home › It's cozy at home › Recovery after a stroke. Psychological assistance to a patient after a stroke

Recovery after a stroke. Psychological assistance to a patient after a stroke

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

Psychological recovery program

The state after a stroke requires mandatory psychological rehabilitation and understanding from others, which are impossible without constant communication and contact with the outside world. Psychological recovery after a stroke is aimed at developing an adequate attitude towards health and illness, focus and strong motivation for a speedy recovery, returning to the public and working life. For each patient, a individual program on psychological rehabilitation, which would take into account:

a state of psychological status, which can be unburdened or burdened (neurosis, depression, psychopathic character traits, psychoses, etc.);
the presence of mental complications caused by cerebral hemorrhage or a particular response of the patient's personality to the disease.

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

The home environment contributes to a faster recovery. Patience and gentleness of relatives and friends contribute to the adaptation of the patient to his condition and avoid severe depression. The ability to learn to enjoy life again, to enjoy communication, to make plans for the future life helps to tune in to the need to patiently and regularly follow all the recommendations of doctors and understand that the disease worsens the quality of life, but is not a threat to it, but requires a fight against the consequences of the disease .

Relatives of a patient after a stroke need to learn to anticipate those tasks that are difficult for a still not fully rehabilitated patient.

As a rule, it is difficult for such people, especially in the morning, to get up or get out of bed, take large pieces of bread and bring them to their mouths, drink from a cup. In such cases, you can offer them finely chopped pieces of bread and a drinking straw.
It is important to be able to help the patient maintain self-esteem in any situation and always refrain from criticizing his condition.
The daily regimen must necessarily include the usual activities that instill in the patient a sense of security and self-confidence. For example, if he is used to working in the garden, then his involvement according to the measures of his strength will contribute to the normalization of his emotional state and bring pleasure from his favorite pastime.
Conflicts with the patient should be avoided in every possible way, since this can lead to a deterioration in his well-being and cause him resentment and isolation. Be sure to keep calm, try to joke more often in a kind way, do not argue or criticize in a negative way.
You should not refuse the help of friends, relatives, employees and neighbors. Such communication will benefit both the patient and his relatives.
You need to leave time for yourself. Such minutes and hours of rest will help to overcome severe psycho-emotional and physical activity and continue caring for the sick in good spirits.
To prevent overwork caused by overestimating your capabilities, you need to think in advance about who can help and replace you. Many relatives who care for such patients overestimate their capabilities and patience - this can lead to neurosis, nervous breakdowns and depression.

Activities for psychological recovery

individual and group psychotherapy;
autogenic training;
psychotherapy with the use of acupuncture;
book therapy;
psycho-gymnastics with the use of pantomime, rhythm, dancing, singing, etc.;
cultural therapeutic activities;
work in the clubs of "former patients".

How to set up the patient to fight the disease?

Try to be specific about each step.
Distract from moral self-torture by comparisons with those who are even worse off.
Learn to recognize the need for humility with what happened.
Get involved in helping others.
Encourage hope and improvement in the future.
Teach the patient to live for today.
Learn to adapt to the created conditions of life.
To give the opportunity to feel needed and needed member of the family and society.
Avoid slovenliness and detachment from society.
Learn to behave with dignity in any situation.

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

Ermakova N.G.

Candidate of Psychological Sciences, Associate Professor of the Department of Clinical Psychology and Psychological Assistance, Russian State Pedagogical University. A.I. Herzen

PSYCHOLOGICAL ASSISTANCE TO PATIENTS WITH MOTOR DISORDERS AFTER A STROKE AND THEIR RELATIVES

annotation

Psychological assistance to patients after a stroke is aimed at creating a positive therapeutic and life perspective.The results of the use of individual psychological correction in 84 patients with the consequences of a stroke in inpatient rehabilitation were analyzed. Upon completion of the correction, there is an improvement in the mood of patients, an increase in self-esteem, adherence to treatment. It was carried out with relatives of patients family counseling aimed at improving relationships with patients.

Keywords Keywords: clinical (medical) psychology, rehabilitation, stroke, psychological correction, family counseling.

Ermakova N.G.

PhD in Psychology, Associate professor of the Chair of Clinical Psychology and Psychological Care, Herzen State Pedagogical University of Russia

PSYCHOLOGICAL CARE OF PATIENTS WITH MOVEMENT DISORDERS AFTER STROKE AND THEIR FAMILIES

Abstract

Psychological care of patients after a stroke is aimed at the formation of a positive medical and life perspective. The results of using the individual correction in 84 patients with stroke in a stationary rehabilitation were analyzed. Upon completion of psychological correction program marked improvement in patients with mood, self-esteem, boost adherence to treatment. With relatives of patients was conducted family counseling aimed ataboutptimisation relationships with patients.

keywords: clinical (medical) psychology, rehabilitation, stroke, psychological correction, family counseling.

Introduction. In recent decades, there has been an increase in the number vascular diseases of the brain, which makes the rehabilitation of patients with the consequences of a stroke an urgent medical and social problem, aimed at restoring impaired functions, social contacts, returning the patient to society and to feasible work. A long process of rehabilitation of patients with the consequences of a stroke, impaired motor and cognitive functions to a large extent affect the emotional state of the patient, negatively affect his self-esteem, the prognosis of treatment and life prospects, lead to depressive, hypochondriacal reactions to the disease. Apathy, uncertainty about the future reduces the patient's adherence to treatment and activity in activities rehabilitation treatment which makes it necessary to include psychological assistance in the process of rehabilitation of patients after a stroke.

In the rehabilitation of post-stroke patients, the principle of the unity of biological and psychosocial methods of treatment is implemented (Kadykov A.S.). In the process of treatment, biological rehabilitation methods are used (drug therapy, exercise therapy, physiotherapy, balneotherapy, occupational therapy), aimed at restoring impaired motor functions and self-service. Psychosocial methods include: speech therapy, social work, occupational therapy, psychological assistance. They are aimed at restoring disturbed higher mental functions, at correcting personality relationships, at psychological and social adaptation of the patient. It should be noted that in recent years, little attention has been paid to psychosocial methods of influencing a patient after a stroke. scientific research. While the characteristics of the patient's personality play big role in the formation of attitudes to treatment, to the disease, to oneself; affect the adaptation to society after the disease. A favorable family climate also contributes to the activation of the patient in the restoration of impaired functions (Kadykov A.S. et al. 2008). .

The family is a system of interrelated roles, the relationship between which is determined, on the one hand, by socio-cultural norms, and on the other hand, by the individual properties of individuals. Family and intra-family relations can serve not only as a subtle indicator of upcoming personality changes, but also be one of the indicators social adaptation in society. The role of the family is great both as the closest social environment on the way to the return of the patient to life, and as the most important sociotherapeutic factor affecting the personality of the patient. to pathological reactions of a sick person can lead to a psychological conflict in the family and social decompensation of patients, to a deterioration in their clinical condition. On the other hand, being surrounded by excessive care, removing the patient from all household activities after a stroke, contributes to the development of a passive attitude towards treatment, and prevents the restoration of self-service, the formation of the patient's responsibility for the restoration of impaired functions. .

Of great importance at the stage of resocialization is the work with relatives of patients, correction of intra-family relations (Kabanov M. M., 1998; Demidenko T. D., 1989, 2004).

It should be noted that for relatives, a sudden serious illness of loved ones with consequences that are difficult to overcome is stressful. Rehabilitation of the patient is accompanied by moral and physical stress of relatives and financial costs, prolonged neuropsychic stress, often leads to psychosomatic disorders. In this connection, psychological assistance to relatives of the patient is of great importance.

As noted by a number of authors (Kadykov A.S. et al. 2007), it is important to teach relatives the rules of caring for patients, as well as teach doctors to conduct schools for relatives of patients (Skvortsova V.I., 2008;); recommend special literature of a sanitary and educational nature. Arkhipov V. V., Prokudin V. I., 2005; they write about the activities of the psychotherapeutic service at the stage of early rehabilitation of patients with the consequences of a stroke in a hospital. If it was impossible to contact patients after a stroke at this stage (up to 60% of patients with speech and cognitive impairments), they carried out rational psychotherapy in relation to relatives of patients and socially significant people caring for patients. The authors held conversations with relatives, weekend seminars, where they taught relatives the simplest methods of caring for the sick, answered relatives' questions; placed information on the stands for relatives to care for, answered their questions so that they could competently carry out care for the sick at home.

Work with relatives is aimed at regulating relationships in the family, correcting overprotection, and teaching a tolerant attitude towards the patient. The aim of the study was to study the dynamics of self-attitude of patients in the process of psychological assistance and to identify the most important targets of influence in working with relatives in the process of family counseling.

Research program.

We observed 84 patients; -55 men, 29 women; aged 40-49 years-13; from 50 to 59-32 patients; from 60 to 70 -39 patients. The duration of the disease from 2 to 6 months was observed in 36 patients; 7 to 12 months in 26; from 1 to 3 years in 22 patients. The first stroke was observed in 59 patients, repeated in 25. Localization of the lesion in the pools of the arteries of the left hemisphere was observed in 40 patients; in the right hemisphere in 27 patients, in the vetero-basilar basin in 17 patients. Ischemic stroke was observed in 72 patients; hemorrhagic in 12 patients. Movement disorders in the form of mild hemiparesis were observed in 11; moderate severity in 40 patients, severe motor disorders in 24; vestibular disorders in 9 patients. Speech disorders were observed in 45 patients: aphasia in 32, dysarthria in 13. Group 1 disability in 20 patients; 2 groups in 64 patients. The study did not include patients with stroke duration less than 2 months and with residual manifestations of sensory aphasia. Clinical interviews were conducted with patients before and after psychological correction; self-service assessment on the Barthel scale (Belova A.N.), quality of life (Logunov K.V.), Dembo-Rubinstein self-assessment scale (Rubinshtein S.Ya.). The mean values of the indicators were compared using the Student's t-test, and the Statistics 6.0 program was used to process the results. The patients received complex rehabilitation treatment in the inpatient rehabilitation of the city hospital No. 40, St. Petersburg.

The treatment included biological methods (drug therapy, exercise therapy, physiotherapy); and psychosocial methods (speech therapy, psychological assistance). All patients received informed consent for psychodiagnostics and psychological assistance. Psychological assistance was aimed at the formation of adherence to treatment, cooperation relations with the staff, positive self-attitude. Individual psychological correction was applied 1-2 times a week, for 30 minutes in the office; and classes in a small group (5-6) people 1-2 times a week, during which art therapy and music therapy were carried out.

We observed 84 relatives of patients. Among the relatives were mostly women aged 25 to 65 years - 64 people of different family status: of them mothers - 3; wives - 42, daughters - 14, sister and other relatives - 5. Among the relatives of men, 20 people were observed; from 42 to 67 years old, including 17 husbands, 2 sons, 1 father. With relatives of patients; information and family counseling was used (Demidenko T.D., Ermakova N.G.); (Eidemiller E.G.); (Arkhipov V.V., Prokudin V.I.). Relatives were provided with information about the features of the patient's cognitive impairment, emotional state; reactions of the individual to the disease, information about necessary assistance the patient from relatives to restore impaired motor and cognitive functions, depending on the severity of the patient's clinical disorders and the localization of the lesion; about the goals and objectives of psychological rehabilitation at different stages. Informing was carried out individually and in the form of a wall print (sanitary lists for patients and relatives). Family counseling was aimed at improving the opportunities for interaction between relatives and the patient. Social support of patients from relatives was important in strengthening the positive self-attitude of patients after a stroke.

Results and their interpretation.

Patients were observed in the conditions of inpatient rehabilitation and were characterized by difficulties in accepting their illness, its consequences, their participation in treatment; distrust of treatment; the difficulty of forming a collaborative relationship with staff. This group included patients mainly with astheno-depressive and astheno-hypochondriacal reactions to the disease.

Table 1 - Comparison of parameters of patients (n=84) before and after correction using Student's t-test (M ± σ)

Index	Correction period		p*<
Index	Before	After	p*<
Barthel Self-Service Scale	79.7 ± 3.8	85.0±3.5	0,05
The quality of life	2.2±0.5	2.7±0.2	–
Dembo-Rubinstein self-esteem scale:
Health	31.4 ± 4.3	42.6 ± 3.7	0,05
Mood	31.3 ± 3.4	47.1 ± 3.2	0,05
Self service	48.2 ± 4.2	66.1 ± 3.8	0,01
Participation in treatment	46.8 ± 3.3	63.3 ± 3.5	0,01

After carrying out complex rehabilitation treatment with the use of individual and group psychological correction, improvement in self-service (Bartel scale) is noted. Average score on the Barthel Self-Service Scale before correction 79.7 after -85.0-partial dependency. noted significant increase self-assessment of self-service and participation in treatment, which indicates a greater involvement of the patient in the treatment process.

There was also an increase in self-esteem of mood and health, which is associated with the patients' awareness of the possibility of restoring impaired functions, the emergence of hope and faith in recovery. At the same time, in the process of rehabilitation, patients became aware of the long process of restoring impaired functions, the need for independent daily repeated repetition of exercises. physiotherapy exercises requiring will, patience, and diligence, and this circumstance led to the fact that self-assessments of health and mood did not increase much.

Information and family counseling were conducted with the relatives of the patients. Quite often, the initiators of the appeal to the psychologist were relatives of patients, concerned about their emotional state, disbelief in recovery, apathy, and unwillingness to participate in therapeutic measures. In some cases, relatives were interested in the possibility of restoring impaired functions (cognitive, emotional, behavioral) of patients; as well as their possible participation in accompanying the recovery process.

When working with relatives, we have identified the types of relations between relatives and their wards:

1. Empathic, empathetic. Care and care was observed in combination with empathy and warmth in relationships - 29 (34.5%) people with different family roles: mother, father, sisters, wives, husbands, daughters. Relationships of mutual understanding and sympathy developed before the disease and persisted after the disease

2. Motivating, moralizing. Care, care and mentoring were observed.-21 (25%). The motivation of the patient by relatives was not combined with sympathy and empathy and was in the nature of duty and moralizing. ("Here you will do it yourself, you will walk"; "There is nothing to be lazy, let's develop a hand"). According to the relatives of this subgroup of patients before the disease, they did not follow the doctor's prescriptions -therapist (taking antihypertensive drugs, following a hypocholesterol diet); some patients abused alcohol, smoking. Often relatives (wives, husbands, children) believed that the sick themselves were to blame for their illness.

3. Organizing, formal: Relatives limited themselves to organizing treatment, not showing emotional support and empathy - 26 (30.9%). Family roles: children, husbands, wives. They organized and paid for treatment: the work of a nurse, medicines, orthopedic aids (a ship, a bedside toilet, a cane, etc.) and believed that their mission was exhausted on this. The protective distancing of relatives of this subgroup is associated with complex relationships with the patient before his illness (dominant, despotic character traits of patients; capriciousness, willfulness). (“It’s hard to argue with my mother, she will do everything as she wants herself”) Unwillingness of relatives to change the existing relationship. 4. Indifferent, condoning: There was partial care and concern. Relatives themselves were the sources of problems (alcohol abuse) -4 (4.7%), as a rule, men (father, husband).

5. Confused, infantile: insufficient understanding of the severity of illness of sick relatives and the need for assistance in their care; - 4 (4.7%). Relatives of patients are adult children living separately from their parents in their families. They did not understand enough that the time had come to repay their debts to their relatives for care and concern.

Relatives of groups 1 and 2 had more questions to the psychologist about optimizing interaction with patients, about the features of restoring mental functions. They were given recommendations on interaction with patients, restoration of cognitive functions at home. Relatives of groups 1 and 2 were also recommended to delegate part of the burden of care at home to other family members and acquaintances of patients, as a prevention of psychosomatic disorders of caring relatives. With the 3rd subgroup of relatives, psychological correction was aimed at strengthening empathy and support towards the sick and, if possible, greater personal participation in communicating with the patient or involving one of the relatives (grandchildren, nephews) in the care. A conversation was conducted with the 4th and 5th subgroups of relatives about the need to help patients in the implementation of self-service; the need for care and attention. The possibility of attaching a social worker to the patient at home after discharge from the hospital was discussed. Often, adult children of patients did not fully understand the severity of the disease of their relatives and were at a loss. They needed help organizing care for the sick.

Findings.

The long process of rehabilitation of patients with the consequences of a stroke, impaired motor and cognitive functions significantly affect the emotional state of the patient, negatively affect his self-esteem, the prognosis of the treatment and life prospects, which makes it necessary to include psychological assistance in the process of rehabilitation of patients after a stroke.

Psychological assistance is aimed at correcting the relationship of the individual to himself, to the disease, to treatment, to society, focused on the psychological and social adaptation of the patient.

After complex rehabilitation treatment with the use of individual and small-group psychological correction, there is a significant increase in self-esteem of self-service and participation in treatment, which indicates a greater involvement of the patient in the treatment process. An increase in self-esteem of mood and health was observed, which is associated with the patients' awareness of the possibility of restoring impaired functions.

The relations of relatives to patients were based on the relations that had developed before the disease: either the relationship of interaction and mutual assistance; or relationship of subordination and dependence. When working with relatives, we have allocated different types relations of relatives to their patients, targets of influence in the process of family counseling were identified. Depending on the type of relationship, informing and family counseling of relatives of patients was carried out.

Literature

Aleksandrovsky Yu.A. Mental disorders in general medical practice. M.: Geotar-Media, 2004.-240s.
Arkhipov V.V., Prokudin V.I. Methodological foundations of early psychosocial rehabilitation in a neurological clinic in patients with stroke. //Journal of Neurology and Psychiatry. S.S. Korsakov, Supplement Stroke, vol. 14, 2005, p.35-42.
Balunov O.A., Demidenko T.D., Yankovskaya E.M., Alemasova A.Yu., Ermakova N.G., Kotsyubinskaya Yu.V. The role of family relationships in the rehabilitation of stroke patients. Method.recommended. - St. Petersburg: 2000.-31s
. Belova A.N., Shchepetova O.N. Scales, tests, questionnaires in medical rehabilitation. - M. : Antidor, 2002. - 440 p.
Belyanskaya E.N., Krasnova L.V. Stroke. How to live on?. M.: Eksmo Publishing House, 2005.-192p.
Grigorieva V.N. Psychosomatic aspects of neurorehabilitation. Chronic pain. N.Novgorod: Publishing house of NGMA, 2004.-420p.
Gusev E.I., Bogolepova A.N. Cognitive impairment in cerebrovascular diseases.-.-M.: MEDpress-inform, 2013.-176p.
Danilov D.S. Therapeutic cooperation (compliance): the content of the concept, mechanisms of formation and optimization methods.// Neurology, neuropsychiatry, psychosomatics. 2014;(2):P.4–12
Demidenko T.D. Rehabilitation in cerebrovascular pathology. L.: Medicine, 1989.-208s.
Demidenko T.D., Ermakova N.G. Fundamentals of the rehabilitation of neurological patients. St. Petersburg: Tome, 2004.-304 p.
Kabanov M.M. Psychosocial rehabilitation and social psychiatry. St. Petersburg, 1998, 255c
.Kadykov A.S., Manvelov L.S., Shakhparanova N.V. Step by step after a stroke. (Manual for patients and their relatives) M.: Association of scientific publications KMK, author's academy. 2007, - 122p.
Kadykov A.S., Chernikova L.A., Shakhparanova N.V. Rehabilitation of neurological patients.-M.: Medpress-inform, 2008.-560p.
. Klochikhina O.A., Stakhovskaya L.V. Analysis of the epidemiological indicators of stroke according to the data of territorial population registers 2009–2012 // Journal. neurology and psychiatry. S.S. Korsakov. - 2014. - No. 6. - P. 63–70.
Kurpatov V.A. Psychotherapy in a somatic clinic.//In the book: Psychosomatic disorders in the practice of a therapist. A guide for doctors. (Edited by V.I. Simonenkov). St. Petersburg: Spetslit, 2008. P. 250-278.
Logunov K.V. Evaluation of the effectiveness of therapeutic and diagnostic methods. - St. Petersburg. : SPbMAPO, 1999. - 26 p.
Parfenov V.A., Verbitskaya S.V. Secondary prevention of ischemic stroke; international recommendations and clinical practice // Neurological Journal / 2014, No. 2.С.4-11.
Popp A.D., Deshaye E.M. Guide to neurology (translated from English) M.: Geotar-Media, 2014.-688s.
Rubinshtein S.Ya. Experimental methods of pathopsychology and the experience of their application in the clinic.--M.: Institute of Psychotherapy, 2010.-384p.
Sidorenko E.V. Methods of mathematical processing in psychology - St. Petersburg: Speech, 2007 - 350s.
Skvortsova V.I. (ed.). Health School. Life after a stroke. A guide for doctors. M. GEOTAR-Media, 2008, 208 p.
Eidemiller E.G., Dobryakov I.V. Nikolskaya I.M. Family diagnosis and family psychotherapy. St. Petersburg: Speech, 2005.- 336s.
Yankovskaya E.M. An integrated approach to psychotherapeutic support for families of patients with stroke. Abstract of diss. cand. psychol. Sciences, St. Petersburg: 2008, 25s.
Barton J.Stroke and Rehabilitation:Psychological Perspectives//In: Oxford Handbook of Rehabilitation Psychology(Oxford Library of Psychology)/ Kennedy P.(Ed.) ,N.Y.,2012,Oxf.Univ.press.-576p./ 235-248p
S.,Smith D.S. Changes in family functioning for stroke rehabilitation patients and their families // International Journal of Rehabilitation Research.- 1999.-V.22.-P.171-179.
Palmer, S.; Glass, T. A. Family Function and Stroke Recovery: A Review.//Rehabilitation Psychology, Vol 48(4), Nov 2003, 255-265.

References

Aleksandrovskij YU.A.Psihicheskie rasstrojstva v obshchemeditsinskoj praktike. Moscow: Gehotar-Media, 2004.240p. (In Russ.)
Arkhipov V.V., Prokudin V.I. Methodological bases of early psychosocial rehabilitation in neurological clinic in patients with stroke.//Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova, Prilozhenie Insul't./[ Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova, Suppl.stroke], vyp. 14, 2005, p.35-42.
Balunov O.A., Demidenko T.D., Yankovskaya E.M., Alemasova A.Yu., Ermakova N.G., Kotsyubinskaya Yu.V. Rol' semeinykh vzaimootnoshenii v reabilitatsii bol'nykh, perenesshikh insul't. Method.rekom.- Sankt-Peterburg,.,2000,-31p(In Russ.)
Belova A.N., Shchepetova O.N. Shkaly, testy, oprosniki v meditsinskoi reabilitatsii. Moscow: Antidor, 2002. 440 p. (In Russ.)
Belyanskaya E.N., Krasnova L.V. Insul't. How zhit'dal'she?.[Stroke. How to live?.]. Moscow: Eksmo, 2005.192p. (In Russ.).
Grigor'eva V.N. Psychosomatic aspekty neiroreabilitatsii. Khronicheskie boli. Nizhnii Novgorod: Izd-voNGMA, 2004. 420 p. (In Russ.)
Gusev E.I, Bogolepova A.N. Kognitivnye narusheniya pri tserebrovaskulyarnykh zabolevaniyakh. Moscow: MEDpress-inform, 2013. 176 p. (In Russ.)
Danilov D.S. Terapevticheskoe cooperation (komplaens): soderzhanie ponyatiya, mekhanizmy formirovaniya i metody optimizatsii [Therapeutic cooperation (compliance): maintenance of concept, mechanisms of formation and methods of optimization]//. Neurologiya, neiropsikhiatriya, psikhosomatika. 2014;(2):p.4–12
Demidenko T.D. Reabilitatsiya pri tserebrovaskulyarnoi patologii.
Demidenko T.D., Ermakova N.G. Osnovy reabilitatsii nevrologicheskikh bol’nykh [Basics of the rehabilitation of neurological patients]. Sankt-Peterburg: Foliant, 2004. 304 p. (In Russ.)
Kabanov M.M. Psikhosotsial’naya reabilitatsiya i sotsial’naya psikhiatriya. [Psychosocial rehabilitation and social psychiatry]. Sankt-Peterburg, 1998,255p. (In Russ.)
.Kadykov A.S.,Manvelov L.S.,Shakhparanova N.V.Shag za shagom posle insul’ta.(Posobie dlya patsientov i ikh rodstvennikov) [Step by step after stroke.Guide for patients and their families]. Moscow: Tovarishchestvo nauchnykh izdanii KMK, avtorskaya akademiya, 2007, 122p. (In Russ.)
Kadykov A.S., Chernikova L.A., Shakhparanova N.V. Reabilitatsiya nevrologicheskikh bol'nykh. Moscow: Medpress-inform, 2008. 560p. (In Russ.)
Klochikhina O.A., Stakhovskaya L.V. Analiz epidemiologicheskikh pokazatelei insul’ta po dannym territorial’no-populyatsionnykh registrov 2009–2012 gg. . Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2014. No. 6. Pp. 63–70. (In Russ.)
Kurpatov V.A. Psikhoterapiya v somaticheskoi klinike .Psikhosomaticheskie rasstroistva v praktike terapevta Ed. V.I. Simanenkov. Sankt-Peterburg: Spetslit, 2008. Pp. 250–276. (In Russ.)
Logunov K.V. Otsenka effektivnosti lechebnykh i diagnosticheskikh metodov . Sankt-Peterburg: SPbMAPO, 1999. 26 p. (In Russ.)
Parfenov V.A.Verbitskaya S.V.Vtorichnaya profilaktika ishemicheskogo insul’ta; mezhdunarodnye rekomendatsii i klinicheskaya praktika // Nevrologicheskij zhurnal/2014, No. 2, pp. 4-11.
Popp A.D., DehshajeEH.M. Rukovodstvo po nevrologii (per.s angl.) Moscow: Gehotar-Media, 2014.-688p. (In Russ.)
Rubinstein S. Ya. Ehksperimental’nye metody patopsikhologii i opyt ikh primeneniya v klinike..[ Experimental methods pathopsychology and experience of their use in the clinic]; Moscow: Isd-vo Instituta Psihoterapii, 2010.384p. (In Russian)
Sidorenko E.V. Methodology matematicheskoi obrabotki v psikhologii. Sankt-Peterburg: Rech`, 2007. 350 p. (In Russ.)
Skvortsova V.I. (red). Shkola zdorov’ya. Zhizn’ after insul’ta. Rukovodstvo dlya vrachei. Moscow: GEOTAR-Media, 2008, 208p. (In Russ.)
Eidemiller E.G., Dobryakov I.V.. Nikol’skaya I.M. Semeinyi diagnoz i semeinaya psikhoterapiya [Family diagnosis and family therapy] Sankt-Peterburg: Rech’, 2005. 336p. (In Russ.)
Yankovskaya E.M. Abstract cand. psychology Science. Sankt-Petersburg, 2008, 25p. (In Russ.).
Barton J.Stroke and Rehabilitation:Psychological Perspectives// Oxford Handbook of Rehabilitation Psychology(Oxford Library of Psychology)235-248pp/ Kennedy P.(Ed.), N.Y.: Oxf.Univ.press, 2012.576p.
ClarkM.S., Smith D.S. Changes in family functioning for stroke rehabilitation patients and their families // International Journal of Rehabilitation Research.- 1999b.-V.22.-P.171-179.
Palmer, S.; Glass, T. A. Family Function and Stroke Recovery: A Review//Rehabilitation Psychology, Vol 48(4), Nov 2003, 255-265.

Problem psychological support personality in the period of illness, which often leads to disability, social maladjustment is multifaceted, needs modern research and development.

In the departments of ONMK ( acute disorder cerebral circulation) and emergency cardiology, both elderly people and patients of young working age (+- 25-45 years old) who need not only drug treatment but also in psychological care.

E.I. Gusev and A.S. Kadykov note that the rehabilitation of post-stroke patients, aimed at restoring impaired functions, social contacts, professional skills, returning the patient to society and to feasible work, is becoming an urgent medical and social problem.

L.V. writes about the importance of using a multidisciplinary approach in the treatment of patients with stroke. Mustafin, including the significant role of the psychologist both in neuropsychological diagnostics and in the psychotherapeutic process.

An integral part of modern treatment and prevention of CVD is a psychotherapeutic effect.

In a significant part of patients after myocardial infarction, the elimination of the pathology of the coronary arteries, an objective improvement in hemodynamics and an increase in exercise tolerance, persistent neurotic disorders persist.

Apparently, in some patients, the “personality crisis” provoked by the disease is not overcome at the stages of rehabilitation, and sometimes intensifies under outpatient observation, which undoubtedly requires intensive psychological assistance and support.

The choice of a specific method of psychotherapy is based primarily on considerations of ease of use, cost-effectiveness and accessibility for the patient. Thus, psychotherapeutic intervention must meet the requirement of "subjective adequacy" and correspond to the peculiarities of the internal picture of the disease, the patient's expectations, his ability to comprehend, intellectual and educational level. Equally important is the correspondence of the proposed method to the personal characteristics of the patient.

Psychological support of patients at the stage of hospitalization in a hospital is carried out in order to reduce the intensity of acute stress, correct neurotic, hypochondriacal reactions, in order to develop an individual program of psychological rehabilitation.

At the first stage of work with the patient, psychodiagnostics or neuropsychological testing is carried out (to assess damage to the HMF in stroke) in order to identify the psychopathological structure of the personality during illness, premorbid features, resources, and the degree of pathological changes in the psyche. It is important to determine the content of the internal picture of the disease of a particular patient for an effective assessment of the rehabilitation potential. The diagnostic procedure allows, in the form of a conversation, a formalized interview, to help the patient express significant experiences in the initial stages of hospitalization in the form of verbal messages.

At the second stage of psychological support of patients, the psychologist is engaged in the restoration of pathological neurotic reactions, anxiety-depressive, apathetic-depressive, neurotic, asthenic conditions, sleep disorders. Elements of client-centered psychotherapy by C. Rogers, cognitive-behavioral therapy by A. Beck are used. During a period of stress, patients need empathy, unconditional positive acceptance, help in understanding feelings, emotions, and symbolization of experience. Psychological support of patients includes assistance in expanding the ways of responding to the disease, decatastrophization, searching for alternative behavioral strategies, and forming motivation for further treatment and rehabilitation. With patients who do not have cognitive impairment or have a slight level that does not interfere with the assimilation of new information, methods of change are used. negative thoughts(method "Awareness of negative thoughts", "Scaling" technique (S.A. Kulakov, 2003), exercise "Reducing the significance of the upcoming event" (according to P. Shimer, S. Ferguson, 1990)) .

The psychologist discusses with the patient how to plan goals and actions during the treatment period.

Relaxation activities play an important role in psychological support. Group classes on autogenic training are held in the cardiology department (techniques are used: autogenic training No. 1 "Relaxation and relaxation", No. 2 "Poise and resistance to stress". Authors: prof. A.A. Vostrikov, psychotherapist, prof. A.A. . Tabidze, psycho-pedagogue) to relieve stress, switch consciousness to pictures of nature, listening to relaxation music (the “Healing Music” series is recommended by the Center for Restorative Medicine of the Ministry of Health of the Russian Federation for stress relief, relaxation and recovery. Examples of compositions: Beethoven - Moonlight Sonata, Grieg - Morning Mood from Peer Gynt, Tchaikovsky - Oveture Miniature to The Nutcracker Suite, Mozart - Clarinet Quintet K.581 Largetto & K.581 Allegre and others).

Patients are offered the exercises “Resting Place” (according to M. Loscalzo, 1996), “Memories pleasant sensations associated with color ", which help to relax, relieve tension in the body.

Often strokes and heart attacks are accompanied by pain syndromes (headache, heart pain, pain in the upper or lower extremities), in connection with this, the psychologist offers an effective exercise "Breathing against pain" (according to M.E. Sandomirsky, 2005).

Contraindications for performing exercises, psychotherapeutic conversations are moderate and severe cognitive impairment, intellectual deficiency, acute psychotic states, psychopathic behavior.

Patients who, for medical reasons, are able to move, attend preventive group classes, where a psychologist talks about the features of the disease, risk factors and rules of behavior that can ensure life safety. There is a separate block of classes on secondary prevention smoking, alcohol abuse.

The art therapy group of self-discovery "Colors of my soul" is being implemented in the ONMK department. In the group, patients learn to better understand their needs, feelings, emotions with the help of plasticine, paints, pencils. The group helps expand Creative skills allows you to rediscover the world through color, shape, shades. The group discusses topics: “Me and my world”, “My relationship with others (my family)”, “Me and illness”, “My dream”, “Nature”, “Feelings and mood” and much more.

The psychologist also uses the exercises "My portrait in the sun", which helps in the development of communication skills, promotes the process of self-disclosure. The "Tree of Feelings" exercise promotes the free expression of feelings, patients learn to understand their feelings and experiences, to adequately express and control them.

Training is being conducted on the development of cognitive processes in the elderly according to the recommendations of M.A. Kraevoy, T.O. Tarasova, E.A. Chizhova, which contributes to effective adaptation in living conditions, increases the level of self-regulation and quality of life after discharge from the hospital.

Training, relaxation and preventive classes, individual counseling are carried out no more than 30 minutes 2 times a week, as patients are prone to rapid exhaustion and fatigue.

The third stage of psychological support is to work with relatives of patients. Relatives often need support, help in communicative interaction with the patient, recommendations for care. To implement these tasks, the school "Life after a stroke" is being held. This lesson is of a lecture nature on the topics: “Mechanism of Stroke Development”, “Symptoms of Stroke and First Aid to the Victim”, “Peculiarities of Rehabilitation in Stroke”, “Post Stroke Depression. Recommendations on how to get rid of depression.

For relatives of patients with stroke, the following recommendations have been developed (Part 1):

Use the principle of visibility, demonstration in communication with the patient. It is recommended to communicate with patients in the acute period of a stroke, as with children aged 3-5 years. It is important to explain something and demonstrate at the same time. You can use pictures, elements of non-verbal behavior.
Be patient. A stroke is not the flu - recovery can take months or years! The patient's behavior often resembles the behavior of a child: capriciousness, attracting attention. Remember that this is a sick person and try to treat his actions not as the actions of a healthy person.
Compliance with the daily routine. You need to sleep at least 7-8 hours. Be sure to sleep at night, stay awake during the day.
The principle of activity. Try to activate the patient from the first days, if there are no contraindications for this. Perhaps it is worth reminding the patient that not everything depends only on medications and the attending physician, it is worth doing the restoration of movements, the development of memory every day.
The principle of encouragement. Try to encourage the patient even for minor changes.
The principle of independence. Try to let the patient act independently in situations. Don't be a babysitter. Do not instead of, but together with the patient.
The principle of division of responsibility: it is not recommended to take the entire burden of caring for the sick only on one relative. Consider who you can share the load with. You can contact the authorities social protection for more help.
Pay attention to your needs, leave time for yourself, for hobbies. In cases of suspected depression, if there are problems in relationships with a sick relative, if there are frequent conflicts in the family, misunderstanding, in cases of crisis, feelings of guilt and insolvency, seek help and support from a psychologist / psychotherapist.

For relatives of patients with a heart attack, the following recommendations have been developed (part 2):

Distribution of adequate load: protect a sick relative from heavy physical exertion.
Daily regime. You need to sleep at least 7-8 hours. Be sure to sleep at night, stay awake during the day.
Stress. Try to minimize the impact of stress in the patient's life. A psychologist will help you learn to change your attitude to what is happening.
Patients should not change the climatic zone of residence.
Nutrition. Read the recommendations for nutrition that the patient needs. Information can be obtained by contacting a doctor for advice.
If the patient is concerned about cardiophobia, fear of death, anxiety, then it is necessary to contact a psychologist / psychotherapist.
If you have problems communicating with a relative or the relative himself is experiencing stress, it is recommended to consult a psychologist.

Watch out for control blood pressure from a sick relative.
Follow the regular and timely intake of drugs and the implementation of all the recommendations of the attending physician, observations in the clinic at the place of residence.
Express care and understanding.

Thus, psychological support is built taking into account the individual characteristics and needs of patients. This is a comprehensive psychological assistance aimed at regulating the mental state during hospitalization, optimizing further functioning in the family and society.

Bibliography:

Burno M.E., Igovskaya A.S. Psychotherapy of patients with personality disorders characterized by the predominance of hypochondria // Journal of neuropathology and psychiatry. - 2008.108 (12): pp. 27-31.
Grigorieva V.N., Tkhostov A.Sh. Psychological help in neurology. - N. Novgorod.: Publishing house of the Nizhny Novgorod State Medical Academy, 2009: P. 205-230.
Gusev E. I., Skvortsova V. I. Cerebral ischemia. - M.: Medicine, 2001: S. 326.
Ermakova N.G. Psychological features of patients with the consequences of a stroke in the left and right hemispheres of the brain during rehabilitation // Bulletin of St. Petersburg State University. - 2008. - Ser. 11. Issue. 3.
Kadykov A.S. Rehabilitation after a stroke. — M.: Miklosh, 2003: S. 176.
Kostenko M.B., Cheperin A.I., Stepanova O.N., Drachuk T.A., Osatyuk N.I., Zinkina A.P. Experience in the implementation and functioning of models of psychosocial treatment and rehabilitation in the conditions of the Omsk region // Collection of articles and modular practices for psychologists / - Omsk, 2011: P. 76.
Kraeva M.A., Tarasova T.O., Chizhova E.A. Training of cognitive processes of elderly and senile persons / edited by I.M. Nikolskaya - St. Petersburg: Rech, 2003: P. 62.
Medvedev V.E. Prevention and therapy of psychopathological disorders in patients with cardiovascular diseases // Journal of Neurology. Neuropsychiatry. Psychosomatics. - 2012. - No. 3: P. 1.
Mustafina L.V. Early rehabilitation of post-stroke patients by a multidisciplinary team: Abstract of the thesis. diss. for the degree of candidate of medical sciences. - M., 2008: S. 22.
Sudzhaeva S.G., Sudzhaeva O.A. Rehabilitation after myocardial revascularization. - M: Medical Literature, 2008: P. 128.

Help after a stroke

Help with psycho-emotional disorders after a stroke

Psycho-emotional disorders in stroke

Effective rehabilitation measures for stroke will contribute to the formation of an adequate attitude of the patient towards himself, illness, health, stabilize and ultimately improve his psycho-emotional state. This will allow to achieve a position of cooperation with the patient, his acceptance of personal responsibility for the implementation of the doctor's recommendations and prescriptions. Thus, the level of motivation of the patient in restoring his own health will increase.

In the acute period of the disease in stroke survivors, cerebral symptoms come to the fore, manifested in:

Fast onset exhaustion mental activity,

Increased fatigue at the end of a task

Lack of interest in results

Refusal of further examination.

Psycho-emotional disorders in stroke can be caused both by the reaction of the individual to the disease, and by specific symptoms, depending on:

Localization of the lesion

The extent of the lesion

The presence of strokes in the past.

With damage to the right hemisphere of the brain, emotional disturbances are more pronounced than with damage to the left. They can be expressed in causeless euphoria, indifferent mood, frequent laughter, inability to emotional control, violation of the subjective assessment of emotions, frivolity, underestimation of the severity of the disease, carelessness, lack of initiative, disinhibition up to tactlessness, distractibility and verbosity. With such patients, hard work is necessary, in the first stages constant stimulation from the outside is required.

When the left hemisphere is affected, patients are restless, preoccupied, pessimistic, often crying. However, they retain the awareness of their defect and the motivation for recovery necessary for rehabilitation.

With previously existing disorders of cerebral circulation, as a rule, depressive reactions, weakness, and tearfulness increase. Which is natural and justified: with repeated strokes, more severe neurological symptoms can be observed.

In the first place among the disorders of mental functions, which are described as a consequence of a stroke, are depressive disorders.

Depression can occur at different times after a stroke: early depression develops in the first 3 months, late - after 2 years and later. Women develop post-stroke depression twice as often as men.

Patients complain of a reduced background of mood, sadness, a negative idea of themselves, the world, their future.

Patients have a hard time being cut off from their usual way of life, they feel embarrassed for their helpless state, they are accompanied by a fear of being a burden for their relatives, of remaining disabled for life, longing for immobility, social and physical isolation. Which further leads to an increase in depressive symptoms.

If patients are emotionally depressed, relatives are more likely to develop depression.

Discovered and inverse relationship: The presence of depression in caregivers leads to an increase in depressive symptoms in the patients themselves.

Among the methods of treatment for the development of depression during and after a stroke, we pay attention to two types of influence:

Treatment with plastic art (painting, small plastic arts, graphics) with the aim of influencing the patient's psycho-emotional state implies:

Activation of communication with a psychotherapist or in a group

Differentiation of the experiences of the patient

Reduction of emotional stress through creative self-expression, sublimation of experiences

Development of motivation for recovery through the activation of patients' motivation for independent creativity.

MUSIC THERAPY

This is a method that uses music as a psychotherapeutic tool in the treatment of depression. Allows you to create models for the patient to get out of a state of tension at the level of feelings or images, makes it possible to experience "relaxation" as a real, controlled process and thus translates it into the category of achievable phenomena.

It exists in two forms:

Active (musical activity - reproduction, improvisation, playing)

Receptive (the process of perceiving music for a therapeutic purpose).

Socio-psychological rehabilitation after a stroke

Stroke is a formidable disease and a big problem for a person and his family. A person who has experienced a stroke suffers from his helplessness, sometimes not finding psychological support from doctors. psychologist, like Social worker can significantly help by providing psychological assistance in rehabilitation.

Psychologists working with patients after a stroke have identified the basic principles for the rehabilitation of such patients:

§ Early start of rehabilitation activities that are carried out from the first days of a stroke (if it allows general state patient), which will help to quickly restore impaired functions, prevent the development secondary complications.

§ Active participation of the patient and his family members in the rehabilitation process.

Recovery of psychological and social adaptation

My experience as a psychologist allows us to assert that most patients with the consequences of a stroke in one way or another have a violation of psychological and social adaptation, which is facilitated by such factors as pronounced motor and speech deficits, pain syndrome, and loss of social status. Such patients need a warm psychological climate, the creation of which should be largely facilitated by explanatory conversations conducted with relatives and friends of a psychologist. Social work psychologist, not only supports the recovering person, but also serves the purposes of training and adaptation.

Tasks and content of psychological support:

In the process of work, psychological correction of the following violations of higher mental functions takes place:

§ cognitive impairment (decrease in memory, intelligence, concentration of attention);

§ emotional-volitional disorders, praxis (impaired performance of complex motor acts in the absence of paresis, impaired sensitivity and coordination of movements);

§ gnosis, more often spatial (disorientation in space).

In the process of working with patients, rational psychotherapy is carried out in order to reduce the concern that has arisen in relation to the existing motor defect and the desire to overcome it. Along with antidepressants, psychological correction contributes to overcoming depression, which is accompanied by 40-60% of post-stroke patients.

The object of psycho-correctional influence of a psychologist is reactive-personal layers ( decreased self-esteem, loss of faith in recovery), especially pronounced in patients with severe defects in motor, sensory and other functions

The task of a psychologist in the socio-psychological rehabilitation after a stroke is the prevention of recurrent strokes. To do this, the psychologist collects information about the patient's risk factors, and organize preventive treatment taking them into account. The vast majority of repeated strokes develop according to the same mechanism as the first ones, so it is necessary to determine the possible genesis of the first stroke. For the prevention of recurrent intracerebral hemorrhage, it is necessary to conduct psychological conversations.

Organization of socio-psychological rehabilitation

Psychological counseling within the framework of this program is carried out by me with patients 1-2 times a week for 1-1.5 hours. The number of meetings with a psychologist and their frequency are negotiated at the beginning of the program and during.

Psychological assistance to a patient after a stroke

The consequences of a stroke experienced by a patient are determined by the presence of spasm in the arms and legs. Behavioral characteristics are subject to large changes. It becomes difficult to communicate with such a person, depression appears.

After an illness, the patient may refuse to eat for days on end and physical activities, be active in everything that happens around him. The mood changes: from a strong feeling of anger, to completely unexpected fun and joy.

Violation of behavioral characteristics

The right hemisphere is responsible for the psyche and behavior, there is a zone of mental functions. Its defeat occurs with an extensive stroke of a right-sided stroke, which is determined by instantaneous pathological processes in the cerebral cortex during stroke.

Depression in people after a stroke occurs due to their own incapacity, the inability to live a normal and full life. It seems that no one needs them, even the world is not the same as it was felt before the stroke. Ensure that the patient does not become depressed or have suicidal thoughts.

More often, a changing internal state is associated with mental deviations, when the patient is confused in recent events. This is possible if the patient's initial rehabilitation took place after a severe cerebral hemorrhage.

Most of the stroke people have problems with sleep, the victims wake up several times a night. Due to insufficient sleep, there is a sharp jump in the emotional state, at these moments they become more aggressive, uncontrollable from the outside.

Social and psychological adaptation

The period after a stroke is especially acute for those who, before the moment of illness, were engaged in vigorous activities or were in high positions. This age ranges from 25 to 60 years:

Such a person is in pathological condition when even elementary actions and skills become complex:
They are unable to answer simple questions, due to the weakness of the facial, articulatory muscles responsible for the control and correctness of speech.
There is no need to be offended and shout at such a person if, for some reason, he does not want to respond to appeals and perform simple exercises. So that the patient after a stroke can feel the love from his loved ones, give him more attention by giving small assignments around the house.

It is important that a person undergoing rehabilitation after a stroke is surrounded by people. This is achieved if the patient is admitted to a sanatorium center for the recovery of insular patients.
Communicate more often and encourage the patient. Give him faith in a speedy recovery. Remember together funny moments from living together. In particularly difficult circumstances, seek the help of a psychotherapist.

AT retirement age, you can practice various types home hobbies: learn to knit or sew toys from colored scraps for your own grandchildren. Such people should go out more often, to various city events or exhibitions.

The role of psychological assistance

The help of a psychologist after a stroke mainly lies in the fact that a person learns to control his actions and behavior in society. Reduce depression and worries, increase the volitional side of behavioral factors, overcome difficulties on your own.

Together with psychological counseling, there is an improvement in the patient's perception processes. The attending physician prescribes drugs with sedative properties, which has an effect on improving the blood flow of the brain and increasing the mental abilities of a stroke survivor.

Thanks to this approach in the treatment of stroke, the doctor, based on the results of the psychological conversation, determines a specific algorithm for further rehabilitation. Selects appropriate drugs and most suitable advice when caring for the sick at home.

Tasks of a psychologist

It consists in correcting the instability of behavior, which manifests itself for the following reasons:

Damage to the areas of the brain responsible for the cognitive side of thinking after a stroke. The patient is unable to assimilate new information, cannot remember stories from his life before the disease. The patient does not define a specific situation, it becomes difficult for him to reproduce simple words, his train of thought becomes less adequate.
Solves issues related to the volitional nature, which is necessary for patients during the rehabilitation of motor disorders after a stroke.

Acalculia, at the time of such a sign of a stroke, the patient does not determine where it is less or more.
Helps to identify existing disorders of gnosis. When the patient does not recognize familiar faces. Including concepts, forms of objects are difficult. Has disorientation in their own sensations, where the paralyzed arm or leg is located. People in this state are unable to remember why they ended up in the hospital. Due to speech disorders, a sick person is confused in the name of the subject.

Psychological counseling at home

Work with a psychologist at home is carried out according to the course of the patient's treatment in the hospital.

If in a hospital a psychological course takes place according to the scheme from 1 to 1.5 hours per lesson, conducted once or a couple of times within one week, then after discharge, the patient can communicate with a psychologist at home, at least 10 times in 6 months.

This will allow you to observe how a person after a stroke behaves before and after psychological counseling.

At the start of rehabilitation

The patient does not present a real picture of what is happening to him. Therefore, even after a partial return of lost functions, the patient is not always fully aware of what happened. Relatives, while caring for such a person, need not only to monitor his hygiene and exercise, but also pay attention to changes in his behavior:

The patient is crying or depressed.
The patient behaves not too actively, denies the presence of ailments. Refuses to exercise, often nervous.
Such people, who, due to the significant consequences of a stroke, begin to worry too much about their well-being, feel useless.

Only positive emotions can be useful, in no case reproach and resentment.

Psychological online tests

Psychological recovery after a stroke

Psychological recovery program

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

a state of psychological status, which can be unburdened or burdened (neurosis, depression, psychopathic character traits, psychoses, etc.);
the presence of mental complications caused by cerebral hemorrhage or a particular response of the patient's personality to the disease.

Relatives of a patient after a stroke need to learn to anticipate those tasks that are difficult for a still not fully rehabilitated patient.

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

Activities for psychological recovery

individual and group psychotherapy;
autogenic training;
psychotherapy with the use of acupuncture;
book therapy;
psycho-gymnastics with the use of pantomime, rhythm, dancing, singing, etc.;
cultural therapeutic activities;
work in the clubs of "former patients".

How to set up the patient to fight the disease?

Try to be specific about each step.
Distract from moral self-torture by comparisons with those who are even worse off.
Learn to recognize the need for humility with what happened.
Get involved in helping others.
Encourage hope and improvement in the future.
Teach the patient to live for today.
Learn to adapt to the created conditions of life.
To give the opportunity to feel needed and needed member of the family and society.
Avoid slovenliness and detachment from society.
Learn to behave with dignity in any situation.

Psychological and mental problems after a stroke

The process of rehabilitation after a stroke, along with somatic complications, is hampered by a disorder of cognitive functions, pathological emotional reactions of the patient to the consequences of the disease. For this reason, there is a need for psychological adaptation of patients who have undergone acute cerebrovascular accident. Complete psychological rehabilitation patients after a stroke consists of several directions.

Intrapersonal correction

Complications after a stroke lead to deformity mental processes and pathological changes in the personality of the patient.

Post-stroke depression

Depressive states cannot be unequivocally explained by only one vascular lesion of the brain. At an early stage of recovery, a person’s rejection of his new physical and mental appearance arises. The patient develops an acute sense of shame due to the resulting helplessness and forced dependence on others, there is a fear of possible disability, self-esteem falls. The characteristic features of the personality are aggravated: apathy, tearfulness are possible, in others - outbursts of irritability, anger.

Realizing the duration and complexity of treatment, patients often overestimate the severity of their condition and lose faith in their ability to recover. As a result, the motivation for inclusion in the rehabilitation process decreases. As a result of depression, patients not only stop making personal efforts for the sake of recovery, but also reject the help of doctors and relatives.

Psychological help

After a stroke, psychological correction is indicated using the methods of humanistic psychotherapy. It is necessary to get the patient to accept his position, take responsibility for restoring his health, and form adherence to treatment. Acceptance of oneself occurs due to the acceptance of the patient in a new state by his micro-society: a psychologist, relatives, friends, medical personnel, members of a rehabilitation group.

Group classes (art therapy, video therapy) contribute not only to the restoration of tactile sensitivity and motor skills, but also contribute to emotional uplift and satisfaction of the need for communication.

Application of methods of body-oriented psychotherapy, special breathing exercises for relaxation, they help relieve muscle tension, restore coordination of movements and establish contact with your body.

Medical therapy

Unfortunately, depression after a stroke also develops as a result of certain drugs (corticosteroids, tranquilizers, barbiturates, cardiac glycosides) prescribed for bodily recovery. In the case of a permanent depressed mental state of the patient, a correction of the course of drug therapy, the selection of antidepressants is required. Elderly patients are prescribed Escitalopram. With moderate depression of the psycho-emotional state and for the prevention of depressive disorder, it is recommended to take Tazodone, Paroxetine, Fluoxetine, Malnacipran.

Vascular dementia

It has been established that a stroke of the left hemisphere or several micro-strokes significantly increase the risk of dementia. Clinical manifestations of vascular dementia are very diverse and are determined by the localization of the lesion. Most often, the disease is diagnosed in elderly patients and is characterized by a decrease in memory and an increase in dementia. Psychological assistance to people with dementia includes classes in art therapy, music therapy, aimed at improving memory, maintaining intellectual activity. Classes in a group for the development of communicative potential are shown.

Post-stroke psychosis

After a stroke, there is often a regression of the mental activity of the victim. Many functions of the psyche are temporarily lost, there is inappropriate behavior. Excessive emotional arousal, spontaneity, spontaneity, or, conversely, deceit, suspicion, aggressiveness, obsessions. Most often, aggression is observed in older patients. The closest circle of relatives and friends of the patient is not ready for such changes. The danger of this condition is that the patient can harm himself and others.

Psychosis, predominantly in the form of hallucinations and delusions (delusions of jealousy, damage, poisoning, and exposure are more often noted), remains a rare complication of stroke. It develops as a result of damage to certain areas of the brain. It can manifest itself immediately after an ischemic attack with the formation of a pathological focus in the left hemisphere, or even after a year or more if the focus is on the right. In people with pre-existing mental disorders in history or predisposition to them, the likelihood of developing psychosis after a stroke increases several times.

On early stage vascular psychosis, the condition can be controlled with medication (atypical antipsychotics, anticonvulsants). The main thing is to timely detect a change in the personality of a loved one and seek help from a doctor (neurologist, psychiatrist). He will be able to assess the severity of the patient's condition and the amount of medical care required.

Interpersonal correction

As a result of the disease, the patient experiences the loss of the former social roles and changing the nature of relationships with others. Therefore, a special target audience for the work of a psychologist is also the relatives of the patient, who need help to build the right relationship with him, help him understand his condition, deal with his own experiences.

Formation of new life values and meaning of life

In many patients, complications after a stroke provoke a decrease or complete loss of working capacity. There is a need for premature termination of labor activity or its continuation in changed conditions. The impossibility of realizing professional skills, the loss of the former social status, the crisis of self-identity often lead to frustration. Therefore, patients need help in adjusting to fatal

Family members of a person who has had a stroke often experience a state of serious mental stress, caused both by worries about their loved one and their own physical overstrain.

Lack of sleep due to strong feelings and additional workload due to the need to be torn between home and hospital affect. It does not get easier when the patient is discharged from the hospital, because you need to learn. A stroke changes the life of not only the patient, but also the environment.

The recovery period after a stroke can be delayed for quite a long period of time. A person caring for a sick person develops chronic fatigue, and then both the patient and the caregiver begin to be overcome by an oppressive feeling of anxiety. Hope for a return to the old way of life begins to melt.

It is very important to prevent such a development of events, and for this, the caregiver needs, first of all, to take care of his condition.

Memo to the relatives of the patient to maintain their psychological well-being

Are you on the edge? Take a breather

The expression "Hunted horses are shot" has not yet been canceled. Give yourself a break, do not drive yourself to the point where you start to fall off your feet. The effectiveness of any activity is greatly increased if you take breaks in the process and give yourself days off. You will be able to experience relief from the improvement of the patient's condition with him only if you give so much time and effort so as not to feel like a victim and not regret the efforts expended. Do you feel guilty about letting yourself rest? Understand simple thing- the patient is weighed down by your selfless sacrifice of yourself.

Divide the responsibilities

Determine what your assistance to the patient will consist of, and what responsibilities can be delegated to other family members. Do not take everything on your own shoulders! Remember that your life is just as important as the life of the person you care for. Do not hesitate to ask others for help and do not reject the support that they themselves are ready to provide. Look for a person who can temporarily replace you when you go to the store or pharmacy when you are on vacation. This person can be not only family members, but also a neighbor or girlfriend. Perhaps someone you know will help with medicines or care products for the sick.

Keep in touch with your surroundings

Do not fence yourself off from the world, share your experiences with people around you. Consult doctors, talk to friends about your difficulties. It may be that someone close to you has care experience and can help you with advice.

Learn to silence negative thoughts

Look for activities that will distract you from negative thoughts and cheer you up. The recovery process of the patient can last several months and it is very important to maintain a positive attitude all this time. Rejoice in the little things: good tasty tea or coffee, favorite music, good interesting books. Or maybe you have a hobby that you abandoned due to difficulties? Buy nice little things for yourself, go to visit - this will help to distract and please yourself.

Find ways to relieve stress

There are many ways to relieve stress. It can be hiking, taking a relaxing bath, playing sports, yoga, massage, soothing herbal infusions. Many people calm down by knitting or embroidering.

A good way to get rid of tension is to write down your experiences on paper or draw a picture of your fears, fatigue or resentment. Use the techniques of self-hypnosis and auto-training. Here you can recommend the book of the famous psychologist Vladimir Levy "The Art of Being Yourself". Classes do not take much time, but you will definitely feel the effect.

Boost your health with vitamins

Additional load and stress undermine the strength of your body. Vitamin complexes will help you cope with the tasks you face. Available in pharmacies a wide range of vitamin preparations - choose something for yourself.

Contact a psychologist

It often becomes easier for us if we have the opportunity to speak out. A psychologist is not one of your acquaintances, in front of whom you need to “keep a face”, and it is not an accidental acquaintance who is unlikely to be able to give good advice. A psychologist will be able to give you advice that will help you cope with the situation, taking into account exactly your situation and your psychological features. You can also attend "support groups" created for people with problems similar to yours. But remember that there should be a measure in everything - do not get carried away, otherwise you risk getting used to complaining about the life of the people around you all the time.

Use the services of a babysitter.

Choose to help. Professionally trained people will make life easier for you and the ward. After all, the nurse is engaged not only in caring for the sick, but also communicates, instilling hope and optimism for a speedy recovery. And as you understand, inner peace and faith in a good outcome are the main base in any treatment.

For example, I will say that agency nurses “ Family circle NN” are first of all tested by a psychologist and are selected for work according to very strict criteria. People with extensive experience, goodwill, patience, and the ability to find an approach to the ward work here. It is important that the selection of a nurse is carried out for each individual patient. And this happens taking into account the fact that the nurse has successfully dealt with a similar case more than once. A good location of the nurse to the patient improves the quality of life of the ward and allows relatives to remain calm for his well-being.

Optimism and faith in victory

All the methods listed here will only lead to success if you consciously set yourself up to win. Fatigue and anxiety can lead to feelings of hopelessness, irritation and even hostility towards the patient. This is quite natural, so don't make things worse by judging yourself for these feelings. Just don't let yourself stay in this state for long. With a little effort, switching your attention to something pleasant, a walk - and you can regain goodwill and optimism. Believe in victory!

In my opinion, these tips are useful for relatives in case of any long-term and serious illness of a loved one.

I saw the article here:

Relatives of a stroke patient also need psychological help.

A stroke dramatically changes the life of not only the patient, but also his household.

They experience what happened no less, and often even more than the patient himself. A huge additional burden suddenly falls on the shoulders of relatives: in the first month they are torn between home, work and hospital visits.

Then, after discharge, the mastering of the difficult work of caring for a bedridden patient begins.

If the restoration of impaired functions in a patient is delayed, freedom of movement, memory, speech, self-service skills do not return for a long time, then chronic fatigue accumulates in the patient’s relatives – both emotional and physical, and the so-called “responsibility fatigue”.

Like the patient himself, the family member caring for him experiences an oppressive sense of anxiety.

And sometimes he also leaves the hope of returning to his former life, which now, from afar, seems prosperous and carefree ...

Basic rules and techniques that will help you deal with stress and fatigue

1. If you are almost at the limit, stop and rest.

Strange as it may seem, many people neglect this simple rule, not giving themselves a break until fatigue literally knocks them off their feet. Meanwhile, breaks, smoke breaks, breaks and weekends significantly increase the efficiency of any activity.

2. Ask other people for help.

There is nothing shameful about asking for help in a difficult situation. Help can be very different - a neighbor or girlfriend can sit with the patient while you are resting, go to a store or pharmacy. Someone you know or Charitable organization may help with medications or nursing aids.

3. Finally, you may also need psychological counseling.

Try to find or organize a "support group" for people with similar problems. Sometimes it's good to just talk. However, in this you need to know the measure and not get used to constantly complaining about life to everyone around.

4. Find ways to distract yourself from painful thoughts and improve your mood.

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

5. Use traditional stress relief.

Among them are hiking, a variety of water treatments, sports, yoga and meditation, acupressure, aromatherapy, sedatives herbal preparations and listening to music. Many are calmed by knitting or sorting out the rosary. It is also useful to describe on paper or draw your fear, resentment or fatigue (it doesn’t matter if you do it professionally or not).

6. Use self-hypnosis and auto-training techniques.

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

7. Choose for yourself a complex of vitamins, adaptogens, general strengthening and immunostimulating nutritional supplements.

To your organism and, in particular, to nervous system life is now demanding. Therefore, you need additional support. In any pharmacy you will find a sufficient range of vitamin and restorative products. Choose from them the most suitable for you.

8. Stay optimistic.

All the methods listed above will only help you if you consciously set yourself up to win.

Of course, from time to time feelings of hopelessness, irritation, and even hostility towards the patient can cover even the most patient person, and you should not condemn yourself for them.

It is only important not to remain in these states for a long time, but to stubbornly return oneself to benevolence, patience, endurance and optimism.

Popular in category: