditions and their death during a stroke, it is possible to “switch on” previously inactive cells, establish connections between them and, thus, restore some functions.

To limit the size of the lesion at the earliest possible date, medications are prescribed after a stroke that can:

Reduce swelling around the affected tissue (- mannitol, furosemide);
Provide a neuroprotective effect (Actovegin, Cerebrolysin).

Restorative measures should be selected and carried out individually depending on the severity of the condition and the nature of the violations, but they are carried out for all patients in the following main areas:

The use of physical therapy and massage to correct movement disorders;
Restoration of speech and memory;
Psychological and social rehabilitation of the patient in the family and society;
Prevention of delayed post-stroke complications and recurrent stroke, taking into account existing risk factors.

Or a heart attack, accompanied by necrosis and death of neurons with dysfunction of the part of the central nervous system in which it developed. As a rule, cerebral infarctions with small sizes and hemispheric localization have a fairly favorable prognosis, and the recovery period can proceed quickly and very effectively.

It takes the life of most of its survivors, and in surviving patients it most often leads to persistent impairment of various functions without the possibility of their complete or even partial recovery. This is due to the fact that during hemorrhage, a significant volume of nervous tissue dies, and interactions between the remaining neurons are disrupted as a result of cerebral edema. In such a situation, even years of regular and persistent training, unfortunately, do not always give the expected result.

Recovery from a stroke can take quite a long time, so the effectiveness of measures taken at this time depends on the patience and perseverance of relatives, friends and the patient himself. It is important to instill a sense of optimism and faith in a positive outcome, to praise and encourage the patient, since many of them are prone to manifestations of apathy and irritability.

When certain parts of the brain are damaged, astheno-depressive syndrome is especially pronounced, so do not be offended if a person close to you who has suffered a stroke is not in the mood, grumbles at family members and refuses to do exercises or massage. There is no need to insist on their mandatory implementation; perhaps it will be enough to just talk and somehow distract the patient.

Disability after a stroke still remains a significant medical and social problem, since even with the most thorough and timely treatment and rehabilitation, most patients do not fully regain their lost abilities.

Therapy that will help the patient recover faster should be started early. As a rule, you can start it at stage of inpatient treatment. In this regard, physical therapy methodologists, rehabilitation doctors, and massage therapists will provide significant assistance in the department of neurology or vascular pathology of the brain. As soon as the patient's condition has stabilized, it is necessary to transfer him to rehabilitation department to continue rehabilitation treatment. After discharge from the hospital, the patient is observed in clinic at the place of residence, where he performs the necessary exercises under the supervision of a specialist, attends physiotherapeutic procedures, massage, a psychotherapist or speech therapist.

It would not be amiss to send the patient to a rehabilitation center, modern and well-equipped, designed for neurological patients, where there are all the necessary conditions for further correction of lost functions. Due to the high prevalence of acute vascular pathology of the brain, which increasingly affects the young and able-bodied population, the creation of such centers, although expensive, is completely justified, since it allows the use of the maximum possible number of treatment methods with the fastest return of patients to their usual way of life.

Restoration of motor functions

Among the consequences of a stroke, motor disorders occupy one of the main places, since they are expressed to one degree or another in almost all patients, regardless of whether a heart attack or a cerebral hemorrhage occurred. They are expressed in the form paresis(partial loss of movement) or paralysis(complete immobilization) in the arm or leg. If both an arm and a leg on one side of the body are affected at the same time, they speak of hemiparesis or hemiplegia. It happens that changes in the limbs are not the same in severity, however, restoring the function of the hand is much more difficult due to the need to improve fine motor skills and writing.

There are various methods of restoring motor function:

Electrical stimulation;
Using the biofeedback method.

Physiotherapy

The main and most accessible method of recovery from paralysis is physical therapy (kinesitherapy). Its tasks include not only the development of the previous strength and range of motion in the affected limbs, but also the restoration of the ability to stand, walk, maintain balance, and also perform ordinary household needs and self-care. Activities that are familiar to us, such as dressing, washing, eating, can cause serious difficulties if even one limb is affected. Patients with severe disorders of nervous activity cannot sit up in bed independently.

The volume and nature of the exercises performed depend on the severity of the patient’s condition. In cases of deep violations, it is applied first passive gymnastics: a physical therapy instructor or relatives move the limbs of a bedridden patient, restoring blood flow in the muscles and developing joints. As health improves, the patient learns to sit down independently, and then to stand up and walk independently.

If necessary, use support - a chair, headboard, stick. If you have sufficient balance, it becomes possible to walk first around the ward, then around the apartment, and even down the street.

Some patients with small areas of brain damage and good recovery potential begin to stand up and even walk around the ward within the first week from the onset of a stroke. In such cases, it is possible to maintain working capacity, which is very important for young people.

If the course of the post-stroke period is favorable, the patient is discharged from the hospital for recovery at home. In this case, as a rule, the main role is taken by relatives and friends, on whose patience further rehabilitation entirely depends. The patient should not be tired by frequent and prolonged exercise. Their duration and intensity should gradually increase as a particular function is restored. To facilitate the movement of a sick person at home, it is good to provide him with special handrails in the shower and toilet, and small chairs for additional support will not be amiss.

Video: a set of active exercises after a stroke

Particular attention should be paid to restoring hand function with the ability to perform small movements and write. It is necessary to perform exercises to develop the muscles of the hand and restore coordination of finger movements. It is possible to use special simulators and wrist expanders. Along with gymnastics, it will also be useful to use hand massage, which helps improve trophism in the muscles and reduce spasticity.

This process may require a lot of time and perseverance, but the result will be the performance of not only the simplest manipulations such as combing, shaving, tying shoelaces, but even cooking and eating food yourself.

If the rehabilitation period is favorable, it is necessary to expand the patient’s social circle and household responsibilities. It is important that a person feels like a full member of the family, and not a helpless disabled person. You should not neglect conversations with such a patient, even if he cannot fully answer questions. This will help avoid possible apathy, depression and isolation of the patient with reluctance to further recovery.

Ways to “stir up” a patient from the outside

Electrical stimulation method muscle fibers is based on the influence of pulsed currents of various frequencies. At the same time, trophism in the affected tissue improves, muscle contractility increases, and tone is normalized during spastic paresis and paralysis. It is especially advisable to use electrical stimulation for long-term patients in whom active rehabilitation exercises are difficult or impossible. Currently, there are many different devices that allow you to use this method at home under the supervision of the attending physician at the clinic.

Using biofeedback method the patient performs certain tasks and, together with the doctor, receives audio or visual signals about various functions of his body. This information is important for the doctor to assess the dynamics of recovery, and for the patient, in addition, it allows him to increase reaction speed, speed and accuracy of actions, as well as observe positive results from the exercises performed. As a rule, the method is implemented using special computer programs and games.

Along with passive and active kinesiotherapy, massage after a stroke also has a good effect., especially with a tendency to spasticity and long-term rehabilitation. It is performed using conventional techniques and does not have any significant differences from that of other neurological diseases.

It is possible to begin massage in the hospital in the early stages of the post-stroke period. A massage therapist at a hospital or rehabilitation center will help with this. In the future, massage at home can also be entrusted to a specialist, or relatives themselves can master its basic principles.

Restoring speech and memory function

Restoring speech after a stroke is an important stage, first of all, in the social rehabilitation of the patient. The sooner contact is established, the sooner a return to normal life will become possible.

Speech ability is affected in most stroke survivors. This may be due not only to impaired functioning of the facial muscles and articulation, but also to damage to the speech center, located in the left hemisphere of right-handed people. If the corresponding parts of the brain are damaged, the ability to reproduce meaningful phrases, count, and understand spoken speech may disappear.

In case of such disorders, a specialist – speech therapist – aphasiologist will come to the aid of the patient. With the help of special techniques and constant training, he will help not only the patient, but also give advice to his family and friends regarding the further development of speech. Exercises to restore speech should begin as early as possible, and classes should be regular.

The role of relatives in regaining the ability to speak and communicate with others cannot be overestimated. Even if it seems that the patient does not understand anything, you should not ignore him or isolate him from communication. Perhaps, even without the ability to say something, he perceives addressed speech well. Over time, he will begin to pronounce individual words, and then entire sentences. Restoring speech greatly contributes to the return of the ability to write.

Most stroke patients experience memory loss. They have difficulty remembering past events in their lives; the faces of relatives may seem unfamiliar to them. In order to restore memory, you need to constantly train it using simple exercises and techniques. In many ways, these exercises can be reminiscent of activities with small children. So, with the patient you can learn nursery rhymes that are easy to remember and reproduce. First, it is enough to memorize one sentence, then a whole stanza, gradually complicating and increasing the amount of memorized material. When repeating phrases, you can bend your fingers, forming additional associative connections in the brain.

In addition to poems, you can remember events from the patient’s life, how the day went, what happened a year or month ago, and so on. As memory, speech and cognitive functions are restored, you can move on to solving crossword puzzles and memorizing various texts.

It is useful to carry out memory restoration exercises constantly: while eating, while cleaning the house, while walking. The main thing is that they should not cause anxiety to the patient and cause negative emotions (memories of unpleasant events from the past).

Video: exercises for speech restoration with afferent aphasia

Psychological and social rehabilitation

Considering the possible pain syndrome, the inability to perform usual activities, participate in social life, as well as the need for constant help from others, such patients are prone to depression, attacks of irritability and isolation. The task of relatives is to provide a favorable psychological environment in the family, to support and encourage the patient.

Sometimes there are hallucinations after a stroke, and the patient may describe them to relatives. In such cases, do not be alarmed: as a rule, prescribing special medications is sufficient to eliminate them.

The rehabilitation measures carried out must correspond to the real functional capabilities of the body, taking into account the depth of neurological disorders. You should not isolate the patient, citing his loss of ability to speak normally or forgetfulness - it is better to tell him the right word or assign him simple homework. For many, for effective recovery and an optimistic attitude towards exercise, it is important to feel needed.

In addition to creating psychological comfort at home, sessions with a psychotherapist and, if necessary, prescription of medications (sedatives, antidepressants) have a good effect.

Social adaptation plays an important role in returning to normal life. It’s good when there is an opportunity to return to your previous job or do another, simpler one. If a person is already retired or emerging impairments do not allow him to work, he needs to look for other ways of socialization: visiting the theater, exhibitions, finding a hobby.

A specialized sanatorium is another method of social adaptation. In addition to physiotherapeutic procedures and classes with various specialists, the patient sometimes receives a much-needed change of environment and additional communication.

Prevention of late complications and recurrent strokes

Most patients and their relatives are interested in the question: what are its complications in the future? What treatment is needed after a stroke? To do this, it is enough to follow simple conditions:

Continuation of initiated rehabilitation measures (physical therapy, massage, memory and speech training);
The use of physiotherapeutic methods (magnetic, laser therapy, heat therapy) to combat increased muscle tone in the affected limbs, adequate pain relief;
Normalization of blood pressure (in case of previous hemorrhage and presence), prescription (in case of ischemic brain damage);
Normalization of lifestyle with the elimination of bad habits, adherence to diet after a stroke.

In general, there are no strict restrictions or significant dietary features, so after a stroke you can eat everything that will not harm a healthy person.

It is, however, necessary to take into account the concomitant pathology and the nature of the existing changes. If the function of the pelvic organs is impaired, the patient is in a supine position, it is advisable to exclude foods that help slow down the passage of intestinal contents, and increase the proportion of vegetable salads, fruits, and cereals. To avoid disorders of the urinary system, it is better not to get carried away with sour, salty, or sorrel dishes.

The diet for cerebral stroke depends on the mechanism of occurrence of acute cerebrovascular accident and previous causes. So, in case of hemorrhages as a result, it is better not to eat salty foods, drink plenty of fluids, or strong coffee and tea.

It is necessary to adhere to it after an ischemic stroke (cerebral infarction). In other words, you should not give preference to fatty, fried foods, and easily accessible carbohydrates, which contribute to the development of atherosclerotic damage to the vascular walls. It is better to replace them with lean meats, vegetables and fruits.

Stroke and alcohol are incompatible things , regardless of whether the patient has a heart attack or hemorrhage. Drinking even small doses of alcohol leads to an increase in heart rate, increased blood pressure, and can also contribute to. These factors can cause a recurrent stroke with worsening neurological impairment and even death.

Many patients, especially young people, are interested in whether sex after a stroke is acceptable. Thanks to various studies, scientists have proven not only the absence of harm from it, but also its benefits in the rehabilitation process. However, there are certain nuances associated with a serious illness:

Possible dysfunction of the genitourinary system, decreased sensitivity and potency;
Taking antidepressants, irritability and apathy with decreased libido;
Movement disorders that make sexual intercourse difficult.

If the recovery period is favorable, a return to normal marital relationships is possible as soon as the patient feels strength and desire. The moral support and warmth of your spouse will also help improve your psycho-emotional state. Moderate physical activity and positive emotions will have an extremely beneficial effect on further recovery and return to a full life.

The consequences of a stroke for a person’s general health depend directly on the volume and location of the lesion in the brain. With severe and extensive strokes, complications from other organs are inevitable, the most common of which are:

Inflammatory processes of the respiratory system (congestive pneumonia in bedridden patients);
Dysfunction of the pelvic organs with the addition of a secondary infection (cystitis, pyelonephritis);
Bedsores, especially if not properly cared for;
A decrease in intestinal motility with a slowdown in the movement of contents through it, which is fraught with the development of chronic inflammation and constipation.

When caring for a patient who has suffered a stroke, it is necessary to remember that a person who has suddenly lost his previous way of life, the ability to work and communicate in his usual environment, requires manifestations of not only moral support, but also affection and kindness.

In general, rehabilitation after an ischemic stroke is faster and easier than after a hemorrhage. Many patients return to their normal lifestyle quite early, and young and able-bodied people even regain their skills at their previous jobs. The outcome and consequences of the disease depend on the patience, perseverance and desire for recovery not only on the part of the patient, but also on the part of his relatives. The main thing is to believe in a successful outcome, then a positive result will not be long in coming.