Compression stockings.

In this article, we will talk about physiotherapy exercises after a stroke in the early recovery period. This is a very important period for the restoration of movements in post-stroke patients, right now it is important to form the correct full-fledged movements in paralyzed limbs, to prevent complications such as muscle spasticity and limitation of mobility in the joints of paralyzed limbs - contracture. If the patient is given enough attention and dealt with conscientiously, then it is possible to achieve a complete restoration of all movements. It must be remembered that the rehabilitation of post-stroke patients depends on the depth of damage to the nervous system, the age of the patient, concomitant diseases and other factors. That is, we can not always achieve what we want, but we must strive for more.

The previous articles on this topic are preparatory to the very process of exercise therapy in order to recover patients who have had a stroke or other diseases of the nervous system. Information is of great importance in reducing the recovery time. In these articles we talked

On the psychological aspects that need to be taken into account when working with neurological patients in order to establish good contact, without which things will not work;
- (techniques for turning patients in bed, laying limbs in the position of the patient lying on his side, pulling up in bed, transferring to a chair and back to bed);
- because during physiotherapy exercises a second stroke can occur;
- , the use of which greatly accelerates the recovery time of post-stroke patients, reduces possible complications facilitates the recovery process.

Now let's get down to business. Our final goal is to achieve the maximum recovery of movements lost as a result of a stroke, especially self-care skills, as well as to contribute to the prevention of complications that occur after a stroke.

Complications are:
venous stasis in the extremities,
bedsores,
joint atrophy,
muscle contracture,
congestive pneumonia,
constipation,
depression.

The post-stroke patient is first in intensive care under the supervision of sensitive medical staff. As a result of a stroke, cerebral edema occurs, which can worsen the patient's condition. At this stage, from the side of exercise therapy, the treatment is positioned depending on the patient's condition.

Further, when the patient's condition stabilizes, he is transferred to the intensive care unit in the neurological department, where the treatment of the disease, the consequence of which is a stroke, and the prevention of stroke complications continue.

The right action on your part would be to find an opportunity to talk with the attending neurologist and the exercise therapy instructor of the hospital and find out what help you can provide for the speedy recovery of your relative, what can and cannot be done.

You need to deal with the patient as often as possible, there are many tasks: prevention of congestive pneumonia, bedsores, muscle contractures, in which there may be a limitation of mobility in the joints, the formation of correct movements in the limbs. (Let me remind you that “right hemisphere” post-stroke patients are more disinhibited than “left hemisphere” ones, they strive to start walking as soon as possible, they do not obey, and this leads to the formation of abnormal walking, which looks like dragging a paralyzed leg to a healthy one). You need to approach a neurological patient with a positive attitude, talk about the good, convince that everything will work out, you just need to work well and conscientiously and remember the instructions of the doctor and exercise therapy instructor.

Prevention of contractures.

"Glove".

Prevention and treatment of spasticity in the muscles of the limbs after a stroke includes a special,

the use of splints and fixators,

correct passive and active gymnastics,

therapeutic massage and other physiotherapy procedures.

First you need to either buy a special fixator for the hand, or make a plywood splint for the hand of a paralyzed hand to prevent muscle contracture. It is easier and more practical to make a splint like a mitten, but if the doctor

Longuet like mittens.

says that you need a longuet like a glove, then so be it. Longet is cut out of durable plywood according to an individual pattern of the shape of the hand and half of the forearm from paper (newspaper). If there is no spasticity, then a splint can be made along the contour of the sore arm; if spasticity has appeared, then you can outline the contour of your patient's healthy arm. Contact an exercise therapy instructor so that an experienced health worker can help you correctly “draw” a stencil of a patient’s hand on paper, order a carpenter to make this part out of plywood. You need to ask the master that the plywood carpal splint is smooth, durable, without burrs. You will need to buy at the pharmacy for the arms and legs three good quality elastic bandages of 2 meters each.

We will bandage the splint on the hand with an elastic bandage for 30 minutes three times a day so that the fingertips are located along the edge of the splint, and the thumb is laid aside. When spasticity appears in the hand, the fingers are clenched into a fist: you must first fix the splint in the area of ​​​​the wrist joint, and then straighten the fingers one by one; adjust the longuet so that the brush is correctly positioned according to its shape, and bandage it loosely so as not to disturb the blood circulation in the hand. Under the palm closer to the fingers, you can put a regular medium-sized bandage in order to give the physiological position of the hand: the fingers will be slightly bent.
A straightened arm with a bandaged splint is placed in three positions for 10 minutes each (the patient lies on his back): along the body, up and to the side with the hand turned with the palmar surface up. If there is spasticity, then the hand will tend to lower towards the body, bend at the elbow joint, fingers clenched into a fist. If it is not possible to sit and hold the patient's hand in the desired position, you need to come up with some devices: press down with pillows or tie wide ribbon to the bed (you can use sheets instead of tape for soft fixation).

In case of complete paralysis in the upper limb it is necessary to alternate either applying a straightening carpal splint, or laying the fingers into a fist in order to maintain the range of motion in the joints of the hand. We will make the position of the hand into a fist as follows: put a large bandage or a napkin rolled up in a roller, or a small ball the size of an orange into the brush, bend the fingers of the paralyzed hand so that they somehow capture this small roller, and gently bandage it in this position, starting with wrist joint, for 30 minutes 3 times a day.

If you do not have the opportunity to apply a splint 3 times a day due to being busy with other things, then apply at least once a day for no more than 2 hours.

The feet also require attention, because during prolonged bed rest the feet “sag”, the ankle joint is gradually deformed, and then, when the patient learns to walk, the foot cannot stand up correctly, this creates difficulties for walking: the patient needs to learn to control the paralyzed leg, and even the foot is deformed.

Therefore, from the first days after the stroke, we put both feet in the extension position at an angle of 90 degrees so that the feet do not sag, using either ordinary plywood boxes or placing the feet on the back of the bed, you can adapt the Cramer splint for this or buy a special device in medical equipment for feet. And, when the patient can sit on a chair, put the emphasis on the floor so that there is a right angle between the foot and the lower leg. In the supine position with straightened legs, we remember the need to place a soft roller (15 cm in diameter) under the patient's knees in order to give a physiological position.

Passive gymnastics.

The procedure for passive gymnastics for the limbs is simple: look at what movements an arm or leg can make in a given joint, and perform these movements with your patient 10 to 15 times. It is necessary to pay attention to the fact that passive gymnastics is performed slowly, smoothly, carefully; it is not necessary to make movements in the paralyzed limbs with the maximum possible amplitude, so as not to “loose” the joints. Start with the distal limbs: from the hands and feet, then move on to the medium and large joints.

Passive gymnastics for paralyzed limbs is performed on all joints:

Flexion and extension of the fingers;
flexion and extension of the hand, rotation of the hand;
flexion and extension of the elbow joint;
rotation of the arm in the shoulder joint, abduction and adduction of the arm, raising the arm up and down along the body.

Flexion and extension of the foot
rotation of the foot clockwise and counterclockwise,
flexion and extension of the knee joint,
rotation in the hip joint.

You can tilt the legs bent at the knee joints to the sides with a limited amplitude. This is pleasant for a patient who has stagnation in all organs and tissues due to long lying and inability to move. Movement is a vital need of the body. Therefore, treat the post-stroke patient with understanding and compassion. This exercise will help improve blood circulation in the tissues of the lower back.

It is important to note that the muscles of the paralyzed arm do not hold the shoulder joint in the shoulder joint capsule, it is held in place by the ligamentous apparatus, but the ligaments are able to stretch. It is convenient to detect this when the patient is sitting on a chair: put your palms on the patient's shoulders and feel the surface of both shoulder joints with your fingers, you will find the difference: on the diseased side, a gap between the head of the humerus and the articular bag is revealed. Therefore, in order to prevent stretching of the ligaments and dislocation of the arm, one should not pull the patient by the paralyzed arm, and when vertical position the patient (sitting or standing), the hand must be tied with a scarf or a special arm support bandage should be purchased.

Passive gymnastics is combined with massage elements to improve blood circulation in the limbs. You can do stroking from the periphery to the center, light rubbing and gentle kneading. Vibration (kneading) and deep kneading should not be done, as this contributes to increased muscle tone, which can lead to spasticity, since the nervous system is significantly activated by sending impulses, and can “give out” pathological commands to the muscles. Therapeutic massage is best left to experienced professionals.

Prevention of bedsores.

Bedsores are formed with a long monotonous position of the patient, more often - on the protruding parts of the body: the sacrum, shoulder blades, heels, elbows, nape. Due to a violation of blood microcirculation in the soft tissues of the protruding parts of the body, their necrosis occurs. Dead tissues become a source of intoxication of the body, suppurate and become infected. This cannot be allowed.

1). It is necessary to change the position of the patient every two hours: lay it on the back, then; sit down in bed, placing pillows under the upper body, or a special device for sitting down.

It is very convenient to care for the sick if there is a functional bed. The comfort of the bed means a lot to both the patient and those who care for him. Therefore, consult with your doctor about choosing a bed according to the necessary functions.

If it is not possible to buy such a bed, then I advise you to put an ordinary bed with an orthopedic mattress on a hard surface so that it can be accessed from three or all four sides. A bed with a width of 90-100 cm is comfortable: this makes it possible to turn the patient in bed either to the right or to the left side, simply by rolling him. That is, you do not have to pull it to the center every time, as on a narrow bed, so that the person does not fall when turning on his side.

2). An anti-decubitus mattress is used to prevent bedsores. Air is alternately pumped into the cells of such a mattress, then it is blown off, thus unloading soft tissues and improving blood microcirculation in them.

3). More tips. When changing the position of the body, it is recommended to do a light massage of the tissues that are most susceptible to compression during prolonged lying: light spiral kneading with shifting the skin around the protruding parts with warm, clean hands, without calluses, so as not to scratch the skin.

Be careful to bed sheets and the shirt of the patient were well straightened, do not allow wrinkles - they can affect the formation of pressure sores.

Prevention of congestive pneumonia.

Prevention of congestive pneumonia is to

1). regularly change the position of the patient's body, (it is very useful to sit down in bed, lay on the stomach (if the patient's condition allows), sit on a chair),
2). practice breathing exercises:

diaphragmatic breathing,
- breathing with a sound exhalation: "U-u-u-ff" and "U-u-u-u-xxx" (10 times several times a day),
- a home-made breathing simulator: a bottle of water into which a long tube is inserted (you can take it from a drip system). Inhale through the nose, exhale through the tube into the water for 10 minutes 3 times a day.
- Frolov's breathing simulator is perfect.
- If you can inflate balloons, it will be wonderful.
In general, what the patient can do, then use it.

To teach diaphragmatic breathing, for clarity, you can use the border of the abdominal wall excursion: the instructor's palm is at a distance of 2–3 cm above the patient's abdomen, the abdomen inflates while inhaling, the patient tries to reach the instructor's palm with his stomach. This good advice, but you can come up with other techniques so that the patient understands the task.

3). Useful percussion massage in the projection of the lungs on the back. Please note that it is impossible to beat in the kidney area. Their projection is easy to find if you slide your fingers along the edge of the costal arch from front to back closer to the spine, where the palms lay down, approximately there is the projection of the kidneys.

Prevention of venous stasis in the lower extremities.

Prevention of venous stasis in the lower extremities is carried out from the first days after a stroke, since it is dangerous not only for circulatory disorders in the legs, but also for the formation of blood clots. I recommend not using stockings, but elastic bandages, since when bandaging it is possible to adjust the tension of the elastic bandage. Elastic anti-varicose stockings or elastic bandages should be periodically removed for an hour so that the skin and soft tissues legs are rested. During physiotherapy exercises, therapeutic stockings should be worn, especially if there are blood clots in the veins. Of particular danger are blood clots in medium-sized vessels.

We are talking about the complications of the post-stroke period because it plays a significant role in their prevention. The exercise therapy instructor takes an active part in the prevention and treatment of complications of the post-stroke period, but he cannot be near one patient all the time, so relatives should be involved in the care of post-stroke patients and actively help health workers in the recovery of the patient. This is also useful because you will learn the most necessary manipulations for caring for the patient, and at home after he is discharged from the hospital, it will be much easier for you to care for him.

Therapeutic exercise after a stroke.

We will begin to restore movement as soon as the patient begins to understand you. I recommend that you first do a massage of the brushes using the main system of correspondence to the human body. (I repeat in different articles, but this is important to speed up the recovery process). On the hands of a post-stroke patient, we mentally represent his body as it is, the patient's hands turn into a control panel for this person's body, and we massage with our hands from the fingertips to the wrist joint, concentrating on what you want to achieve: imagine that blood circulation in paralyzed limbs improves, nerve conduction is restored, and the muscles of the arms, legs and torso work like a healthy person. It will be easier to cope with those who have knowledge of human anatomy and physiology. For each brush - about 3 minutes.

We perform passive gymnastics for paralyzed limbs with massage elements to improve blood circulation in them and to send sensitive impulses to the brain.

Starting to gradually connect active gymnastics.

The first classes are carried out in bed lying on your back.

We ask the patient to slowly squeeze the healthy hand into a fist several times and extend the hand as much as possible, spreading the fingers. We pay attention to the fact that he remembers these movements well. Now we will do the same with the brush on the paralyzed side. We give the task to simultaneously squeeze and unclench the hands, at first very slowly so that the student can concentrate on this movement. We help the paralyzed hand, slightly pushing the fingers. Verbally support: “Strong, brave, healthy! And-and-and-rrraz! And-and-and-two-a! ... ". We do the same with the feet, helping the hands to make movements in the feet.

We give the task to close the hands in the lock and, with the help of a healthy hand, straighten the arms up and down, the same - behind the head, rotation with straightened arms clockwise and counterclockwise. The student can do this exercise independently several times during the day.

Attributes increase interest in exercises. I have successfully used a short stick 35 - 50 cm long. The patient is held by a healthy hand at one end. And we bandage the other hand in the grip position with the brush to the second end of the stick. The student is given the task to bend and unbend his arms in the elbow joints, at this time we help the sick arm to move correctly.

The following task is also performed: raise the stick up (towards the ceiling), as if it were a barbell. The upward movement should be fast, and lower to the starting position smoothly. Before each straightening of the arms, a short pause should be made to prepare for the repetition of the movement, since the nervous system must remember how to control the body. Therefore, the focus of the student on the qualitative performance of tasks is required.

Straightened arms with a stick raise and lower behind the head, put. Return to starting position.

Raise straightened arms with a stick and stretch forward, trying to raise the upper half of the body, as if imitating an attempt to stand up. Return to starting position, relax.

Bandage the stick to the patient's hand in the center, with support, he straightens his arm up (towards the ceiling), we give the task to rotate the stick in one direction and the other.

The hands are closed in a castle, straightened arms are raised and lie on a pillow near the head. Alternately bend your knees, starting with a healthy leg, and grab your knee with your hands. We help move the paralyzed leg, support the arm.

When movements appear in the hand, we complicate the task: straighten the arms with the hands closed in the lock upwards with the palms turned out.

Alternate flexion and extension of the legs in the knee joints, sliding the feet on the bed, starting with a healthy leg. As always, we help move the “sore” leg.

"Bicycle" alternately with each leg for 4 circles, starting with a healthy one. Repeat several times at a slow pace. Strive for the emphasis to be on self-pulling the foot, as this movement plays a big role in learning to walk.

A good exercise with the knees tilted to the sides. Bend the legs, feet are on the bed, bandage the knees to each other with an elastic bandage, while tilting the knees to the sides, help only where the patient finds it difficult: support the knees a little and set the desired amplitude. In the same position of the legs, you can teach to raise bent legs, tearing your feet off the bed.

Sending impulses.

If the patient is capable of figurative thinking, then alternately raising straightened arms with eyes closed. First, the healthy hand slowly rises and falls, then the "sick" hand. You may choose not to raise the student's paralyzed arm, but you may. The patient himself mentally raises and lowers his hand, as if healthy. At this time, the nervous system is activated, impulses are sent from the brain to muscle contraction. The patient feels a tickle or a breeze on the arm.

We also train the student to control the legs: alternately raise straightened legs, starting from the healthy side.

We ask the patient to focus on the "sick" foot and give the task to bend and unbend the feet and hands at the same time. On which organ the student will focus, in that place there will be more nerve impulses. When you begin to practice and apply the sending of impulses by focusing on a specific organ, then evaluate the effectiveness of this technique, a creative approach will also appear, you will be able to invent new various tasks yourself, which undoubtedly increases the patient's interest in exercises, exercise therapy after stroke becomes a favorite pastime, especially when there is at least a tiny victory.

Usually, flexion of the arm in the elbow joint is restored first. This is a great joy for the patient, he is inspired to actively engage. We explain to him that we must fundamentally strive to straighten the arm, and bend the leg. The rest will follow. You can not overwork nervous system, it is better to do it several times a day a little with pauses for rest and accumulation of strength for a new impulse to the muscles and joints.

At this stage, we teach the patient to turn on his side. Technique: bend your knees, tilt them in the direction where the body will turn. We help only where there are difficulties, you can’t pull on a paralyzed arm, we try to “force” the arms, legs and body muscles to work independently. Every day, with quality regular exercises, the movements will improve. The student's attention should be drawn to the fact that nothing worked before, but now he already knows how to perform some movements.

If the patient can lie on his stomach, great. We put our hands in the “in front of us” position, the foot of the “sick” leg lies on the ankle of the healthy leg. We give the task to bend and unbend the legs at the knee joints. It will be great if the student can focus on the "sore" leg and consciously make it work. Then the recovery of movements in the leg flexors will occur faster.

Then we learn to sit on the edge of the bed. After turning on your side, lower your legs down from the edge of the bed and straighten the body, pushing off the bed with your hand. The legs should rest on the floor with the entire surface of the feet at a small distance from each other. The body leans forward slightly to create stability in a sitting position. It is easier to sit up on the bed after turning to the healthy side. But we must train the student to stand on either side. Therefore, we will have patience and we will lay on our back, turn on our side, push off the bed with our hand, straightening the body, either on the right side or on the left. This should be done slowly so as not to cause dizziness in the patient. This exercise trains the vestibular apparatus, helps to restore the sense of body position in space and balance. If there is dizziness, then we simply carefully sit down in bed, without changing the position of the body many times. We will increase the load gradually, coordinating our actions with the doctor.

Followed by transfer from bed to chair. I have simplified this technique: the chair is placed close to the bed and the patient's leg, both of whose legs are joined together and the feet are firmly planted on the floor at the point around which the patient's body will be rotated and transferred to the chair. During transplantation, the weight of the patient's body is transferred to his feet, and so that the legs do not move, we hold his knees between our legs. Before transferring the student to a chair, we grab him with our arms in an embrace under the chest, swing with him, and at the expense of “one ..., two ..., three!” with a quick movement, we transfer the body from the bed to the chair. This technique can be called the compass technique, since the stop of the feet corresponds to the end of the compass with a needle, and the pelvic part of the body corresponds to the end of the compass with a pencil.

Sit on the chair - this is an exercise for a paralyzed patient: it is very difficult to keep the body upright after a long lying down, he may fall. Therefore, we will provide for as many points of support as possible, these are legs apart with feet firmly resting on the floor, the body should be strictly vertical, the patient should not fall back, should not be cushioned from all sides, as we need to train the muscles of the body. Sitting on a chair, the patient holds on to the bed or other support with his healthy hand, and on the other hand, a table or other furniture should be placed to prevent falling. The paralyzed arm should be tied with a scarf so that the ligaments of the shoulder joint do not stretch under the weight of the sagging arm. You can sit on a chair in the early recovery period for 20 minutes, later you can sit for an unlimited amount of time.

I will note the wonderful exercise of transplanting the patient with movement along the edge of the bed into one and then into reverse side. The muscles of the legs and torso are strengthened, preparations are made for standing up. First, we rearrange the student’s legs closed together, then we transplant him to the side along the edge of the bed a little further than the stop point of the feet, transferring the weight of the patient’s body to his feet at this time. Then again move the feet slightly to the side. And so we continue to change to the right, to the left to the headboard. That is, in one direction the feet alternately move with an emphasis on a point on the floor, then the butt is a little further than the feet.

When the patient can sit confidently in a chair and not fall, . First, let's practice doing this exercise: the patient lies in bed on his back, paralyzed, bent at the knee joint, with his leg (foot) rests on the chest of the exercise therapy instructor, who leans his chest on the patient's foot, at the command “Push me. And-and-and-time! the student pushes the instructor with his foot, straightening it. Let's repeat 5-6 times.

Metal hinges allow only block-like movements (flexion-extension) and exclude the possibility of overextension in the knee joint.

Before standing up, the knee of the paralyzed leg should be fixed either with a special knee brace or bandaged with an elastic bandage to prevent the knee joint from extending backwards, as this can lead to sprains and damage to the knee joint.

You need to get up with him in an embrace from the healthy side so that he can hold on to you with his healthy hand. The patient's legs are slightly apart. You need to sit on a chair slowly, slightly tilting the body forward to transfer the weight of the body to the feet, and you need to get up decisively, slowly getting up is a big load on the muscles; but it is necessary to straighten up when standing up slowly so that there is no fall back (with a quick straightening when standing up, the patient may not calculate the amplitude of movement). Learn to sit down and stand up several times in one session.

We have mastered the ability to stand, go to, there is a separate article about this. And now you can learn to trample from foot to foot. Now the patient can get up from the chair himself and stand, holding his hand on some kind of support (for example, the back of the bed).

Mastering and sliding the feet forward - back while sitting on a chair. (You can use a roller foot massager). As soon as the student manages to move the lower leg back (under the chair), you can quietly rejoice, since it is believed that the patient has "gone." From this moment on, you can be sure that you will teach him to walk.

Master any manipulation with the movement of a post-stroke patient on healthy person, then you will have a better idea of ​​the possible difficulties.

As you can see, there is a lot of trouble in recovering from a stroke. We haven't covered all the exercises yet. In the following articles, we will talk about self-care skills as well.

I want to remind you of the need to take care of yours while working with a paralyzed patient. You can put on a lumbosacral corset before a heavy load on the spine, strengthen the muscles that hold the spine in a physiological state with special exercises.

Think also about how difficult it is to restore the body after the death of part of the brain as a result of a stroke. It is much better to prevent a stroke or myocardial infarction by early detection of those diseases, the complications of which they are. Do not ignore the advice and prescriptions of doctors, but you must conscientiously be treated and monitor your health.

So, we touched on very important points for the care and recovery of post-stroke patients in the early period. Of course, it is impossible to describe absolutely all the techniques and techniques in the article. It is necessary to communicate with interest with the medical workers who are involved in the restoration of your relative, and see with your own eyes how everything should be done.
Wish you good health and active longevity.
With love to you, Nina Petrova.

A stroke never goes away without consequences. Because of acute violation blood circulation, massive death of brain cells occurs.

As a result - loss of functionality of organs and limbs.

Problems with motor activity can persist for years, but with the right physiotherapy treatment, it is possible to mitigate the consequences of the disease, returning the person to normal life.

So, what are the types of gymnastics for recovering from a stroke at home and how to do the exercises correctly?

The main goal of all such exercises is to restore the ability to fully move.

Moreover, such gymnastics has no contraindications as such.

It can be practiced already 5-6 days after a cerebral hemorrhage, unless, of course, a “command” is given from the doctor.

Exercise principles:

• restoration of the sensitivity of the affected limbs due to constant motor activity;
• return of activity to the affected brain cells;
• if too many cells have died, then gymnastics is designed to “replace” them with previously inactive brain cells.

Gymnastics is the basis of a person’s recovery after a stroke, and no additional medical procedures she does not require. All medicinal methods of recovery are allocated to another group of therapeutic measures.

These exercises are available to almost everyone, as they do not require large physical exertion.

A stroke never goes away for a person without a trace. and is it dangerous?

Drugs used to treat stroke should not be ignored as they eliminate blood clots and improve memory. You will find a list of funds.

Complex of passive gymnastics

Passive gymnastics is not aimed at strengthening muscles and developing joint flexibility. Its task is to restore the activity of the affected brain cells. These nerve cells are delicately involved in motor activity by performing simple exercises:

• Flexion and extension of the limbs. It is necessary to work with both the affected and the healthy side. You need to start the complex on the side of the body that was not affected by the stroke.
• Contractions of the hands. It consists in simple squeezing and unclenching. We start with a healthy hand, then connect the patient. The doctor sometimes recommends adding to this simultaneous work with both hands.
• Rotational movements. The limbs are twisted in a circle. In this case, the amplitude of rotation should gradually increase.
• Leg movements. The legs are bent at the knees, after which they are retracted and brought to the stomach.

A set of passive exercises

The complex of passive exercises also includes breathing exercises. It consists in several deep breaths, followed by a return to the normal mode of operation of the lungs.

A person who has had a stroke is very weak. Even these simple exercises can cause him severe fatigue. Try not to set too large loads.

Gymnastics in the prone position

These exercises belong to the "passive" complex. They are used to restore limb activity immediately after a stroke. Gymnastics is aimed at "development" different groups muscles.

• Neck muscles. The person fixes his gaze in front of him, and begins to turn his head in different sides as much as the body's capacity allows.
• Fingers. You can perform gymnastics both alternately and on both hands at the same time. Moreover, this exercise is permissible in any position, but is usually done in a prone position. After 10 finger curls, a break is taken for 10 minutes, after which the exercise is repeated. The more and more often you engage with your fingers, the faster the effect will come.
• Knees. The person lies on his back, bending and unbending his legs 10 times per approach. Moreover, the feet should not come off the bed, it is necessary that they slide along its surface.
• Arms and upper back. The patient takes the back of the bed with his hands, lying on his back, and pulls himself up to the first fatigue.
• Hand joints. The man lies on his back, slowly bending left hand, and then just as slowly placed on the bed. Immediately after this, the right is bent in the same way.
• Eye exercises. First, the eyeballs alternately move up and down and left and right. After that, close your eyes and make a few rotational movements. During rest, you need to blink quickly for 7 seconds.

The main task of this complex is to remove the fixation of muscles in a contracted position. The first results come at different times, it all depends on general condition sick.

Gymnastics in a sitting position

These exercises are suitable for people who have already partially recovered from a stroke and can sit up on their own (with a little help). Exercise strengthens the arms and legs and prepares the person for walking.

• deflections. You should lean on the pillow and grab the bed with both hands. The legs are extended forward and, if possible, kept on weight. First you need to slowly bend forward, throwing your head back, and then slowly return to the starting position.
• Move your legs. Hands should hold firmly on the edges of the bed, and stretch your legs forward. Next, the person should alternately slowly raise and lower the legs, trying to make sure that the feet are completely on the floor. You can’t hold your breath, repeat 4 times for each leg in one approach.
• Hand motor development. For these exercises, you will need "props". We take a deep bowl and put a lot of items in it. different forms, colors and destinations. Also, they should differ in weight. For this, pencils, nuts, dried peas, coils, buttons, figures are suitable. The person will have to sort them out with his hands, and then, with his sore hand, he will individually transfer them to another container.

These exercises may seem difficult for people who have had a stroke recently. If you have the strength, but there is no desire, then you should “influence”, but you don’t need to force it to work, it’s better to do the “lying” exercises for the time being.

Gymnastics in a standing position

These exercises are considered difficult for "stroke sufferers", so they should be done already in the final stages of recovery and with the consent of the attending physician. Their main task is to teach a person to fully stand and walk, as well as perform complex movements in a standing position.

• Tilts. The legs are placed shoulder-width apart, hands rest on the lower back. Slowly, a forward bend is made while inhaling, and while exhaling, you should slowly unbend. You can do up to 10 slopes in one trip. Tilts to the sides are made according to the same scheme, but in this case it is necessary to simultaneously do lunges with the legs in the direction of the declination of the body.
• Jumping. You can jump as you like, the main thing is to keep your hands on your belt. The exercise is continuously repeated for 35-40 seconds, after which you should rest.
• Walking in place. You can replace it with a light jog around the apartment. Perform approaches for no more than 6 minutes. This exercise well restores breathing and strengthens the lungs.
• Squats. The peculiarity of this exercise is that one arm is extended forward, and the other is removed behind the head. After each full squat, the hands change. A break is made every 10 times.
• Mill. Strengthens almost all muscles, activating large sectors of the brain. Legs together, one arm above the head, the other extended along the body. We count to ten, changing hands at each count. It is done 10 times per approach, but if a person is already strong enough and gets tired slightly, you can try to increase the rate to 15.

Gymnastics for the eyes

If it suddenly turns out that these exercises are too heavy, then they should be abandoned until the general condition of the body improves.

Stroke survivors are often moody. For example, a person is able to perform an exercise, but does not want to, starting to refer to fatigue. You need to learn to recognize such whims and stop them.

Recovery after a stroke is a long and complex process, fraught with many pitfalls. Gymnastics is the basis of this process. It allows you to activate the affected brain cells, and also strengthens the muscles and develops the flexibility of the joints.

You should not greatly overload a person, forcing him to do exercises that are unbearable for his condition, everything should be in moderation. Remember that the fate of a loved one who has had a brain hemorrhage depends on your care and understanding!

Since stroke is a very common pathology, it exists. You can familiarize yourself with the algorithm of events by reading the article.

What is a migraine stroke and does it have anything in common with a regular stroke, you will find out.

Related video

Nerve cells die and motor disorders are observed in 80% of patients. Rehabilitation measures are needed to restore functions, including physiotherapy exercises.

Exercise therapy is an individually selected set of exercises, taking into account the characteristics of the disease, its degree and stage of development, and the patient's well-being. Dosed daily loads are shown, starting from 2-3 days after the attack.

About the benefits of exercise therapy

Exercise after a stroke speeds up the recovery process. Daily activities improve blood circulation, do not allow blood to stagnate, contribute to the restoration of muscle memory, reduce muscle tone, prevent the development of contractures, bedsores, atrophy and spasms, eliminate involuntary movements of the limb.

Physical exercise lead to positive changes in the body:

• improves the functioning of the cardiovascular system;
• breathing normalizes;
• metabolic processes are stimulated;
• getting better emotional condition sick.

Exercise therapy after a stroke includes compensatory mechanisms for the restoration of functions. Multiple repetitions of exercises contribute to the emergence of new conditioned reflex connections.

Contraindications to exercise therapy

Physiotherapy exercises are not prescribed for the following conditions:

• being in a coma;
• repeated people;
• epileptic seizures;
• mental disorders and aggressive behavior;
• availability diabetes, tuberculosis, malignant tumors.

At hemorrhagic stroke Exercise therapy is prescribed when the patient's symptoms stop growing, the work of the vascular system improves and internal organs. In the first 3 days from the start of classes, breathing exercises and surface massage are shown. Therapeutic exercise is contraindicated if blood pressure exceeds 180/105 mm Hg. Art.

Preparatory activities

Preparation for exercise therapy consists of the following steps:

1. Changing the position of the patient's body to prevent stagnation of blood.
2. Passive loads for different joints and muscle groups by medical staff: circular movements and abduction of limbs, flexion and extension.
3. Breathing exercises to improve lung function.
4. Mental gymnastics to restore muscle memory.
5. Massage to normalize blood circulation and prepare the body for more active activities.

Passive loads

When the patient regains consciousness, passive gymnastics is prescribed. IN early period perform position correction. On the affected muscles increased tone apply light strokes. For the rest of the muscles, deeper massage techniques are used: gentle rubbing and kneading.

Gymnastics for bedridden patients is carried out carefully, the patient's breathing should be free. With stiffness, classes begin with large joints, in the absence of contractures and increased muscle tone - from the distal parts of the arms and legs.

To restore muscle memory, use mental gymnastics. To restore memory, you need to perform mental exercises daily, during which the patient himself or his relative voices what movement he makes. For example: "I move my hand to the side."

A person who has had a stroke is depressed, feels disabled, does not believe in himself, so he needs to be encouraged and praised.

Paralysis often leads to impaired speech. It is important to do articulation exercises every day and not interrupt your practice. In order for the function to recover faster, it is necessary to talk with the patient, he must hear speech. Classes begin with the reproduction of individual sounds, then gradually move on to syllables and words.

Passive exercises should be done 2-3 times a day, 10-15 repetitions for each joint. It is important to monitor the patient's reaction. You can not allow holding your breath, the appearance of pain and increased muscle tone.

Active physical activity

Active loads are aimed at restoring old and forming new conditioned reflexes.
Exercises include 2 phases - static and dynamic. Performed by a methodologist for exercise therapy. The first phase causes muscle tension, develops the ability to hold an arm or leg in the desired position. The second phase is the movement itself.

The goal of active training is to achieve isolated movements in the patient with the help of light resistance.

When a person is paralyzed, the fine motor skills. Its recovery depends on the degree of loss of motor function. If the hand does not move at all, passive loads are needed. Then they move on to exercises on turning cards, collecting scattered coins, writing letters, etc.

Patients are shown exercises on a stationary bike to train the cardiovascular system and restore motor skills of the lower extremities.

If there are no contraindications during the recovery period, you can connect the yoga method, but not earlier than 6 months after the stroke.

Lying exercises

Gymnastics in bed is started in the early period of rehabilitation. Exercises after a stroke are performed in the supine position, stomach, healthy side.

Exercise 1. The patient lies on his back. His ankles need to be clasped with his hands and his legs bent at the knees so that the feet slide on the bed (imitation of walking).

Exercise 2. Suspend the affected arm of the paralyzed person on a towel and rotate it in a circle. Do up to 30 minutes with breaks of 2-3 minutes.

Exercise 3. To restore the swallowing reflex, you need to perform the following exercises:

1. strain your mouth, depicting a whistle without a sound;
2. cough up;
3. to yawn;
4. snore;
5. pushing, pronounce "a" and "e".

Lying down, you can do exercises for the eyes and hands.

Lying gymnastics is preparation for the next stage, when the patient will be able to perform sitting and standing exercises for the vestibular apparatus, restore coordination of movements and begin to learn to walk.

Complexes from a sitting position

When the acute period ends and the patient can sit down, they move on to sitting.

Exercise 1. Lean back against the pillow, stretch your legs, hold on to the edges of the bed with your hands. While inhaling, bend forward a little, while exhaling - take the starting position. Repeat 5 times.

Exercise 2. Sit on the bed, keep your back straight, take your hands to the sides. Bring shoulder blades together. Repeat 5 times.

Exercise 3. In a sitting position, hold on to the edge of the bed with your hands. Raise the left and right legs alternately. Perform 4 times with each leg.

Complexes from a standing position

Exercise 1. Feet shoulder width apart, hands on the belt. While inhaling, turn to the left, while exhaling - to the right. Perform slowly 5 times in each direction.

Exercise 2. Feet shoulder-width apart, arms lowered along the body. Raise your hands up, stretch slightly, inhale; lower your hands down, describe a circle with them, exhale. Repeat 5 times.

Exercise 3. Stand on your toes, raise your hands up and stretch, as if trying to reach the ceiling.

Exercise 4. Walking in place for 30 seconds.

Eye Complex

The motor function of the eyes is restored after a stroke with the help of the following exercises:

1. With an effort to squeeze and unclench the eyelids 15 times.
2. Move eyeballs up-down-right-left with open and closed eyes.
3. Fix your gaze at one point.
4. Blink frequently.
5. Roll your eyes clockwise and counterclockwise.

Loads for hands

With an affected hand, flexion and extension of the fingers are performed in any convenient position 10 times.

To strengthen the shoulder joint, an exercise is performed lying on a healthy side. Methodist fixes right hand shoulder joint, slowly and smoothly removes the affected limb from the body with the left hand. The methodologist holds the patient's elbow with the forearm in a state of pronation, and the hand in an extended position, then raises his arm up, takes it to the side, then back.

In the supine position, the methodologist unbends the patient's arm at the elbow with abduction to the side.

When minimal voluntary movements appear in the paralyzed hand, they proceed to the exercise of raising and lowering the affected limb using a block device and a healthy hand.

Loads for the legs

To restore movement in the joints and muscles of the legs, the following exercises are used:

1. Abduction and adduction of the hip.
2. Rotation in the hip joint.
3. Passive flexion and extension in the knee joints.
4. Passive knee extension lying on the side with the hip extended.
5. Raising the leg with a healthy hand and using a block with a cord.
6. Passive movements in the ankle.

They start with healthy limbs, then alternate them with exercises for the paralyzed, combined with massage and muscle relaxation.

Active movements are done slowly, avoiding painful exercises.

Complex for articulation

In case of violation cerebral circulation Stroke paralyzes the muscles of the face, and the person loses the ability to pronounce sounds. The following complex helps to restore articulation:

1. Roll the lips into a tube and stretch.
2. Stick out your tongue as much as possible.
3. Open your lips wide, as for the pronunciation of "y".
4. Bite the upper and lower lips alternately.

Daily classes make it possible to quickly return intelligible speech.

Breathing exercises

Classes should be started when the patient regains consciousness and can control the muscles of the face. The simplest action is to exhale through closed lips.

Gymnastics after a stroke consists of a deep breath, a delay for a few seconds of breathing and a slow exhalation.

The patient must see the result and believe that the function will be restored. When he gets better, he can puff balloon or blow into a tube dipped in water. So he sees how the ball increases in size, or hears how water gurgles.

Breathing exercises are often performed with rest breaks. You can not strain while holding your breath, so that dizziness or headaches do not occur.

simulators

To rehabilitate after a stroke, classes on simulators help, such as:

• The verticalizer gives the human body a vertical position.
• Rehabilitation exercise bike with electric or mechanical drive.
• Lokomat is designed for people who are learning to walk.
• Exercise equipment for legs and arms. "Bud" develops fingers. "Shagong" imitates walking and can be used for bedridden patients.

In order for the patient to recover faster, A complex approach. Medical therapy without exercise therapy will not give the desired result.

Many patients after a stroke manage to return to working capacity and lead a normal life. The main condition is activity, perseverance, self-confidence. And most importantly - movement, movement, movement. Even a bedridden patient can and should exercise. And if he cannot, due to complete immobility, then those who care for him should do passive gymnastics for him.

Here are a few examples of how paralyzed bedridden patients after a stroke were able to fully recover from disabled people to full-fledged people. As well as advice on rehabilitation after a stroke

Rubbing for those who have had a stroke

This tool helps to restore body mobility to bedridden patients after a stroke. To prepare the rub, you need to take the following dry crushed ingredients: half a glass of black radish peel, 1/2 cup horseradish leaves, 2-3 pods of hot pepper, 1/4 cup partitions walnut, 1/4 cup pine nut peel. Put all this in a jar and pour 500 ml of alcohol or triple cologne. Infuse the mixture for 7-9 days. Rub the entire body of the patient dry from head to toe. (HLS 2000, No. 14, p. 12)

You can limit yourself in tincture to only black radish peel and hot capsicum (HLS 2010, No. 14, p. 19)

Stroke Exercises - Post Stroke Massage

A man at work had a stroke. taken away Right side body, swallowing functions disappeared. Hospital, injections, tube feeding... 10 days have passed, and there was no improvement. Then the wife, who decided to use folk remedies. Daily gave 8 teaspoons of blue iodine on jelly during feeding. As a result, 4 days after that, he began to swallow on his own. From Gavaa Luvsana's book "Essays on Oriental Reflexology Methods," she wrote out points on the meridians that should be massaged in case of a stroke. First, the right foot warmed up, which was icy, then the right side began to function. As a result, the man again went to work (HLS 2000, No. 24, p. 7)

Care of the bedridden patient after a stroke

In the first days after a stroke, the patient is doomed to complete immobility. To prevent pulmonary edema, a bedridden patient should be turned in bed every 2 hours. When the condition improves, sit him in bed for a few minutes. If the patient is conscious, it is necessary to force him to do breathing exercises, most often they are allowed to inflate inflatable toys.
So that a paralyzed bedridden patient does not form bedsores after a stroke, it is necessary to wipe the skin daily with camphor alcohol or a mixture of vodka and shampoo. If the patient still has skin damage, it is necessary to wipe them with a solution of potassium permanganate and lubricate with rosehip oil.

With a bedridden patient after a stroke, even if he is completely immobilized, it is necessary to carry out passive gymnastics, this prevents blood stasis and thrombophlebitis. The patient's arms and legs must be bent, unbent, lifted and massaged.
It is necessary to constantly talk with the patient, even if it seems to you that he does not understand the speech addressed to him. This will allow faster recovery logical thinking and speech. (HLS 2001, No. 3, p. 8-, from a conversation with Dr. MN Kadykov A. S.)

Exercise after a stroke

A 65-year-old woman suffered a stroke, her right side was paralyzed. At first she fell into depression, she did not want to live, so as not to be a burden on the family, but her daughters convinced her to fight for life. And she began to fight. At the hospital, doctors taught the patient to walk, moving a chair in front of her, at home she continued these classes, and as a result she was able to move independently.

Every day he does exercises for paralyzed hands and feet: gymnastics, counting, rolling with sticks (smooth and spiked), rolling a tennis ball and rubber balls. He also collects pyramids with his right hand, puts 100 pencils from the table into a box, collects dominoes, squeezes the carpal expander, sorts through the knuckles of the beads with his fingers, shakes right foot“frog” (foot pump for inflating chambers) 120 times, pulls the expander with his right hand - 200 times, sits down and stands on a high chair, holding the handrail - 50 times, reads aloud to restore speech.

There is a desire to reduce the number of exercises, but every time a woman pulls herself up and tries to increase them every month. Everyone is happy to celebrate small victories: the hand has already begun to clench into a fist, now it turns out to eat with a spoon in the right hand, etc ...
(HLS 2002, No. 10, p. 3)

Exercises for the hands and fingers.

1. Drum your fingers on the table
2. Do finger splits
3. Widely spread, and then squeeze your fingers
4. Put the brush on the table or on the bed. Raise each finger in turn, then raise the whole palm.
5. Holding a paralyzed hand with a healthy hand, raise a sick hand
6. Putting your elbow on the table, hold your hand vertically, reach your palm with your fingers
7. thumb hands to press on each other finger of the same hand.
8. Putting your palms together, rest each finger in turn on the opposite
9. Elbows on the table, palms together. Raise and lower your elbows, sliding them on the table
10. Roll the rolling pin on the table with your palm.
11. Roll up the foam with your fingers.
12. Take a stick in both outstretched hands and twist it, intercepting, clockwise and counterclockwise
13. Throw a stick from one hand to another.
14. Roll the ball with your fingers away from you and towards you.
15. Like spinning a light bulb, spin the ball clockwise and back
16. Squeeze the ball between the palms and put pressure on it
17. Toss the ball from hand to hand.

Exercises after a stroke for the arms and development of the shoulder joint.

1. Stretch your arms forward and put the diseased healthy arm, bending at the elbows. A "frame" is formed. We make turns, moving the "frame" to the left and right.
2. Lower and raise hands in the lock, helping a paralyzed healthy hand
3. With hands clasped in a lock, make circular movements.
4. Without disengaging your hands, rotate your shoulders back and forth
5. Raise the hands clasped in the lock up, spread apart and lower

Exercises after a stroke for the legs.

1. Sit on the floor, unbend and bend your knees, sliding your feet along the floor.
2. Sitting on the floor, legs extended forward. Move your legs in turn to the side, sliding your feet on the floor
3. Raise a straight leg and put it on the other.
4. Pull one knee to the chest, then the other.
5. Lying on your stomach, toes rest on the floor, tear your knees off the floor.
6. Crawl
7. Sitting on a chair, roll your feet from heel to toe and back
8. Sitting on a chair, spread and flatten your heels. Then lower your legs to your heels and bring them together - spread your socks
9. Put the affected leg on the healthy one and rotate the ankle joint.

Massage and exercise for stroke prevention

In Russia, 400,000 strokes occur annually. The reasons are stress, deterioration of blood circulation in the vessels of the brain.
To manage yourself and resist stressful situations, a relaxation exercise will help: you need to sit comfortably, close your eyes and be alone with yourself for 10-15 minutes. Do this exercise 2-3 times a day.
To increase cerebral circulation and avoid a stroke, it is useful to do a head massage.
1. With fingers clenched into a fist, you need to stroke your head from the forehead to the back of the head and neck, and then to reverse direction(2-3 times)
2. Beat the whole head with fingertips for 1-2 minutes
3. With fingertips, beat whiskey and cheeks for 1-2 minutes
4. Rub your ears with your palms.
5. Rub the left shoulder with the right hand
6. Rubbing the right shoulder with the left hand

To improve cerebral circulation, it is useful to perform vibro-gymnastics. Stand on tiptoe and drop sharply, hitting the heels on the floor. 20 concussion-lifts with the vertical position of the head, 20 - with the head tilted to the right, 20 - with the tilt to the left and 20 - with the head tilted forward. (HLS 2002, No. 24, p. 12)

Mental exercise after a stroke

"Mental gymnastics" helps patients recover, even bedridden patients after a stroke can do it. It is possible to restore the central nervous regulation that controls the motor activity of the affected areas of the body by creating a mental image of a particular exercise.

Imagine that you clench your fingers into a fist, raise your feet up, lower them down. The clearer the “picture”, the faster connections are formed with other parts of the brain, which will take over the functions of nervous regulation of the parts of the body affected by paralysis.

Each mental exercise leaves its mark in the brain, when repeated, a chain of such traces is created and a new center of nerve connections is formed that controls movement.

Depending on the severity of brain damage, the will of the patient, patience and perseverance, the process of building new connections can take a month or a year. And you also need unconditional faith in the power of mental training. Whether this faith is true or false, it will work wonders. Set goals and go for them. (HLS 2002, No. 13, p. 19. Boris Goryachev, doctor)

Exercise "Kalmyk yoga"

Many senile diseases are associated with impaired cerebral circulation. Patients fight these diseases with breathing exercises according to the methods of Strelnikova, Budeiko, Frolov. These systems have one thing in common: the content of carbon dioxide in the blood rises, and this increases the blood flow to the brain and heart, dilates blood vessels. The exercise “Kalmyk yoga” works on the same principle.

There are cases when the exercise "Kalmyk yoga" completely removed the diagnosis of "diabetes mellitus", many people significantly lower the level blood pressure(from 190/100 to 140/90). But you need to practice every day for 2-3 years. This is a long time, but this exercise will not only save you from recurrent stroke and heart attack, but also completely rejuvenate and strengthen the body.

“Kalmyk yoga” is squats with breath holding and the torso tilted parallel to the floor. When doing the foundation exercise thumbs close the nostrils. You should do 10-15 sets of 20-60 squats.
The man suffered a heart attack, his wife showed him an article about Kalmyk yoga. He began to do exercises daily, gradually gave up all medications, the pressure returned to normal, his health became perfect. (Healthy lifestyle 2003 No. 3, p. 23)

Simple gymnastics for bedridden patients

A 58-year-old man suffered a stroke. He knew that the only way so that a bedridden patient after a stroke turns into a full-fledged person - these are daily physical exercise. There is no time to waste, you need to start exercising immediately, while still lying in bed, in order to overcome the consequences of a brain stroke.

You can start with the simplest exercises (1) and move on to more complex ones (10):
1. Raising a paralyzed hand, first you can help with a healthy hand, and even earlier, those who care for the paralyzed patient should raise the sick hand for the paralyzed patient.
2. Squeeze a clothespin with the affected hand, it will not work the first time, but it will work out on the tenth or hundredth attempt.
3. Lying down, squeeze the mattress with a sick hand and make circular movements on it.
4. After you get stronger and start to sit down, learn to write with your left hand.
5. Dip in water and wring out a rag. Over time, wipe the tiles in the kitchen and bathroom.
6. Squeeze a rubber ball with your hand to make it more pleasant to do - pierce it. Perform 100 repetitions.
7. Sculpt balls from plasticine.
8. To develop the legs, use a rubber ball, round sticks - you need to roll them with your foot on the floor, gradually increasing the pressure.
9. Rest against the wall with your hands (if the sick hand does not rise, help her with a healthy one), shift from one foot to the other.
10. Lean forward, touching the floor with your fingers.
The most important thing is to defeat apathy, laziness, the belief that you are no longer good for anything and will not be able to return to normal life.
The man has been doing these exercises for three years, as a result, he learned to serve himself, walks around the apartment freely, and on the street with a stick, he learned to write with his right hand, on which, after a stroke, he could not even move his fingers.
(Healthy lifestyle 2003 No. 17, p. 10)

Exercise after a stroke

After a stroke, the son took the woman to his home, she began to do exercises in the hospital - the doctors showed the complex. They soon seemed too simple. She asked her son to find more large buttons, there were 17 pieces. They were dumped into a pile, and the woman carried them with one paralyzed hand to another pile at a distance of 30-50 cm. Then she did the same exercise with matches, then she learned to put the spilled matches into a box.

A table was placed near the patient's bed so that she could learn to get up and walk leaning on it. Over time, she was able to walk around the apartment, holding on to the wall.

The paralyzed arm after a stroke was very swollen, the woman bandaged aspen pegs to it, and the swelling went away. Also, a paralyzed hand can be tied to the neck so that it is less below, so it almost does not swell.

The patient had a strict routine - exercises 3 times a day, exercises with buttons, exercises with matches, long walking around the apartment. Soon she learned how to peel potatoes and cook soup for the arrival of children. To develop strength in a paralyzed arm, she carried in a bag first half a loaf of bread, then a whole loaf.

Now, 4 years after the stroke, her main exercise is “Kalmyk yoga”, she does 30 squats daily. Previously, they called an ambulance 2-3 times a month, now the pressure has returned to normal, and I managed to give up the pills. A wish for those who have experienced a stroke: work slowly and hard, work and work within your capabilities. Movement is life, while we move, we live. The main thing is not to lose heart, always set a goal and achieve it. (HLS 2006, No. 23, p. 18,)

Walking and exercise helped recover from a stroke

A man in 19955 was in the hospital with a diagnosis of stroke. The left side was paralyzed. The memory was gone for 8 days. 41 days after the stroke was in the hospital. I couldn't sit, I couldn't hold a spoon, I couldn't eat, because my mouth hardly opened, I only drank, my head hurt a lot.

When the hands began to act a little, he began to rise on the bed with the help of a rope with knots tied to the headboard. Sat for two minutes. After some time, he began to lower his legs from the bed, immediately felt relieved, because the blood began to flow into his legs. I did this exercise several times a day. He began to roll the roller with his feet, plus a foot massage. Feel a little better, appetite appeared.

When he was discharged home, he began to learn to walk, first around the house, holding on to the wall and with a cane. A month later, he asked to go outside. There he decided to go alone to the next entrance, somehow he succeeded, sat there on a bench and on the way back. After that, his legs hurt all day, but the next day he walked 2 times more, and every day he increased the distance. A week later, I was already walking around the three-entrance house.

Then the patient asked to be taken to the village where he had a house built. There he every day 100 m to the farm and 100 m back. His legs became more obedient, but still he often fell. Soon he began to train his left paralyzed arm - he carried a bucket with 2 liters of water. At first with a rest, then he carried it to the end, without letting go of it, it was very hard - the fingers unbent and the bucket tried to slip out.

Gradually increased the distance - did 5 walkers daily - 1 km, then 2 km. Arms and legs got stronger, he began to work in the garden and at home, 12 years have passed since the stroke, the patient is now 70 years old, he emerged victorious from the fight with the disease.
(HLS 2007, No. 8, p. 8,)

Massage after a stroke

A woman who has been massaging people for 25 years wrote to the newspaper. Her main patients are bedridden patients paralyzed after a stroke. When she came to another patient for the first time, she decided that no massage would help here. The woman was very heavy - she did not speak, did not move, did not think, did not understand where she was and what had happened to her.

For the first six months after the stroke, the patient was massaged daily. And then courses 2 times a year.
3 years have passed after the stroke, her speech and memory have returned to her, now she is learning poems and reciting them by heart, knitting socks, planting flowers, doing everything around the house herself, doing gymnastics.

The masseuse did not have such patients yet, usually lazy patients who did little to heal themselves came across. In order to defeat the consequences of a stroke, one must simply not be lazy.

Employees of the editorial office of the newspaper "Herald Healthy Lifestyle" called this patient to find out the secret of the cure. It turned out that there is no secret, but there is an amazing fortitude and perseverance. “I don’t give myself a moment of rest, I do something all day long. Sometimes I get so tired that I have no strength, I want to lie down, but I can’t, I have to move, move and move. The only indulgence is to lie down after dinner for 15 minutes, ”the patient said by phone. (HLS 2009, No. 9, p. 9)

Breathing exercises after a stroke

This breathing exercise helps with a variety of diseases, in particular, cerebral vascular sclerosis and stroke. Just a month of classes, and you will forget what sclerosis is, and stroke patients will gain hope for recovery. A 74-year-old woman, after reading an article about this gymnastics, practiced for almost 2 years. As a result high pressure, which was not lowered by any medications, returned to normal, his state of health improved significantly.

First you need to choose a position: either reclining in a chair or lying on your back. Relax and drop all thoughts. Close the left nostril with the left hand and inhale calmly, very slowly through the right nostril. Make a full breath to rise rib cage. Then close the right nostril, freeing the left. Do not breathe as long as possible, endure with the last of your strength. This is the point of the exercise. Then begin to exhale through the left nostril. Repeat the exercise 5-7 times. Then we do the opposite: inhale through the left, exhale through the right nostril, also 5-7 times. This is 1 cycle. Such cycles should be done 3-5 times.
After about a week in the solar plexus area during the exercise, you will feel a slight tingling and warmth. After 2 months, your abdominals will become elastic like a drum. All this suggests that the exercises are going correctly and are beneficial (HLS 2011, No. 9, p. 19)

How to start exercises for a bedridden patient after a stroke - Stages of rehabilitation

1st stage

From the first hours of the acute period of a stroke, positional treatment is applied to avoid contractures of the paralyzed limbs. They also do passive gymnastics.

2nd stage

By the end of the first week, active gymnastics is prescribed, developed by exercise therapy instructors in a hospital. It is first performed in isometric mode, without movement in the joints. Sick limbs are lifted by an assistant, and the goal of the patient is to hold the raised arm or leg. The hand cannot be raised by the hand. If the sick hand is raised by the sick healthy hand, he must lift it by the elbow, turn the hand with the palm up, if the assistant raises the hand, then with one hand it is taken above the elbow from below, and with the other hand by the wrist from above.

3rd stage

The patient is taught to sit. They begin with 3-5 minutes of reclining, putting pillows under the back and head, after 2-3 days the patient is transferred to a semi-vertical position.
Then they sit on the bed with their legs down, substituting a bench under them.

4th stage

Strengthening the muscles of the legs. Exercises are carried out using an expander or a frog pump for inflating rubber mattresses. In a supine position, they do the exercise "imitation of walking" - the legs bend and unbend at the knees, the feet slide along the sheet.

5th stage

Walking. The patient from a sitting position tries to get up, holding on to a stable support - the back of the bed, a nearby chair or armchair. When the patient learns to stand confidently, he should begin to shift from foot to foot. Having mastered this exercise, you can move on to walking in place, holding on to the headboard. Then they try to walk in place without support.

Hand exercises

Simultaneously with exercises for the legs, it is necessary to develop the muscles of the hands. To do this, they assemble and disassemble pyramids, children's designers, cubes, and sculpt from plasticine. It is useful to shift objects with a sore hand, flipping through books, tightening nuts, fastening zippers, tying ribbons. To relax muscles, it is useful to lie on your back and hang your paralyzed arm, swing it.

For the development of the shoulder joint:

1. hands in the lock, raise them up, tilt them left and right
2. take a stick with both hands, lift it up, lower it behind your head.
At the same time, the diseased hand is passive, it is pulled by a healthy hand.

But the main thing in rehabilitation after a stroke is walking. Choose flat routes without climbs with benches for rest. Gradually increase the distance. The pace of walking is slow - 40-50 steps per minute. Rest every 5-10 minutes. Do not spare the paralyzed side, because the muscles that are not working cannot be restored. (HLS 2011, No. 22, pp. 6-7)

People after a stroke have the possibility of full or partial recovery. Experts insist on carrying out rehabilitation measures within three years.

As a rule, ischemic stroke gives more hope, since it is characterized by less dangerous damage to the cells of the cerebral cortex, the use of "reserve" vessels for nutrition. In the hemorrhagic form, physical rehabilitation is limited by the prevention of repeated circulatory disorders, the timing of hematoma resorption, and the use of surgery.

Gymnastics after a stroke is part of the planned rehabilitation measures along with medicines, physiotherapy, diet, regimen.

What tasks does exercise therapy solve after a stroke?

Exercise therapy in stroke plays an important role in the prevention of complications, the development of a person's adaptation to self-service, and the mastery of lost functions.

A long period of forced immobility in bed is dangerous for the development of severe consequences. Complex exercise therapy helps alert:

• the formation of bedsores on the buttocks, back;
• congestive type pneumonia;
• the occurrence of heart failure;
• progressive atrophy of non-working muscles;
• the formation of blood clots with subsequent embolism in vital organs;
• spasm of muscle groups with increased tone in paresis and paralysis of the spastic type, the formation of contractures (change in the shape of the limb).

Gymnastics after a stroke has a positive effect on microcirculation and metabolism in organs and tissues that are reduced as a result of the disease. It allows you to resume active movements, in the long term it helps to get the opportunity to draw, write, use dishes and household appliances. It leads to the normalization of the work of internal organs (urination, defecation), helps to restore speech.

When can you start exercising?

The beginning of the use of physical activity, their volume. Target orientation is determined by the attending physician. It depends on the:

• the extent of damage to brain tissue;
• sufficient ability of the body to recover;
• timeliness and completeness of treatment.

The first 6 months are considered the acute period. At this time, changes occur in the ischemic focus: some of the cells die irrevocably, while the other retains the ability to perform its functions, but needs help. This is what exercises after a stroke are designed for. At the cellular level, there is a special memory that should “remember” the range of movements, restore the pathways for the transmission of nerve impulses.

If the patient is not in a coma and consciousness is preserved, then on the third day he is recommended to start breathing exercises. Its purpose is to prevent congestion in the lungs. From the fifth day, physiotherapy exercises (exercise therapy) are prescribed. The sets of exercises include habitual movements, the patient's condition, the ability to sit or stand independently, the degree of loss of motor functions are taken into account.

Continuation of physical education is recommended after discharge at home. For this, relatives should themselves learn the necessary exercises, support and encourage the patient's desire. positive emotions and good mood play a significant role in the speed of rehabilitation.

In the late period (after six months or more), the patient needs to use a rehabilitation course of treatment in specialized centers and sanatoriums. It is recommended to repeat the therapy 2 times a year. Here, in addition to the sports rehabilitation complex, there are opportunities for extended physiotherapy treatment under the supervision of medical personnel:

• oxygen baths;
• massage;
• acupuncture;
• hardware electrical stimulation of paralyzed muscle groups;
• impulse magnetotherapy;
• electrosleep.

Neurostimulation of leg muscles

How to do breathing exercises?

In the supine position, the patient just needs to take a few deep breaths, repeat throughout the day as often as possible. When the doctor allows you to sit, it is important not to bend your back, but to keep it straight so that the air expands the lungs as much as possible.

Breathing exercises are reduced to a slow deep breath, holding the breath for a few seconds and then a gradual exhalation. After each such breath, the patient needs rest. You need to make sure that dizziness does not increase, do not strain while holding your breath.

There are options for long exhalation control:

• inflation of a rubber balloon;
• using a cocktail straw dipped in a cup of water.

The patient feels the result of his work by the volume of the ball and the gurgling of the liquid. In the future, you can begin to master the course of exercises according to the Strelnikova method.

This is important at any stage of rehabilitation

Proper physical rehabilitation is impossible without targeted support for mental activity. Muscle memory allows even weakened cortical structures to issue commands. The patient is recommended to accompany all exercises with mental "orders" to move his legs and arms.

Such modern approach to recovery allows you to make the patient a full participant in the recovery process.

What exercises can be done lying down?

If the patient is not allowed to sit and get up or he cannot do this, the exercises are carried out first in a passive mode, then in an active one.

Passive physical education means the absence of the participation of the patient, the use of the efforts of another person

Exercises are limited to movements in the joints of the arms and legs. The complex gradually includes passive flexion, extension, rotation, abduction and adduction with increasing amplitude. You should not immediately try to fully fulfill the maximum option. They start with small fluctuations up to 15 movements in each joint 3-4 times a day.

It is recommended not to forget about the sequence of joint development: from the center to the periphery. In other words, exercises for the arm start from the shoulder, then move on to the elbow joint, wrist and hand. Similarly on the legs: from the femoral to the small joints of the foot.

Passive exercises in the hand with monoparesis can be performed by the patient himself with the help of a healthy hand. As a device for self-study, a loop of fabric, wide rubber is used, into which the patient threads a fixed limb and performs movements, clinging to it.

The patient performs active exercises independently. For this, special complexes have been developed. They start lying down and continue in a sitting position.

A set of active movements for the hands

Hands can do independent movements up to 20 times in one approach:

• clench and unclench your fingers into a fist;
• circles in both directions in the wrist joint (it is recommended to keep the fist clenched at the same time);
• flexion and extension at the elbows;
• from a position along the body, slow rises and falls, while the shoulder joints are loaded;
• swing to the sides.

In exercises with dumbbells, the study of the flexor muscles and holding by clenching the hand into a fist are used.

A set of active exercises for the legs

For the legs, exercises can also be started from a period of strict bed rest and continue sitting. The number of repetitions should not tire the patient and increase gradually up to 20.

• The toes actively carry out flexion and extension.
• Pull the socks “towards you”, then take them to the opposite extreme position (it is recommended to mentally imagine the pressure on the pedals).
• Slow knee flexion, extension.
• Abduction to the side due to the work of the hip joint.

How to develop the muscles of the body?

Lying on your back, you can perform the following exercises 5-10 times:

• turns to the sides with a roll from one side to the other;
• with an emphasis on the shoulder blades, the back of the head, the feet, with the help of the elbows, raise the pelvis;
• try to slightly raise the upper body, straining the abdominal muscles.

What other movements need to be developed?

Physical education after a stroke, except for the limbs, requires the development of facial muscles, especially the eyes. To prevent drooping of the eyelid, the following exercises are recommended 5-7 times:

• eye movements up and down and to the sides;
• describe with your eyes a circle in one direction, then in the other;
• blink and squeeze for a few seconds.

To strengthen the muscles of the neck, you need:

• make slow turns of the head to the sides;
• rest your head on the pillow, then relax.

After a stroke, a person loses the ability to make small movements with his fingers. And this is very necessary in the restoration of self-service. For the development of motor skills, the brush is recommended:

• put in a big bowl small items(nuts, buttons, spools of thread, pencils);
• the patient must transfer them with the affected hand from one bowl to another.

In sanatoriums, games of mosaic, loto, and collection of pyramids are used.

Standing exercises

For a patient who is able to stand and move slowly, the number of exercises should be increased, diversified. However, do not rush. You need to start with a simple complex, and then move on to a more complex one with increased load.

Exercises are considered simple:

• sipping with a description of circular movements with the hands and obligatory control of breathing (when moving up - deep breath, down - full exhalation);
• alternating rolling from socks to heels with tension in the calf muscles;
• turns to the sides (5-6 times each);
• squats without taking your heels off the floor 4-5 times;
• tilts to the sides with the rise of the opposite arm above the head 4 times;
• swing legs forward and to the sides, 4 each;
• alternating lunges forward with a slight transfer of weight to the front leg.

Half-lunge with clasped hands is used to increase the load

In the complex with increased load are added:

• sips with hands clasped into a “lock”;
• swinging your legs while holding your hand on the fixed headboard of a bed or chair;
• tilts forward and to the sides 10 times, standing on tense legs in a position slightly wider than shoulders;
• "boxing" with hands while turning the torso;
• circular rotation in the shoulder joints forward and backward;
• random jumps.

Exercises should be completed by walking on the spot, deep breathing movements for 5 minutes.

Contraindications

Restrictions in rehabilitation depend on the condition of the patient. Physical activity is not shown in the following cases:

• the patient did not come out of the coma;
• there are mental changes in behavior, aggressiveness;
• repeated stroke in an elderly person;
• there are symptoms of epileptiform seizures, cramps in the limbs;
• a stroke is accompanied by a severe form of diabetes mellitus, tuberculosis, and cancerous tumors.

An important point in physiotherapy exercises is the comfort of the patient. The appearance of headaches, weakness requires control of blood pressure, rest, and a slower pace of increasing the load.

After getting the opportunity to walk, it is necessary to use walks in the air with a gradual lengthening of the route. Self-confidence and the support of loved ones allows the patient to take the most useful stroke therapy, strive for a full recovery.