Stroke Recovery: Directions, Approaches, Relapse Prevention

Despite the fact that the prevalence of acute vascular disorders in the brain (strokes) and mortality from them are quite high, modern medicine has the necessary methods of treatment 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 permanently disabled, and the degree of restoration of lost functions depends entirely on timely, competent and comprehensive rehabilitation.

As is known, in violation of cerebral circulation with brain damage, various abilities of the body are lost, 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 independently and contact 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 trouble and their death during a stroke, it is possible to “turn on” previously inactive cells, establish connections between them and, thus, restore some functions.

To limit the size of the lesion in the most early dates such medications are prescribed after a stroke that are capable of:

• Reduce swelling around the affected tissue (- mannitol, furosemide);
• To have 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, however, they are carried out for all patients. in the following main areas:

1. Usage physiotherapy exercises and massage for the correction of movement disorders;
2. Recovery of speech and memory;
3. Psychological and social rehabilitation of the patient in the family and society;
4. 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 impaired function of that 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 those who have undergone it, and in surviving patients, it most often leads to persistent violations of various functions without the possibility of their full or even partial recovery. This is due to the fact that during a hemorrhage, a significant amount 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 hard work, unfortunately, do not always give the expected result.

Recovery after a stroke can take a long time, so the effectiveness of the 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, praise the patient and encourage, as many of them are prone to manifestations of apathy and irritability.

With damage to some parts of the brain, astheno-depressive syndrome is especially pronounced, so you should not be offended if a person close to you who has had a stroke is not in the mood, grumbles at family members and refuses to do exercises or massage. It is not worth insisting on their obligatory conduct, perhaps it will be enough just to talk and somehow distract the patient.

Disability after a stroke still remains a significant medical and social problem, because even with the most thorough and timely treatment and rehabilitation, most patients never fully regain their lost abilities.

Therapy, which will help the patient recover faster, should be started early. As a rule, you can start it on stage of inpatient treatment. In this, methodologists of physiotherapy exercises, rehabilitation doctors, masseurs in the department of neurology or vascular pathology of the brain will provide significant assistance. As soon as the patient's condition stabilizes, it is necessary to transfer him to rehabilitation department to continue rehabilitation. After discharge from the hospital, the patient is observed in polyclinic at the place of residence, where he performs the necessary exercises under the supervision of a specialist, visits physiotherapy, massage, a psychotherapist or a speech therapist.

It would not be superfluous to refer 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. In view of the high prevalence of acute vascular pathology of the brain, which more and more often affects the young and able-bodied population, the creation of such centers, although costly, is quite justified, since it allows the use of the maximum possible number of intervention methods with the fastest return of patients to their usual way of life.

Recovery 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 cerebral hemorrhage has taken place. They are expressed in the form paresis(partial loss of movement) or paralysis(complete immobilization) in the arm or leg. If both the arm and the 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, it is much more difficult to restore the function of the hand due to the need to establish fine motor skills and writing.

There are various motor function recovery methods:

• electrical stimulation;
• Using the biofeedback method.

Physiotherapy

The main and most affordable way recovery from paralysis physical therapy (kinesitherapy). Its tasks include not only the development of the former strength, 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-service. Such habitual actions for us 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 on their own.

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

If necessary, use a support - a chair, headboard, stick. If there is 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 get up and even walk around the ward within the first week after the onset of a stroke. In such cases, it is possible to maintain working capacity, which is very important for young people.

With a favorable course of the post-stroke period, the patient is discharged from the hospital for recovery at home. In this case, the main role is taken, as a rule, by relatives and friends, on whose patience further rehabilitation entirely depends. Do not tire the patient with frequent and prolonged exercises. Their duration and intensity should gradually increase as one or another 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, toilet, and small chairs for additional support will not be superfluous.

Video: a set of active exercises after a stroke

Particular attention should be paid to the restoration of hand function with the ability to perform fine movements and writing. It is necessary to perform exercises to develop the muscles of the hand, to return the coordination of finger movements. It is possible to use special simulators and carpal expanders. It will also be useful, along with gymnastics, to use hand massage, which helps to 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, and even self-cooking and eating.

With a favorable course of the rehabilitation period, it is necessary to expand the circle of communication and household duties of the patient. It is important that a person feels like a full member of the family, and not a helpless disabled person. Do not neglect conversations with such a patient, even if he cannot fully answer questions. This will help to avoid possible apathy, depression and isolation of the patient with unwillingness to further recovery.

Ways to "stir up" the patient from the outside

Electrical stimulation method muscle fibers is based on the impact of pulsed currents of different frequencies. At the same time, trophism in the affected tissue improves, muscle contractility increases, tone normalizes with spastic paresis and paralysis. It is especially advisable to use electrical stimulation for long-term patients in whom active restorative gymnastics is 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 of the clinic.

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

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

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

Restoration of speech and memory function

Restoration of 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 it will be possible to return to normal life.

Speech ability suffers in most stroke survivors. This may be due not only to impaired functioning of the muscles of the face and articulation, but also to damage to the speech center, located in right-handed people in the left hemisphere. With the defeat of the corresponding parts of the brain, the ability to reproduce meaningful phrases, count, and also to understand addressed speech may disappear.

In case of such disorders, a specialist will come to the aid of the patient - a speech therapist - an aphasiologist. 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 be started as early as possible, 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 and isolate him from communication. Perhaps, even without the ability to say something, he perceives the addressed speech well. Over time, he will begin to pronounce individual words, and then whole sentences. The restoration of speech contributes a lot to the return of the ability to write.

Most stroke patients have memory impairment. They hardly remember past events of their lives, the faces of relatives may seem unfamiliar to them. In order to restore memory, it is necessary to constantly train it with the help of simple exercises and tricks. In many ways, these exercises can resemble classes with young 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 recall events from the life of the patient, how the day went, what happened a year or a month ago, and so on. As memory, speech and cognitive functions are restored, you can move on to solving crossword puzzles, memorizing various texts.

It is useful to conduct memory recovery classes all the time: at meals, when cleaning the house, on walks. Most importantly, they should not cause anxiety to the patient and cause negative emotions (memories of unpleasant events from the past).

Video: exercises for restoring speech with afferent aphasia

Psychological and social rehabilitation

In addition to caring for a patient after a stroke, restoring motor and cognitive functions, psychological and social adaptation is of no small importance. It is especially important in young and able-bodied patients with a small amount of brain damage, who are likely to return to their previous lifestyle and work.

Considering the possible pain syndrome, the inability to perform habitual actions, participate in social life, as well as the need for constant help from others, such patients are prone to depression, bouts 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 can describe them to relatives. In such cases, do not be afraid: as a rule, the appointment of special medications is sufficient to eliminate them.

The rehabilitation measures performed should correspond to the actual functional capabilities of the body, taking into account the depth of neurological disorders. It is not necessary to isolate the patient, referring to the loss of his ability to normal speech or forgetfulness - it is better to tell him the right word or entrust a 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, classes with a psychotherapist and, if necessary, prescribing medications (sedatives, antidepressants) give a good effect.

Social adaptation plays an important role in returning to normal life. It is good when there is an opportunity to return to the previous work or perform another, simpler one. If a person is already retired or the violations that have appeared do not allow him to work, you need 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 physiotherapy procedures, classes with various specialists, the patient sometimes receives such a necessary change of scenery and additional communication.

Prevention of late complications and recurrent strokes

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

1. Continuation of the initiated rehabilitation measures (exercise therapy, massage, memory and speech training);
2. The use of physiotherapeutic methods of influence (magnetic, laser therapy, heat therapy) to combat increased muscle tone in the affected limbs, adequate pain relief;
3. Normalization of blood pressure (with a hemorrhage and presence), appointment (with ischemic brain damage);
4. Normalization of lifestyle with exception bad habits compliance with the diet after a stroke.

In general, there are no strict restrictions and significant features in nutrition, so you can eat after a stroke everything that does not harm a healthy person.

It is necessary, however, to take into account the accompanying pathology and the nature of the existing changes. If the function of the pelvic organs is impaired, the patient is lying down, it is advisable to exclude products that slow down the passage of intestinal contents, and increase the proportion of vegetable salads, fruits, and cereals. To avoid violations of the urinary system, it is better not to get involved in sour, salty, as well as sorrel dishes.

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

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

Stroke and alcohol don't go together regardless of whether the patient had a heart attack or hemorrhage. The use of even small doses of alcohol leads to an increase in heart rate, an increase in blood pressure, and can also contribute. These factors can cause recurrent stroke with aggravation of neurological disorders and even death.

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

• Possible dysfunction of the organs of the genitourinary system, decreased sensitivity and potency;
• Reception of antidepressants, irritability and apathy with a decrease in sexual desire;
• Movement disorders that make it difficult to have sex.

With a favorable course of the recovery period, a return to normal marital relations is possible as soon as the patient feels strength and desire in himself. The moral support and warmth of the spouse will also contribute to the improvement of the psycho-emotional state. Moderate physical activity and positive emotions at the same time will have an extremely favorable effect on further recovery and return to 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. In severe and extensive strokes, complications from other organs are inevitable, the most common of which are:

1. Inflammatory processes of the respiratory organs (congestive pneumonia in bedridden patients);
2. Dysfunction of the pelvic organs with the addition of a secondary infection (cystitis, pyelonephritis);
3. Bedsores, especially with improper care;
4. Decrease in intestinal peristalsis with a slowdown in the movement of contents through it, which is fraught with the development of chronic inflammation, constipation.

When caring for a patient who has had a stroke, it must be remembered that a person who has suddenly lost his former 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 usual way of life early enough, and young and able-bodied people even restore their skills at their previous jobs. The outcome and consequences of the disease depend on 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.

Video: how to restore movement after a stroke? Healthy Living Program

After a stroke, patients experience a violation of many areas of the body and the loss of skills, such as walking, talking, and the ability to serve oneself. This requires a variety of activities that involve not only physical exercises, but also various physiotherapy procedures, and much more. Therefore, rehabilitation after a stroke at home is especially important after returning from a medical institution.

Recovery steps

Since a stroke is an acute circulatory disorder in the brain, it requires a gradual recovery and a gradual increase in stress on the body.

In a hospital, the patient usually stays for about 20-25 days, after which the first of the three stages of rehabilitation at home begins - early. Its duration does not exceed three months, and the following goals are set for the patient:

• Restoration of the ability to independently sit on the bed, stand near it, after visiting the restroom and perform everyday functions such as independently dressing and eating.
• Independent maintenance of personal hygiene.
• Restoring control of the urinary system.
• Return of visual acuity and speech quality.
• Recovery of sensitivity.

Most often, by the end of the second month of the first stage, a person manages to stand on his feet without help and maintain balance at the same time. For movement, he still needs support in the form of a stick or walker.

The second stage takes up to six months from the moment of the attack and is based on the fact that it is required to return fully or partially his self-service skills. The basis of this period is training walking. In the first weeks, it should be carried out with the help of loved ones or an instructor, as well as with devices such as sticks. After six months of this stage, the patient should:

• Walk without anyone's help and additional items.
• Use cutlery, writing utensils.
• Read, memorize and repeat whole texts.

The third part - the completion of recovery takes a period from the end of six months after a stroke to a year. He must walk, gradually increasing the duration of his stay in the air, speech is actually restored, and at this time the emphasis is on developing fine motor skills hands

Interesting! With a reasonable approach to the rehabilitation period, by the end of 18 months from the moment of an attack, about 90% of patients become able to lead a normal and independent life without the support of outsiders.

What is the most important thing in rehabilitation

How long a person will be able to rehabilitate after a stroke, and how much lost or impaired functions will be restored, depends on some aspects:

• Where is the focus located, and how big is it.
• What was the state of health before the attack.
• Conditions at work and at home.
• Degree of motivation.
• Attitude of close people and their support.
• The professionalism of the attending physicians and instructors.

In this regard, three basic principles are being formed, which medical rehabilitation at home must comply with:

• Multidisciplinarity.
• Early start.
• Succession and continuity.

The team of specialists whose goal is to help the patient and cure him should include:

• The resuscitator begins work from the first hours after an attack.
• Neurologist.
• The doctor and instructor of physical therapy, as well as the resuscitator, starts at an early stage.
• Physiotherapist, connected from 3-5 days.
• A psychoneurologist is necessary at the first stages not only for the patient, but also for his relatives.
• Speech therapist.
• Physiotherapy nurse.
• An ergotherapist may join later or not be included in the process at all.

This provides a multidisciplinary approach to recovery.

An early start depends more on the patient, since he must be ready at the first opportunity to start the struggle for his restoration as a fully functioning member of society. And continuity and continuity mean that there should be no breaks between inpatient treatment and each stage of rehabilitation at home.

Features of rehabilitation after ischemic and hemorrhagic stroke

Those patients who have experienced ischemic or hemorrhagic stroke and become completely or partially paralyzed require special attention in three aspects of recovery:

• Decreased muscle spasm.
• Restoration of the upper limbs.
• Restoration of the lower extremities.

In order to relieve muscle spasm, you need to use the Bobath method, which includes a series of movements, they are repeated first three times, then five, doing everything slowly and carefully. The complex contains:

• lead thumbs hands until an angle of 90 degrees is formed, in this position it is required to hold out for about three minutes.
• Pull all the fingers of the hand apart.
• With outstretched spread fingers, first bend and unbend the hand, then bend the arm at the elbow joint, and the next time the movement is made in the shoulder joint.
• Gradually pull straight thumb on your foot and freeze like this for two minutes.
• Lying on your back, bend your knees, if this causes difficulty, you can tap your hand on the popliteal fossa. Then take the thumb and gently pull the foot to the side and down. In the end, the pose should look like the legs are turned outward, slightly bent at the knees, and the heels or the entire foot are in contact.

The upper limbs are somewhat more difficult to restore than the lower ones, therefore, the following exercises are used to strengthen the shoulder girdle:

• Leading a straight arm to the side.
• Outlining a circle with the shoulders in turn or simultaneously.
• Shoulder lifts with a sharp drop.
• Reduction and dilution of the shoulder blades.

Only after the exercises for the shoulder have been done, do they go down to the elbow joint and after it to the wrist joint. At the same time, the latter is given the most time, since its recovery is the most difficult.

A comfortable program has been created for the legs, including:

• Bringing the leg bent at the knee joint to itself and its subsequent straightening.
• Taking the leg to the side without lifting it from the bed.
• Sliding heels on the bed.
• Simulation of cycling.

Psychological support as part of recovery

Given how much a patient's life changes after a stroke, depression often occurs, from which it is very difficult to return a person to a positive view of their future. The patient needs constant communication, moral support and regular contact with the outside world. home furnishings it should be extremely positive. Conversations between the patient and his close people must include various topics that are abstracted from treatment.

What should be the diet of the patient

In the first 14 days after the attack, the patient is fed exclusively with a teaspoon. At the same time, food is made semi-liquid, thoroughly crushed and rubbed through a sieve.

After swallowing is restored, patients are transferred to more solid foods, removing from the diet what will increase cholesterol: muffins, pastries and fatty foods. They try to include as many as possible in the basis of the menu:

• Wheat, rice and buckwheat.
• Vegetables, especially peas, beans, foods with a dark green and orange tint.
• Fruit, fresh or dried.
• Dairy products with a low percentage of fat.
• Protein, especially boiled or steamed poultry and fish.
• Nuts and products with natural fats in small quantities, vegetable oils.

Restoration of important body functions and skills

Speech and vision impairment is a big problem for people after a stroke.

To restore speech, the help of a speech therapist and the participation of the patient's cohabitants, who will read the primer to him, help him gradually pronounce sounds, then syllables and words, is required. With a long absence of progress, a person is taught sign language to make life easier.

Important! During communication with the patient, speech should be quiet, measured and absolutely calm. It is recommended to ask questions and try to learn some songs or tongue twisters.

The restoration of vision requires the inclusion of eye gymnastics in rehabilitation, for example, the patient can follow some object without turning his head. There are also computer programs aimed at training visual function and eye movement.

Therapeutic exercise for the patient

In the first few days after the patient is discharged, the restoration of motor functions begins in the mildest way - the person should simply change the position of the body in bed. After that, they already switch their attention to passive exercises in order to gradually relax and prepare the muscles for future loads.

Each day of the patient begins with a small warm-up, then during the day specific loads are given, which must alternate in order to gradually connect different groups muscles. The training program is created individually for each patient, and it is strictly forbidden to violate it, as this may cause a new attack.

Other types of rehabilitation fragments

Recovery requires not only therapeutic exercises, proper nutrition and psychological support, other methods should be used.

Ergotherapy

Inclusion in the treatment of ergotherapy requires the equipment of the patient's housing for his comfort: the installation of handrails and additional handles, shelves, seats, countertops and stops, as well as bedside tables. The patient is gradually taught to wash with an electric toothbrush, comfortable manicure scissors and nippers are selected, and an electric razor is chosen.

Important! As for dressing, a person must adapt to putting things on the affected part of the body first, and then on the healthy one.

It is better for him to comb while sitting, leaning his elbows on the table. In terms of eating, you will need to take deep plates, light cups with two handles, and to simplify nutrition, you can put nozzles on appliances that increase the capture area.

To make life easier for the patient, you can also use devices for fastening buttons, special overlays for door handles and elongated models of shoe horns.

Massage

Classes are complemented by massage from the early stages. In the case of ischemic stroke, it is used from 2-4 days after the attack, in the case of hemorrhagic - from 6-8 days. The first procedures last 5-10 minutes, then gradually the time increases to 30 minutes.

The general course should include 20-30 massage sessions daily. Then there is a break for one and a half to two months, and the sessions are resumed.

For massage, it is not necessary to invite a massage therapist, you can do it to the patient yourself, the main thing is to first get advice from a specialist and discuss this with your doctor.

Manual therapy

Home treatment may include soft tissue manual therapy, which will help with increased muscle tone, ligament tension, pain, and joint stiffness. But it is not allowed in the presence of skin lesions in the area of ​​future manipulation, with malignant neoplasms, acute diseases and pathologies of a mental nature.

Physiotherapy of a different kind

Patients can also undergo rehabilitation with the help of other options for physiotherapy, for example:

• Electrophoresis with Eufillin, Papaverine, magnesium sulfate or potassium bromide.
• Electrical stimulation of spasmodic muscles with modulated currents.
• Magnetotherapy.
• Laser therapy.
• Thermal treatment with paraffin, ozocerite or mud.

Also in the recovery period included sanatorium treatment.

The use of folk remedies

Folk recipes are often used in the rehabilitation period. You can use tools such as:

• Tincture on pine cones. For her, several cones are crushed and poured with vodka, then the mixture is sent to a jar, closed and left for a couple of weeks in the refrigerator. Drink the composition in a tablespoon after breakfast daily.
• Citrus tincture. 2 lemons and oranges are passed through a meat grinder, having previously pulled out the bones, and 2 tablespoons of pure honey are added to them. The composition is placed in a jar and left for 24 hours in a room, after which it is stored in the refrigerator. Use a tablespoon two to three times a day inside, drinking tea.
• Rubbing based bay leaf. For her, take 30 g of bay leaf, pour 200 ml of it olive oil and let it brew for two months in a warm and dark place, then boil and cool. Rub the remedy into paralyzed limbs.

The right approach to rehabilitation after a stroke will make it easy to restore a person at home. A early start rehabilitation measures increases the return of lost skills and functions.

A person who has suffered an attack of acute cerebrovascular accident always faces big amount problems. The main issues of concern to patients and their families are the timing of rehabilitation and prognosis for a full recovery after a stroke. How long is the recovery period and how can it be accelerated?

What determines the speed of recovery?

According to research Science Center neurology of the Russian Academy of Medical Sciences, the terms and volumes of the return of lost skills, as well as forecasts for the future life, are directly related to the form of stroke suffered by the patient, the size of the brain tissue lesion, the age of the patient, and the usefulness of the therapeutic measures provided to the victim. Rehabilitation after a stroke is never easy, as cerebrovascular accident always entails many different negative consequences manifested several years after the stroke.

Stroke severity affects recovery time

The recovery period for different people can vary significantly in terms of the timing and rate of return of skills. In patients who have had a major stroke, there are serious disorders of the most important functions, so it will take a long time to return the lost skills, and even with the maximum implementation of the prescribed rehabilitation program, the prognosis is in most cases unfavorable. The greatest difficulties are associated with the full return of speech and motor function - relatives who devote enough time to special classes with the patient can help reduce the time.

In young people with a small brain lesion, in the absence of comorbidities and careful observance of medical prescriptions, the period of full recovery passes quickly - it can take no more than two months, while the forecasts for a complete cure will be favorable.

When to start classes?

During a stroke, it is customary to distinguish periods that differ in clinical symptoms and the body's susceptibility to therapeutic measures:

• The period of the most acute manifestations is the first day after the onset of the disease; the speed of first aid and the usefulness of the treatment directly affect the prognosis of the disease and the speed of recovery after a stroke.
• Acute period - takes the first three weeks of the disease.
• The subacute period is from the third week to the third month after the stroke. It is at this time that experts recommend starting the simplest exercises to restore motor skills - these can be passive exercises performed with the help of an assistant, or exercises for the development of speech. A special method is the position treatment method: the patient's limbs are placed in different positions to prevent the development of muscle hypertonicity. An important condition that accelerates the pace of rehabilitation is the timely intake of prescribed medicines.
• The early recovery period is from the third to the sixth month from the onset of the disease. This time is the most favorable for rehabilitation, classes during this period are considered the most productive. In no case should treatment be delayed due to the high risk of slowing down the rate of recovery. The patient is prescribed intensive massage, active physiotherapy exercises are added to passive exercises, and physiotherapy is carried out. Most often, the patient is already discharged from the hospital during this period, so all activities are carried out on an outpatient basis.
• The period of late rehabilitation is the second half of the year from the onset of the disease; the body's potential for recovery gradually decreases, but remains sufficient to return the lost skills.
• Long-term consequences - a year after a stroke, the rate of return of functions decreases, recovery is delayed; exercises during this period give little results.

The sooner you start recovery measures, the more effective they will be.

How long is the hospital stay? On average, treatment in a hospital is carried out during the first month, and it is recommended to start classes already at this time - in this case, the probability of reducing the rehabilitation period is maximum. The exercise program is always selected individually, based on the nature of the violations in the patient; the prescribed tasks should be performed systematically over a long period, or rather, until the lost skills are fully returned. Many tasks are performed with some effort.

Estimated terms of rehabilitation

As it becomes clear, the terms of a complete cure for each patient are different. For some patients, a couple of months is enough, but in most cases, patients need a significant amount of time. It's hard to say how much - sometimes the rehabilitation period stretches for several years.

The fundamental factor is the early start of measures to restore lost skills and the patient's focus on the result - without the patient's internal desire to recover, the effect of the classes will be low, and the prognosis will be unfavorable.

Any treatment after a stroke should be carried out under the supervision of a specialist - only he can make changes to the rehabilitation program, regulate the level physical activity and appoint medications. With an extract from the hospital, the recovery period of the patient does not end. Doing the prescribed exercise daily over a long period of time will help reduce the chance of another attack of acute cerebrovascular accident.

Prognosis after a stroke

It is possible to talk about forecasts for a further full life only after the acute period of the disease is over. Much depends on the form of stroke - in case of circulatory disorders of the hemorrhagic type, the prognosis is more favorable and recovery will go faster. Ischemic stroke almost always entails more severe consequences, so favorable signs in this case are: the absence of a pronounced speech disorder, cerebral symptoms, the presence of movements in the limbs in the first three days after the stroke. In patients with such symptoms, a complete recovery is possible within the first months. In the case of falling into a coma on the first day after a cerebral infarction, unilateral loss of sensitivity, severe speech impairment and preservation of paralysis after three months, the prognosis for restoring the ability to self-service is unfavorable. The absence of active movements in the limbs after six months or a year indicates a minimal likelihood of progress.

The prognosis for the recovery of motor skills after a stroke is in direct proportion to the age of the patient - the older he is, the less likely it is to fully return the functions and the longer the rehabilitation period. In many ways, how long the recovery will take depends on the patient's mood for a positive outcome and the desire to work on himself.

Rehabilitation after a stroke is a long stage in the life of a person who has suffered a serious illness.

This step requires a lot of patience and care. medical workers, relatives and just surrounding people. A stroke rehabilitation hospital gives the initial impetus to get rid of complications, but only rehabilitation after a stroke at home gives a person a return to a full life. Naturally, in addition to a great desire to help, close people should know the basic principles of treatment and be able to put them into practice.

The essence of the problem

As you know, the brain regulates the work of the entire human body, and damage to any part of it affects the functional abilities in the most negative way. With a stroke, the blood supply to a certain part of the brain stops, which leads to the death of cells in its tissue. There are 2 types of pathology: ischemic and hemorrhagic stroke. With the ischemic variety (the most common), blockage of blood vessels occurs, blood flow is blocked. The hemorrhagic variant is characterized by rupture of blood vessels and hemorrhage of blood into the brain tissue.

Blocking the blood supply causes cell death as a result of the lack of oxygen, brain edema is formed. Dysfunctions internal organs stroke depends on the location of the affected area. After a lesion, a person may have impaired perception of any information about the world around him, limb mobility and coordination of movements, the swallowing process, the ability and regulation of urination and defecation. The patient may lose hearing, vision, the ability to speak, lose memory and the ability to think logically. He may lose the ability to control emotions.

Goals of rehabilitation measures

When a stroke occurs, rehabilitation is aimed at restoring the affected brain tissues and normalizing the functions of internal organs that were impaired during brain damage. Rehabilitation after an ischemic stroke is a very long period, including a gradual, phased recovery. In general, the treatment of pathology includes 3 main stages: emergency measures to save a person with the elimination of the affected areas of blood vessels; stationary neurological impact to restore the blood supply to the affected area and the rehabilitation period, which begins in a hospital and continues at home.

When carrying out rehabilitation measures, one must honestly realize that the possibilities of rehabilitation depend on the degree of brain damage, and sometimes a complete cure is impossible. Dead cells are not restored, and the normalization of the brain is carried out at the expense of the surviving neurons, which have a certain reserve that can compensate for the loss of other neurons. If the lesion does not have catastrophic consequences, then rehabilitation measures make it possible to mobilize the reserve of undamaged cells and restore the working capacity of the brain.

The following possibilities of therapeutic and rehabilitation actions can be noted, taking into account their duration. When did ischemic stroke, rehabilitation for minor neurological disorders until partial recovery takes 1.5-2.5 months, until complete recovery - 2.5-4 months. If a stroke occurred with noticeable neurological consequences, then the duration until partial normalization of functions with the restoration of independence is about 6.5-7 months, and full recovery lasts several years and does not have a full guarantee of a cure. In the case of a widespread stroke of both types with severe consequences, the possibility of achieving partial independence of the patient is achieved only after 1.5-2.5 years of active rehabilitation measures, and a complete cure is almost impossible.

Basic principles of rehabilitation measures

Rehabilitation after a stroke includes a complex of medical, psychological, pedagogical and social procedures. All of them are aimed at restoring the lost functions of the body, returning full independence, self-service and adaptation of a sick person in society. The main stages can be distinguished: early rehabilitation, restoration of independence and the adaptation period.

Early rehabilitation is carried out in stationary conditions and is aimed at restoring the most important functions that provide the possibility of breathing, nutrition and, if possible, elementary movements. For such purposes, a specialized rehabilitation center after a stroke is most suitable. Rehabilitation after a stroke in Moscow is highly effective. The goal of medical institutions is the most complete restoration of brain functions and the prevention of secondary complications. Eliminates the risk of congestive pneumonia, thrombophlebitis, muscle dystrophy.

When a hemorrhagic or ischemic stroke has occurred, rehabilitation at home is carried out at the next stage. It is important that the transfer to home conditions does not violate the system of rehabilitation measures that have been started, but becomes a natural continuation of it. The second stage takes a long period, but the procedures should be continued constantly with the maximum participation of loved ones. If a stroke occurs, rehabilitation at home provides a complete recovery, and only the patient implementation of all recommendations gives a chance for recovery.

Recovery of motor abilities

One of the first tasks of rehabilitation measures is the return of motor ability to a person, which makes it possible for self-service and independent continuation of treatment. The main method is kinesitherapy, based on the use of special physiotherapy exercises. The tasks of exercise therapy include restoring balance control, joint mobility, muscle tone and muscle strength, the ability to move and self-service. In specialized centers, the possibilities of exercise therapy are expanding through the use of electrical stimulation of the neuromuscular system and the biofeedback method.

Exercises should be started literally from the first days after a stroke, as soon as the presence of consciousness allows. Classes begin with the help of a rehabilitation doctor or health worker (passive gymnastics).

As the general condition of the patient improves, the exercises gradually, systematically become more difficult - a sitting position is provided artificially, with the gradual learning of independent sitting and getting out of bed. With a significant impairment of motor abilities, the initial exercises imitate walking in a lying or sitting position. The next step is learning to walk. The first movements are walking in place, then moving, holding on to a wall or backrest, with a gradual transfer to support on a cane. Restoring the ability to self-service is carried out at home according to the same principle: from simple to complex. The first steps are holding a spoon while eating, then personal hygiene techniques (washing, brushing your teeth). The next important step is dressing yourself, using the toilet and finally the bathroom.

Accounting for complicating factors

After a stroke, a sick person may experience a number of complications that interfere with the recovery process. One of these phenomena is the increasing muscle tone in the extremities - muscle spasticity. This phenomenon greatly complicates the normalization of motor ability. To eliminate this negative factor, the following rehabilitation measures are carried out:

• specific stretching of the limbs with the help of special splints for 1.5-2.5 hours daily;
• contrast massage: slow muscle smoothing with increased tone And active influence on other, not activated muscles;
• applications from paraffin or ozocerite;
• taking drugs with muscle relaxant properties;
• on such muscles, loads that increase tone are prohibited: expanders, squeezing a rubber ball.

Another important factor is the articular changes in the limbs. To eliminate this factor, the following measures are recommended: physiotherapy with analgesic effect (electro-, magneto- and laser therapy, acupuncture); measures to normalize traffic (applications, hydrotherapy, hormonal agents); application of a fixing bandage.

Measures to restore speech

The restoration of the speech apparatus is extremely slow. Moreover, the patient not only cannot speak himself, he does not distinguish between the speech of others. Rehabilitation in this direction requires perseverance and patience from loved ones - classes must continue constantly, even in the absence of any effect. Speech rehabilitation can continue for years until it gives a positive effect.

The main task of speech rehabilitation is to force the nerve cells of the affected speech center of the brain to perform their lost functions. This is achieved only by constant exercises on the organs of hearing. It is necessary to constantly talk with a sick person, even if he does not understand anything.

Lost speech is restored through training. Classes begin with the pronunciation of sounds and syllables. The patient should try to say the word without pronouncing the ending. The playback volume of sounds gradually increases. One of the final stages is the recitation of verses. The most favorable training is with the use of singing. As a rule, the pronunciation of words in the form of singing in the patient is faster.

An important rehabilitation process includes the development of facial and chewing muscles, which accelerate speech adaptation. The following procedures are recommended as simple exercises in this direction: periodic folding of the lips in the form of a tube; baring of teeth; sticking out the tongue to the maximum distance; biting lips (upper and lower alternately); licking the lips with a rotating movement of the tongue.

Memory rehabilitation

Recovery of memory in a person who has experienced a stroke is usually one of the longest rehabilitation processes. It should be borne in mind that after a stroke, both operational and event memory can be impaired. The first stage includes drug exposure. For this purpose, an injection of nootropic drugs that normalize metabolic transformations is carried out. Gradually, injections can be replaced by taking pills at home. The following agents are most often prescribed: Piracetam, Lucetam, Nootropil, Phezam, Thiocetam. The course of drug treatment is 2.5-4 months.

Working memory training includes such activities: memorizing and repeating numbers, memorizing poems and phrases. A good workout is the use of board games with memorization elements.

Medical recovery

Full rehabilitation after a stroke is impossible without medical support for recovery processes. Usually complex therapy is carried out with the appointment of the following drugs:

• to normalize blood supply - Pentoxifylline, Cavinton, Cerebrolysin;
• to normalize metabolism - Cerakson, Actovegin, Cortexin, Cinnarizine, Solcoseryl;
• universal preparations - Fezim, Thiocetam, Neuro-norm;
• to reduce the excitability of neurons - Glycine;
• to improve muscle activity - Sirdalud;
• antidepressants - Gidazepam, Adaptol.

Rehabilitation after a stroke is a necessary step in the overall treatment regimen for pathology. Such events are held in special Centers, but the main procedures are carried out at home, which requires special patience and care on the part of loved ones.

Article publication date: 11/25/2016

Article last updated: 12/18/2018

In this article, you will learn: what recovery measures after a stroke include, and what functions of the body most often need to be restored. How can you train muscles without resorting to expensive equipment and specialists.

Rehabilitation after a stroke is a set of measures that are aimed at the fastest and most complete adaptation of a person to life in new conditions. New conditions are the consequences of the disease: partial or complete loss of the functions of the arms and (or) legs, as well as speech, memory and intelligence disorders. All this causes partial temporary or complete disability, social maladaptation (impossibility to live as before a stroke), the quality of life decreases.

The consequences of a stroke depend on which parts of the brain were affected.

A set of rehabilitation measures begins within the first hours after a stroke and continues after discharge from the hospital. There are three stages during a stroke:

1. acute (up to 21-28 days);
2. subacute - a period of up to 3 months;
3. recovery period - up to a year.

This is followed by a period of long-term consequences, when work on your physical body, begun in the acute period, continues. The patient is still under the supervision of specialists, undergoing treatment in a sanatorium, periodically visits the clinic and the "School of Life" for people who have had a stroke.

The doctors who deal with the problem are rehabilitators, but usually a whole group of doctors is involved in rehabilitation.

Physicians-rehabilitators are engaged in the rehabilitation of patients after a stroke

What exactly needs to be restored after a stroke?

After a stroke, several functions suffer, without the restoration of which it is impossible to return to a full life: motor, speech and cognitive.

Functional impairments and the frequency with which they occur are presented in Table 1.

Movement disorders

Speech disorders

Cognitive impairment (memory, mental abilities)

Cognitive impairment is observed during the first three months, followed by recovery in 30% of cases by the end of the first year. If a stroke occurred in old age (after 75 years), then, most likely, the process will be aggravated.

So, the violations come to the fore: partial violations of motor functions, loss of speech and loss of intelligence.

Principles and tasks of rehabilitation

At the heart of the speedy return of a person “to service” are several principles (how and when to start and continue recovery):

1. Early start of rehabilitation measures.
2. Regular (daily or several times a day), adequate (those loads that are feasible), long-term treatment with medication and exercise. The entire rehabilitation period can be from several months to several years.
3. Active desire, participation of the patient, help of loved ones.

During the recovery period, the support of loved ones is very important.

Rehabilitation tasks (what needs to be done, what aspires to):

1. Partial or complete restoration of lost functions.
2. The fastest social adaptation of the patient.
3. Preventive measures to prevent deterioration of important functions. The disease causes severe emotional discomfort, but in no case should one “give up”.

Only guided by principles can you achieve your goals! There are no other ways! It is very difficult psychologically for such patients, meaning and joy are lost, it is unusual to feel dependent. However, you yourself can start correcting the situation today.

Neurologists believe that in order to restore motor functions, new pathways of interaction between the limbs and the centers of the brain must be formed. It's possible. Already 50% of patients who have suffered a stroke by the end of the first year can partially or completely restore motor functions, which are so important at the initial stage.

Complex of rehabilitation measures

Doctors believe that if at least one link in the complex recovery of a patient after a stroke is defective, then the effect is sharply reduced. An integrated approach includes:

Doctors of the following specialties treat such patients:

1. Resuscitators (when in the intensive care unit and intensive care).
2. Neurosurgeons, vascular surgeons. Sometimes it is advisable to restore blood flow in the arteries (large vessels that feed the brain).
3. Neurologists.
4. Psychoneurologists.
5. Cardiologists (if correction of cardiovascular disorders is required), rehabilitation doctors (make up an individual rehabilitation plan, the so-called IPR).
6. Speech therapists-aphasiologists (restoration of speech disorders), physiotherapists.
7. Occupational therapists (teach self-service skills in specialized labor workshops).
8. Masseurs.
9. Specially trained junior medical staff.

The whole complex of activities that was started in the hospital is necessarily continued at home. For one or several months, patients are on sick leave and develop lost functions.

During this period, they must be visited at home by specialists (from the list above), who will help and direct training in the right direction; change medications or keep the same. Later (after 6 months) you can go to a sanatorium. When the condition allows, the patient attends the "School of Life" for people with the same problems.

1. Drug treatment

The drugs discussed in Table 2 are used in courses, intravenously, intramuscularly or in the form of tablets. The choice depends on the stage of rehabilitation, the characteristics of the general condition, the localization of the focus area. A focus is a section of brain cells affected during a stroke (some of them completely die, some are restored).

Drug groups	Main action
Drugs that stabilize the movement of blood through the vessels	Intravenous medications, Normalize the work of the heart, rhythm, breathing
Drugs to lower blood pressure	Reduce the negative impact of hypertension. Reduce vascular tone and prevent the risk of recurrent stroke
Blood thinning with antiplatelet agents or anticoagulants	Prevent the development of thrombosis of the lower extremities, Used after doctors rule out hemorrhagic stroke
Antioxidants	Needed to prevent brain cell death and partial recovery
Muscle relaxants	Relieve painful spasms (sharp contraction) of the muscles of the limbs
Neurotrophic agents	Used for speech disorders, memory, to restore motor activity
Antidepressants	When in a bad mood

2. Recovery of speech disorders

Since these are the highest mental functions, it takes more time to restore them - from two years. Of course, it's a long time. But the child spends more time on it!

Speech therapist uses pictures to restore the patient's speech

At the next stage, a speech therapist teaches a person to tell and retell, to conduct a dialogue. Start with classes for 20-30 minutes, increasing their duration to an hour. The final moment is learning the monologue.

Speech rehabilitation after a stroke occurs against the background of drug therapy with drugs that improve the blood supply to the brain.

3. Restoration of memory and mental abilities, work with a psychologist

For these tasks, use drug treatment. The control of restoration of functions is carried out according to the results of the electroencephalogram.

Psychological sessions are required. By the end of the first year, memory recovery is observed in a third of all patients.

A stroke is a tragedy for patients and their families. Psychologists consider the communication of the patient, joint pastime, walks to be extremely important. You can help not only with medicines, but also with a word.

The work of a psychologist and (or) a psychiatrist is aimed at identifying depression, psychopathic conditions (for example, epilepsy) and creating a motivational factor for recovery. The psychologist is looking for new goals and helps the patient to set goals - this is how the doctor forms an interest in life in new conditions. Also, the psychologist necessarily discusses with the patient his condition and treatment - after all, this is the main thing for the patient.

4. Recovery of motor functions

This recovery begins from the first hours after a stroke, if there are no contraindications in the form of angina pectoris (cardiac ischemia), arterial hypertension. The whole complex of measures to restore motor functions must be applied at home.

simulators

The recovery process after a stroke is long, it may be worth buying some kind of simulator. There is a huge group of simulators designed for active (at the expense of the patient) or passive (at the expense of the apparatus) actions in the affected limbs of the arms and (or) legs:

1. Seat simulators for developing skills of lifting from a chair;
2. Playgrounds for teaching walking skills;
3. Exercise bikes for arms and legs.

Types of simulators for recovery after a stroke

Robot trainers or robotic equipment

In 2010, Japanese doctors introduced the public to a completely new approach to restoring motor functions. The method is based on the assumption that the central nervous system very plastic, and it is possible to train it (namely the brain) already at the stage of observation.

Robotic equipment helps stroke patients restore the function of affected limbs and improve their mobility

The patient after a stroke is extremely unmotivated, and the principle of "observe and move" on himself (virtual reality) perfectly stimulates the desire to practice. The method clearly demonstrates how the affected limb moves. A person remembers repeatedly repeated movements and begins to imitate.

Forecast

Perhaps the main concern of these patients is disability.

In many ways, the prognosis depends on the volume of brain damage, on the location of the focus and the disorders that accompany a stroke. The situation becomes clear in terms of prognosis (disability or not) by the end of the first month after the event.

Table 3 shows the data for Russia, which were published by the doctors of the Cathedral Hospital of the Moscow Medical Academy named after Sechenov in 2012 (Journal "Clinical Gerontology"):

Degree of disability	Number of patients